The future of podiatry

[bloxxeeey]

I’m a pod student reading all this….
makes me consider cutting my losses and going to a trade school before I’m in so much debt that I can’t leave.

As a resident, if I could go back I would’ve dropped out anytime and not gone through this. The problem is it’s almost like a Ponzi scheme, the further you go in the more you invest, the more you lose.

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[deleted1149159]

As a resident, if I could go back I would’ve dropped out anytime and not gone through this. The problem is it’s almost like a Ponzi scheme, the further you go in the more you invest, the more you lose.

All of higher education is like this at this point in time. No one is guaranteed anything.

 

[bloxxeeey]

All of higher education is like this at this point in time. No one is guaranteed anything.

I have friends who are PAs/NPs who make more than our attendings working less days a week. Oh don't forget they have benefits and if they want they can move anywhere across the US and get a well paying job. Oh they don't like working one speciality anymore, thank god they have a board exam to do another speciality, oh wait they don't. They can just do it. Well maybe their student loans are more than ours! Nope, it's cheaper too oh and don't forget shorter. Well at the end of the day they don't get to call themselves a doctor, get paid like a resident and have the privilege of paying 300-400k of debt back at a time when interest rates are rising.

 

[deleted1149159]

I have friends who are PAs/NPs who make more than our attendings working less days a week. Oh don't forget they have benefits and if they want they can move anywhere across the US and get a well paying job. Oh they don't like working one speciality anymore, thank god they have a board exam to do another speciality, oh wait they don't. They can just do it. Well maybe their student loans are more than ours! Nope, it's cheaper too oh and don't forget shorter. Well at the end of the day they don't get to call themselves a doctor, get paid like a resident and have the privilege of paying 300-400k of debt back at a time when interest rates are rising.

I mentioned "higher education". Once you go beyond a basic Bachelor degree, all the schools are Ponzi schemes. That's what I meant.

Sounds like you have an option to bail into and pay off your loans more quickly.

 

[newfeet]

Where is podiatry heading in 10 years? 5 years?

In the midst of the bull**** boards, what can practitioners expect in the future?

Multi specialty groups, supergroups , MSO’s , solo practices, hospital based employment (shudder) what’s the best structure to examined and prepare for the future of medicine

What has worked for me has been hospital employed. But hopefully it’s a good mix of all possible employment structures

 

[deleted1149159]

yes podiatry is the worst mistake you can make in your life

Nope. Not finishing high school, not having a job and getting someone, or getting pregnant, before you finish high school are statistically the worst mistakes you can make in your life. All of those things individually and in unison cause about 70% of the why people live in poverty. And trusting your "close friends" is on that short list, too.

Come on people. Stop with the ridiculous hyperbole. If you hate your job so much, do something else. Please. You deserve to be happy, and clearly many people here just aren't. This doomsday stuff is really laughable at this point.

 

[AttackNME]

Nope. Not finishing high school, not having a job and getting someone, or getting pregnant, before you finish high school are statistically the worst mistakes you can make in your life. All of those things individually and in unison cause about 70% of the why people live in poverty. And trusting your "close friends" is on that short list, too.

Come on people. Stop with the ridiculous hyperbole. If you hate your job so much, do something else. Please. You deserve to be happy, and clearly many people here just aren't. This doomsday stuff is really laughable at this point.

Truth be told, my family and I had a medical company in Montreal we started from scratch. We sold the company within ten years, and I used my profit shares in the company to pay off my and my wife's student debt. We also got an inheritance years later which helped with some of our other debt. Without those two helpful situations, I would have had to file for personal bankruptcy for sure.

Don’t know how you’re so positive when you needed to sell a medical company and use your inheritance to pay off the debt that you incurred from podiatry. That sounds terrible to me

 

[deleted1149159]

Don’t know how you’re so positive when you needed to sell a medical company and use your inheritance to pay off the debt that you incurred from podiatry. That sounds terrible to me

It is what it is and it's in the past. It was the path I chose, and I own it. As I said, for me, all I cared about was caring for my family, and making sure they had what every father wants for his children, and every husband wants for his wife. My wife and I made it work. And now that we're completely on the other side of it, we don't really give it much thought. Wefocus on our many blessings. Why be miserable about something you can't change anymore?

I did make some serious mistakes along the way. Things I would have 100% done differently. But I learned from them, didn't make the mistakes again, and here I am. One thing I will say, and not to toot my own horn, but my wife and I always had the courage to make a change when it was needed. Moving half across the USA with three young kids for a new job in a community where we had no ties was terrifying. But it was the right move for us, despite the challenges we faced when we got there. Life is a journey. For better or worse. And now, it's infinitely better than it every was. I am looking forward to the next and possibly final chapter of my career with great anticipation.

Btw, I paid off our loans with the sale of the medical company. My wife had substantial loans from getting her Master's Degree as well. The rest was because of a bad business deal trusting someone I thought was my best friend. It had nothing to do with "podiatry" per se. You know how many industries that happens in? I'd say pretty much all of them.

 

[Shiyuan]

BTW Happy Thanksgiving all!

 

[deleted1149159]

BTW Happy Thanksgiving all!

Happy Thanksgiving, brother!!

 

[DYK343]

As a resident, if I could go back I would’ve dropped out anytime and not gone through this. The problem is it’s almost like a Ponzi scheme, the further you go in the more you invest, the more you lose.

I dont think it's there yet. Maybe the first 1-3 years out of residency it is for many of us but there is good money to be made.

....Until they graduate the 2 new schools. Then its gonna be a $hit show ponzi scheme.

 

[bloxxeeey]

I dont think it's there yet. Maybe the first 1-3 years out of residency it is for many of us but there is good money to be made.

....Until they graduate the 2 new schools. Then its gonna be a $hit show ponzi scheme.

Does it though, it just looks like most people go from private practice to private practice and so many of these jobs are offering between 70-100k. So you jump from practice to practice making in that 70-100k range....

 

[Weirdy]

Does it though, it just looks like most people go from private practice to private practice and so many of these jobs are offering between 70-100k. So you jump from practice to practice making in that 70-100k range....

Anecdotal- know many making much much more than that.

Combination of luck and work. Sometimes more luck than work. Sometimes moving far away/having no geographical constraints.

 

[Feli]

I dont think it's there yet. Maybe the first 1-3 years out of residency it is for many of us but there is good money to be made.

....Until they graduate the 2 new schools. Then its gonna be a $hit show ponzi scheme.

Yes, think there is good value in podiatry. It is not too hard to find a job with good income, good hours, good respect.

The issue is just the fact that one needs to get good training, good luck, good networking, high locations flexibility, etc to attain it. Various stars need to fall into place (aka hard work + good fortune).

In nursing or a lot of gigs, all one needs to do is basically graduate and pass basic boards, and they're in high demand. There is not a ton of undercutting for wages or cutthroat for certain areas. Yeah, if a RN wants to work OB in a super lush suburb or wants CRNA school, they do better knowing somebody or being an honors student... but still many other great jobs regardless.

...people always say, "SDN is not real, it's mostly only well-trained DPMs, most overall actually work 90k PP associate mills." Well, that's simply not the case, and of course the ppl who cared enough to excel in school and match well are who takes the time to post and discuss year after year. You get the occasional complainer or self-interested accounts, but someone who didn't study for boards and will settle for any NYC residency that's left over in scramble is almost never the ppl PMing me to ask training or jobs Q's. In general. It's ppl who look to max their edu+career (and they will).

I agree the new schools will make the market rougher. Strategy is the same as always: work hard, tune out the noise, be easy to work with, build ppl up, get the BEST residency you can, pass all boards you can, keep your eyes open, keep expenses low... esp in training and early attending.

 

[heybrother]

Not the first time I've posted this but - my biggest understated issue for people going forward is deteriorating payor environment. Obviously podiatry has no shortage of other issues - saturation, local "climate", poor associate pay/treatment etc. However, looming underneath it all is future decreasing payment for the same services. Insurance companies don't value - take your pick - our services or physician services in general.

Whenever someone shares with you their PAST experience of happiness and satisfaction - you aren't going to be paid those same contractual rates going forward. Its like the investing expression "past performance is no guarantee of future returns". Their experience is retrospective.

Things I've seen in literally the last 3 years

-Medicare Advantage plans crowding out Medicare with sub-Medicare rates routinely offered
-United aggressively cutting rates to sub-Medicare. UHC is scum but they didn't use to be the worst insurance.
-Pathetic Aetna rates. I just got my 2023 fee schedule - terrible. Sub-Medicare.
-Grandfathered Cigna rates for old providers, new pathetic rates for new providers.

The large payors not named BCBS are essentially driving reimbursement down to crap.

Future associates will take the double whammy of both poor contractual reimbursement from their owner but ultimately poor total reimbursement from insurance providers.

There's a reason private practice doctors are focused on dubious cash practices - they are trying to find anything that is an uncovered service where insurance doesn't set the price.

Meanwhile, guess where prices and staff wages are going.

 

[deleted1149159]

Yes, think there is good value in podiatry. It is not too hard to find a job with good income, good hours, good respect.

The issue is just the fact that one needs to get good training, good luck, good networking, high locations flexibility, etc to attain it. Various stars need to fall into place (aka hard work + good fortune).

In nursing or a lot of gigs, all one needs to do is basically graduate and pass basic boards, and they're in high demand. There is not a ton of undercutting for wages or cutthroat for certain areas. Yeah, if a RN wants to work OB in a super lush suburb or wants CRNA school, they do better knowing somebody or being an honors student... but still many other great jobs regardless.

...people always say, "SDN is not real, it's mostly only well-trained DPMs, most overall actually work 90k PP associate mills." Well, that's simply not the case, and of course the ppl who cared enough to excel in school and match well are who takes the time to post and discuss year after year. You get the occasional complainer or self-interested accounts, but someone who didn't study for boards and will settle for any NYC residency that's left over in scramble is almost never the ppl PMing me to ask training or jobs Q's. In general. It's ppl who look to max their edu+career (and they will).

I agree the new schools will make the market rougher. Strategy is the same as always: work hard, tune out the noise, be easy to work with, build ppl up, get the BEST residency you can, pass all boards you can, keep your eyes open, keep expenses low... esp in training and early attending.

I agree, but this is with everything in life.

When I was much younger, I fancied a career as a professional guitarist. I was playing in clubs, started a band, and a local band asked me to tour with them. The chances that I was going to be a career musician without what you mentioned above were slim to none. Yes, it didn't involve $300K of debt, but the financial risks weren't much less than that. There are literally millions of amazing, talented guitar players out there. Who "makes it" and who doesn't is generally pure, dumb luck. And a lot of work. The people that work the hardest tend to also be the luckiest.

 

[NatCh]

I see everything that is being talked about on SDN unfolding in front of my eyes and I am just sadden and depressed. I don't know what to do anymore. I'm just going through the motion but I'm dead inside. And I'm way too early in my career to feel like this.

Log off of this forum and never come back. I say that with the nicest intent, not malice. Go to some conferences and chat with colleagues in person. I wish you all the best.

 

[MalleableMan]

I’m a pod student reading all this….
makes me consider cutting my losses and going to a trade school before I’m in so much debt that I can’t leave.

I would recommend staying away from this forum if you’re a current student. I couldn’t help but peruse it as a 1st and 2nd year student and it made me absolutely miserable. Thank goodness I had the sense to eventually avoid it and seek out mentors I respected who took me under their wing. I was way happier and did better in school and on my rotations. You don’t know who is talking to you from behind their anonymous avatar in this forum. I promise you probably wouldn’t take their advice if you met them face to face.

 

[deleted1149159]

I would recommend staying away from this forum if you’re a current student. I couldn’t help but peruse it as a 1st and 2nd year student and it made me absolutely miserable. Thank goodness I had the sense to eventually avoid it and seek out mentors I respected who took me under there wing. I was way happier and did better in school and on my rotations. You don’t know who is talking to you from behind their anonymous avatar in this forum. I promise you probably wouldn’t take there advice if you met them face to face.

Nothing I say here, I haven't said to residents and students face to face. It's why I put my name here. Anyone in the areas I've practiced in, and residents I've trained who have gone all over this country, know exactly how I am.

It's what baffles about the TOS saying not to use your real name here. It breeds toxicity to hide behind an avatar. Which, to me, is rather unprofessional. Although I may disagree with @diabeticfootdr, I have great respect for him for being honest and not hiding behind a fictitious name.

 

[deleted1149159]

Log off of this forum and never come back. I say that with the nicest intent, not malice. Go to some conferences and chat with colleagues in person. I wish you all the best.

Why is that? Why can't we endeavor to be more positive and help? Instead of the doomsday naysaying there is here? And I don't mean to lie about how wonderful things are, but at least be real. There is plenty good amongst the bad. But human nature tends to focus on the bad. Be the light. Not the dark.

 

[NatCh]

Why is that? Why can't we endeavor to be more positive and help? Instead of the doomsday naysaying there is here? And I don't mean to lie about how wonderful things are, but at least be real. There is plenty good amongst the bad. But human nature tends to focus on the bad. Be the light. Not the dark.

I've been trying for over 15 years...

 

[deleted1149159]

I've been trying for over 15 years...

I'm here to help you, brother! For real. I would love for this forum to become somewhere our younger colleagues can came to, for real help.

 

[podiatryresident]

I'm here to help you, brother! For real. I would love for this forum to become somewhere our younger colleagues can came to, for real help.

Dear Dr.Ron. Could you please give new resident a guideline how to open the practice from the beginning if you have time ? I really want to know if it's doable or not ? Thank you

 

[thefootfixer]

Dear Dr.Ron. Could you please give new resident a guideline how to open the practice from the beginning if you have time ? I really want to know if it's doable or not ? Thank you

This would be most beneficial

 

[ExperiencedDPM]

ASCs aren't the cash cows they used to be. Not even close.

Not sure I agree with you, as a part owner of two ASCs.

If your surgeons are expecting to use 6,500 instrument sets for their proprietary Lapidus procedures and it’s allowed, of course the ASC takes a beating. Same with crazy priced fixation devices for hammertoes, etc.

Many ASCs aren’t crazy about having pod cases anymore because of all the bells and whistles they like to use in the OR. And some of these new systems also significantly increase OR time. And ASCs need to turn those rooms.

Prior to being an owner, I used to have block time at an ASC. And I am fast in the OR and waste no time. But the eye docs came in and wanted to do cataracts. They knock out a boatload of cases with only an operating microscope and a lens implant.

At our ASC we LOVE the ophthalmologists and pain Mgmt docs. The ophthalmologists knock out a lot of cases and the pain Mgmt docs can book 20 cases a day. They run two rooms and as soon as they leave room one they bounce into room two and so on and so on.

They need a friggin’ syringe and C-arm. No hardware. No sutures. No implants. No amniotic grafts. No wounds. No splints. No casts. No dressings. Just a Band Aid or two.

So when an ASC books its cases with pain Mgmt and cataract cases, it is very profitable since the case volume daily is so high.

 

[ExperiencedDPM]

Dear Dr.Ron. Could you please give new resident a guideline how to open the practice from the beginning if you have time ? I really want to know if it's doable or not ? Thank you

Isn’t it important to first find out if Dr. Ron, me or anyone else on this site HAS opened a practice from scratch?

 

[deleted1149159]

Isn’t it important to first find out if Dr. Ron, me or anyone else on this site HAS opened a practice from scratch?

I have and helped many others do the same. Including helping to start a medical company, which was the first of it's kind in Quebec, and selling it less than ten years later for ten times what it cost to start up.

 

[deleted1149159]

Dear Dr.Ron. Could you please give new resident a guideline how to open the practice from the beginning if you have time ? I really want to know if it's doable or not ? Thank you

This will be the topic of a combined Podcast and Blog with Podiatry Today as a series. Stay tuned.

Yes, it's doable, but getting money to do that from a bank is getting more and more difficult.

 

[msion]

Not the first time I've posted this but - my biggest understated issue for people going forward is deteriorating payor environment.

And the Great Medicaid Expansion in most states coming next year, with the ****ty company called Molina.

 

[heybrother]

And the Great Medicaid Expansion in most states coming next year, with the ****ty company called Molina.

Only 1 PP podiatrist in my town accepts Medicaid. My partner used to ask every once in awhile should we be seeing Medicaid. The state of Texas generously pays $34 to $37 for a 99213. When I see other people's collections I don't think they got there by maximizing their encounters with poorly paying insurance but that is something I'm trying to better understand.

 

[deleted1149159]

Only 1 PP podiatrist in my town accepts Medicaid. My partner used to ask every once in awhile should we be seeing Medicaid. The state of Texas generously pays $34 to $37 for a 99213. When I see other people's collections I don't think they got there by maximizing their encounters with poorly paying insurance but that is something I'm trying to better understand.

In Southern NJ, most Medicaids pay for orthotics. And shoes. Some twice a year. And a casting fee. And an OV. When it comes down to it, taking most Medicaids in South Jersey can be quite profitable. Yes, seeing them for nail care, or OVs and injections may not pay well, but they do also need someone to care for them. I've heard people say that Medicaid doesn't pay well for surgery, but that's an urban legend so more people will decide not to take Medicaid, which means more for those who do. Typical "I want it all" BS ideology.

That also being said, if you don't take Medicaid, it means doing a lot of the hospital and inpatient surgery stuff for free. Especially in certain parts of South Jersey. YMMV.

 

[dtrack22]

I've heard people say that Medicaid doesn't pay well for surgery, but that's an urban legend so more people will decide not to take Medicaid, which means more for those who do.

Is the Medicaid fee schedule 100% of Medicare in much of the northeast? Or are other commercial plans and MA plans sub-Medicare which means Medicaid reimbursements are competitive “relative” to other insurance plans in your area?

Some of this stuff is very regional. TX had what I would now consider poor reimbursements. But that’s because I went to an area where my worst commercial contract was UHC at ~130% of Medicare, the other commercial plans at 180-190% of Medicare. Medicare advantage plans were all 100% of Medicare and Medicaid was something like 76% of Medicare. So Medicaid is far and away the worst reimbursing plan and it isn’t close. In our state Medicaid does not have some different fee schedule for surgery vs e/m, office procedures. So it definitely does not pay well for surgery. Or in clinic.

That also being said, if you don't take Medicaid, it means doing a lot of the hospital and inpatient surgery stuff for free.

I’ve never understood this. Then again, I’ve never seen hospital bylaws that mandate you see every consult. Or don’t have the option to be some sort of courtesy staff where you can get your OR privileges and be allowed to bring cases to the hospital without having any sort of call responsibility. Only Podiatrists have the above mindset. If the hospital wants you to see underfunded and unfunded patients then they should pay you for call. Period. End of story. Of course this requires an area without too many desperate DPMs who will take call for free and accept unfunded patients for free. As long as there are a few you’ll never get the call pay you deserve.

 

[msion]

In Southern NJ, most Medicaids pay for orthotics. And shoes. Some twice a year. And a casting fee. And an OV. When it comes down to it, taking most Medicaids in South Jersey can be quite profitable. Yes, seeing them for nail care, or OVs and injections may not pay well, but they do also need someone to care for them. I've heard people say that Medicaid doesn't pay well for surgery, but that's an urban legend so more people will decide not to take Medicaid, which means more for those who do. Typical "I want it all" BS ideology.

That also being said, if you don't take Medicaid, it means doing a lot of the hospital and inpatient surgery stuff for free. Especially in certain parts of South Jersey. YMMV.

Hmmm... medicaid is highly regional. Here in the great state of California it's like < 30% of Medicare rates. Not worth it.
For hospital stuff I just decline to see them. They can always get Ortho or Plastics to do these cases as they are paid to be on-call. We are volunteers and volunteers need to value their time. Unless some kinda bottom feeder decides to sleep in the ED and volunteer to see all podiatry consults for free, and there's a lot of them outta there.
Two things I learned from my mentor: 1. There is always another patient. Value your time and efforts. 2. Drop the bad contracts. Higher selectivity is correlated with higher quality of life.

 

[deleted1149159]

Is the Medicaid fee schedule 100% of Medicare in much of the northeast? Or are other commercial plans and MA plans sub-Medicare which means Medicaid reimbursements are competitive “relative” to other insurance plans in your area?

Some of this stuff is very regional. TX had what I would now consider poor reimbursements. But that’s because I went to an area where my worst commercial contract was UHC at ~130% of Medicare, the other commercial plans at 180-190% of Medicare. Medicare advantage plans were all 100% of Medicare and Medicaid was something like 76% of Medicare. So Medicaid is far and away the worst reimbursing plan and it isn’t close. In our state Medicaid does not have some different fee schedule for surgery vs e/m, office procedures. So it definitely does not pay well for surgery. Or in clinic.




I’ve never understood this. Then again, I’ve never seen hospital bylaws that mandate you see every consult. Or don’t have the option to be some sort of courtesy staff where you can get your OR privileges and be allowed to bring cases to the hospital without having any sort of call responsibility. Only Podiatrists have the above mindset. If the hospital wants you to see underfunded and unfunded patients then they should pay you for call. Period. End of story. Of course this requires an area without too many desperate DPMs who will take call for free and accept unfunded patients for free. As long as there are a few you’ll never get the call pay you deserve.

LOL, let me get this straight. All we ever do is fight for things like equal ED call, then when we get it, we start picking and choosing what we take? Isn't that something every student asks about for the residencies their looking at? Whether there is ED call and what kind of stuff the residents will get called in for?

Most other surgical specialties don't actually have a choice whether they take ED call or not. General Surgeons have to take call. So do Orthos, Vascular, ENT, Urology, etc. And yes, the hospitals I've worked at mandate ED call. Some specialties do get paid, but only if they can't find a group to work call there.

Are you saying you get called to the ED, ask for what insurance the patient has, then decide whether you're going to accept the call or not? Now I don't understand.

Also, if you get consulted on the floor and turn it down, well...do that enough and the calls will stop coming in altogether.

 

[deleted1149159]

Hmmm... medicaid is highly regional. Here in the great state of California it's like < 30% of Medicare rates. Not worth it.
For hospital stuff I just decline to see them. They can always get Ortho or Plastics to do these cases as they are paid to be on-call. We are volunteers and volunteers need to value their time. Unless some kinda bottom feeder decides to sleep in the ED and volunteer to see all podiatry consults for free, and there's a lot of them outta there.
Two things I learned from my mentor: 1. There is always another patient. Value your time and efforts. 2. Drop the bad contracts. Higher selectivity is correlated with higher quality of life.

Who pays them? Are they hospital employees or private?

Yes, some hospitals pay for their on call when they can't find anyone else to take it otherwise. Some hospitals mandate it. I.e, if you want to operate there, you are required to take call.

It's one thing if you aren't on the plan and don't want to do pro-bono work, but if you are on these plans, it may even break your contract with them if you refuse to care for them.

 

[dtrack22]

LOL, let me get this straight. All we ever do is fight for things like equal ED call, then when we get it, we start picking and choosing what we take? Isn't that something every student asks about for the residencies their looking at? Whether there is ED call and what kind of stuff the residents will get called in for?

You’re all over the place. Your quote that everyone is responding to is below in case you forgot. Yes, we should fight for equal call abilities/privileges. That means getting paid to take call. Your previous message, which is quoted directly below insinuates that you are not being paid to take call. Because if you’re being paid to take call then you aren’t doing free work when seeing Medicaid patients, even when you aren’t a Medicaid provider. That’s the entire point of being paid for call, to make up for those losses you take on unfunded and underfunded patients.

That also being said, if you don't take Medicaid, it means doing a lot of the hospital and inpatient surgery stuff for free.

Are you saying you get called to the ED, ask for what insurance the patient has, then decide whether you're going to accept the call or not?

If you are not a Medicaid provider, and you aren’t getting paid to take call, then yes. You absolutely should refuse to do stuff you aren’t getting paid to do. Ortho is getting paid to be on call and can do an I&D or amp. If the hospital really wants podiatry to take care of underfunded or unfunded patients they can either pay for call, or they can hire their own podiatrist. Pick one. Nobody else should be doing free work just to save a hospital system money.

Who pays them? Are they hospital employees or private?

It doesn’t matter. Every other surgical specialty gets paid to take call wether hospital employed or in private practice.

 

[ExperiencedDPM]

In Southern NJ, most Medicaids pay for orthotics. And shoes. Some twice a year. And a casting fee. And an OV. When it comes down to it, taking most Medicaids in South Jersey can be quite profitable. Yes, seeing them for nail care, or OVs and injections may not pay well, but they do also need someone to care for them. I've heard people say that Medicaid doesn't pay well for surgery, but that's an urban legend so more people will decide not to take Medicaid, which means more for those who do. Typical "I want it all" BS ideology.

That also being said, if you don't take Medicaid, it means doing a lot of the hospital and inpatient surgery stuff for free. Especially in certain parts of South Jersey. YMMV.

In my experience, when insurance pays for shoes, orthoses, etc., it is often abused by many providers.

In your area, what are the criteria for Medicaid to pay for shoes and orthoses. Do they pay for both?

And in your experience, have you seen this abused by peers who stretch the criteria?

 

[thefootfixer]

I'm here to help you, brother! For real. I would love for this forum to become somewhere our younger colleagues can came to, for real help.

For new practices, what strategies do u suggest for finding/retaining initial staff members? What kind of benefits can a start up offer? Seems like it would have to be based on the business loan..without benefits, I feel like it would be hard to find someone to work, unless u pay them higher than normal hourly wage. Would love you thoughts

 

[deleted1149159]

In my experience, when insurance pays for shoes, orthoses, etc., it is often abused by many providers.

In your area, what are the criteria for Medicaid to pay for shoes and orthoses. Do they pay for both?

And in your experience, have you seen this abused by peers who stretch the criteria?

Of course it's abused by our peers. I don't abuse it, and that's all I care about.

In general, they pay if there is a musculoskeletal reason with pain associated. And yes, they pay both. Not all. Some every six months. Some every year or two. Some only peds. It depends on each individual plan.

 

[deleted1149159]

You’re all over the place. Your quote that everyone is responding to is below in case you forgot. Yes, we should fight for equal call abilities/privileges. That means getting paid to take call. Your previous message, which is quoted directly below insinuates that you are not being paid to take call. Because if you’re being paid to take call then you aren’t doing free work when seeing Medicaid patients, even when you aren’t a Medicaid provider. That’s the entire point of being paid for call, to make up for those losses you take on unfunded and underfunded patients.

If you are not a Medicaid provider, and you aren’t getting paid to take call, then yes. You absolutely should refuse to do stuff you aren’t getting paid to do. Ortho is getting paid to be on call and can do an I&D or amp. If the hospital really wants podiatry to take care of underfunded or unfunded patients they can either pay for call, or they can hire their own podiatrist. Pick one. Nobody else should be doing free work just to save a hospital system money.

It doesn’t matter. Every other surgical specialty gets paid to take call wether hospital employed or in private practice.

Ahhhh, I see. So a hospital that sends you a bunch of work, but also will send you something you may have to do for free once in awhile is a no go for you.

Sorry, but I don't see things that way at all. I do plenty of pro-bono stuff because I can. And they need care. I see the patients because that's what they need. And because the people that refer to us are good to us. So we help them handle all the patients they need us to. I couldn't care less about the hospital system and whether they save money or not.

So we should never take call because the practice we work for won't pay us to? Nor the hospital system? And no, not everyone gets paid to take call. You do realize that had your predecessors had this attitude, we likely would have never been able to start seeing patients in the ED at all, right? And you'd still be complaining how no residents get ED patients, for better or worse.

You want your cake and to eat it to. Good for you.

 

[deleted1149159]

For new practices, what strategies do u suggest for finding/retaining initial staff members? What kind of benefits can a start up offer? Seems like it would have to be based on the business loan..without benefits, I feel like it would be hard to find someone to work, unless u pay them higher than normal hourly wage. Would love you thoughts

Treat them well, and pay them better. Assure them they have worth working for you. Make sure they are well trained (by you) for the job you expect them to do, and don't expect them to go "above and beyond". Unless you are willing to pay them more. I encourage everyone to look up "quiet quitting" and the backlash that came about by people who created this phrase. It will also be the subject of a blog.

The days are long gone where you can pay people in breadcrumbs, treat them like crap, and they will still be loyal to you. This is likely the #1 issue in the business world since COVID. People just aren't willing to be abused for no pay anymore. Or same, crap pay, and asked to do more and more because the boss thinks they should. This should have happened a long time ago, but it took a global pandemic to open people's eyes.

 

[msion]

Who pays them? Are they hospital employees or private?

Yes, some hospitals pay for their on call when they can't find anyone else to take it otherwise. Some hospitals mandate it. I.e, if you want to operate there, you are required to take call.

It's one thing if you aren't on the plan and don't want to do pro-bono work, but if you are on these plans, it may even break your contract with them if you refuse to care for them.

I haven't encountered a single Ortho or plastic surgeon being put on the on-call schedule without reimbursement. They may be hospital employees or private practice attendings. It doesn't matter. Most hospitals are community hospitals. The PP attendings decide if we want to take our cases or send patients there.

And yes how it works here is hospitalist will call community podiatrists to see if anyone would see a medicaid patient. Most will say no, and some will say yes. If they can't find anyone then the case will go to Plastics on-call, because their on-call contract makes it mandatory for them to see patients with or without insurance. Again, we are just volunteers and considered a non-essential service.
Even if you are on the plan you are not breaking any contract by refusing to see them. Heck most podiatrists in my area are not accepting new Medicaid patients anyway. These patients were never referred to you in the first place. It's just a patient in the hospital that you may volunteer to see. As simple as that.

The mentality that you have to see every patient even to do pro-bono work to expand your practice or earn a living is what gets us into this mess. Just as enough podiatrists finally gathered around to discuss on-call pay and schedule with the hospital admin, some random podiatrist will always say "But...I will do it for free."

Let's discuss solutions to our problems by not being the problem. Not taking unpaid call is a good first step. Shutting down some schools is a second step. Let these bogus residency directors lose their positions can be the third. And eventually that will bring us quality jobs by changing demand and supply.

 

[ExperiencedDPM]

I haven't encountered a single Ortho or plastic surgeon being put on the on-call schedule without reimbursement. They may be hospital employees or private practice attendings. It doesn't matter. Most hospitals are community hospitals. The PP attendings decide if we want to take our cases or send patients there.

And yes how it works here is hospitalist will call community podiatrists to see if anyone would see a medicaid patient. Most will say no, and some will say yes. If they can't find anyone then the case will go to Plastics on-call, because their on-call contract makes it mandatory for them to see patients with or without insurance. Again, we are just volunteers and considered a non-essential service.
Even if you are on the plan you are not breaking any contract by refusing to see them. Heck most podiatrists in my area are not accepting new Medicaid patients anyway. These patients were never referred to you in the first place. It's just a patient in the hospital that you may volunteer to see. As simple as that.

The mentality that you have to see every patient even to do pro-bono work to expand your practice or earn a living is what gets us into this mess. Just as enough podiatrists finally gathered around to discuss on-call pay and schedule with the hospital admin, some random podiatrist will always say "But...I will do it for free."

100%.

 

[deleted1149159]

I haven't encountered a single Ortho or plastic surgeon being put on the on-call schedule without reimbursement. They may be hospital employees or private practice attendings. It doesn't matter. Most hospitals are community hospitals. The PP attendings decide if we want to take our cases or send patients there.

And yes how it works here is hospitalist will call community podiatrists to see if anyone would see a medicaid patient. Most will say no, and some will say yes. If they can't find anyone then the case will go to Plastics on-call, because their on-call contract makes it mandatory for them to see patients with or without insurance. Again, we are just volunteers and considered a non-essential service.
Even if you are on the plan you are not breaking any contract by refusing to see them. Heck most podiatrists in my area are not accepting new Medicaid patients anyway. These patients were never referred to you in the first place. It's just a patient in the hospital that you may volunteer to see. As simple as that.

The mentality that you have to see every patient even to do pro-bono work to expand your practice or earn a living is what gets us into this mess. Just as enough podiatrists finally gathered around to discuss on-call pay and schedule with the hospital admin, some random podiatrist will always say "But...I will do it for free."

In my neck of the woods, most doctors are not paid to be on call by anyone. They are required to take call if they want to operate out of the hospital system.

And my mentality is what got us into the ED in the first place. I take everyone. Paid and unpaid, because they need care. And I take that very seriously. We are physicians. Our goal is to help people that need our help. Are you actually saying that's a bad thing? YOUR mentality is perhaps why medicine has such a bad rap these days. It isn't about patient care anymore. It's about money. Yet, you probably also complain about how all hospitals care about is their bottom line.

Maybe they call me because I take it all. I don't ask. Yes, I do pro-bono work, but they also send me patients with all other insurances, too. Because they know that if they call me, I'm happy to show up and care for the patient. Period.

 

[msion]

In my neck of the woods, most doctors are not paid to be on call by anyone. They are required to take call if they want to operate out of the hospital system.

And my mentality is what got us into the ED in the first place. I take everyone. Paid and unpaid, because they need care. And I take that very seriously. We are physicians. Our goal is to help people that need our help. Are you actually saying that's a bad thing? YOUR mentality is perhaps why medicine has such a bad rap these days. It isn't about patient care anymore. It's about money. Yet, you probably also complain about how all hospitals care about is their bottom line.

Maybe they call me because I take it all. I don't ask. Yes, I do pro-bono work, but they also send me patients with all other insurances, too. Because they know that if they call me, I'm happy to show up and care for the patient. Period.

It's a good mentality to have when your life is all settled, student loans paid off, and has a good living with grandchildren visiting you on Thanksgiving and Xmas.

It's a complete different world for younger doctors who are now bearing a higher cost of living than ever, later time to start a family than ever, and repaying the student loans. I earn a decent salary but I am not the norm. The norm is $100k jobs and taking free call after work.

And sorry, please get off your moral high horse. Doctors are just service providers in the eyes of hospital systems and insurances, and the MBAs that are behind all this. They are the problems why medicine has such a bad rap.

I am glad you can continue to do pro-bono work for your community. I am happy for you.

 

[deleted1149159]

It's a good mentality to have when your life is all settled, student loans paid off, and has a good living with grandchildren visiting you on Thanksgiving and Xmas.

It's a complete different world for younger doctors who are now bearing a higher cost of living than ever, later time to start a family than ever, and repaying the student loans.

And sorry, please get off your moral high horse. Doctors are just service providers in the eyes of hospital systems and insurances, and the MBAs that are behind all this. They are the problems why medicine has such a bad rap.

I am glad you can continue to do pro-bono work for your community. I am happy for you.

I've had this attitude since the day I walked out of residency. Get off my moral high horse? That's kind of insulting. Helping people because they need it is a moral high horse? I'm sorry for you that all you think about is your wallet when there is a sick patient in the ED requiring your care. Don't worry, though. There are people like me who will see those patients. And eventually see every other ED patient while you refuse to take the patients they call you for because of their insurance status. Then you'll cry how the hospital never calls you anymore. And blame it on some Ortho conspiracy to get at you because you're a lowly DPM.

I don't care how the hospital systems, insurances or MBAs see me. I care how my patients see me. Sorry if that give me the air of being on a moral high horse. To me, patient care is what matters.

 

[msion]

I've had this attitude since the day I walked out of residency. Get off my moral high horse? That's kind of insulting. Helping people because they need it is a moral high horse? I'm sorry for you that all you think about is your wallet when there is a sick patient in the ED requiring your care. Don't worry, though. There are people like me who will see those patients. And eventually see every other ED patient while you refuse to take the patients they call you for because of their insurance status. Then you'll cry how the hospital never calls you anymore. And blame it on some Ortho conspiracy to get at you because you're a lowly DPM.

I don't care how the hospital systems, insurances or MBAs see me. I care how my patients see me. Sorry if that give me the air of being on a moral high horse. To me, patient care is what matters.

I won't cry if hospitals stop calling me, and I work with Orthos pretty well here.
I can earn a pretty good living by just doing in-office procedures/consults with a good payor mix. Hospital work is just extra stuff for me.
I will cry if the medicaid patients that I volunteered to see bring their disability forms over and start yelling at me cuz I couldn't fill them out on the same day, or asking me to prescribe them pain meds.
Been there, done that.

Again, I am not saying these Medicaid patients don't deserve care. But we should be compensated just like Orthos/Plastics to take care of these patients while taking call. If you insist that we should do these for free then I really can't argue with you. You are a good man.

 

[deleted1149159]

You know, maybe this is why I'm so positive and happy despite all the crap over my career. Because to me, patient care is paramount in my profession. If I know I did the best I could for my patients, whether they can pay for it or not, I can sleep at night.

Maybe I'd have made more money if I had done things differently. I can't change that now. Money isn't the only thing. You may want to ask yourself if money is the only thing that drives you. Because if it is, you 100% chose the wrong field. Not just in Podiatry, either. Medicine in general. Most don't get rich being doctors anymore. If you think you will being a Podiatrist, well, the joke's on you.

 

[deleted1149159]

I won't cry if hospitals stop calling me, and I work with Orthos pretty well here.
I can earn a pretty good living by just doing in-office procedures/consults with a good payor mix. Hospital work is just extra stuff for me.
I will cry if the medicaid patients that I volunteered to see bring their disability forms over and start yelling at me cuz I couldn't fill them out on the same day, or asking me to prescribe them pain meds.
Been there, done that.

Good for you. So why are so vehement about this towards what I'm saying? I've clearly touched a nerve. Even though that wasn't my intention at all. So ultimately, if this is how you feel, why so serious?

 

[msion]

Good for you. So why are so vehement about this towards what I'm saying? I've clearly touched a nerve. Even though that wasn't my intention at all. So ultimately, if this is how you feel, why so serious?

Because the tone of your posts reminded me of an older attending asking all residents to trim inpatients' toenails during rounds because "Don't forget, we are podiatrists and we should care about their nails."
Easy thing for him to say, but soul-sucking for the residents. Glad I only externed there and never applied. But I bet Dr. Ron will have a pair of double action nippers ready to care for these patients.
Sorry, I just can't and won't do it.