Need advice, I want to be a non-surgical podiatrist after graduating from surgical residency.

[mistermetatarsal]

Long time reader, first time poster. I am a 2nd year resident in a 3 year program and have decided surgery isn't for me. I thought it was, but I don’t enjoy it or the headaches that come with it. Am I seriously limiting myself by doing this in terms of job opportunity and is my salary going to be significantly lower? I originally thought it would be the same if not higher but after reading several averages online the surgical podiatrist was significantly higher than non-surgical (maybe they work more hours?)

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[NatCh]

I think the answer to your questions is yes, you will limit your opportunities and your income will be lower if you choose not to do any surgery whatsoever. Of course you won't have to take a patient to surgery if you don't want to, but the expectation will be that you could.

You will be in a good position in that you will have the surgical training so that you could do surgery if you wanted to, and can choose not to. Those podiatrists who can't do surgery due to lack of training or privilege restrictions are in a less favorable position.

I'm curious what headaches you're seeing that are turning you away from wanting to do surgery? Is it severe complications? Extended hospitalization? Poor outcomes? I'd love to know. Once you get a feel for proper patient selection, if you were to limit yourself to the core forefoot procedures the headaches aren't all that bad in my opinion, or you get used to it.

 

[mistermetatarsal]

I think the answer to your questions is yes, you will limit your opportunities and your income will be lower if you choose not to do any surgery whatsoever. Of course you won't have to take a patient to surgery if you don't want to, but the expectation will be that you could.

You will be in a good position in that you will have the surgical training so that you could do surgery if you wanted to, and can choose not to. Those podiatrists who can't do surgery due to lack of training or privilege restrictions are in a less favorable position.

I'm curious what headaches you're seeing that are turning you away from wanting to do surgery? Is it severe complications? Extended hospitalization? Poor outcomes? I'd love to know. Once you get a feel for proper patient selection, if you were to limit yourself to the core forefoot procedures the headaches aren't all that bad in my opinion, or you get used to it.

Thanks for the reply. I think I just find myself better off and less stressed with a 9 to 5 job of routine monotonous office work and nursing homes. There are several turn offs for surgery but it's mainly the poor reimbursement (including the global period), complications, and yes the poor outcomes you get from time to time. Surgery is getting less lucrative and in today’s litigious economy another lawsuit is right around the corner. If I do a bunion and only get back $300-400 that is ridiculous. The mechanic down the street charged me that much for some small amount of car work he did in 45 min. That is an hour of my time (plus the global period) I could have seen several patients, did a nail avulsion, whatever and made more money with less headache.

If I do surgery I agree I would limit myself to the forefoot, but the variety of cases you need in the 7 year period to get your numbers for board certification is another headache. If I’m working in a wound care clinic and just want to do debridements and amps, I would still have to do my bunions and fractures whether I like it or not so I can reach my numbers. There are several things I just don't want to do or feel great at doing yet this forces us to do them.

I started following some pods that did no surgery, just office work and nursing homes and home health care and it seemed less hectic, there was no call, and the money actually seemed better... but I could be wrong.

Thoughts?

 

[CoffeeMonster]

Thanks for the reply. I think I just find myself better off and less stressed with a 9 to 5 job of routine monotonous office work and nursing homes. There are several turn offs for surgery but it's mainly the poor reimbursement (including the global period), complications, and yes the poor outcomes you get from time to time. Surgery is getting less lucrative and in today’s litigious economy another lawsuit is right around the corner. If I do a bunion and only get back $300-400 that is ridiculous. The mechanic down the street charged me that much for some small amount of car work he did in 45 min. That is an hour of my time (plus the global period) I could have seen several patients, did a nail avulsion, whatever and made more money with less headache.

If I do surgery I agree I would limit myself to the forefoot, but the variety of cases you need in the 7 year period to get your numbers for board certification is another headache. If I’m working in a wound care clinic and just want to do debridements and amps, I would still have to do my bunions and fractures whether I like it or not so I can reach my numbers. There are several things I just don't want to do or feel great at doing yet this forces us to do them.

I started following some pods that did no surgery, just office work and nursing homes and home health care and it seemed less hectic, there was no call, and the money actually seemed better... but I could be wrong.

Thoughts?

If you're good enough, you could do a bunion in about 20 minutes. What a lot of docs do is line up 4-5 in a row and knock them all out in a morning. I guarantee that you'll make more than any mechanic could in that time frame. The most successful pods I've seen have been those that divided their time between surgery and clinic and did so in an optimized way. Sure you could do mostly nail care and palliative services at nursing homes and things like that, but to me that would get old real quick.

 

[newfeet]

Long time reader, first time poster. I am a 2nd year resident in a 3 year program and have decided surgery isn't for me. I thought it was, but I don’t enjoy it or the headaches that come with it. Am I seriously limiting myself by doing this in terms of job opportunity and is my salary going to be significantly lower? I originally thought it would be the same if not higher but after reading several averages online the surgical podiatrist was significantly higher than non-surgical (maybe they work more hours?)

I was where you are when I was a second year. I was in a PMS -24 program that converted to a PMSR without RRA. I didn't want to be a surgical podiatrist. I knew that from the first day of school. I didn't want to spend all day in the OR or looking for surgical cases. When I started look for positions in locations I wanted I found that they were looking only for surgical podiatrist. I decided I would do surgery but only on my terms.

I let my potential employers know from the beginning I trained in at a program that had a strong focus on diabetic foot wound care and forefoot surgery. I told them I wanted diabetic foot care and wound care to be a key focus of my practice in addition to surgery. I got lucky and found a great position.

Now as an attending I found that surgery is a small part of what I do. I'm doing 2, 3 surgical cases max a week. The rest of the week I'm in clinic or the wound care center. Surgery is skill. I do offer that skill to my patients when it is appropriate. If you don't want to ankle reconstruction/ rear foot don't apply to those type of jobs. There are plenty of opportunities to be a low key surgical podiatrist. I do mostly bunions and soft tissue cases. I have no desire to more than that.

You are not selling yourself short by not wanting to do surgery or doing just forefoot surgery.

 

[AttackNME]

Thanks for the reply. I think I just find myself better off and less stressed with a 9 to 5 job of routine monotonous office work and nursing homes. There are several turn offs for surgery but it's mainly the poor reimbursement (including the global period), complications, and yes the poor outcomes you get from time to time. Surgery is getting less lucrative and in today’s litigious economy another lawsuit is right around the corner. If I do a bunion and only get back $300-400 that is ridiculous. The mechanic down the street charged me that much for some small amount of car work he did in 45 min. That is an hour of my time (plus the global period) I could have seen several patients, did a nail avulsion, whatever and made more money with less headache.

If I do surgery I agree I would limit myself to the forefoot, but the variety of cases you need in the 7 year period to get your numbers for board certification is another headache. If I’m working in a wound care clinic and just want to do debridements and amps, I would still have to do my bunions and fractures whether I like it or not so I can reach my numbers. There are several things I just don't want to do or feel great at doing yet this forces us to do them.

I started following some pods that did no surgery, just office work and nursing homes and home health care and it seemed less hectic, there was no call, and the money actually seemed better... but I could be wrong.

Thoughts?

kaiser has nonsurgical positions, starting salaries range from 120k to 180k depending on location

 

[NatCh]

You're over half way finished with your residency training so you may as well see it through and later get your board certification. That way you won't get excluded from insurance panels and hospital staff.

Although it's a commonly stated idea that one can make more money in the office than doing surgery, it's misleading because you don't make the choice of either doing conservative care OR surgery on a patient. You do conservative care first THEN if it becomes necessary you take them to surgery. I'm other words what you make from doing surgery is on top of what you made from doing conservative care. It's atypical for a podiatrist to do only surgery without also doing office work. I've read that there are some of us who work almost exclusively in the operating room but it's not common.

Also, the idea that one can make more money doing office work than surgery assumes you're actually in the office doing higher-paying procedures during the time you would otherwise have been in the operating room. Most surgeries pay more than even half a dozen nail debridements, and if you're at the gym or playing on a computer instead you're not making any money at all.

In the big picture though, whether you make more money being surgical or non-surgical depends on how your business is run. Either way can be lucrative or not.

Most colleagues I've met only do a few cases per week at most, so they're not dealing with surgery the majority of the time. However if they didn't have the ability and credentialing to be able to take those patients to surgery they wouldn't have hospital privileges, wouldn't hacve board certification, and therefore wouldn't be on insurance provider panels. Their income and career would suffer.