Podiatry in general

[acej]

I'm looking at my options and podiatry def. falls into one of my categories for something to pursue if I don't go the medical school route..

But I wanted to know where do podiatrists usually go after residency? In private practices? In hospitals? If in hospitals doing what? Would they be considered orthopedic surgeons? Also, do you have different branches of podiatry?

The one thing that confuses me is that podiatrists usually spend 7 years in school compared to regular doctors yet do not get the same credit even though the cirriculum's are the same.

I read a few articles where podiatrists were complaining that they could not get accepted by insurance companies, podiatry field was dead, etc.. is this still true?

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[Northerner]

Would they be considered orthopedic surgeons?

No. Orthopedic surgery is an MD/DO specialty.

The one thing that confuses me is that podiatrists usually spend 7 years in school compared to regular doctors yet do not get the same credit even though the cirriculum's are the same.

First off, the "cirriculum's" are not the same. Second, podiatry school is 4 years, as is medical school. Both require a bachelor's degree. Both require post-graduate training (residency). I'm not sure what you mean by "same credit". A DPM is a medical degree that allows you to practice podiatry. If you want something else, get different training.

 

[SportDPM]

First of all, the field of podiatry is NOT dead! Diabetes is on a dramatic rise in this country along with the growth of older individuals who want to stay active. Both of these factors along with many others contribute to podiatry being a long term occupation. Secondly, podiatrist's can pursue either option you mentioned above. They can work in hospitals, in orthopedic groups, or in podiatry groups along with other options. You are right that podiatrist's don't get the same credit for doing the same procedure and that is changing through out the u.s. For example, in the city of Des Moines DPM's can now admit their own patients and thus are considered physicians. On most insurances podiatrist's do get paid less for the same procedure. This is usually because of how they were perceived before they were required to do surgical residencies. With in a couple years most 2 year residencies will dropped or changed to 3 year ones. Hopefully, this helps you out!

 

[jonwill]

But I wanted to know where do podiatrists usually go after residency?

Private practice, hospital, multispecialty, or ortho groups generally. As Northerner said, pod school is four years and then pods generally do a 3 year residency (some still do two but the majority now do three).

 

[jonwill]

For example, in the city of Des Moines DPM's can now admit their own patients and thus are considered physicians.

Yes and no. Many hospitals throughout the country allow pods to admit. This is nothing new. Des Moines was a bit behind in this department. However, pods generally only use admitting privileges for trauma and pain control on healthy patients. When a healthy person has an ankle fx, calc fx, achilles rupture, etc, we'll admit the patient, do the surgery, and they are generally gone in a few days. For patients that have multiple co-morbidities, we'll either co-admit with medicine or admit and consult med. Pods generally don't medically manage these patients for liability reasons. But this is something you will see across the board with many specialties. Internists are good at what they do and are well utilized.

Now I know there are exceptions to the rule and in Des Moines, Broadlawns Medical Center has pods that admit and manage most of their patients. I have seen other hospitals like this as well. But for the most part, in hospitals, pods are treated as a surgical sub-specialty meaning we get them to the OR, do our stuff, and then let IM determine when they are medically stable for discharge.

 

[NatCh]

On most insurances podiatrist's do get paid less for the same procedure

Unless I misunderstand you, I don't think the above is true. Each procedure has a CPT code, and the CPT does not take into account one's degree or specialty. Whether you are a Family Practitioner, Dermatologist, Orthopedic Surgeon, or Podometrist you bill CPT code 11750 when you do a matricectomy for instance.

You send the CPT code to the insurance company along with how much you charge for it (you get to set your own prices), then the insurance company pays you whatever the heck they want to.

Nat

 

[krabmas]

Unless I misunderstand you, I don't think the above is true. Each procedure has a CPT code, and the CPT does not take into account one's degree or specialty. Whether you are a Family Practitioner, Dermatologist, Orthopedic Surgeon, or Podometrist you bill CPT code 11750 when you do a matricectomy for instance.

You send the CPT code to the insurance company along with how much you charge for it (you get to set your own prices), then the insurance company pays you whatever the heck they want to.

Nat

This depends on the state that you work in and what the state laws are. Not all states have parody. Some actually do pay less to podiatrists and have separate CPT codes for the podiatrist and separate ones for the MDs.

 

[NatCh]

This depends on the state that you work in and what the state laws are. Not all states have parody. Some actually do pay less to podiatrists and have separate CPT codes for the podiatrist and separate ones for the MDs.

Separate codes by law? Seriously? That's unfortunate. Do you know which states?

 

[Northerner]

This depends on the state that you work in and what the state laws are. Not all states have parody. Some actually do pay less to podiatrists and have separate CPT codes for the podiatrist and separate ones for the MDs.

You mean "parity"?

I wouldn't correct it, but it was a particularly funny mistake.

 

[NatCh]

You mean "parity"?

I wouldn't correct it, but it was a particularly funny mistake.

I thought she meant "parrot-ey." As in, not all states have talking birds.

 

[cool_vkb]

Separate codes by law? Seriously? That's unfortunate. Do you know which states?

Yeah i was also searching the medicaid fee schedule for podatrists in wisconsin and illinois and i came acorss other states and they pay very different when that procedure is performed by a pod or a physician.

ex: for CPT code 10061 , state of wisconsin pays the same to a Podiatrist as well as the Physician.

but for the same CPT code 10061, there are some states (i cant remember the name but i saw it yesterday) that they pay differently to a physician and a podiatrist. Infact they have two seperate fee schedule manuals. One for physician where CPT code 10061 pays XYZ and one manual for podiatrist where CPT code 10061 is pays less.

Note: i have no clue what CPT code 10061 even means. i just did research to find schedule. so plzz dont hold me accountable if CPT code 10061 is not even in our scope

 

[NatCh]

Yeah i was also searching the medicaid fee schedule for podatrists in wisconsin and illinois and i came acorss other states and they pay very different when that procedure is performed by a pod or a physician.

ex: for CPT code 10061 , state of wisconsin pays the same to a Podiatrist as well as the Physician.

but for the same CPT code 10061, there are some states (i cant remember the name but i saw it yesterday) that they pay differently to a physician and a podiatrist. Infact they have two seperate fee schedule manuals. One for physician where CPT code 10061 pays XYZ and one manual for podiatrist where CPT code 10061 is pays less.

Note: i have no clue what CPT code 10061 even means. i just did research to find schedule. so plzz dont hold me accountable if CPT code 10061 is not even in our scope

Wow, that could put a damper on one's spirits (and income) couldn't it? I wonder if it carries over strongly to private insurers or only to Medicaid? I just emailed a colleague who practices in Madison, WI to get his input on it. I'll let you all know what he says.

10061 is I&D of abscess, complicated or multiple.

 

[podoc123]

Natch, is this not true for oregon. I shadowed a pod in Salem who said he was paid less than a physician for the same procedures. He also said they were fighting to change it and it should happen soon. Is this true or due you get the same amount in oregon?

 

[cool_vkb]

Wow, that could put a damper on one's spirits (and income) couldn't it? I wonder if it carries over strongly to private insurers or only to Medicaid? I just emailed a colleague who practices in Madison, WI to get his input on it. I'll let you all know what he says.

10061 is I&D of abscess, complicated or multiple.

yeah thats really bad. but then i thought may be it has to do with malpractice. i mean you know i heard in SDN forum that some states have ridiculously high malpractice and other states have very low malpractice for pods. so may be since we have low malpractice we get paid less and since physians pay a good amount of income in just paying malpractice may be they get higher paid for procedure so that after paying malpractice and stuff they still will have something left to take home . i dont know its just my theory.

 

[NatCh]

Natch, is this not true for oregon. I shadowed a pod in Salem who said he was paid less than a physician for the same procedures. He also said they were fighting to change it and it should happen soon. Is this true or due you get the same amount in oregon?

It is not true in OR as far as I know. Every DPM uses the same CPT codes as anyone else, and gets reimbursed the same. If it turns out we've all been using the wrong code book and my comfortable income suddenly takes a digger, I'm blaming all you all!

yeah thats really bad. but then i thought may be it has to do with malpractice. i mean you know i heard in SDN forum that some states have ridiculously high malpractice and other states have very low malpractice for pods. so may be since we have low malpractice we get paid less and since physians pay a good amount of income in just paying malpractice may be they get higher paid for procedure so that after paying malpractice and stuff they still will have something left to take home . i dont know its just my theory.

I don't know if they justify it by malpractice rates or not, nor if they should. If the reimbursement rates are for MD's and DO's, that includes those at both the high end of their pay scale and those at the low end. An orthopedic surgeon and a Family Practitioner can both do nail procedures just as we can, but their income and malpractice rates vary greatly. I see where you are coming from with your theory though.

I have a brother-in-law who is an orthopedic surgeon (shoulders, sport med), and I heard him grumbling a couple of years ago about paying some $250,000 per year for malpractice. Cripes! How do you like that? Let' s just say mine is dirt cheap in comparison.

I also just received a reply from the DPM in Wisconsin. He said that if there's a different reimbursement schedule for DPM's then he doesn't know about it. He's been in practice a couple of decades. I think someone should get confirmation on this rumor.

Oregon Medicaid does limit what I can do (and therefore what codes I can use). For example, I can charge an initial office visit but I can not do any procedures unless the patient has an infection or fracture. As far as I know reimbursement is on the same (lousy) scale as everyone else.

Nat

 

[cool_vkb]

I also just received a reply from the DPM in Wisconsin. He said that if there's a different reimbursement schedule for DPM's then he doesn't know about it. He's been in practice a couple of decades. I think someone should get confirmation on this rumor.

Nat

hey regarding wisconsin iam 100% sure, they pay physicians and podiatrists same reimbursements and same codes.

i was saying abt other states which are different in terms of paying physicians and pods.

but as far as wisconsin goes, they pay the same to both MDs and DPMs like Oregon.

 

[NatCh]

hey regarding wisconsin iam 100% sure, they pay physicians and podiatrists same reimbursements and same codes.

i was saying abt other states which are different in terms of paying physicians and pods.

but as far as wisconsin goes, they pay the same to both MDs and DPMs like Oregon.

Which other states?

 

[krabmas]

I thought she meant "parrot-ey." As in, not all states have talking birds.

funny.

thanks for the correction, northerner