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podiatrystinks

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Curious to know what those DPMs who are close to completing residency have been offered as salary. List the highs and the lows (they need to be heard) and the difficulty of finding a position. Please list what part of the country you were offered that salary and what type of practice offered it to you. Sharing is much appreciated.
 

Feli

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Please also list how much money you have in your checking, savings, and investment accounts? Heck, just post your 1040 :)

There are some threads on this topic, but you're asking some pretty personal info when you ask for hard numbers.
 

darazon

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With a screen name of podiatrystinks you might not get the best responses ;).
 

podiatrystinks

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wow is it that bad?...it's not that personal i don't know who you are and you don't know me it's only a screen name...but yeah you can make it personal include your DEA #'s and SS #'s if you want also and i'll get back to you :D
 

darazon

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I have heard first hand that the Kaisers in San Fran start at $195k.
 

PADPM

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I would like to know what prompted you to use the screen name "podiatrystinks"?

If the name is serious, why wouldn't you seek another field/option rather than dedicate the next 30-40 years doing something you dislike?
 

podiatrystinks

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Good questions PADPM. My name is serious. I am considering and actively trying to find something else. My experiences at my school have led me to despise the profession almost. I'm almost done with school but don't know that I want to practice podiatry and I have yet to find what field I would like to work in. How did you know podiatry was for you? Patients tell me a lot that I make them feel better by debriding calluses or doing whatever insignificant thing but it really doesn't mean anything to me. If I do practice podiatry, it will only be money driven. I could careless if i do something simple that makes someone "feel better" it gives me no satisfaction personally but I don't let patients know that.
 

g squared 23

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^ Wow, you sound like a perfect candidate for the realm of business. I am sorry that medicine is not your cup of tea. Hopefully you will find your true calling. You could always go into health insurance and try to stick it to your former patients and colleagues :laugh:
 

PADPM

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Good questions PADPM. My name is serious. I am considering and actively trying to find something else. My experiences at my school have led me to despise the profession almost. I'm almost done with school but don't know that I want to practice podiatry and I have yet to find what field I would like to work in. How did you know podiatry was for you? Patients tell me a lot that I make them feel better by debriding calluses or doing whatever insignificant thing but it really doesn't mean anything to me. If I do practice podiatry, it will only be money driven. I could careless if i do something simple that makes someone "feel better" it gives me no satisfaction personally but I don't let patients know that.

I find your post actually "sad". I'm not sure if you're serious or ball-busting, but I'll bite and assume you're serious.

Is it simply the "trivial" work that leaves you unsatisfied even though your patients are happy? If that's the case, there are many subspecialties within the field that you may find rewarding.

In my career, I've done it all, from the simple routine care to the most complex reconstructive surgery. And yes, it's not very mentally challenging to trim a callus or cut a nail, but many of those patients are more appreciative than major surgical patients.

However, that still does not mean you'll be satisfied or fulfilled. But once again, is it that making patients happy in GENERAL does not fulfill your satisfaction or was it simply the "trivialty" of the actual task.

Podiatry can include a specialty in surgical care, diabetic care, wound care, sports medicine, pediatrics, dermatology (Bryan Markinson, DPM at Mt. Sinai in NYC), and other fields. You can opt to never perform palliative care if that's your desire.

Every field has it's "mundane" tasks. My neighbor is a well known and top rated internist, and he certainly doesn't look forward to performing rectals on 85 y/o obese patients with poor hygiene and rectal problems.

Similarly, I have a friend who is a board certified otolaryngologist (ENT) with additional fellowship training. With all his surgical expertise, he doesn't exactly get excited and it's not an academic challenge when someone comes into his office to have ear wax removed.

So prior to thinking podiatry is the only field with some less than glamorous and trivial tasks, the grass isn't always greener on the other side.

Consider whether there may be a subspecialty in the field that peaks your interest, or whether making patients happy via any method just "ain't your thing".
 

RTaspiringDO

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Please also list how much money you have in your checking, savings, and investment accounts? Heck, just post your 1040 :)

There are some threads on this topic, but you're asking some pretty personal info when you ask for hard numbers.

HAHAHAHAH i laughed for a good 2 minutes at this LOL :D:D:D
 
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newankle

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What you're offered out of residency really isn't that pertinent since the vast majority of practitioners never stay with their 1st practice opportunity. I came out about 2.5 years ago. I took a position in a podiatry practice where I made $80K + 40% of collections above $200K and made roughly $105K year #1. I left and joined an ortho practice as the sole F&A surgeon. 1st year there I made $120K plus 20% of collections above $240K and made $175K. Now 2nd year there I make $220K plus incentive-based bonus. We are considering accepting an offer from a healthcare system trying to partner with our practice and I would get a base salary of $300K plus an RVU-based bonus and a quality of service-based incentive bringing an expected yearly salary of over $400K. This is real. Now, this is extremely rare and graduates certainly cannot expect this sort of situation but I am proof that it is possible. You must be very well trained, efficient, business savvy, and lucky.
 

PADPM

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newankle,

You are obviously well trained and very fortunate. But I would say that you're really in the minority of most docs in your early stages of practice.

I know of very few DPM's making $400,000 and know of none that have that in their radar in their first 3-5 years of practice.

I think that's great and hope that door stays open for other young practitioners.
 

g squared 23

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newankle,

I have a question regarding residency selection. Does it really matter where you do your residency as long as you are very well trained? Do you have to go to one of the big names to take advantage of all the of premier opportunities, or do employers even care?
 

newankle

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Yes, I totally agree and am fortunate these opportunities have presented themselves to me. Sad thing is when I was looking for a new position in this area before taking the one I currently have I was negotiating with another podiatry practice that was offering me $60K base plus 30% of collections above I think $180K.
 
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Newankle,

Thanks for your input. If you don't mind me asking...did you land a typical 3 yr high volume surgical residency or did you land one of the few and coveted 4 yr programs?

Also, why didn't you attempt to get a job with an ortho practice to start out with when coming out of residency?

------------------------

Now just a few comments:

I think Newankle's situation is pretty interesting. He/she is currently in an awesome spot both professionally and financially. But before this opportunity was landed newankle was working for significantly less money for a podiatry practice.

I understand that signing a new physician to the practice is an investment and that ultimately the practice wants to make more money. Both a pod practice and a ortho practice share these same goals so why don't they offer the same starting salaries?
 

newankle

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studywithfury,

I did a long well-known residency. I owe everything to my attendings and experiences. I did the residency I knew I wanted from year one of podiatry school. I wanted an ortho job out of residency but one was not available where I wanted to live. I also did not want to be in an ortho practice where I was not getting to do what I want (surgery) and was forced to do all the orthotics as I see many times. I also wanted a situation where I would be offered partnership.
Now, your latter question in "comments" is the question many have - why do podiatry practices offer packages so different from multidisciplinary/ortho practices? I personally think part of it is based on what your experiences are. An older established podiatrist would like to offer a competitive package to a new associate but sometimes he can't afford it/that extra margin of money will come out of his pocket. When he joined a practice he took a low salary or he built that practice and there is no set price on sweat equity if that makes any sense. However I think the main reason for the differences is based on how the 2 models are run. Some podiatry practices try to keep overhead down commonly by limiting staff. The doc(pod) thereby has to do more work himself, sees less patients, and has more stress. Our practice is very large and has many employees. We see over 300 patients a day every day between us. Our staff helps with everything. I have my own medical assistant that brings the patient back and briefs me. They get xrays before I see them. I review films, see the patient, fill out the bill then tell the MA what to do. The cast techs do all the braces, boots, and casts. If I'm going to do surgery I fill out a sheet and give it to my surgery scheduler who then handles it all, has the patient come in to see one of our PA's to do H&P, sign consent, get Rx etc.. PA's also will do all my postop appointments and fracture care followups. I have our orthotics & prosthetics person do orthotics. We have all services in-house. I see a lot of acute care like fractures, sprains/strains, etc.. Larger organizations can absorb larger costs and make more money, smaller ones cannot and that is the main reason.
 

PADPM

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Hopefully this will not "reveal" your identity, since I respect your anonymity, but can you tell us the state or at least region where you practice, so I can have a better understanding of reimbursements?

Thanks.
 

newankle

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PADPM,
I would like to remain anonymous but I practice in the same geographic region as you, the one with the lowest average reimbursements per region.
 

misskittyPA

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It seems like pods joining ortho practices is a fairly new thing and like most things in life, all are not created equal.

How does one go about testing the job market in the ortho realm for pods? Is it like pod practices, mostly word of mouth?

Are some regions better than others for the possibility of joining an ortho practice?

Are some residencies better for placing you with an ortho practice, if so which ones?
 
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Black Surgeon

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We see over 300 patients a day every day between us. Our staff helps with everything. I have my own medical assistant that brings the patient back and briefs me. They get xrays before I see them. I review films, see the patient, fill out the bill then tell the MA what to do. The cast techs do all the braces, boots, and casts. If I'm going to do surgery I fill out a sheet and give it to my surgery scheduler who then handles it all, has the patient come in to see one of our PA's to do H&P, sign consent, get Rx etc.. PA's also will do all my postop appointments and fracture care followups. I have our orthotics & prosthetics person do orthotics. We have all services in-house. I see a lot of acute care like fractures, sprains/strains, etc.. Larger organizations can absorb larger costs and make more money, smaller ones cannot and that is the main reason.

Sounds like clock work with minimal patient-physician interaction. How much time do you guys actually spend with each patients? As a patient or refferring physician, this may/would raise a red flag.
 

that1guyfromFL

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Sounds like clock work with minimal patient-physician interaction. How much time do you guys actually spend with each patients? As a patient or refferring physician, this may/would raise a red flag.

Putting your Jump to Conclusions doormat to good use I see.
 

dtrack22

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Black Surgeon said:
Sounds like clock work with minimal patient-physician interaction. How much time do you guys actually spend with each patients? As a patient or refferring physician, this may/would raise a red flag.

You are a med student...this is your future. You read "minimal patient-physician interaction" in newankle's post and I read "Modern medicine". In the word's of Lil Wayne, you gotta get wit it or get lost
 

newankle

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Sounds like clock work with minimal patient-physician interaction. How much time do you guys actually spend with each patients? As a patient or refferring physician, this may/would raise a red flag.

Those referring must be happy with me because my numbers just keep going up. When I first started I did my own preops, postops, and fracture care followups however much of that is wasted time. I go over everything with patients so that they fully understand but cast techs do casts and braces better than I do. The PA's can do H&P's, write orders, refill Rx just as well as I can. Every new patient sees me, not the PA. They see the less complicated fracture care followups, not all of them. Referring docs care about 2 things: seeing their patients ASAP and making them better (especially when they or others have not been able to do so). We all need these PA's and others helping us be more efficient so we can see more patients, not to make more money but because the demand keeps increasing. Patients are willing to accept a long waiting list for surgery but not to be initially seen.
 

Black Surgeon

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Those referring must be happy with me because my numbers just keep going up. When I first started I did my own preops, postops, and fracture care followups however much of that is wasted time. I go over everything with patients so that they fully understand but cast techs do casts and braces better than I do. The PA's can do H&P's, write orders, refill Rx just as well as I can. Every new patient sees me, not the PA. They see the less complicated fracture care followups, not all of them. Referring docs care about 2 things: seeing their patients ASAP and making them better (especially when they or others have not been able to do so). We all need these PA's and others helping us be more efficient so we can see more patients, not to make more money but because the demand keeps increasing. Patients are willing to accept a long waiting list for surgery but not to be initially seen.

Point taken :thumbup:.
 

sinustarsi

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Newankle: it seems like you got an offer with $400k reserved for foot and ankle orthopod. However, the orthopod can some times take calls for the practice and do other sx beside foot and ankle. Why would they hire you knowing that you are just limited just for the foot and ankle when they can hire someone who can do more for the same price? That is shocking/exiting with just with 3 yrs out and too good to be true. Can you tell us what residency program or the state you trained so I can extern at the program?

This is for other pods who are out 1-3yrs, and 3-5 yrs? What is your "average" monthly income after taxes. I know taxes varies by where you live but want to get a simply idea. Thanks.
 

PADPM

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I would like to reiterate what I believe is a very important point. I believe "newankle" and congratulate him on his tremendous opportunity and success.

He is obviously good at what he does, not simply "lucky", but he is also fortunate that the "stars all lined up" in his case. Because we will all agree that there are a lot of well trained DPM's not making that kind of money.

And that is EXACTLY my point. Before you all start smacking your lips and counting your money, I can assure you that at the present time, newankle is the exception, and not the rule.

I've been involved with residency training, the APMA, the ACFAS, the ABPS, etc., as well as what I consider an extremely large and successful practice (about 15 doctors now). And in all those years, being exposed to a LOT of doctors, students, externs, residents, etc., I have never heard of another DPM making $400,000 3 years out of training.

I actually know of very few DPM's making that amount of money their entire career.

As I've stated many times, as a well trained, honest/ethical DPM you have the potential to earn a much better than average income. But just because you graduate the same school and/or the same residency program as newankle, does not mean you'll be earning the same income.

I consider him the exception and not the rule, but truly hope that everyone in the future proves me wrong.
 

Feli

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Sounds like clock work with minimal patient-physician interaction. How much time do you guys actually spend with each patients? As a patient or refferring physician, this may/would raise a red flag.
Those referring must be happy with me because my numbers just keep going up. When I first started I did my own preops, postops, and fracture care followups however much of that is wasted time. I go over everything with patients so that they fully understand but cast techs do casts and braces better than I do. The PA's can do H&P's, write orders, refill Rx just as well as I can. Every new patient sees me, not the PA. They see the less complicated fracture care followups, not all of them. Referring docs care about 2 things: seeing their patients ASAP and making them better (especially when they or others have not been able to do so). We all need these PA's and others helping us be more efficient so we can see more patients, not to make more money but because the demand keeps increasing. Patients are willing to accept a long waiting list for surgery but not to be initially seen.
This is important info. As a student or resident, you are used to changing dressings, casting, splinting, crutch training, taking H&Ps, etc for each patient. Sometimes you even position and develop your own x-rays, put on VACs, etc.

It's important that you learn how to do those things since you might do them occasionally as an attending, but the main reason for doing them is so that you can eventually train your assistants on those tasks. When you enter practice, you need to realize which services take actually doctor's skill, which services a midlevel provider can do, which a RN can do, and which a med asst can do. You have to realize that each member of the clinic/rounding team has a different educational level, different skill set, and different patient care capabilities/limitations.

When it comes down to it, the medical world is based on rank, not unlike a military system. Attending docs write down or verbally give other team members "orders" for a reason (they're not called "suggestions," now are they?), and there is a hierarchy of the team members due to different levels of training. One of our program's alumni, who works in a group which does a high volume of surgery, likes to jokingly call the lower level skills and patient cares "NOB that nurses and PAs take care of" (NOB = non-operative bulls***). He's sorta kidding around, but sorta serious at the same time. In order to run an efficient business, you have to realize which cares demand which level of skill and therefore what each member's typical job duties are... ie for pod:

-Attending docs: surgery (incl sharp wound debridements), most initial evals of pts (formulation of diagnosis and care plan), ordering and eval of medical imaging or other tests, prescribing most Rx, major bedside or office procedures (ie fracture reduction, office surgery), etc (and any thing below)
-Residents, PAs, or NPs: assisting in surgery, H&Ps, initial prelim diagnosis and plan (to be discussed with attending for definitive plan), most follow-up visits or post-op rounding notes and orders, casting/splinting, prescribing some basic Rx or refill Rx, some simple and non-consented office or bedside procedures (lac repair, injects, or derm lesions), etc (and anything below)
-RNs: IV access and prepping/giving meds, bandage changes, wound VACs and some wound cares if certified, initial medical history taking, blood draws, assisting with complex patient hygene/grooming (and anything below)
-Med/Nurse/Pod Assistants or Techs: taking vitals, taking XRs, crutch training, restocking clinic supplies, cleaning instruments, assisting with patient positioning or basic hygene/grooming, bandage breakdown or basic bandaging, assisting above providers in any higher level clinic cares, etc

You can imagine how an attending doc who did all of his own dressing changes, casting, vital sign taking, etc is just not being efficient at all. Sure, if you're brand new to practice, you only have 10pts per day, and you don't want to pay for assistants you don't need, then you were trained on how to do those things yourself. Still, it's not a great habit to get into since patients may begin to "expect" the doc himself to do those things in the future. Once the docs are busy enough that they would have to see fewer patients per day to do the lower level cares, then there's absolutely no reason they should be doing that stuff. It's simply inefficient for a doc who can bring the office ~$200+/hr to be doing things a ~$35/hr PA or a ~$25/hr nurse could do... much less doing tasks that a $10/hr med asst has been trained to do.

In an efficient office's first patient visit, the med asst would take vitals, the nurse or PA would do the history, doc would see the pt and come up with a plan, med asst may take XR, doc would read XR, and then the PA would cast or inject the pt... or maybe the med asst or nurse would bandage the patient. For a follow up visit after a surgery the doc did, it might be the med asst taking the bandage down, PA evaluating the incision, RN removing stitches, and med asst re-bandaging. If the doc did it all himself every step of the way, he's just wasting his time (and the practice is hemorrhaging money).

It's not "dumping" the tasks on anyone, it's just a matter of efficiency. Would you see an army captain or general cleaning the rifles, training new recruits, pitching the tents for the camp, or cooking in the mess hall? Doubtful... the higher ups know how to do those things, but the army is efficient. The higher ranked members are probably busy making the battle plans and interpreting intel while the privates, maybe corporals, do the more basic things that the unit requires to run efficiently.
 

that1guyfromFL

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This is important info.

Great post Feli.

The task delegation you described is very close to how the busy and successful practice I work in is organized and run day to day.
 

newankle

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Newankle: it seems like you got an offer with $400k reserved for foot and ankle orthopod. However, the orthopod can some times take calls for the practice and do other sx beside foot and ankle. Why would they hire you knowing that you are just limited just for the foot and ankle when they can hire someone who can do more for the same price? That is shocking/exiting with just with 3 yrs out and too good to be true. Can you tell us what residency program or the state you trained so I can extern at the program?

This is for other pods who are out 1-3yrs, and 3-5 yrs? What is your "average" monthly income after taxes. I know taxes varies by where you live but want to get a simply idea. Thanks.


Hmmm...
$400K is not reserved for F&A orthopod - you'll know they get more than that, well more at teaching institutions - they are in HIGH demand. Before getting me, my practice searched for one for six years and could not find one they liked or was not willing to take general call or was not satisfied by salary they were offering. Even though I don't share in the general ortho call it is helpful to them to know they don't have to worry about any F&A trauma. The only things they care to do are acute ankle fractures and then rarely. When they are on call and get called about a F&A issue they just have them see me in the office the next day - clean and easy for them. I also don't currently make $400K. See my past post in this section - that is an offered possibility but my group has not agreed yet.
As for those who want to spend time where I did my residency - I filled my toolbox with skills and experience there and learned how to think outside the box and many many things for which I could go on and on forever but that didn't directly effect my getting the position I have today. No residency director making calls or connections made that way. My group knew I was well-trained by the institution I came from and speaking to me for 5 minutes. A surgeon can rather quickly ascertain in a short time whether they like you, can work with you, and if you know what the heck you're doing. The two main guys in my group trained nearby where I did and we got along. You can't just go after any ortho group. You have to be smart about it and know what doors may be open to you because many many will not be.
 

Black Surgeon

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This is important info. As a student or resident, you are used to changing dressings, casting, splinting, crutch training, taking H&Ps, etc for each patient. Sometimes you even position and develop your own x-rays, put on VACs, etc.

It's important that you learn how to do those things since you might do them occasionally as an attending, but the main reason for doing them is so that you can eventually train your assistants on those tasks. When you enter practice, you need to realize which services take actually doctor's skill, which services a midlevel provider can do, which a RN can do, and which a med asst can do. You have to realize that each member of the clinic/rounding team has a different educational level, different skill set, and different patient care capabilities/limitations.

When it comes down to it, the medical world is based on rank, not unlike a military system. Attending docs write down or verbally give other team members "orders" for a reason (they're not called "suggestions," now are they?), and there is a hierarchy of the team members due to different levels of training. One of our program's alumni, who works in a group which does a high volume of surgery, likes to jokingly call the lower level skills and patient cares "NOB that nurses and PAs take care of" (NOB = non-operative bulls***). He's sorta kidding around, but sorta serious at the same time. In order to run an efficient business, you have to realize which cares demand which level of skill and therefore what each member's typical job duties are... ie for pod:

-Attending docs: surgery (incl sharp wound debridements), most initial evals of pts (formulation of diagnosis and care plan), ordering and eval of medical imaging or other tests, prescribing most Rx, major bedside or office procedures (ie fracture reduction, office surgery), etc (and any thing below)
-Residents, PAs, or NPs: assisting in surgery, H&Ps, initial prelim diagnosis and plan (to be discussed with attending for definitive plan), most follow-up visits or post-op rounding notes and orders, casting/splinting, prescribing some basic Rx or refill Rx, some simple and non-consented office or bedside procedures (lac repair, injects, or derm lesions), etc (and anything below)
-RNs: IV access and prepping/giving meds, bandage changes, wound VACs and some wound cares if certified, initial medical history taking, blood draws, assisting with complex patient hygene/grooming (and anything below)
-Med/Nurse/Pod Assistants or Techs: taking vitals, taking XRs, crutch training, restocking clinic supplies, cleaning instruments, assisting with patient positioning or basic hygene/grooming, bandage breakdown or basic bandaging, assisting above providers in any higher level clinic cares, etc

You can imagine how an attending doc who did all of his own dressing changes, casting, vital sign taking, etc is just not being efficient at all. Sure, if you're brand new to practice, you only have 10pts per day, and you don't want to pay for assistants you don't need, then you were trained on how to do those things yourself. Still, it's not a great habit to get into since patients may begin to "expect" the doc himself to do those things in the future. Once the docs are busy enough that they would have to see fewer patients per day to do the lower level cares, then there's absolutely no reason they should be doing that stuff. It's simply inefficient for a doc who can bring the office ~$200+/hr to be doing things a ~$35/hr PA or a ~$25/hr nurse could do... much less doing tasks that a $10/hr med asst has been trained to do.

In an efficient office's first patient visit, the med asst would take vitals, the nurse or PA would do the history, doc would see the pt and come up with a plan, med asst may take XR, doc would read XR, and then the PA would cast or inject the pt... or maybe the med asst or nurse would bandage the patient. For a follow up visit after a surgery the doc did, it might be the med asst taking the bandage down, PA evaluating the incision, RN removing stitches, and med asst re-bandaging. If the doc did it all himself every step of the way, he's just wasting his time (and the practice is hemorrhaging money).

It's not "dumping" the tasks on anyone, it's just a matter of efficiency. Would you see an army captain or general cleaning the rifles, training new recruits, pitching the tents for the camp, or cooking in the mess hall? Doubtful... the higher ups know how to do those things, but the army is efficient. The higher ranked members are probably busy making the battle plans and interpreting intel while the privates, maybe corporals, do the more basic things that the unit requires to run efficiently.

Yes Medicine is partly a business, but "efficient" business practices is not and should never be an excuse for not practicing "good medicine". i.e, A quick NEJM literature review would allow you the benefit of knowing that something around 70% of all diagnosis can be obtained through a simple H&P. Although I must admit that I am unfamiliar with exactly how much diagnosing goes into Foot and ankle surgery/Medicine, I don't see such a task as one which can be deemed too lowly for the "higher ups". Furthermore, repetitive competent post-op care and follow up can be vital to circumventing post-op complications, this is also not a task I would label as lowly. The importance of competent Post-op care becomes even more apparent when considering the increasing role podiatric physicians are anticipated to play in diabetic/limb salvation Medicine within the coming decades.

One does not need to be a clinician in training to know that physician-patient interaction is vital to practicing "good Medicine". As soon as we start reducing this instrumental ploy with phrases like:

"It's simply inefficient for a doc who can bring the office ~$200+/hr to be doing things a ~$35/hr PA or a ~$25/hr nurse could do... much less doing tasks that a $10/hr med asst has been trained to do."

It becomes difficult to uphold practicing "good Medicine" as our primary goal in treating patients. This (the imprortance of being a physician first and a business man second) is something I believe PADPM: a poster I have come to admire on this forum, has also echoed in many of his posts when he speaks of "honest and ethical" practices. The Medicine you speak of is what one of my clinical professors likes to call "in-office outsourcing".
 
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janV88

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Yes Medicine is partly a business, but "efficient" business practices is not and should never be an excuse for not practicing "good medicine". i.e, A quick NEJM literature review would allow you the benefit of knowing that something around 70% of all diagnosis can be obtained through a simple H&P. Although I must admit that I am unfamiliar with exactly how much diagnosing goes into Foot and ankle surgery/Medicine, I don't see such a task as one which can be deemed too lowly for the "higher ups". Furthermore, repetitive competent post-op care and follow up can be vital to circumventing post-op complications, this is also not a task I would label as lowly. The importance of competent Post-op care becomes even more apparent when considering the increasing role podiatric physicians are anticipated to play in diabetic/limb salvation Medicine within the coming decades.

One does not need to be a clinician in training to know that physician-patient interaction is vital to practicing "good Medicine". As soon as we start reducing this instrumental ploy with phrases like:

"It's simply inefficient for a doc who can bring the office ~$200+/hr to be doing things a ~$35/hr PA or a ~$25/hr nurse could do... much less doing tasks that a $10/hr med asst has been trained to do."

It becomes difficult to uphold practicing "good Medicine" as our primary goal in treating patients. This (the imprortance of being a physician first and a business man second) is something I believe PADPM: a poster I have come to admire on this forum, has also echoed in many of his posts when he speaks of "honest and ethical" practices. The Medicine you speak of is what one of my clinical professors likes to call "in-office outsourcing".

Couldn't you argue though that efficient business practices can help to maximize physician - patient time? By freeing up the physician from the "mundane" tasks, the physician has more time for the patient.

I see 2 different scenarios from a more efficient practice.
1) See 10 patients per day but the physician can spend more time per patient.

2) See 15 patients per day instead of 10.

Scenario 1 should theoretically improve patient outcomes. Scenario 2 helps patients see the physician sooner...lower wait times, increased access.
 
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PADPM

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Feli,

I almost always agree with your post and I've always been impressed by your wisdom considering your relatively early stage of training.

But I've got to differ with you a little on this one. Without constantly rehashing my experience, yada, yada, yada, I'm not sure that realistically, the great majority of podiatric practices function in the capacity you have in your scenario.

In reality, I have been exposed to hundreds, yes hundreds of podiatric practices both large and small, and I can think of less than a handful that function in the capacity you describe. I personally believe that this is presently more common in orthopedic practices. Those practices have traditionally employed PA's, cast techs, etc., to perform some of the tasks you mentioned. I have only personally witnessed one large orthopedic practice where a PA actually performed an arthrocentesis on a knee.

I know many podiatric practices where the staff removes/changes dressings, removes sutures, casts for orthoses, takes x-rays, etc. However, I am not personally aware of any podiatric practice where an ancillary member of the staff performs injections, etc.

I agree with BlackSurgeon, that whether or not a member of my staff prescreens a patient, I will ALWAYS perform my own H&P, since I often find my answer in that portion of the visit. I also personally want to change my own post op dressings, because I want to see if there is any exudate, drainage, etc., and I want to be the first to see the post op wound, etc.

I have fought to keep our busy offices "personal" and not make the office an assembly line of person A does this, person B does this, person C does this and finally the doctor walks in and says "hello" and walks out.

I'm NEVER too busy for my patients and don't delegate duties to ancillary staff on a regular basis. Maybe that has contributed to my success and patient loyalty.

On the other hand, I've interviewed potential new associates with MAJOR attitude that expected to do NOTHING other than treat the patient. They were prima-donnas. Sorry, that "don't fly" in my offices.

Yes, when patients enter for palliative care we have staff that "grinds" the nails and/or applies accommodative padding. However, if a patient asks for ME, I will happily oblige. That HAS occurred, even though I may have performed a complete reconstruction on that patient's relative the day before.

I don't count my minutes/dollars, etc. I treat patients, not insurance companies and I delegate responsibility when necessary, but not all the time.

Additionally, in today's economy, you have got to be making HUGE money to afford a PA, an RN, a cast tech, etc., in addition to your office manager, front end staff, back end staff, etc., and pay for their benefits.

It's not always economically feasible, despite your calculations. It takes a VERY, VERY large and busy practice to justify having ancillary staff pick up those responsibilities/duties.

I can assure you that unless you are entering a very large, busy, successful practice, you'd better get ready to "do it all" AND be happy doing it!
 

azfootdoc

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So someone asked...
I am just finishing year 3 out of residency and work for a multi-specialty group. I therefore am paid as a W-2 employee. My income reported from salary last year on my taxes was 145K. But bear in mind that I try to pay for as much stuff through the business as I can. Last year I paid my life insurance premium ($600), health insurance (12k), Dental (1200), CME, cell phone (me and my wife), new Apple computer for home (2k/got to remote log into see xrays at hosptial), my internet connection (600/yr). So you can see that I try to pay for a lot of stuff through the business so I can pay taxes on as little as possible.

Oh yeah I took my staff to go see a Phoenix Suns game too. Paid for 15 tickets, 3 hotel rooms at the Hyatt, food, etc. You get to a point where, at least for me, I would rather go do something fun than pay a bunch in taxes.

And at least for me I pick CME in part based on where we want to go for Vacations. Going to Disneyland/Western this summer. Went to Park City in the past. These are all legit expenses you can run through a business that you get benefit from but reduce your tax liability. Keep this in mind when looking at other jobs. Kaiser for instance. You might make more but you aren't going to be able to do some of this other stuff to lower your taxes.

I bet if I didn't pay for all of the "other" stuff above I'd be doing 160-170k.

Sorry to be so long winded.
 

sinustarsi

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Is the 145k before or after taxes? Do you have student loans? This sounds more real to me than newankle's salary. Thanks for the honesty.
 
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