Relevancy of PM News

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
BubbaWub said:
You cannot put a price tag on that $.
Click to expand...
You either are great and can generate organic leads from happy customers or get ready to pay for Google Ads to trap those too lazy to research a good doc.
 
1733613006977.png


So much for being "masters" of the foot and ankle if you have to ask this after 4 years of school, 3 years of residency and a Bako fellowship
 
This is why I still do after-hours pus bus cases. If all you see are patients with anxiety about their dystrophic toenails, you turn into someone who gets anxiety about dystrophic toenails and lose perspective about real threats to life and limb
 
dtrack22 said:
Why didn’t you just link the report/disciplinary action?
Click to expand...
Really easy to find. Just copy one paragraph from the post above and drop it in Google and you’ll have your answer in 2 seconds.

Just think of a pompous guy who has a concierge practice on the west coast.
 
What was the last thing he injected that’s crossed out?

Nvm I found the article of discipline. What a *******
 
Last edited by a moderator:
Just connected the dots and found this:

paincur.com

What Is Paincur?

Home What Is Paincur? How It Works Am I a Candidate? FAQ’s Sciatica Pain Sports Injury Relief Back Pain Relief Arthritis Pain About Us Why Choose Paincur?™ Dr. Ivar Roth Request Consultation Your F…
paincur.com paincur.com

Wow...Just Wow.
 
Adam Smasher said:
Just connected the dots and found this:

paincur.com

What Is Paincur?

Home What Is Paincur? How It Works Am I a Candidate? FAQ’s Sciatica Pain Sports Injury Relief Back Pain Relief Arthritis Pain About Us Why Choose Paincur?™ Dr. Ivar Roth Request Consultation Your F…
paincur.com paincur.com

Wow...Just Wow.
Click to expand...
If I wanted to make a parody I couldn’t make it this good
 
ExperiencedDPM said:
Really easy to find. Just copy one paragraph from the post above and drop it in Google and you’ll have your answer in 2 seconds.

Just think of a pompous guy who has a concierge practice on the west coast.
Click to expand...
Those are images and can’t just be copied and pasted. I’m not retyping out a paragraph on my phone. So here’s the link that could have been posted the first time for folks to peruse…

Ivar Roth injecting hands and stuff
 
We're losing sight of the big picture here - everyone, every students, every resident, etc should read the Accusation. Everyone should look at his website and see his contract documents and claims.

When I was growing up my parents used to tell me that you never could tell how much money someone had just by looking at their car. It can all just be an illusion. Dr. big time California concierge success is a relentless self promoter, but in the end he's just another shameful podiatry huckster pushing magic elixirs. The guy couldn't even stay in his lane and respect the scope of practice.

*I will say there is a lesson for legit people though. Cash pay patients still require quality documentation.
 
heybrother said:
We're losing sight of the big picture here - everyone, every students, every resident, etc should read the Accusation. Everyone should look at his website and see his contract documents and claims.

When I was growing up my parents used to tell me that you never could tell how much money someone had just by looking at their car. It can all just be an illusion. Dr. big time California concierge success is a relentless self promoter, but in the end he's just another shameful podiatry huckster pushing magic elixirs. The guy couldn't even stay in his lane and respect the scope of practice.

*I will say there is a lesson for legit people though. Cash pay patients still require quality documentation.
Click to expand...
Sir you may not be ready for the internet then.... Definitely don't check out Instagram.
 
The lawsuit mentions a PainCur XXX...

I'm scared to ask where he administered those injections 😨😨😨
 
paincur.com

Paincur

The groundbreaking approach to treat chronic to acute pain
paincur.com paincur.com

Even the logo is just crazy. That wouldn’t fly in my state where I practice. The word guaranteed wouldn’t be allowed.
 
said doctor posted this in 2013 which is even more funny
 

Attachments

  • IMG_8070.jpeg
    IMG_8070.jpeg
    242.8 KB · Views: 92
HaimFeldman said:
The lawsuit mentions a PainCur XXX...

I'm scared to ask where he administered those injections 😨😨😨
Click to expand...
lol XXX is wild. That’s some gas station energy pill nomenclature
 
heybrother said:
We're losing sight of the big picture here - everyone, every students, every resident, etc should read the Accusation. Everyone should look at his website and see his contract documents and claims.

When I was growing up my parents used to tell me that you never could tell how much money someone had just by looking at their car. It can all just be an illusion. Dr. big time California concierge success is a relentless self promoter, but in the end he's just another shameful podiatry huckster pushing magic elixirs. The guy couldn't even stay in his lane and respect the scope of practice.

*I will say there is a lesson for legit people though. Cash pay patients still require quality documentation.
Click to expand...
I vividly recall him posting on the PM News rag that he has developed a 100% cure for onychomycosis. People challenged him and asked for his magic and he kept stating he will post his results, etc. All smoke and mirrors.

Ethics, morals?
 
ExperiencedDPM said:
I vividly recall him posting on the PM News rag that he has developed a 100% cure for onychomycosis. People challenged him and asked for his magic and he kept stating he will post his results, etc. All smoke and mirrors.

Ethics, morals?
Click to expand...
Desperate people desperately being separated from their money by a salesman in a suit.
 
We should be able to delegate tasks like cutting nails to our staff. Period.

It doesn't take 10 paragraphs of backpatting to say that. It doesn't take a new degree or a new qualification or new standards. We will always be responsible for what happens in our own offices. I don't need to wonder if my "nail nurse" is there that day. I don't need someone I have to pay $25 an hour to - the base service isn't worth anything anyway and the average staffer has become progressively more worthless. There should be no question that we can delegate a task like this as we see fit to a qualified individual.

The thing that is really difficult for me to describe is the way that we are entirely dependent on nailcare and yet it also destroys us. PP docs are dependent on using nails/calluses to generate office-visits, surgery, to generate reasons to bring patients in the door or for more follow-up - all in exchange for a base procedure that is worth $30.

There is no one else in medicine who is dependent or rendering a $30 procedure to their patients. Every visit no matter how trivial elsewhere is a 99212 in truth and probably a 99213 if the doc has ever been to a coding course.
 
heybrother said:
It doesn't take 10 paragraphs of backpatting to say that. It doesn't take a new degree or a new qualification or new standards. We will always be responsible for what happens in our own offices. I don't need to wonder if my "nail nurse" is there that day. I don't need someone I have to pay $25 an hour to - the base service isn't worth anything anyway and the average staffer has become progressively more worthless. There should be no question that we can delegate a task like this as we see fit to a qualified individual.
Click to expand...
I agree, but I've always maintained it's not about podiatry, it's about keeping medicare beneficiaries--aka voters--happy. They want their nails cut, they want them cut by a qualified professional, and they want to pay as little as possible for it. Even barbers need to pass a licensing exam.

I would happily hire a Foot Care Assistant for 50k/year if this person could do routine screenings and nails/calluses with the same level of supervision from me as the PAs in the emergency dept have from the attendings supervising them. Hell, I would go as high as 80k
 
Adam Smasher said:
I agree, but I've always maintained it's not about podiatry, it's about keeping medicare beneficiaries--aka voters--happy. They want their nails cut, they want them cut by a qualified professional, and they want to pay as little as possible for it. Even barbers need to pass a licensing exam.

I would happily hire a Foot Care Assistant for 50k/year if this person could do routine screenings and nails/calluses with the same level of supervision from me as the PAs in the emergency dept have from the attendings supervising them. Hell, I would go as high as 80k
Click to expand...
I don't buy it. The connection between a voter and something being paid for by a government agency is too indirect. Your local congressman has no idea whether nails are paid or are not. Podiatrists were the ones who had this implemented because that's what we did and that's what we wanted and needed.

That said, it doesn't really matter where it came from or who is right or wrong. We are rendering a service where the reimbursement no longer takes into account the level of effort or the expectation of the service we must render. It probably never did, but the continuous deterioration in reimbursement has accentuated the issue. I think the nail nurse thing would massively blow up in your face. Unless every patient has calluses you are doubling down on literally the worst part of your practice and massively increasing its cost. Your $80K worker is going to require a matching social security contribution, potentially a 401K, vacation, training/certification because you've created a new bureacratic creature, a health insurance policy that will potentially cost $4-7K. Yes, some of those things apply to every employee, but the heart of medicine is that there's less meat left on the bone each year so we have to control costs. You will essentially have to find a way to fill all those encounters on your own schedule with more lucrative events. You could argue that if I'm against this then shouldn't all associates be money losers, but independent physicians should generate value of their own.

Or you can do my way. The MA making $15-20 an hour looking at her phone cuts some nails. It looks fine. You rub some alcohol on it. She flirts with the patient a little as I leave the room.
 
$30x120 patients/week x 48 weeks = $172,800, so 80k + taxes and benefits is a good deal

And this is a variant on the hospital employed orthoplastic foot and ankle super-surgeon hiring a mid-level to do the rounding. Yeah, they're billing a bunch of 99024s and basically operating at a loss but they free up the actual doctor to render actual medicine.
 
Adam Smasher said:
$30x120 patients/week x 48 weeks = $172,800, so 80k + taxes and benefits is a good deal

And this is a variant on the hospital employed orthoplastic foot and ankle super-surgeon hiring a mid-level to do the rounding. Yeah, they're billing a bunch of 99024s and basically operating at a loss but they free up the actual doctor to render actual medicine.
Click to expand...
You've obviously conservatively made an estimate based on nails without calluses which produces a lot of opportunity for upside in your estimates. I wrote a medium length doomer poster but ultimately decided it was too pessimistic and the subject too hypothetical. I would not argue for more regulation - even with potential upside.

That said - its not comparable to the hospital model because the hospital podiatrist gets a ridiculous organizational fee schedule. Within the last 2 years that rollingstone ABFAS supporter guy posted his collections. When I did the math on his collections vs RVUs his organization was pulling something stupid along the lines of like $170 an RVU. The finances of a hospital and the finances of a physicians office are just non-comparable.
 
I have so much time on my hands I'm not sure what else I would be doing if I didn't do routine nail care. I'm well aware of the surgical volume of podiatrists in my area and it is not that impressive. I find it hard to believe that there are all these surgical cases out there that are not being addressed due to lack of access to a podiatrist because he/she is too busy cutting toenails.

While I would love to have a member of my staff take care of these patients, it isn't because it would free me up to see more complicated patients.
 
Clearly hiring a podiatric mid-level is not going to make sense for all office situations. As for me, I could hire someone in the scenario I described above to do 120 nailcare pts/week and still be busy. There are things out there that are not surgery and not nailcare.

Eventually enough people will figure out the emperor has no clothes and it doesn't take a doctorate to trim nails.
 
Dermato Fight Club said:
... I find it hard to believe that there are all these surgical cases out there that are not being addressed due to lack of access to a podiatrist because he/she is too busy cutting toenails.

While I would love to have a member of my staff take care of these patients, it isn't because it would free me up to see more complicated patients.
Click to expand...
Yes, no pod is going to be doing a lot more triple arthrodesis Achilles tendon rupture visits if they didn't do nail care.
Maybe on planets like podiatry marketing or hospital DPM supersurgon - but not in normal PP office.
It pays the bills, fills the schedule, gives people what they came for... that's what I want.
And I mainly want more fishing and playing basketball... and less nails and Lapidus. Won't get to that with open schedule spots. :=|:-):

heybrother said:
We should be able to delegate tasks like cutting nails to our staff. Period. ...
Click to expand...
I thought we could.
I mean, not wise to delegate invasive stuff unless it's a RN (injects, wounds, etc), but anything else should be fair game for staff (DME, wraps, OTC, edu, vitals, etc). I guess I figured that "illegal to have MAs cut nails" was just dumb pod student student rumors. :bullcrap:

...I do nail care myself - always will - just because it's faster for me to do nail care while MA does the note, cleans instruments, cleans rooms, rooms the next patient, puts out instruments for next. It's my choice. I am faster and better... and they are better than me at other stuff. Even at associate jobs I had where MAs did nails, always I told them not to.

Even in a really busy office (not my style, but they definitely exist), I'm still going to be in the room talking to the patients and doing quick exam anyways, so why not do the RFC while talking to them? Takes 2-5min to do RFC... and it's done well. MAs take twice as long - to do what I usually to re-do anyways. Those old dirtbag docs that don't even go into the room at all for the RFC patients deserve what they get if the MA ever missed a puncture wound, PAD, etc and it ended up in ER.

In my exp, a lot of MAs are skittish about nail care, they'll then make the patient skittish,
many MAs don't like cutting nails, so patients don't like the RFC visit,
MAs might quit if they don't like their job (RFC), and new ones will be even worse at RFC,
it involves sharp instruments and potential for issues you don't want MA stuck with,
or (main reason) the MAs - even better ones - are usually just slow or just not good at nails... but I went to school for it. 🙂

In all seriousness tho, it is a skill for RFC... not a super hard skill, but I'm better/faster at it now than first few years out of training. No decent surg residency does much nail care. It's hard to expect MAs to be fast at nails until years of exp; few of them stay that long (and by then, they're more valuable for other stuff if they do). I doubt a "grad" from cosmo school is A+ at cutting nails when they do their first pedicure shop job? No... and those are mostly easy non-dystrophic nails. I will stick to doing it myself.
 
Adam Smasher said:
$30x120 patients/week x 48 weeks = $172,800, so 80k + taxes and benefits is a good deal

And this is a variant on the hospital employed orthoplastic foot and ankle super-surgeon hiring a mid-level to do the rounding. Yeah, they're billing a bunch of 99024s and basically operating at a loss but they free up the actual doctor to render actual medicine.
Click to expand...
120 patients a week that qualify for nail care? That is a ton more than I’ve ever witnessed at any office.
 
You must log in or register to reply here.

Similar threads

air bud
  • Locked
Best of PM News
Replies
4
Views
1K
DexterMorganSK
DexterMorganSK
K
PM News Annual Survey Net Income
Replies
27
Views
3K
JewOnThis
J
air bud
Breaking: Class of 2030 to begin taking USMLE
Replies
6
Views
1K
Bored Snorlax
Bored Snorlax
Santyl Claus
Making the best of a limited scope clinic?
Replies
39
Views
2K
iridocyclitiss
iridocyclitiss
T
Choosing a EMR/PM for a new practice
Replies
11
Views
4K
heybrother
heybrother
Top