Excellent question(s).
First and foremost, you must do what makes you happy, and not be motivated strictly by financial gains. Surgery in our profession seems to naturally draw more attention, because it is certainly more glamorous, prestigious and "sexy" than performing c&c, palliative care, etc.
However, not all patients require surgery, and there is nothing like seeing a very satisfied patient walk out of your office extremely happy after learning that he/she does NOT need surgery, and that you have just solved his/her problem conservatively and relieved the discomfort with a simple injection, strapping, orthoses, etc.
Surgical intervention has it's indications in our TOTAL armementarium of practice, but I sincerely believe too many of the younger DPM's are a little TOO quick to cut, and eventually that's going to bite them in the rear end regarding legal matters.
I presently have several law suits sitting on my desk to attempt to defend, all involving young DPM's that performed major reconstructive procedures on patients that absolutely did NOT need these procedures, after not offering these patients any conservative options. Each procedure failed miserably and now these patients are crippled. The doctors never even OFFERED or attempted conservative care for very treatable conditions in the early stages.
High volume surgical practices can sustain financially, especially if you have residents rotating through your office or great ancillary help. If you have to spend a lot of time removing dressings, removing casts, reapplying dressings, reapplying casts, taking x-rays, etc., etc., it can become very time consuming and not cost effective.
Additionally, if your hospital does not have residents, the simply amount of time traveling to and from the hospital, performing the paper work, prep work, etc., can add hours to a case. Not to mention whether or not there are complications and you have to come in at night or weekends.
NOT ALL DPM'S ARE GOING TO SCORE GREAT JOBS WITH ORTHOPEDIC PRACTICES. Please repeat that 10 times!!!!
When you land a job with an orthopedic practice, you basically show up, work and collect a check. When you are in private practice, YOU now are responsible for paying the bills, not someone else. That becomes a WHOLE different story. Additionally, a patient schedule isn't handed to you, it is YOUR responsible to find patients and fill your own schedule.
So please remember that it's not ALWAYS a utopia out there and there are only so many "perfect" positions.
Yes, in reality you can probably hour for hour, dollar for dollar make more money performing P&A's and orthotics all day than major surgeries. A few weeks ago I received a whopping $348 for performing a subtalar arthrodesis, with the OR time and all the resultant follow up required.
I did a P&A on the patient's cousin, and charged $300 for the right hallux and the same for the left hallux. A few weeks later I received a check for $525 for the 10 minutes in took me. YOU do the math.
But you can't look at patients like dollar bills....or at least I can't. In my office I do everything from cutting old ladies toenails to performing major procedures with ex-fix frames. I turn away no patients and treat patients, not insurance companies.
Economy and times are hard, so although you love surgery, my recommendation is to not forget your roots and practice the full scope. It will never hurt. Then, when you are super successful and start hiring associates, pick and choose.
