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It has been quite a few years since I have been on SDN. Thought I would make a post about what it is like to practice in Canada, especially Alberta. Looking through some of the posts in the past, there is a lot of misinformation, or outdated information about what is like to practice here. Seems like there is still a lot of Canadian lurkers here, so I hope this will help benefit them.
Looking at some of the posts on SDN about practicing in the United States, I have come to the realization that it seems very complex. Here in Alberta, it is very simple and not overly complicated at all. But it is unique. This is to the best of my knowledge, some things may not be 100% accurate.
Scope of Practice
All podiatrists in the province are regulated by the College of Podiatric Physicians of Alberta (CPPA). Legally, we are defined as podiatric physicians. Our scope is defined as anything relating to the foot and ankle. To be registered by the college, you must obtain a Doctor Podiatric Medicine (DPM) degree from an accredited U.S. institution, passed Part 3 of the American Podiatric Medical Licensing Exam (AMPLE) and have completed at least a 2 year podiatry residency. Chiropodists and UK trained podiatrists can not be members of the college, and therefore can not practice in Alberta.
Surgeries or either performed in private surgical centers, personal surgical suites, government funded hospitals, or government contracted surgical centers. Your surgical scope of what you are authorized to do is set by the College after a review of your case logs during residency.
Billing
We still use ICD-9 codes.
Funding for doctors is provided in the province made by Alberta Health Care Insurance Plan (AHCIP or just AHC), the universal government funded health plan. However, podiatrists are not considered full physicians, and therefore do not fall under the same regulations as the MDs do. Meaning, we can bill a patient directly for services (Private Pay). While our MD colleagues cannot.
AHC does cover podiatry services. There are two contracts available for podiatrists in Alberta. The Podiatry Schedule and the Podiatric Surgery Schedule. The Podiatry Schedule covers podiatry services for every patient in the province up to a maximum of $250 per year. Every podiatrist in the province can bill off of this schedule. The Podiatric Surgery Schedule has higher reimbursement rates for clinic visits and surgical procedures and has no maximums, but can only be billed by a podiatrist with hospital privileges. To hold hospital privileges you must have board certification with either the American Board of Foot and Ankle Surgery (ABFAS) or American Board of Multiple Specialties in Podiatry (ABMSP).
In addition to AHC, there is also 3rd party private insurance that has funding for podiatry (Greenshield, Manulife, Blue Cross, etc.). Most plans will have about $500 per patient per year. These are typically included as part of the benefits package for your job.
WCB can also provide funding for patient services and surgery. Other sources of potential revenue include Non-insured health benefits for First Nations and Inuit (NIHB) and Assured Income for the Severely Handicapped (AISH) which can both provide medical funding for patients that fall into these categories.
With AHC billing, you can bill for an office visit and also for a procedure as long as you have a different ICD-9 code for each. Eg, a diabetic comes in for routine debridement of an ulcer would give you;
Office Visit $20-27, Debridement $46-$80 (rates depending on which schedule you can bill)
Keep in mind that you also have the ability to charge the patient for any services rendered. Eg, you can charge them for the office visit, the debridement, or both in addition to AHC.
Practice Types
They are basically three different types of podiatry practices in the province.
Doctors who bill off of the podiatry schedule only, have the option of performing private surgery. Some practices will have an in-house surgical suite that is accredited by Alberta Health. Some choose to rent a surgical room from an accredited surgical centre. Private surgery can be a viable option for some patients who have the means, as surgical wait times for government funded surgeries can be anywhere from 6 months to 4 years for elective cases.
Minor procedures, like a matrixectomy, can be performed in the private clinics, at a cost to the patient (around $500-$600), and then also billed to AHC ($65-$85). Keep in mind that each patient only has $250 AHC coverage per year.
Public clinics are not common and they are only a handful of them in the Calgary Health Region. These doctors bill off of the Podiatric Surgery Schedule, and work out of the one of the major hospitals in the city, the Peter Lougheed Centre. They also maintain their own clinic which typically has very little overhead. They do not bill anything private, except for the odd orthotic. They take call at the hospital and also cover the Zivot Limb Preservation Centre. Call is typically limited to diabetic wounds and some forefoot trauma. They perform their publicly funded surgeries at the hospital or at a contracted Surgical Centre. New patients that are referred can be billed to AHC for $93. Although the can legally charge a co-pay or for minor procedures, they opt not to. They stick to just AHC payments only. Their surgical wait list is typically short for most smaller procedures as they have easy access to the main ORs and also to the minor surgical suite in the hospital. They take care of most of the high risk diabetic care in the province.
As of right now, the only way a doctor can join this group is to complete a Fellowship in Diabetic Limb Salvage, preferably at their own fellowship the Rose Zivot Fellowship in Limb Preservation and Foot Reconstructive Surgery sponsored by the University of Calgary.
Hybrid Clinics are also not very common. These doctors bill on the Podiatric Surgery Schedule and also privately. In Calgary, they typically do not work out of the Peter Lougheed Centre, but they do hold admitting privileges there. They do not work in the Zivot Limb Preservation Centre, or take call at any of the hospitals. Their AHC surgeries are performed at a contracted Surgical Centre. Other’s that fall into this category hold privileges at rural hospitals around Edmonton, Calgary and Lethbridge. They perform their publicly funded surgeries at these hospitals and may take floor or ER consults on the day that they are in the hospital performing surgery. Their wait lists tend to be the highest with the range of 2-4 years due to lack of access to the operating room. Typically these rural hospitals are far away from their main clinics. A few have privileges at more than one rural hospital. Surgical supplies are very limited at the rural hospitals, often just limited to what is in your small or mini frag sets. These doctors still perform private surgery in accredited surgical centers, or private surgical suites. Patients are usually given the option to be on a wait list or pay privately.
Because there are two contracts, or schedules, with the government for podiatry services, this can make for some very heated discussions at our annual general meetings. It does divide the profession into “Podiatrists” and “Podiatric Surgeons.” Some of those who are fully funded by AHC, do not like that others are charging privately for some services. Some are pushing for full AHC coverage for podiatrists, and therefore no private pay at all. Others, who are only partially funded complain that they do not get paid as much from the government. Most of these people are very unwilling to give up their private procedures and copays. Some also strongly believe that the College of Podiatric Physicians of Alberta should be absorbed by the College of Physicians and Surgeons of Alberta (the governing body for MDs). Others are adamant against it. There are 2 associations that represent these two groups; the Association of Alberta Podiatric Surgeons and the Alberta Podiatric Medical Association.
Because of this disparity and strong difference of opinion, there will unlikely be any change in the near future in my opinion. there have always been rumors of a school or residency program opening up here, I do not see that happening to be honest.
Because there is a slight barrier to entry for podiatrists to live and work in Alberta, we do not have many new grades coming here often and most of them are Canadian, however Americans can and do work here. In the last 8 years, we have had 15 new podiatrists registered by the College. Many DPMs are about 5-10 years away from retirement. There are currently 97 registered podiatrists in Alberta serving a population of 5 million. Some of these are part time and some have already retired.
Podiatry practices do fairly well here in Alberta. Some practices are known as more of an orthotic mill, some just focus on routine foot care, and some are more surgically orientated. I think most full-time DPMs bill anywhere from 500k to 1.5 million a year. Take home pay obviously depends a lot on overhead costs and whether you are an associate or an owner. Many run their own clinic while some are in small groups. From my first-year out of residency, I made nearly double what my co residents made who were down in the U.S. However, I was not doing the complex rearfoot cases that they were doing. You will not be doing any total ankles, you will not be using any Taylor Spatial frames, nobody knows what Ilizarov is. You can do private MIS but you will have to purchase the equipment for it.
Hope this helps!
Looking at some of the posts on SDN about practicing in the United States, I have come to the realization that it seems very complex. Here in Alberta, it is very simple and not overly complicated at all. But it is unique. This is to the best of my knowledge, some things may not be 100% accurate.
Scope of Practice
All podiatrists in the province are regulated by the College of Podiatric Physicians of Alberta (CPPA). Legally, we are defined as podiatric physicians. Our scope is defined as anything relating to the foot and ankle. To be registered by the college, you must obtain a Doctor Podiatric Medicine (DPM) degree from an accredited U.S. institution, passed Part 3 of the American Podiatric Medical Licensing Exam (AMPLE) and have completed at least a 2 year podiatry residency. Chiropodists and UK trained podiatrists can not be members of the college, and therefore can not practice in Alberta.
Surgeries or either performed in private surgical centers, personal surgical suites, government funded hospitals, or government contracted surgical centers. Your surgical scope of what you are authorized to do is set by the College after a review of your case logs during residency.
Billing
We still use ICD-9 codes.
Funding for doctors is provided in the province made by Alberta Health Care Insurance Plan (AHCIP or just AHC), the universal government funded health plan. However, podiatrists are not considered full physicians, and therefore do not fall under the same regulations as the MDs do. Meaning, we can bill a patient directly for services (Private Pay). While our MD colleagues cannot.
AHC does cover podiatry services. There are two contracts available for podiatrists in Alberta. The Podiatry Schedule and the Podiatric Surgery Schedule. The Podiatry Schedule covers podiatry services for every patient in the province up to a maximum of $250 per year. Every podiatrist in the province can bill off of this schedule. The Podiatric Surgery Schedule has higher reimbursement rates for clinic visits and surgical procedures and has no maximums, but can only be billed by a podiatrist with hospital privileges. To hold hospital privileges you must have board certification with either the American Board of Foot and Ankle Surgery (ABFAS) or American Board of Multiple Specialties in Podiatry (ABMSP).
In addition to AHC, there is also 3rd party private insurance that has funding for podiatry (Greenshield, Manulife, Blue Cross, etc.). Most plans will have about $500 per patient per year. These are typically included as part of the benefits package for your job.
WCB can also provide funding for patient services and surgery. Other sources of potential revenue include Non-insured health benefits for First Nations and Inuit (NIHB) and Assured Income for the Severely Handicapped (AISH) which can both provide medical funding for patients that fall into these categories.
With AHC billing, you can bill for an office visit and also for a procedure as long as you have a different ICD-9 code for each. Eg, a diabetic comes in for routine debridement of an ulcer would give you;
Office Visit $20-27, Debridement $46-$80 (rates depending on which schedule you can bill)
Keep in mind that you also have the ability to charge the patient for any services rendered. Eg, you can charge them for the office visit, the debridement, or both in addition to AHC.
Practice Types
They are basically three different types of podiatry practices in the province.
- Private Clinics
- Public Clinics
- Hybrid Clinics
Doctors who bill off of the podiatry schedule only, have the option of performing private surgery. Some practices will have an in-house surgical suite that is accredited by Alberta Health. Some choose to rent a surgical room from an accredited surgical centre. Private surgery can be a viable option for some patients who have the means, as surgical wait times for government funded surgeries can be anywhere from 6 months to 4 years for elective cases.
Minor procedures, like a matrixectomy, can be performed in the private clinics, at a cost to the patient (around $500-$600), and then also billed to AHC ($65-$85). Keep in mind that each patient only has $250 AHC coverage per year.
Public clinics are not common and they are only a handful of them in the Calgary Health Region. These doctors bill off of the Podiatric Surgery Schedule, and work out of the one of the major hospitals in the city, the Peter Lougheed Centre. They also maintain their own clinic which typically has very little overhead. They do not bill anything private, except for the odd orthotic. They take call at the hospital and also cover the Zivot Limb Preservation Centre. Call is typically limited to diabetic wounds and some forefoot trauma. They perform their publicly funded surgeries at the hospital or at a contracted Surgical Centre. New patients that are referred can be billed to AHC for $93. Although the can legally charge a co-pay or for minor procedures, they opt not to. They stick to just AHC payments only. Their surgical wait list is typically short for most smaller procedures as they have easy access to the main ORs and also to the minor surgical suite in the hospital. They take care of most of the high risk diabetic care in the province.
As of right now, the only way a doctor can join this group is to complete a Fellowship in Diabetic Limb Salvage, preferably at their own fellowship the Rose Zivot Fellowship in Limb Preservation and Foot Reconstructive Surgery sponsored by the University of Calgary.
Hybrid Clinics are also not very common. These doctors bill on the Podiatric Surgery Schedule and also privately. In Calgary, they typically do not work out of the Peter Lougheed Centre, but they do hold admitting privileges there. They do not work in the Zivot Limb Preservation Centre, or take call at any of the hospitals. Their AHC surgeries are performed at a contracted Surgical Centre. Other’s that fall into this category hold privileges at rural hospitals around Edmonton, Calgary and Lethbridge. They perform their publicly funded surgeries at these hospitals and may take floor or ER consults on the day that they are in the hospital performing surgery. Their wait lists tend to be the highest with the range of 2-4 years due to lack of access to the operating room. Typically these rural hospitals are far away from their main clinics. A few have privileges at more than one rural hospital. Surgical supplies are very limited at the rural hospitals, often just limited to what is in your small or mini frag sets. These doctors still perform private surgery in accredited surgical centers, or private surgical suites. Patients are usually given the option to be on a wait list or pay privately.
Because there are two contracts, or schedules, with the government for podiatry services, this can make for some very heated discussions at our annual general meetings. It does divide the profession into “Podiatrists” and “Podiatric Surgeons.” Some of those who are fully funded by AHC, do not like that others are charging privately for some services. Some are pushing for full AHC coverage for podiatrists, and therefore no private pay at all. Others, who are only partially funded complain that they do not get paid as much from the government. Most of these people are very unwilling to give up their private procedures and copays. Some also strongly believe that the College of Podiatric Physicians of Alberta should be absorbed by the College of Physicians and Surgeons of Alberta (the governing body for MDs). Others are adamant against it. There are 2 associations that represent these two groups; the Association of Alberta Podiatric Surgeons and the Alberta Podiatric Medical Association.
Because of this disparity and strong difference of opinion, there will unlikely be any change in the near future in my opinion. there have always been rumors of a school or residency program opening up here, I do not see that happening to be honest.
Because there is a slight barrier to entry for podiatrists to live and work in Alberta, we do not have many new grades coming here often and most of them are Canadian, however Americans can and do work here. In the last 8 years, we have had 15 new podiatrists registered by the College. Many DPMs are about 5-10 years away from retirement. There are currently 97 registered podiatrists in Alberta serving a population of 5 million. Some of these are part time and some have already retired.
Podiatry practices do fairly well here in Alberta. Some practices are known as more of an orthotic mill, some just focus on routine foot care, and some are more surgically orientated. I think most full-time DPMs bill anywhere from 500k to 1.5 million a year. Take home pay obviously depends a lot on overhead costs and whether you are an associate or an owner. Many run their own clinic while some are in small groups. From my first-year out of residency, I made nearly double what my co residents made who were down in the U.S. However, I was not doing the complex rearfoot cases that they were doing. You will not be doing any total ankles, you will not be using any Taylor Spatial frames, nobody knows what Ilizarov is. You can do private MIS but you will have to purchase the equipment for it.
Hope this helps!