Why podiatrists take unpaid call (and what to do about it)

[Feli]

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I don't like to convo in the meme thread, but it's an important issue.

I don't understand why our profession agrees to take call without pay. A lot of the stuff we do can be done at surgery centers, except for some of the big stuff maybe. I don't know how it got to the point where we are the only specialty that take call without pay. I never knew this as a student and recently learned this as a resident and it's extremely frustrating.

Yes. Tons of DPMs, usually in various PPs (pod, MSG, ortho group... big group, little, solo), take unpaid call every day, every night.
The call does often pay other people indirectly (group owners/partners, lightens call load for partners, etc).

Hello....

It's called saturation

Everyone is just dying for whatever volume they can get their hands on.

If you won't do it the CEO is going to find another crusty DPM down the road to do it. Or maybe the new fellowship trained DPM who is starting their own practice.

Yes, it's saturation... if you won't do it, some other DPMs will.
Why would any hospital pay for what they can get for free?
Why would PP group owners not have associates take more call and get more patients/cases? (and the group may get paid for it)

As said, this seldom happens in MD/DO surgeon professions where PP docs don't get paid for call. Podiatry it's almost universal to do unpaid call; there are too many of us - many desperate for patients/cases/work/money.

...and, bottom line, what to do about all of this unpaid podiatry call? (and often inpt low/no pay consults also)
A few options to handle it:

• Go with it. Simply take call as an associate or new grad or whatever to "go along to get along."
• Refuse it. Try to scrape by with outpt refers, patients finding you, and wait for what ER stuff makes it to your clinic.
• Try to get paid for call. (almost universally be unsuccessful for DPMs unless willing to change PP to hospital FTE)
• Get paid for it. This means being a hospital FTE and having it baked into salary/bonuses. q3, q4 etc call.
• Find someone else to do the call for you... residents, fellows, associate DPMs or junior hospital DPMs... whatever.

Hurdles:

• Some hospitals will try to require call. They'll put it in bylaws to be on medical staff. It'll be job req for hospital FTEs.
• PKTY will end up in ER, so you usually want to go in for those (esp if small/rural area and hospital you're on staff at).
• Precedent will have been set by prior area podiatry docs, docs in your group, prior hospital FTEs to take call and consults.

...for me personally, I've settled on boundary of that I don't take new ER or inpts requiring INpatient surgery anymore. That's my best solution.
I still take ER follow-ups to my clinic and inpt consults not needing urgent inpt surgery (it's fine if they need ORIF or whatever that can be sched outpt basis). I'm solo, and it's just too destructive to my office schedule to try to find OR time with a packed office and other surgeons having the OR days I don't have block. I will take a look at PKTY in ER if they end up with a post-op infect or whatever, but that's pretty rare as I dodge most of the worst wound/infection stuff being at a smallish hospital and not doing ER/inpts requiring inpt surgery anymore.
Hospital doesn't love it (they want me to see all comers obviously, don't want to xfer pts), but I'm busy enough in the office and had a few troubles with getting OR team in and/or having to push on other surgeon elective blocks. Podiatry is low priority, and they want to push you into certain times, and that doesn't gel with booming outpt office or my health/sleep. I made the decision of no ER/inpt requiring urgent inpt surgery, and I communicated it to ER and inpt docs. Regardless, that's my strategy to keep my clinic running smooth and profitable, not stress my staff out, not butt into with other surgeons' blocks, not be antagonizing OR staff with add-on cases, and not burn myself out. Jmo.

I would say that, like any surgery docs, our notes and our evenings/weekends are our biggest frustrations in practice.
...Who else has a ER/inpt strategy to get paid, build profits, or limit frustration?

 

[Adam Smasher]

If hospital bylaws require you to be on call, and you truly detest inpatient surgery, consider quiet quitting.

If it's your call week, you get the consult request, make your way to write the consult note within 24h, and there's all sorts of passive-aggressive ways of ending it there.

• "recommend IV antibiotics and outpatient follow up in wound care center for serial bone debridement/HBOT"
• "pt will need operative amputation; this procedure however is not in my repertoire. consult general/vascular/orthopedic surgery"
• "I am not available to render surgical care for this patient. Recommend transfer to a tertiary care facility."
• "Inadequate OR availability, recommend transfer to a tertiary care facility."

I imagine eventually someone will come down on you for not doing their dirty work, but unless the hospital bylaws stipulate that all surgeons must operate whenever the hospitalists ask them to, your obligation begins and ends as soon as you write your consult note and issue your recommendations. If the chief medical officer wants to talk to you about this, you can use that conversation to discuss how much revenue your surgery creates for the hospital in terms of OR utilization with a $0 implant bill, as well as lab, imaging, and rehab services, and that some of this revenue could fund a call stipend for podiatrists on staff. If the CMO says there's no funds available for stipends, then you gently remind them it's their job to make it make sense for everyone involved so it's mutually beneficial for everyone. I've not yet had this conversation, but that's how it could go.

To be clear, the above is VERY bad politics. In reality, they'll find some loser who's content to hang out 3 hours after clinics to do an add-on $150 toe amputation. Which I guess solves your problem as an individual because you won't need to deal with the call.

 

[619]

I've settled on boundary of that I don't take new ER or inpts requiring inpt surgery anymore.

Same here. Very difficult to do an add-on case. it's been almost 2 years since I did an add-on case at 10pm after getting done from clinic at 5pm. I hated myself and said never again. For the past year, I have respectfully declined consults. At my hospital, consult is voluntary. Other specialty have official call schedule but there is none for podiatry. There are 2 big pod groups less than a mile from me and also a few solo docs around a 5 mile radius so I am sure the hospital will be fine.

I already despise hospital consults but it makes it 10 times worst when you can't find time to schedule an inpatient surgery. They always want my case in the add-on room and the case can go anywhere from 6pm, 7, 8 or even midnight. Obviously other surgeons also go through the same fiasco and frustration (we all complain in the doctors lounge together) but then they are hospital FTE or work in big groups so they are paid very well for their troubles. A $200 toe-amp or I&D at 10pm is not sad anymore but laughable. A five mins office Ingrown nail procedure pays more than that even for the lowest reimbursing medicaid. I will happily work in clinic 8 days a week.

With all the saturation, I don't think any solo PP doc greater than 2 years owning a practice is taking call at the hospital for free. Initially starting out as a solo PP, you want to build your practice and surgical numbers so it's tempting to gravitate towards taking free hospital call but after building your practice to a good volume, you first ditch taking free hospital calls and then ditch the bad insurance with low reimbursement.

 

[heybrother]

I went and saw my own patient in the hospital recently when they needed a ray resection. Worst week of my life. Not kidding, close to 40 hours of worthless rounding/waiting/getting bumped. Was about to scrub in once and got bumped for a high pressure puncture injury. I spent the week doing reverse advertising where I told desperate hospitalists that no, they cannot call me.

Everytime you think about taking ER call / rounding etc - you should ask yourself - does your receptionist ever ask you to see an extra patient / add someone on and you say no. If the answer is yes - add the extra patient and skip the rounding. Its probably worth more money than a hospital case.

 

[AttackNME]

is paid call even worth the money?

 

[Feli]

is paid call even worth the money?

 

[heybrother]

 

[Homo sapien]

is paid call even worth the money?

**** no.

My new job has no call and I'm happier than a pig in ****. I value My time, health, sleep

 

[Weirdy]

Didn't realize that's how they were compensated for call

 

[deleted1162946]

Call is awful. I’ve been the unhealthiest I’ve been taking call nonstop. Don’t do it.

 

[deleted1162946]

Didn't realize that's how they were compensated for call

Be lucky you’re not in an ortho group where they get paid call and you don’t and then when they get a consult they just give it to you anyways

 

[DYK343]

is paid call even worth the money?

I used to get $800/day (plus whatever I collected). Hospital paid us medicare rates for uninsured patients. Typically did 3 days at a time. Mix of trauma and diabetic. Usually pretty busy but some dead weekends (which sucked - if im on call and not out doing stuff I want to work). Usually got about 4-5k for 3 days of work (Fri-Sun). Wasnt bad but did take a weekend away. I would do it again.

I wouldnt do it for free. No way.

 

[MoostashPod]

I used to get $800/day (plus whatever I collected). Hospital paid us medicare rates for uninsured patients. Typically did 3 days at a time. Mix of trauma and diabetic. Usually pretty busy but some dead weekends (which sucked - if im on call and not out doing stuff I want to work). Usually got about 4-5k for 3 days of work (Fri-Sun). Wasnt bad but did take a weekend away. I would do it again.

I wouldnt do it for free. No way.

What's crazy is that an orthopedic doctor can make 4-5x or more in that same amount of time being on call and doing surgeries. I agree. Definitely don't do it for free. Ever.

 

[LastToeStanding]

I am currently in the process of getting a contact to work for a hospital in a smaller city in the north east with a good base and RVU bonus structure. Only one other podiatrist on staff at the hospital currently, so we would be splitting call evenly, i.e. every other week. Seemly the consult volume seems lower which we all know can easy change. If I was to attempt fight for compensation what would be a good going rate to ask for?

 

[podiatryresident]

I am currently in the process of getting a contact to work for a hospital in a smaller city in the north east with a good base and RVU bonus structure. Only one other podiatrist on staff at the hospital currently, so we would be splitting call evenly, i.e. every other week. Seemly the consult volume seems lower which we all know can easy change. If I was to attempt fight for compensation what would be a good going rate to ask for?

I talked to a surgical tech recently and he said he gets paid by $16/h for taking call from home 🙂

 

[Feli]

I am currently in the process of getting a contact to work for a hospital in a smaller city in the north east with a good base and RVU bonus structure. Only one other podiatrist on staff at the hospital currently, so we would be splitting call evenly, i.e. every other week. Seemly the consult volume seems lower which we all know can easy change. If I was to attempt fight for compensation what would be a good going rate to ask for?

q2 is inanity. Have you ever taken call before (as an attending)?

It doesn't really matter what volume is. No call is good call. Being required to be in the area (usually 20-30min or max 60min arrive time), to be fairly ready and sober and friendly at any given time is the killer part. It's the waking up wondering if you might have missed a call... telling your partner/family you can't take that road trip... even being at a restaurant or gym or movie wondering of you have your phone turned up. That anxiety and restriction is the backbreaker.

You won't want to do that stuff q2.
The only time I ever did q2 was in IHS for a short span when a third and 4th doc was on leave or they were hiring a new one. You simply do NOT want those restrictions on your life that often q2. Even if you barely ever go in or do sugery and seldom get phone calls when on-call, it is still a big limitation. In small hospitals, you usually have midlevels that call with dumb questions you have to answer or check XRs on; in bigger hospitals, they tend to not ask about easy stuff... but they get higher acuity and more surgery stuff you need to go in and see/operate for on-call.

It suuuucks to know you may have to jump out of a hot tub or quit a basketball game in the middle to quick change clothes and drive to the ER or hospital bedside. That is why ortho gets the call rates you see above: nobody wants to do it. Even taking call q3 is pretty bad, call q4 (one week per month) is fine and fairly standard for hospital jobs, but q2 is really a way to ruin your life enjoyment, sir. You need that time to be OUT of "work mode" mentally. Podiatry is a dump ground, and the "better" you do on call, the more they will try to expand your scope or get you in on more cases; sad but true. It makes you old fast.

 

[Toe-Diatrist]

Hospital employed. 6 days per month of call required- anything over 6 days gets paid at $900 per day. Rarely get called.

 

[Feli]

Hospital employed. 6 days per month of call required- anything over 6 days gets paid at $900 per day. Rarely get called.

Yeah, this above is pretty standard ^^
5-10 days call per month - unpaid but basically rolled into salary - is standard for hospital employed... for any surgical specialty (ortho, gen surg, OB, whatever). The more in-demand specialties might be able to get a lot more pay (ortho, CT, etc) or they might be able to wiggle out of call even as hospital employ (plastics, derm, ENT, ophtho, onco surg, etc). Regardless, it's an absolute must to have that "call shall not exceed X days per year" or that more call is paid a lot more in the contract to keep the call reasonable.

For podiatry (or others), the VA and IHS especially have pretty easy/mid difficulty call most of their places, but they can also take foreveeeeeeer to replace a fired/quit doc or a locum who is done, so going from q4 to q3 or changing q3 to q2 without any more pay is a huge and common problem. The govt jobs mostly just have salary + bonuses decided mainly or completely by supervisors. They do some subjective stuff (retention, signing, seniority, performance, rank, etc bonuses) that are not the purely objective rvu or call pay or stuff you tend to have in contracts with private hospitals FTE docs' situations. It's very easy for the VA/IHS to be understaffed (docs or support staff) and/or to dump call duty (and clinic) onto new hire docs while the oldies are paid more for less work. Having a decent supervisor is very important (everywhere... but especially in jobs that are more/all on salary and less productivity).

Required call is also the main reason hospital employed pods are usually higher paid than msg group or supergroup pods - even though the latter might still have to do a bit of rounds/call/consult in PP (so yeah, TFPs and call are the reasons for pay gaps). But any call sucks.

The q2 is insanity. The free call is insanity. We need to stop the insanity. 🙂

 

[DYK343]

7 days a month call. The 7 days is built into my compensation plan. I absolutely get called when im not on call but its very rarely an emergency. 99% of the time I tell them ill see patient next business day. If its an emergency they send it out or beg someone else.

Most podiatry stuff isnt a true emergency. Part of that is most of the open trauma here goes to ortho. Most trauma I get is splinted and sent to my office. I definately get gas but true necrotizing infection is rare. Small bubble of gas can wait until the next day or monday. I have daily OR block to manage inpatients. Im already in the hospital. Diabetic stuff also can pay extremely well.

I generated about 24RVU between 7-9AM this morning doing stuff no one else wants to do. Delayed primary closure one case (10-15 min) and a TMA on another (30 min)- packed open so another DPC/12 RVU monday.

Rough math I need 35 RVU a day to make the salary I want. I had a full day of clinic today to follow my morning cases. Diabetic emergencies are very profitable. And quite easy.

Ive said it before but its extremely helpful to already be in the hospital. Walk down the hall to the ER to see a consult or an elevator to the surgical floors at lunch or after work is fast, easy, and doesnt really tax the soul much. Taking the time to drive X amount of miles daily or multiple times daily to the hospital really makes call feel horrible.

 

[Feli]

7 days a month call. The 7 days is built into my compensation plan. I absolutely get called when im not on call but its very rarely an emergency. ...

Why is this? The 7d/mo part makes 100% sense, but you are either on or off call. That's lame to get calls on days/nights/weekends off.
Do they not make the call schedule clear to ER?
No other (employed) pods taking the remaining twenty some days?
No staff PP pods (read: associates) who need the pts or the money?
Being called for your own surgical or wound PKTYs going to ER?

That seems like a problem that could be fixed if you are going to be there awhile? There has to be other DPMs or gen surg or ortho on staff to take the foot ER stuff on your off days?. We did that in IHS sometimes... Dr Feli takes week 1 call, Dr DPM2 takes week 2, gen surg takes week 3, repeat (until we hire another DPM or two... replace gen surg). Even if not, there should be a way to put your foot down... "guys, I do my required days, but I need to be off on the other nights and weekends"? This is what most docs do if they are the only... urologist or GI or ortho or whatever takes a week per month (no ER coverage for that specialty the rest of the month... ER and hospitalist has to xfer or just handle it).

Fwiw, my nearby hospital can call me anytime, any day (I'm not paid, not on any schedule... don't tell them if I go on vaca or something). They rarely call, and I'm never under any obligation to come in or look at XR/CT remotely or even to answer the phone (and as above, they know I won't do urgent/emergent ER/inpt surgery). I will typically answer to discuss cases if I can, but that's mainly just because no other DPMs live nearby. When I first came to this area, it was also to pick up pts... but haven't needed that in a long time.

+1 for being in/near hospital.
My office is in the hospital, and I live 10-15min away... so that's the only reason I let ER call me to come over and eval/counsel a patient (daytime) or possibly come in (eve/weekend). It's an absolute headache if the office is any significant distance from the call ER/floor. Back at IHS, I lived in hospital housing within view of the hospital I worked in... and the neighborhood was all hospital employees. That got a bit bleak too... hard to mentally check out from work for days off unless you truly left the area/state. 😛

 

[AttackNME]

Anyone tried employing a “podiatrist hospitalist” to take care of these call duties?

 

[Feli]

Anyone tried employing a “podiatrist hospitalist” to take care of these call duties?

I know a few DPM who've been offered those jobs... all were in bigger cities (rounding multiple hospitals, consults, ER evals, wound center, sometimes minor surgery). It is usually vascular groups or bigger DPM groups offering and fairly low salary/bonus (esp when considering many are post op global patients and how much driving and parking is involved). The hiring group docs essentially want to do other stuff... but keep that revenue (same way some ortho groups want a non/forefoot surgery DPM). I think those jobs will continue to be popular... just like "university" podiatrist jobs with very limited scope. Those groups and facilities basically want a podiatry PA, which is logical.

One of the podiatrists in Santa Fe (hospital FTE) does a setup this... non-op, wound care (basically just does a ton of debrides and grafts, not sure if much/any inpatient). So, I send rare Charcot or osteomyelitis patients to his WCC who said no when I told them to get a BKA... they kill their kidneys with linezolid or stuff for a few weeks and get amnio and vacs and fish skin and real cool stuff. They probably are "healing?" Then, the ER usually calls me a month or two later saying the patient has gas up to the ankle, septic, midfoot osteomyelitis with 4x7cm abscess around the calc, and can I save the foot. 🙂

 

[air bud]

I am currently in the process of getting a contact to work for a hospital in a smaller city in the north east with a good base and RVU bonus structure. Only one other podiatrist on staff at the hospital currently, so we would be splitting call evenly, i.e. every other week. Seemly the consult volume seems lower which we all know can easy change. If I was to attempt fight for compensation what would be a good going rate to ask for?

Probably will have 10 days required built into contract...pretty standard

 

[dtrack22]

Why is this? The 7d/mo part makes 100% sense, but you are either on or off call. That's lame to get calls on days/nights/weekends off.
Do they not make the call schedule clear to ER?
No other (employed) pods taking the remaining twenty some days?
No staff PP pods (read: associates) who need the pts or the money?
Being called for your own surgical or wound PKTYs going to ER?

I let Hospitalist and ED docs (both are groups who send mostly the same people through our facility for 3-4 days at a time) that they can call me any time. I’m the only DPM that covers the hospital where I am employed. We are also rural, critical access and therefore small. We are one of the busiest critical access hospitals in the entire country but our wound clinic does a good job of preventing the need for inpatient care/work on my end. So while I only have 10 days of call built into my contract, I do the above, and here are my reasons:

1. I have no problem saying “no” or “I’m not available.” If I am free I’m happy to see the patient at some point over the weekend for example (I’m never officially listed on call outside of Monday-Thursday), which helps to get everything set up for Monday. If I’m not available, taking the call and passing off to ortho is easy.

2. These patients are generally going to wind up in my lap (even if ortho sees them over the weekend), so I would rather know of their existence from day 1. Most of the time I just tell ortho what I’d like them to do (if it needs to go to OR before I’m available), so being in the loop from the beginning makes my life easier.

3. I don’t get consulted often. We can go months without a diabetic foot infection that needs admitted. And some admissions i can justify transferring out because of vascular needs that we can’t take care of. I would draw more strict boundaries if the phone calls were more than 1-2 per month.

4. I rarely get called just to help an ED doc make up their mind about whether or not the patient should be admitted. I’m not being called for advice, I’m being called because the person is most likely going to need surgery. They seldomly waste my time, so I don’t mind when they call my cell when I’m not officially on call. Not to mention, many of the ED docs and Hospitalists won’t bother calling me when my name isn’t on the call sheet even if I tell them it’s ok, further limiting the number of calls I get when not “on call.”

In my job answering your phone doesn’t mean you have to go in, and it makes things easier on me in the long run more often than not. Obviously I have a unique setup, but I could see why other folks in certain situations would do the same thing.

 

[DYK343]

Why is this? The 7d/mo part makes 100% sense, but you are either on or off call. That's lame to get calls on days/nights/weekends off.
Do they not make the call schedule clear to ER?
No other (employed) pods taking the remaining twenty some days?
No staff PP pods (read: associates) who need the pts or the money?
Being called for your own surgical or wound PKTYs going to ER?

That seems like a problem that could be fixed if you are going to be there awhile? There has to be other DPMs or gen surg or ortho on staff to take the foot ER stuff on your off days?. We did that in IHS sometimes... Dr Feli takes week 1 call, Dr DPM2 takes week 2, gen surg takes week 3, repeat (until we hire another DPM or two... replace gen surg). Even if not, there should be a way to put your foot down... "guys, I do my required days, but I need to be off on the other nights and weekends"? This is what most docs do if they are the only... urologist or GI or ortho or whatever takes a week per month (no ER coverage for that specialty the rest of the month... ER and hospitalist has to xfer or just handle it).

Fwiw, my nearby hospital can call me anytime, any day (I'm not paid, not on any schedule... don't tell them if I go on vaca or something). They rarely call, and I'm never under any obligation to come in or look at XR/CT remotely or even to answer the phone (and as above, they know I won't do urgent/emergent ER/inpt surgery). I will typically answer to discuss cases if I can, but that's mainly just because no other DPMs live nearby. When I first came to this area, it was also to pick up pts... but haven't needed that in a long time.

+1 for being in/near hospital.
My office is in the hospital, and I live 10-15min away... so that's the only reason I let ER call me to come over and eval/counsel a patient (daytime) or possibly come in (eve/weekend). It's an absolute headache if the office is any significant distance from the call ER/floor. Back at IHS, I lived in hospital housing within view of the hospital I worked in... and the neighborhood was all hospital employees. That got a bit bleak too... hard to mentally check out from work for days off unless you truly left the area/state. 😛

I actually have a fairly well tuned system. There are other people (outside our hospital system) but the hospital likes to keep it all in house so they prefer me to do inpatient stuff. Ortho/gen surg wont touch diabetic foot. Gen surg will do legs which is great because I hate legs.

Basically ER/hospitalists knows that when im not on call they cant call me outside business hours. I put a stop to that REAL quick. And they know that im not coming in afterhours when im not on call. If its a saturday and im off call and there is true gas - they send out or beg someone else (which doesnt work - they send out). I put my foot down when they call for these cases and im off call so they know not to call me.

But the vast majority are admitted and wait until next business day.

They will add patients to my list commonly and wont even call me. Which is awesome. I have 7-9AM block Monday-Friday for inpatient care. I fill almost every day 1-2 cases.

Its an RVU machine. Im not turning down that golden carrot. Its also really low stress work. I prefer it 100 fold over a bunionectomy.

I start surgery at 7. Clinic 9-3. At about 330 I round and add on the next days cases. Typically out the door 4-5pm with all my notes done. I rarely do a 5pm case. Maybe 1 a month. Wash repeat. Works well for me.

Today (no clinic fridays)
#1 I&D bone cortex 9.4RVU
#2 Delayed primary closure 12 RVU
#3 Infected hardware removal (calc) and I&D bone cortex midfoot 15.4 RVU
#4 Split thickness skin graft (scheduled) 10 RVU
#5 toe amp 3.5 RVU (scheduled)

50 RVU today. My goal is 35 RVU a day. Easy day. Didnt stress. Didnt have to think too much. Wash repeat. Out the door by 2pm and that includes being bumped 1.5 hrs for a testicular torsion case at 645AM.

 

[DYK343]

Anyone tried employing a “podiatrist hospitalist” to take care of these call duties?

I feel like I am essentially this. Plus 6hrs clinic 4 days a week.

 

[heybrother]

The difference between an employed doc and a PP doc doing this role is that if all of those patients have Medicare then the collections / total reimbursement is almost identical + maybe a couple hundred dollars more than Dyk's personal direct reimbursement.

I don't actually begrudge hospital docs getting paid for inpatient work. I just put my clinic address into Google because I was curious how far I actually was from the hospital. Technically not an enormous distance, but a lot of red lights and a parking garage that is always full to the top floor.

 

[MicroPod]

Attendings in my residency said they would not be willing to take call if there weren’t residents doing most of the work. Many of the attendings would just show up for the cases, never having met the patients before and then peace out letting us do all the rest of the inpatient work - kinda similar to how PA’s function for ortho or other surgical specialties.

 

[heybrother]

Attendings in my residency said they would not be willing to take call if there weren’t residents doing most of the work. Many of the attendings would just show up for the cases, never having met the patients before and then peace out letting us do all the rest of the inpatient work - kinda similar to how PA’s function for ortho or other surgical specialties.

I don't think that's an uncommon thing for attendings to say.

This thread captures the myriad of factors that can make inpatient lucrative or a stone around your neck.

1) You have to be paid RVUs for it.
2) You need to already be in the hospital.
3) You need to have easy OR access/availability. Waiting 6 hours for a toe amp doesn't work.
4) If you don't have readily available vascular support you need to be able to punt
5) You need a hospitalist who handles almost everything other than the cutting and the dressings.
6) You need to be able to customize your clinic schedule to fit it in.
7) In a perfect world, you'd have colleagues who are collegial, like-minded, and capable.

 

[AttackNME]

In a perfect world, you'd have colleagues who are collegial, like-minded, and capable.

Why would that matter? Most people when they’re on call do everything themself and clean up after themselves

 

[heybrother]

Why would that matter? Most people when they’re on call do everything themself and clean up after themselves

I'm simply stating that people with heavy inpatient/call burdens would benefit from colleagues who they can count on.

 

[Feli]

I'm simply stating that people with heavy inpatient/call burdens would benefit from colleagues who they can count on.

This is definitely a thing for VA, IHS, bigger hospitals (multiple FTE hospital pods) etc with rotation call and all docs on the call are employed (even if locums). That requires communication and all docs taking call to be fairly well-trained. In podiatry, our training is obviously allllll over the board.

Still, when a doc's on call for any specialty, the job is to HANDLE IT and not leave much/any for the next guy when that Sun to Monday or whenever the handoff comes. That doc is are basically on an island for call; they're the shield so the other docs can travel or sleep or relax and get away from work - mentally and physically. Everybody hates those guys who are "on call" yet manage to leave half-done surgeries that could've been single-stage, call another pod who is not on call, just let inpatients cook on abx who needed surgery, or who accepted admits/consults that are crashing off the guardrails of what the facility/docs/dept are capable of.

...for PP, it very seldom applies.
There are the super rare groups that have coordinated call (sometimes even paid) and rotate it... typically with heavy resident support. A few PP groups have each group doc follow their own patients/surgery, and the hospital ER/floor calls to consult the docs directly. In the vast majority of pod PP, we know podiatry PP owners just put the new associates on call (officially or unofficially) for all of the calls or the complications of associate/owner/partner/new pts. Some groups/solo logically don't take any call.

Why would that matter? Most people when they’re on call do everything themself and clean up after themselves

Most. 🙂

 

[Retrograde_Nail]

Anyone tried employing a “podiatrist hospitalist” to take care of these call duties?

This is big in Minnesota. I've seen it most frequently there in terms of job postings. Would just be charcot and pus all day everyday. Still worth while from an RVU standpoint if you can handle those things.

 

[Aresnebula]

How are people not taking calls for hospitals, operate? Are you doing most of your cases at surgery centers? If so, how much ankle/rearfoot stuff are you doing? Tbh, I hate and I mean really HATEE diabetic stuff. I don't want to do dirty stuff when I am out.

 

[AttackNME]

How are people not taking calls for hospitals, operate? Are you doing most of your cases at surgery centers? If so, how much ankle/rearfoot stuff are you doing? Tbh, I hate and I mean really HATEE diabetic stuff. I don't want to do dirty stuff when I am out.

Hate all you want, your tune might change later. those patients need the help and the work pays more (in clinic).

This is big in Minnesota. I've seen it most frequently there in terms of job postings. Would just be charcot and pus all day everyday. Still worth while from an RVU standpoint if you can handle those things.

What’s the salary range you’ve seen? Is it paid by hospital?

 

[air bud]

Hate all you want, your tune might change later. those patients need the help and the work pays more (in clinic).



What’s the salary range you’ve seen? Is it paid by hospital?

It's just market standard and inpatient work only. No elective outpatient stuff

 

[Feli]

How are people not taking calls for hospitals, operate? Are you doing most of your cases at surgery centers? If so, how much ankle/rearfoot stuff are you doing? Tbh, I hate and I mean really HATEE diabetic stuff. I don't want to do dirty stuff when I am out.

No hospital can make you take call (if you're not their employee).
A few will try to have you take call - or absolutely require - call to be on staff (most PP pods avoid those hospitals).
If you have almost any non-podiatry specialty, they'll offer call pay.
Some groups will take the pay from hospital call (and/or the $ from pts gained) and make their employee docs take call.

The majority of hospitals will just occasionally ask pods if you want to take call, if you're able, if interested, etc.
It might be the admins asking, it might be ER, the hospitalists, the floor nurses telling the doc to call you, etc. It might be casual or maybe more formal ask. If you come in for ER and consults, they'll call more and more. Try not to do that if you have better things to do.
Most hospitals will just basically expect PP podiatrists to want to take free call (to pick up patients), groups will expect their docs to take call (for more "bonus", more surgery, etc), and ERs will call you for PKTY or call you when they know you're in/near the hospital.

...In general, leave the call to the hospital FTE pods (if there are any). They have it baked into their salary.
If podiatry call is not paid (99% won't be), tell them you don't want it, don't have time, can't do it. Nearby associate mills will probably want it.
Where I live, the biggest group (pod supergroup) went to full VCap now, so I'm sure they'll have merry associates who either choose to accept free call and/or are contractually made to take podiatry call at most of the state's hospitals.

I dislike the diabetic stuff also. I wouldn't go so far as to say I hate it, but I like recon, elective stuff a lot more (mainly that it pays more reliably, the patients get better typically, and that it doesn't screw up your evenings/weekends). You can largely mitigate it from your practice if you wish; you will still be on staff at hospitals. You won't be relegated to ASCs only.
The truly harder part is that, in most areas, podiatry is very saturated, and it can be tough getting reliably enough patients/refers for the non-diabetic F&A stuff. That wound/amp stuff is the low hanging fruit that MDs don't want to do, most midlevels don't want, and even floor nurses don't want (bandage changes, nail clips, decubs, etc). It is there for the taking, and some most hospitals expect podiatry to do it. 🙂

 

[PeaJay]

How are people not taking calls for hospitals, operate? Are you doing most of your cases at surgery centers? If so, how much ankle/rearfoot stuff are you doing? Tbh, I hate and I mean really HATEE diabetic stuff. I don't want to do dirty stuff when I am out.

Most hospitals have different “classes” of privileges. A requirement of being “full staff” is participation in call coverage. This can be circumvented by being “courtesy staff”. This allows you to provide services to the community without voting privileges. This means you are not able to vote on any policy, but are ally to provide care within scope of degree/training. Courtesy staff typically do not have to participate in call coverage.

 

[Feli]

Most hospitals have different “classes” of privileges. A requirement of being “full staff” is participation in call coverage. This can be circumvented by being “courtesy staff”. This allows you to provide services to the community without voting privileges. This means you are not able to vote on any policy, but are ally to provide care within scope of degree/training. Courtesy staff typically do not have to participate in call coverage.

Yes, this is an option. It's always worth reading the bylaws.
The downside to this avoiding active medical staff is that they typically only allow those courtesy/affiliate staff class for less than X patients (X may be 10, 12, 20, 24, etc patients) cared for per year (cared = surgery, inpatients you admit or consult on, etc). That unfotunately doesn't work for most DPMs... they will want/need more encounters for that hospital to be useful. Most places I've every seen, it's between 10 and 25 as the cutoff for courtesy staff.

If the facility also considers patients you send for imaging, labs, outpatients in wound center, etc toward that total... then it's definitely no use (even if the X = 50+). You will have to be active staff (or nothing). That is the case at most facilities.

 

[PeaJay]

Yes, this is an option. It's always worth reading the bylaws.
The downside to this avoiding active medical staff is that they typically only allow those courtesy/affiliate staff class for less than X patients (X may be 10, 12, 20, 24, etc patients) cared for per year (cared = surgery, inpatients you admit or consult on, etc). That unfotunately doesn't work for most DPMs... they will want/need more encounters for that hospital to be useful. Most places I've every seen, it's between 10 and 25 as the cutoff for courtesy staff.

If the facility also considers patients you send for imaging, labs, outpatients in wound center, etc toward that total... then it's definitely no use (even if the X = 50+). You will have to be active staff (or nothing). That is the case at most facilities.

Definitely worth reading the fine print. My hospital has no limitations. This lack of specifics is likely more common in rural settings. A lot of the docs in my area commute to the rural settings and thus are not able to meet the 30 min call range. The hospital has to decide whether to have lots of docs with no call or no docs.

 

[heybrother]

I just recredentialed and it turns out I'm active staff. I'm grateful not to have to take call and even more grateful that my hospital just built a beautiful new day surgery hospital in the wealthier part of town close to where I live where I can't get stuck behind a liver resection. Wish they were an ASC so BCBS would pay ASC incentive pay, but whatever.

Here's a somewhat mixed blessing. The hospital in question fired their podiatrist. I'm now getting lots of referrals, yay, ...for Obamacare plans that no one takes (but me) where the patient's no show like its Medicaid. No amount of calls or texts could make the 8:30 am new patient show up last week.

How are people not taking calls for hospitals, operate? Are you doing most of your cases at surgery centers? If so, how much ankle/rearfoot stuff are you doing? Tbh, I hate and I mean really HATEE diabetic stuff. I don't want to do dirty stuff when I am out.

I hope you are given the opportunity in the future to build the practice you want. Having spent the last 5 years learning what insurances to drop, fighting it out with Humana/UHC, and joining an IPA - I now recognize that part of staying in business is just having a full schedule. Quantity has a quality of its own. You may be more tolerant of palliative type wounds when you are being paid for them.

 

[Feli]

.... You may be more tolerant of palliative type wounds when you are being paid for them.

Eh, there are enough deformities and sports injuries and ingrowns and warts and RFC (in some places). 🙂

 

[msion]

Just came across this on my reddit page.
Not too late to make a career change guys.
No more unpaid calls.

Now I need to get back to debride a failed TMA stump someone else dumped in the hospital. I guess that counts as an extra "shift" per Ramsey? 😆

 

[dtrack22]

Just came across this on my reddit page.
Not too late to make a career change guys.
No more unpaid calls.

Now I need to get back to debride a failed TMA stump someone else dumped in the hospital. I guess that counts as an extra "shift" per Ramsey? 😆
View attachment 396638

$90/hr is significantly better than I was paid by two different podiatry practices, as an associate.

But now it’s a huge pay cut, so no thanks

 

[msion]

$90/hr is significantly better than I was paid by two different podiatry practices, as an associate.

But now it’s a huge pay cut, so no thanks

Do understand most of the frequent visitors on SDN do make above average income. Feli is good, I am fine, you are fine, and Retro is gonna retro.
After all we are considered the SDN bunch on Reddit 😉

 

[pod squad]

Just came across this on my reddit page.
Not too late to make a career change guys.
No more unpaid calls.

Now I need to get back to debride a failed TMA stump someone else dumped in the hospital. I guess that counts as an extra "shift" per Ramsey? 😆
View attachment 396638

So the solution is forming a Podiatry Union!!

 

[Retrograde_Nail]

This is a typical response. We “complain”. Sorry we are informing the masses…

We “don’t do anything about it”. How can we? The same guys who created this mess are still in charge. They block out anyone who doesn’t go along with their ideas. Defame others. That’s what podiatry does.

 

[Adam Smasher]

I had a flight of fancy about starting a podcast of my own discussing those aspects of podiatry that no one wants to discuss. Not the Deans Chat fluff productions. Put my name and face behind it so it carries some actual weight. I figure I'll do it if I ever become so filthy rich off of my crypto holdings that I don't need to practice podiatry anymore. Or if I lose my license. There's a way to do it without sounding bitter ("I love my job and I hate my profession.")

We've got a nice thing going here with our little meme page and our inside jokes but I could also make a meme account on X which would double to promote that podcast. I bet I would make dozens of dollars doing this too. Unfortunately, no one whose livelihood depends on podiatry will ever criticize podiatry outside of anonymous complaints.

 

[dtrack22]

Do understand most of the frequent visitors on SDN do make above average income. Feli is good, I am fine, you are fine, and Retro is gonna retro.
After all we are considered the SDN bunch on Reddit 😉View attachment 396641

Jokes on them, I’m not ABFAS certified. And in case I ever go to prison, I no longer identify as a “guy” either.

 

[Feli]

Do understand most of the frequent visitors on SDN do make above average income. Feli is good, I am fine, you are fine, and Retro is gonna retro.
After all we are considered the SDN bunch on Reddit 😉View attachment 396641

It absolutely boggles my mind ppl spend time to go on social media... just to talk about what ppl on another social media are saying.

Truly wild.

...and yeah, concur with @Retrograde_Nail ... not much to do. We can discuss how to try to max podiatry ROI or what might help it fix the glaring issues. But at the end of the day, if Microsoft had twice as many shares outstanding, they'd have less than half the value for each share. There is only so much demand. Nobody here is in control of supply of DPMs... save for a few fluffers who pass through to try to drum up more podiatry apps because it lines their pockets.