Integration of Podiatric Services into every US Hospital

[thefootguy]

The future of the profession requires strong leadership and a new approach to promoting podiatrists as the experts in foot and ankle care.

Dtrack said it best. There needs to be a marketing campaign from the APMA to integrate podiatric services into every US hospital and system.

I spoke to an APMA BOT member about this recently. It was suggested that this proposition be addressed at the Annual APMA HOD meeting. The direction of the APMA and its actions are mandated/directed from the HOD and its resolutions.

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[Feli]

Its a good idea on paper. No doubt.

However, keep on mind you're talking to the same ppl approving LECOM and Utex schools without need or residencies - despite the residency shortage after unnecessary Western, approving and re-accrediting joke 'surgical' residencies with abysmal ABFAS pass rates, re-accrediting schools where a third of students fail minimum competence exams, and letting ABPM implant non-elected ppl and make misleading certs and do whatever it is they do.

This brain trust are the ones pitching recruiting efforts with aging population and diabetes growth and population growth (since they can't say DPM pay/jobs are great right now), running CME meetings that are mainly info-mercials while publishing a joke journal, and taking Jublia money and toenail microscope and shoe approval monies.

Talk is cheap. Look at the APMSA hopes and dreams students are fed, the 'Vision 20xx' plans, the talking points...versus what actually materializes.

We are oversupplied, pure and simple. There is no way you need as many DPMs as total orthos coming out. We have tons more grads than ENT or plastics or ophthalmo or derm or many other outpt or procedures and surg specialties. There are about as many podiatrists in practice as general surgeons or aggregate orthopedic surgeons - even before the new podiatry schools.

So, there's that.^^^
Basically, you are trying to talk (second or thirdhand) to the "leadership"ppl who get $ for every pod student and most practicing DPMs, and they can demand more corporate sponsorship fees based on more podiatrists. They make decisions accordingly. I wish you luck. Temper your expectations?

 

[air bud]

Its a good idea on paper. No doubt.

However, keep on mind you're talking to the same ppl approving LECOM and Utex schools without need or residencies - despite the residency shortage after unnecessary Western, approving and re-accrediting joke 'surgical' residencies with abysmal ABFAS pass rates, re-accrediting schools where a third of students fail minimum competence exams, and letting ABPM implant non-elected ppl and make misleading certs and do whatever it is they do. They are the ones pitching recruiting efforts with aging population and diabetes growth, running CME meetings that are mainly info-mercials while publishing a joke journal, and taking Jublia money and toenail microscope and shoe approval monies.

Talk is cheap. Look at the APMSA hopes and dreams students are fed, the 'Vision 20xx' plans, the talking points...versus what actually materializes.

We are oversupplied, pure and simple. There is no way you need as many DPMs as total orthos coming out. We have tons more grads than ENT or plastics or ophthalmo or derm or many other outpt or procedures and surg specialties. There are about as many podiatrists in practice as general surgeons or aggregate orthopedic surgeons - even before the new podiatry schools.

So, there's that.^^^
Basically, you are trying to talk (second or thirdhand) to the ppl who get $ for every pod student and most practicing DPMs, and they can demand more corporate sponsorship fees based on more podiatrists. They make decisions accordingly. I wish you luck. Temper your expectations?

Sir vision 2020 was a resounding success. Myself, dtrack, nail/cuts, dyk343 are all products of this innovative campaign.

 

[619]

Integration of podiatric services into every US hospital and system should have happened 20 years ago when they mandated 3 years surgical residency for everyone. So that boat have sailed a long time ago.

MD/DO/NP/PA can combine and do all that we do. But they choose not to because they are not lobsters like us.

 

[Hybrocure]

I think if it’s approached in the right way it would have good success. I think every hospital would benefit from podiatrists for limb salvage/amps/infections while reserving trauma for ortho. That way ortho welcomes the integration (less infectious garbage for them, we don’t interfere w their work, more jobs for us). It takes the infection load off of vascular/gen surg too so they can be in the OR doing real call emergencies rather than them being occupied doing a toe amp or TMA while an emergency rolls in.

 

[DYK343]

I am a hospital employed DPM.

Podiatrists are insanely profitable for hospital systems. We should be employed at every hospital and if not they are loosing big $$$

You have to maneuver carefully though.

The only way we are not considered is because another profession is stomping their feet (ortho/gen surg).
ER docs and PCPs/hospitalists LOVE podiatry.

Im doing estimated 250k a year right now on inpatient pus work only (at least 250k office on top of that).
Im busier with inpatient pus than in my office. We have anywhere between 5-15 inpatients at any given time with pus in their foot or S/P I&D.

My experience ortho wants nothing to do with anything infection. Glad to see it gone.

But depending on how busy they are - gen surg/vascular might look at that lost pus income and throw you under the bus.
IME our worst enemies in the hospital is the general surgeon (or another DPM... but thats been covered here extensively).

Ortho will stomp their feet if you start syphoning trauma from the ER.
If you get on the wrong side of ortho they control the hospital and its going to be rough for you.
But I haven't found ortho to be that hard to maneuver. They hate pus and are happy they are not getting called anymore.

I've been at my new job less than a year. Since I started the podiatry program here our OR volume has increased significantly because of the podiatry service. Our CEO/CFO loves podiatry. In addition to elective surgery Im doing 1-2 pus cases a day. Im able to get people in and out of the hospital quicker. We have 4 competing hospitals. We are the only one with a dedicated podiatry program. Were getting more emergent referrals to our ER from outside providers who have a patient with a diabetic foot infection because they know we have a podiatry program. One of the competing hospitals is currently transferring all diabetic foot infections to our ER because they dont have anyone who will operate on pus in their system (its a small community hospital). The ticket to hospital employment is open arms and interest in riding the pus bus.

Now that im established and profitable for the hospital I am going to try to test the waters and expand my trauma coverage.

 

[air bud]

I am a hospital employed DPM.

Podiatrists are insanely profitable for hospital systems. We should be employed at every hospital and if not they are loosing big $$$

You have to maneuver carefully though.

The only way we are not considered is because another profession is stomping their feet (ortho/gen surg).
ER docs and PCPs/hospitalists LOVE podiatry.

Im doing estimated 250k a year right now on inpatient pus work only (at least 250k office on top of that).
Im busier with inpatient pus than in my office. We have anywhere between 5-15 inpatients at any given time with pus in their foot or S/P I&D.

My experience ortho wants nothing to do with anything infection. Glad to see it gone.

But depending on how busy they are - gen surg/vascular might look at that lost pus income and throw you under the bus.
IME our worst enemies in the hospital is the general surgeon (or another DPM... but thats been covered here extensively).

Ortho will stomp their feet if you start syphoning trauma from the ER.
If you get on the wrong side of ortho they control the hospital and its going to be rough for you.
But I haven't found ortho to be that hard to maneuver. They hate pus and are happy they are not getting called anymore.

I've been at my new job less than a year. Since I started the podiatry program here our OR volume has increased significantly because of the podiatry service. Our CEO/CFO loves podiatry. In addition to elective surgery Im doing 1-2 pus cases a day. Im able to get people in and out of the hospital quicker. We have 4 competing hospitals. We are the only one with a dedicated podiatry program. Were getting more emergent referrals to our ER from outside providers who have a patient with a diabetic foot infection because they know we have a podiatry program. One of the competing hospitals is currently transferring all diabetic foot infections to our ER because they dont have anyone who will operate on pus in their system (its a small community hospital). The ticket to hospital employment is open arms and interest in riding the pus bus.

Now that im established and profitable for the hospital I am going to try to test the waters and expand my trauma coverage.

So I need to modify that meme for you? Maybe you should be the pus bus driver

 

[thefootguy]

I don’t disagree with many points made above. I am in a similar hospital-employed setup to Feli. I too see the value of a Podiatry/Foot and Ankle service line/division to most hospitals. Some will need to sacrifice certain pathology and others may not. But we need a seat at the table.

Have leaders of APMA and ACFAS missed the mark on how to promote Podiatry to hospitals/health systems, other physicians/specialists, and the general population?

What barriers and opportunities exist to promote our specialty as leaders and experts in foot and ankle surgery across those demographics?

 

[GreenHousePub]

Sir vision 2020 was a resounding success. Myself, dtrack, nail/cuts, dyk343 are all products of this innovative campaign.

I think you're forgetting Vision 2015

 

[Retrograde_Nail]

I think you're forgetting Vision 2015

yeah Vision 2015 never happened. This is what our leadership is capable of...nothing. We didn't even come close to the goals of Vision 2015.

 

[HalluxSlicer]

I have many friends who are APMSA. They come back to campus with excitement, fun drinking stories, and bellies full of steaks n lobsters courtesy to our membership fees talking about how great the profession is and they’re making a difference for all of us. When we ask them what’s new or any new prepositions, they all respond with “can’t tell non members” or “we signed an NDA”, etc.

I know the filthy wealthy non practicing podiatry big wigs are feeding them placebo just like the Vision [insert year here] that they come up with which has no real meaning. We should follow and make friendship with PA and NP lobbying groups because they’re doing Lord’ work for their profession expanding scopes of practice and marketability while we’re out here wank1ng about ABFAS vs ABPM and exterminating the trolls of SDN

 

[Hybrocure]

I have many friends who are APMSA. They come back to campus with excitement, fun drinking stories, and bellies full of steaks n lobsters courtesy to our membership fees talking about how great the profession is and they’re making a difference for all of us. When we ask them what’s new or any new prepositions, they all respond with “can’t tell non members” or “we signed an NDA”, etc.

I know the filthy wealthy non practicing podiatry big wigs are feeding them placebo just like the Vision [insert year here] that they come up with which has no real meaning. We should follow and make friendship with PA and NP lobbying groups because they’re doing Lord’ work for their profession expanding scopes of practice and marketability while we’re out here wank1ng about ABFAS vs ABPM and exterminating the trolls of SDN

Vision 2020 couldn’t even predict covid. Cap.

 

[Retrograde_Nail]

I have many friends who are APMSA. They come back to campus with excitement, fun drinking stories, and bellies full of steaks n lobsters courtesy to our membership fees talking about how great the profession is and they’re making a difference for all of us. When we ask them what’s new or any new prepositions, they all respond with “can’t tell non members” or “we signed an NDA”, etc.

I know the filthy wealthy non practicing podiatry big wigs are feeding them placebo just like the Vision [insert year here] that they come up with which has no real meaning. We should follow and make friendship with PA and NP lobbying groups because they’re doing Lord’ work for their profession expanding scopes of practice and marketability while we’re out here wank1ng about ABFAS vs ABPM and exterminating the trolls of SDN

Who is a troll? I am guy who works hit nuts off doing 800-1000 RVUs month at a big tertiary referral center. My practice is crazy busy and growing. I am more podiatry than anybody sitting in a leadership position in this entire profession.

 

[air bud]

Vision 2020, 2015 same thing

I think you're forgetting Vision 2015

Yeah that's what I meant vision 2020 2015 same thing

 

[air bud]

Who is a troll? I am guy who works hit nuts off doing 800-1000 RVUs month at a big tertiary referral center. My practice is crazy busy and growing. I am more podiatry than anybody sitting in a leadership position in this entire profession.

Yeah that doesn't sound like podiatry to me

 

[diabeticfootdr]

I have many friends who are APMSA. They come back to campus with excitement, fun drinking stories, and bellies full of steaks n lobsters courtesy to our membership fees talking about how great the profession is and they’re making a difference for all of us. When we ask them what’s new or any new prepositions, they all respond with “can’t tell non members” or “we signed an NDA”, etc.

I know the filthy wealthy non practicing podiatry big wigs are feeding them placebo just like the Vision [insert year here] that they come up with which has no real meaning. We should follow and make friendship with PA and NP lobbying groups because they’re doing Lord’ work for their profession expanding scopes of practice and marketability while we’re out here wank1ng about ABFAS vs ABPM and exterminating the trolls of SDN

There shouldn’t be an NDA for APMSA delegates. They represent you.

Ask to see the NDA they signed.

 

[Shiyuan]

There shouldn’t be an NDA for APMSA delegates. They represent you.

Ask to see the NDA they signed.

I never had a NDA as a delegate. Sounds shady.

 

[msion]

Im doing estimated 250k a year right now on inpatient pus work only (at least 250k office on top of that).
Im busier with inpatient pus than in my office. We have anywhere between 5-15 inpatients at any given time with pus in their foot or S/P I&D.

My experience ortho wants nothing to do with anything infection. Glad to see it gone.

Can confirm this is true. Not sure what my number stand for inpatient pus work, but it is quite a bit even for a guy like me in private practice.

This is one of the reasons I still defend Dr. Rogers here. I know he's kinda hated on social media. But one thing he did tell me when he visited our school was the key to a good job is to let hospitals know you can do DFIs. Forget about traumas. Scrambling for traumas will not get you the support from MDs.

I followed that advice and it's working. If he were to sell me the crap about doing TARs all day long like the ACFAS reps did, I would definitely hate him for not telling the truth.

 

[PTPuser]

Can confirm this is true. Not sure what my number stand for inpatient pus work, but it is quite a bit even for a guy like me in private practice.

This is one of the reasons I still defend Dr. Rogers here. I know he's kinda hated on social media. But one thing he did tell me when he visited our school was the key to a good job is to let hospitals know you can do DFIs. Forget about traumas. Scrambling for traumas will not get you the support from MDs.

I followed that advice and it's working. If he were to sell me the crap about doing TARs all day long like the ACFAS reps did, I would definitely hate him for not telling the truth.

Do you feel as though you're properly compensated compared to hospital pod in terms of DFI?

I know Feli mentioned the pros and cons of it between PP and hospital.

 

[msion]

Do you feel as though you're properly compensated compared to hospital pod in terms of DFI?

I know Feli mentioned the pros and cons of it between PP and hospital.

Properly compensated? No. But these are quick cases that add up.
I don't seek them out. I just take them based on the insurances and schedule them on a weekday evening.

 

[Feli]

Do you feel as though you're properly compensated compared to hospital pod in terms of DFI?

I know Feli mentioned the pros and cons of it between PP and hospital.

My TMA guy who came in today paid $50 on his bill (~$3000 from my ER consult, inpt rounds, TMA with DPC, f/u visits).

I let my office workers split anything he pays (they were marvelling at his balance first office f/u after he got d/c from hospital... they are used to seeing $0.00). They are instructed to ask him every f/u visit if he has MCA yet and if he wants to make an installment.

I will get my way to jannah or heaven or celestial or thetan or shamayim... if those were real. Reserve my spot?
Luckily, those of free/MCA wound visits are <5% (prob <2%) of my practice. I've had associate jobs where that was a fair chunk. Limb salvage in PP is easy AF but financially tedious. It will find you. If you have better stuff to do, turf as much limb savage as you can on the hospital FTE pods and consider the majority of the wound/amp/salvage work you must do to be charity.

 

[DYK343]

Properly compensated? No. But these are quick cases that add up.
I don't seek them out. I just take them based on the insurances and schedule them on a weekday evening.

I dont think I could manage 10+ inpatients If I was not already in the hospital everyday fulltime (with a full outpatient clinic).

I get 2-3 calls every morning and 2-3 every evening about inpatients. If youre only rounding at night that would be the ideal way to do it as an off campus PP DPM - though most hospitalists want morning notes so they can make their plans.

Also staying late every night (especially after operating) of the week would really really suck. I typically spend 2ish hours or more a day rounding/documenting. Not including operating.

Its so nice to sneak up for a quick consult when a patient falls off the list - which I see a lot of medicaid so a lot of them cancel same day or no show.

Do you feel as though you're properly compensated compared to hospital pod in terms of DFI?

I know Feli mentioned the pros and cons of it between PP and hospital.

wRVU pay the same no matter insured or not. I dont even look at insurances unless im prescribing a drug or something I need to take note of for insurance purposes. I dont care what their insurance is.

 

[Retrograde_Nail]

Hospital employed here. Worked at two hospitals so far in career.

At both jobs there is no comparison when it comes to productivity for pus in hospital setting vs private practice. PP has to worry about insurance and actually getting paid. I worry about how many RVUs I can milk out of limb salvage case and that I get paid $50-60 per RVU for them.

Hands down the best aspect of being hospital employed. It makes dealing with non compliant trolls more tolerable because every time they don't listen and get infected etc that is just more productivity. Now multiply that by 50x in a busy hospital setting. That is 500-600 RVUs per month right there.

Mix in some elective, some trauma that ortho dumps on you, toenails, injections, etc and you can get yourself to 800-1000 RVUs per month pretty easy.

I do every case possible but my practice currently is more limb salvage, wounds, charcot, trainwreck trauma that ortho dumped on me. I did do two brostroms and ankle scopes today which was a rare treat.

I've only done 3 bunions this entire first year I have been with my new hospital. I've done like 30 nails this past year and probably 10-15 ex-fix cases during that same time and also way more poly traumas where ortho trauma didn't want to fix the mangled foot.

We also have hyperbaric medicine team at the hospital and HBOT inpatient. Whenever it is indicated I am consulting HBOT. Why? Because it is definitely helpful and it is job security. Yeah I said it. Admin loves it and they love me. This $hit is chess, it's not checkers.