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Yes, I’ve switched to this construct with better outcomes than foot beaming.
Podiatry Surgery Volume
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Yes, I’ve switched to this construct with better outcomes than foot beaming.
That is a shame you guys have a hard time finding someone who wants to do charcot. I would take them all off your hands.
BeaverBlade
Full Member
Where are you located? I’ll purchase an airline ticket for some patients.
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One of the main contraindications of a TCC is a highly exudative wound. They work good in the correct patient/use.
I have always hated wounds/infections, even in residency, because they are the ones who made me go to the hospital in the middle of the night. It is probably a PTSD effect but I have had few wound patients in PP and I absolutely detest it. They just ruin my mood for the entire day because none of them are getting better and they don't listen. I am trying to find a wound clinic to send them to because I don't wanna deal with that. The owner gave me a hard time saying I am a podiatrist and I should do wounds but to be fair I have tried liking them, but I just can't. Those patients really piss me off. I would much rather treat sports injuries, do orthotics, nail avulsions, etc. all day (except routine).
I’m the opposite. I enjoy wounds and routine. I find that sports med patients are very high maintenance and with AI now it’s even worse. I couldn’t imagine doing the plantar fascia or Achilles speech 20x a day.
Smart patients who think they know more than you are the absolute worst. And that’s generally a lot of MSK athletic patients. Weekend warrior midlife crisis TRT fueled cold plunge maniacs. If you think diabetics are noncompliant wait til you deal with these guys on a regular basis.
Gotta break it up with some quiet time and that’s where routine care and wound debridements come in, that’s the only way I can deal with level 10 black belt cyclist pickleball champions.
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“Are you telling me I can’t roll for the next 3 weeks?”
Why do you hate surgery?
Even though this is my first attending job ever (PP), I am starting to dislike/out-right hate everything with this field. RFC (although I can tolerate this one the most), wounds, sports injuries, elective stuff like bunions hammertoes, hospitals, clinics, all of it lol. I actually enjoyed podiatry in school and training, but not anymore.
I thought being an attending would be better than being a resident, but it's been much much worse. Working similar hours as being a resident when not on call, and wayyyyy more when on-call (compared to residency) cause rounding and inpatient cases all happen at night. Catching up on notes, op notes, etc. every night and morning too. IDK how people enjoy this.
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The secret is to not do any nail Care and only see Ms case stuff or grossly infected wounds that need surgery.
FEW
Not really a choice as an associate in a PP. lol
Grossly infected wounds and MSK stuff are the encounters that take the longest to do, have the longest notes, take time to book the cases, etc.
The nail care visits/notes are much faster.
The key for me has been to not seek fulfillment from podiatry. Podiatry is the thing I do for work. I work so I have money to spend on things that bring joy to my life. No I don't have a private jet (yet) but I have hobbies and eat well and can go to nice restaurants every now and then. But imagine a trash collector saying "I don't find fulfillment from my job." No 💩, it's trash collection, it pays the bills but, from my experience as a trash producer, I think it's still a pretty important job.
Similar to what Adamsmasher said.
Its a job. Its a way to make ends meet, provide my family with a better quality of life.
If I wasn't married with a kid- the prestige and grind would matter more.
There are small wins here and there with genuine patients.
I don't even care about the title or ego anymore- its non existent. I don't see myself as a doctor or surgeon. I'm just me taking care of patients.
Show up. Do good work. Take care of your patients best you can. Go home.
There's more to life than podiatry.
It took me a good 1.5 years to get my head out of that residency Koolaid
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Theres low paying volume. 11721 is hot garbage reimbursement (as least on wRVU - not sure PP). It is only worth it if they have another complaint to justify a 99213.
Or high paying complexity. 99204 is easy to get and pays decently. Especially if you tack on a wound debridement. One 99204 is worth five 11721s.
As above complex stuff is easier handled with support systems hosptials can provide their providers.
Liability too
I second this. I’m fresh out of residency, where I had excellent training at a Level I trauma teaching hospital. I saw a high volume of reconstructive cases and had strong relationships with the orthopedic trauma surgeons, who let us perform cases from skin to skin (I was offered a job by one of the foot and ankle MDs after graduations) also had a great pediatric orthopedics rotation with the same level of hands-on experience.
In my current job, I’m seeing around 70 diabetic patients, many for nail care or wounds, and many who aren’t good surgical candidates for medical or social reasons. I’m having a hard time with the change, and I miss surgery and trauma. At the same time, I have a family. Coming home at 5 p.m. and spending weekends with them reminds me how much I value this schedule. During residency, I worked 100-hour weeks and barely saw my partner. That was hard.
I’m at cross roads, I think Il can make my self happy here. I hope.
Meanwhile in my area of PP land:
a 99204 is paying about $156.
vs
a 11721 and a 11055 combine to about a $100. However, I generally double book most RFC and can copy/paste the note.
The level 4 has a good chance of needing DME, xrays, etc. but the documentation is gonna require a lot more effort.
I find on RFC heavy days, I long for complexity and feel like a glorified pedicurist. When there isn't much RFC, I leave with lots more notes and stress and end up wishing for RFC. I think there's natural tendency for humans to desire the opposite of what it has, so maybe this is normal?
Definitely normal.
This is the basic dilemma of podiatry:
- The easier part of what we do (RFC, DM exams) pays fine and is pretty easy... but a high school kid could do it.
- The ego part (proced, surg) is much more stress and worse per hour (assuming not RVU type), but it satisfies that prestige and being-a-doctor side, which is why
we all99% of us descended from pre-med to podiatry school in the first place. 🙂
I don't hate surgery. I hate amps, wounds and I&Ds and the type of noncompliant patients that come with them. I enjoy most electives and SOME trauma, I can do them all day. Maybe if I was in a hospital setting with a dedicated wound center, nurses, other specialties, I would have liked it a bit more since I have most of the resources. PP, not many resources and frankly, I don't wanna spend more than 20min with a patient trying to apply a TCC.
For routines: I feel like they always have a thousand other complaints. I don't even ask them anymore if there is anything else bothering today because that opens up the flood gates. If you need me to address a separate issue then make a separate appointment.
Doing these in real practice is different than residency because most of the time you did not have to deal with the post op appointments, post op pain, swelling, and other complications not to mention FMLA and other annoying things associated with elective surgery. I changed my tune quite a bit on this once I started practicing on my own. Elective cases tend to cause me more stress than the wound and infection cases, but of course it’s much easier to handle when you work at the hospital they are admitted at.
Why are you leaving E&Ms on the table bro.
Huh? I’m home by 5pm except for 6 days per month where I might be home earlier or late at night based on if the pus bus shows up or not. I do about 8-9 cases per week and average about 450k. I also went to a similar residency as you where we put in long hours day after day. That’s not how it is for non academic hospital employed pods…
Now don’t get me wrong, I felt pretty lame doing a TAR in private practice making 150k knowing the damn rep for that case was making more than me, but I wanted to keep my skills up as I hoped to escape associate private practice hell every single day. It took me over 2 years and hundreds of applications before I finally landed a hospital gig.
Huh? I’m home by 5pm except for 6 days per month where I might be home earlier or late at night based on if the pus bus shows up or not. I do about 8-9 cases per week and average about 450k. I also went to a similar residency as you where we put in long hours day after day. That’s not how it is for non academic hospital employed pods…
Now don’t get me wrong, I felt pretty lame doing a TAR in private practice making 150k knowing the damn rep for that case was making more than me, but I wanted to keep my skills up as I hoped to escape associate private practice hell every single day. It took me over 2 years and hundreds of applications before I finally landed a hospital gig.
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This is the way
Now don’t get me wrong, I felt pretty lame doing a TAR in private practice making 150k knowing the damn rep for that case was making more than me, but I wanted to keep my skills up as I hoped to escape associate private practice hell every single day. It took me over 2 years and hundreds of applications before I finally landed a hospital gig.
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This is the way
630-5 most days.
But I stay until all my notes are done. I could be done earlier. My last clinic patient is 330. I finish notes and see any consults on the floors that came in thru the day.
You uhhhh might be missing 100k+ in income a year.
I only accept patients with diabetes and neuropathy for nail care. If that diagnosis is not in the chart I wont see it.
Because #1 those patients actually need it. #2 they always have something else (becasue 11721 alone is pointless on RVU).
I refuse to see class findings nail care. Pointless. Not even sure why medicare covers this.
Bingo..adding a 25 modifier for a new complaint turns 1 patient visit into 2 patient visits
I walked to work so I leave my house at about 7:52 and I'm there for clinic at 8:00... Maybe I round on a patient so I leave at 740
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I also drive from home to clinic which starts at 8, except for my OR day which starts at 7 but I’m usually done with cases by 4. I literally work less hours per week for 3x as much as I made as an associate. As others have said, we have staff that change our vacs/dressings and fill out all of the FMLA paperwork. Our clinic nurses triage all of the post-op calls and half the time I don’t even have to respond to the in basket message because the nurse has it taken care of.
What happens when the patient wants to “talk to the doctor” in PP I feel this is 90% of my patients calls to the office. Always feel like I gotta do it or get a bad review or lawsuit.
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BeaverBlade
Full Member
Unless they cut that procedure code in half 😢 scary times right now
You and I have a very different clinic dynamic it seems. What you describe is a very rare occurrence. The clinic RN takes care of most issues. Pain med requests get sent as an inbasket message that take a second to sign. Nurse visits get setup for patients who call in (or send MyChart messages) that they bled through their post op splint etc.
There's a big difference between MA and RN
3.6 visits on wrvu (compared to only billing 11721)
11721 0.5 - lame
99213 1.3 - still pretty lame
1.8 = not lame
15 minute drive to work. I get there at 7 most days and do a quick workout at hospital gym before clinic starts at 8. Surgery day starts at 7. Most of the time I’m heading back home by around 4:30 or 5
7am to 3pm on clinic days. 1.5 hour lunch and see 28-30 patients. I use Abridge/Haiku ambient dictation for notes. I just dictate physical exam and sign note.
Most days I’m double booking slots to accommodate urgent referrals. Without AI dictation I can not do this
Most days I’m double booking slots to accommodate urgent referrals. Without AI dictation I can not do this
Pointless !!??!!! Lot money made over utilizing that plus callus or visit…
I ignore their other problems due to time, I am almost always running behind. There are certain HMOs in my area which only has prior auth for strict nails and calluses and that is it. You guys gave me something to think about though.
Sorry, there is no 1-900-SMASHER number that bills 6.99/min. I train my staff to "please convey my regrets that my schedule will not allow for an extended telephone consultation," and elicit a specific, actionable concern to which I can respond, and my assistants can communicate that response. Otherwise their concern is best handled during a [billable] office visit.
…so how do we get the link to the onlyfans?
Yes, class finding nail care is pointless.
Im not a nail salon.
I called that number. They put me on hold to verify insurance and said the wait time was one billable office visit.
Last week a patient not seen yet called our department and wanted his case escalated because I took him off the schedule. No DM. said he called Medicare and they said his nail visits are covered every 2 months. Wasted stupid time with our supervisor to give a reason why I removed patient from schedule
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emergency nails. Triage to the nearest ED for a trimming
I 100% agree with you. I don't look for fulfillment from my work in particular. It's just that time commitment just to get through day-to-day stuff is what is really the crux of the issue. At least the trash collector gets to clock out and turn his/her brain off.
With us, even though clinic's over, then we (or at least I) have a bunch of stuff to catch up on or round or do cases if you're on call.
Patients are scheduled from 8 AM to 4:30 PM. But I get to the clinic ~ 6:30 because I always have notes or DME/surg forms to fill out, and then chart checking the days schedule so that the MAs know who to X-ray and what stuff I need in the rooms and what lab results to upload, etc.
By the time I'm actually done with the last patient, it's about 5-5:10. Catch up on documentation/DME/surg orders as much as I can until about 6-7pm (leave the rest until the next AM).
If on call, it's game over and you can add another 1-4 hours on top of the 6:30am-7pm depending on OR availability. The last time I was on call a few weeks ago, I didn't get home till 10 PM on 3 out of the 7 nights. At least I was able to get my clinic notes/chart check the next mornings schedule done waiting around for the OR's, lol. It seems like all the general surgeons and orthos and ENT, etc., around here bookcases at night too, so it's always backed up unfortunately.
I try to convince myself that these crazy hours are just since everything is still relatively new to me, and within 2 to 3 years, it won't be as bad. Plus, I have a lot of family involved in VC/investment banking who work way worse hours than I do. Granted, they make way more and will be able to retire probably 10-15 years earlier than me, lol.
Maybe I should start doing this. I have been thinking about it, but couldn't bring myself to do it. And I think that's part of what's slowing me down so much and making my documentation take forever. I may start adopting the PCP adage of telling the patients to schedule another appointment if they want to talk about anything other than one or two issues.
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That's right, I forgot you're with that toxic practice that treats n' streets 40 pts/doc/day. I guess the company culture is to write crappy notes, so you may as well follow suit. Remember, as an associate, any malpractice verdicts against you are the employer's liability to pay off, under the doctrine of respondeat superior. So take this opportunity to exercise some real creative license with your charting.
During your call weeks, you need to engage in weaponized incompetence. Next time you are consulted for a gangrene toe, advise the hospitalist that the patient is too medically complex to be within your comfort zone of management and that they need a second opinion or, preferably, transfer to a different hospital.
Hold on, I didn't know this to be true! I thought I was still considered independent practitioner and if my patient sues then it is me who gets sued.
Ok you gave me something to think about. I don't take formal calls but get calls for consults from the next door hospital (all for free btw). I am definitely using this tactic!
My guy, those are CRAZY hours. Those are close to my residency hours but even then, I could come home in between for an hour to decompress because I lived right there. This practice is a recipe for burnout. When I was interviewing I was VERY strict about work/life balance and if it didn't mesh with the interviewer, I didn't proceed with the next steps. My family is extremely important to me, way more than patients (sorry to say). i guess it depends what your goals are, some people love the hustle but I hate it. I am an 8 hours per day kinda person. I am not gonna work beyond that for someone else. Now if it is my practice, I will gladly put in 100 hours a week.
