You’ve been made, all 10 of you

[deleted1149159]

Don’t tell Kanye…

Funny, my son was a huge fan. Had flags, t-shirts. When he heard what Ye said, they all went in the trash.

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[PlainsPod]

I have nothing to add to this thread, but I laugh every time I read the title

 

[CutsWithFury]

I have nothing to add to this thread, but I laugh every time I read the title

It's pathetic isn't it?

 

[footdoctor22]

You’re totally the reason why, not the salary to debt ratio the profession is producing 😂. Read both attachments.

View attachment 359976

I went to TUSPM from 2012-2016. Worst teachers I have ever had, and the school just wants your money, they couldn't care less about you with regards to educating you or any kind of academic support. I really hope that more people considering Podiatry school think again, because you are basically wasting your life when you could be doing something better. Podiatry as a profession is headed downhill as more and more people learn the truth about i.

 

[heybrother]

I went to TUSPM from 2012-2016. Worst teachers I have ever had, and the school just wants your money, they couldn't care less about you with regards to educating you or any kind of academic support. I really hope that more people considering Podiatry school think again, because you are basically wasting your life when you could be doing something better. Podiatry as a profession is headed downhill as more and more people learn the truth about i.

So what's your story?

I think we're most persuasive on this forum when we actually talk about our experiences / what we've been through / what challenges we're facing. When we simply post "podiatry sucks" I think it can be easy for pre-pods to dismiss us and for the APMA cheerleaders to try and write us off even though everyone on here knows what you mean when you say it.

 

[PTPuser]

I'm reminded of this thread again and my poor decision as I retract and stand there dissociating for a 1st MTP fusion that took us 4 hrs to do....

 

[heybrother]

I'm reminded of this thread again and my poor decision as I retract and stand there dissociating for a 1st MTP fusion that took us 4 hrs to do....

That's a shame. It shouldn't. I'm not a stud and I can get prepped / positioned / plated in under just under 30 minutes if I'm perfect in the sagittal on my 1st throw. Crushing the 1st MPJ fusion is the cornerstone to crushing a 1st MPJ + panmetatarsal head resection + 4 toes. If you can do the 1st MPJ in 30-40 you can complete the 9 procedure cases in under 2 hours.

 

[619]

That's a shame. It shouldn't. I'm not a stud and I can get prepped / positioned / plated in under just under 30 minutes if I'm perfect in the sagittal on my 1st throw. Crushing the 1st MPJ fusion is the cornerstone to crushing a 1st MPJ + panmetatarsal head resection + 4 toes. If you can do the 1st MPJ in 30-40 you can complete the 9 procedure cases in under 2 hours.

Suturing is the worst part especially the toes with thin skin. A back breaking wrist cramping task.

 

[heybrother]

Suturing is the worst part especially the toes with thin skin. A back breaking wrist cramping task.

Amen. I don't miss much about residency but I miss having 2 people to close.

 

[ExperiencedDPM]

I'm reminded of this thread again and my poor decision as I retract and stand there dissociating for a 1st MTP fusion that took us 4 hrs to do....

What can you possibly do for 4 hours for a first MTPJ fusion.

 

[ExperiencedDPM]

I was asked to review 25 cases by an old school MIS doc who does MIS like some docs trim nails.

He can do 10 cases a day. Done in office and same crap for every patient. Stab incisions to rasp an “exostosis” on every toe and every slight prominence on the foot. Stab incision for a flexor tenotomy on every toe, etc. The most time was spent anesthetizing the toes and surgical sites.

No hardware. No layered closure. No skin sutures. Just a steri strip.

This guy is knocking these out in minutes and billing 15-20 procedures per patient and making crazy money.

He’s a pig and the issue is all the “exostectomies” he does on every patient.

When patients were interviewed, not one ever had a complaint of any “bumps” or prominences.

So while you’re spending hours doing a TAR for 950 bucks, this guy is doing 10 cases and making enough to buy a car daily.

But I believe that will be coming to a screeching halt very soon. And you may be reading about the money he’s paying back to Medicare.

 

[Pronation]

I was asked to review 25 cases by an old school MIS doc who does MIS like some docs trim nails.

He can do 10 cases a day. Done in office and same crap for every patient. Stab incisions to rasp an “exostosis” on every toe and every slight prominence on the foot. Stab incision for a flexor tenotomy on every toe, etc. The most time was spent anesthetizing the toes and surgical sites.

No hardware. No layered closure. No skin sutures. Just a steri strip.

This guy is knocking these out in minutes and billing 15-20 procedures per patient and making crazy money.

He’s a pig and the issue is all the “exostectomies” he does on every patient.

When patients were interviewed, not one ever had a complaint of any “bumps” or prominences.

So while you’re spending hours doing a TAR for 950 bucks, this guy is doing 10 cases and making enough to buy a car daily.

But I believe that will be coming to a screeching halt very soon. And you may be reading about the money he’s paying back to Medicare.

Wow this is incredible. Do you think I have enough time to start up a little surgical suite in my office to do these before Medicare stops reimbursing these? Thanks in advance for your legal and practice management advice.

 

[deleted1138023]

I was asked to review 25 cases by an old school MIS doc who does MIS like some docs trim nails.

He can do 10 cases a day. Done in office and same crap for every patient. Stab incisions to rasp an “exostosis” on every toe and every slight prominence on the foot. Stab incision for a flexor tenotomy on every toe, etc. The most time was spent anesthetizing the toes and surgical sites.

No hardware. No layered closure. No skin sutures. Just a steri strip.

This guy is knocking these out in minutes and billing 15-20 procedures per patient and making crazy money.

He’s a pig and the issue is all the “exostectomies” he does on every patient.

When patients were interviewed, not one ever had a complaint of any “bumps” or prominences.

So while you’re spending hours doing a TAR for 950 bucks, this guy is doing 10 cases and making enough to buy a car daily.

But I believe that will be coming to a screeching halt very soon. And you may be reading about the money he’s paying back to Medicare.

do people actually think they can get away with this forever?

 

[NatCh]

What can you possibly do for 4 hours for a first MTPJ fusion.

For real. Maybe he was watching it fuse in real-time?

I recall hearing about an 8 hour in-office Chevron down in AZ. Good god.

 

[ExperiencedDPM]

do people actually think they can get away with this forever?

Absolutely. I can tell you stories that would make your head explode. There are lots of what I call one trick ponies.

They bill the same thing all the time. There is one doc who bills for an excision of a soft tissue mass every time he does a tailor’s bunion. The “mass” is always the same size on every op report for the past 7 years.

Another doctor bills for a nerve decompression for every single bunionectomy.

When I’m asked to review these cases to see if this is the “norm”, I’m astounded how brazen these docs can be. They aren’t even inventive enough to mix it up a little. The same things get billed every case.

 

[ExperiencedDPM]

Wow this is incredible. Do you think I have enough time to start up a little surgical suite in my office to do these before Medicare stops reimbursing these? Thanks in advance for your legal and practice management advice.

These guys aren’t performing the newer MIS procedures under C arm with hardware.

They are likely doing these procedures in the same room that they just schnided someone’s nails.

I doubt these clowns even own an autoclave.

 

[dtrack22]

stand there dissociating for a 1st MTP fusion that took us 4 hrs to do....

This feels like hyperbole. What did you guys actually do for 4 hours on one joint? Like I need a play by play of what happened in each 30 minute interval of that case

These guys aren’t performing the newer MIS procedures under C arm with hardware.

Don’t tell Feli this, he likes to lump people doing the stuff you describe with those doing the same osteotomies percutaneously as he does open 😉

because there is no difference between untrained pods doing percutaneous surgery in clinic with no fluoro and no fixation and what is now called MIS bunion surgery. None.

 

[PlainsPod]

I was asked to review 25 cases by an old school MIS doc who does MIS like some docs trim nails.

He can do 10 cases a day. Done in office and same crap for every patient. Stab incisions to rasp an “exostosis” on every toe and every slight prominence on the foot. Stab incision for a flexor tenotomy on every toe, etc. The most time was spent anesthetizing the toes and surgical sites.

No hardware. No layered closure. No skin sutures. Just a steri strip.

This guy is knocking these out in minutes and billing 15-20 procedures per patient and making crazy money.

He’s a pig and the issue is all the “exostectomies” he does on every patient.

When patients were interviewed, not one ever had a complaint of any “bumps” or prominences.

So while you’re spending hours doing a TAR for 950 bucks, this guy is doing 10 cases and making enough to buy a car daily.

But I believe that will be coming to a screeching halt very soon. And you may be reading about the money he’s paying back to Medicare.

15-20 procedures PER PATIENT ???!!!???

If you work with wounds, you’re going to do perc flexor Tenotomies. They seem to go hand in hand, but that level of grift is astounding.

 

[ExperiencedDPM]

15-20 procedures PER PATIENT ???!!!???

If you work with wounds, you’re going to do perc flexor Tenotomies. They seem to go hand in hand, but that level of grift is astounding.

Easily 15-20 per patient. A flexor tenotomy toes 2-5 bilaterally. An MTPJ capsulotomy 2-5 bilaterally. That’s up to 16 right there. Then they take a rasp and a stab and remove an “exostosis” from 5-8 different sites. And that’s just the icing on the cake.

 

[PTPuser]

This feels like hyperbole. What did you guys actually do for 4 hours on one joint? Like I need a play by play of what happened in each 30 minute interval of that case

It was a slow motion trainwreck consisting of someone who shouldn't be operating, an agressive rep, someone who don't know their anatomy, trying to "learn, explore" new toys and a combo of other stuff

 

[ExperiencedDPM]

It was a slow motion trainwreck consisting of someone who shouldn't be operating, an agressive rep, someone who don't know their anatomy, trying to "learn, explore" new toys and a combo of other stuff

Wow, in the facilities I work, this provider would be reported. Barring any unforeseen complications or equipment failure, this is truly bordering on malpractice.

The increased anesthesia time puts the patient at higher risk. The increased OR time puts the patient at higher risk for complication, infection, DVT, etc.

The anesthesia Dept usually takes this sort of thing very seriously. Putting a patient’s health in jeopardy with a case taking at least 4 times or more of the normal is simply dangerous and unacceptable.

 

[wakaflocka88]

It was a slow motion trainwreck consisting of someone who shouldn't be operating, an agressive rep, someone who don't know their anatomy, trying to "learn, explore" new toys and a combo of other stuff

That’s why I stick to the tried and true hardware. Do not let reps try to sell you on the next great invention. Seen that Arthrex MaxForce MPJ fusion plate? Dumb. If a procedure can be done with Synthes screws and plates, keep it simple.

 

[air bud]

That’s why I stick to the tried and true hardware. Do not let reps try to sell you on the next great invention. Seen that Arthrex MaxForce MPJ fusion plate? Dumb. If a procedure can be done with Synthes screws and plates, keep it simple.

Why don't you want free steak dinners?

 

[DYK343]

That’s why I stick to the tried and true hardware. Do not let reps try to sell you on the next great invention. Seen that Arthrex MaxForce MPJ fusion plate? Dumb. If a procedure can be done with Synthes screws and plates, keep it simple.

I have not used the arthrex version but I have used other companies basically same plate with slightly different tech. I agree expensive and not gonna fly at a ASC. But they are FAST and make really easy 1st MPJ positioning. Its basically fool proof and nearly impossible to over dorsiflex/plantarflex the hallux when ligned up with the plate. I've been using them over the last 1.5 years (Not arthrex version) and have had good results - though not really any different than lag screw and plate. Stitches in somewhere between 35-45min. Onto the next.

 

[heybrother]

So does anyone know what their 1st MPJ hardware costs? ie. what does a Synthes plate + screw cost? or this Maxforce thingy above?

Anyone using just 2 screws?

One of my attendings back in the day was using a Synthes locking plate. The impression I was under was the plate + locking screws drove the cost up to $1600.

How much do you all think an ASC gets for a Medicare 1st MPJ fusion?

 

[wakaflocka88]

So does anyone know what their 1st MPJ hardware costs? ie. what does a Synthes plate + screw cost? or this Maxforce thingy above?

Anyone using just 2 screws?

One of my attendings back in the day was using a Synthes locking plate. The impression I was under was the plate + locking screws drove the cost up to $1600.

How much do you all think an ASC gets for a Medicare 1st MPJ fusion?

I’m mainly Stryker/Wright and I recently checked how much my cases have been costing because our ASC uploads the implant cost sheet to the EMR. I was honestly shocked. Locking plates each around $1600. Screws around $150 each. They even charge for the drill bits and guide wires.

I have not used the arthrex version but I have used other companies basically same plate with slightly different tech. I agree expensive and not gonna fly at a ASC. But they are FAST and make really easy 1st MPJ positioning. Its basically fool proof and nearly impossible to over dorsiflex/plantarflex the hallux when ligned up with the plate. I've been using them over the last 1.5 years (Not arthrex version) and have had good results - though not really any different than lag screw and plate. Stitches in somewhere between 35-45min. Onto the next.

Which system is this? The part that takes me the longest is getting the sagittal alignment. One time I felt I had it right on the flat plate but post op the patient weight bearing ended up being a tick dorsiflexed and felt it. Ugh.

 

[wakaflocka88]

Why don't you want free steak dinners?

Bro. I only use companies that supply me with smoking hot female reps. Steak dinner second on the list.

 

[DYK343]

I’m mainly Stryker/Wright and I recently checked how much my cases have been costing because our ASC uploads the implant cost sheet to the EMR. I was honestly shocked. Locking plates each around $1600. Screws around $150 each. They even charge for the drill bits and guide wires.



Which system is this? The part that takes me the longest is getting the sagittal alignment. One time I felt I had it right on the flat plate but post op the patient weight bearing ended up being a tick dorsiflexed and felt it. Ugh.

Zimmer stratum has been my go to recently for 1st MPJ fusions.

 

[PTPuser]

Bro. I only use companies that supply me with smoking hot female reps. Steak dinner second on the list.

Oh lord, the amount of infidelity taking place between these people is an STI party from what I'm seeing so far.

 

[DYK343]

I’m mainly Stryker/Wright and I recently checked how much my cases have been costing because our ASC uploads the implant cost sheet to the EMR. I was honestly shocked. Locking plates each around $1600. Screws around $150 each. They even charge for the drill bits and guide wires.

And this is almost certainly with the ASC discount! In hospital its more, guarenteed.

 

[air bud]

Zimmer stratum has been my go to recently for 1st MPJ fusions.

Used stratum for a year. 1st mpj plate is tough on a small foot. But nothing compresses like stratum

 

[DYK343]

Used stratum for a year. 1st mpj plate is tough on a small foot. But nothing compresses like stratum

its scary at times. Ive almost cracked a metatarsal

 

[NatCh]

How much do you all think an ASC gets for a Medicare 1st MPJ fusion?

I think it's a little over $6300. Someone feel free to fact check me on this number.

FWIW, I've never been denied (or even chastised for using) a locking plate + screws from a surgery center.

If you want to keep it really simple you can use K-wires:

Immediate weight bearing following first metatarsophalangeal joint fusion with Kirschner wire fixation - PubMed

4.

pubmed.ncbi.nlm.nih.gov

 

[wakaflocka88]

Zimmer stratum has been my go to recently for 1st MPJ fusions.

Oh wow. I just looked up their system and I am very intrigued now. It takes out a lot of the plate positioning guess work. Do you use it for other bone work or only MPJ fusions? Plate and frag screw? Do you feel comfortable with this fixation for

 

[DYK343]

Oh wow. I just looked up their system and I am very intrigued now. It takes out a lot of the plate positioning guess work. Do you use it for other bone work or only MPJ fusions? Plate and frag screw? Do you feel comfortable with this fixation for

I use it mostly for 1st MPJ fusions.

Ive used it on Lapidus and I prefer plate/interfrag screw fixation over the set. Its hard to bend the stratum plate and use the compression tongs. I felt it had a tendincy to dorsiflex the 1st ray with lapidus.

I did a medial column fusion with it awhile back and it worked really well.

There is a bit of a learning curve. The tongs can be a bit of a pain at first. You gotta be precise when you use the kwires to drill the tong holes. I hate their dumb little plastic blue drill guide covers. They bend/break and are a risk to leave behind in the patients foot. Its a really dumb idea with the system. THey also individually peel pack every screw which does add a little time to the case. Ive also broke the ramp removing it from the plate as it can get stuck.

The system probably isnt for everyone. But I like it for 1st MPJ fusions.

 

[NatCh]

That’s why I stick to the tried and true hardware. Do not let reps try to sell you on the next great invention. Seen that Arthrex MaxForce MPJ fusion plate? Dumb. If a procedure can be done with Synthes screws and plates, keep it simple.

Oh wow. I just looked up their system and I am very intrigued now. It takes out a lot of the plate positioning guess work. Do you use it for other bone work or only MPJ fusions? Plate and frag screw? Do you feel comfortable with this fixation for

Ummmm...

 

[air bud]

Oh wow. I just looked up their system and I am very intrigued now. It takes out a lot of the plate positioning guess work. Do you use it for other bone work or only MPJ fusions? Plate and frag screw? Do you feel comfortable with this fixation for

No the opposite it requires perfect plate fixation. The prongs are 2 points of contact so you can't rotate. Once you have drilled the holes for the prongs you bought the placement. Unless you cut off one of the prongs so then can rotate.

 

[wakaflocka88]

Ummmm...

Ok stop it. I’m not using it. The Zimmer reps near me are all men anyways.

 

[dtrack22]

Anyone using just 2 screws?

I did this morning. Did it perc with joint prep using a burr.

Otherwise I’m using a dorsal plate with no crossing screw(s). I do like the Arthrex plate because without crossing screws I need to be able to compress through the plate. I liked the Checkmate plate (arthrosurface I think?) because of the external compression mechanism (a clamp essentially).

There’s no wrong way to fuse a big toe. I’ve seen plenty that have healed with nothing more than a few k-wires. I lied, anything that takes you 4 hours means you’re doing it wrong.

 

[deleted1138023]

I like the ortholoc plate the best from wright.

 

[DYK343]

I did this morning. Did it perc with joint prep using a burr.

Otherwise I’m using a dorsal plate with no crossing screw(s). I do like the Arthrex plate because without crossing screws I need to be able to compress through the plate. I liked the Checkmate plate (arthrosurface I think?) because of the external compression mechanism (a clamp essentially).

There’s no wrong way to fuse a big toe. I’ve seen plenty that have healed with nothing more than a few k-wires. I lied, anything that takes you 4 hours means you’re doing it wrong.

Doing this MIS how do you get the denuded cartilage out? Just "milk" it out thru the stab incision? Scope?

 

[NatCh]

Ok stop it. I’m not using it. The Zimmer reps near me are all men anyways.

You wouldn't be the first one here to get lured in by shiny metal bits.

 

[dtrack22]

Doing this MIS how do you get the denuded cartilage out? Just "milk" it out thru the stab incision? Scope?

You ever see a dr pimple popper clip? 😂

It all squeezes out like toothpaste. I found that putting the toe through ROM also caused the cartilage and bone slurry to shoot out. My incision was probably 7-8mm? So it wasn’t like a poke hole just big enough to get the bur in. Seemed like plenty of space to get everything out and irrigate

 

[CutsWithFury]

Doing this MIS how do you get the denuded cartilage out? Just "milk" it out thru the stab incision? Scope?

Scope a 1st MTP joint? The most podiatry procedure ever.

 

[Feli]

So does anyone know what their 1st MPJ hardware costs? ie. what does a Synthes plate + screw cost? or this Maxforce thingy above?

Anyone using just 2 screws?

One of my attendings back in the day was using a Synthes locking plate. The impression I was under was the plate + locking screws drove the cost up to $1600.

How much do you all think an ASC gets for a Medicare 1st MPJ fusion?

I use screws occasionally (2 for MPJ, 2-3 for Lapidus... all across MCJ, none of the intercuni silliness). 1 screw + pin or 2 screw + pin can work too. Not for diabetics, not for most older ppl, not for very many ppl at all. It works though. I do it for young ppl Lapidus sometimes... mainly to lessen chances of HWR vs plate.

The reason for plating - esp on Lapidus - is just to give that insurance against someone who has a fall or stumble, ambulates early in boot, ambulates without boot too AMA, lies to you about going back to work and does that very fast post-op, miscommunicates, etc. Screws work well with good technique... plates are just more of a safety net.

With first MPJ, I use pins sometimes (failed implants), and that's probably more common than cross screws actually... basically what NatCh showed. The grafts you have to put in after failed implants don't need a ton of metal through them, and there is often very bad bone where the implant seated to put anything into (basically same principle as osteoporotic fractures or RA pt surgery... be very careful with a lot of drill and screws!). Besides, the MPJ fusions don't really have nonunion and tolerate delay union or fibrous well.

The implant costs are totally based on locality... facilities can negotiate. Hospitals have so many backdoor deals for vendor prefs that you wouldn't believe it. Many ASCs that I've gone to tell me use whatever is approved... they just offer one price for any lag + lock combo (ie $1500 for MPJ or $2000 for distal fibula, regardless of brand) or fixed price for any hammertoe implant (ie $400 for SmartToe or HammerLock or any similar). Most take it, some don't. Stainless will virtually always be less/same than titanium. Cannulated always costs more.

In the end, it's not our concern... use what works well and what makes sense. For me, steel is stronger (by size), cheaper/same cost, harder and much less chance to strip screws or cold weld into plates... so, it's kinda dumb to use titanium unless pt has true nickel allergy or the thing you need doesn't come in steel version. Also, the drivers to remove standard AO stuff is everywhere the pt may ever live and need HWR, so it's a lot smarter than using newbie companies with questionable nonsense just to get batted eyelashes from a rep or a free burger... just my logic on it.

 

[NatCh]

I like how quick and easy putting in two compression staples across a 1st MTP fusion is (but it's pricey).

 

[GaftAndToe]

Inflation is 8.8% YoY. Why are podiatry associate salaries still barely $100k?

Also have the same question. My friend just graduated NP school, and was doing it while full time RN. Her first job out of school is 115K, M-F 9-5, holidays paid time off, no call, no consults, no nursing homes, + benefits. She also found it in 1 week, 20 min from her home.

Most job offers in podiatry are in low 100K, but I do have friends who got 200K+ offers in the hospital, but require constant call and complicated surgeries on a daily basis and require relocation. But those jobs are rare for a new grad after the residency.

No wonder, less and less people applying to pod schools. They should get back non-surgical podiatry and let people practice non surgical podiatry without residency. And only people who want and mart enough to do surgery can go to residency/fellowship and get top surgical hospital jobs. No way all those residency programs are graduating well trained surgeons. And even if they were, there are just not enough of those positions.

 

[heybrother]

Also have the same question. My friend just graduated NP school, and was doing it while full time RN. Her first job out of school is 115K, M-F 9-5, holidays paid time off, no call, no consults, no nursing homes, + benefits. She also found it in 1 week, 20 min from her home.

Most job offers in podiatry are in low 100K, but I do have friends who got 200K+ offers in the hospital, but require constant call and complicated surgeries on a daily basis and require relocation. But those jobs are rare for a new grad after the residency.

No wonder, less and less people applying to pod schools. They should get back non-surgical podiatry and let people practice non surgical podiatry without residency. And only people who want and mart enough to do surgery can go to residency/fellowship and get top surgical hospital jobs. No way all those residency programs are graduating well trained surgeons. And even if they were, there are just not enough of those positions.

What's your podiatry story?

 

[GaftAndToe]

What's your podiatry story?

Newly grad. Was committed to be in a specific location due to family. Applied early in the fall to everything available in the area. Got a PP position working for a solo practitioner. Base + bonus (not sure if would be possible). No call, working in two locations. One location is very slow. My boss said we just need to market more. I am relatively happy with everything so far, but was not able to do many surgeries, just grafts and exostoses for now. My biggest concern is that it is very slow some days. When I started, some days I saw 4 patients a day, now 10-18. It is not very busy. So, I am not hopeful about the bonus. In my free time I go to doctor's offices and give brochures and cards, and set up lunches. Boss pays for lunches.

 

[Adam Smasher]

Met a DPM NP last week. After speaking with her, I am really considering doing the same thing after I am done with residency if things are still going downhill.

I am from a state that NP has full scope. She does everything head to toe. Will spend a day or so with her to see what it all entails.

Interesting career move. Reminds me of how Nova Southeastern used to have their accelerated DO program for podiatrists who had graduated from at minimum a 2-year residency. However, you'd have to be facing some truly awful job prospects before you make that kind of jump.