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- Nov 23, 2015
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100I 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."
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'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 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.