The future of podiatry

[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

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 would like to think that patient care matters to all of us. There simply isn’t enough money in what we do to just do it for the money. There are too many easier ways to make a buck.

I do not accept Medicaid and have no guilt. I also care about my patients and that is reflected in patient surveys. Accepting Medicaid and doing pro bono work are two different issues.

Our practices used to accept Medicaid. The fees were costing us money and the no-show rate was astounding, despite reaching out to confirm appts.

Those no-show appts took spots away from other patients who needed care. So we decided it just caused too many issues in our offices.

Pro bono is a different story. Our practices never turned down an uninsured patient, etc and did outreaches to care for underserved populations.

The ED thing is realistically a non issue for most. How many times a year to you honestly get called to the ED? Does your hospital have a residency? If it does, that’s the first layer and decreases your time commitment.

I work for free when I decide to work for free. That doesn’t mean when I have ED call I’m going to leave a full schedule of patients to run to the ED for free. It means I get paid for on call and keep my schedule light in case I get called. But there is no way I can cancel 40 or more patients to run to the ER to treat that Medicaid patient who missed 3 appts or ANY patient. If you want me to be on call, you will pay me and I will alter my schedule accordingly.

And again, I’ve done more than my share or pro bono and volunteer work and have never once turned away a patient who couldn’t afford my services.

And I know of no specialty who doesn’t receive remuneration for being on call.

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[619]

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

This has been discussed extensively in previous post. Just a summary, I opened my practice in Oct 2020. With one staff, I had a staff for a year till I added one and added another this year and was also able to get a student part-time. My one staff was and is paid well with benefits (401k, health insurance, paid holidays etc) but then again she ran the entire front office. Check-in, check-out, schedule patients, room patients etc and she also did my billing as she had experience in coding and billing. Was I lucky to find a unicorn? YES.

I also did my hard work at the back end. I started with one staff means I had no MA. I cleaned my room myself, set up procedures etc. If you read my previous post, we had arguments about how I can open a practice with just one staff but that's the world we live in. You have to work hard and you don't need an army of staff to open up shop. The amount I paid my one staff with benefits, I could easily hire 2 staffs with no benefits however you get what you pay for. My original one staff was 100% reliable. she never called in sick once and up till this day she has never missed a day of work (she never used her vacation days so I just paid her for it). She shows up to work every single working day with a smile on her face. Very lovely lady and never a bad day with her. So once again did I find a unicorn? YES.

So back to your initial question. Most people find staff on indeed, zip recruiter etc but the most important you want someone with front office experience. I will pick someone older and reliable. They will want more money but there is a big difference between paying someone $10/hour vs $20/hour. You get what you pay for. My initial staff used to work at a podiatry office so she already knew the drill and I did not have to train her with the front dest task. She was 100% independent from day one. I honestly also didn't know any front desk stuff. I am a doctor and I want to focus on the back. And it's funny how a lot of folks can't function without their MA. If you want to go solo. You must 100% be able to run the back by yourself and not depend on anyone. Same way in the OR, if you have to depend on the scrub tech to set you up for your case then you are not fully competent. If your scrub tech drops down mid case, you should be able to finish your case without panicking.

 

[msion]

I work for free when I decide to work for free. That doesn’t mean when I have ED call I’m going to leave a full schedule of patients to run to the ED for free. It means I get paid for on call and keep my schedule light in case I get called. But there is no way I can cancel 40 or more patients to run to the ER to treat that Medicaid patient who missed 3 appts or ANY patient. If you want me to be on call, you will pay me and I will alter my schedule accordingly.

And again, I’ve done more than my share or pro bono and volunteer work and have never once turned away a patient who couldn’t afford my services.

And I know of no specialty who doesn’t receive remuneration for being on call.

This.
I provided quite a bit of free services for undocumented immigrants here. Ranging from pulling a piece of glass to treat their ingrown toenails.

If enough podiatrists get together we can make paid hospital call a reality. I almost made it happen for $300 per on-call period for a group of 5 community podiatrists in different practices. Not much, but a start. And then 2 podiatrists told the hospital admin just to call them cuz they will do it for free.
That's the problem.

 

[dtrack22]

In my neck of the woods, most doctors are not paid to be on call by anyone.

Even with no knowledge of your practice area, I can guarantee this is not true by any stretch of the imagination. Go ahead and post the ortho group who takes call at a hospital without getting paid. I will call their office and verify and then post an apology.

Who else practices in an area where on call ortho, Gen surg, ENT, OMFS, Urology, etc. are not getting any call pay from the facility? Bueller? Bueller? Oh, nobody?

 

[AttackNME]

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.

What happens to those consults when you’re out of town or on sick leave? Are there other podiatrists in your community who will pick it up when you’re away?

 

[ExperiencedDPM]

Even with no knowledge of your practice area, I can guarantee this is not true by any stretch of the imagination. Go ahead and post the ortho group who takes call at a hospital without getting paid. I will call their office and verify and then post an apology.

Who else practices in an area where on call ortho, Gen surg, ENT, OMFS, Urology, etc. are not getting any call pay from the facility? Bueller? Bueller? Oh, nobody?

Spot on.

 

[619]

If enough podiatrists get together we can make paid hospital call a reality. I almost made it happen for $300 per on-call period. Not much, but a start. And then 2 podiatrists told the hospital admin just to call them cuz they will do it for free.
That's the problem.

We have over 500 podiatrists graduating every year and they are worried about getting their surgery numbers for board certification. So this "problem" is never going to end with 2 new schools opening. Folks jumping over each other for surgery cases even if it is free work so you wonder why the $80k-$100k starting base salary are never going anywhere. The future of podiatry is not bright.

 

[NatCh]

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

Pay them well and treat them well. Employees are definitely looking at the benefits package maybe more so than the base pay rate. Health insurance costs a ****load so they're definitely going to pick the job that offers it over the one that doesn't. I don't know if you can avoid it without expecting a lot of turnover.

 

[wakaflocka88]

This.
I provided quite a bit of free services for undocumented immigrants here. Ranging from pulling a piece of glass to treat their ingrown toenails.

If enough podiatrists get together we can make paid hospital call a reality. I almost made it happen for $300 per on-call period for a group of 5 community podiatrists in different practices. Not much, but a start. And then 2 podiatrists told the hospital admin just to call them cuz they will do it for free.
That's the problem.

Yup same exact thing happened in my area when I was still in PP (but I refused to take any kind of call). These young hungry fresh fellows fight each other for call and think they can completely turn a hospital system around so all trauma goes to them instead of ortho. I laughed so hard when he told me his plan. Defies logic how only podiatry is willing to spend hours waiting for an add on case, spend hours rounding on every single patient and making sure it’s a specific dressing - give me a break.

 

[619]

Pay them well and treat them well. Employees are definitely looking at the benefits package maybe more so than the base pay rate. Health insurance costs a ****load so they're definitely going to pick the job that offers it over the one that doesn't. I don't know if you can avoid it without expecting a lot of turnover.

100% correct. Big difference between hiring a teenager/early 20s vs hiring a fully reliable adult.

 

[619]

Yup same exact thing happened in my area when I was still in PP (but I refused to take any kind of call). These young hungry fresh fellows fight each other for call and think they can completely turn a hospital system around so all trauma goes to them instead of ortho. I laughed so hard when he told me his plan. Defies logic how only podiatry is willing to spend hours waiting for an add on case, spend hours rounding on every single patient and making sure it’s a specific dressing - give me a break.

I will 100% confess that I was once of those who thought I could convince the hospital ER in a small town to send me all the trauma. Looking back it is laughable. I lobbied so ****ing hard with the docs in the ED. Nothing came of it. Anyway, every year over 500 pods graduate and will lobby so hard like all of us. There is no reason for a hospital to pay podiatrist to take call. Not now or in 10 years or a 100 years.

 

[deleted1149159]

Ohhhh, I get it. You give free services out, but don't take Medicaid because it doesn't pay enough. Got it! Come on folks.

 

[deleted1149159]

What happens to those consults when you’re out of town or on sick leave? Are there other podiatrists in your community who will pick it up when you’re away?

Other podiatrists in our practice, yes.

 

[deleted1149159]

Spot on.

No it's not. Plenty of hospitals require ED call if you operate there with no remuneration whatsoever.

Amazing how our experiences are so different, eh? Makes me wonder.

 

[deleted1149159]

Even with no knowledge of your practice area, I can guarantee this is not true by any stretch of the imagination. Go ahead and post the ortho group who takes call at a hospital without getting paid. I will call their office and verify and then post an apology.

Who else practices in an area where on call ortho, Gen surg, ENT, OMFS, Urology, etc. are not getting any call pay from the facility? Bueller? Bueller? Oh, nobody?

How can you guarantee this if you don't practice where I do? Just stop.

You don't want to believe me? I couldn't really care less. You deal with where you are, and I'll do the same.

 

[NatCh]

100% correct. Big difference between hiring a teenager/early 20s vs hiring a fully reliable adult.

This is all hypothetical but...

I think the ideal candidate is in his or her middle years. Old enough to be all done having children (no maternity leave), yet young enough where health insurance doesn't cost an arm and a leg (older employees' insurance costs more). You can't discriminate based on age though. Learn what you can and can't ask in job interviews.

Younger employees are more likely to want to move on to another job. Working the front desk in a podiatry office doesn't seem like a lifetime career position for a 20 year-old. Be ready for them to give notice. Furthermore, Gen Z is less likely to stick around with bad management. They'll simply take a hike if you ask for too much. We had an employee who was with us for 15 years until one of my partners, who is getting older and more difficult (okay boomer stuff), drove her crazy. She was awesome.

Older employees are more reliable but then they start to slow down and can have difficulty with technology and quick decision making. We had an older employee who was with us for over a decade until she became a grandma and got recruited to take care of her granddaughter in another state. She was awesome.

Keep in mind that to you, the practice owner, the business is your baby. You're going to pour everything into taking care of it. To your employees it's just a paycheck. You can't demand that they feel loyalty or an attachment to it like you have. Loyalty and attachment are something you might be able to earn from your employees but they're simply never going to be as invested as you.

 

[bloxxeeey]

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.

This is true unless you're a podiatry associate

 

[deleted1149159]

This is all hypothetical but...

I think the ideal candidate is in his or her middle years. Old enough to be all done having children (no maternity leave), yet young enough where health insurance doesn't cost an arm and a leg (older employees' insurance costs more). You can't discriminate based on age though. Learn what you can and can't ask in job interviews.

Younger employees are more likely to want to move on to another job. Working the front desk in a podiatry office doesn't seem like a lifetime career position for a 20 year-old. Be ready for them to give notice. Furthermore, Gen Z is less likely to stick around with bad management. They'll simply take a hike if you ask for too much. We had an employee who was with us for 15 years until one of my partners, who is getting older and more difficult (okay boomer stuff), drove her crazy. She was awesome.

Older employees are more reliable but then they start to slow down and can have difficulty with technology and quick decision making. We had an older employee who was with us for over a decade until she became a grandma and got recruited to take care of her granddaughter in another state. She was awesome.

Keep in mind that to you, the practice owner, the business is your baby. You're going to pour everything into taking care of it. To your employees it's just a paycheck. You can't demand that they feel loyalty or an attachment to it like you have. Loyalty and attachment are something you might be able to earn from your employees but they're simply never going to be as invested as you.

This, times a million! Same with physician employees. Many hire young doctors and expect them to treat the practice as if they are owners. Even though they are paid and treated like subordinates.

 

[NatCh]

This is true unless you're a podiatry associate

Maybe those days are ending too?

 

[deleted1149159]

This is true unless you're a podiatry associate

I truly believe this is going to change.

 

[deleted1149159]

Maybe those days are ending too?

Another blog topic!

 

[NatCh]

This, times a million! Same with physician employees. Many hire young doctors and expect them to treat the practice as if they are owners. Even though they are paid and treated like subordinates.

Yes. My first job after residency was as an Associate in which one of the Partners treated me like an apprentice. He set it up so that the office manager and receptionist had more say than I did. It was awful. I finally told him, "You're an ass" and within a couple of weeks I was without a job. Best move I ever made though. Decided never to work for anyone else again.

Edit: That was actually my second place of work. I forgot about the first place. It's been a long time...

 

[ExperiencedDPM]

No it's not. Plenty of hospitals require ED call if you operate there with no remuneration whatsoever.

Amazing how our experiences are so different, eh? Makes me wonder.

If I feel it’s spot on, I assure you that you’re not going to convince me it’s not.

I don’t need to convince you, and you’re certainly not going to convince me.

Aren’t you the one who posted about agreeing to disagree?

 

[619]

This is true unless you're a podiatry associate

I truly believe this is going to change.

With 2 new schools opening? We will let supply and demand be the ultimate judge.

 

[ExperiencedDPM]

Maybe those days are ending too?

I think there is no choice. If it doesn’t end, private practice will disappear. At least practices looking to hire.

 

[619]

This is all hypothetical but...

I think the ideal candidate is in his or her middle years. Old enough to be all done having children (no maternity leave), yet young enough where health insurance doesn't cost an arm and a leg (older employees' insurance costs more). You can't discriminate based on age though. Learn what you can and can't ask in job interviews.

Younger employees are more likely to want to move on to another job. Working the front desk in a podiatry office doesn't seem like a lifetime career position for a 20 year-old. Be ready for them to give notice. Furthermore, Gen Z is less likely to stick around with bad management. They'll simply take a hike if you ask for too much. We had an employee who was with us for 15 years until one of my partners, who is getting older and more difficult (okay boomer stuff), drove her crazy. She was awesome.

Older employees are more reliable but then they start to slow down and can have difficulty with technology and quick decision making. We had an older employee who was with us for over a decade until she became a grandma and got recruited to take care of her granddaughter in another state. She was awesome.

Keep in mind that to you, the practice owner, the business is your baby. You're going to pour everything into taking care of it. To your employees it's just a paycheck. You can't demand that they feel loyalty or an attachment to it like you have. Loyalty and attachment are something you might be able to earn from your employees but they're simply never going to be as invested as you.

I agree with you 100% however I am currently shopping for health insurance for next year with my employees. Age is not a factor except for those under 26 y/o who can still be under their parents health insurance. Once again I will say you get what your pay for. I will and do pay for premium health insurance (50%) for my employees if they are 100% reliable. It's all 100% tax deductible anyway.

 

[bloxxeeey]

With 2 new schools opening? We will let supply and demand be the ultimate judge.

I still can't believe they're doing this ****. When there isn't enough jobs to go around for the spots, but hey most people won't realize it until their 300k in debt and halfway through their 3rd year looking at a 80k job with the lovely $4700 a month salary and $2700 after student loans. Maybe inflation will turn to deflation and make that worthwhile but I'm sure podiatry salaries would deflate faster than deflation.

 

[619]

I think there is no choice. If it doesn’t end, private practice will disappear. At least practices looking to hire.

With new pod schools opening, PP will continue to flourish. There is not enough hospital jobs/MSG/IHS/VA to hire every new graduating podiatrist. 10 years from today(regardless of inflation), the $100k base salaries in PP will still be here.

 

[ExperiencedDPM]

Yes. My first job after residency was as an Associate in which one of the Partners treated me like an apprentice. He set it up so that the office manager and receptionist had more say than I did. It was awful. I finally told him, "You're an ass" and within a couple of weeks I was without a job. Best move I ever made though. Decided never to work for anyone else again.

“You’re an ass” is a classic. But I have a feeling you knew that was likely your last conversation with him!

 

[CutsWithFury]

With new pod schools opening, PP will continue to flourish. There is not enough hospital jobs/MSG/IHS/VA to hire every new graduating podiatrist. 10 years from today(regardless of inflation), the $100k base salaries in PP will still be here.

This is accurate.

Which in return hurts people who are employed at hospitals because they don't have a leg to stand on when trying to negotiate for a better salary. The hospitals know they can get someone else if they want to for cheaper although in my experience this is rare. Especially if the podiatrist negotiating for a better salary has been profitable for the hospital. But it still gives the hospitals ultimately the upper hand.

Creating 2 more schools is the dumbest thing podiatry has done in a long time. The same people who sit on top of the food chain extracting money from the profession are the same people telling the young better trained podiatrists that we are entitled. This is a scam.

 

[ExperiencedDPM]

With new pod schools opening, PP will continue to flourish. There is not enough hospital jobs/MSG/IHS/VA to hire every new graduating podiatrist. 10 years from today(regardless of inflation), the $100k base salaries in PP will still be here.

Valid point.

 

[bloxxeeey]

This is accurate.

Which in return hurts people who are employed at hospitals because they don't have a leg to stand on when trying to negotiate for a better salary. The hospitals know they can get someone else if they want to for cheaper although in my experience this is rare. Especially if the podiatrist negotiating for a better salary has been profitable for the hospital. But it still gives the hospitals ultimately the upper hand.

Creating 2 more schools is the dumbest thing podiatry has done in a long time. The same people who sit on top of the food chain extracting money from the profession are the same people telling the young better trained podiatrists that we are entitled. This is a scam.

Don't worry they'll add laterality to the board certification so maybe I'll be right forefoot certified and possible left rearfoot certified if I'm part of the 30% pass rate. It'll help advance the profession!

But it was a terrible choice to do that, and I bet those schools are already trying to figure out how to expand class sizes.

 

[msion]

Ohhhh, I get it. You give free services out, but don't take Medicaid because it doesn't pay enough. Got it! Come on folks.

Taking free call and seeing patients for free in the clinic are two different things.
I think being paid for call like other specialties with a consistent call schedule rotating among community podiatrists is a step forward for our profession. If hospitals want more reliable and consistent podiatry coverage, then they can start paying us like all other doctors. Unless you are suggesting we are just lowly DPMs and how dare we ask for this.

On the other hand, someone telling hospital admins that he/she can see patients for free will not do the profession any good.

I think it's a security/inferiority complex you got. The reply you had earlier suggesting not taking these hospital calls for free will result in less patients for the practice is a classic mentality a lot of podiatrists have. Sorry I won't cry about not having enough hospital patients, but you certainly did at one point in your career.

I tell my associates that it's their choice to see patients in the hospital. I don't make them do it. But a lot of podiatrists do because doing so will help to "build the practice." I never believed in such crap. Building the practice means doing quality work in the community, get referrals from primary care doctors, and then negotiate for better payor contracts. If one insurance (say Molina) won't value my services, then I drop that insurance.

 

[CutsWithFury]

Don't worry they'll add laterality to the board certification so maybe I'll be right forefoot certified and possible left rearfoot certified if I'm part of the 30% pass rate. It'll help advance the profession!

But it was a terrible choice to do that, and I bet those schools are already trying to figure out how to expand class sizes.

The profession is broken not the board exam. They accept terrible students. The podiatry school education is sub par. The residency training is variable. Lots of hurdles to ultimately become a competent podiatrist in the profession.

The students who are top 10-15% in podiatry school get better than average residencies and are best prepared to pass the board certification tests first time through.

 

[NatCh]

I agree with you 100% however I am currently shopping for health insurance for next year with my employees. Age is not a factor except for those under 26 y/o who can still be under their parents health insurance. Once again I will say you get what your pay for. I will and do pay for premium health insurance (50%) for my employees if they are 100% reliable. It's all 100% tax deductible anyway.

Maybe it’s just our carrier. Our rates went way up when we hired someone who was in her 50s. Rates went down again after she left.

 

[NatCh]

“You’re an ass” is a classic. But I have a feeling you knew that was likely your last conversation with him!

Oh most definitely. I had my bags packed by that point.

 

[619]

Maybe it’s just our carrier. Our rates went way up when we hired someone who was in her 50s. Rates went down again after she left.

You are correct. But how much did rate go up or down? Regardless I don't think can put a price on a good solid reliable employee.

Don't save pennies to lose a dollar. Post-covid, most folks don't want to work and hard to even find someone to show up to work.

 

[deleted1149159]

If I feel it’s spot on, I assure you that you’re not going to convince me it’s not.

I don’t need to convince you, and you’re certainly not going to convince me.

Aren’t you the one who posted about agreeing to disagree?

Yes, I do. Are you asking to do that? If so, why be rhetorical about it? Just spit it out next time.

 

[deleted1149159]

The profession is broken not the board exam. They accept terrible students. The podiatry school education is sub par. The residency training is variable. Lots of hurdles to ultimately become a competent podiatrist in the profession.

The students who are top 10-15% in podiatry school get better than average residencies and are best prepared to pass the board certification tests first time through.

I do not believe Podiatry School education is sub par. You get out of it what you put into it.

The residency training is no more variable than the training for DOs and MDs. I really don't know why people think or say this. And the fact is, like education, you get out of it, what you put into it.

Great schools can put out terrible practitioners, and terrible schools can put out excellent practitioners. Same with residencies. If all the students coming out of every school were terrible, I would agree with you. And if all amazing residencies put out amazing practitioners, I would agree with you as well. The fact is, that's not the case. Not by a long shot.

So...what are you doing to help fix things? Are you involved with the APMA, CPME, ABFAS, or your state Association? Do you publish any research to further our education? Do you write for any of our trade publications and discuss ways to improve things?

 

[619]

Taking free call and seeing patients for free in the clinic are two different things.
I think being paid for call like other specialties with a consistent call schedule rotating among community podiatrists is a step forward for our profession. If hospitals want more reliable and consistent podiatry coverage, then they can start paying us like all other doctors. Unless you are suggesting we are just lowly DPMs and how dare we ask for this.

On the other hand, someone telling hospital admins that he/she can see patients for free will not do the profession any good.

I think it's a security/inferiority complex you got. The reply you had earlier suggesting not taking these hospital calls for free will result in less patients for the practice is a classic mentality a lot of podiatrists have. Sorry I won't cry about not having enough hospital patients, but you certainly did at one point in your career.

I tell my associates that it's their choice to see patients in the hospital. I don't make them do it. But a lot of podiatrists do because doing so will help to "build the practice." I never believed in such crap. Building the practice means doing quality work in the community, get referrals from primary care doctors, and then negotiate for better payor contracts. If one insurance (say Molina) won't value my services, then I drop that insurance.

When I opened my practice in the year of Covid, It was tempting to do hospital work for free. However I learnt from when I was a pod associate, I hustled at the local hospital ER and all I got was "junk".

Going solo, my office practice is next to a level 2 trauma hospital but I decided not to market myself to the ER or even take call at the hospital (I was asked to take call and I declined). I decided to just do the ground walk like election campaign officers knocking from one PCP to PCP office doors. I will rather see 15-20 patients a day in clinic than see 40+ patients and half of them are medicaid or no insurance follow up from the hospital.

You can't build a practice with medicaid or self-pay paying follow-up patients from the hospital.

 

[deleted1149159]

When I opened my practice in the year of Covid, It was tempting to do hospital work for free. However I learnt from when I was a pod associate, I hustled at the local hospital ER and all I got was "junk".

Going solo, my office practice is next to a level 2 trauma hospital but I decided not to market myself to the ER or even take call at the hospital (I was asked to take call and I declined). I decided to just do the ground walk like election campaign officers knocking from one PCP to PCP office doors. I will rather see 15-20 patients a day in clinic than see 40+ patients and half of them are medicaid or no insurance follow up from the hospital.

You can't build a practice with medicaid or self-pay paying follow-up patients from the hospital.

Although I mostly agree with you, there are very good opportunities to make an incredible living seeing Medicaid and self pay patients in government clinics if you can get the gig. Those pay INCREDIBLY well. Especially if you use it to supplement your existing practice. And know how to adjust your schedule accordingly.

 

[dtrack22]

How can you guarantee this if you don't practice where I do?

Post the hospital where this happens. Or post the surgical group taking call and not getting paid for being on-call. Should be pretty easy.

 

[ExperiencedDPM]

Yes, I do. Are you asking to do that? If so, why be rhetorical about it? Just spit it out next time.

“Just spit it out next time”. Very professional comment. I’ll just sit back and watch you argue with Cuts With Fury, msion, dtrack22…..

 

[DYK343]

Hospital employed - forced to take call for free due to contract. But insurance status is irrelevant. Get same wRVU regardless of insurance.

Private practice - no way in hell I would wait around all day taking call for free and then go see uninsured patients. Thats just not happening. ER can call someone else.

My last employment I had paid call. It was enough to make it worth it. I definately had 1-2 patients a week without insurance (and tons of medicaid which paid 100% medicare rate) but the stipend for waiting paid for it. I never had to cancel clinic but if that was happening regularly I would have to rethink paid call (or they would have to pay me more to keep schedule light).

 

[DexterMorganSK]

Being respectful and courteous with one another is one of the TOS. Please be respectful and on topic. Also, please learn to ignore posts that will further derail a thread.

 

[ExperiencedDPM]

Being respectful and courteous with one another is one of the TOS. Please be respectful and on topic. Also, please learn to ignore posts that will further derail a thread.

Amen.

 

[diabeticfootdr]

I still can't believe they're doing this ****

Who are you referring to?

CPME? Because CPME can not consider anything other than a candidate schools ability to comply with the accreditation standards in the documents. If they did, it would be anti-competitive.

If someone wants to open a new school or 10 more schools, if they meet the standards, they must be accredited.

 

[diabeticfootdr]

… and I bet those schools are already trying to figure out how to expand class sizes.

There are already more applicants to UTRGV for next year’s class than all the other schools in the US combined.

So yes, Texas will probably increase the class size in the future as long as there are qualified Texans who desire to be podiatrists and can’t get in to the state-sponsored school because of class size.

 

[ExperiencedDPM]

There are already more applicants to UTRGV for next year’s class than all the other schools in the US combined.

So yes, Texas will probably increase the class size in the future as long as there are qualified Texans who desire to be podiatrists and can’t get in to the state-sponsored school.

What percentage of this years students are from Texas?

 

[diabeticfootdr]

What percentage of this years students are from Texas?

It’s not 100%, but it’s almost 100%

Edit: Oh, this year’s students. 1/27 is not a Texas resident. I thought you mean the applicants for next year.