The Ins And Outs Of Forming A Multispecialty Practice

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When Communication Breakdowns Can Affect Care

As I am sure we have all experienced, communication between specialists can frequently be fragmented and incomplete. While this is certainly not intentional, given busy schedules and passive patients, it happens.

Here is an example. One of my diabetes patients came in with a mixed neuropathic-ischemic ulcer under one of his metatarsal heads. After evaluating the patient, we determined he needed an arteriogram and, hopefully, a distal bypass operation in order to heal the wound. At this time, the wound was a full-thickness ulcer but had not penetrated to bone, capsule or joint. We debrided and offloaded the wound, started appropriate wound care and referred the patient to a vascular surgeon. The plan was, after restoration of adequate perfusion, he would need a more aggressive debridement.

The patient underwent a successful distal bypass and was aggressively walked postoperatively in order to try avoid the possibility of postoperative complications such as blood clots. Unfortunately, due to a communication breakdown, there was no offloading of the wound and the only wound care orders were a cursory “cover with a dry sterile dressing.” Although we would like our patients to be proactive in their care, they assume that the doctors are communicating. The patient developed osteomyelitis and when we could have healed this patient less aggressively, it took a ray resection to save his foot.

The Ins And Outs Of Forming A Multispecialty Practice
The Ins And Outs Of Forming A Multispecialty Practice
By Leon R. Brill, DPM, FACFAS, CWS

The winds of change have blown through the medical community with a vengeance in the last 25 years. Managed care has turned medicine upside down. Dramatically lower fees and higher overhead expenses have made us work doubly hard just to maintain some level of consistency in our practice. Just as we have seen in the hospital community, economic necessity has made some strange bedfellows.
Hospitals and outpatient centers, who previously may have been formidable competitors, have now become partners. Some specialty groups, such as anesthesiologists, vascular surgeons and primary care practitioners, have merged to reduce overhead expenses and capture increased patient population.
Podiatric medicine is no exception. I have seen several groups of podiatrists, who previously were aggressive competitors, suddenly merge into large single specialty groups to decrease their costs and increase their geographic area to capture a larger patient population. We have all managed to survive.
An emerging but less common trend in podiatric medicine is the development of multispecialty practices. Why is this trend becoming more popular? In no small way, diabetic care and wound care have played a major role. Diabetic foot medicine and wound care have done more to bring podiatric medicine into the mainstream medical community than any other venue we have ever seen since our profession began. We have become a “natural fit.”
With the increase in multidisciplinary conferences, such as the American Diabetes Association’s Foot Council meetings and the Wound Healing Society meetings, we, as a group of specialists, have had ever increasing exposure to other specialties. They see we have value to bring to the table. Certainly, wound care is not the only “fit” for us. It may be the most natural fit, however. Podiatric sports medicine, orthopedic medicine and geriatric medicine are also viable areas in which to explore multispecialty care.

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