Concerning Trends

[podmed78]

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With the recent action from U of U and Texas, I am deeply concerned for the future of our profession with respect to scope, insurance, and our overall presence in the medical community.

Personally, the APMA seems to have made little progress legislatively both on a state and federal level. If you question this, just review their history. This is not saying they couldn't make future strides but as of now, it's just a pipe dream.

My brother, a dental anesthesiologist (DDS), asked me why podiatrist don't have a specialty similar and candidly, I agree. There's no reason why a DDS with a 2 year residency in dental anesthesiology can perform such procedures yet a DPM can't.

I can't reiterate it enough. The future is both bright in a sense of how it could turn out, and dreary in a sense of the aforementioned items. I hope and pray we will make the strides necessary to establish or re-establish the kind of respect we deserve in the medical community.

 

[DPMstudent]

Don't lose too much sleep over what happens in one hospital in Utah. As stated before, it probably just hurts the patients there the most. As for the Texas issue, I believe the decision is being appealed right now so it may get overturned in the not too distant future. Don't sweat it too hard.

 

[podmed78]

I find it very concerning. It's a trend that should raise eye brows.

If you elect to ignore such issues and put them on the back burner, they'll come back to haunt you.

 

[DPMstudent]

maybe if you read more about the issues you wouldn't be so worried

 

[j0ez0r]

i think theres always a reason to worry about your livelihood in a profession, especially if you're dumping quite a bit of money as an investment into the future. With that being said, I think podiatry is on the up and up....getting to do new surgeries, putting pods out that are better trained, elevating stats of incoming students (at some of the schools). No doubt its better than it has been in the past and I believe this is just the beginning.

 

[Feli]

i think theres always a reason to worry about your livelihood in a profession, especially if you're dumping quite a bit of money as an investment into the future. With that being said, I think podiatry is on the up and up....getting to do new surgeries, putting pods out that are better trained, elevating stats of incoming students (at some of the schools). No doubt its better than it has been in the past and I believe this is just the beginning.

This is my outlook also.

Podiatry's PG training is the best it's ever been... nearly all grads will now get 3 year training... some even get 4yr programs. There are also more fellowships than ever for those who choose to undergo them.

APMA is getting record contributions and increasing awareness of podiatry's capabilities. Based on our improved training, applicant interest in the schools should continue to improve in both quantity and quality. Even with Medicare cuts, good training still has DPM incomes increasing.

Most importantly, our literature continues to make strides. JFAS is contantly improving, and it's on a level as high as FAI in my opinion (arguably higher for some areas... especially FF surg). The ACFAS is growing, and its meetings, workshops, and research are amazing. More and more grant money is going to pod research from both the government (namely for DM foot risk/treatment research) as well as the private sector (fixation, pharm, prosthetic, etc industries).

 

[Feli]

...My brother, a dental anesthesiologist (DDS), asked me why podiatrist don't have a specialty similar and candidly, I agree. There's no reason why a DDS with a 2 year residency in dental anesthesiology can perform such procedures yet a DPM can't...

If I had wanted to do anesthesia, I'd have applied to MD or CRNA schools.

Podiatrists CAN be podopathologists, podopediatricians, podiatric radiologists, F&A infectious dz focused clinicians, researchers, etc if they seek out the appropriate training. Frankly, I don't see why someone couldn't be a F&A anesthesiologist if they really wanted to, but to get the optimal training, they'd have to go back and get an MD to do an anesthesia residency training IMHO. I guess I just didn't go to podiatry school to put people to sleep 😴

Personally, I want to be a comprehensive F&A specialist, and I'd imagine most other pod students/residents feel the same way. I would like to be ready to treat anything within my scope (or at least know where I should refer it). For that reasoning, I will select a balanced residency (FF, RF, trauma, elective, peds, geriatric, DM and limb salvage, biomech, etc). I could always do a fellowship afterwards if I found one area I really wanted to zone in on, but I want the general exposure first and foremost.

 

[densmore22]

There's not a single podiatrist that has been out for less than 10 years that hasn't said they wish they were getting into podiatry right now because it is so much better now than when they first started out (an obvious overexageration, but I have yet to talk to any). I would like to think that those guys and gals that have been out for awhile would be pretty up to speed on national as well as their state issues and have the experience behind them for that statement to be incredibly accurate and truthful. Ask around to pod's who've been out and I bet you'll hear the same thing over and over again, it's a great time to be a pod or a pod student. Yes, things can and will get worse, but things can and will get better. It's a trade off, you'll lose some things, but gain others. If you're looking for the all around package in medicine, you'll never find. Not one specialty out there can guarantee you academic, financial and professional success. It's what you put in to your education and what you make of it that will determine your worth and value as a clinician and educator in the future.

 

[jonwill]

With the recent action from U of U and Texas, I am deeply concerned for the future of our profession with respect to scope, insurance, and our overall presence in the medical community.

Personally, the APMA seems to have made little progress legislatively both on a state and federal level. If you question this, just review their history. This is not saying they couldn't make future strides but as of now, it's just a pipe dream.

My brother, a dental anesthesiologist (DDS), asked me why podiatrist don't have a specialty similar and candidly, I agree. There's no reason why a DDS with a 2 year residency in dental anesthesiology can perform such procedures yet a DPM can't.

I can't reiterate it enough. The future is both bright in a sense of how it could turn out, and dreary in a sense of the aforementioned items. I hope and pray we will make the strides necessary to establish or re-establish the kind of respect we deserve in the medical community.

I don't think these are trends per se, they are isolated incidences. These are turf wars and are nothing new to the medical field nor are they limited to our profession. There really were no pods practicing at the U of U in the first place (two did part time stuff there) or it never would have happened. This is one hospital. As far is Texas is concerned, it is basically a "pissing match" that will never really amount to anything (after most likely years of being tangled in the legal system).

The trend in the profession is still a very positive one and one that is moving in the right direction.

 

[DPMstudent]

I don't think these are trends per se, they are isolated incidences. These are turf wars and are nothing new to the medical field nor are they limited to our profession. There really were no pods practicing at the U of U in the first place (two did part time stuff there) or it never would have happened. This is one hospital. As far is Texas is concerned, it is basically a "pissing match" that will never really amount to anything (after most likely years of being tangled in the legal system).

The trend in the profession is still a very positive one and one that is moving in the right direction.

thats exactly what i was trying to say

 

[Pedicure]

There's not a single podiatrist that has been out for less than 10 years that hasn't said they wish they were getting into podiatry right now because it is so much better now than when they first started out (an obvious overexageration, but I have yet to talk to any). I would like to think that those guys and gals that have been out for awhile would be pretty up to speed on national as well as their state issues and have the experience behind them for that statement to be incredibly accurate and truthful. Ask around to pod's who've been out and I bet you'll hear the same thing over and over again, it's a great time to be a pod or a pod student. Yes, things can and will get worse, but things can and will get better. It's a trade off, you'll lose some things, but gain others. If you're looking for the all around package in medicine, you'll never find. Not one specialty out there can guarantee you academic, financial and professional success. It's what you put in to your education and what you make of it that will determine your worth and value as a clinician and educator in the future.

Quick question. If they were pods 10 yrs ago, wouldn't that make them even BETTER now? They have the experience, etc. under their belts with patient care and so, should have a huge lift in income, etc. They can now bill insurance not billable in the past, yes? I'm thinking a pod that has veteran experience would be happy to be in this position now. Can you confirm why they may not be happier now. Getting into pods now seems late, since these other guys have the one up on any newly graduated pod. I realize training has advanced but alot of pods training these NEW pods, are THESE older 10yr plus vets I'd think. 😕

 

[Feli]

Quick question. If they were pods 10 yrs ago, wouldn't that make them even BETTER now? They have the experience, etc. under their belts with patient care and so, should have a huge lift in income, etc. They can now bill insurance not billable in the past, yes? I'm thinking a pod that has veteran experience would be happy to be in this position now. Can you confirm why they may not be happier now. Getting into pods now seems late, since these other guys have the one up on any newly graduated pod. I realize training has advanced but alot of pods training these NEW pods, are THESE older 10yr plus vets I'd think. 😕

Yes, pods 10yrs out now probably have more patients/income, more experience, less debt, etc than they did fresh out of training.

However, the training, on average, is just much better now, and I'd have to assume that is what the pod who is 10yr out was commenting on. Sure, there was top training like Bay Area, PI, West Penn, Swedish, Penn-Presby, Oakwood, etc 10 years ago too, but a lot of the middle of the road programs have improved greatly (in both quality and quantity). 10yrs ago, the number of grads getting 3yr training was relatiely small, but now 3yr is the standard for the vast majority of grads.

The main DPM I had shadowed as a pre-pod had graduated Des Moines in the early 1990s. He was top 5 in his class, had secured a 1yr residency, and was doing FF surgery (bunions, HTs, toe amps, etc) but little else; he did have a nice practice with good hours and nice income, though. Similarly, a mid 90s Barry grad I talked to last year was an above average student, did 1yr of PG, makes pretty solid income, but mostly does just wound care, orthotics and C&C in his practice. He stated to me and some of my classmates that "you guys are lucky. 3yr residencies barely existed when I graduated. You are part of the golden age of podiatry." Well, he's right.

Training is the key. If you don't learn things in residency, you won't be able to do them afterwards. There are a few exceptions, but that is the basic rule for the most part. The post-grad training and surgical volume that DPMs are now getting is the best it's ever been; some would even say it's better then F&A ortho (I'd say it depends on the program). Regardless, training is the key, and more training has been correlated again and again with higher avg income.

 

[NatCh]

If you don't learn things in residency, you won't be able to do them afterwards.

To elaborate, you will be able to acquire new skills after Residency and put them into practice. Hardware manufacturers are dying to have us use their products, and will facilitate you getting the training to use them. They sponsor workshops and the Sales Reps will hook you up with other docs who are doing whichever procedure/product you're looking to learn. The Podiatry Institute also holds hands-on workshops. If you want to learn something then you can learn it, even outside of Residency.

The limiting factor is if your hospital will permit you to schedule a case. If you don't have RF/ankle privileges then you can't schedule an ankle case. If you have privileges for forefoot, rearfoot, and ankle procedures then you will likely be able to schedule whatever you want, even if you haven't done it before. Once you are on staff, no one at the hospital is going to be picking through your logs to see if you've ever done such-and-such procedure every single time you call to book a case. To them it's all "foot surgery" and you are a foot surgeon, so good enough.

Probably only if you try to book something that is far out of the norm will it draw attention (e.g., mostly do forefoot, then suddenly you try to schedule an iliac crest graft harvest). I think that the longer you are on staff and are known not to be hazardous, the less likely it is anyone will interfere with you scheduling whatever you want within reason.

When you apply for privileges the hospital will ask for your surgical case logs to show what you've done. This is where having done a big Residency comes in. You already can show that you've done a procedure so you get privileged easily since all you do is submit the paperwork. If you learn something after Residency, you may have to prove to the hospital credentialing committee that you can do it. Some hospitals require you to be ABPS RF/ankle Qualified or Certified to do any RF/ankle cases. If your Residency did not lead to RF/A Qual/Cert then you are out of luck.

Surgery Centers are sometimes less stringent, so you may be able to take your cases there (if they don't require hospitalization of course). They often grant privileges for "foot surgery" without dividing up the foot into regions like the ABPS does.

The bottom line is that having a big Residency gives you more options more easily.

 

[Feli]

To elaborate, you will be able to acquire new skills after Residency and put them into practice. Hardware manufacturers are dying to have us use their products, and will facilitate you getting the training to use them. They sponsor workshops and the Sales Reps will hook you up with other docs who are doing whichever procedure/product you're looking to learn. The Podiatry Institute also holds hands-on workshops. If you want to learn something then you can learn it, even outside of Residency.

The limiting factor is if your hospital will permit you to schedule a case. If you don't have RF/ankle privileges then you can't schedule an ankle case. If you have privileges for forefoot, rearfoot, and ankle procedures then you will likely be able to schedule whatever you want, even if you haven't done it before. Once you are on staff, no one at the hospital is going to be picking through your logs to see if you've ever done such-and-such procedure every single time you call to book a case. To them it's all "foot surgery" and you are a foot surgeon, so good enough.

Probably only if you try to book something that is far out of the norm will it draw attention (e.g., mostly do forefoot, then suddenly you try to schedule an iliac crest graft harvest). I think that the longer you are on staff and are known not to be hazardous, the less likely it is anyone will interfere with you scheduling whatever you want within reason.

When you apply for privileges the hospital will ask for your surgical case logs to show what you've done. This is where having done a big Residency comes in. You already can show that you've done a procedure so you get privileged easily since all you do is submit the paperwork. If you learn something after Residency, you may have to prove to the hospital credentialing committee that you can do it. Some hospitals require you to be ABPS RF/ankle Qualified or Certified to do any RF/ankle cases. If your Residency did not lead to RF/A Qual/Cert then you are out of luck.

Surgery Centers are sometimes less stringent, so you may be able to take your cases there (if they don't require hospitalization of course). They often grant privileges for "foot surgery" without dividing up the foot into regions like the ABPS does.

The bottom line is that having a big Residency gives you more options more easily.

Excellent advice 👍

 

[aphistis]

My brother, a dental anesthesiologist (DDS), asked me why podiatrist don't have a specialty similar and candidly, I agree. There's no reason why a DDS with a 2 year residency in dental anesthesiology can perform such procedures yet a DPM can't.

Purely out of curiosity, why would you want to? Podiatry doesn't have the historical relationship to anesthesia that dentistry does. Anesthesia has always been an integral part of dentistry, and many of the pioneers in anesthesiology have been dentists. It sounds like podiatry has come a very long way in just the past few years. I'd hate to have all that progress overlooked merely for the sake of a misunderstood quest for greener grass.

 

[cool_vkb]

Purely out of curiosity, why would you want to? Podiatry doesn't have the historical relationship to anesthesia that dentistry does. Anesthesia has always been an integral part of dentistry, and many of the pioneers in anesthesiology have been dentists. It sounds like podiatry has come a very long way in just the past few years. I'd hate to have all that progress overlooked merely for the sake of a misunderstood quest for greener grass.

👍