Feli is correct. There are so many factors involved, and in my opinion, geographic area can also play a major role in those numbers.
In some areas, patients are insured primarily by managed care contracts and these patients may be "capitated", which means the doctor is payed one lump sum per month, no matter how many times a patient is seen and no matter what procedure(s) are performed, including surgery.
Therefore, you can perform a major reconstructive surgery on a patient with an external frame and spend hours out of the office, in the O.R. and collect ZERO dollars for the case.
Yes, ideally we should all be performing surgery when indicated and treating patients and not insurance companies. But the reality is that doctors would be going out of business if they were aggressively pursuing surgical cases and spending their entire day in the O.R. on these capitated patients. So unfortunately many doctors with a lot of capitated managed care contracts simply choose not to perform much surgery.
Additionally, many younger doctors are rather aggressive and some are aggressive gathering cases in order to obtain board certification. In our practice, we actually keep an eye on this, to make sure that our younger docs are only performing surgery when indicated.
And some of us have "been there, done that" and realize that despite excellent training, having obtained all the certifications and letters and initials after our names, etc., etc., sometimes conservative care is a great alternative for a patient.
For example, I had a patient that was "primed and ready to go" in my office yesterday. She was 88 years of age and entered my office REQUESTING a bunionectomy. She was seen two weeks earlier by another DPM who does not perform surgery. He recommended conservative care and she wasn't happy with that recommendation.
Therefore, she sought my opinion, knowing that I've performed surgery on some of her friends, relatives, etc. She had a painful lesion on her 2nd toe secondary to pressure from her hallux/bunion. Therefore, she wanted her bunion corrected. She had absolutely NO bunion pain. She had bilateral pedal edema, no hair growth to bilateral lower extremities and faint pulses.
Regardless of her vascular status and/or age, she had NO bunion/HAV pain and a very small keratotic lesion in the first interspace. Simple padding to prevent irritation was all that was required to prevent recurrence, in addition to shoes with a slighter wider toebox.
One of our younger associates was in the office and was licking his chops and didn't understand why I would "pass up" on a patient that was actually ASKING for surgery!!!! He thought I was crazy, until I sat him down and gave him a dose of reality.
Having served as a surgical residency director, I had exposure to a lot of DPM's and can tell you that the amount of surgeries a DPM performs is NOT always linked to his/her training, or his/her credentials (APMA, ABPS, ACFAS) but can often be linked to a doctors morals and ethics.
I've seen doctors that I wouldn't let cut my pet's toenails book 10-15 cases a week. Out of those 10-15 cases, I would say it's safe to say that if those patients were in my office only 1 or 2 would end up in the O.R.
Obviously, the better your training, the more surgery you will be able to perform. I always tell my residents that it's their role to use their skills responsibly, and with control. Patients are placing their TRUST in you, therefore, I urge them to only use their surgical skills when they are truly indicated, not for financial gain and not to boost their egos.
