Can I ONLY do surgery related to wound care?

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hyperbaricoxy

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Hi everyone, long time reader 1st time poster. I just finished a 3 year podiatry residency that was heavy on surgery but had an emphasis on limb salvage and I spent most my time in the wound care center.

My question: I got a job offer at a wound care clinic and don't mind seeing everything but when it comes to surgery I ONLY want to do surgeries dealing with wound care (ex: toe amputations, TMA, debridements, I&D, etc). I do NOT want to do elective surgeries and bunionectomies, hammertoes, fractures, etc. I have no interest in the latter and don't see the point of "having" to do them when I have no intention of continuing to do them. If someone needs a bunionectomy I will simply send them to my partner who is more than happy to do them.

So, is this possible? I hear differing opinions. I assumed when it came to surgery you must do everything at first (ex: you must do XX 1st ray procedures, XX bunions, XX fractures, etc) then after you hit your numbers you can do whatever you want. Is there another way around this so I can do wound care surgeries in the hospital? It just doesn't make sense to have to go through all those procedures and numbers if I have no intention of ever doing them.

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If you are trying to become board certified with ABFAS, they will require you to do a certain amount of diversity. I don't know about the other boards. Aside from board certification, I am not aware of any requirement that you would have to do the elective cases. You may want to look into the ABPM, not sure if they have similar diversity requirements.
 
Honestly I would get your board certification in whatever you have first and then tailor down your practice as you deem fit.

You are going to need board certification if you ever leave your current job and apply for privileges at another hospital.


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Getting board certified isn't a problem as there are many surgical/non-surgical boards I could take and get privileges at a hospital. As you know the main surgical boards the ABFAS have forefoot and rearfoot parts. If I do either one of those, I MUST do the procedures they have listed in order to remain certified and continue surgeries. Once I get those numbers I realize I could tailor down my practice and pick and choose which surgeries I want. My problem is I simply don't want to do a large portion of those numbers (in my practice I don't see many bunions and fractures, and even if I did I have no interest in fixing them) and want to stick with limb salvage/wound care.
 
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First of all, there is no certification in forefoot surgery. There is FOOT and RRA. And the foot encompasses the toes to the heel.

As far as other board cert other than ABFAS, save your money.

In my opinion you're too young and early in your career to potentially back yourself into a corner. You never know if your current position may not work out and then you'll have decreased value on the job market. Or you may simply change your mind and regret that you only stuck with wound care.

Many wound centers are moving away from having pods on staff. Instead of the pod coming in and billing for services, some wound centers are hiring a surgeon or vascular surgeon full time as a medical director and that doc does it all and all the money stays with the wound care center.

Later on in your career when you are stable and established, it may be okay to only work on wounds. At this time it may be a decision you regret down the line.

I'm just the opposite. I did a lot of wound surgery and amps, but really prefer reconstructive surgery. But I did whatever came my way to maintain my skills and "value".
 
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For every "surgeon" that's hired by wound care centers there are a ton of internal medicine doctors that have no idea what they are looking at but are treating "wounds" in the wound care center. Surgical DPMs should be staffed in these centers because a ton of money is being flushed down the toilet each year by wound care providers who have no idea what they are doing. Many DPMs are also guilty/ included in this group.

A well educated and talented surgical DPM can do a lot of good in a wound care center.


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Agreed. But some of the larger wound care companies are trying to keep the money in house. Traditionally, the wound care centers had DPMs on staff and the pods billed for their own services. I personally don't know of any wound care centers that actually employ pods. They want to actually hire docs who are salaried and they can bill the services and collect the money for the corporation. I'm not implying anyone is doing a better job than the DPM, it's all about the money.
 
First of all, there is no certification in forefoot surgery. There is FOOT and RRA. And the foot encompasses the toes to the heel.

As far as other board cert other than ABFAS, save your money.

In my opinion you're too young and early in your career to potentially back yourself into a corner. You never know if your current position may not work out and then you'll have decreased value on the job market. Or you may simply change your mind and regret that you only stuck with wound care.

Many wound centers are moving away from having pods on staff. Instead of the pod coming in and billing for services, some wound centers are hiring a surgeon or vascular surgeon full time as a medical director and that doc does it all and all the money stays with the wound care center.

Later on in your career when you are stable and established, it may be okay to only work on wounds. At this time it may be a decision you regret down the line.

I'm just the opposite. I did a lot of wound surgery and amps, but really prefer reconstructive surgery. But I did whatever came my way to maintain my skills and "value".
Thanks for your input.
I'm almost 40 (still relatively young I realize) as I am a late bloomer in the field and have had years of experience as an OR nurse, so I feel very comfortable in what I want to do and what I don't want to do. There are so many areas in podiatry that are needed so I do not feel I am decreasing my job market value. For instance, let's say I wanted to do ZERO surgery, there are a TON of places that would (and have) hired me for that job with a great income. Likewise, if someone was more surgery oriented and didn't want to clip nails they too will find a job looking for that. I've done enough bunions, hammertoes, fractures, frames, etc to know I hate it. Frankly, I hate surgery. The reason I find wound care interesting is the same reason most hate it, I am intrigued by it and it is so disgusting at times that it grabs my attention. Nothing like taking out dead bone or cutting into a huge abscess! Not to mention the reimbursement for surgery is absolute crap (atleast in the states I've been at). It is a joke how much we get reimbursed for a bunion and such which is another reason I want out of surgery for the most part.

I am not sure about wound care centers moving away from pods because all the ones in this area have pods on staff or are looking. And the same was true in the area I did my residency. But that might be true in your area.
 
Not to mention the reimbursement for surgery is absolute crap (atleast in the states I've been at). It is a joke how much we get reimbursed for a bunion and such which is another reason I want out of surgery for the most part.

Well now you just sound like all those AAPPM guys
 
Thanks for your input.
I'm almost 40 (still relatively young I realize) as I am a late bloomer in the field and have had years of experience as an OR nurse, so I feel very comfortable in what I want to do and what I don't want to do. There are so many areas in podiatry that are needed so I do not feel I am decreasing my job market value. For instance, let's say I wanted to do ZERO surgery, there are a TON of places that would (and have) hired me for that job with a great income. Likewise, if someone was more surgery oriented and didn't want to clip nails they too will find a job looking for that. I've done enough bunions, hammertoes, fractures, frames, etc to know I hate it. Frankly, I hate surgery. The reason I find wound care interesting is the same reason most hate it, I am intrigued by it and it is so disgusting at times that it grabs my attention. Nothing like taking out dead bone or cutting into a huge abscess! Not to mention the reimbursement for surgery is absolute crap (atleast in the states I've been at). It is a joke how much we get reimbursed for a bunion and such which is another reason I want out of surgery for the most part.

I am not sure about wound care centers moving away from pods because all the ones in this area have pods on staff or are looking. And the same was true in the area I did my residency. But that might be true in your area.

I think it's great that you've found what you like and don't like to do, and that you are dedicating your efforts into limb salvage. From what I gather, you know yourself well and seem happy to do what you're doing, and your question seems to stem from the fact that you're taking a relatively uncommon path and you're concerned about that. Well I think what you're doing is absolutely viable, and you will be a valuable asset to almost any practice. The ONLY reason why I think having some reconstructive experience would be useful is if you want to reconstruct the deformed diabetic foot, which in and of itself is a controversial topic, and candidates for such reconstructions are so few that you ca refer those out and not lose any productivity because of it.
 
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