Question about nursing home job offer

[podiatryrookie]

Hi there, I was offered 45% of collections for a nursing home part time position? Is this the normal going rate?

Thanks

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[dtrack22]

That’s pretty bad unless they are paying benefits and sending a medical assistant with you.

 

[HardRoadPaved]

55% overhead?.... wonder if a DPM is running this gig.

 

[619]

Except if you are your own boss and own your practice and also directly own the nursing home contract, you will not get anything better than 45%-50% of collections. 40% of collections is the typical starting rate.

The big podiatry nursing home companies (Preferred Podiatry Group, 360 care, etc all start you out at 40% or $500 minimum per day, whichever is greater). They do provide you an MA, instruments, laptops etc. You work as a 1099 independent contractor, no benefits. Least I forget, they deduct your malpractice insurance (that you are required to get from them) monthly from your paycheck.

 

[NobodyDPM]

Except if you are your own boss and own your practice and also directly own the nursing home contract, you will not get anything better than 45%-50% of collections. 40% of collections is the typical starting rate.

The big podiatry nursing home companies (Preferred Podiatry Group, 360 care, etc all start you out at 40% or $500 minimum per day, whichever is greater). They do provide you an MA, instruments, laptops etc. You work as a 1099 independent contractor, no benefits. Least I forget, they deduct your malpractice insurance (that you are required to get from them) monthly from your paycheck.

Bolded mine.

I was involved in a court case about this, and the judge concluded that a private doctor can't "own" a nursing home contract. A lot of times this can be "included" in the sale of a practice, and there is no way to enforce this at all. In fact, most of the time, it doesn't happen. The doctor selling the practice can vouch for the new doctor, but the Nursing Home is under no obligation whatsoever to have the new doctor come in. Unless you actually work for the company that owns/runs the Nursing Home, this fallacy about Podiatrists being able to transfer care of a nursing home to another Podiatrists is BS. It is always the choice of the Nursing Home owners.

 

[Feli]

I would say it depends if it's a stop-gap and you don't care much for NH work or if you find it ok and might do it awhile (I leave out finding it "awesome" as I know zero people who do). Unless you view it as a long term thing/career gig, you'd likely be better off going with set $ amount per pt visit or per day. That gets you more money up front, makes trust with employer and their billing/collection a non-issue, and eliminates a lot of hassles when you exit.

Supposing you do the gig for 6mo or 12mo or something to fill a temp job gap or start your solo office, it might be tough getting the actual % of collections in the trailing months after you leave the company. As was said, 50% or more should be the goal... and having an assistant, possibly driver if many NH locations. The overhead on nursing homes or house calls is very low compared to typical office-based clinic. It's usually as simple as just finding the NH contracts and paying for or doing the billing, very little supplies and very little physical office rent/util (which is why most DPMs just do it themself). House calls needs driver+vehicle obviously - or makes DPM drive themselves, but bills better codes to offset that.

Except if you are your own boss and own your practice and also directly own the nursing home contract, you will not get anything better than 45%-50% of collections. 40% of collections is the typical starting rate.

The big podiatry nursing home companies (Preferred Podiatry Group, 360 care, etc all start you out at 40% or $500 minimum per day, whichever is greater). They do provide you an MA, instruments, laptops etc. You work as a 1099 independent contractor, no benefits. Least I forget, they deduct your malpractice insurance (that you are required to get from them) monthly from your paycheck.

I think I would honestly rather start my own lawn n' leaf service and live in a van down by the river?

 

[heybrother]

So - no interest in NHs for a lot of reasons - but question. All of the nursing home billing you perform is "in facility rate" isn't it?

So for example - in my area 11056 pays about ~$79 in office while in facility rate is $22.

Am I missing something/incorrect?

 

[619]

Bolded mine.

I was involved in a court case about this, and the judge concluded that a private doctor can't "own" a nursing home contract. A lot of times this can be "included" in the sale of a practice, and there is no way to enforce this at all. In fact, most of the time, it doesn't happen. The doctor selling the practice can vouch for the new doctor, but the Nursing Home is under no obligation whatsoever to have the new doctor come in. Unless you actually work for the company that owns/runs the Nursing Home, this fallacy about Podiatrists being able to transfer care of a nursing home to another Podiatrists is BS. It is always the choice of the Nursing Home owners.

By "own the nursing home contract", I meant direct contract with the nursing home without a middle man. You bill and collect your money 100% without anyone taking a dime. I did not imply you can own the contract and later sell it. Some nursing homes even have various pods coming through to see their patients. There is no monopoly anymore.

In this day and age, I don't think many pods are lining up to take over a nursing home contract let alone purchase it. Funny how the only constant pod jobs out there always advertising with so called sign-on bonus is nursing home gigs.

 

[heybrother]

By "own the nursing home contract", I meant direct contract with the nursing home without a middle man. You bill and collect your money 100% without anyone taking a dime. I did not imply you can own the contract and later sell it. Some nursing homes even have various pods coming through to see their patients. There is no monopoly anymore.

In this day and age, I don't think many pods are lining up to take over a nursing home contract let alone purchase it. Funny how the only constant pod jobs out there always advertising with so called sign-on bonus is nursing home gigs.

I think both your posts had merit. This isn't something talked about enough but people do regularly talking about "ownership" when having a contractual relationship would be a better explanation.

 

[NobodyDPM]

By "own the nursing home contract", I meant direct contract with the nursing home without a middle man. You bill and collect your money 100% without anyone taking a dime. I did not imply you can own the contract and later sell it. Some nursing homes even have various pods coming through to see their patients. There is no monopoly anymore.

In this day and age, I don't think many pods are lining up to take over a nursing home contract let alone purchase it. Funny how the only constant pod jobs out there always advertising with so called sign-on bonus is nursing home gigs.

I understood what you meant. That being said, many older podiatrists will erroneously say that they "own the contract" to get into Nursing Home XYZ. This is to entice younger Podiatrists to purchase, and at a higher price, since that's included in the "gross" collections. And yes, there are plenty of Pods who are looking to take over nursing homes the moment they smell blood in that regard. It's easy money and doesn't cost them anything.

Example being, if they make $50K a year out of nursing homes, they "guarantee" that income as stable, as the seller. Which they can't. And it bites the purchaser in the ass. Every time.

 

[NobodyDPM]

I think both your posts had merit. This isn't something talked about enough but people do regularly talking about "ownership" when having a contractual relationship would be a better explanation.

I've been doing nursing homes to a degree my whole career, and those "contracts" with Nursing Homes are worthless. Many I've worked won't even do that because they don't want to deal with the red tape associated. All they really need is your license and malpractice info. Otherwise, these "contracts" mean nothing. With those large companies that send doctors to nursing homes it's different. And those are usually contracts negotiated nationally. Not just one doctor to one facility. One whole organization with a huge number of facilities where the organization promises coverage.

 

[619]

I've been doing nursing homes to a degree my whole career,

I am sure you are keeping 100% of your collection that is why nursing home is worth it.

But going through a company or being an associate doing nursing home visit is back breaking. OP is getting 45% of collections which is on the high end. We should remember that If OP was an associate working for another pod, OP typical contract will be 20%-30% of collection for the same nursing home visit.

 

[GreenHousePub]

Hi there, I was offered 45% of collections for a nursing home part time position? Is this the normal going rate?

Thanks

Have you tried just calling the nursing home and say you'll do it cheaper than the other guy?

 

[Feli]

Have you tried just calling the nursing home and say you'll do it cheaper than the other guy?

The most time-tested and proven of all TFP early retirement pearls right there

 

[dtrack22]

We should remember that If OP was an associate working for another pod, OP typical contract will be 20%-30% of collection for the same nursing home visit.

But that would also theoretically include benefits. Of course we know that benefits in a podiatry group aren’t actually worth the difference. If we pretend they provide healthcare and all association and licensing fees and malpractice and 401k match and paid CME and the other things basically any other medical group would offer (even small groups from other specialities like OB or Derm or Ortho)…never mind that’s a waste of everyone’s time. Sorry.

Nursing homes are awful work even if you’re getting 100% of collections. Nails pay in the $20 range. None of them walk, there are no calluses to trim. Even if you make up calluses it might be a $40 visit? It takes awhile if you’re by yourself, if you bring an MA you’re paying them to be there and no longer getting 100% of collections. Nursing facilities may or may not schedule/bring patients to you efficiently. Do 4 matrixectomies in an office setting and you’ve collected as much as you would from 30 nursing home patients.

The OP might just have to do what he/she has to do. I’ve done nursing home work as a little 3-4 month bridge between gigs. I’d do it right out of residency to avoid working for another podiatrist for a few months while I continue the job search. But depending on the rest of the details of the job, 45% of collections still isn’t good. I got 50% of what was billed, not collected.

 

[JewOnThis]

Hi there, I was offered 45% of collections for a nursing home part time position? Is this the normal going rate?

Thanks

45% isn’t bad. I would shoot for at least 50% or even 65% assuming there are no benefits. You are part time, 1099?

 

[ExperiencedDPM]

Bolded mine.

I was involved in a court case about this, and the judge concluded that a private doctor can't "own" a nursing home contract. A lot of times this can be "included" in the sale of a practice, and there is no way to enforce this at all. In fact, most of the time, it doesn't happen. The doctor selling the practice can vouch for the new doctor, but the Nursing Home is under no obligation whatsoever to have the new doctor come in. Unless you actually work for the company that owns/runs the Nursing Home, this fallacy about Podiatrists being able to transfer care of a nursing home to another Podiatrists is BS. It is always the choice of the Nursing Home owners.

Exactly.

 

[ExperiencedDPM]

I would personally rather work in a factory putting erasers on #2 pencils than clip nails in a nursing home.

4 years of college, 4 years of pod med school, at least 3 years of residency, to go bed to bed and cut toenails.

The same thing the untrained assistant is doing for the patient’s fingernails.

Sometimes it’s not all about the money.

 

[Pronation]

I would personally rather work in a factory putting erasers on #2 pencils than clip nails in a nursing home.

4 years of college, 4 years of pod med school, at least 3 years of residency, to go bed to bed and cut toenails.

The same thing the untrained assistant is doing for the patient’s fingernails.

Sometimes it’s not all about the money.

Could not agree more. Good riddance.

 

[619]

The same thing the untrained assistant is doing for the patient’s fingernails.

Will be hilarious to see a Hand Surgeon clip fingernails even in their private clinic let alone at a nursing home.

Funny how diabetic patients demand to have their toenails cut but will never dare request that from a Hand surgeon. Even your local PCP will not call to put a nail clipping patient on a Hand surgeon clinic schedule.

 

[NobodyDPM]

Will be hilarious to see a Hand Surgeon clip fingernails even in their private clinic let alone at a nursing home.

Funny how diabetic patients demand to have their toenails cut but will never dare request that from a Hand surgeon. Even your local PCP will not call to put a nail clipping patient on a Hand surgeon clinic schedule.

I'm not aware of diabetics losing their hands because their fingernails are cutting into their hands...

 

[dtrack22]

I'm not aware of diabetics losing their hands because their fingernails are cutting into their hands...

That doesn’t change the fact that a nurse could be cutting toenails. I’ve worked in two offices where medical assistants did most of the nail cutting. I’m sure that’s not rare. The patient demands to have their toenails cut because it’s a covered service, if it wasn’t many wouldn’t go to a doctors office to have it done and nursing home jobs for podiatrist wouldn’t be a thing. They’d hire a $15 /hr nail tech/MA to do it

 

[NobodyDPM]

That doesn’t change the fact that a nurse could be cutting toenails. I’ve worked in two offices where medical assistants did most of the nail cutting. I’m sure that’s not rare. The patient demands to have their toenails cut because it’s a covered service, if it wasn’t many wouldn’t go to a doctors office to have it done and nursing home jobs for podiatrist wouldn’t be a thing. They’d hire a $15 /hr nail tech/MA to do it

And that doesn't change the fact that diabetics have had parts of their feet amputated because of improper toenail care.

 

[dtrack22]

And that doesn't change the fact that diabetics have had parts of their feet amputated because of improper toenail care.

That’s both incredibly rare and inadequate justification for the pervasive thinking (thanks podiatry) of “only a doctor can cut your toenails.”

I currently have a diabetic who has had more fingers amputated than he has toes, two of which were due to finger paronychia. So why can a nurse, family member, or Korean lady at the mall, still cut his fingernails?

 

[NobodyDPM]

That’s both incredibly rare and inadequate justification for the pervasive thinking (thanks podiatry) of “only a doctor can cut your toenails.”

I currently have a diabetic who has had more fingers amputated than he has toes, two of which were due to finger paronychia. So why can a nurse, family member, or Korean lady at the mall, still cut his fingernails?

Apparently, according to our Government, it is more than adequate justification for the pervasive thinking of our profession. And, as you know, the justification is that you are doing a foot exam at the same time, as a preventative measure. Are you actually disputing this?

 

[nikkisorous]

Apparently, according to our Government, it is more than adequate justification for the pervasive thinking of our profession. And, as you know, the justification is that you are doing a foot exam at the same time, as a preventative measure. Are you actually disputing this?

It's really time to stop putting podiatrists and routine nail clippings in the same sentence. I don't know about y'all's training, but I've never even had a single lecture or "hands on education" when it came to how to cut toenails. I kid you not, years ago at DMU they're just like here do it. So if podiatry students are just being told to do it, so can a MA or a nurse. The flow should be podiatrists examine the patient as a preventative measure, followed by an MA or nurse cutting the toenails. We are not pedicurists, we did not obtain massive student debt to just clip toenails all day. This is one big reason podiatry has a hard time getting parity when viewed by other physicians. What other speciality is literally bent over on the floor cutting nails at times.. give me a break.

 

[NobodyDPM]

It's really time to stop putting podiatrists and routine nail clippings in the same sentence. I don't know about y'all's training, but I've never even had a single lecture or "hands on education" when it came to how to cut toenails. I kid you not, years ago at DMU they're just like here do it. So if podiatry students are just being told to do it, so can a MA or a nurse. The flow should be podiatrists examine the patient as a preventative measure, followed by an MA or nurse cutting the toenails. We are not pedicurists, we did not obtain massive student debt to just clip toenails all day. This is one big reason podiatry has a hard time getting parity when viewed by other physicians. What other speciality is literally bent over on the floor cutting nails at times.. give me a break.

If you aren't prepared to cut toenails for at least part of your day as a practitioner, you picked the wrong profession. And cutting Grandma's toenails is an excellent way to cultivate more patients into your practice.

Sad that some modern day podiatry students can't seem to see the big picture, in their chosen profession. It's also a matter of honoring those before you that made podiatry what it is today. You want to be a big shot surgeon? Good for you. You should have gone into a General Surgery residency out of MD or DO school.

"Parity"? Why do you want "parity"? Ask yourself how that will make your daily practice life better. What will "parity" bring you that you don't already have? "Parity" has been this BS image that has perpetuated since before I was even in podiatry school. What exactly IS "parity" anyway? You want respect? Earn it from your patients. The rest will fall into place.

 

[nikkisorous]

If you aren't prepared to cut toenails for at least part of your day as a practitioner, you picked the wrong profession. And cutting Grandma's toenails is an excellent way to cultivate more patients into your practice.

Sad that some modern day podiatry students can't seem to see the big picture, in their chosen profession. It's also a matter of honoring those before you that made podiatry what it is today. You want to be a big shot surgeon? Good for you. You should have gone into a General Surgery residency out of MD or DO school.

"Parity"? Why do you want "parity"? Ask yourself how that will make your daily practice life better. What will "parity" bring you that you don't already have? "Parity" has been this BS image that has perpetuated since before I was even in podiatry school. What exactly IS "parity" anyway? You want respect? Earn it from your patients. The rest will fall into place.

One, I'm not a podiatry student. I'm a fellowship trained podiatrist who does not see any nail care. Two, you're welcome to continue your old school train of thought, but if you are are not able to build good rapport with your patients during the clinical encounter and believe its all coming from nail care then *shrug*.

Why is parity important? Let's start with income. Its a tragedy that some new grads consider ridiculously low offers of 75-90k because of "those before me" abusing them for their own financial gain. I've never seen an MD/DO come out of residency making 75k. So, until basic quality of life changes like that are corrected, forgive me if I don't buy into "the rest will fall into place" mentality.

 

[NobodyDPM]

One, I'm not a podiatry student. I'm a fellowship trained podiatrist who does not see any nail care. Two, you're welcome to continue your old school train of thought, but if you are are not able to build good rapport with your patients during the clinical encounter and believe its all coming from nail care then *shrug*.

Why is parity important? Let's start with income. Its a tragedy that some new grads consider ridiculously low offers of 75-90k because of "those before me" abusing them for their own financial gain. I've never seen an MD/DO come out of residency making 75k. So, until basic quality of life changes like that are corrected, forgive me if I don't buy into "the rest will fall into place" mentality.

Good for you. I encourage you to read what you wrote and think on it a bit. What you wrote about good rapport makes no sense at all with a little thought. I can almost guarantee that once you've been in practice for 20 years, you will have cut some toenails. And if you don't, you are the extreme exception. A control group of one is meaningless.

If you feel you can increase the pay for your eventual need for an associate, then by all means, pay more. Whether we have "parity" or not has nothing to do with reimbursement and everything to do with practice management.

If you are employed in a hospital position or work for an Ortho group, I'd be very interested to know how much actual practice management experience you have. Which, based on your comment about nail care, makes me think that's exactly who you are employed by.

 

[nikkisorous]

Good for you. I encourage you to read what you wrote and think on it a bit. What you wrote about good rapport makes no sense at all with a little thought. I can almost guarantee that once you've been in practice for 20 years, you will have cut some toenails. And if you don't, you are the extreme exception. A control group of one is meaningless.

If you feel you can increase the pay for your eventual need for an associate, then by all means, pay more. Whether we have "parity" or not has nothing to do with reimbursement and everything to do with practice management.

If you are employed in a hospital position or work for an Ortho group, I'd be very interested to know how much actual practice management experience you have. Which, based on your comment about nail care, makes me think that's exactly who you are employed by.

It actually makes perfect sense. You mentioned cutting grandma's nails gets more patients through the door. I'm arguing that good rapport with your patients is a better way to cultivate more patients. Word of mouth is by far the best way to grow a practice, and providing excellent compassionate care goes much further than you cutting toenails. The patients will not care if someone else clips them as long as you provided excellent care.

Also to answer your question, I neither work for a hospital position or an ortho group.

IMO parity definitely plays a big role in reimbursement.. if we don't have the same level of respect as our peers, then the ones setting reimbursement rates are not going to give us the same cut. Why is it in some states ultrasound guided injections aren't reimbursed for podaitrists but are for other physicians? Why are other specialities sometimes being paid more for the same procedures? These all have to do with parity.

 

[NobodyDPM]

It actually makes perfect sense. You mentioned cutting grandma's nails gets more patients through the door. I'm arguing that good rapport with your patients is a better way to cultivate more patients. Word of mouth is by far the best way to grow a practice, and providing excellent compassionate care goes much further than you cutting toenails. The patients will not care if someone else clips them as long as you provided excellent care.

Also to answer your question, I neither work for a hospital position or an ortho group.

IMO parity definitely plays a big role in reimbursement.. if we don't have the same level of respect as our peers, then the ones setting reimbursement rates are not going to give us the same cut. Why is it in some states ultrasound guided injections aren't reimbursed for podaitrists but are for other physicians? Why are other specialities sometimes being paid more for the same procedures? These all have to do with parity.

So you're saying you gain more of a rapport with a patient you've seen once for an office visit than for a patient I see every 62 days? Who willingly returns to see me, over a few years? And sends every other family member to me, as well? Ooooookay...

Wow, this again?

Other physicians who are doing US guided injections didn't milk the cow dry and then whine when there was no cow left. Podiatry does this time and time again.

And your question of some specialties getting paid more...well, if you are in a group of 30 doctors, practicing the same specialty, you have some leverage and can negotiate BY CONTRACT for those things. From EACH PAYOR. It is ILLEGAL to do this on a per physician basis. If you have intimate knowledge of one doctor getting paid more for doing a bunion that you, please make it public by sending a letter to both the Federal government and your payors.

This, btw, is where podiatry is seriously behind the 8 ball. We can't get along as a group long enough to force payors to pay us more. I betcha Hal Ornstein's group, Chris Hyer's group and Weil's group have negotiated higher rates than are paid to the individual podiatrist in their area. Strength in numbers, brother.

Seems to me you have very little practice management experience. And talk to me in 20 years about that nail cutting thing.

 

[Boba Foot]

Y’all sound like med residents that think they’re too good to do a guaiac or a PCP who refuses to do a prostate exam.

It’s gross, it ain’t glorious, but it comes with the territory. Get over it, do it, and then bill for it. There are worse things than having to cut a diabetic’s nails.

 

[NobodyDPM]

Y’all sound like med residents that think they’re too good to do a guaiac or a PCP who refuses to do a prostate exam.

It’s gross, it ain’t glorious, but it comes with the territory. Get over it, do it, and then bill for it. There are worse things than having to cut a diabetic’s nails.

That's exactly what it sounds like.

Particularly when they throw out the "Fellowship trained..." No one cares. Are you a good physician and surgeon? That's all anyone cares about. And you can have the best training in the World and still be terrible. Spewing your credentials, especially here, is laughable.

 

[nikkisorous]

That's exactly what it sounds like.

Particularly when they throw out the "Fellowship trained..." No one cares. Are you a good physician and surgeon? That's all anyone cares about. And you can have the best training in the World and still be terrible. Spewing your credentials, especially here, is laughable.

No. I don’t think that makes me better than anyone, I was clarifying that I’m not a student. You on the other hand are clearly throwing your age and experience around to make yourself seem mighty while being extremely condescending. Not worth the energy or time. Have a great day.

 

[NobodyDPM]

No. I don’t think that makes me better than anyone, I was clarifying that I’m not a student. You on the other hand are clearly throwing your age and experience around to make yourself seem mighty while being extremely condescending. Not worth the energy or time. Have a great day.

Only reason I thought you were a student was because it says so in your avatar.

And I have a lot more experience than you do. Yet, you talk to down to me like you are superior. You come across as very aloof, yet don't really have the knowledge to back it up. Your comment about different pay shows that glaringly well.

You'll find that I treat others the way they treat me. You think my condescending demeanor isn't becoming? Look in the mirror. That's how you come across. Fix you, and I'll fix how I respond to you.

 

[nikkisorous]

Only reason I thought you were a student was because it says so in your avatar.

And I have a lot more experience than you do. Yet, you talk to down to me like you are superior. You come across as very aloof, yet don't really have the knowledge to back it up. Your comment about different pay shows that glaringly well.

You'll find that I treat others the way they treat me. You think my condescending demeanor isn't becoming? Look in the mirror. That's how you come across. Fix you, and I'll fix how I respond to you.

Naw, I'm not talking down to anyone. The mentality of asking people to respect podiatry elders simply because they've been around is literally toxic. I don't know if I respect you, because I don't know who I'm talking to behind the computer screen. Students should respect teachers, residents should respect attendings, fellow podiatry colleagues should not be forced to respect someone based off age. Respect should be earned by what you do.

Completely unrelated - but aloof is not the word you were looking for. Not sure how "being distant" has anything to do with knowledge, per your wording.

 

[NobodyDPM]

Naw, I'm not talking down to anyone. The mentality of asking people to respect podiatry elders simply because they've been around is literally toxic. I don't know if I respect you, because I don't know who I'm talking to behind the computer screen. Students should respect teachers, residents should respect attendings, fellow podiatry colleagues should not be forced to respect someone based off age. Respect should be earned by what you do.

Completely unrelated - but aloof is not the word you were looking for. Not sure how "being distant" has anything to do with knowledge, per your wording.

LOL you say this as you're talking down to me. Some introspection is required, and it doesn't seem you have any.

What's "literally" toxic is someone who refuses to accept being told that his behavior needs work. And thinks there's nothing wrong with it.

 

[wakaflocka88]

One, I'm not a podiatry student. I'm a fellowship trained podiatrist who does not see any nail care. Two, you're welcome to continue your old school train of thought, but if you are are not able to build good rapport with your patients during the clinical encounter and believe its all coming from nail care then *shrug*.

Why is parity important? Let's start with income. Its a tragedy that some new grads consider ridiculously low offers of 75-90k because of "those before me" abusing them for their own financial gain. I've never seen an MD/DO come out of residency making 75k. So, until basic quality of life changes like that are corrected, forgive me if I don't buy into "the rest will fall into place" mentality.

I'm in an ortho group and even though PCP's rarely send me diabetic nail stuff - these nail care patients still find me somehow and I still do some in my practice. I will happily take care of it as long as they meet Medicare guidelines for high risk nail care, no problem.

Regarding parity - I let my hard work do the talk. Ortho in my group and in the hospitals/surgery centers I do cases at can also see my work. I don't need to get involved in the politics as I've built a relationship from my work, as other OG posters on here have done so as well - buildign up a practice from scratch and gaining respect from their peers.

 

[nikkisorous]

I'm in an ortho group and even though PCP's rarely send me diabetic nail stuff - these nail care patients still find me somehow and I still do some in my practice. I will happily take care of it as long as they meet Medicare guidelines for high risk nail care, no problem.

Regarding parity - I let my hard work do the talk. Ortho in my group and in the hospitals/surgery centers I do cases at can also see my work. I don't need to get involved in the politics as I've built a relationship from my work, as other OG posters on here have done so as well - buildign up a practice from scratch and gaining respect from their peers.

Okay, but you're highlighting the point I've been trying to make. If ALL you did was nail care, you would not be getting the same level of respect that you have built for yourself that the hospitals/surgery centers are seeing. There is nothing wrong with doing nails here or there just as a continuum of care for someone that sought you out, but it should not be the majority of your practice. Not everyone has to be a surgeon, but there is more to podiatry than either nails or surgery. If all podiatrists can't get on this same page, we are just holding each other back. We went to school to treat foot and ankle pathology. Can anyone even recall a SINGLE question they ever took on boards or an in school test that related to routine nail clippings? That is not the focus of our education or training, yet somehow podiatrists over the years have convinced themselves this is what the career has become.

 

[NobodyDPM]

Okay, but you're highlighting the point I've been trying to make. If ALL you did was nail care, you would not be getting the same level of respect that you have built for yourself that the hospitals/surgery centers are seeing. There is nothing wrong with doing nails here or there just as a continuum of care for someone that sought you out, but it should not be the majority of your practice. Not everyone has to be a surgeon, but there is more to podiatry than either nails or surgery. If all podiatrists can't get on this same page, we are just holding each other back. We went to school to treat foot and ankle pathology. Can anyone even recall a SINGLE question they ever took on boards or an in school test that related to routine nail clippings? That is not the focus of our education or training, yet somehow podiatrists over the years have convinced themselves this is what the career has become.

Now you're backpeddling, LOL.

Bolded mine. Where did ANYONE say this? I said, "at least part of your day". And you hopped all over me about it.

 

[nikkisorous]

Now you're backpeddling, LOL.

Bolded mine. Where did ANYONE say this? I said, "at least part of your day". And you hopped all over me about it

I'm not backpedaling at all. Our conversation shifted to a discrepancy about rapport versus cutting toenails to generate business. That is not what my previous comment was about. My previous comment was simply saying that if that is at your door, then obviously you treat it, the patient always comes first, but toenail clippings should not be how we market ourselves or our businesses.

 

[NobodyDPM]

I'm not backpedaling at all. Our conversation shifted to a discrepancy about rapport versus cutting toenails to generate business. That is not what my previous comment was about. My previous comment was simply saying that if that is at your door, then obviously you treat it, the patient always comes first, but that should not be how we market ourselves or our businesses.

Bold mine. And where did anyone say you should?

And why not? It is part of what we do every single day. Why not attract business any way you can?

Again, you are showing just how little practice management experience you have.

 

[nikkisorous]

Bold mine. And where did anyone say you should?

I'm really not sure why you're taking everything so personal. When did I say YOU said any of this? I think its asinine to suggest that we all can't think of at least one podiatrist where essentially all they do is toenail clippings. If you don't, then go to google and search podiatry jobs, and the majority are just nursing home toenail clipping gigs.

With that being said, something you did say, is that students that want to focus on surgery should go to medical school and follow a different career path. One of the beautiful things about our profession is you can really forge your own future. If you want to be surgical, more power to you, if you never want to step foot in an OR, also more power to you. My opinion on nail clippings is staying the same though. We all worked way too hard to constantly be featured on a never ending joke that podiatrists aren't real doctors, we just give pedicures.

 

[NobodyDPM]

I'm really not sure why you're taking everything so personal. When did I say YOU said any of this? I think its asinine to suggest that we all can't think of at least one podiatrist where essentially all they do is toenail clippings. If you don't, then go to google and search podiatry jobs, and the majority are just nursing home toenail clipping gigs.

With that being said, something you did say, is that students that want to focus on surgery should go to medical school and follow a different career path. One of the beautiful things about our profession is you can really forge your own future. If you want to be surgical, more power to you, if you never want to step foot in an OR, also more power to you. My opinion on nail clippings is staying the same though. We all worked way too hard to constantly be featured on a never ending joke that podiatrists aren't real doctors, we just give pedicures.

Bold mine.

Why? Because you're crapping on what 90% of us do for at least part of the day. And paying our bills doing it.

And the ones that clipped nails most of their day were the ones that paved the way for you to be a "Fellowship trained podiatrist". That's why.

If you feel that we are a "never ending joke" for helping people, sounds like you've got a bit of a self esteem issue. It is up to YOU to educate people about what we do for our patients. If you're not willing to do that, you're the worst kind of hypocrite.

 

[msuDPM]

I'm no Mod, but seems we can go ahead and lock this one.

Doesn't seem like NobodyDPM or nikkisorus are interested in OPs nursing home offer...

 

[NobodyDPM]

@nikkisorous

I'm curious. What kind of practice do you work in that all you do is surgery and don't cut any nails.

I ask because I know a very intelligent, talented Podiatrist who also mostly does surgery, but he also has other doctors that work for him that do mostly nail care. They are older, so their time of doing the fancy surgeries have passed and they understand that. And the Podiatrist who owns the practice also understands that nail care is not only an important part of what we do, but pays the bills as well. He also understands that many of the surgical patients he sees are family and friends of the nail care patients that refer their family to the practice.

One serves the other.

 

[nikkisorous]

@nikkisorous

I'm curious. What kind of practice do you work in that all you do is surgery and don't cut any nails.

I ask because I know a very intelligent, talented Podiatrist who also mostly does surgery, but he also has other doctors that work for him that do mostly nail care. They are older, so their time of doing the fancy surgeries have passed and they understand that. And the Podiatrist who owns the practice also understands that nail care is not only an important part of what we do, but pays the bills as well. He also understands that many of the surgical patients he sees are family and friends of the nail care patients that refer their family to the practice.

One serves the other.

I never once said all I do is surgery, and that was not the impression I was trying to give off either. I work with a vascular group hired specifically for diabetic limb salvage.

 

[nikkisorous]

I'm no Mod, but seems we can go ahead and lock this one.

Doesn't seem like NobodyDPM or nikkisorus are interested in OPs nursing home offer...

Fair point. We certainly did go off on a tangent. Tbh, I didn't really comment on it because more knowledgable posters gave their opinion on the matter. With what limited knowledge I have with nursing home gigs, I would second the notion that 45% is on the low-average end.

 

[NobodyDPM]

I never once said all I do is surgery, and that was not the impression I was trying to give off either. I work with a vascular group hired specifically for diabetic limb salvage.

Ahhhh, so you work with a vascular group. So rather than hire a Vascular Surgeon to do limb salvage, they hire a Podiatrist, pay him a lot less than a Vascular Surgeon, and get the same service from him.

Now, when they get rid of you for whatever reason in 5 to 10 years, what are you going to do? You won't have a clue about running a practice and won't have real World experience cultivating your own practice. Maybe only then will you realize the value of what nail care has to offer. Are you getting the diversity of cases necessary for Board Certification?

 

[nikkisorous]

Ahhhh, so you work with a vascular group. So rather than hire a Vascular Surgeon to do limb salvage, they hire a Podiatrist, pay him a lot less than a Vascular Surgeon, and get the same service from him.

Now, when they get rid of you for whatever reason in 5 to 10 years, what are you going to do? You won't have a clue about running a practice and won't have real World experience cultivating your own practice. Maybe only then will you realize the value of what nail care has to offer. Are you getting the diversity of cases necessary for Board Certification?

This is my final reply, as we have been rightfully called out for polluting this post with banter.

1) While I won't share specific numbers, my salary + benefits package has me satisfied. I may not be making 500k+ like some vascular surgeons, but I do quite well for myself, I will leave it at that.

2) Vascular surgeons do not do Charcot reconstruction, that is a big part of what I do here. The other big part being skin flaps.

3) What am I going to do if they end up getting rid of me? Thankfully there are ample books, coding seminars, and plenty other opportunities to learn how to do your own billing if I decide to go that route. People don't magically wake up one day and learn how to bill, the same way you learned, I will learn too. One of the things I sought out when choosing a fellowship was practice management, I am not walking into any situation completely blind sighted and ignorant.

4) Yes, I am getting plenty of cases for board certification. I am not getting much elective forefoot from where I'm at, but I have one day a week where local podiatrists refer cases to me to meet diversity criteria.