What is the scope of practice for Pods in the 50 States???

[mrfeet]

I was wondering if anyone knew of a website source, or (and I know this would be a lot of trouble) could someone post on here a chart of each state and their respective scope of practice.

I would really like to know this information in regard to selecting residency programs in the future. There are a lot of good residencies in New York, but I hear that they have one of the most limited scopes of practice.

I would appreciate any and all information on this topic.

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[Dr_Feelgood]

I was wondering if anyone knew of a website source, or (and I know this would be a lot of trouble) could someone post on here a chart of each state and their respective scope of practice.

I would really like to know this information in regard to selecting residency programs in the future. There are a lot of good residencies in New York, but I hear that they have one of the most limited scopes of practice.

I would appreciate any and all information on this topic.

The APMA issued a manual in 2002. If you'd like I can send you the pdf files, all you need to do is PM your email address.

 

[gustydoc]

Just an FYI, even if a state has a restrictive scope of practice it would not apply to you as a resident. While a resident at a teaching hospital there is virtually no restriction on what you can do, assuming your attending will let you. Also every year there are changes in at least a couple states, so if there are certain states you want to practice in I would suggest contacting the local associations.

 

[Dr_Feelgood]

I didn't even catch that. Good pick up, Gusty.

 

[capo]

Feelgood, which state you personally think has the most liberal or 'best earning-potential' scope of all 50? Just wondering. Does it follow that the more a pod can do in a state's scope, the more $ he will/can earn? Or is it more the patient base and wealth of the state?

Example would be in Cali or NY, where despite the limited scope vs other states, here a pod has a better wealthy pop.(perhaps better insurance coverage as well) base in NYC or Los Angeles then would a pod in Alabama or rural Montana, etc.

Of course, I know you don't know the answer to these questions -- I just wanted to make you feel important to be asked them.

 

[Dr_Feelgood]

I had this discussion with one of the doctors at CPMS. Vermont has a really good scope on the books, but he said that just b/c the law allows a scope doesn't mean the hospitals will. His choice was New Mexico.

The state that had the highest income according the department of labor is Nevada. That beginning said, I think if you are looking for a good scope that you can make good money you might look to the SW part of the US. Areas that are high in retired folk have higher percentage of patients with insurance, so you are more likely to get paid for your time. Some areas in the US, most of your patients will be cash and carry patients which might mean you'll be having a lot of tax write offs.

Thanks for making me feel important.

 

[capo]

I had this discussion with one of the doctors at CPMS. Vermont has a really good scope on the books, but he said that just b/c the law allows a scope doesn't mean the hospitals will. His choice was New Mexico.

The state that had the highest income according the department of labor is Nevada. That beginning said, I think if you are looking for a good scope that you can make good money you might look to the SW part of the US. Areas that are high in retired folk have higher percentage of patients with insurance, so you are more likely to get paid for your time. Some areas in the US, most of your patients will be cash and carry patients which might mean you'll be having a lot of tax write offs.

Thanks for making me feel important.

So do tax writeoffs mean you make more than insurance billing? Would you rather have a mostly cash patient base in rich Beverly Hills, Cali or would you rather have a mostly insurance base in Phoenix, AZ?

Which doc would fare better in his pocket, after all monies are counted?

 

[jonwill]

I had this discussion with one of the doctors at CPMS. Vermont has a really good scope on the books, but he said that just b/c the law allows a scope doesn't mean the hospitals will. His choice was New Mexico.

The state that had the highest income according the department of labor is Nevada. That beginning said, I think if you are looking for a good scope that you can make good money you might look to the SW part of the US. Areas that are high in retired folk have higher percentage of patients with insurance, so you are more likely to get paid for your time. Some areas in the US, most of your patients will be cash and carry patients which might mean you'll be having a lot of tax write offs.

Thanks for making me feel important.

Hey now, everybody stay out of Albuquerque. That is my turf!

 

[capo]

Hey now, everybody stay out of Albuquerque. That is my turf!

Jonwill, what do you know on this? Is the desert SW the hot spot, because of retirees? I know Fla is # 1 for retirees. # 2 is PA, beleive it or not. # 3 is AZ, I think. I guess NM comes in close to there, as does Cali. But doesn't Cali have a weird scope?

 

[krabmas]

Jonwill, what do you know on this? Is the desert SW the hot spot, because of retirees? I know Fla is # 1 for retirees. # 2 is PA, beleive it or not. # 3 is AZ, I think. I guess NM comes in close to there, as does Cali. But doesn't Cali have a weird scope?

I heard that cali depends on the hospital that you work in.

I'd rather have a cash base as long as the patients actually pay and I have lots of them.

I do not want to have to beg insurance companies to pay me if I do not have too.

Remember it is not just about $$$. It is also about your happiness and sanity.

If you spend all your time begging for money from the insurance companies or even paying someone else to do it - it all takes away from your pocket or patient care.

There are podiatrists like the dentists that do not take insurance.

The ones that do not take insurance can charge all the patients similar rates thereby having semi-discount rates compared to those that take insurance. What I mean by that is... if you are patient A and do not have insurance but go to DPM 1 that takes insurance you'll pay like $400 for a visit and procedure. If you are patient A and do to DPM B that does not take insurance whether you are insured or not you'll pay about $100 for a visit.

So in the end I'd rather be the sane, happy DPM who does not gouge the non-insured.

 

[jonwill]

Jonwill, what do you know on this? Is the desert SW the hot spot, because of retirees? I know Fla is # 1 for retirees. # 2 is PA, beleive it or not. # 3 is AZ, I think. I guess NM comes in close to there, as does Cali. But doesn't Cali have a weird scope?

My thoughts are that there is money to be made wherever you go as long as you're smart about it. Every state is going to have its upside and downside. Scope, demographics, pay scales, etc will all play a part. It is important that when considering residency, you consider all of those aspects because a lot of doctors end up practicing near where they did their residency.
As I'm in the middle of preparing my residency apps right now, I'm only applying to places that I'd be willing to live and practice after residency.

 

[capo]

My thoughts are that there is money to be made wherever you go as long as you're smart about it. Every state is going to have its upside and downside. Scope, demographics, pay scales, etc will all play a part. It is important that when considering residency, you consider all of those aspects because a lot of doctors end up practicing near where they did their residency.
As I'm in the middle of preparing my residency apps right now, I'm only applying to places that I'd be willing to live and practice after residency.

But jonwill, if you had a choice of anywhere to practice as of today, where would u pick? If u had any residency that would take you, what's 1st choice? There must be a SPECIFIC state that right now, is the BEST state in the usa to practice, no? The thing is, who really knows this answer?
So far NM is THE best in usa then, according to feelgood's doc buddy.

 

[jonwill]

But jonwill, if you had a choice of anywhere to practice as of today, where would u pick? If u had any residency that would take you, what's 1st choice? There must be a SPECIFIC state that right now, is the BEST state in the usa to practice, no? The thing is, who really knows this answer?
So far NM is THE best in usa then, according to feelgood's doc buddy.

I'm from NM and know various podiatric physicians that practice there. I'm also spending a few months there this fall at the residency program. NM has a good scope of practice but I wasn't aware that it was that good of a place to practice. If you are big into diabetic wound care, I'm sure that you could clean up.

 

[capo]

I'm from NM and know various podiatric physicians that practice there. I'm also spending a few months there this fall at the residency program. NM has a good scope of practice but I wasn't aware that it was that good of a place to practice. If you are big into diabetic wound care, I'm sure that you could clean up.

True, the SW has the highest pop. of diabetes. So if you'd do only wound care (which is low malpractice I'm sure, as it's non invasive like surgery or cosmetic podiatry) you'd do very well.

Also, you can live in a low cost state so your low expenses would increase your take home income. You'll make alot AND live in a dirt poor state, that's got a long way to go to equal the west or east coast cost of living.

NM it is!

 

[krabmas]

True, the SW has the highest pop. of diabetes. So if you'd do only wound care (which is low malpractice I'm sure, as it's non invasive like surgery or cosmetic podiatry) you'd do very well.

Also, you can live in a low cost state so your low expenses would increase your take home income. You'll make alot AND live in a dirt poor state, that's got a long way to go to equal the west or east coast cost of living.

NM it is!

according to Dr. Steinberg (Limb Center at Georgetown) diabetic limb salvage/wound care had a high rate of mal-practice suits. mostly due to lack of patient education.

this is just one person's take but I thought I'd include it.

He also says that non-compliance is mostly due to a lack of patient education. not all but a lot is due to lack of patient education. and I blame the insurance companies for making medicine into a numbers game, more patients, less time.

 

[capo]

according to Dr. Steinberg (Limb Center at Georgetown) diabetic limb salvage/wound care had a high rate of mal-practice suits. mostly due to lack of patient education.

this is just one person's take but I thought I'd include it.

He also says that non-compliance is mostly due to a lack of patient education. not all but a lot is due to lack of patient education. and I blame the insurance companies for making medicine into a numbers game, more patients, less time.

Hmmm I didn't know that. So everyone, if someone was to choose between a surgical patient base, a diabetic base or a predominantly cosmetic practice, which of these 3 has the lowest chance of being sued?

 

[krabmas]

Hmmm I didn't know that. So everyone, if someone was to choose between a surgical patient base, a diabetic base or a predominantly cosmetic practice, which of these 3 has the lowest chance of being sued?

In our art of doctoring class they tell us you can be a pretty crappy doc and never get sued as long as your patients like you.

 

[capo]

In our art of doctoring class they tell us you can be a pretty crappy doc and never get sued as long as your patients like you.

What are YOU going to do to make them like YOU?
Or dare I ask?

 

[krabmas]

What are YOU going to do to make them like YOU?
Or dare I ask?

Well,.... if I do convert to Mormonism I can marry all the guy patients. How often do husband's sue wives whom they are not divorcing?

And for the femal patients, ... hmmm.... I do not know. Pretty women are so threatening to other women so I guess they will all just hate me and sue my _ss off. (at least it will be smaller )

Back to reality....

I have been working in clinic for a year now and some days the patients hate me and some days they like me. Sometimes I think it is my fault and other times it is a patient that I would fire from my practice.

I think as long as you do the best you can and appear to be trying to help the patient and take time to explain what you are doing and why and what the alternatives are (your toe may fall off if you do not let me remove your nail) the patients are pretty happy with that.

I look at it as putting on a performance for each patient b/c sometimes I am just not in the mood to deal with them. But I put on my clinic face (smile) and pretend that all I care about is that patient for that moment.

 

[capo]

Well,.... if I do convert to Mormonism I can marry all the guy patients. How often do husband's sue wives whom they are not divorcing?

And for the femal patients, ... hmmm.... I do not know. Pretty women are so threatening to other women so I guess they will all just hate me and sue my _ss off. (at least it will be smaller )

Back to reality....

I have been working in clinic for a year now and some days the patients hate me and some days they like me. Sometimes I think it is my fault and other times it is a patient that I would fire from my practice.

I think as long as you do the best you can and appear to be trying to help the patient and take time to explain what you are doing and why and what the alternatives are (your toe may fall off if you do not let me remove your nail) the patients are pretty happy with that.

I look at it as putting on a performance for each patient b/c sometimes I am just not in the mood to deal with them. But I put on my clinic face (smile) and pretend that all I care about is that patient for that moment.

LIAR!!!






Hahaaaa.

Ok, seriously it is true that not ALL peeps will like you ALL the time. So put on your 'game face' and do the best you can daily.

 

[Dr_Feelgood]

So do tax writeoffs mean you make more than insurance billing? Would you rather have a mostly cash patient base in rich Beverly Hills, Cali or would you rather have a mostly insurance base in Phoenix, AZ?

Which doc would fare better in his pocket, after all monies are counted?

Tax write-offs mean you make nothing. Many times when people do not have insurance; you have to write off most of the bill b/c they don't have the means to pay you.

I would rather have the insurance b/c you will get paid. Cash customers may never pay; you can turn them over to a collection agency but good luck. You can't get blood from a turnip.

You don't have to go to any area that is high in retirees, I would suggest any area that has a high level of insurance coverage. For example, I discussed the job market in Omaha with another physician. He said that the great thing about Omaha is that about 70% of the people in the city have health insurance. So you get paid.

Retired people usually have Medicare and perhaps extra health coverage, that is why I brought up the idea of NM's retiree population.

 

[doclm]

Tax write off? What does that have to do with taxes?

Correct me if I'm wrong. But, isn't a tax write-off something you can do in the spring of the following year to save $$ that you have to pay back to uncle sam. For example, for me a tax write off is the interest that I paid on a student loan from the previous year. For a Podiatrist with a business, it could be building utilities, interest on federal loans, gas to drive to work and back if you have two businesses, donating $$$ to a Podiatry student in the form of scholarships, ect, ect. Right??

Tax write-offs mean you make nothing. Many times when people do not have insurance; you have to write off most of the bill b/c they don't have the means to pay you.

I would rather have the insurance b/c you will get paid. Cash customers may never pay; you can turn them over to a collection agency but good luck. You can't get blood from a turnip.

You don't have to go to any area that is high in retirees, I would suggest any area that has a high level of insurance coverage. For example, I discussed the job market in Omaha with another physician. He said that the great thing about Omaha is that about 70% of the people in the city have health insurance. So you get paid.

Retired people usually have Medicare and perhaps extra health coverage, that is why I brought up the idea of NM's retiree population.