I could see why an ortho group would want to hire a non-surgical DPM. If that group has orthopods who do foot and ankle surgery, they want to keep the surgical cases for themselves but don't like the idea of referring out the ingrowns, plantar warts, diabetic foot care, and other non-surgical foot issues that they don't do. If they refer out, they make no money. If they keep those patients in the practice, then they will make some money. If the patients some day develop a surgical problem, then they are still an active patient of the practice and will likely seek surgical care there.
For example, a recent patient had bunion surgery by a local orthopod. She developed an ingrown nail and called the ortho office about it. She was told that they don't treat ingrown nails, so she ended up in my office. If that group had a DPM on staff then they would have gotten the business. Of course they don't want any surgical DPM's because they have three F&A orthos on staff to divvy up the foot surgeries.
I've seen this arrangement before at the Tucson Orthopaedic Institute:
http://www.tucsonortho.com/Physicians/specialty.html
I've seen it in other groups but they use Nurses (costs even less than DPMs) to do nail care and wound care.
Every little thing you guys can do in-house (DME dispensing, PT, orthotics, radiology, diagnostic ultrasound, lab services, etc.) can potentially make you money. The question will be whether you are willing or able to do it. Everything you send out is money walking out the door. This is not to say you should
try to keep every last thing in-house. If you can't do a good job at something, say administering PT, then refer it out for the sake of the patient.
You could make more money by fabricating orthotics by hand in your own office or garage, but do you really want to spend your weekends screwing around with Barge cement, polypropylene, and rolls of top covers when you could just have a professional lab do a quality job for $60-$130? On the other hand, if you started your own orthotic lab company and had a staff to make orthotics, plus solicit orders from other local DPM's then that might be a different story...
This is the same scenario that PCP's face. Many treat ingrown nails on their own, but many realize they just aren't able to provide the same level of care as I do so they send them to my office.
You can get your own CLIA number (allows you to run a lab) and do your own lab services such as fungal cultures, or you could just call the local lab for a pick-up and get on with your day.
http://www.cms.hhs.gov/CLIA/downloads/HowObtainCLIACertificate.pdf
This premise also applies to non-medical services. If you do your own bookkeeping, you don't have to hire a bookkeeper. If you have your staff do the cleaning at the end of the day, you don't have to hire a custodian. You get the idea.
You will eventually decide if it's worth your time and effort to do something or if you'd rather just pay someone else to do it so you can move on to stuff you prefer to do. These are the same type of decisions that apply to basic living. You could cook your own dinner, make your own clothes, or grow your own vegetables and save money, but sometimes you'd rather just pay someone else to do it.
I'm guessing the F&A orthopods don't feel like "wasting" time debriding nails for $39 when they could free up that time slot for a potential surgical patient who has a $3000 procedure. They'd rather turf it to their DPM.
I hate Mondays:
