Job market

[podfam3008]

Okay, I know the job market is not great for Podiatry in general. A lot of jobs are word of mouth, but has anyone noticed that lately it has been extra terrible??? It seems like the only job postings I see repeatedly are nursing homes. Maybe this is just my state? Is it related to COVID-19? Have you all noticed this too?

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[NobodyDPM]

Jobs are out there. And yes, most are word of mouth. Most jobs out there won't advertise on those "job posting" sites because they don't need to.

 

[air bud]

Jobs are out there. And yes, most are word of mouth. Most jobs out there won't advertise on those "job posting" sites because they don't need to.

Make your future happen. Pick up the phone

 

[JewOnThis]

Podiatry has always been terrible and will Not change anytime soon. Nursing home jobs actually pay well. I saw a posting for 185K a year. I have never made that much when I was enslaved by a former APMA officer in PP.

 

[newfeet]

Jobs are out there. And yes, most are word of mouth. Most jobs out there won't advertise on those "job posting" sites because they don't need to.

Okay, I know the job market is not great for Podiatry in general. A lot of jobs are word of mouth, but has anyone noticed that lately it has been extra terrible??? It seems like the only job postings I see repeatedly are nursing homes. Maybe this is just my state? Is it related to COVID-19? Have you all noticed this too?

I send emails, I created alerts on indeed and I looked at hospital websites to see if they were hiring. I checked the postings on jobs sites everyday. I still have the habit of checking them everyday. There are jobs out there.

 

[DYK343]

It is hard for new grads.
Non new grads with board certification and experience it is not as hard as some posters make it seem.
I recently almost jumped ship on a nibble I sent out. But decided to stay despite it being a stupid financial decision to stay.

 

[619]

I saw a posting for 185K a year.

Very certain that no one working nursing homes is making anything close to $185K except if one is billing aggressively. Nails pay like 30 bucks on average at Nursing homes. You know how many nails you will have to cut?

I did nursing home once a week for about 7 months (with 360 care) when I was opening up my practice so I am speaking from a first hand experience.

 

[air bud]

Quit checking job boards, browsing websites etc and hoping for something to happen. Pick up the g** d*** phone and call. One of our friends on here has 3 legit MSG/Hospital offers in less than month of trying. How? He/She/They treated the job hunt like a job and pounded the phone lines. But yeah, having a job and being board certified makes it easier.

 

[JewOnThis]

Quit checking job boards, browsing websites etc and hoping for something to happen. Pick up the g** d*** phone and call. One of our friends on here has 3 legit MSG/Hospital offers in less than month of trying. How? He/She/They treated the job hunt like a job and pounded the phone lines. But yeah, having a job and being board certified makes it easier.

I tried cold calling many years ago. It didn’t work so well. But yeah, pick up the phone and start calling if you don’t have any luck with online job searching.

 

[podfam3008]

Actually, I have called many many multi-speciality groups, hospitals, and clinics. Unfortunately, I am looking for part-time work, and a lot of the people who showed interest initially have ghosted due to funding, implementation etc, which is just odd. Hence the question of whether you guys noticed the same trend recently. I do not and have NEVER depended on online postings. I am already board certified in ABFAS with several years experience too. I have gotten good job positions in the past from actively calling and pounding the pavement. It was a simple question, given the pandemic.

Also, I don't know who the heck is making 185k from nursing homes unless you are over-billing. The company I worked for a day a week, I barely scraped a few thousand dollars taking home 40%.

 

[HardRoadPaved]

Also, I don't know who the heck is making 185k from nursing homes unless you are over-billing. The company I worked for a day a week, I barely scraped a few thousand dollars taking home 40%.

185k / .4 = $462,500 total collections
Assume average $50 reimbursement (all nails no calluses)
$462,500 / $50 = 9,250 visits needed
9,250 visits in 250 work days (2 weeks vacay to rest those hands/back) = 37 patients per day.

Sounds awful.... or as you said... fraudulent.

 

[JewOnThis]

The company was hiring a full time podiatrist for 185k base salary in north or South Carolina. I saw that posting a few months ago. I’m sure it was happily filled by an sdn member. 😂

 

[dtrack22]

Assume average $50 reimbursement (all nails no calluses)

This is generous given that you are reimbursed at a facility rate which means $27 in areas where 11721 pays around $50 in clinic.

You have to bill calluses in nursing home visits to make $185k and as someone who has done nursing home work, none of them actually have calluses. Can’t get them when you are in a wheelchair or laying in bed all day. So you’re right, fraud would probably be required.

 

[Shiyuan]

I may of mentioned before, but look into Federally Qualified Health Centers (FQHCs). Similiar benefits to VA (malpractice coverage through government, medical, 401k w/match, etc...), good pay (one I know of pays it’s pod >250k... and BTW salaries are public given gov funding), decent lifestyle, etc...

Many FQHCs act as mini MSGs... mostly family med with some dentistry, peds and social work. But many are starting to gravitate toward podiatry given our diabetic management, routine care and wound care.

 

[dtrack22]

I may of mentioned before, but look into Federally Qualified Health Centers (FQHCs). Similiar benefits to VA (malpractice coverage through government, medical, 401k w/match, etc...), good pay (one I know of pays it’s pod >250k... and BTW salaries are public given gov funding), decent lifestyle, etc...

Many FQHCs act as mini MSGs... mostly family med with some dentistry, peds and social work. But many are starting to gravitate toward podiatry given our diabetic management, routine care and wound care.

This is good info. A newer grad started at a FQHC where I live (small metro but a lot bigger than where I actually practice) a year and a half ago. Same setup as described above with family led, peds, psych/counseling, and dentistry. Reps say he isn’t real busy surgically, mostly pus and bread and butter forefoot. But if he’s making a few hundred grand and has good hours, benefits, etc. then it’s 10x better than working for a DPM out of residency.

And if you’re one of those folks with $300k+ of student loans I’d imagine the above jobs make PSLF a real possibility and worthwhile.

 

[JewOnThis]

This is good info. A newer grad started at a FQHC where I live (small metro but a lot bigger than where I actually practice) a year and a half ago. Same setup as described above with family led, peds, psych/counseling, and dentistry. Reps say he isn’t real busy surgically, mostly pus and bread and butter forefoot. But if he’s making a few hundred grand and has good hours, benefits, etc. then it’s 10x better than working for a DPM out of residency.

And if you’re one of those folks with $300k+ of student loans I’d imagine the above jobs make PSLF a real possibility and worthwhile.

I don’t know of any DPM doing surgeries at a FQHC facility.

 

[dtrack22]

I don’t know of any DPM doing surgeries at a FQHC facility.

The FQHC is a clinic. He doesn’t do any surgery at the clinic, he does them at the hospitals he has privileges at.

 

[619]

Reps say he isn’t real busy surgically, mostly pus and bread and butter forefoot. But if he’s making a few hundred grand and has good hours, benefits, etc. then it’s 10x better than working for a DPM out of residency.

This is the truth. Majority of podiatrist are not going to be busy surgically after residency. Doing 10 cases or more a week during residency is not going to happen out in practice. Luckily clinic is where the money is anyway - office procedures, DME etc can and does bring in a lot of income.

 

[DYK343]

This is the truth. Majority of podiatrist are not going to be busy surgically after residency. Doing 10 cases or more a week during residency is not going to happen out in practice. Luckily clinic is where the money is anyway - office procedures, DME etc can and does bring in a lot of income.

Its amazing how much surgery really does not pay (unless you're Airbud - ive seen his reimbursements!). Some contracts are lucrative but most of the time its not worth the headache.

If I'm doing 1-2 cases that day its not really worth getting out of bed. I try to stack my surgery days with 4-5 cases if I can. I'm still doing RRA and recons to pad my ego but honestly I might just give that up all together. I can do 2-3 smaller cases for every big case and the income is more with less headache and happier patients. Big cases big problems.

Office procedures are where its at.

 

[JewOnThis]

The FQHC is a clinic. He doesn’t do any surgery at the clinic, he does them at the hospitals he has privileges at.

That’s what I meant. Those malpractice insurance from FQHC facilities do not cover patient care outside the clinic. At least that was what I was informed. That DPM must have another malpractice insurance I am assuming.

 

[wakaflocka88]

Its amazing how much surgery really does not pay (unless you're Airbud - ive seen his reimbursements!). Some contracts are lucrative but most of the time its not worth the headache.

If I'm doing 1-2 cases that day its not really worth getting out of bed. I try to stack my surgery days with 4-5 cases if I can. I'm still doing RRA and recons to pad my ego but honestly I might just give that up all together. I can do 2-3 smaller cases for every big case and the income is more with less headache and happier patients. Big cases big problems.

Office procedures are where its at.

100% on this. Tenotomies, injections, nail avulsions, even a delayed primary closure pays good moola. Love in office procedures.

 

[deleted1097413]

100% on this. Tenotomies, injections, nail avulsions, even a delayed primary closure pays good moola. Love in office procedures.

how much do you get paid for these?

 

[DYK343]

how much do you get paid for these?

A matrixectomy pays me about 1/2 of a bunion. Maybe a little more than half. Matrixectomy takes 15 minutes and I see another patient in between when they are numbing up.

In office tenotomy pays about the same as a traditional hammertoe correction in OR. Total time 15 minutes.

 

[Shiyuan]

#18 gauge tenotomies are the best!

 

[air bud]

#18 gauge tenotomies are the best!

Yeah, I used to mess around with a 15 blade and obviously incorrectly bill it as an open procedure. Now billing correctly as perc and amazingly easy with just a needle. I used to mess around with putting a dressing on and stitches and a surgical shoe and now it's just a needle in a Band-Aid and wear a regular shoe and see you later.

And yeah the OR is what pays my bills....1800 to 2300 for a private practice Brostrom. 1500 to 1900 for a lapidus....800 bucks for 20902 you better believe I am harvesting bone graft for almost every fusion....

 

[dtrack22]

#18 gauge tenotomies are the best!

They are great but not as great financially if you bill them as perc procedures. I’m sure nobody here bills the open tenotomy/capsulotomy codes when doing it with a needle…lol.

Kidding, of course everyone is billing it as an open procedure after describing their “stab incision.”

Those malpractice insurance from FQHC facilities do not cover patient care outside the clinic. At least that was what I was informed. That DPM must have another malpractice insurance I am assuming.

No idea, but he takes call at a local hospital so he’s clearly covered by some malpractice outside of the clinic.

 

[air bud]

They are great but not as great financially if you bill them as perc procedures. I’m sure nobody here bills the open tenotomy/capsulotomy codes when doing it with a needle…lol.

Kidding, of course everyone is billing it as an open procedure after describing their “stab incision.”



No idea, but he takes call at a local hospital so he’s clearly covered by some malpractice outside of the clinic.

Right but no reason to stay say stab incision. As the acfas billing "gurus" say, it doesn't matter how large or small of an incision it takes you to do something it's still an incision....

 

[JewOnThis]

They are great but not as great financially if you bill them as perc procedures. I’m sure nobody here bills the open tenotomy/capsulotomy codes when doing it with a needle…lol.

Kidding, of course everyone is billing it as an open procedure after describing their “stab incision.”



No idea, but he takes call at a local hospital so he’s clearly covered by some malpractice outside of the clinic.

Your friend sounds likes a guy who practices in the Austin proper.

 

[dtrack22]

Right but no reason to stay say stab incision. As the acfas billing "gurus" say, it doesn't matter how large or small of an incision it takes you to do something it's still an incision....

There is a percutaneous tenotomy code. You can’t bill the open code if you say you poked an 18 gauge needle through the skin. That’s percutaneous, not “open.”

 

[Shiyuan]

I think the CPT is 28010

 

[dtrack22]

Your friend sounds likes a guy who practices in the Austin proper.

I don’t know the guy personally. He works where I live in the PNW so I have an understanding of his practice but the details I shared is really all I know

 

[air bud]

There is a percutaneous tenotomy code. You can’t bill the open code if you say you poked an 18 gauge needle through the skin. That’s percutaneous, not “open.”

Right that is what I am saying. 28010 for perc instead of the 28232 for "open"

 

[wakaflocka88]

Right that is what I am saying. 28010 for perc instead of the 28232 for "open"

Ya I do 28010 for my 18g tenotomies. I also know people that bill the “open” code for the same procedure. Not for me.

 

[king22]

I used to do 18g tenotomies, now I use a 67 blade. I make two "stab" incisions in a V formation, then transect both tendons. I then suture it in a V-Y fashion (which takes usually no more than 3 stitches). I bill a 28232.

I've been doing this for the past 3 years and have found that the results are superior compared to just a simple 18ga. It also really doesn't take significantly longer.

 

[wakaflocka88]

I used to do 18g tenotomies, now I use a 67 blade. I make two "stab" incisions in a V formation, then transect both tendons. I then suture it in a V-Y fashion (which takes usually no more than 3 stitches). I bill a 28232.

I've been doing this for the past 3 years and have found that the results are superior compared to just a simple 18ga. It also really doesn't take significantly longer.

I feel I can get both tendons with my 18g most of the time and so far on my follow ups, their toes stay pretty rectus - granted it wasn’t a terrible HT deformity to start with.

How much more does a 28232 reimburse compared to a 28010?

 

[air bud]

I used to do 18g tenotomies, now I use a 67 blade. I make two "stab" incisions in a V formation, then transect both tendons. I then suture it in a V-Y fashion (which takes usually no more than 3 stitches). I bill a 28232.

I've been doing this for the past 3 years and have found that the results are superior compared to just a simple 18ga. It also really doesn't take significantly longer.

Interesting. I would consider that If truly doing open procedure. Never really happy with a simple suture feels like contracts the toe and would like the lengthening aspect of the v to Y. I mean at that point why not bill it that way....

 

[DYK343]

Yeah, I used to mess around with a 15 blade and obviously incorrectly bill it as an open procedure. Now billing correctly as perc and amazingly easy with just a needle. I used to mess around with putting a dressing on and stitches and a surgical shoe and now it's just a needle in a Band-Aid and wear a regular shoe and see you later

I bandage and put on cephalexin 3 days. I dont trust diabetics (which is the majority of the reason I do them).

I used to do 18g tenotomies, now I use a 67 blade. I make two "stab" incisions in a V formation, then transect both tendons. I then suture it in a V-Y fashion (which takes usually no more than 3 stitches). I bill a 28232.

I've been doing this for the past 3 years and have found that the results are superior compared to just a simple 18ga. It also really doesn't take significantly longer.

Interesting. Do you get floating toe/extensor contracture with cutting both tendons? I usually sever only the long flexor at DIPJ w 18g. So far good results with that.

 

[heybrother]

At some point I have to try this needle thing. I use a #64 blade and still do a very small open longitudinal. 1 suture. 1 follow-up visit - suture out and discharge if appropriate. I won't argue the virtue of the fact that your patient has no true incision and no suture and ...no dressing. Ok. Its sexy. Open does allow me to push the limits if I'm trying to keep someone from the operating room.

Rare but possible complication - swan neck deformity. A plantarflexed middle phalanx with an extended distal phalanx

Random fun thing - hallux flexor tenotomies. So much more tactile feedback. I had a patient awhile back with a semi-rigid hallux flexion contracture (no MPJ deformity) who was ulcerating on top of the toe. Cut the flexor - nothing. Entered the joint and ultimately was able to release enough to change the position. Then I got paid sub-$200 because of insurance. Which brings me back to something that keeps coming up around here lately. Procedures only pay well if you have good contracts. I can't prove it but I strongly believe my practice leaves $100K+ on the table due to our poor contracts.

 

[air bud]

I bandage and put on cephalexin 3 days. I dont trust diabetics (which is the majority of the reason I do them).

Interesting. Do you get floating toe/extensor contracture with cutting both tendons? I usually sever only the long flexor at DIPJ w 18g. So far good results with that.

Agree I do DIPJ and only long flexor

 

[NobodyDPM]

The FQHC is a clinic. He doesn’t do any surgery at the clinic, he does them at the hospitals he has privileges at.

This is bizarre. Is he an actual employee of the FQHC? If he is, there are issues associated with what you are saying he does. FQHCs function by bringing patients into the clinic. Each patient brings in $X. How is your friend getting paid for the actual surgeries? Since it's not done in the clinic, he must be billing separately which increases his overhead, and brings in a whole other complexity factor to the job. And as mentioned, he must be paying his own malpractice, as well.

Ultimately, he may have a contract to cover the facility only, and has the rest to do on his own. I have never heard of an FQHC that is busy enough with podiatry to have their own podiatrist employee. Most of them use contractors from private practices.

 

[HardRoadPaved]

I then suture it in a V-Y fashion (which takes usually no more than 3 stitches). I bill a 28232.

Tack on 14040 for the v-y tissue closure?

 

[air bud]

Tack on 14040 for the v-y tissue closure?

Hey man, just trying to reduce risk of recontracture...

 

[Shiyuan]

This is bizarre. Is he an actual employee of the FQHC? If he is, there are issues associated with what you are saying he does. FQHCs function by bringing patients into the clinic. Each patient brings in $X. How is your friend getting paid for the actual surgeries? Since it's not done in the clinic, he must be billing separately which increases his overhead, and brings in a whole other complexity factor to the job. And as mentioned, he must be paying his own malpractice, as well.

Ultimately, he may have a contract to cover the facility only, and has the rest to do on his own. I have never heard of an FQHC that is busy enough with podiatry to have their own podiatrist employee. Most of them use contractors from private practices.

I know of 4 FQHCs with full time podiatrist(s). But for all of them, I think they are just nonsurgical positions.

 

[king22]

I feel I can get both tendons with my 18g most of the time and so far on my follow ups, their toes stay pretty rectus - granted it wasn’t a terrible HT deformity to start with.

How much more does a 28232 reimburse compared to a 28010?

It's about a $150 more.

 

[king22]

I bandage and put on cephalexin 3 days. I dont trust diabetics (which is the majority of the reason I do them).

Interesting. Do you get floating toe/extensor contracture with cutting both tendons? I usually sever only the long flexor at DIPJ w 18g. So far good results with that.

Rarely. The few times I did get an extensor contracture I just performed an extensor/capsulotomy.

 

[air bud]

It's about a $150 more.

Is that 150 worth the online scorn of @ExperiencedDPM ?

 

[king22]

Is that 150 worth the online scorn of @ExperiencedDPM ?

Scorn away! I make two stab incisions, reflect the apex of the V, extend the PIPJ which brings tendon/tendons into view, then I cut.

If that's not considered an "open" procedure then I'm not sure what would qualify.

 

[air bud]

Scorn away! I make two stab incisions, reflect the apex of the V, extend the PIPJ which brings tendon/tendons into view, then I cut.

If that's not considered an "open" procedure then I'm not sure what would qualify.

Yeah that is legit open. I meant just using a 15 blade and stabbing stuff

 

[DYK343]

Do you bill for both capsulotomy and flexor tendon release? I've only billed it as a perc flexor tendon release but I almost always do a capsulotomy as well.

 

[heybrother]

Do you bill for both capsulotomy and flexor tendon release? I've only billed it as a perc flexor tendon release but I almost always do a capsulotomy as well.

26. If the code descriptor of a HCPCS/CPT code includes the phrase “separate procedure,” the procedure is subject to NCCI PTP edits based on this designation. The CMS does not allow separate reporting of a procedure designated as a “separate procedure” when it is performed at the same patient encounter as another procedure in an anatomically related area through the same skin incision, orifice, or surgical approach.