Should You Still Be Doing Surgery in Private Practice? (An Honest Answer)

READ TIME – 2 MINUTES

Hello, Don here—welcome to Podiatry Practice Mastery, where we help you get to the $2M mark and beyond.

I recently got a great question from a younger doctor just out of residency:

“Should I stop doing surgery? Is surgery really worth it in private practice?”

This is an honest conversation, so I’ll start with my own disclaimer. I did a three-year surgical residency. I can do surgery. But I don’t do much of it—and that was a hard, humbling decision.

Here’s why.

Early on, I felt like I should be doing surgery. Ego. Training. Boards. Expectations. So I did cases that, deep down, I wasn’t fully comfortable with. And the result? I lost a lot of sleep. Second-guessing. Stress. Worrying about outcomes.

Eventually, I made a simple rule for myself: I wrote down a list of procedures I felt truly confident with—things like simpler forefoot cases. That became my “yes” list. Everything else? I referred out.

And something interesting happened.

Patients did better. I slept better. And my practice actually became more profitable.

Today, I work with excellent surgeons in my practice who love surgery and are very good at it. I happily refer complex cases to them, and I focus on what I enjoy and do best—clinic-based care and in-office procedures.

Here’s the big takeaway:

• If you don’t like surgery, don’t do it.
• If you’re not good at surgery, don’t do it.
• And if surgery drains you emotionally, it will eventually drain your practice.

Now, if you do want to do surgery, here’s the financial reality: The profit often isn’t in the surgery itself—it’s in the adjunctive therapies.

Shockwave, biologics, bone stimulation, laser, red light therapy—when packaged correctly, these can significantly improve outcomes and revenue. Without those add-ons, going to the hospital for many cases simply isn’t worth the time.

Quick note on shockwave since I get asked this a lot: Yes, you may hear it’s “covered.” I treat it as self-pay only. I’m cautious about temporary codes and future takebacks. If that ever changes, I’ll tell you—but for now, build it as a cash service.

As for devices: be careful with cheap knockoffs. Shockwave can become one of the most profitable tools in your practice. You want something reliable, serviceable, and effective. In my experience, you get what you pay for.

Bottom line: You don’t need surgery to build a $2M+ practice. You need clarity, confidence, and a model that fits you.

Key Takeaways

• You are not required to do surgery to be successful
• Refer out what you don’t enjoy or aren’t great at
• Profit often comes from adjunctive therapies, not the surgery itself
• Shockwave works best as a self-pay, well-positioned service
• Build a practice that lets you sleep at night