02/17/2016    Kevin A. Kirby, DPM

Podiatrists Joining Orthopedic Groups (Ira M. Baum, DPM)

In response to Dr. Baum’s questions regarding why
a podiatrist would join an orthopedic group, I
would like to provide my experiences of being in
a group practice with three orthopedic surgeons
for over 17 years and having an orthopedic
surgeon work in my own practice for the last 14
years.

First of all, I believe my decision to work in an
orthopedic group was probably one of the best
decisions that I ever made in my practice career.
Not only have learned a great deal from my
orthopedic colleagues in how they treat a wide
variety of foot and lower extremity pathologies,
but, probably more importantly, the orthopedic
surgeons who have personally witnessed both my
conservative and surgical treatment results have
literally had to positively change their minds
about podiatry…and podiatrists.

A number of orthopedic surgeons in my community,
including a foot and ankle orthopedist, now ask
me for second opinions on their patients and even
refer me patients for procedures they don’t feel
comfortable doing. This has occurred, I believe,
because I have been so closely associated with
orthopedic surgeons over the past three decades
and they know that I can offer them a different
perspective of treatment than another orthopedic
surgeon can. In much the same manner, I am much
more likely to refer my difficult surgeries to
the local foot and ankle orthopedic surgeon since
I have found that his approach is excellent and
he can offer my patients excellent care that I
don’t specialize in.

For me, it’s become a win-win situation being
affiliated with orthopedic surgeons since they
help me with my difficult cases and I help them
with their difficult cases.

It is my strong belief that unless podiatrists
begin to work more commonly in a multi-
disciplinary setting with other MDs, including
orthopedic surgeons, that there will continue to
be an academic and psychological gulf between
podiatrists and orthopedists (and other MDs) that
will prevent each of them from appreciating how
much the other specialty can truly help the
other. In the Kaiser Medical Centers here in
Northern California, podiatrists and orthopedic
surgeons routinely work in the same clinics
together, much as I have for the past 30+ years,
and don’t have any of the “turf battles” that
seem common place in other areas of the U.S.

Therefore, the question should not be “Why does
an individual train to become a podiatrist and
then join an orthopedic group?” Rather, I believe
the question should be, “Why don’t more
podiatrists join orthopedic groups to enhance
their practice and stimulate their intellectual
growth?!”

Kevin A. Kirby, DPM, Sacramento, CA

Other messages in this thread:

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02/15/2016     Michael M. Rosenblatt, DPM

Podiatrists Joining Orthopedic Groups (Ira M. Baum, DPM)

Dr. Baum asks the (reasonable) question why DPMs
would join MD orthopedic groups? I think the
answer certainly is pay, even if DPMs are not paid
as much as orthopedists. But there is sometimes a
"separation" in pay when comparing this to multi-
specialty groups: The pay of the DPM resides only
in the decision of the orthopod remuneration
committee if you work for only orthopedic
surgeons. However, if you work for a multi-
specialty group, your pay is decided by a mix of
practitioners and may be more connected to your
actual production. This means if your production
exceeds that of other doctors, you may be paid
more than them.

Patient billing is done through the MD group,
which means that the amount paid for a specific
service may be more than it would otherwise have
been if you were a separate DPM practitioner.
Insurance contracts may have been negotiated with
a power metric you could never have as an
individual DPM.

This strange metric can mean very large salaries
for DPMs, even if they are still not paid as well
as an MD orthopedic surgeon. I know of several
DPM's who work for large group practices. In one
case, the DPM was paid very well, but decided to
leave because of very severe excess work-load and
ER time, without any increase in pay. He joined
another group practice instead.

In answer to Dr. Baum, I would also say that DPM's
who practice for a larger multispecialty or a
singular orthopedic group have ACCESS to volumes
of patients they would never find in private
practice. This is a double edged sword, in that
the DPM might not be able to "refuse" patents who
are not reliable and risky. They work for someone
else. But at least they can "share" the
responsibility more easily and dilute their own
risk by internal referring.

When you work for a group practice your
"production" is a key issue in your employment.
The more you generate for them, the more you are
"respected." Long hours and large increases in
surgical responsibility are the norm, even if the
pay is very high. The owners of the group practice
are always watching how much you work and bring
in. Also, everything you do is watched very
closely. These facts will never change.

Michael M. Rosenblatt, DPM, San Jose, CA

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02/15/2016     Martin Taubman, DPM

Podiatrists Joining Orthopedic Groups (Ira M. Baum, DPM)

Thank you, Dr. Baum, for opening this topic.
I pondered the question: Why are podiatrists
joining orthopedic groups? To me, the more
interesting question is: Why are orthopedic groups
hiring podiatrists?

The answer is simple. There aren’t enough
orthopedic foot specialists available. Podiatry is
now recognized as the premier profession for
treating the foot and ankle. The orthopedic groups
want to garner the business, not just for the foot
and ankle patients, but for the additional patient
resource.

Young practitioners are generally highly-trained,
and have enormous debt. They don’t have the time
or inclination to spend years building a private
practice, being liable for employees, etc. It’s
just easier to work as an employee for a group of
some sort. Of course, they also don’t have the
luxury to name their own hours, take time off when
they wish, and have the personal satisfaction of
owning their own business.

I’ve been in practice over forty years now. I’m
proud to see where our profession has gone.
Frankly, it is my opinion that the future of
podiatry is multi-specialty and orthopedic groups.
Private practice is more difficult to maintain
every year. The healthcare system is changing and
we must recognize and change with it. There will
still be a niche for the private practices in
certain instances, but most practices, even
private must still be a “provider” for various
insurance delivery systems. It makes for an
esoteric question: Aren't we all working for
someone else? It is what it is.

Martin Taubman, DPM, San Diego, DPM