Episode Description

Should you keep doing surgery just because you trained for it—or is there a smarter way to structure your practice? A younger associate recently asked whether surgery is still worth it in private practice, especially when stress, risk, and lifestyle are factored in.

In this episode, we break down the real-world economics of surgery, the emotional and professional pressure many podiatrists feel to “do it all,” and why selectively doing—or even fully referring—surgical cases can be the right move. We also discuss how adjunctive therapies like shockwave can outperform surgery financially when structured correctly.

Finally, we address common questions about shockwave therapy: insurance coverage myths, device selection, and whether cheaper “knockoff” machines are worth the risk.

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Timestamps

• [00:00] A young doctor asks: Is surgery still worth it in private practice?

• [00:45] Personal disclaimer: surgical training vs. real-world preference

• [01:30] The ego trap: residency expectations vs. practice reality

• [02:10] Creating a “surgical comfort list” and setting boundaries

• [02:55] Referring complex cases and reclaiming mental bandwidth

• [03:30] The real profit driver: adjunctive therapies, not the surgery

• [04:15] Shockwave therapy and insurance coverage concerns

• [04:55] Choosing a shockwave device and avoiding cheap knockoffs

• [05:40] Final thoughts on aligning surgery with lifestyle and strengths

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Key Takeaway

If surgery causes stress, poor sleep, or low margins, it’s not a requirement for success—strategic referrals and high-value adjunctive therapies can be far more profitable and sustainable.

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Conclusion

Surgery should serve your practice and your life—not the other way around. Whether you refine your surgical scope, fully refer out, or build around in-office and adjunctive treatments, clarity and confidence in your model matter most.

Have thoughts or questions on surgery, shockwave, or practice structure? Reach out, share feedback, or start the conversation—these decisions shape long-term success.