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Hybrocure said:
No primary care physician wants their patient to take their shoes off in their office. Period.
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PTSD from my IM residency clinic at the VA. We had to ask every patient if they want their foot checked and we dreaded it.
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Looks like this is just the start. I still say prehealth students aren't stupid. Nothing we say, good or bad, matters. They'll figure it out on their own.
 
Weirdy said:
...Love clinic but forsaking surgery feels like I'm doing my referral base a disservice? Or maybe its just purely an ego thing where I'm not using the training I went through and it feels like a waste?
Or maybe its just the straight up fear of not operating in a long time and shying away from it.

Regardless of inner feelings- the cases I've done have been a huge time sink with little ROI as a new grad.

Edit: Havn't shared this with anyone else cause it makes me look like a wimp but you guys hate the mods on here anyways so why not. We're all internet strangers in the same hole.
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It's normal.

If it helps at all, I usually look at it as I'm the best in the area for the cases/surgery. If I'm clearly not, I refer it. But yeah, like most surgeons, I did many procedures that I did few/none of in training- despite a pretty good residency. Good prep and planning and good surgical principles (much surgery overall in residency)... they turned out well.

Is my volume high? Heck no.
Most podiatrists, myself included, do fewer cases/procedures in most months than F&a orthos do in a day or two. And sure, there are a tiny fraction of DPMs who do a third or half the surgery volume F&a orthos do... but they're usually doing a lot of easy pus cases or if they do tons of recon, they are mostly the <1% fellowship directors type like Hyer, Camasta, Cotton, etc with MANY other podiatrists feeding them cases/revisions. Very few of us are that.

My late residency director was big on ABFAS and prez at one time, and we'd look at PRR logs. Almost nobody's doing a lot (even ppl you think do a ton do usually a small handful of cases per week, relatively few big trauma or recons... many avg pods do VERY little). So yeah, even a lot of guys on lecture podium or who seem to be on OR schedule a lot really aren't in the grand scheme or relative to even a low volume ortho. Blame APMA for missing the boat on 'everyone is a surgeon' and watering down our volume badly. In the old days, good podiatrist surgery training was rare - but those guys were fairly busy surgically; now, its more common, but there are simply WAY too many of us.

But yeah, don't be afraid to do stuff if you're superior to most/all in your area. If you have Jeff McAlister or a good F&A ortho nearby, you obviously shouldn't be doing one or two TAR per year. But calcs, lisfranc, flatfoot, bimall, Achilles, etc... do it if you have the training and interest. If you can become owner/partner, or at least get DME incentives, recon and bigger surgery is not as painful from collections standpoint. 👍
 
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HaimFeldman said:
There was no clearer representation as to where our profession is at as when an elderly new diabetic patient tried tipping me $10 after I finished clipping her toenails.

That is, until it happened a second time.
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We need some podiatry office tip jar memes asap
 
Homo sapien said:
It's not just you. It's a lot of us. Podiatry isn't a surgical profession- like ortho or general surgery or something. It's a foot specialty with some surgery sometimes. Many things in the foot can be cared for without cutting
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Does not compute. Error.
 
Prehealth1011 said:
PTSD from my IM residency clinic at the VA. We had to ask every patient if they want their foot checked and we dreaded it.
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During medical school I had an attending on the wards make everyone a “fall risk” so they had to keep the grippy socks on all the time. Out of sight, out of mind.
 
Adam Smasher said:

Podiatry Management Online

Podiatry Management is the national practice management and business magazine, reaching over 22,403 subscribers.
podiatrym.com

Looks like this is just the start. I still say prehealth students aren't stupid. Nothing we say, good or bad, matters. They'll figure it out on their own.
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Shocking, PE guy and residency director wants the associate pipeline chugging right along.
 
Boba Foot said:
Shocking, PE guy and residency director wants the associate pipeline chugging right along.
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This. Look on the Upperline website, they list 21 executives on the leadership team and then 6 additional board members. That is a lot of overhead to be paid.

I would like to know the average starting salary of Upperline associates and how it aligns with the statistics listed on this website. Also would be good to know how those same associates are doing 2-4 years later, and how much of their collections they keep. With this much overhead to pay for it seems unlikely they keep more than 30%.

This has been a slow motion disaster unfolding since residency was standardized to 3 years for surgical purposes, but it is deeper than that. Our profession developed because medicine in the US had not evolved to appropriately manage low grade pathology that patients experience as real physical problems (nails they can't cut, calluses that can hurt like hell). Those problems are often due to progressive digital deformities (hammertoes, bunions), which lead to logical surgical intervention that really can help in the right patients. Nobody was paying attention as enterprising and bold individuals pushed the envelope and created the surgical podiatrist in the shadows of rural hospitals and safety net medical centers, as well as in office surgical suites. At some point, a small number of well-trained surgical podiatrists had a really good thing going. Reimbursement for surgical procedures was good and ortho/medicine in general was not paying too much attention, it was the foot after all. Naturally, these well trained individuals trained more and more, until podiatry became a caste system dictated by surgical training. With expertise, training, and skill wildly inconsistent, all behind the same degree (DPM), it made sense to standardize the field as a surgical profession with at the very least an honorable attempt to standardize surgical residency training. Unfortunately nobody considered supply and demand.

What Feli states above is the crux of the problem. There used to be a few highly trained surgical podiatrists doing a ton of surgery. Now there are thousands of podiatrists with surgical ambition. There are still a good amount doing high volume (I know plenty, I think Feli understimates how many podiatrists are actually surgically busy) , but the difference is that there is a whole lot that claim the same crediential, expertise, and experience but just do not have the volume to support these claims.

Those guys who were really busy, they got a bunch of referrals from the non-surgical or minimally-surgical pods. That kept them busy. In my practice I have gotten some surgical referrals from some of the guys in the community. All of them are older, I almost never got a referral from those around my age/experience. Those times are done.

The invisible hand of the market will correct, but not without collateral damage. Lots of vice presidents to pay.
 
Calogero said:
This. Look on the Upperline website, they list 21 executives on the leadership team and then 6 additional board members. That is a lot of overhead to be paid.

I would like to know the average starting salary of Upperline associates and how it aligns with the statistics listed on this website. Also would be good to know how those same associates are doing 2-4 years later, and how much of their collections they keep. With this much overhead to pay for it seems unlikely they keep more than 30%.

This has been a slow motion disaster unfolding since residency was standardized to 3 years for surgical purposes, but it is deeper than that. Our profession developed because medicine in the US had not evolved to appropriately manage low grade pathology that patients experience as real physical problems (nails they can't cut, calluses that can hurt like hell). Those problems are often due to progressive digital deformities (hammertoes, bunions), which lead to logical surgical intervention that really can help in the right patients. Nobody was paying attention as enterprising and bold individuals pushed the envelope and created the surgical podiatrist in the shadows of rural hospitals and safety net medical centers, as well as in office surgical suites. At some point, a small number of well-trained surgical podiatrists had a really good thing going. Reimbursement for surgical procedures was good and ortho/medicine in general was not paying too much attention, it was the foot after all. Naturally, these well trained individuals trained more and more, until podiatry became a caste system dictated by surgical training. With expertise, training, and skill wildly inconsistent, all behind the same degree (DPM), it made sense to standardize the field as a surgical profession with at the very least an honorable attempt to standardize surgical residency training. Unfortunately nobody considered supply and demand.

What Feli states above is the crux of the problem. There used to be a few highly trained surgical podiatrists doing a ton of surgery. Now there are thousands of podiatrists with surgical ambition. There are still a good amount doing high volume (I know plenty, I think Feli understimates how many podiatrists are actually surgically busy) , but the difference is that there is a whole lot that claim the same crediential, expertise, and experience but just do not have the volume to support these claims.

Those guys who were really busy, they got a bunch of referrals from the non-surgical or minimally-surgical pods. That kept them busy. In my practice I have gotten some surgical referrals from some of the guys in the community. All of them are older, I almost never got a referral from those around my age/experience. Those times are done.

The invisible hand of the market will correct, but not without collateral damage. Lots of vice presidents to pay.
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I applied for a job at Upperline health once. They offered 150-160K base and benefits but to bonus you needed to hit 600K in collections and you got 30% of whatever you grossed after that. Terrible deal. It is an oversaturated market in the areas where they are trying to set up locations. So you don't have favorable market conditions to bonus.

These podiatrist super groups are the way though. Upperline is just one of them. Weil has a supergroup. There is another one named Curalta. Many more after that.

We will have supergroups because then everyone can possibly get a trickle of extra cash being a share holder as these groups continue to hire cheaper and cheaper help to pump money into the group. It's like a giant pyramid scheme.

Or you work as an associate for a small private practice group making less money....

Or you go out on your own with no work experience....

Supergroups are here to stay and they are going to continue to expand and buy up smaller practices.
 
Boba Foot said:
Shocking, PE guy and residency director wants the associate pipeline chugging right along.
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Not everyone is out to get you. Dr. DeHeer is one of the most honest people I know. He truly cares about the future of the profession and is one of the few taking action. I have heard him acknowledge some the concerns that are posted by SDN regulars have validity. As the face of APMA's campaign, he's an easy target for all of you, but those of you who have met him would likely agree with me.

I know this is "the Internet" where anonymous bomb throwing and the villainization of leaders is the norm, but perhaps a different tactic would help you more. Acting like a professional and reaching out to him with your concerns and working on a solution?
 
There's no solution to be found. If DeHeer is just the face of the campaign, the APMA has placed him in an impossible situation. Prehealth students are, as a group, not stupid. But it's a bell curve, so some in the tails will be sort of stupid.

If you tell students their incomes will be in the mid 200s, when, in fact, it takes years to get to that point, and if you emphasize surgery, when, in fact, surgery is not the emphasis of podiatry, only the stupid prehealth students will believe this. And there are not enough stupid prehealth students to keep college enrollments up.
 
diabeticfootdr said:
Not everyone is out to get you. Dr. DeHeer is one of the most honest people I know. He truly cares about the future of the profession and is one of the few taking action. I have heard him acknowledge some the concerns that are posted by SDN regulars have validity. As the face of APMA's campaign, he's an easy target for all of you, but those of you who have met him would likely agree with me.

I know this is "the Internet" where anonymous bomb throwing and the villainization of leaders is the norm, but perhaps a different tactic would help you more. Acting like a professional and reaching out to him with your concerns and working on a solution?
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Deheer is a legit guy. He cares a lot about the profession/residents/students/patients.
If i had to choose anyone to be the face of anything podiatry he would be high on the list.
 
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diabeticfootdr said:
Not everyone is out to get you. Dr. DeHeer is one of the most honest people I know. He truly cares about the future of the profession and is one of the few taking action. I have heard him acknowledge some the concerns that are posted by SDN regulars have validity. As the face of APMA's campaign, he's an easy target for all of you, but those of you who have met him would likely agree with me.

I know this is "the Internet" where anonymous bomb throwing and the villainization of leaders is the norm, but perhaps a different tactic would help you more. Acting like a professional and reaching out to him with your concerns and working on a solution?
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You villainize everyone on here because you can't control the narrative. If you were in charge every single post would be deleted. The moderators on the podiatry forums regulate here more than I can ever remember going back to 15 years ago when I first enrolled into podiatry school. So clearly you have some influence in that. Or the APMA does.

My problem is your inability to even consider what we say on here despite our significant experience. You are so pro podiatry when very clearly there many on here who disagree with you on a consistent basis.

In your mind we are clearly not telling the truth. But being so pro podiatry are you telling the truth? I've never really read a legitimate reason from you on WHY we need more schools and more podiatrists other than you saying diabetes is on the rise. Who cares. Diabetics don't and won't make up a 100% of everyone's practice. Even non surgical podiatrists.

You do realize that there are more podiatrists graduating from residency in the USA than there are orthopedic residents for ALL SPECIALTIES every year right? Ortho caps volume to ensure there is good demand. Podiatry is a free for all. Where we focus on volume and not quality. We are specialists in the foot, ankle, leg. Yet even TODAY the training is VARIABLE. We are still producing podiatrists with variable training despite "standardized" three year residency training. The focus on volume has completely undone anything that we were suppose to achieve with "standardized" training.

It looks good on paper but NOBODY is buying it. Not even AOFAS. Not even AAOS. Insurance companies don't buy it. Nobody buys it. People see it when they see podiatrists who all can't do the same thing when it comes to one specific area of the body. We say pre-health students are not stupid. Neither is ortho and hospital administration either.

I work in a state where there are significant rural areas in a hospital system with satellite hospitals in each of those areas. EVERY SINGLE RURAL HOSPITAL IN THOSE AREAS HAS A PODIATRIST EMPLOYED. There is one satellite hospital that services a town of only 40,000 people and now they have FOUR surgical podiatrists employed. FOUR for 40,000 people.....

This is a state nobody really puts at the top of their list to live in.

Do we REALLY need all these podiatrists? The answer is clearly no. But you want MORE. The APMA wants more. WHY?

The APMA, you and anyone who is at the top of the food chain in the profession are not in touch with reality.

On top of ALL OF THIS you have single handedly created division within the profession with this board certification nonsense that has been going on. Yet the podiatrists on SDN are the problem...
 
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Aging population/rise of diabetes should not be the justification for increasing the supply of podiatrists. We should be leading the charge for an increase in Foot Care Nurses UNDER THE SUPERVISION of podiatrists. The leaders of this profession know damn well that 95% of these aging diabetic patients are not coming in for complex recon surgery, they want their nails clipped. Otherwise we're just recruiting more nail techs with a medical degree.
 
diabeticfootdr said:
Dr. DeHeer is one of the most honest people I know. He truly cares about the future of the profession and is one of the few taking action.
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I am sure he’s just swell. What I said was not a personal attack, rather pointing out that his new website project has misleading income numbers and as a PE shareholder, he has a direct benefit from low wages for newly practicing pods. And you know for a PE firm to employ a doctor with a reputation like his, he has quite a stake in that firm.

I would love to hear a solution from him for the abysmal job market for new pods. I dare say prospective students are probably more concerned with that than most of the points listed on that website. I think we can unanimously say on here that the answer for the job market isn’t further diluting the pool…
 
Just another thought: the masterminds behind this campaign probably did polls and focus groups to figure out what prehealth students are paying attention to. These are undergrads who have already been brainwashed by counselors that going medicine for the money is doing it for the wrong reasons. So ROI isn't a prime consideration for them...yet. But being a ✨️surgeon✨️ surely gets their attention. Hence the current ad campaign. This is the gamble, let's check back in 7 years how class of 2032 feels if it was worth it
 
Adam Smasher said:
Just another thought: the masterminds behind this campaign probably did polls and focus groups to figure out what prehealth students are paying attention to. These are undergrads who have already been brainwashed by counselors that going medicine for the money is doing it for the wrong reasons. So ROI isn't a prime consideration for them...yet. But being a ✨️surgeon✨️ surely gets their attention. Hence the current ad campaign. This is the gamble, let's check back in 7 years how class of 2032 feels if it was worth it
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Let's check back on Vision 2020 and see if that was worth it
 
Adam Smasher said:
Just another thought: the masterminds behind this campaign probably did polls and focus groups to figure out what prehealth students are paying attention to. These are undergrads who have already been brainwashed by counselors that going medicine for the money is doing it for the wrong reasons. So ROI isn't a prime consideration for them...yet. But being a ✨️surgeon✨️ surely gets their attention. Hence the current ad campaign. This is the gamble, let's check back in 7 years how class of 2032 feels if it was worth it
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Can you imagine if that 4 million dollars was used to offer scholarships. Life changing.
 
AttackNME said:
do you think we should have a route for nonsurgical podiatry? If so, how would that look like?
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Absolutely. If you know surgery isn't for you, you could match into a 1 year nonsurgical residency or even start out right after graduation. It makes no sense to foist surgical training on every single DPM grad. The reality is there is a decent percentage of folks who have no business doing surgery or little/no interest, but feel as though they 'have to' as part of the job description and that's what they trained for. Make it like MD/DO where only the top students match into surgical residencies, that way you solve the oversaturation problem as well.
 
AttackNME said:
do you think we should have a route for nonsurgical podiatry? If so, how would that look like?
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Nope. Too late. No one to date in leadership has answered why we need more students when there is over saturation. They spend more time calling us disgruntled and trolling on the internet.
 
it’s more complicated than just follow dental model, cus a lot people think we will be going backwards if we retract and say oops nvm we aren’t all surgeons anymore. Won’t that be confusing to the public if we do train surgeons and non-surgeons? What would happen to the states that require residency to have a podiatry license? If we want nonsurgical to practice without residency that would be a problem. Do we then split existing residencies and label some nonsurgical? This isn’t a simple fix, let’s think about it some more
 
AttackNME said:
it’s more complicated than just follow dental model, cus a lot people think we will be going backwards if we retract and say oops nvm we aren’t all surgeons anymore. Won’t that be confusing to the public if we do train surgeons and non-surgeons? What would happen to the states that require residency to have a podiatry license? If we want nonsurgical to practice without residency that would be a problem. Do we then split existing residencies and label some nonsurgical? This isn’t a simple fix, let’s think about it some more
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Idk, I think what’s more confusing to the public is the complete lack of standardization of training. You have people advertising themselves as expert foot and ankle surgeons but referring out anything more complicated than a bunion. One person’s podiatrist may do total ankles and another person in the same city only sees their DPM for toenails every 61 days. This is not the case for any other surgical specialty in medicine.

Anyways, this is a pointless discussion because we ain’t going back in time. It’s more likely that fellowships will become mandatory than non-surgical residencies pop up.
 
pod squad said:
Idk, I think what’s more confusing to the public is the complete lack of standardization of training. You have people advertising themselves as expert foot and ankle surgeons but referring out anything more complicated than a bunion. One person’s podiatrist may do total ankles and another person in the same city only sees their DPM for toenails every 61 days. This is not the case for any other surgical specialty in medicine.

Anyways, this is a pointless discussion because we ain’t going back in time. It’s more likely that fellowships will become mandatory than non-surgical residencies pop up.
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This isn’t a pointless discussion, we have some people on here like airbud advocating for the dental model which is technically gonna “go back in time”. Why not hash it out here?
 
AttackNME said:
This isn’t a pointless discussion, we have some people on here like airbud advocating for the dental model which is technically gonna “go back in time”. Why not hash it out here?
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I’m all for hashing out ideas, but the reality is the leadership of this profession just got bilked out of $4M to make a website saying ‘you can be a foot surgeon even though you’re not qualified to be a surgeon of any other body part, apply today!’ Mandatory surgical training isn’t going anywhere.
 
At one of my rotations I heard of a resident who finished one year, got his state license and then quit residency and just opened up his own office and does no surgery. Not sure if this is allowed in all states but I guess it worked out for him though he had a bad reputation from other pods around the area due to him quitting residency early.
 
pod squad said:
I’m all for hashing out ideas, but the reality is the leadership of this profession just got bilked out of $4M to make a website saying ‘you can be a foot surgeon even though you’re not qualified to be a surgeon of any other body part, apply today!’ Mandatory surgical training isn’t going anywhere.
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Why should a new website stop us from deliberating different directions for our profession?

And med schools don’t think feet are important enough to care about, some even skip foot anatomy entirely. Foot and ankle ortho is among the lowest paying ortho specialty for a reason. We don’t need the best and brightest surgeons to do the bulk of the general podiatry work (which is still important and meaningful). Why should someone who doesn’t want to do hindfoot reconstruction be forced to do mandatory 3 year surgical residency and dilute numbers for the few who actually would do the orthopedic type foot and ankle work?
 
I agree with you completely. Unfortunately nobody with any sort of decision making capacity does. In fact, it’s clearly quite the opposite.
 
I’m actually on the fence, just asking questions. The cool thing is we aren’t in leadership positions where we have to tie our opinions to our names. We could use this forum to work out these issues in detail with no ramifications to our reputation. What changes would you enact if you held leadership positions?
 
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MicroPod said:
At one of my rotations I heard of a resident who finished one year, got his state license and then quit residency and just opened up his own office and does no surgery. Not sure if this is allowed in all states but I guess it worked out for him though he had a bad reputation from other pods around the area due to him quitting residency early.
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The thing about reputation is the only patients who care about that are high maintenance ones
 
4 years school + 3 year residency = Doctor of Podiatric Medicine AND Surgery
3 years school + 1 year residency = Doctor of Podiatric Medicine
3 years school, no residency = you can essentially practice as a chiropodist or something idk

Let the market determine the value of each of these degrees. Or you just wipe this profession from the face of the earth and pretty much nothing changes, but hey I'm just disgruntled 🙂
 
This is what the dental model looks like:

Nonsurgical podiatrists get dpm degrees and do X years of residency. They do warts and ingrowns and heel pain and grind lots and lots of toenails. They refer surgical patients to orthopedic surgeons with MD degrees. Because the market is not saturated with quasi-surgeon dpms, CMS is forced to increase reimbursement for foot surgery performed by aforementioned MDs so it becomes economically viable for them.

Also PCPs and physician extenders figure out the warts and ingrowns, physical therapists handle the heel pain, good feet store sells orthotics, nurses take over nails and wounds, and...whither podiatry?
 
To me "dental model" means "no insurance". Sounds pretty cool if I can make all the rest of you disappear.

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I will respond more seriously when I get back to my home base!
 
AttackNME said:
it’s more complicated than just follow dental model, cus a lot people think we will be going backwards if we retract and say oops nvm we aren’t all surgeons anymore. Won’t that be confusing to the public if we do train surgeons and non-surgeons? What would happen to the states that require residency to have a podiatry license? If we want nonsurgical to practice without residency that would be a problem. Do we then split existing residencies and label some nonsurgical? This isn’t a simple fix, let’s think about it some more
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I trust our leaders.to figure it out. Case closed.
 
Podiatry would legit run smoother if SDN attendings and that one Reddit attending (Adamsmasher’s bestie) took over.
 
If you trust our leaders then why did you start this thread airbud? And since when did you trust our leadership to figure this out?

Mimicking the dental model doesn’t mean we have to copy them 100%. There is good rationale to a shorter and possibly cheaper pathway to nonsurgical podiatry. The problem is that right now if we decide to do that, it would be going backwards and could be seen as confusing to the public what our training exactly is. Is this a risk our leadership should take? How should the message be to the public? How do we market nonsurgical vs surgical podiatry to patients and prospective students? If we mess up the messaging it could be extremely embarrassing.

Podiatry isn’t going away, the reason we stepped into the surgical role is because MD/DOs haven’t filled that role properly. Patients had to wait months for a foot and ankle ortho appointment and yet they still made less than their ortho colleagues. Obviously there isn’t going to be more foot/ankle ortho docs in the works. The demand for foot/ankle care is there and we own the nonsurgical space and now share the surgical space with ortho. We won’t and shouldn’t try to monopolize the surgical space. So the question is, how best should we structure our profession to serve the community?
 
Has anyone else noticed that the majority of people promoting podiatry are heavily involved in academia, residency programs, or educational roles? It seems like platforms such as Dean's Chat mainly feature individuals whose livelihoods are tied to education/residency—essentially promoting job security for themselves including Jeff Jenson.

Why isn’t anyone addressing the real issue of market saturation in our profession? You would absolutely have to be nuts to go into podiatry and spend 300k and 7-8 years only to be smoked by a PA, NP or a travel nurse / midlevels.

Good jobs are increasingly rare, and the few that do exist often receive 50+ applicants. The profession is severely saturated, yet those in secure academic positions continue to self-promote under the guise of advocacy. It’s frustrating and feels disingenuous.
 
First step is for those in power to admit that there could be potential saturation problem. Clearly with this new campaign they don't believe there is.

I would advocate for an outside consulting firm to look at the issue and give recommendations regarding graduation numbers.

Once it is established that there is a real problem, I think there are essentially three options.

First, is to continue to do nothing and allow insurance companies to continue to cut our reimbursement because they already have enough podiatrists on their panel taking 60% of Medicare. The declining reimbursement rate combined with declining patient load means collection numbers (income) continue to drastically decrease.

Second option would be the dental model as described above. Limit residencies to the above recommended number from the consulting firm (maybe 50 spots?) Those who graduate from a 3 year residency obtain a degree of DPS (Doctor of Podiatric Surgery). The students who do not get a residency are able to go out and start practicing but will not sniff the inside of a hospital/surgical center. Obviously, there would need to be legislation changed in some/most? states but this is likely the best scenario.

Third option would be to just decrease the enrollment numbers significantly which seems to be something that is not on the table at all especially considering this new campaign of attempting to attract more applications.

I've mentioned this before but I think we have way too many people operating on the foot and ankle. In my area there are like 25-30 who are probably doing about 2-8 cases/month. I think the community would be far better served with 2-4 of those who have had great training doing 20-40 cases/month.
 
hematosis said:
Has anyone else noticed that the majority of people promoting podiatry are heavily involved in academia, residency programs, or educational roles? It seems like platforms such as Dean's Chat mainly feature individuals whose livelihoods are tied to education/residency—essentially promoting job security for themselves including Jeff Jenson.

Why isn’t anyone addressing the real issue of market saturation in our profession? You would absolutely have to be nuts to go into podiatry and spend 300k and 7-8 years only to be smoked by a PA, NP or a travel nurse / midlevels.

Good jobs are increasingly rare, and the few that do exist often receive 50+ applicants. The profession is severely saturated, yet those in secure academic positions continue to self-promote under the guise of advocacy. It’s frustrating and feels disingenuous.
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All Deans chat interviews are students and residents. Of course they will speak positive about the profession. But being a student and resident is not the real world. Interview those people when they graduate residency and work for some podiatrist making 75-100K per year with an impossible bonus structure. Let's see how much they like it now.

People promoting podiatry need butts in the seats to keep their own careers going. It is a pyramid scheme. Deans and DPM teachers need students. Private practice owners need new graduates with no where to go. Supergroups need struggling private practices willing to make a deal to get some financial security.

The only DPMs that are free are hospital employed DPMs. If they lose their job then God help them.
 
Dermato Fight Club said:
First step is for those in power to admit that there could be potential saturation problem. Clearly with this new campaign they don't believe there is.

I would advocate for an outside consulting firm to look at the issue and give recommendations regarding graduation numbers.

Once it is established that there is a real problem, I think there are essentially three options.

First, is to continue to do nothing and allow insurance companies to continue to cut our reimbursement because they already have enough podiatrists on their panel taking 60% of Medicare. The declining reimbursement rate combined with declining patient load means collection numbers (income) continue to drastically decrease.

Second option would be the dental model as described above. Limit residencies to the above recommended number from the consulting firm (maybe 50 spots?) Those who graduate from a 3 year residency obtain a degree of DPS (Doctor of Podiatric Surgery). The students who do not get a residency are able to go out and start practicing but will not sniff the inside of a hospital/surgical center. Obviously, there would need to be legislation changed in some/most? states but this is likely the best scenario.

Third option would be to just decrease the enrollment numbers significantly which seems to be something that is not on the table at all especially considering this new campaign of attempting to attract more applications.

I've mentioned this before but I think we have way too many people operating on the foot and ankle. In my area there are like 25-30 who are probably doing about 2-8 cases/month. I think the community would be far better served with 2-4 of those who have had great training doing 20-40 cases/month.
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These are 2 separate issues, student recruitment vs. professional branding.

First, there is not an oversaturation of podiatrists for the amount of work available (foot and ankle problems), surgical or non-surgical. In fact, there is a growing need. But obviously, according to the opinions of SDN posters, the projected is not leading to increased job demand or compensation parity. The APMA does recognize this (I am not representing the APMA, just aware of their plans) and they will shortly be engaging in a re-branding campaign for the profession similar to what the DOs did about 20 years ago to entice patients to choose a podiatrist first for their foot and ankle provider. This is to help grow the demand for podiatrists, hopefully something you all will applaud.

Second, the issue of student recruitment is one that requires a separate strategy. The APMA does not control the number of seats available, but they recognize that unfilled seats or unqualified matriculants are bad for the profession. That is the focus of www.discoverpodiatry.org

Lastly, everyone can opine on the best training models, but the standardized 3-year residency was implemented to solve several problems (non-standardization, discrimination, and GME funding) and we won't be going backward to multiple residency types. The 4-4-3 model is the standard in American medicine (not set by podiatry) and if we want to be treated the same as any other doctor, we must adopt their model for parity. The profession may adopt a more standardized fellowship model for subspecialization in the future and perhaps the residency curriculum (while staying 3 years) will be lighter on RRA.

Some of the solutions proposed by SDN posters, while may solve their main concern of "oversaturation" in the short-term, would be considered anti-competitive, possibly illegal, and wouldn't survive a challenge.
 
diabeticfootdr said:
there is not an oversaturation of podiatrists for the amount of work available
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Somewhere around 40% of my patient visits on any given day are diabetic/geriatrics whose principle concerns are having their nails trimmed and hassling me about free shoes. So we're clear, is this what you're talking about when we talk about the amount of work available?
 
Adam Smasher said:
Somewhere around 40% of my patient visits on any given day are diabetic/geriatrics whose principle concerns are having their nails trimmed and hassling me about free shoes. So we're clear, is this what you're talking about when we talk about the amount of work available?
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Crystal
 
[QUOTE="Retrograde_Nail, post:
Where are we getting your information about there not being over saturation? Or are we drawing conclusions or assuming because “diabetes is on the rise”.

I think A LOT of recent graduates from residency would beg to differ.[/QUOTE]

Where are you getting your information that it is oversaturated?

If it’s personal experience, then yours differs from mine.

When I started at UT, we had a waiting list of one thousand two hundred new patients. I had to send anyone with insurance out to community practices to reduce our demand.

I’m not discounting your experience, just that there are many factors that contribute to the demand for foot and ankle care and those factors are circumstantial.
 
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AttackNME said:
If you trust our leaders then why did you start this thread airbud? And since when did you trust our leadership to figure this out?

Mimicking the dental model doesn’t mean we have to copy them 100%. There is good rationale to a shorter and possibly cheaper pathway to nonsurgical podiatry. The problem is that right now if we decide to do that, it would be going backwards and could be seen as confusing to the public what our training exactly is. Is this a risk our leadership should take? How should the message be to the public? How do we market nonsurgical vs surgical podiatry to patients and prospective students? If we mess up the messaging it could be extremely embarrassing.

Podiatry isn’t going away, the reason we stepped into the surgical role is because MD/DOs haven’t filled that role properly. Patients had to wait months for a foot and ankle ortho appointment and yet they still made less than their ortho colleagues. Obviously there isn’t going to be more foot/ankle ortho docs in the works. The demand for foot/ankle care is there and we own the nonsurgical space and now share the surgical space with ortho. We won’t and shouldn’t try to monopolize the surgical space. So the question is, how best should we structure our profession to serve the community?
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It was a joke.
 
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