RFC Private Practice

[SouthPod7]

This is gonna be the Mack Daddy of TFP posts but since I'm a new associate graduating from a program that was very strict with how/when RFC was returned, so I figured I'd ask.

In general, how frequent do you return your RFCs? I know Medicare's global period is 61 days for nail care but if I returned all my new nail care consults at 61 days then that's pretty much all I will be doing in 61 days. I try to spread it out between 3-6 months depending on physical exam and risk factors and stuff. One of the older docs I work with says I should rarely wait longer than 3 months if they qualify with a Q modifier but ALL he does is RFC.

In general, if they have a Q mod I'll bring them in in 3 or 4 months. If not, then I'll do 6 months.

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[dtrack22]

3 months. Some patients voluntarily elect to extend that to 4-6.

Godfather gets them back in there on day 62

 

[CutsWithFury]

I do 3 months for everyone. If they insist earlier I tell them to go see somebody else.

 

[SouthPod7]

Thanks for the quick responses guys.

Last question(s):

Do you guys do the nail care yourselves or do you have staff/MAs do it for you? Also, what % of your daily schedule is RFC?

 

[G0dFather]

Godfather gets them back in there on day 62

9-12 weeks depending on how at risk they are

 

[G0dFather]

This is gonna be the Mack Daddy of TFP posts but since I'm a new associate graduating from a program that was very strict with how/when RFC was returned, so I figured I'd ask.

In general, how frequent do you return your RFCs? I know Medicare's global period is 61 days for nail care but if I returned all my new nail care consults at 61 days then that's pretty much all I will be doing in 61 days. I try to spread it out between 3-6 months depending on physical exam and risk factors and stuff. One of the older docs I work with says I should rarely wait longer than 3 months if they qualify with a Q modifier but ALL he does is RFC.

In general, if they have a Q mod I'll bring them in in 3 or 4 months. If not, then I'll do 6 months.

If this was your place or you were paid percentage, you wouldnt be asking this LOL

 

[NatCh]

In general, how frequent do you return your RFCs? I know Medicare's global period is 61 days for nail care but if I returned all my new nail care consults at 61 days then that's pretty much all I will be doing in 61 days.

1. You could have your scheduler spread the patients out so that you don't have them all on one day. Set a limit of a certain number of RFC patients per day.

2. You could try to set them all in one day and consider it an easy day.

3. You don't really have this option right now as an Associate but you could eventually do like I did and hand them the business card of a colleague who is still willing to do RFC. I haven't done any in years.

 

[619]

The MAs cuts them low then I come in to finish it up and dremel it down. Some MAs do a good job that all I have to do is dremel. Keeps things moving from room to room.

 

[CutsWithFury]

The MAs cuts them low then I come in to finish it up and dremel it down. Some MAs do a good job that all I have to do is dremel. Keeps things moving from room to room.

Dremel? Very podiometric. Do you do this by choice or because you work for a senior podiatrist who insists on dremeling?

 

[NatCh]

Quit Dremeling.

 

[heybrother]

I've billed 1 patient as painful onychomycosis. It was their first visit and it was one of their many issues. I otherwise don't code nail debridement this way. I've rambled on about it elsewhere, but this just seems like a rabbit hole of crap to climb down. They don't have risk factors. I don't think most meet the pain criteria - in residency I regularly saw people being billed this way who listed their pain as zero and who were scheduled when they were supposed to be PRN (which would be its own can of worms). The pay is garbage since only nails can qualify under pain - calluses do not qualify. The world is f^&*(ing full of people who think we are just there to cut their nails - as if I need another $23-32 encounter. These should just be cash pay.

Cash pay seems better for PP than hospital based... I literally have people who pay $70 to cut 1 toenail. I suppose if you are hospital based this is just worth the RVU value of 11720. Am I wrong?

3 months works for the vast, vast majority of people. Another plus - if you consistently aim for 3 months you are much less likely to somehow accidentally land on 59. I have a new front desk person and 3 months has somehow become 2.5 months. I intend to rectify this - 3 months is 3 months and a few days. If a patient says - I'm doing so great I should do 4 months - boom, make it happen. I share cuts opinion above - patients who demand to be seen sooner will often become problem patients and will continue to push the envelope/advance the time table. Some of them may be legit pathology, but most are not. Don't let yourself get pushed into billing callus encounters as fake E&M surgery encounters or just 99212 hammertoe or bunion or whatever. If they are surgery patients with a painful callus or whatever - offer them surgery, but dear lord, actually make the callus go away. I was listening to someone speak at a conference lately and they said they'd never done a panmetatarsal head resection (though I think more often 2-4) - these are some of my happiest patients and they don't all have rheumatoid. Random aside - just pushing something I think works.

If you work for a private practice - set a high enough cash pay price that you can stomach the idea of seeing a person whenever. I have a few patients who have recurrent callus-ulcer-callus situations and some of them I have advanced down to the minimum qualifying time period. I don't like these situations.

Now I shall give you my limited understanding of the old school pod mentality.

Straight medicare (and well negotiated MA) plans pay $90-120 (region and code dependent) for 11720-1 + 11056-11057. In my state I can delegate essentially any task (I should, I don't). If you are efficient these encounters pay better and are less "risky" than someone complaining for awhile who ultimately is a 99213 with BCBS. BC PPO pays $83 where I am for a 20550. In short - nailcare pays. and I didn't even throw on a G0127 (which I think adds like $8 if you do some of the above with it). Of course we're all theoretically looking at a 9-11% procedural paycut next year...

 

[G0dFather]

I literally have people who pay $70 to cut 1 toenail.

Straight medicare (and well negotiated MA) plans pay $90-120 (region and code dependent) for 11720-1 + 11056-11057.

BC PPO pays $83 where I am for a 20550.

ISN'T PODIATRY GREAT!? This is the best money, easy quick money .... what other profession gives you this much buck for this little risk and can be scaled with ease ?!

Don't let yourself get pushed into billing callus encounters as fake E&M surgery encounters or just 99212 hammertoe or bunion or whatever.

MANY MANY MANY pods bill this way ... ironically to avoid getting audited for RFC ( yet that is what they are doing) ... however if one is caught doing this one would be exposing themselves even more as you are not Evaluating & Managing anything and making less money (now that is the real fraud)

 

[king22]

ISN'T PODIATRY GREAT!? This is the best money, easy quick money .... what other profession gives you this much buck for this little risk and can be scaled with ease ?!

Derm.

 

[G0dFather]

Derm.

I cant disagree with you on that ... lucky for us we can adpot much of what they do ... any others ?

 

[SouthPod7]

Twice this month I've had patient's family members if I can cut their fingernails and not just their toenails.

 

[NatCh]

Twice this month I've had patient's family members if I can cut their fingernails and not just their toenails.

I wonder if they ask a Dermatologist to cut and style their hair?

 

[G0dFather]

I wonder if they ask a Dermatologist to cut and style their hair?

The whole point of RFC is to "prevent" issues from occurring to a vulnerable population which will save money for these big systems in the long run... this is the roots of the profession

 

[CutsWithFury]

The whole point of RFC is to "prevent" issues from occurring to a vulnerable population which will save money for these big systems in the long run... this is the roots of the profession

Non diabetic population is not a vulnerable population. Controlled diabetics with no other risk factors (PVD, toe deformities, etc) are not a vulnerable population. Unfortunately a lot of these patients make up RFC for a lot of podiatrists. It is rather frustrating to change this referral pattern by PCPs.

 

[NatCh]

The whole point of RFC is to "prevent" issues from occurring to a vulnerable population which will save money for these big systems in the long run... this is the roots of the profession

RFC is for people who aren't vulnerable and that's part of the reasoning why insurance never pays for it.

Copied/pasted from the internet:
Routine Foot Care General Information
Routine foot care is not a covered Medicare benefit. Medicare assumes that the patient or caregiver will perform these services by themselves, and therefore, these services are excluded from coverage, with certain exceptions. The Centers for Medicare & Medicaid Services (CMS) has established national-level guidelines governing routine foot care and treatment of mycotic nails.

Routine foot care is defined as:

The cutting or removal of corns or calluses.
The trimming, cutting, clipping or debriding of nails.
Hygienic and preventive maintenance care such as:
Cleaning and soaking the feet.
The use of skin creams to maintain skin tone of either ambulatory or bedfast patients.
Any other service performed in the absence of localized illness, injury or symptoms involving the foot.

 

[DYK343]

So many patients a day want me to trim their nails.
They here for plantar fasciitis and want a "pedicure before I go?"

 

[NatCh]

So many patients a day want me to trim their nails.
They here for plantar fasciitis and want a "pedicure before I go?"

I bet you die inside a little every time you hear that.

 

[G0dFather]

RFC is for people who aren't vulnerable and that's part of the reasoning why insurance never pays for it.

Copied/pasted from the internet:
Routine Foot Care General Information
Routine foot care is not a covered Medicare benefit. Medicare assumes that the patient or caregiver will perform these services by themselves, and therefore, these services are excluded from coverage, with certain exceptions. The Centers for Medicare & Medicaid Services (CMS) has established national-level guidelines governing routine foot care and treatment of mycotic nails.

Routine foot care is defined as:

The cutting or removal of corns or calluses.
The trimming, cutting, clipping or debriding of nails.
Hygienic and preventive maintenance care such as:
Cleaning and soaking the feet.
The use of skin creams to maintain skin tone of either ambulatory or bedfast patients.
Any other service performed in the absence of localized illness, injury or symptoms involving the foot.

Ok ok ... you know what i meant by RFC.... at this point in this forum i was under the impression that RFC is synonymous with at risk care



Copied and pasted the same place you got it from on the internet ( but conveniently left it out to fit your narrative, real classy ):

Exceptions
Medicare allows exceptions to this exclusion when medical conditions exist that place the beneficiary at increased risk of infection and/or injury if a non-professional would provide these services. Medicare may cover routine foot care if it is a necessary and integral part of otherwise covered services

In certain circumstances, services ordinarily considered to be routine may be covered if they are performed as a necessary and integral part of otherwise covered services, such as diagnosis and treatment of ulcers, wounds or infections.

 

[G0dFather]

So many patients a day want me to trim their nails.
They here for plantar fasciitis and want a "pedicure before I go?"

Def opportunistic pts .. there are many them, trying to get most bang for the buck ( especially if they have a high copay, very common now) ... if they dont fit criteria i just hand them a sheet describing when "RFC" is covered and that settles it

 

[DYK343]

Def opportunistic pts .. there are many them, trying to get most bang for the buck ( especially if they have a high copay, very common now) ... if they dont fit criteria i just hand them a sheet describing when "RFC" is covered and that settles it

"But this is unacceptable. Dr X up the road did it. My insurance will pay."

..Heard something along those lines weekly for about 3 years now.

Been called a "bad doctor" for telling people their nails are not covered for nail debridement too many times.

6ish months ago I had a patient leave unhappy because I wouldnt cut her (absolutely normal) nails. An hour later her husband came into the office and threw an absolute fit in the waiting room. Threatening comments the whole deal. Police were called but he left before they arrived.

None of my negative reviews I have got are surgical or musculoskeletal related. All my negative reviews are related to RFC. I guess I should just start commiting fraud more like everyone else. At least my reviews will be better.

 

[NatCh]

Ok ok ... you know what i meant by RFC.... at this point in this forum i was under the impression that RFC is synonymous with at risk care



Copied and pasted the same place you got it from on the internet ( but conveniently left it out to fit your narrative, real classy ):

Exceptions
Medicare allows exceptions to this exclusion when medical conditions exist that place the beneficiary at increased risk of infection and/or injury if a non-professional would provide these services. Medicare may cover routine foot care if it is a necessary and integral part of otherwise covered services

In certain circumstances, services ordinarily considered to be routine may be covered if they are performed as a necessary and integral part of otherwise covered services, such as diagnosis and treatment of ulcers, wounds or infections.

Oh damn, he attacked my class.

Here's a handout for everyone for the sake of clarity. RFC is NOT a covered benefit. When certain qualifying conditions are met then you add a Q-modifier to your bill to show that it's no longer RFC and therefore a covered benefit.

https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnmattersarticles/downloads/SE1113.pdf

 

[NatCh]

"But this is unacceptable. Dr X up the road did it. My insurance will pay."

..Heard something along those lines weekly for about 3 years now.

Been called a "bad doctor" for telling people their nails are not covered for nail debridement too many times.

6ish months ago I had a patient leave unhappy because I wouldnt cut her (absolutely normal) nails. An hour later her husband came into the office and threw an absolute fit in the waiting room. Threatening comments the whole deal. Police were called but he left before they arrived.

None of my negative reviews I have got are surgical or musculoskeletal related. All my negative reviews are related to RFC. I guess I should just start commiting fraud more like everyone else. At least my reviews will be better.

That interaction sounds nuts! The best thing one can do is to play by the rules, and you'll sleep well. The sooner you rid your practice of those people the better. It can be a little awkward if your business partner bends the rules when you won't though. Thankfully mine also go by the book.

 

[DYK343]

That interaction sounds nuts! The best thing one can do is to play by the rules, and you'll sleep well. The sooner you rid your practice of those people the better. It can be a little awkward if your business partner bends the rules when you won't though. Thankfully mine also go by the book.

I will say Im not booked out 3 months with RFC and as a result I do most of the acute musculoskeletal pathology in the area while the others in the area are bustin nails all day.

So it pays off.

 

[air bud]

So glad I get paid for callus care in my region. I think I am going to only do at risk nail care. Screw painful fungal toenails. Cash pay only.

 

[619]

Dremel? Very podiometric. Do you do this by choice or because you work for a senior podiatrist who insists on dremeling?

Senior podiatrist does it so that is the standard for all the associates in the practice. Personally I don't mind it, we also lotion the foot at the end lol the senior pod bought the practice about 9 years ago from a retiring pod so this was what the patients were used to so he continued the tradition. Patients always back.

On a side note, I am in the processing of buying a practice from a retiring doc in the neighboring state where I did my training. He was actually one of my attending. He closed the practice 6 months ago due to Covid-19 and I reached out to him about taking over his office lease and buying the hard assets (X ray, furnitures, supplies etc). So when I have my own practice, I will still do nail care, dremel and lotion the feet to keep them coming back till I build a solid patient base. I know everyone will hate me for doing this but Beggars can't be choosers.

I applied for a business bank loan and with my perfect credit score and no other debt except student loans, it still got denied due to Covid so I am doing this with about $25k cash savings and seller financing payment plan for the hard assets. Will start with just one front desk staff and no MA. I can run the back by myself.

With podiatry, at risk foot care will keep your doors open and keep you afloat. I personally don't mind it and patients appreciate it. Just my 2 cents.

 

[air bud]

Senior podiatrist does it so that is the standard for all the associates in the practice. Personally I don't mind it, we also lotion the foot at the end lol the senior pod bought the practice about 9 years ago from a retiring pod so this was what the patients were used to so he continued the tradition. Patients always back.

On a side note, I am in the processing of buying a practice from a retiring doc in the neighboring state where I did my training. He was actually one of my attending. He closed the practice 6 months ago due to Covid-19 and I reached out to him about taking over his office lease and buying the hard assets (X ray, furnitures, supplies etc). So when I have my own practice, I will still do nail care, dremel and lotion the feet to keep them coming back till I build a solid patient base. I know everyone will hate me for doing this but Beggars can't be choosers.

I applied for a business bank loan and with my perfect credit score and no other debt except student loans, it still got denied due to Covid so I am doing this with about $25k cash savings and seller financing payment plan for the hard assets. Will start with just one front desk staff and no MA. I can run the back by myself.

With podiatry, at risk foot care will keep your doors open and keep you afloat. I personally don't mind it and patients appreciate it. Just my 2 cents.

Lotion the foot GTFO

 

[619]

Lotion the foot GTFO

I know it may sound extreme. Well here is the sequence. MA rooms patients and cuts the toenail down, Doc comes in and cuts it more if needed and trim calluses, afterwards dremel, then wipe the foot down with gauze soaked in alcohol and then apply lotion at the end. All done in 10 mins. As an associate, you do as you are showed. Sure I could choose not to do the whole sequence but I got hooked to it and I never mind doing it.

Patients get the whole nine yards.

 

[air bud]

I know it may sound extreme. Well here is the sequence. MA rooms patients and cuts the toenail down, Doc comes in and cuts it more if needed and trim calluses, afterwards dremel, then wipe the foot down with gauze soaked in alcohol and then apply lotion at the end. All done in 10 mins. As an associate, you do as you are showed. Sure I could choose not to do the whole sequence but I got hooked to it and I never mind doing it.

Patients get the whole nine yards.

Have some self respect. Will die on this hill along @dtrack22 @CutsWithFury @DYK343 @NatCh and every other pod with some dignity.

 

[heybrother]

I said this in another thread recently, but we all engage in activities that we were taught that may or may not have any significance. I guess you are trying to create an experience of sorts. You're better than me in that I still do the cut myself so I can only give you limited grief. I only have 1 person to room for me. Almost all of the people I've inherited got dremeled. I'm not doing it and I'm not hearing anything about it. We tell ourselves we have to do this or that and we often don't. I suppose the foot lotioning gets out nail bits that fall between the toes. Doesn't take lotion to accomplish this. Lotioning and stinky foot 1 time isn't going to change this patient's life or outcome.

I met this awful lady awhile back - she was a consultant for this guy who wanted me to buy his practice. She wanted me to pay like 95% of collections or something absurd. Anyway, I went and read her website and I do have to give her credit for some of her ideas - our time is money. She was a shill when it came to pumping up practice values, but it seems her main service for practices was encouraging doctors to really look at how they spend their time and figure out what did and did not make money. That can get you in trouble but it can also help you really look at your business.

Consider the fact that the guy I work with cuts every plantar fasciitis patient a felt pad to try before he tries a $26 OTC Spenco orthotic. Literally my nurses take turns pre-cutting hundreds of felt pads out of a felt sheet and then he goes back and adds squishy posting padding to everyone's orthotics. Even to garbage do nothing inserts people bring to him as if they could ever do anything. People become creatures of habit but that doesn't mean we need to be. People never ask me for all this insert modifying crap. Literally one person asked me awhile back - someone had added felt onto the insert that came with his shoes. He was much happier with an OTC orthotic I got him into that I didn't modify at all.

My partner's plantar fascial injection is marcaine, lidocaine and then like 20 mg of Kenalog. What does he think he's accomplishing with two anesthetics? Don't waste your time coming up with an explanation because 1 anesthetic works fine. Someone may say plantar fascial injections don't work - we already had a thread about that!

I'm in the OR the other day doing a metatarsal head resection (which is in and of itself a rejection of the bullcrap self serving motions and gestures we do to the forefoot). I'm with some OR people I'd never been with before and they were trying to come up with some complicated draping, wanted to know if I wanted to exsanguinate etc Noooope. Minimalist draping. Separate clean from sterile. No exsanguination. Tourniquet in this case at 200 - there's nothing magic about the numbers people come up with. Patient did great. I trained with some people who had these ultracomplicated dressings that literally served only to lead to ****show breakdowns at the start of surgery - it reminded me of the lowering of a flag by marines but in this case someone will fold the flag just a little wrong and the world explodes.

 

[air bud]

I said this in another thread recently, but we all engage in activities that we were taught that may or may not have any significance. I guess you are trying to create an experience of sorts. You're better than me in that I still do the cut myself so I can only give you limited grief. I only have 1 person to room for me. Almost all of the people I've inherited got dremeled. I'm not doing it and I'm not hearing anything about it. We tell ourselves we have to do this or that and we often don't. I suppose the foot lotioning gets out nail bits that fall between the toes. Doesn't take lotion to accomplish this. Lotioning and stinky foot 1 time isn't going to change this patient's life or outcome.

I met this awful lady awhile back - she was a consultant for this guy who wanted me to buy his practice. She wanted me to pay like 95% of collections or something absurd. Anyway, I went and read her website and I do have to give her credit for some of her ideas - our time is money. She was a shill when it came to pumping up practice values, but it seems her main service for practices was encouraging doctors to really look at how they spend their time and figure out what did and did not make money. That can get you in trouble but it can also help you really look at your business.

Consider the fact that the guy I work with cuts every plantar fasciitis patient a felt pad to try before he tries a $26 OTC Spenco orthotic. Literally my nurses take turns pre-cutting hundreds of felt pads out of a felt sheet and then he goes back and adds squishy posting padding to everyone's orthotics. Even to garbage do nothing inserts people bring to him as if they could ever do anything. People become creatures of habit but that doesn't mean we need to be. People never ask me for all this insert modifying crap. Literally one person asked me awhile back - someone had added felt onto the insert that came with his shoes. He was much happier with an OTC orthotic I got him into that I didn't modify at all.

My partner's plantar fascial injection is marcaine, lidocaine and then like 20 mg of Kenalog. What does he think he's accomplishing with two anesthetics? Don't waste your time coming up with an explanation because 1 anesthetic works fine. Someone may say plantar fascial injections don't work - we already had a thread about that!

I'm in the OR the other day doing a metatarsal head resection (which is in and of itself a rejection of the bullcrap self serving motions and gestures we do to the forefoot). I'm with some OR people I'd never been with before and they were trying to come up with some complicated draping, wanted to know if I wanted to exsanguinate etc Noooope. Minimalist draping. Separate clean from sterile. No exsanguination. Tourniquet in this case at 200 - there's nothing magic about the numbers people come up with. Patient did great. I trained with some people who had these ultracomplicated dressings that literally served only to lead to ****show breakdowns at the start of surgery - it reminded me of the lowering of a flag by marines but in this case someone will fold the flag just a little wrong and the world explodes.

Lol who is our generations Richie? Does he have a son or a daughter that is a pod?

Met head resections fix lots of problems. Also a hill I will die on.

Edit:. Lol I bet you Alan Jacobs has a great grand child that is probably graduating podiatry school by now.

Second edit:. Yeah if the special magical dressing you are doing is the key to a good outcome...you are doing it wrong.

 

[619]

Have some self respect. Will die on this hill along @dtrack22 @CutsWithFury @DYK343 @NatCh and every other pod with some dignity.

Have self respect for taking care of my patients? lol you sound ridiculous.

I am in the process of starting my own practice and doing my own thing. Trust me I have a lot of self respect. I enjoy what I do either y'all agree or not.

We all treat the same feet either you lotion or not.

 

[air bud]

Have self respect for taking care of my patients? lol you sound ridiculous.

I am in the process of starting my own practice and doing my own thing. Trust me I have a lot of self respect. I enjoy what I do either y'all agree or not.

We all treat the same feet either you lotion or not.

Just giving you a hard time. Unless you lotion at your new place. Then you are dead to me. But good luck being your own boss and blazing your own trail.

 

[CutsWithFury]

Have self respect for taking care of my patients? lol you sound ridiculous.

I am in the process of starting my own practice and doing my own thing. Trust me I have a lot of self respect. I enjoy what I do either y'all agree or not.

We all treat the same feet either you lotion or not.

Hell no. Do any other physicians lotion their patients? Why would any new graduate lotion anyone's feet or dremel anyone's nails? If up and coming podiatrists (who graduate with 3 years of residency training and have a possible additional year of fellowship training) have any desire to progress the profession then that has to stop. We need to change the perception...actively.

Your patients can get the same service during a pedicure. Done by someone who most likely doesn't have a college degree. Not sure why a well trained and educated physician needs to do this.

You want to make money? Go into wound care. Bill your ass off on wound debridements and do percutaneous flexor tenotomies and PL tenotomies in the clinic. Equinus? Take everyone to the OR for an endoscopic Gastroc recession. You will make so much more money doing these MIS procedures then trimming nails and calluses and lotioning feet. Even if you never develop a high surgical practice. Diabetic offloading procedures is legit medicine and does work and does change lives.

My two cents

 

[heybrother]

I'm somewhat reminded of the episode of the Office where Michael tries to steal Danny.
Do you want more happiness, less happiness, or to stay the same?
Do you want more freedom, less freedom, or to stay the same.

I cannot convince you of the unnecessary and disgusting nature of what you do.

But wouldn't you be happier if you didn't dremel? Consider, I too hate my employer. I too will start my own practice in the semi-soon.

Two providers. Two new offices. One dremmeling. One not.

Who is happier?

Probably me just because. But you could be happier and freer too. Free of the podiatry chains that bind. Free of the blinding dust. Free to participate in a nasal fungal study which would hopefully demonstrate very little fungus in your respiratory tract as opposed to what it will look like in years ahead if you continue down your podiatry path.

 

[619]

Hell no. Do any other physicians lotion their patients? Why would any new graduate lotion anyone's feet or dremel anyone's nails? If up and coming podiatrists (who graduate with 3 years of residency training and have a possible additional year of fellowship training) have any desire to progress the profession then that has to stop. We need to change the perception...actively.

Your patients can get the same service during a pedicure. Done by someone who most likely doesn't have a college degree. Not sure why a well trained and educated physician needs to do this.

You want to make money? Go into wound care. Bill your ass off on wound debridements and do percutaneous flexor tenotomies and PL tenotomies in the clinic. Equinus? Take everyone to the OR for an endoscopic Gastroc recession. You will make so much more money doing these MIS procedures then trimming nails and calluses and lotioning feet. Even if you never develop a high surgical practice. Diabetic offloading procedures is legit medicine and does work and does change lives.

My two cents

I do all of the above, my practice is very surgical and I do lots of cases from bunions, hammertoes, coalition resection, fusions to ankle fractures. I graduated in 2019 and I am not going to brag and tell you the program I graduated from. Nobody cares in the real world anyway. I am well trained to do anything that walks through the door. Above all, I enjoy the at risk foot care, those patients are happy and appreciate what I do. Just because I lotion the feet does not mean I am not surgical.

No one one SDN is going to shame me for what I do. I could care less. I will keep doing it when I open my own practice which is very soon.

 

[619]

I cannot convince you of the unnecessary and disgusting nature of what you do.

Oh treating the feet is now disgusting? lol y'all here are ridiculous.

Send me all your feet patients, I will be happy to treat them and I will lotion at the end

 

[heybrother]

I can't in good conscious do that because your office will be a mold hot spot!

 

[air bud]

Oh treating the feet is now disgusting? lol y'all here are ridiculous.

Send me all your feet patients, I will be happy to treat them and I will lotion at the end

You are dead to me.

 

[SouthPod7]

I never dremmeled in residency. At my current job I dremel maybe one out of five RFC patients, mostly I just feel for sharp areas and smooth them down with dremel so they don't catch on socks or whatever since a lot of these patients have poor mobility and would struggle with that I feel.

I think wearing a mask with COVID going on makes it a lot more tolerable though. Maybe I should write myself for some oral terbinafine too though after hearing about fungal growths in the airway and what not.

 

[G0dFather]

Personally I don't mind it, we also lotion the foot at the end lol the senior pod bought the practice about 9 years ago from a retiring pod so this was what the patients were used to so he continued the tradition. Patients always back.

This has to be done or patients will leave.. i get it its all about keeping the same cashflow coming in when you acquire... business is business

He closed the practice 6 months ago due to Covid-19 and I reached out to him about taking over his office lease and buying the hard assets (X ray, furnitures, supplies etc). So when I have my own practice, I will still do nail care, dremel and lotion the feet to keep them coming back till I build a solid patient base. I know everyone will hate me for doing this but Beggars can't be choosers.

DO IT!!

so I am doing this with about $25k cash savings and seller financing payment plan for the hard assets.

BEST INVESTMENT YOU WILL EVER MAKE! ( until you make serious money and start investing in pre ipo companies)

I do all of the above, my practice is very surgical and I do lots of cases from bunions, hammertoes, coalition resection, fusions to ankle fractures. I graduated in 2019 and I am not going to brag and tell you the program I graduated from. Nobody cares in the real world anyway. I am well trained to do anything that walks through the door. Above all, I enjoy the at risk foot care, those patients are happy and appreciate what I do. Just because I lotion the feet does not mean I am not surgical.

No one one SDN is going to shame me for what I do. I could care less. I will keep doing it when I open my own practice which is very soon.

I respect you ! You have the right mentality here ... feel free to PM me with anything you may need

 

[G0dFather]

Maybe I should write myself for some oral terbinafine too though after hearing about fungal growths in the airway and what not.

LMFAO!

 

[619]

This has to be done or patients will leave.. i get it its all about keeping the same cashflow coming in when you acquire... business is business




DO IT!!



BEST INVESTMENT YOU WILL EVER MAKE! ( until you make serious money and start investing in pre ipo companies)



I respect you ! You have the right mentality here ... feel free to PM me with anything you may need

Thank you @G0dFather

 

[619]

You are dead to me.

You do You

 

[CutsWithFury]

I do all of the above, my practice is very surgical and I do lots of cases from bunions, hammertoes, coalition resection, fusions to ankle fractures. I graduated in 2019 and I am not going to brag and tell you the program I graduated from. Nobody cares in the real world anyway. I am well trained to do anything that walks through the door. Above all, I enjoy the at risk foot care, those patients are happy and appreciate what I do. Just because I lotion the feet does not mean I am not surgical.

No one one SDN is going to shame me for what I do. I could care less. I will keep doing it when I open my own practice which is very soon.

I was not questioning your competency. I was questioning you lotioning feet. If we want Ortho and anti-podiatry MD/DO physicians to think we are doctors then the salon/boutique crap has to go. Don't get it twisted. I'm sure you are an excellent surgeon.

It's all about perception for me. Personally I think that's where we as a profession struggle to make an impact. Currently we have so many generations of podiatrists still practicing. It's very confusing for MD/DO physicians and the public to figure out and understand our educational and surgical training progress. Carrying on these "podiometric" practices of dremeling has no science behind and is potentially medically dangerous. Lotioning someone's feet should be done by the nail technician in the beauty salon down the street. Not a physician. My two cents.

 

[heybrother]

Maybe I should write myself for some oral terbinafine too though after hearing about fungal growths in the airway and what not.

I would be happy to sell you some Tolcylen Extra Strength Nasal Douches and a Copper Fit Anti-Fungal electrostatic protection dremmeling mask. It comes with a $25 credit to a Podiatry Presents CME event sponsored by Amnio-Glob. Amnio-Glob - smear it everywhere. High quality overseas recycled placental issues.

I also have an entire product line for your patients to use and wear while you dremel them.

Read more about it on Podiatry News, coming to your spam folder, today!

 

[air bud]

Who are we kidding? Except for @NatCh we all bust fungies.