Copied from Podiatry Online (Good reading)

From: Michael M. Rosenblatt, DPM
Comment: Ambulatory Surgery Center Ownership and Income

CONSPICUOUS ABSENCE IN OTHERWISE EXCELLENT APMA STUDY

I urge APMA members to look at the excellent study on
podiatrists' income (and other features) located at the APMA
membership income survey for 2001, which has just been
published and is available for free on a Adobe Acrobat reader
download.

(APMA Members interested in obtaining a copy of the 2002 Podiatric
Practice Survey, may download the survey at http://www.apma-online.org
or contact APMA to purchase a hard copy for $25. Contact the Audiovisual
Department at 1-800-ASK-APMA (275-2752), extension 277.)

Unlike a "certain infamous OIG study on nail care,"
this study is highly documented and researched. Whereas the
database for the OIG study was defective and undisclosed, APMA
is to be congratulated for their thoroughness and trustworthiness
of data.

My only criticism is that it does not discuss ownership interest in
accredited ambulatory surgical centers and this impact (if any) on
podiatrist income. This data would be extremely valuable to
readers. I don't want to rehash the study, but there are some
obvious factors that increase income. One obvious factor is more
patient visits. Another is board certification. Others would follow
naturally, such as "more years of experience" and retirement of
college loans.

It takes an average of 15-19 years to pay off college loans. This
is a long time. On the other hand 36% of respondent podiatrists
had a gross income of over 300,000/year. While this is certainly
not as high as orthopedic surgeons, for example, who have a
NET income of well over 300,000/year, it would appear that we
are not starving! But there are a certain small number of
podiatrists who have an income closer to orthopedic surgeons,
and we are all naturally curious as to why this is. Could it relate to
ASC ownership?

Most podiatrists still get their lion's share of income from
Medicare. Heel pain and nail complaints comprise that largest
share. So there must be a reason why the outliers in income
vastly exceed that number. I believe that facility fees from ASC's
could explain that difference, since there are only a certain
number of hours/day in which you can treat patients, and the
income you derive from grinding nails or treating heel complaints
will not be different for those with a higher income than you.
Could ASC facility fees explain that difference?

Financing of ASC's and the "difficulty" in setting one up are often
key reasons why some podiatrists shy away from it. For example,
in some states, an external power generator is necessary, which
can cost 22,000 dollars. Yet, if the gross income you derive from
owning one increases to over 500,000/year, that and the other
associated expenses in setting one up would seem to be minor.
The key element of that argument rests in CONTINUING a
500,000 dollar gross over an extended period of practice years,
say between your 35th and 60th year of practice. That would
represent a 25-year duration, which would clearly put you into the
realm of the typical orthopedists' income. Anyone who
experiences a gross income of over 500,000/year over 25 years
will have an enormous lifetime income.

Even if you "split" an ASC with several other podiatrists instead of
owning yours by yourself, there would seem to be a continued
value of having an owners' interest.

Most podiatrists with large incomes are somewhat reluctant to
disclose the actual nature of their exceptional income. I would
define them as follows:

1) ABPS Certification

2) ASC ownership

3) Willingness to work long hours (including the health to do so)

4) Clear awareness and use of the CPT codes that are most
profitable

5) Attendance at seminars to learn new techniques

6) Group practice affiliation

7) Ownership of their own practice

Throughout my 28 years of practice, including the ownership of a
Medicare Certified Surgical Center, and considering my earlier
years of financial starvation, I have come to the conclusion that:

1) Podiatrists are not doing at all badly, despite what you read on
this column.

2) I vastly eclipsed my own father's income as a schoolteacher
after my 3rd year of practice.

3) Orthopedic surgeon's income is at least twice ours, but some of
us come closer to them. I think I know why.

4) I thought that college loans were a significant problem. While it
takes a long time to pay them off, going to podiatry school is still a
great idea.

5) The "art" of practice depends on a small number of treatment
codes, which are very profitable, and unfortunately not all
podiatrists use them.

I need to disclose here that I have a fiduciary interest in ASC
development. My web site is:
http://officeascaccreditation.homestead.com/

Judge for yourself.

Michael M. Rosenblatt, DPM
ROSEY1@prodigy.net
San Jose, California