ABPM Credential/Privileging

[Winograd1717]

Why are they closing?

they would rather close open spots than take bad candidates

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[Pronation]

We keep saying this, but does anyone actually believe this? I sure don't.

I mean, we all did clerkships, right?
We all talked to classmates, co-residents, etc about what they saw on rotations?
We all go to meetings and have colleagues and other local DPMs with wiiide variance in practice/competence?
And I'd assume we realize this isn't the norm in other medical specialties... 99% ENT do tonsils, 99% OB do c-sec, 99% ortho do femurs, etc.

I would maintain that the board pass results are almost directly correlated to the wide variance in residency qualities/volume.
There are a lot of DPM residencies out there that don't prepare grads (academically or reps/exp/practically) for many aspects of F&A surgery.
Those are also the programs that tend to match/scramble the lower DPM grads who had trouble in school, further compounding the issue.
Most of those need to be shut down, spots reduced, or combined with others to give full F&A surgery training/exp. But that's unlikely.

So, the residencies are standardized in length only... and now a fair amount of attendings/cases also pull out to "fellowship."

dtrack is100% that the boards process can improve, but the DPM post-grad training needs to be addressed and improved and truly standardized regardless. It was not long ago that only those who did surgical programs - almost always top half of their class - took ABPS (ABFAS). Now that "all programs are surgical" and "all programs are 3 year 'standardized' ," we have a bunch of issues with boards and pass rates. That's not coincidence.

99% of podiometric sturgeons do total toenail replacement surgery so what’s your point?

 

[air bud]

99% of podiometric sturgeons do total toenail replacement surgery so what’s your point?

I think you forgot to type "don't"

You are an elite sub sub sub specialist.

99% of podiatrist DO practice the art of human farriery.

I have decided my first book is going to be titled "Farriery for the Human Foot : Principles and Techniques"

 

[Feeter]

I get 20+ patients a day trying to make appointments to "have my toenails clipped". I dont even live in an area thats under saturated. There are plenty of DPMs around who do nail care. There is still a lot of demand for DPMs just not really surgical DPMs (IMO).

If you want to run a 9-4 C&C practice as a DPM with no weekends, coach your kids teeball team, and have time to be the town mayor while making 200-300k a year those opportunities are readily available (once escaping the 1st-3rd year typical DPM associate job).

F&A surgery jobs are not readily available.

ABPM private practice "bunion once a month at surgery center" makes tons of sense.

ABFAS for heavy surgical oriented/trauma pods who need to be tested for competance/weeded out.

There is a reason most hospital/ortho want ABFAS. It is harder. A lot harder. They want to see that you can pass the exam.

Is the exam unfair at times and do dumb dumbs still get through? Sure. But its not a walk in the park and you do have to understand rheumatoid arthritis or how to manage an open fracture or how to identify a benign vs malignant tumor, etc.

If there is a C&C job making 300k doing 9-4 and no weekends let me know I'll take that job. Seems like a great gig. Most of these types of jobs are rural unfortunately but I'd take a 250k no weekends job in any metro. If those exist in plenty then let's stop complaining this is a good field then.

 

[deleted1138023]

If there is a C&C job making 300k doing 9-4 and no weekends let me know I'll take that job. Seems like a great gig. Most of these types of jobs are rural unfortunately but I'd take a 250k no weekends job in any metro. If those exist in plenty then let's stop complaining this is a good field then.

Yeah can @DYK343 post these jobs. I don’t like surgery much anyways. If I can do a normal 9-5 and make $300k cutting nails I’m down

 

[DYK343]

If there is a C&C job making 300k doing 9-4 and no weekends let me know I'll take that job. Seems like a great gig. Most of these types of jobs are rural unfortunately but I'd take a 250k no weekends job in any metro. If those exist in plenty then let's stop complaining this is a good field then.

@Feeter
Honestly my hospital is considering hiring a midlevel to handle all the calls for nail care.
We get 20+ a day wanting to see me. Thats not an exaggeration
May be interested in a non surgical DPM in the near future as I doubt a midlevel will take the job.
Would probably make MGMA for 'non surgical DPM'. No calls or weekends.
Feed surgical cases to the two surgical DPMs.
Its not currently a position but may be in the coming month(s).

 

[Feli]

If there is a C&C job making 300k doing 9-4 and no weekends let me know I'll take that job. Seems like a great gig. Most of these types of jobs are rural unfortunately but I'd take a 250k no weekends job in any metro. If those exist in plenty then let's stop complaining this is a good field then.

There are plenty of 200-300k jobs - op or non... it's called being an owner.
Probably 1.5x or 2x that in a good payer area with good management and production.

One should be able to clear 200k non-op even as an associate, but that depends on the owner, the NH company, the associate productivity, area payers, etc. Surgery doesn't add a ton of value in most PP setups (employed).

...a lot of ppl don't consider just the $, though. The job quality tends to matter a twitch when it's something you'll do for decades. A lot of ppl want to be able to use the skills they trained for. I think that's the big disconnect: expectation of "F&A surgery" with reality of very few jobs/opportunities that have those pts and good $ + location for doing it. The compromise, for most DPMs, is less surgery/complex, significantly more RFC and general podiatry, and usually less income than expected.

"The whole pattern of medical education is backwards: by the time we realize that we are not going to be TV docs undressing ripe-titted beauties, but rather House docs disimpacting gomers, we’ve invested too much to quit….”

 

[Pronation]

@Feeter
Honestly my hospital is considering hiring a midlevel to handle all the calls for nail care.
We get 20+ a day wanting to see me. Thats not an exaggeration
May be interested in a non surgical DPM in the near future as I doubt a midlevel will take the job.
Would probably make MGMA for 'non surgical DPM'. No calls or weekends.
Feed surgical cases to the two surgical DPMs.
Its not currently a position but may be in the coming month(s).

Isn’t it hilarious that an APP/midlevel won’t do the pedicure crap that a “non surgical” TFP will do

 

[DYK343]

Isn’t it hilarious that an APP/midlevel won’t do the pedicure crap that a “non surgical” TFP will do

I agree but midlevel would max out at 120k (typically salary) where a DPM could probably max out at 275-300k for same job.

Cost of education and time of training might make the jobs more equivalent than it looks but I dont blame a midlevel for wanting to do derm or pulm or cards over cutting toenails all day for same pay.

 

[dtrack22]

Cost of education and time of training might make the jobs more equivalent than it looks but I dont blame a midlevel for wanting to do derm or pulm or cards over cutting toenails all day for same pay.

I mean the one thing most DPMs and midlevels have in common is the desire to be a real doctor. Podiatrists have to take whatever podiatry job they can get. Midlevels can practice independently in various medical/surgical specialty clinics. I honestly think it would be harder to get an NP to cut toenails all day than it would be a DPM. But I’ve never hired one or been at a facility or in a clinic where an NP or PA is in a job just to do RFC

 

[Podstar]

@Feeter
Honestly my hospital is considering hiring a midlevel to handle all the calls for nail care.
We get 20+ a day wanting to see me. Thats not an exaggeration
May be interested in a non surgical DPM in the near future as I doubt a midlevel will take the job.
Would probably make MGMA for 'non surgical DPM'. No calls or weekends.
Feed surgical cases to the two surgical DPMs.
Its not currently a position but may be in the coming month(s).

We have this at my hospital. We have 3 NPs that take all of the nail patients and routine callus care referrals. Works out great for us making our clinics mostly full of good pathology.

 

[Feeter]

There are plenty of 200-300k jobs - op or non... it's called being an owner.
Probably 1.5x or 2x that in a good payer area with good management and production.

One should be able to clear 200k non-op even as an associate, but that depends on the owner, the NH company, the associate productivity, area payers, etc. Surgery doesn't add a ton of value in most PP setups (employed).

...a lot of ppl don't consider just the $, though. The job quality tends to matter a twitch when it's something you'll do for decades. A lot of ppl want to be able to use the skills they trained for. I think that's the big disconnect: expectation of "F&A surgery" with reality of very few jobs/opportunities that have those pts and good $ + location for doing it. The compromise, for most DPMs, is less surgery/complex, significantly more RFC and general podiatry, and usually less income than expected.

"The whole pattern of medical education is backwards: by the time we realize that we are not going to be TV docs undressing ripe-titted beauties, but rather House docs disimpacting gomers, we’ve invested too much to quit….”

If one can clear 300k as a non op or as an op pod without weekends as an owner people on this forum should advocate for this field. Seems like a great field to be in. I am Not in PP but my impression based on my circle of pods and this forum is that it's tough to clear 300k in PP being non op. Maybe I've been wrong.

Regarding expectations of foot and ankle surgery I think that has been driven by ACFAS a lot. Schools are for the most part advertising as podiatry schools but I agree generally speaking podiatrist aren't foot and ankle surgeons and residents think they will be when they graduate only to find lot of clinical jobs with little surgery.

 

[dtrack22]

it's tough to clear 300k in PP being non op.

It’s tough to clear that doing primarily RFC. But ingrowns and warts and plantar fasciitis and bumps/bruises/sprains should pretty easily get you $600k+ in collections. That’s $300k before taxes very easily. But the problem is that it’s less easy (or completely undesirable for some) to be a business owner…

 

[icebreaker32]

It’s tough to clear that doing primarily RFC. But ingrowns and warts and plantar fasciitis and bumps/bruises/sprains should pretty easily get you $600k+ in collections. That’s $300k before taxes very easily. But the problem is that it’s less easy (or completely undesirable for some) to be a business owner…

That is what most in PP are primarily making their money from unless they make a lot from their ASC or something scammy like hardware kickbacks.

The only problem with this plan is saturation in many areas and however long it takes to ramp up. Running a business always comes with lots of risks and you can only afford to buy so many insurance policies.

 

[Feli]

That is what most in PP are primarily making their money from unless they make a lot from their ASC or something scammy like hardware kickbacks...

I was on the road awhile, but regular non-op C&C can make 200-300k net easily with full time fairly full schedule (keep in mind their malpractice and supplies are lower, much less staff time if not needing the surgery paperwork/forms).

If we add any/all of the below to the basic TFP plan, it should be significantly more:
-other non op therapeutic proc (injects, ign, verr, etc)
-diag proc (biopsy, abi, u/s, etc)
-wound care
-DME
-OTC
-do occasional hospital consults
-good payer area
-hire associate(s)
-vascular or path or other referral kickbacks

Now, obviously one can take any of or all those categories/things - or others - as little or as far as they want (no biopsies to nail "biopsy" nearly every pt, abi legit candidates vs almost everyone, solo to milking from many associates, etc). It crosses the line from legit to 'scammy' when the doc, the pts, the community, Medicare, etc say it does.

...I was purely talking bare bones non-op PP. Human farrier-esque: 18 or 20ish pts daily. No joke. Bill for 99213 (on avg, some will be new or -14... but some are also no pays) and 11721 (some have much more proc rvu, some less). So, that's ~100pts/wk, so ~5k visits/yr. That's $100/pt (very low end estimate to assume avg/low payer area or bad billing/collections). With all those limitations, thats still $500k gross and should pretty easily have 50% or less overhead in single location full time office... even if you do a bit of marketing. That's without adding any "frills" above.

And yeah, there are tons of places to capture that market. You will have to acquire a letterman jacket (or sweater) with 'TFP' sewn on its back, but hey... you won't be broke.