Which Pays More - Surgery or Office?


by Jarrod Shapiro, DPM
Joined practice July 2006 of
John K Throckmorton, DPM, PC
Lansing, Michigan

As members of a surgical subspecialty, many of us complete years of training dreaming of the moment when we´ll have our surgical practice. Patients will be banging down our doors, begging and pleading us for a surgical fix for every problem from hammertoes to flat feet to ulcers.

"Please doctor pod, just take me to the OR and fix me with your magic scalpel!"

Then you wake up and realize your attending is yelling at you to "cut the @!#% suture already."

Actually, when you really wake up is the moment you enter practice and realize that the world is more complicated than your patients wanting or even needing surgery. That´s the interactive part of medicine, the human part.

But what about the business aspect? Ah, now that´s an issue that´s even more fraught with peril. You might want and even obtain that surgical practice, but is it worth it? Is surgery a profitable endeavor from a business standpoint? Well, I´m not 100% sure yet, so let´s explore a couple of comparisons to get a feel for it.

For those of you billing experts out there feel free to write in with your input. We´d love to hear if the years of experience have affected your opinion.

Let´s take a look at a few examples of surgeries first. I´ve tabulated some recent surgeries during my first year of practice, including what we´ve billed and what Medicare pays. I´d focus more on what the reimbursement is because you can bill any amount you want, but what you actually get paid is what matters and that is determined by the insurance company. I´ve also added an estimated time frame for each procedure (with delays, turnover times, patient consent time, boarding, etc. added in) and an estimated hourly rate.

Table 1. Estimated Fees and Reimbursements for Common Podiatric Procedures

*These figures are based on the Medicare 2007 fee schedule in my area of Michigan. Reimbursement varies by insurance carrier and area.

Based on the above survey of common podiatric cases, I averaged $380/hour. The estimated times are probably on the low side. Remember, delays occur and drive times vary, as do lengths of procedures, and the amount of counseling time and voluminous paperwork preoperatively.

OK. Now let´s look at the non surgical side of things. Does a day in the office pay more or less than a day in the OR? According to my schedule, I´m allowed 15 minutes for a new patient and 10 minutes for follow-ups. During a completely full day I could conceivably see 45-50 patients/day. Let´s say a max of 40 patients to make the numbers easier. The following is a list of common codes and procedures we do in the office. On an average day I see about 5 new patients, order 8-10 radiographs, give 2-3 injections, and perform an average of 2 nail procedures per day. The rest are follow-up visits of varying complexity. I´m basing the reimbursement amounts on the Medicare fee schedule for my area.

•  99203 (new patient E&M): Charge $95, paid $90
•  99213 (follow-up E&M): Charge $75, paid $60
•  99212 (follow-up E&M): Charge $50, paid $37
•  11750 (nail avulsion): Charge $210, paid $180
•  73630 (3 view foot radiographs): Charge $75, paid $30
•  20550 (plantar fascia injection): Charge $125, paid $55

If we take these numbers and extrapolate out (with a goodly bit of guesswork) we come out with:

5 new patients ($450) + 15 established patients/99213 ($900) + 15 established patients/99212 ($555) + 10 foot radiographs ($300) + 3 heel injections ($165) + 2 nail procedures ($360) = $2730

Let´s take into account the cam walkers, night splints, orthotics, and other odds and ends we dispense, not to mention ulcer debridements, and postop visits (which you don´t get paid for) and add in another $200.

$2730 + $200 = $2930 per day, which equals $366.25/hour based on an 8 hour day.

A Drum Roll Please....

$380/hour vs $366.25/hour

Draw your own conclusions...

I'll leave you with a few thoughts. First, this is a completely non-scientific analysis. Second, the comparison assumes you're in surgery and the office equal amounts of time. Third, these are gross figures – you still haven´t paid your bills yet (overhead´s a killer). Fourth, we don´t get paid nearly as much as we should for anything we do, much less surgery.

Finally, I do surgery primarily because I enjoy it (same reason for being a physician), not because of the monetary value. As long as I can make at least some money from surgery I´ll keep doing it and the whole argument is moot.

Best wishes.



Jarrod Shapiro, DPM
PRESENT New Docs Editor
[email protected]