Podiatry in Alberta, Canada

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darazon

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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 Looking through some of the posts in the past, there is a lot of misinformation, or outdated information about what is like to practice here.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.
  • Private Clinics
  • Public Clinics
  • Hybrid Clinics
Private clinics cover the majority of podiatrists in Alberta. These doctors will bill off of the Podiatry Schedule only for AHC, everything else is cash pay. For example, a new patient coming in with chief complaint of heel pain, will likely be charged a co-pay (usually between $80-$120), the doctor will then bill AHC for the encounter ($45 if they were referred or $38 if they self referred). The patient will also likely end up with orthotics if they already do not have them (around $600). If you happen to have an x-ray machine, you can bill both AHC ($55 for both feet/ankles) and the patient ($40-$80) for x-rays. Everything above AHC billing is billed directly to the patient who pays at the clinic. The patient will then be reimbursed by their 3rd party insurance company.

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!

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ABMSP ftw??? Guess if you are picking a second rate podiatry board, doesn't matter which one :lol:

Good info and glad you like it. Seems crazy the private pod "patient will also likely end up with orthotics if they already do not have them." I'm assuming their insurance or gov plan obviously pays them back? I could not imagine if the vast majority of my office pts got orthotics... I'd have about 5 Ferraris by now, lol.

It's absolutely frightening that the only way into Calgary public employ podiatry for DPMs is that Calgary preferred 'fellowship'. Yikes. There are some joke podiatry "limb salvage" fellowships in USA obviously - but they're not required just to do that entry level podiatry DM/wound work. The DM wounds is just such basic stuff that any half-decent DPM residency covers just fine. Truly sad that they put up barriers to doing work, which they only have because MDs don't want it in the first place. That's garbage... simply limiting their competition, I suppose.

...fyi, you might want to say if your $$ figures above are CAD or USD if you're trying to drum interest. And I'd say your own income past and present in USD if you are comfortable with that? Also list what hospital jobs pay. Most people don't know the diff, and CAD has been less/more than USD a few times just in my lifetime. I don't think it's a real consideration for any DPM not from Canada to go practice there with weather and much diff health care, but you never know. Salary is the first question on any pod job. Money always matters, so maybe clarify? Nobody is going to consider it without a sizeable carrot on the stick. If it pays more for entry level Calgary podiatry than the $150k-200k USD most associateDPM jobs in USA do, people might consider going to a place they're not crazy about (just like IHS and rural jobs in USA... but with citizenship/visa stuff?). GL with recruiting.
 
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Canada is struggling to keep medical doctors as a lot of them moved south of the border for better pay and benefits. Podiatry is no different. People prefer to practice in the States than in Canada for various reasons. Canada also has a huge healthcare issue, although it's free healthcare (socialized healthcare), and there's long waiting times for emergency rooms, surgery scheduling, advanced imaging (MRIs, CT, etc) that many would prefer to go across the border to get them done...with their own money. Family doctors aren't accepting new patients and are choosy when they get new patients. This is what I gathered from friends/colleagues up north.
 
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You think housing affordability is a problem here....check out Canada
 
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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).
ABPM on suicide watch right now. ABLES is cackling with laughter knowing they got absorbed last year.
 
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You think housing affordability is a problem here....check out Canada
They're probably averse to ever trying to negotiate down house prices. They're a very polite bunch.

...unless you try to pull their girl at the bar. Then they're big mean hockey playin dudes that'll kick your hoser azz.*

*Trust me bro.


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Why are we crapping on Canada. Canada is awesome. We should totally have conquered them forever ago. I had an amazing time there everytime I visited. Simultaneously the best Chinese food and crepes I've ever had. Half of the complaints I hear about the USA lately are that we spend money "elsewhere" instead of on Americans. They don't even come close to meeting their NATO commitment. They spend all their money on their universal healthcare and they still have to come to America to get care. Its like the definition of what everyone I talk to claims they want. Their winters are Narnian in length. Maple syrup candy. Hockey. They apparently love custom orthotics. You need to control that overpronation 'eh. It sounds like they have unconquered podiatry markets ripe for the picking for anyone willing to bundle up and cheer for the Blue Jays. My guess is that you can be a poorly trained NYC TFP and really make it work there. No more cutting nails into a nursing home courtyard bucket while the OIG watches you with binoculars. Ohhhhhhhh Cannnnnnaaaaaaddddda. And if you move to Canada you can buy Cantharone direct from Dormer labs without the FDA f****ing you and the rest of American while letting American pharmaceutical giants destroy the country. Canada probably will let you buy cheaper Ozempic so you can shed that big American butt you got eating food out a hospital vending machine late at night taking free call.

Podiatry Manifest Destiny baby. Its waiting for you in Canada.
 
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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.
With only 97 podiatrists for 5 million ppl, how do you manage patient demand and prioritize care? Do other HC professionals provide podiatric services to address this gap?
 
With only 97 podiatrists for 5 million ppl, how do you manage patient demand and prioritize care? Do other HC professionals provide podiatric services to address this gap?
No, we have a VERY special skill set. Nobody can duplicate. Must wait, thems the rules.
 
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With only 97 podiatrists for 5 million ppl, how do you manage patient demand and prioritize care? Do other HC professionals provide podiatric services to address this gap?
The smartest thing - by far - to do in Canada as a DPM would be to go with fully cash pay PP (completely cash pay... don't even take govt healthcare crap insurance for anything... set your own prices top to bottom). As is, it's a pretty bad place to practice - unless you really do like the area and want to retire/citizen/etc there. Like any socialized med country, there are just far too few working people paying for the health care (and general welfare) of the non-working/disabled/retired/sick/old/poor/etc etc. Reimbursements will accordingly be lame... and getting worse.

Some patients would go for cash pay podiatry, but most won't. Most people are pigheaded and want to use "their" govt insurance (aka tax $ of others) or employer insurance no matter the wait or the quality of care or if they have plenty of money. Dent or plastics or derm could do this and kill it very quickly after opening... unlikely for podiatry. It'd take a looong time to get going, and you'd have to give superior outcomes and superior quality of pt experience versus the govt hospital or chummy PPs taking the govt and other insurances, but you could gain a rep for being outstanding and make bank in the long game - if you're good.

Minor problems:
Hospitals/surg centers would likely cockblock you for going against the grain.
PCPs and other pods and most docs who play the socialized med insurance game may try to black eye you for being greedy.
City/area might not like your biz model and try to block you by not letting you advertise or taxing you hard or etc.

Major problem:
Canada is not a great place weather-wise for 80% of the year.
Exchange rate of CAD is bad (vs US, the markets where you'd want to put your $ made)... really bad right now.
Canada housing (and almost certainly commercial rent) is super high.
 
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Too liberal of a country which is why they'll fail.

Average podiatrist in Alberta makes no where near what they make in The USA. Plus the taxes are beyond anything we have here. I went to the supposed "best city in Canada", Toronto and it was just a bunch of migrants. Incredibly unsafe place to live and visit to be honest. I can't imagine the rest of the country would be safe or nice. Why would we take less money, pay higher taxes and live in a unsafe place...
 
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Too liberal of a country which is why they'll fail.

Average podiatrist in Alberta makes no where near what they make in The USA. Plus the taxes are beyond anything we have here. I went to the supposed "best city in Canada", Toronto and it was just a bunch of migrants. Incredibly unsafe place to live and visit to be honest. I can't imagine the rest of the country would be safe or nice. Why would we take less money, pay higher taxes and live in a unsafe place...

Once again gotta go rural. I'm not Canadian (I just like collecting their parking tickets) but I never had a problem in Vancouver or Quebec City. Toronto, Ottawa was another story. Ended up getting our car broken into and all of our stuff stolen.

Also 25% of their countries population is immigrants. With that high of a percentage the culture will certainly change with time.
 
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Too liberal of a country which is why they'll fail.

Average podiatrist in Alberta makes no where near what they make in The USA. Plus the taxes are beyond anything we have here. I went to the supposed "best city in Canada", Toronto and it was just a bunch of migrants. Incredibly unsafe place to live and visit to be honest. I can't imagine the rest of the country would be safe or nice. Why would we take less money, pay higher taxes and live in a unsafe place...

The oil field folks in Alberta would probably disagree with you about the politics of that particular province. I mean, the Calgary Stampede hosts one of the largest rodeos in the world. I wouldn’t compare it to Toronto.

Podiatry actually sounds like it has a better set up in Canada than the MD/DOs. They aren’t locked in to the national healthcare system and are free to balance bill patients (essentially) according to the OP. I’m pretty sure it actually varies from province to province, but PP podiatrists in Alberta sound like they do better than virtually every US podiatry associate. They probably do a little worse than some of the “practice management” gurus of the American podiatry world. Higher floor, lower ceiling. The salaried folks in the government/public facilities are most likely underpaid. Their MD/DO counterparts definitely are compared to US physicians.
 
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The oil field folks in Alberta would probably disagree with you about the politics of that particular province. I mean, the Calgary Stampede hosts one of the largest rodeos in the world. I wouldn’t compare it to Toronto.

Podiatry actually sounds like it has a better set up in Canada than the MD/DOs. They aren’t locked in to the national healthcare system and are free to balance bill patients (essentially) according to the OP. I’m pretty sure it actually varies from province to province, but PP podiatrists in Alberta sound like they do better than virtually every US podiatry associate. They probably do a little worse than some of the “practice management” gurus of the American podiatry world. Higher floor, lower ceiling. The salaried folks in the government/public facilities are most likely underpaid. Their MD/DO counterparts definitely are compared to US physicians.
No province is safe from the cancer that is Trudeau
 
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The socialized medicine is basically happening in USA also, but it's just not official. Death by 1000 razor blades.
The percentage of ppl with MCR + MCA has risen in nearly every state. It's not the growing seniors like APMA touts... simply lower %s of the populations work jobs. The % of population working jobs crashed down big in 2020 covid... but it was on the decline before that anyways.

It is just really hard to get people off govt services once they're on them, and those people also statistically have the most kids.
You end up with the same pool of money to take care of more and more people. The crowd of something-for-nothing grows.
We all get asked monthly, or even weekly, by patients "can I apply for disability," usually for nonsense like TMA or calc fx. It's lame.

"A nation is born stoic and dies epicurean" is the damn truth.

...As much as we like to complain about podiatry, it's smashing MDs also with annual cutting or stagnating MCR rates ( -2.8% this year).
The family docs, peds, nephros, endos, etc are sure not happy either. It has hit minimal/non procedure specialties hardest.
I don't even know if it matters much what MCA is supposed to pay as it pays so slow and rejects so much anyways. But MCR hurts.
It is worth noting podiatry gets less from private payers fee schedules vs MD/DO, due to saturation... we get less for same CPT than derm, ortho, rheum, etc. We should open some more pod schools?
 
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The socialized medicine is basically happening in USA also, but it's just not official. Death by 1000 razor blades.
The percentage of ppl with MCR + MCA has risen in nearly every state. It's not the growing seniors like APMA touts... simply lower %s of the populations work jobs. The % of population working jobs crashed down big in 2020 covid... but it was on the decline before that anyways.

It is just really hard to get people off govt services once they're on them, and those people also statistically have the most kids.
You end up with the same pool of money to take care of more and more people. The crowd of something-for-nothing grows.
We all get asked monthly, or even weekly, by patients "can I apply for disability," usually for nonsense like TMA or calc fx. It's lame.

"A nation is born stoic and dies epicurean" is the damn truth.

...As much as we like to complain about podiatry, it's smashing MDs also with annual cutting or stagnating MCR rates ( -2.8% this year).
The family docs, peds, nephros, endos, etc are sure not happy either. It has hit minimal/non procedure specialties hardest.
I don't even know if it matters much what MCA is supposed to pay as it pays so slow and rejects so much anyways. But MCR hurts.
It is worth noting podiatry gets less from private payers fee schedules vs MD/DO, due to saturation... we get less for same CPT than derm, ortho, rheum, etc. We should open some more pod schools?
Yes, I feel like opening more schools is definitely the answer. Houston has incredible traffic they're getting ready to spend a ton of money to widen the roads AGAIN. I am sure that will solve the problem though just one more Lane...
 
The smartest thing - by far - to do in Canada as a DPM would be to go with fully cash pay PP (completely cash pay... don't even take govt healthcare crap insurance for anything... set your own prices top to bottom). As is, it's a pretty bad place to practice - unless you really do like the area and want to retire/citizen/etc there. Like any socialized med country, there are just far too few working people paying for the health care (and general welfare) of the non-working/disabled/retired/sick/old/poor/etc etc. Reimbursements will accordingly be lame... and getting worse.

Some patients would go for cash pay podiatry, but most won't. Most people are pigheaded and want to use "their" govt insurance (aka tax $ of others) or employer insurance no matter the wait or the quality of care or if they have plenty of money. Dent or plastics or derm could do this and kill it very quickly after opening... unlikely for podiatry. It'd take a looong time to get going, and you'd have to give superior outcomes and superior quality of pt experience versus the govt hospital or chummy PPs taking the govt and other insurances, but you could gain a rep for being outstanding and make bank in the long game - if you're good.

Minor problems:
Hospitals/surg centers would likely cockblock you for going against the grain.
PCPs and other pods and most docs who play the socialized med insurance game may try to black eye you for being greedy.
City/area might not like your biz model and try to block you by not letting you advertise or taxing you hard or etc.

Major problem:
Canada is not a great place weather-wise for 80% of the year.
Exchange rate of CAD is bad (vs US, the markets where you'd want to put your $ made)... really bad right now.
Canada housing (and almost certainly commercial rent) is super high.
Most of podiatry in Canada is PP. It's the norm.

Alberta is the only province that has some of podiatry covered by the universal health plan. Some DPMs just choose to not take any PP. Most do both. The government will pay you a fee, but you have the choice to charge the patient direct for over and above. Patient's are used to paying out of pocket.

Hospital/Surg centres don't care about cash pay. They would not block you. The surg centre likes private pay -makes them more money.

I hard disagree with the "80%". Winter can be damn cold in some places for sure for a couple of months. But outside of winter, the weather is great.

Exchange rates can be bad for sure. Investing in the US market is not a problem though. The TSX has many ETFs that track US stocks or funds in CAD. You can find the equivalent of Google, NVDA, Tesla etc or invest in the Nasdaq 100 all with CAD.

Housing is expensive in the major cities, but outside of those, it's very affordable.
 
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Too liberal of a country which is why they'll fail.

Average podiatrist in Alberta makes no where near what they make in The USA. Plus the taxes are beyond anything we have here. I went to the supposed "best city in Canada", Toronto and it was just a bunch of migrants. Incredibly unsafe place to live and visit to be honest. I can't imagine the rest of the country would be safe or nice. Why would we take less money, pay higher taxes and live in a unsafe place...
Ya, Alberta is NOT liberal.

Not sure where your getting that AB Pods make so much less than in the US. From what I have read and heard, it's the opposite. I see numbers thrown around under 200k all the time for the US.

Most pods here will make 200-300k their first year here. It only goes up after that.
 
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The salaried folks in the government/public facilities are most likely underpaid.
I'm not so sure. When they are in the wound centre, which is often. They will see around 50 patients a day. The government with pay them around $110 per patient. That's with ZERO overhead.

PCPs and some other specialists definitely get paid less, yes.
 
I'm not so sure. When they are in the wound centre, which is often. They will see around 50 patients a day. The government with pay them around $110 per patient. That's with ZERO overhead.

PCPs and some other specialists definitely get paid less, yes.

Just googled it.

Family med earns 287k CAD, specialist 370k CAD and surgeons 487k CAD. After taxes in Alberta a surgeon is only making 288k take home. That's awful considering the amount of work they do. There is a reason the country and health care are falling apart. Patient's have worse outcomes because their doctors are overworked and underpaid.
 
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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.
  • Private Clinics
  • Public Clinics
  • Hybrid Clinics
Private clinics cover the majority of podiatrists in Alberta. These doctors will bill off of the Podiatry Schedule only for AHC, everything else is cash pay. For example, a new patient coming in with chief complaint of heel pain, will likely be charged a co-pay (usually between $80-$120), the doctor will then bill AHC for the encounter ($45 if they were referred or $38 if they self referred). The patient will also likely end up with orthotics if they already do not have them (around $600). If you happen to have an x-ray machine, you can bill both AHC ($55 for both feet/ankles) and the patient ($40-$80) for x-rays. Everything above AHC billing is billed directly to the patient who pays at the clinic. The patient will then be reimbursed by their 3rd party insurance company.

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
Hope this helps!

Didn’t read any of this. This is nothing more than a clever way of recruiting new associates to pay for your mustache wax.

This is a Canadian mustache pod attack. It’s gone international!
 
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Just googled it.

Family med earns 287k CAD, specialist 370k CAD and surgeons 487k CAD. After taxes in Alberta a surgeon is only making 288k take home. That's awful considering the amount of work they do. There is a reason the country and health care are falling apart. Patient's have worse outcomes because their doctors are overworked and underpaid.
Yeah Google sounds accurate. Just like the Podiatry data.
 
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