MRI Machine....$$$
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What do you mean make serious income "utilizing" an MRI machine?? I refer patients out for an MRI all the time, but I don't "make" any money.
If you have an MRI in your office, YES you can certainly make some profit, but first you have to shell out the big bucks for the actual MRI unit and the build out of your office to meet the safety requirements due to the magnet.
You're looking at a HUGE investment.
And you have to be prepared to be able to provide a quality MRI read that will stand up in court in case you miss some serious pathology.
I send my MRI's to a major university with fellowship trained musculoskeletal radiologists, that are extremely specialized. I know that MRI is their only expertise.
Sometimes quality of care is more important than making a few extra bucks.
Stick to what you do best, if you can make money doing it, than that's great, but if you're looking for ways to make money that fall outside your expertise, in my opinion you're treading on thin ice. And no one is going to convince me that we are better trained to read an MRI than a fellowship trained musculoskeletal radiologist.
If you have an MRI in your office, YES you can certainly make some profit, but first you have to shell out the big bucks for the actual MRI unit and the build out of your office to meet the safety requirements due to the magnet.
You're looking at a HUGE investment.
And you have to be prepared to be able to provide a quality MRI read that will stand up in court in case you miss some serious pathology.
I send my MRI's to a major university with fellowship trained musculoskeletal radiologists, that are extremely specialized. I know that MRI is their only expertise.
Sometimes quality of care is more important than making a few extra bucks.
Stick to what you do best, if you can make money doing it, than that's great, but if you're looking for ways to make money that fall outside your expertise, in my opinion you're treading on thin ice. And no one is going to convince me that we are better trained to read an MRI than a fellowship trained musculoskeletal radiologist.
o no im completely with u on that .... the two pods that i visited in NY had 2 MRI machines ( Downtown Podiatry PC) ... so i was just wondering if they could get patients referred to them just for MRI usage?
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No offense, but after reading some of the info on their website, I would stay away and find other docs to shadow. I get a "bad feeling" about these guys.
http://www.downtownfoot.net/ ..... these guys??!!! really?? How so ?? These are the people that got me to fall in love with podiatry...
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Step 1: MRI machine
step 2: ????
step 3: Profit!
The general recent trends seems to be back away from out-pt radiology and many of these stand alone imagine companies are closing their doors as they are no longer profitable
step 2: ????
step 3: Profit!
The general recent trends seems to be back away from out-pt radiology and many of these stand alone imagine companies are closing their doors as they are no longer profitable
I'm sure they might be great DPMs as well as good businessmen, but the "as seen on TV" stuff kinda seems like a shiny salesman instead of a respected doctor. It may be necessary in a saturated metro area like NYC, so who knows... maybe it's par for the course? Most places, it wouldn't be.
The more DPMs you shadow, the more you will notice that many of the best and most highly trained guys don't need to do much advertising to have a packed office schedule. You also have to really realize that primary care podiatry and surgery are two pretty different things. Toenail and callus care would be like an oil change for your commuter car: it's simple and tons of places can do it, so you just wherever is nearby and fairly cheap (hence lots of ads/coupons/etc). Surgery is more like major engine work for your high end sports car: you definitely want somebody who knows what they're doing and will ask around to find that, so those people will generally have a solid respect and referral base with little or no marketing.
yes i see what your talking about ..... but i can also see why they would advertise like that ... within a 20 block radius from their office there are about 15 or more practices ( downtown Manhattan is the setting here people) and just on their block alone there are 5 other offices ... 2 of which are in the same building .... so def some cut throat tactics are involved here .
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It's just a "gut" feeling based on the website and some of the claims and statements made on the site. I noticed that none of the doctors are board certified by the American Board of Podiatric Surgery, and that they are very involved with the Academy of Ambulatory Foot Surgery, which is a form of surgery that was VERY popular in the late 70's and early to mid 80's.
At that time, the majority of doctors that performed this type of surgery, were doctors that did not have training in "traditional" surgery and did not have hospital privileges. As a result, these doctors performed this type of surgery, also at the time known as "minimal incision surgery".
In the 80's in NYC, doctors would advertise on the subways, in the papers, etc., and it was called "lunchtime" surgery. Patients would walk in with a corn or hammertoe and walk out with surgery, often never even knowing what happened. The doctor would numb the toe, place a drape up so the patient couldn't see, put a drill in the foot and "bur" away the bone and wrap the toe and "alas" a straight toe.
But, that drill did a LOT of damage. Because although a C-arm may have been used, you can't see in that little hole, and many times arteries, veins, nerves were being destroyed. Bunions were being "fixed" the same way and osteotomies were being performed, yet no form of fixation was utilized.
No screws, pins, wires, etc., and I spent the first 2 years of practice performing re-do surgery on patients since a doctor down the street from me was performing this type of surgery in his office.
So, when I see their ad, and see them advertising this type of surgery, I can't help but get this "bad feeling". Then I see the MRI and this compounds the feeling.
I've published articles on MRI and the foot, and I can be "cocky" enough to tell you that I probably know more about MRI than the average DPM, yet I don't have an MRI in my office, because I'm not as qualified to read an MRI as a board certified, fellowship trained musculoskeletal radiologist.
It's not ALWAYS about the $$$$$. It's about quality care, and just wait until the day they miss something important on that MRI. But that MIGHT not happen, because they probably have some "deal" with a radiologist to provide a "back-up" read.
At that time, the majority of doctors that performed this type of surgery, were doctors that did not have training in "traditional" surgery and did not have hospital privileges. As a result, these doctors performed this type of surgery, also at the time known as "minimal incision surgery".
In the 80's in NYC, doctors would advertise on the subways, in the papers, etc., and it was called "lunchtime" surgery. Patients would walk in with a corn or hammertoe and walk out with surgery, often never even knowing what happened. The doctor would numb the toe, place a drape up so the patient couldn't see, put a drill in the foot and "bur" away the bone and wrap the toe and "alas" a straight toe.
But, that drill did a LOT of damage. Because although a C-arm may have been used, you can't see in that little hole, and many times arteries, veins, nerves were being destroyed. Bunions were being "fixed" the same way and osteotomies were being performed, yet no form of fixation was utilized.
No screws, pins, wires, etc., and I spent the first 2 years of practice performing re-do surgery on patients since a doctor down the street from me was performing this type of surgery in his office.
So, when I see their ad, and see them advertising this type of surgery, I can't help but get this "bad feeling". Then I see the MRI and this compounds the feeling.
I've published articles on MRI and the foot, and I can be "cocky" enough to tell you that I probably know more about MRI than the average DPM, yet I don't have an MRI in my office, because I'm not as qualified to read an MRI as a board certified, fellowship trained musculoskeletal radiologist.
It's not ALWAYS about the $$$$$. It's about quality care, and just wait until the day they miss something important on that MRI. But that MIGHT not happen, because they probably have some "deal" with a radiologist to provide a "back-up" read.
I completely understand where your coming from now doctor; it was always obvious to me that they hustled for business ... to them business is the main priority then patients.... although that's not right obviously and goes against the oath, however if that's not the approach in this metro area you'll get eaten up ( which raises serious issues here ).... "survival of the fittest" and "it business not personal" are the two main mottoes in their case.
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Hustling is "okay", as long at it never interferes with patient care. It's okay to be aggressive and competitive, but you must treat patients and not insurance companies.
I think I'm relatively successful, and although this is going to sound as "corny" as it possibly can, I can honestly state that I've never taken an x-ray, dispensed an orthotic or performed a surgery on a patient that I wouldn't have performed on a member of my family.
If you see every patient that walks into your office as a $$$$ sign, then I guarantee you that you'll practicing CRAP medicine and you'll also be looking at lawsuits. And if you practice this way, I hope you don't have a conscience, because if you do you'll have trouble sleeping at night.
While you are visiting or shadowing doctors, please don't EVER confuse doctors that are financially successful with "quality care". Sometimes the two can be on extreme ends of the spectrum.
I know of some brilliant, excellent doctors that are simply not good businessmen, and don't make a great living, and I know many DPM's that make triple what I do and I wouldn't let them cut my pet's toenails.
When you visit offices, you should get a "gut" feeling pretty quickly. If a doctor keeps patting himself on the shoulder.....bad sign. If a doctor keeps telling you how much he makes......bad sign. If a doctor keeps telling you how much he bills.....bad sign. If all a doctor talks about is his billing practices.....bad sign. If a doctor talks a lot about his new car, summer home, vacations.....bad sign. If a doctor appears to be "selling" a lot of services to his patients or "pushing" surgery, etc. ......bad sign.
If a doctor discusses interesting cases with you.....good sign. If a doctor walks into each treatment room and shakes every patient's hand.....good sign. If a doctor asks each patient "do you have any other problems or questions" before he leaves the room....that's a good sign. If a doctor talks academics with you.....that's a good sign. If a doctor asks YOU if you have any questions.....that's a good sign.
Anyway, I think you get it by now. It doesn't take long to make a first impression, and my experience has shown that USUALLY, your first impression is correct. Zebras don't change their stripes.
I think I'm relatively successful, and although this is going to sound as "corny" as it possibly can, I can honestly state that I've never taken an x-ray, dispensed an orthotic or performed a surgery on a patient that I wouldn't have performed on a member of my family.
If you see every patient that walks into your office as a $$$$ sign, then I guarantee you that you'll practicing CRAP medicine and you'll also be looking at lawsuits. And if you practice this way, I hope you don't have a conscience, because if you do you'll have trouble sleeping at night.
While you are visiting or shadowing doctors, please don't EVER confuse doctors that are financially successful with "quality care". Sometimes the two can be on extreme ends of the spectrum.
I know of some brilliant, excellent doctors that are simply not good businessmen, and don't make a great living, and I know many DPM's that make triple what I do and I wouldn't let them cut my pet's toenails.
When you visit offices, you should get a "gut" feeling pretty quickly. If a doctor keeps patting himself on the shoulder.....bad sign. If a doctor keeps telling you how much he makes......bad sign. If a doctor keeps telling you how much he bills.....bad sign. If all a doctor talks about is his billing practices.....bad sign. If a doctor talks a lot about his new car, summer home, vacations.....bad sign. If a doctor appears to be "selling" a lot of services to his patients or "pushing" surgery, etc. ......bad sign.
If a doctor discusses interesting cases with you.....good sign. If a doctor walks into each treatment room and shakes every patient's hand.....good sign. If a doctor asks each patient "do you have any other problems or questions" before he leaves the room....that's a good sign. If a doctor talks academics with you.....that's a good sign. If a doctor asks YOU if you have any questions.....that's a good sign.
Anyway, I think you get it by now. It doesn't take long to make a first impression, and my experience has shown that USUALLY, your first impression is correct. Zebras don't change their stripes.
Yea your absolutely right doc.
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Like PADPM mentioned, having a MRI machine in the office probably isn't the best thing you can do, however, you could always invest (co-partner/owner) at an MRI center. I know of a group of orthopods at a nearby hospital that have done this, I'm sure it is a big headache though that I'm just not aware of.
You can have a MRI machine in your office and have a Radiologist read the MRI. He or she would be paid for the professional portion and you would be paid for the technical portion. If you could afford the machine, this could enhance patient care dramatically.
ABPS certification has nothing to do with honesty or being ethical. Some of the biggest crooks and unethical people in our profession are ABPS certified.
You must still educated yourself on any procedure you perform in your office. You should be able to read a MRI even if a radiologists reads it for you. We all dont have musculoskeletal radiologists at our disposal. I practice in a small town and the radiologists are not as proficent in foot and ankle xray and MRI interpretation as I would expect them to be. I cant tell you how many fractures or other pathology they have missed.
ABPS certification has nothing to do with honesty or being ethical. Some of the biggest crooks and unethical people in our profession are ABPS certified.
You must still educated yourself on any procedure you perform in your office. You should be able to read a MRI even if a radiologists reads it for you. We all dont have musculoskeletal radiologists at our disposal. I practice in a small town and the radiologists are not as proficent in foot and ankle xray and MRI interpretation as I would expect them to be. I cant tell you how many fractures or other pathology they have missed.
I agree with you as "foot and ankle specialists" we shouldnt have trouble reading a foot/ankle MRI taken from various planes ( ie coronal,sagittal,etc..)
