RFC Private Practice

[heybrother]

I don't dremel and I still feel overwhelmed by the yellow cloud.

"Hahaha, so doc you went to school all these years to cut nails."

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[DYK343]

"Hahaha, so doc you went to school all these years to cut nails."

Oh my god I hate this. We've all been asked this. When I read this I actually got physically angry. lol.

"So why do you have to go to school for so long just to cut nails"

We really do need to change the perception of podiatry. So many people, MDs included, think we do nothing but bust nails all day.

 

[NatCh]

"So why do you have to go to school for so long just to cut nails"

I don't miss that one at all.

 

[NatCh]

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.

Not commenting on the practice of using felt pads but why would he pay nurses (or any other human employee) $15 - $40 per hour to cut felt when he could buy bulk pre-cut Hapads for a few dollars each???

 

[heybrother]

Not commenting on the practice of using felt pads but why would he pay nurses (or any other human employee) $15 - $40 per hour to cut felt when he could buy bulk pre-cut Hapads for a few dollars each???

Its the way they've always done it (for like 50 years). Interestingly, they are quite confident that they are great people, doing god's work, and amazing surgeons to boot.

I was perusing the ENT forum and it was amusing reading a doc there posting about how ENT is so interesting because he can have an entire day where everyone sent to him actually has a problem that isn't his specialty. My similar feeling is - a day of non-qualifying nails and calluses where I feel obligated to put down enough HPI/PE etc to try and cover my bases and all that jazz - talk about something else if its happening etc.

I'm sort of looking forward a lot to next year when the documentation requirement goes down. Long nails. Palpable pulses. Non-diabetic. Doesn't qualify. May return and pay out of pocket. $70. Patient says prior podiatrist got it covered by Medicare. They are free to return to original DPM. See - I can't stop myself from writing a longer note than I need to!

 

[heybrother]

Oh my god I hate this. We've all been asked this. When I read this I actually got physically angry. lol.

"So why do you have to go to school for so long just to cut nails"

We really do need to change the perception of podiatry. So many people, MDs included, think we do nothing but bust nails all day.

I don't keep records, but jokingly its always said to me by a man who also usually doesn't qualify.

 

[dtrack22]

Nothing wrong with Spa services, but they should be set up like a dermatology or plastics office. They are done by medical assistants, aestheticians, etc. and they are cash pay only.

The reason people feel like they need to lotion feet is because podiatrists who either don't understand their value or have had nothing else to do/treat have gotten patients accustomed to their "free pedicure." You think anyone walks into a plastics office and expects the surgeon to do their cool sculpting session personally? No? Why not?

I don't care if anyone lotions feet. It doesn't affect me at all. I don't do it because it isn't worth my time and I have found no discernible difference in patient volumes and collections between those who do and those who do not. In fact, individuals with a higher volume of RFC generally have lower collections. MSK pathology will always be worth more, period. These are not patients I actively recruit to my practice. I will see them all because they have sons and daughters and neices and nephews, but I certainly don't go out of my way to provide them with a spa service. If they want a spa service they can pay cash and then I'll have staff put as much lotion on as the patient wants. I make absolutely no mention of nail fungus, nail care, etc. on any marketing materials. I don't bring it up when I meet with potential referral sources. Nail patients will find you, wether or not you ask for it...and regardless of wether or not you lube 'em up when you're done.

 

[619]

When I initially wrote my post about applying lotion to the feet after RFC. I also added about me opening up my own practice after less than 2 years of being an associate. But everyone jumped on the band wagon of applying lotion to the feet like it's the end of the world. I can have my MA do it but I choose to do it. If it's an ego thing that y'all think you are above that, then that's your prerogative.

Those RFC patients that you provide exceptional service to will be your main referral sources for other MSK pathologies down the line, they will tell all their families, friends, church members and neighbors about you based on you just doing an above and beyond RFC. Those patients will return to their PCP and speak highly of you and the PCP will send you even more patients with MSK pathologies. You have to realize that if you are new to the area, the PCPs sends you the "easy" stuffs first to see how you handle it and they want to hear feedback from the patients. Furthermore, those at risk nail care patients become surgical patients/present with MSK pathologies down the line.

Most people attacking me work for a hospital group or MSG. If you work for a hospital group or MSG then you can do whatever you want with the RFC patients because your referral base/marketing is done for you. You can choose not to see RFC patients but don't look down at the solo podiatrist down the road seeing "all foot and ankle pathology" including RFC. The solo podiatrist is more likely making more bank than you. Just because you don't do at risk foot care does not make you special. Some of us enjoy doing it and I truly enjoy it. I don't see how it sets podiatry backwards.

As I said, I see and treat all foot and ankle pathology that works through my door including those vulnerable populations that need nail care. Nothing is below me except the knee. So you can argue all day either to dremel or not to dremel, lotion or not to lotion. We all treat the same feet. I enjoy doing surgery but I am not chasing ambulances for surgeries. In my experience, clinic (9-5) is where the money is at in private practice.

 

[Pronation]

Reading this thread makes me die a little bit inside.

 

[Shiyuan]

Reading this thread makes me die a little bit inside.

It’s nothing a little Vick’s VapoRub can’t fix...

 

[dtrack22]

Those RFC patients that you provide exceptional service to will be your main referral sources for other MSK pathologies down the line

Any practice where RFC patients are the “main” referral source for MSK pathology, doesn’t see very much MSK pathology.

Word of mouth referrals are incredibly important. You want to treat every patient as best you can because you want them to say nice things about you. But the bunion patient who you help/fix will send you more bunion patients than 90 year old Ethel will. Same goes for plantar fasciitis patients, local runners with foot pain, etc.

Those patients will return to their PCP and speak highly of you and the PCP will send you even more patients with MSK pathologies.

Again, the PCP will hopefully send you more patients but thinking that your RFC patients are going to get the PCP to send you an ankle sprain patient (as opposed to ortho) is a big stretch. MSK pathology breeds more MSK pathology. RFC will get you some MSK referrals, but it will also slowly increase the % of RFC you do each day.

Nothing wrong with treating RFC patients well, but for everyone else reading, building a practice around or marketing to RFC patients is a losing strategy. It’s how podiatrists go out of business, or get arrested by the feds. Though if you’re reading this and wind up practicing near me, please take all of the RFC in hopes that it turns into better pathology as opposed to consuming your daily schedule. It is the least efficient way to get the more profitable pathology in the door. It is literally the only pathology in which we are the only professionals who treat it. Why would you go out of your way for the one pathology that has no choice but to see you?

 

[CutsWithFury]

Oh my god I hate this. We've all been asked this. When I read this I actually got physically angry. lol.

"So why do you have to go to school for so long just to cut nails"

We really do need to change the perception of podiatry. So many people, MDs included, think we do nothing but bust nails all day.

I formally discharged a patient from my practice once because his daughter said that to me with a condescending tone. Both the patient and the daughter laughed their asses off while I thought I was providing "much needed service".

I mailed the discharge letter the next day.

We all need to demand respect from our patients. If they don't they can seek care elsewhere which will most likely be an inconvenience to them. Especially if they have Medicaid.

 

[SouthPod7]

I formally discharged a patient from my practice once because his daughter said that to me with a condescending tone. Both the patient and the daughter laughed their asses off while I thought I was providing "much needed service".

I mailed the discharge letter the next day.

We all need to demand respect from our patients. If they don't they can seek care elsewhere which will most likely be an inconvenience to them. Especially if they have Medicaid.

Was this particular patient a Medicaid patient?

 

[CutsWithFury]

Was this particular patient a Medicaid patient?

Yup

 

[DYK343]

We all need to demand respect from our patients.

I've had a few new patients recently refer to me by my first name first time meeting them.
I dont know why that bothers me so much but it does.
I busted my ass for 7 years (and continue to..) to be where I am. At least aknowledge it.

And to the other comments above. I do <10% RFC. I perform about 5-7 surgeries a week and I turn away 5x that amount/treat conservatively. The majority of my clinic is MSK. I turn away nail care because I refuse to do nothing but nails all day. I had an attenting who told me not to start off doing nails because if I do thats all I will get. That attening was right. In 2 years I built a MSK practice. I was pretty slow at first. But I got it going and I am happy I did.

PCPs actually want someone to refer foot pathology to they just dont know who to give it to. If you prove to the PCP you're a glorified nail tech then thats what youre going to get. Prove to them that you know foot/ankle surgery and youre going to get foot/ankle surgery.

Dont get me wrong though. There is nothing wrong with doing nail care. Some people enjoy doing nails. It is actually pretty mind numing easy and on a hard day listening to nothing but whining its kind of nice to hear someone say thank you after doing super easy nail care. With that said I make a lot more $$$ doing my 5-7 cases a week and doing cortisone injections, tenotomies, matrixectomies, etc etc than I would cutting Ethel's nails. I sleep better too because Ethel actually doesnt have painful nails. She just thinks im a pedicurist who intensly trained for 7 years to cut nails.

 

[G0dFather]

Lest I remind people everyone..... taken from a PM news article viz a quick google search

Table 1 lists the top ten CPT codes billed to Medicare by podiatrists in 2000 listed in order of frequency. This information is supplied courtesy of the American Podiatric Medical Association. Since these ten codes represent 64% of all codes billed by DPM’s to Medicare, it follows that knowing the rules for these codes brings you two thirds of the way towards perfection. Seven of the services are surgical procedures and three are Evaluation and Management (E/M) services.

Table 1 Top 10 CPT Code By Frequency Billed To Medicare in 2000 1 11721 6 11719 2 99212 7 11056 3 99213 8 11730 4 11720 9 99202 5 11040 10 G0127




Twenty years later ( couldn't find a concise list like this) i doubt much as changed ... the majority of codes above are involved with something to do with a NAIL and RFC.... come on guys lets cut it out .. this is podiatry this is what puts food on the table .... future and current students please look at these codes very well, THIS is the culmination of everything you are doing now and going to do ... its all leads to those handful of codes lol

 

[G0dFather]

. I had an attenting who told me not to start off doing nails because if I do thats all I will get. That attening was right. In 2 years I built a MSK practice. I was pretty slow at first. But I got it going and I am happy I did.

PCPs actually want someone to refer foot pathology to they just dont know who to give it to. If you prove to the PCP you're a glorified nail tech then thats what youre going to get. Prove to them that you know foot/ankle surgery and youre going to get foot/ankle surgery.

One can do BOTH! .... many many many offices to BOTH! ... RFC and the rest of the foot pathologies are not mutually exclusive , you seem to always talk about them in a all or nothing manner... we get it you do .999999% RFC lol

 

[DYK343]

Ive said it before and ill say it again. Dont practice in New York.

JK.

...Actually. No. Dont practice in NY.

But... We cant all be foot/ankle surgeons. Nail care is needed. We need nail care DPMs and there is nothing wrong with it. You can do well with it. I just chose to not do that with my practice.

To each their own.

Back to NY. If you practice in NY ortho will do all the fun stuff while you go fisticuffs for fungus.

The AOFAS released a statement about 3-5 years ago that quoted what godfather said above. They basically pointed out that DPMs are pedicurist (and backed it up w billing) and shouldnt be surgeons. Circle back to my prior post about educating people that we dont go to school for 7 years to learn to do nothing but cut nails

 

[G0dFather]

But... We cant all be foot/ankle surgeons.

LOL!!

.Actually. No. Dont practice in NY.

WRONG .. NY is where the money is and will always be

The AOFAS released a statement about 3-5 years ago that quoted what godfather said above. They basically pointed out that DPMs are pedicurist (and backed it up w billing) and shouldnt be surgeons.

All hail AOFAS!

 

[Halux]

@NewPodGrad2019
Don't let them shame you they have some kind of PTSD from some clinic when they were students. I cut nails and dremel. MA cleans and puts lotion on. I usually see like 0-5 nail patients a day. Use a podospray to cut down on the dust. Patient's like it and you aren't going to get a fungal infection unless you have compromised immune system. I will not get down from this hill. DREMEL TILL YOU DIE!!

 

[DYK343]

LOL!!

I should retract a bit. I really despise podiatrists who refer to themselves as "foot and ankle surgeons" and ignore the DPM.

What I should have said is we cant all be 95% foot/ankle surgery minded DPMs and do minimal RFC.

With that said I stand by the above. I just chose not to do it and so far its worked out very well.

 

[G0dFather]

I should retract a bit. I really despise podiatrists who refer to themselves as "foot and ankle surgeons" and ignore the DPM.

Great to see you have pride being a podiatrist... respect

 

[dtrack22]

Table 1 Top 10 CPT Code By Frequency Billed To Medicare in 2000 1 11721 6 11719 2 99212 7 11056 3 99213 8 11730 4 11720 9 99202 5 11040 10 G0127

... the majority of codes above are involved with something to do with a NAIL and RFC.... come on guys lets cut it out .. this is podiatry this is what puts food on the table .... future and current students please look at these codes very well, THIS is the culmination of everything you are doing now and going to do ... its all leads to those handful of codes lol

The conclusion reached here is incredibly misleading. Nail codes will always be the most common codes billed by podiatrists nationally. What other medical professional bills 11721, 11720, 11719, 11056, or G0127? As I mentioned before, these patients cannot get this service done anywhere else and have it covered by insurance. Are we supposed to be surprised that those codes are so prevalent within the only profession that bills them?

The fact that these codes are so common doesn't make them the most valuable or the most profitable. Nor does it mean that an individual's practice will ultimately devolve into primarily billing the codes above. It is relatively meaningless in any discussion regarding "value" that a particular pathology brings to your practice. Which is the discussion we were having. Your goal shouldn't necessarily be to perform zero RFC, but if you'd like to increase your PPV, hourly revenue, profitability, etc. then your goal should be to limit RFC.

MSK pathology is more valuable than RFC. Period. This isn't a controversial or even arguable fact. RFC pathology has nowhere else to go for treatment, everything else we see does. Ortho, Derm, UC docs, NPs, FP docs, etc. can treat MSK problems, skin lesions, ingrowns, and everything else that isn't cutting old people's toenails. Purposefully building your practice around RFC because they are the most common codes billed by other podiatrists is a bad idea. Believing that 11721 will inevitably be the most common code you bill because you are a podiatrist is dumb.

But hey, go ahead and fill up your clinic with RFC, dispense DM shoes, have a Vionic shoe store in your lobby...that's the Podiatric recipe for success

 

[CutsWithFury]

While performing at risk diabetic foot care in the right kind of patient (Onychomycosis + toe deformity + PVD + DM2 with neuropathy) I started counseling the patient and strongly advised that they do NOT send money to that online lover that they have been chatting with the last several months.

I did my good deed for the day

 

[king22]

The reality is that the majority of successful private practices do a significant amount of RFC. I'm not saying that it's 90% of what they do; maybe not even 50%, but it's enough to the point that if they lost all their RFC, it would result in a significant loss of a revenue. At least in my practice, Medicare pays more for a 11721 than many of my private insurers pay for a 99213.

 

[king22]

The fact that these codes are so common doesn't make them the most valuable or the most profitable. Nor does it mean that an individual's practice will ultimately devolve into primarily billing the codes above. It is relatively meaningless in any discussion regarding "value" that a particular pathology brings to your practice. Which is the discussion we were having. Your goal shouldn't necessarily be to perform zero RFC, but if you'd like to increase your PPV, hourly revenue, profitability, etc. then your goal should be to limit RFC.

I honestly don't think you can make that sweeping of a generalization. It really depends on your reimbursements. As I stated previously, in my practice, medicare pays more for a 11721 than many of my private plans pay for a 99213. Medicare pays more than $145 for a 11721+11056. To put that in perspective, If I see an established patient with Aetna commercial plan for a initial onset of plantar fasciitis in which I give an injection (billing a 99213 + 73620 + 20550) I'd only make about $135. In the time I took to see that one plantar fasciitis patient, I could have seen two routine care patients bringing my total revenue to $290 vs $135.

 

[dtrack22]

Medicare pays more than $145 for a 11721+11056

which MAC pays over $100 for 11056 and $90 for 11721? Or which MAC doesn’t apply MPPR to 11721?

I know it’s not Noridian so that eliminates jurisdiction E, which is one of 2 jurisdictions where 11056 and 11721 would reimburse $140 if no reduction was applied to 11721. Pretty much just leaves area 4 in jurisdiction K. NGS doesn’t pay both codes in full for the other jurisdictions they service so I guess I’d be surprised if they magically do it in the northeast and not in the Midwest.

As I stated previously, in my practice, medicare pays more for a 11721 than many of my private plans pay for a 99213.

yes, we know you have uniquely terrible “private“ contract. But you can’t compare Medicare reimbursements of 11721 to bad commercial contract reimbursement of a different code. You are comparing apples and oranges. In the plantar fasciitis scenario you laid out, medicare would pay around $190 in your jurisdiction. So the RFC pathology is worth less than the PF patient.

And the established PF patient shouldn’t take any more time in the exam room than your RFC. Another RFC fallacy. Just because the doc is spending less time face to face with the patient in the room does not mean that patient is spending less time in the exam room than a routine MSK problem. Spending 2 minutes in a room vs 10 minutes in a room makes no difference if the patient is in the room for 15-20 minutes in both scenarios.

Personally I can’t believe Derm (or F/A Ortho, after all they should be doing something to catch up with the rest of their colleagues from a revenue standpoint) hasn’t jumped all over this 11721 gold mine we have going on in Podiatry...

 

[king22]

I was under the impression that code combinations that are subject to MPPR are set by CMS, not by the individual contractor

On edit: I just looked at the Medicare Fee Schedule Look-Up tool. The Mult Proc value for 11720/11721 is 0 so therefore there shouldn't be any reduction in the fee.

 

[dtrack22]

I was under the impression that code combinations that are subject to MPPR are set by CMS, not by the individual contractor

On edit: I just looked at the Medicare Fee Schedule Look-Up tool. The Mult Proc value for 11720/11721 is 0 so therefore there shouldn't be any reduction in the fee.

They are. Which is why I asked. But I had been looking at a commercial patient from an old job who did pay less on those codes without taking the time to check my MAC. Whoops. You are correct, no deduction for busting the crumblies.

What do your commercial plans that cut e/m and other cpt fees, pay for RFC codes?

Any ways, the folks in NYC and San Francisco can continue to rake in those $55 11721 visits. Hopefully a majority of those patients have at least 2 calluses so can crack $100 per patient on average. I’m happy for that to never consume more than 10-15% of my practice. If it does I’ll move to New York or California and get paid the big bucks for that kind of work.

 

[Weirdy]

If it does I’ll move to New York or California and get paid the big bucks for that kind of work.

A penny for the student living in a cardboard box on Geary Avenue sir?

Edit: in hindsight, this probably would've been taken offensively by anonymous attendings floating in the electron interwebs. Apologies.

Cost of living is insane (as you probably already know).
Homelessness gets worse every year.
Fires actually affect daily living activities.

Goes without saying.

 

[NatCh]

Edit: in hindsight, this probably would've been taken offensively by anonymous attendings floating in the electron interwebs. Apologies.

LOL. Quick, call Damage Control!

 

[G0dFather]

The conclusion reached here is incredibly misleading. Nail codes will always be the most common codes billed by podiatrists nationally. What other medical professional bills 11721, 11720, 11719, 11056, or G0127? As I mentioned before, these patients cannot get this service done anywhere else and have it covered by insurance. Are we supposed to be surprised that those codes are so prevalent within the only profession that bills them?

The fact that these codes are so common doesn't make them the most valuable or the most profitable. Nor does it mean that an individual's practice will ultimately devolve into primarily billing the codes above. It is relatively meaningless in any discussion regarding "value" that a particular pathology brings to your practice. Which is the discussion we were having. Your goal shouldn't necessarily be to perform zero RFC, but if you'd like to increase your PPV, hourly revenue, profitability, etc. then your goal should be to limit RFC.

MSK pathology is more valuable than RFC. Period. This isn't a controversial or even arguable fact. RFC pathology has nowhere else to go for treatment, everything else we see does. Ortho, Derm, UC docs, NPs, FP docs, etc. can treat MSK problems, skin lesions, ingrowns, and everything else that isn't cutting old people's toenails. Purposefully building your practice around RFC because they are the most common codes billed by other podiatrists is a bad idea. Believing that 11721 will inevitably be the most common code you bill because you are a podiatrist is dumb.

But hey, go ahead and fill up your clinic with RFC, dispense DM shoes, have a Vionic shoe store in your lobby...that's the Podiatric recipe for success

WOW... so much here is just dont know where to start so i just wont!!! ... you are missing the point ... RFC can be the office engine among other things and it brings in people who also have other things going on ( inserts your "advanced" residency training here) ... King 22 has the right idea! ... and yes it pays very well also so its win win .... im looking at it from a purely business aspect ... dont get things twisted either, we do the 10K+ bunions and 20k+ flatfoots when the OUT OF NET patient walks in and complains about it ... NYC BABY!!... "where the money is"

 

[G0dFather]

I guess I’d be surprised if they magically do it in the northeast

surprise surprise ..... take a seat down brotha and just exhale !!

 

[dtrack22]

dont get things twisted either, we do the 10K+ bunions and 20k+ flatfoots when the OUT OF NET patient walks in and complains about it ... NYC BABY!!... "where the money is"

So you could spend time and energy building a practice where you get paid $10k for a bunion and $20k for a flatfoot and you’re talking about how valuable RFC is?

Im not the only person that sees the problem with this logic...right?

 

[G0dFather]

Personally I can’t believe Derm (or F/A Ortho, after all they should be doing something to catch up with the rest of their colleagues from a revenue standpoint) hasn’t jumped all over this 11721 gold mine we have going on in Podiatry...

LMAOOOO!!! .... from the stuff posted on this forum it appears the the PODS themselves dont want it and look down upon it and they are DPMs... imagine what someone with the "coveted" MD degree will do

 

[G0dFather]

So you could spend time and energy building a practice where you get paid $10k for a bunion and $20k for a flatfoot and you’re talking about how valuable RFC is?

Im not the only person that sees the problem with this logic...right?

Ask anyone, in all srsness ... OUT OF NET is far an few, i get what your saying, but its hard to depend solely on it ... innetwork pod stuff keeps things going and its a predictable rev stream/cashflow.. when that stuff comes it its just "bonus" that you try to capitalize on

 

[619]

The argument looks like an "either or" argument. You either do MSK, wound care, etc or RFC. But in reality, most successful private practice sees "all patient" with foot and ankle pathology. You can choose to limit the amount of RFC patients but this is leaving money on the table. Let us assume you have 30 MSK pathology patient scheduled, if you have an extra 5-10 RFC patient that you turn away, then that is turning money away. It cost nothing to see those RFC patients except staff time. MSK pathologies will come and go but those nail care patients will always keep the lights on. The argument that podiatry practices fail due to seeing nail care patients is nonsense.

You can argue to limit the amount of nail care patients which is a no-brainer but most people here make it sound like doing nail care is a taboo and only done by "less trained" podiatrist which is ridiculous.

I would rather look 3 months into my schedule and see that I have 5-10 nail care patients scheduled per day, so worst case scenerio if you don't even get any new MSK patient, I will be happy to come to the office and still see nail care patients. Those nail care patients also present with MSK pathologies during their routine visit. You will be their to-go doctor for all their foot and ankle problems including family members. So it makes no sense to turn them away.

MSK patients "come and go" You get 2 or maybe 3 visits out of them, they get better and they are gone. Nail care patients remain with you for many years. They are easy going, very appreciative and most them requests very little from you.

 

[619]

A podiatry resident or student reading this tread should not think you can join a Podiatry practice as an associate and then decide not to do at risk nail care. Only if you join an ortho group or MSG then you can choose not to do risk nail care since your marketing is done for you.

You should not as a new associate meet the PCPs in town and tell them you don't do nails, that you only do triples and ankle fractures. You want to let the PCP know to send everything to you, that is how you build your patient volume. It is funny going into Podiatry and somehow despising at risk nail care. Makes no sense to me.

From a financial standpoint, there is no argument that MSK pathologies pays more. Sure if anyone have a choice, you will only take MSK pathologies, but life does not always give you what you want.

I have a question to members on this forum for a hypothetical situation, If given the choice, 20 patients a day (15 MSK and 5 at risk nail care) or see 15 patients a day (all MSK). I will pick to see the 20. I think this is where the argument boils down too.

 

[NatCh]

It is funny going into Podiatry and somehow despising at risk nail care. Makes no sense to me.

I was into it going into podiatry but after many, many years I got sick of it and decided that I would only do the things that I want in order to have a nice, long, happy career without burnout. My practice is well-established and I have built a local reputation so I have the choice to do this. Agreed that new docs might not want to be as selective (at least at first).

From a financial standpoint, there is no argument that MSK pathologies pays more. Sure if anyone have a choice, you will only take MSK pathologies, but life does not always give you what you want.

I have a question to members on this forum for a hypothetical situation, If given the choice, 20 patients a day (15 MSK and 5 at risk nail care) or see 15 patients a day (all MSK). I will pick to see the 20. I think this is where the argument boils down too.

I pick 15 with open slots for same-day appointments. Lo and behold, those open slots often fill with new patients and acute issues. If those slots don't fill I leave early and go ride my mountain bike.

 

[NatCh]

MSK patients "come and go" You get 2 or maybe 3 visits out of them, they get better and they are gone. Nail care patients remain with you for many years. They are easy going, very appreciative and most them requests very little from you.

My ideal scenario is to see a patient 2-3 times max and having "fixed" them, never see them again except maybe out skiing or biking.

 

[G0dFather]

But in reality, most successful private practice sees "all patient" with foot and ankle pathology. You can choose to limit the amount of RFC patients but this is leaving money on the table.

The argument looks like an "either or" argument. You either do MSK, wound care, etc or RFC. But in reality, most successful private practice sees "all patient" with foot and ankle pathology. You can choose to limit the amount of RFC patients but this is leaving money on the table.

You can argue to limit the amount of nail care patients which is a no-brainer but most people here make it sound like doing nail care is a taboo and only done by "less trained" podiatrist which is ridiculous.

MSK patients "come and go" You get 2 or maybe 3 visits out of them, they get better and they are gone. Nail care patients remain with you for many years. They are easy going, very appreciative and most them requests very little from you.

THIS GUY GETS IT!!!! Everything said is is on point ... honestly this should be sticked !!

It is funny going into Podiatry and somehow despising at risk nail care. Makes no sense to me.

Yes!! Makes no sense, i was shocked to see it play out on this forum for so long !! But wiill call people out when i see it happen...... despising nail care is hating what you are !! this is the roots of podiatry, this is what the general public perception knows you for when the word podiatrist/foot doctor is mentioned !!! From that we can educate and show that we are a one stop foot and ankle shop, its not the end of the world ...

 

[CutsWithFury]

Nobody is despising RFC.

Just just drop the lotion and dremel DOCTOR

 

[king22]

Nobody is despising RFC.

Just just drop the lotion and dremel DOCTOR

I don't lotion but I do dremel. Frankly, it takes me no more than 30 seconds and makes the patient happy. Make an old church lady happy and she will sing your praises to her friends. Then watch your office phone lines light up!

Also, in residency I remember a patient with severe PVD who traumatically avulsed their left hallux nail due to a "rough edge" left by one of my co-residents who debrided their nails a week prior. It took 2 months to heel that tiny ulcer. I'll take 30 seconds to help prevent this from happening to one of my patients

 

[G0dFather]

Then watch your office phone lines light up!

I like when that happens ..

 

[619]

I was into it going into podiatry but after many, many years I got sick of it and decided that I would only do the things that I want in order to have a nice, long, happy career without burnout. My practice is well-established and I have built a local reputation so I have the choice to do this. Agreed that new docs might not want to be as selective (at least at first).



I pick 15 with open slots for same-day appointments. Lo and behold, those open slots often fill with new patients and acute issues. If those slots don't fill I leave early and go ride my mountain bike.

I will still pick 20 and still see all same-day appointments and fill them up with walk-ins, with new patients and acute issues. Once again it is not an "either or" issue. I am still a fairly new attending, I want to see all the foot and ankle pathologies that walk through the door including the at risk nail care that everyone despises, I don't want to limit myself or my patient schedule, and I have no intention on going home early to ride mountain bikes YET.
I still have student loans to pay off lol

 

[619]

Nobody is despising RFC.

Just just drop the lotion and dremel DOCTOR

Jesus washed his disciples feet and applied oil. Give it a try to one of your patients, it is a very humbling experience. Nothing should be below you DOCTOR (except the knee)

 

[NatCh]

I will still pick 20 and still see all same-day appointments and fill them up with walk-ins, with new patients and acute issues. Once again it is not an "either or" issue. I am still a fairly new attending, I want to see all the foot and ankle pathologies that walk through the door including the at risk nail care that everyone despises, I don't want to limit myself or my patient schedule, and I have no intention on going home early to ride mountain bikes YET.
I still have student loans to pay off lol

Makes sense. I'm out of debt 20 years into this career so I don't have as much pressure to pack the schedule.

I'm not rubbing oil on anyone except my wife.

 

[619]

Makes sense. I'm out of debt 20 years into this career so I don't have as much pressure to pack the schedule.

Ok I agree with you, when I am out of debt then I can see 15 patients and go home early to ride mountain bike. Can't argue with that.

 

[619]

I'm not rubbing oil on anyone except my wife.

LOL!!! was only kidding with @CutsWithFury

 

[podoloco]

I've had a few new patients recently refer to me by my first name first time meeting them.
I dont know why that bothers me so much but it does.
I busted my ass for 7 years (and continue to..) to be where I am. At least aknowledge it.

Immediately introduce yourself as Dr.... when you enter the room. Don't be afraid to politely correct them.