Hello,
I'm interested to know how much rearfoot/ankle procedures are performed in your practice? Also, do you treat the soft tissue up to the tibial tuberosity (depending on your state's laws of course)? Is it becoming more common for pods to do rearfoot/ankle work than in the past? I thought this would be the case recently since the majority of residency spots are 3 years in length and allow one to become "certified" in forefoot, rearfoot, ankle surgery.
I've heard on these forums that a number of pods will stick to mostly forefoot procedures and they are often called the "bread and butter" of the profession (bunions, hammertoes, neuromas, etc). The pros being they are often relatively quick procedures, can be done in-office or surgical suite, pay well, etc.
Also I read that rearfoot/ankle procedures are often more complicated, have longer healing time, often require general anesthesia, higher chance of post-op problems, etc. I understand that surgeries are under a "global fee" which includes post-op visits...so if you have a non-compliant patient or one that is not healing "well" then it can be a problem.
Overall, I'm wondering if there is enough opportunity for future pods to do rearfoot/ankle procedures or surgeries? I understand that 39 states include the ankle in the scope of practice but it is ultimately up to each individual hospital in saying what one can and cannot do.
Thank you very much for the help. I really appreciate it!
I can tell you that the Podiatrists in my group does about 1/3 of the surgeries are rearfoot and the remaining 2/3 of the surgeries are forefoot. We do tons of bunions and hammertoes. We also do quite a bit of neuroma excisions and EPFs. Since we are located in a community hospital that is not a trauma center, I don't get to see that many cool rearfoot fractures that people in level one trauma see. We do see some achilles tendon rupture, ankle fractures, calcaneal fractures, and oddly lisfranc fractures (which are supposedly rare). The remaining reconstructive rearfoot procedures depend on the what we get in the office. Majority of our patient with hindfoot or ankle arthritis do just fine with orthotics or bracing. Very few patients ever progress to a point where they have exhausted all conservative options and surgery is their only option. Perhaps, my group is more conservative than other Podiatry groups. This may be the fact that I am in one of the areas in the country that have very high malpractice risk area and many of the docs practice defensive medicine.
As for more pods doing ankle and rearfoot surgeries, I do believe that we will continue to see more pods doing ankle and rearfoot surgeries due to our improved surgical training. However, as it was pointed out in other forums and by you, your privileges at the hospital or surgery center is really based on the bylaws of the hospital or surgery center. Just because the state law says you can operate on the ankle, it does not mean that hospital will grant you that privilege if the hospital bylaws does not include Pods doing ankles. Of course, hospital bylaws can be changed over time.
In regards to Pods sticking to bread and butter surgery, well, in general, we see more people require forefoot surgery than rearfoot surgery. Hence, the bread and butter surgeriers are forefoot stuff, such as bunion, hammertoes, neuromas, etc....
I was talking to some of the older Podiatrists the other day. They told me that they used to do all of these rearfoot reconstructive surgeries. Howver, several of them have now cut back from doing those surgeries because it is not economical for them to do the surgery. WIth all of the time that you spend doing a major reconstructive rearfoot procedures and the postop visits, they will get paid more doing routine foot care for the same amount of time. Plus, they don't have to deal with the post op complications. For example, I did an Achilles Tendon Rupture repair on an HMO patient. I only got paid my capitation fee, which comes out to be $7.18 per patient, for the entire surgery and post op visits in the global period. So, if one was in an area where you have a lot of HMO patients (30 - 40% patient population are HMO), one may send those more complicated cases off to someone else, like an orthopod or a podiatrist willing to accept capitation fee for that surgery, to do that surgery since it really doesn't pay to do the surgery. Of course, if you are one of those surgeons who do not care how much you earn and you love doing surgery, then you should go on ahead and do the surgery.
I think that there are many opportunities for the Podiatrists to do rearfoot / ankle procedures. With the improvement in our surgical training, it will only help us further our profession.
