Number of proctored surgeries

[p100]

I finished residency in 2021 and have not done surgeries since due to starting with a nursing home job.

Now at a private practice I applied for privileges at a hospital and they want me to do 45 proctored cases before giving forefoot only privileges. I am ABFAS foot qualified if that makes any difference.

I understand the need to be proctored before giving full privileges but 45 cases to confirm I can do a hammertoe or bunion procedure seems ridiculous.

Is this normal or standard?

Thanks in advance for your help and for helping other new pods that might be going through this.

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[Adam Smasher]

Such a dirty business we're in. Someone's looking for a reason to keep you out of the OR. You know damn well what you're capable of and you know to stay out of trouble by not overreaching on cases.

Attention all podiatry alphabet soup leaders who are reading this now and too cowardly to comment: this is further proof we are saturated!!! Someone starts out of residency in a nonoperative role just to get some money in the bank and get themselves on their feet financially, and next thing you know their wings are clipped!

 

[Boba Foot]

Probably a good idea to reference this post any time someone asks whether they should do nursing home gigs straight out of residency.

Sorry to hear someone is trying to screw you.

 

[air bud]

I finished residency in 2021 and have not done surgeries since due to starting with a nursing home job.

Now at a private practice I applied for privileges at a hospital and they want me to do 45 proctored cases before giving forefoot only privileges. I am ABFAS foot qualified if that makes any difference.

I understand the need to be proctored before giving full privileges but 45 cases to confirm I can do a hammertoe or bunion procedure seems ridiculous.

Is this normal or standard?

Thanks in advance for your help and for helping other new pods that might be going through this.

This sucks. More details on who is trying to enforce this? We are certainly assuming a podiatrist.

 

[Pronation]

This all sounds very podiatric.

 

[PatchAdamsFan]

Every hospital that I've had privileges at required a 2 year case history submission at application, and after that required anywhere from 1-10 proctored cases for unrestricted privileges. How did we get from "ABFAS should not be required to perform surgeries" to "I haven't touched a blade since residency, why do I need proctoring"? I trust that you are a good surgeon and apologize if it sounds harsh, but getting surgical privileges without any surgical history over the past 2 years is very fortunate. Yeah 45 cases is extreme, just get it done and over with. To be fair, this is not just podiatry - I have an ortho colleague who went from non-surgical to surgical privileges and required increased proctoring for privileges relative to his surgical peers.

 

[Hybrocure]

Some hospitals do this. I think it’s somewhere in the fine print at one or two of the hospitals I’m on staff at. I’ve never had another doc in my OR. I think (if they even follow through with it) it’s probably just someone reading the OP report or glancing at an OR camera every 30 mins. I think they may have even had the head of anesthesia proctor mine without me knowing because he told me I did good work.

 

[icebreaker32]

I doubt they proctor for 45 cases (maybe 1 or 2)....but the reality is they still gave you a way to do surgery.

If they are too restrictive your only other option is to consider other hospitals/surgery centers.

 

[dtrack22]

How did we get from "ABFAS should not be required to perform surgeries" to "I haven't touched a blade since residency, why do I need proctoring"?

Nobody did that.

45 cases is nuts. I had done surgery and had logs previously and I think I had to have 5 cases proctored. But even new ortho would have that requirement, it’s in the hospital bylaws.

 

[p100]

Every hospital that I've had privileges at required a 2 year case history submission at application, and after that required anywhere from 1-10 proctored cases for unrestricted privileges. How did we get from "ABFAS should not be required to perform surgeries" to "I haven't touched a blade since residency, why do I need proctoring"? I trust that you are a good surgeon and apologize if it sounds harsh, but getting surgical privileges without any surgical history over the past 2 years is very fortunate. Yeah 45 cases is extreme, just get it done and over with. To be fair, this is not just podiatry - I have an ortho colleague who went from non-surgical to surgical privileges and required increased proctoring for privileges relative to his surgical peers.

1-10 sounds reasonable to me, hospitals certainly have to cover themselves with regards to liability and have a moral duty to patients that incompetent surgeons are not allowed.

 

[icebreaker32]

I finished residency in 2021 and have not done surgeries since due to starting with a nursing home job.

Now at a private practice I applied for privileges at a hospital and they want me to do 45 proctored cases before giving forefoot only privileges. I am ABFAS foot qualified if that makes any difference.

I understand the need to be proctored before giving full privileges but 45 cases to confirm I can do a hammertoe or bunion procedure seems ridiculous.

Is this normal or standard?

Thanks in advance for your help and for helping other new pods that might be going through this.

You should consider posting your experience as a recent graduate in a new thread.

What job market is like.

What nursing home gigs are like. Income, hours, coding, risk of audits etc

What being an associate is like.

Podiatry is so saturated while so many other healthcare specialities/fields are the exact opposite.

 

[dtrack22]

You should consider posting your experience as a recent graduate in a new thread.

In the pre-pod forum…

 

[p100]

Probably a good idea to reference this post any time someone asks whether they should do nursing home gigs straight out of residency.

Sorry to hear someone is trying to screw you.

I had a few attendings in residency who are successful now (and relatively young) that started out doing nursing homes so it didn't seem like such a bad idea at the time.

Some hospitals do this. I think it’s somewhere in the fine print at one or two of the hospitals I’m on staff at. I’ve never had another doc in my OR. I think (if they even follow through with it) it’s probably just someone reading the OP report or glancing at an OR camera every 30 mins. I think they may have even had the head of anesthesia proctor mine without me knowing because he told me I did good work.

This would be nice.

 

[Poddy2Hotty]

I would just get it done. You complaining is just going to bring the magnifying glass closer to you.
I feel "rusty" after a 2 week vacation
After 2 years I can't imagine...
I have no doubt you can get back on the horse though

I think this is a valuable lesson for new grads. Once you go non-op it is very hard to get back in the OR.
Had a new grad from a stronger residency program in the area take a non-op podiatry job with a bigger healthcare group ~2 years ago because the pay was good. He has never cut since and probably never will.

For new grads take the crappy 120-140k surgical associate job vs the 170k non op job with a bigger group if you want to try to keep your surgical skills.

 

[Feeter]

I don't think you should sign or agree to anything so restrictive. It is nearly impossible to coordinate someone to proctor you for 45 cases. I would argue that they require ALL surgeons to have 45 proctored if they don't have surgical history for past two years.

Reach out to ABPM and Dr. Rogers. He seems to have some resources that could guide you. Get a copy of the bylaws and see if there is anything in it that you can point to and use to create a more rational plan with medical staff office.

Whatever plan they come up with has to be achievable and a plan that would apply in principles to all specialities.

Sorry to hear you are going through this. It is a terrible feeling to have to fight to practice your craft after such a lengthy training.

 

[Boba Foot]

I had a few attendings in residency who are successful now (and relatively young) that started out doing nursing homes so it didn't seem like such a bad idea at the time.

I don't fault you at all. I considered it before I found a decent job. To some, it makes more sense than taking a low paying PP job. But there are a good amount posts asking if nursing home care is a good move, so this is another thing for those folks to consider.

 

[air bud]

This brings up a larger point about continuing to do surgery and keeping your skills sharp. I left a job that paid well enough in a very rural location because I was only doing about 40 cases a year. I was concerned that my skills would atrophy my case logs would suffer and at some point in the future when I wanted to go someplace else I wouldn't be able to show performing certain cases in a significant amount of time. Now that I'm abfas certified in foot and rear foot, maybe that's not as big of a deal obviously would be hospital dependent. But certainly something to think about if you like surgery are well trained and hope to have a more surgical job in the future but take a minimal surgery or non-op job for the time being.

That being said in four locations, four different Hospital systems I've never had any case proctored.

 

[p100]

Here is what makes it difficult. Here are snippets from the administrative policy booklet.

B. Assignment of a Proctor
1. The Proctor must be a member of the Professional Staff with unrestricted clinical privileges to
perform the procedures that he/she will proctor. If no Professional Staff members who have the
necessary qualifications are available to proctor, special arrangements may be made for the selection
of a Proctor who is not a current member of the Professional Staff or for the Professional Staff
member to receive proctoring at another hospital. In addition, he/she must have documented training,
skill, and current competence in the service or procedure that is the subject of the proctoring. With
regard to Professional Staff members applying for new or additional privileges, the Professional Staff
member is responsible for contacting potential Proctors and choosing his/her Proctor with the
approval of the Department Chairperson.

IV. DEFINITIONS:
A. Proctoring: The personal presence of an assigned Professional Staff member (“Proctor”) who does not
have a treatment relationship with the patient, who is designated to provide clinical teaching or to
monitor the clinical performance of another Professional Staff member to facilitate quality of care to
patients, as required for purposes of credentialing, reappointment, quality improvement, or corrective
action.


5. Proctors shall not receive compensation directly or indirectly from any patient for this service.


D. Responsibility of the Proctored Practitioner
- 4. Any costs of professional fees incurred by the presence and/or assistance of the Proctor will be the
responsibility of the Professional Staff member.

I will have to find someone on staff willing to babysit me for 45 cases and pay them from my own pocket to be there. The timings are also on the proctor's schedule. I just do not see how it will be possible to complete 45 cases in this manner.

 

[Shiyuan]

Here is what makes it difficult. Here are snippets from the administrative policy booklet.




I will have to find someone on staff willing to babysit me for 45 cases and pay them from my own pocket to be there. The timings are also on the proctor's schedule. I just do not see how it will be possible to complete 45 cases in this manner.

Insane. What a joke. As @air bud would put it... it’s because.... Podiatry.

 

[p100]

I would just get it done. You complaining is just going to bring the magnifying glass closer to you.
I feel "rusty" after a 2 week vacation
After 2 years I can't imagine...
I have no doubt you can get back on the horse though

I think this is a valuable lesson for new grads. Once you go non-op it is very hard to get back in the OR.
Had a new grad from a stronger residency program in the area take a non-op podiatry job with a bigger healthcare group ~2 years ago because the pay was good. He has never cut since and probably never will.

For new grads take the crappy 120-140k surgical associate job vs the 170k non op job with a bigger group if you want to try to keep your surgical skills.

I am okay with being proctored and if I it my posts read as complaining it is not intentional. I just do not see how it will be possible to complete with the amount and restrictions. Maybe it will be easy and in a few months will follow up with a post of good news.

 

[air bud]

Now that I think about it, my recent contract said 10 cases proctored. I asked about it and they said no don't worry about since already operating. Was just for new surgeons. Was written into the bylaws. So some cases being proctored is probably reasonable. Not 45. That's just a dic* move

 

[PatchAdamsFan]

I will have to find someone on staff willing to babysit me for 45 cases and pay them from my own pocket to be there. The timings are also on the proctor's schedule. I just do not see how it will be possible to complete 45 cases in this manner.

Wow. Unless the proctoring is only required "on paper" as mentioned by some, I would find a surgery center or two in your area instead.

 

[Pronation]

I would just get it done. You complaining is just going to bring the magnifying glass closer to you.
I feel "rusty" after a 2 week vacation
After 2 years I can't imagine...
I have no doubt you can get back on the horse though

I think this is a valuable lesson for new grads. Once you go non-op it is very hard to get back in the OR.
Had a new grad from a stronger residency program in the area take a non-op podiatry job with a bigger healthcare group ~2 years ago because the pay was good. He has never cut since and probably never will.

For new grads take the crappy 120-140k surgical associate job vs the 170k non op job with a bigger group if you want to try to keep your surgical skills.

How about for a new grad that’s trying to decide between a 225k non op job and a 100k PP heavy free labor and surgical job.

 

[icebreaker32]

Here is what makes it difficult. Here are snippets from the administrative policy booklet.




I will have to find someone on staff willing to babysit me for 45 cases and pay them from my own pocket to be there. The timings are also on the proctor's schedule. I just do not see how it will be possible to complete 45 cases in this manner.

Go to a surgical center and reapply in 2 years.

 

[icebreaker32]

How about for a new grad that’s trying to decide between a 225k non op job and a 100k PP heavy free labor and surgical job.

I say take the money if it is a great job and where one wants to live. Get ABPM and if things change worry about that later.

 

[ChartingChad]

Here is what makes it difficult. Here are snippets from the administrative policy booklet.




I will have to find someone on staff willing to babysit me for 45 cases and pay them from my own pocket to be there. The timings are also on the proctor's schedule. I just do not see how it will be possible to complete 45 cases in this manner.

Is this standard for proctoring cases unless you work with a colleague willing to proctor you for free?

 

[Adam Smasher]

I will have to find someone on staff...and pay them from my own pocket to be there

It's a bribe.

 

[icebreaker32]

Is this standard for proctoring cases unless you work with a colleague willing to proctor you for free?

Most often at other places someone with a title (chief of surgery, maybe another senior podiatrist on staff) peeks their face in for 5 minutes a couple of times your first couple of cases and that is it. It is usually free.

They can do what they want. Outside of podiatry taking a 2 year break from surgery is not common.

I bet most surgery centers would be more accommodating.

 

[icebreaker32]

It's a bribe.

New income possibilities for our saturated market.

 

[Poddy2Hotty]

I am okay with being proctored and if I it my posts read as complaining it is not intentional. I just do not see how it will be possible to complete with the amount and restrictions. Maybe it will be easy and in a few months will follow up with a post of good news.

Maybe ask for ~10 to be proctored in person and 35 cases to be reviewed and signed off on

I needed 6 cases proctored when I started. Yeah its a pain. Other pod scrubbed one with me then just showed up popped head in and signed off.

 

[Poddy2Hotty]

How about for a new grad that’s trying to decide between a 225k non op job and a 100k PP heavy free labor and surgical job.

Lol send me the info on a 225k non op job. Unless it involves tips for sucking toes I call shenanigans!!!

 

[p100]

Maybe ask for ~10 to be proctored in person and 35 cases to be reviewed and signed off on

I needed 6 cases proctored when I started. Yeah its a pain. Other pod scrubbed one with me then just showed up popped head in and signed off.

I requested 5 cases to be proctored before starting this thread with the hope they will counter with 10.

Lol send me the info on a 225k non op job. Unless it involves tips for sucking toes I call shenanigans!!!

 

[Pronation]

Could’ve sworn I saw some non op hospital jobs posted last year for like 200k. Seems reasonable to produce the needed RVUs. Say 230 working days, 20 RVUs per clinic day, 45/RVU (lower for being a non op) results in just over 200k

 

[air bud]

Joke's on all of you guys nonop jobs don't exist anymore that's what nurse practitioners in pas are for. Going forward the only non-op job I could imagine would be with an ortho group with no existing Podiatry experience where they still want somebody who could appropriately diagnose work up things and then just hand them off to Ortho for surgery. But existing hospitals that have podiatrists are not hiring a podiatrist for a nonoperative job they will just have theirs do more surgery and nurse practitioners see non-op stuff post-ops etc.


....... Because Podiatry

 

[podiatryresident]

Hello everyone, can I ask a question here ? How hospital verify your logs or surgical privileges if you just graduate ? How do you keep the logs for applying your 1st or 2nd job ? Thank you so much!

 

[Poddy2Hotty]

Hello everyone, can I ask a question here ? How hospital verify your logs or surgical privileges if you just graduate ? How do you keep the logs for applying your 1st or 2nd job ? Thank you so much!

Print a copy of your MAV/surgical logs with all procedures. Have your director sign it. Save it for your first few years out. You can trash it when you get ABFAS.

 

[air bud]

Hello everyone, can I ask a question here ? How hospital verify your logs or surgical privileges if you just graduate ? How do you keep the logs for applying your 1st or 2nd job ? Thank you so much!

Excel spreadsheet if I recall. Don't you just export your logs to a file?

 

[dtrack22]

Hello everyone, can I ask a question here ? How hospital verify your logs or surgical privileges if you just graduate ? How do you keep the logs for applying your 1st or 2nd job ? Thank you so much!

I used residency logs for first jobs out of residency and then I used logs from ABFAS logging website for most recent job. I just exported them to PDF or whatever they allow you to do, and sent it off to the medical staff person who was working on my credentialing. They didn’t care that it wasn’t some notarized/sealed/official letterhead piece of paper from the actual facilities.

I’m sure some hospitals are more strict than others though. In which case you could have to call old ORs and have them send over your case logs from their facility to the new job.

 

[billBOB213]

I say take the money if it is a great job and where one wants to live. Get ABPM and if things change worry about that later.

This.

 

[DYK343]

I had to do 10 cases at my first job. It really sucked trying to coordinate that.
45 is absolutely insane and gatekeeping.

 

[Feli]

Normal would be 0-5 proctored cases, usually just for RRA cases.
I've had that done for me at two facilities (of probably two dozen I've held privi at).

If you are not in a group where your group docs can proctor for you, it's very hard to do, and you have to work around the proctors' schedule.

I have been asked to proctor other docs (usually after questionable results), and I refused... saying conflict of interests. That's a no-win situation: either say they are ok when they suck at surgery... or say they suck and they hate you for saying they do.

45 cases? Give up on that facility. That's fairly crazy and they obviously want to keep you out, but in their defense, you haven't done any surgery on your own since finishing training... two years ago.

Go to a surgical center and reapply in 2 years.

Yes, exactly... you need to find a different hospital or ASC... the one with 45 required is a no-go.

If that's an important facility to the PP, you will likely lose your PP job (or have to take a paycut and be non-op) over this.

 

[diabeticfootdr]

I finished residency in 2021 and have not done surgeries since due to starting with a nursing home job.

Now at a private practice I applied for privileges at a hospital and they want me to do 45 proctored cases before giving forefoot only privileges. I am ABFAS foot qualified if that makes any difference.

I understand the need to be proctored before giving full privileges but 45 cases to confirm I can do a hammertoe or bunion procedure seems ridiculous.

Is this normal or standard?

Thanks in advance for your help and for helping other new pods that might be going through this.

Medicare requires hospitals to verify your “current experience” which they define as 24 months. The Joint Commission recently revised their standards for 3 years.

So you will have to be proctored, but 45 cases is too onerous and not standard. Don’t agree to it, because then it’s harder to fight later.

These previous suggestions are good:

1. Go to an ASC first
2. Ask for 10 proctored and 35 reviewed

Also, ask for help from your certifying board, your state association, or an attorney.

PICA is uniquely helpful if you are threatened with the loss of privileges, but it’s not covered for the initial application denial.

 

[podiatryresident]

Excel spreadsheet if I recall. Don't you just export your logs to a file?

I used residency logs for first jobs out of residency and then I used logs from ABFAS logging website for most recent job. I just exported them to PDF or whatever they allow you to do, and sent it off to the medical staff person who was working on my credentialing. They didn’t care that it wasn’t some notarized/sealed/official letterhead piece of paper from the actual facilities.

I’m sure some hospitals are more strict than others though. In which case you could have to call old ORs and have them send over your case logs from their facility to the new job.

Print a copy of your MAV/surgical logs with all procedures. Have your director sign it. Save it for your first few years out. You can trash it when you get ABFAS.

Thank you so much for your responses. I'm sorry for that weird question because I don't have seniors in my program. The reason why I asked that question because I feel those logs are scam. Be honest, my program doesn't have many good podiatrists. I only learn from 2 pods and 1 ortho guy. The rest is full of ****. Feel bad if I have to carry those cases around for a job! :|
Is there any chance I will be asked pictures for those cases ? @@

 

[dtrack22]

Is there any chance I will be asked pictures for those cases ?

I’m not sure what you mean but nobody is asking for digital images of your handy work

 

[DexterMorganSK]

Thank you so much for your responses. I'm sorry for that weird question because I don't have seniors in my program. The reason why I asked that question because I feel those logs are scam. Be honest, my program doesn't have many good podiatrists. I only learn from 2 pods and 1 ortho guy. The rest is full of ****. Feel bad if I have to carry those cases around for a job! :|
Is there any chance I will be asked pictures for those cases ? @@

make another thread; thanks

 

[PeaJay]

I’m not sure what you mean but nobody is asking for digital images of your handy work

Darn. I’ve been drawing before and after pictures just incase.

 

[Feli]

As much as it pains me to say this:

"This may be a good reason to do a fellowship."

Ugh... but it's actually kinda true. If you haven't done any OR surgery in a couple years and have never done a single case on your own... yet you still want to do surgery, most facilities are going to require at least some proctoring. If you do a decent fellowship (not tough to get aside from the very few elite ones), you can refresh on F&A surgery, get logs, and probably have little problem getting privileges afterwards. I think some fellows even (try) to use some cases for ABFAS cert.

Fwiw, this is normally the case for MDs also - especially in competitive areas: 2 or 3 years of no same/similar procedures might mean they struggle to ever get those privileges again. At minimum, most places would have them proctored a bit... even for extended maternity, FMLA, etc injury that had a very long time without documented OR work.

 

[icebreaker32]

Is there any chance I will be asked pictures for those cases ? @@

No these are not boards. Use your logs if they ask and get privileges. Only do the privileges you feel comfortable with.

If necessary consider a fellowship.

 

[Feeter]

Could’ve sworn I saw some non op hospital jobs posted last year for like 200k. Seems reasonable to produce the needed RVUs. Say 230 working days, 20 RVUs per clinic day, 45/RVU (lower for being a non op) results in just over 200k

Most op jobs are offering $45s per wRVU in metro areas. Some even lower. I'd think non ops would be lower.

 

[Pronation]

Most op jobs are offering $45s per wRVU in metro areas. Some even lower. I'd think non ops would be lower.

Damn that sucks. Most of my homies are well into the 50s. I know of one that's ultra rural north and in the low 60s.

But as mentioned before, these non op jobs are going to entirely disappear soon because of replacement by APPs.