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A picture is worth a thousand words
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I laughed, but the ACFAS job board is actually maintained on a much larger website for other jobs. What will actually make you laugh is that like 28 of the 44 jobs are actually ortho jobs.
i've posted this on here before, but I always keep my eyes open for other options but there are zero in my area that would come close to my current income. and if one opened up that could compete, it would be a dogfight. this marries you to your employer and i think that feeling is what leads to a lot of disappointment people feel, even if they have a relatively solid income.
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Anecdotes like these give me a a modicum of contentment being a small business owner in private practice, scrounging up whatever bottom feeder work comes my way, because at least I'm doing so on my own terms. 🦞
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Correct. There are more F&A Ortho jobs listed than there are podiatry jobs on a “Podiatry” specific job board, run/sponsored by our lords and saviors, ACFAS.
It is nice to not give a rip about looking for jobs or "networking" again.
We've all applied to jobs that don't even respond or that we got to vid, visit, whatever... yet didn't get the offer. I, like at least a few of us, have also been on the other end posting or sorting apps for a decent podiatry job, and the number of apps, calls, emails is BONKERS. There are sooo many bites, so fast... so many DPMs looking to change jobs. It's pretty sad. We are saturated in every metro... and a lot of smaller areas too. Basically everywhere you can find even a FP doc or two and OB doc, you also see a DPM.
...There are at least a few threads on SDN every year (usually winter/spring) of pgy3s - or pgy2s or even fellows - who are flat out amazed how baaaad the podiatry job market and/or pay is. It's a bucket of cold water in the face for all of us. Most DPMs seem to know by residency that the game is not great and it will be slim pickings, but I think a few earnestly believe that they are a "doctor" and will have vast options just like MD/DO or get recruited, so they are extra miffed and mad about it.
For podiatry grads, it's basically a game of:
- take an associate/supergroup gig to be near/in the area you want
- go to BFE for a small hospital type of job.. CAH, IHS, etc
- settle for pretty low pay for VA gig (if you can get that... usually in a city you don't really want)
- get a very rare normal hospital job or step into booming family PP right out of training
- start up solo or buyout retire doc (once more common but now highly rare, needs fam or other financing)
Correct... the better a podiatry job you have, the more stuck you then become.
The higher pay the hospital job or the more successful the doc's solo PP or whatever, the harder it'd be to replace. It would be a pretty massive undertaking for me to change my office to another state... I'd have to do a ton of work again and feel a sizeable hit on income for at least a couple years. Depending on the area and the partner/spouse, that difficulty changing area can be no big deal... or it can be a big problem. I've seen it burn the husband/wife DPM couples pretty bad... very rare both can find a good job in same metro (one might get hosp/MSG/ortho... other goes to PP associate, sometimes both).
The thing I still don't get (never will) are the supergroup and pod associates who take out a big mortgage and buy a house (on top of student loans). That just seems wild to me. That not only undercuts any partner/raise negotiating power they have, but it also makes it extremely hard to look for better jobs elsewhere. It's almost like giving up.
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I couldn’t live comfortably always on the search for a better and higher level paying job tbh. Moving sucks. Especially when you have a spouse with an job and kids in school.
I know a lot of people here are always on their “grindset” but im just happy to chill
I know a lot of people here are always on their “grindset” but im just happy to chill
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Lived this life....on my 5th job in 9 years....some luck (good and bad) some skill. Don't wish it on worst enemy. It's rough out there.
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Lol yep.
Even trying to find a place to potentially start a private practice is a pain in the butt (I've been scouring google maps for pods). Why the heck are there so many podiatrist even in small cities and towns of 10 to 30,000 people?
Suburbs with <40,000 people have like 7 different practices each with 2 to 3 podiatrists (not even /s). I'm purposely looking at places where not that many people want to live (so avoiding miami, LA, SD, northern Virginia, Seattle, Chicago, Portland, Austin, Dallas, San Antonio, Atlanta, New England,etc. and all its suburbs for 80+ miles)
I'm purposely trying to avoid areas that have a residency or podiatry school and even then, small little towns and suburbs already have multiple podiatrists, not 1 or 2, but multiple.
I've looked at smaller metros in the Midwest and their suburbs, but they are saturated as well. Places like Columbus, cleveland, St. Louis, KC, Detroit, Milwaukee, etc.
It is insane. I've seen a few comments on here discussing going rural or that there's a lot more job opportunities in rural areas, etc., but I feel like the places I'm looking up are rural (within reason; can't be moving to somewhere too unpopulated otherwise there wont be any patients lol).
Also what is with so many >65 year old pods still practicing? Their bios giveaway their age based on photo or year of graduation.
You became a doctor with 1/4 the debt of today, worked in the golden era of reimbursement, and still aren't retired? What was the freaking point?
I am doing all of this to be ABLE TO RETIRE earlier than normal, not work into my 60's. It makes no sense.
Even trying to find a place to potentially start a private practice is a pain in the butt (I've been scouring google maps for pods). Why the heck are there so many podiatrist even in small cities and towns of 10 to 30,000 people?
Suburbs with <40,000 people have like 7 different practices each with 2 to 3 podiatrists (not even /s). I'm purposely looking at places where not that many people want to live (so avoiding miami, LA, SD, northern Virginia, Seattle, Chicago, Portland, Austin, Dallas, San Antonio, Atlanta, New England,etc. and all its suburbs for 80+ miles)
I'm purposely trying to avoid areas that have a residency or podiatry school and even then, small little towns and suburbs already have multiple podiatrists, not 1 or 2, but multiple.
I've looked at smaller metros in the Midwest and their suburbs, but they are saturated as well. Places like Columbus, cleveland, St. Louis, KC, Detroit, Milwaukee, etc.
It is insane. I've seen a few comments on here discussing going rural or that there's a lot more job opportunities in rural areas, etc., but I feel like the places I'm looking up are rural (within reason; can't be moving to somewhere too unpopulated otherwise there wont be any patients lol).
Also what is with so many >65 year old pods still practicing? Their bios giveaway their age based on photo or year of graduation.
You became a doctor with 1/4 the debt of today, worked in the golden era of reimbursement, and still aren't retired? What was the freaking point?
I am doing all of this to be ABLE TO RETIRE earlier than normal, not work into my 60's. It makes no sense.
sdupre_apma
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Hey @footpainhealer, Sam, the statistician for APMA here. Would you be interested in taking a look at something I’ve been working on and give any impressions on validating it based on your searching?
I’ve been working on a workforce estimate product, including georeferencing the practice locations for all NPI registry podiatrists by their multiplicity of practice locations down to the coordinates of their precise street addresses.
I’m finding a real dichotomy here, where there are areas of the US that are absolutely packed with podiatrists and areas that very much aren’t. I’m curious how the mapped results jive with the searching that you’ve outlined.
It’s sidelined for the moment while I work on Marit/APMA compensation report results, but If you’d be curious to setup a call when we get closer to a dataset ready for releasing, let me know? Much of the point of the project is to help DPMs be informed on where podiatrists are clustered and where they are not. To give my anti-click-bait title “the results may not surprise you!”
Warmly,
Sam
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I think you missed the entire point...
Who cares if you got the location of every podiatrist in the country locked down. Who cares. What you will find is that there are few podiatrists in terrible areas that nobody wants to live. Then there will be many podiatrists in areas that people do want to live.
Maybe just maybe there are nice areas where there are no podiatrists but that would mean going into your own pocket to build a practice or begging a local hospital to hire you. What kind of profession is this? If I was a CRNA/MD/DO would they be doing the same thing? No
DPMs have no flexibility. If I was a CRNA I could get a job anywhere in the USA and get paid great money. If I was an MD/DO I could get a job anywhere in the USA and get pain great money. I would even dare to say that nurses doing traveling contracts probably make more money than the typical podiatry associate.
If I am DPM and I want to live in San Diego, with no connections to the area, I can kiss getting a hospital job goodbye and I can entertain 100K job offer from a predatory private practice or a supergroup. That's it.
I once interviewed for a private podiatry practice job in Hoboken (very cool and fun place). I got a 75K offer.
You do not understand how bad it is out there. You have no idea. I am tired of leadership and people like yourself who latch onto podiatry leadership trying to promote this profession like it has no faults.
We are over saturated. Private practice is going to be 5-6 supergroups to rule them all. It is going to be a disaster.
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Oh you are working into your 60s
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Yeah. It's his employer that is the problem, not him.
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No idea how you interpret that and get triggered. This is a you problem.
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I'm just finishing this out and then leaving. I have nothing left in me. Didn't want to quit just yet because I worked so hard to get to this point but it's not fair to ask my SO to continue to play this ridiculous game any longer.
Might even pivot to being an RN, honestly. My SO is a nurse and they're making 80/hr. Been discussing about doing the accelerated program and we can travel together. Either way, Podiatry isn't it and I don't want to invest into this nonsense any longer.
Might even pivot to being an RN, honestly. My SO is a nurse and they're making 80/hr. Been discussing about doing the accelerated program and we can travel together. Either way, Podiatry isn't it and I don't want to invest into this nonsense any longer.
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Dude my search has not been done to the level that I would be of any help to you lol.
I simply picked places to avoid (the larger cities mentioned above + more, and their suburbs because we all know they're saturated) and googled small towns/cities/metros that I have heard of and would be interested in and looked on maps to see how many red dots there were with "podiatrist" in the search bar (then I'd zoom out and scroll around in the surroundings suburbs or exurbs too). Sure, I clicked on a few of the practices just to see who's working there or how many people are working there in each place that I looked, but that's not going to be much help for you. I haven't logged or tracked any of this lol.
Just casually looking.
sdupre_apma
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Thanks guys, fair enough!
@footpainhealer sure, I'll likely put it out for comment or something at some point. Mostly I was curious to see if what I'm seeing jives with what you (and others in your position, looking for places to setup) have seen in your ad hoc searches. I'm equal opportunity here. I'm a staunch proponent of quantitative measures for validating work of course, but the "ask people who actually are doing X if it matches what they see" method will always be critical, even if it's anecdotal.
@Retrograde_Nail you're right, I don't know what it's like out there as a podiatrist. I'm a statistician, I look at the numbers and try and help people at the leadership levels understand things better outside of their filtered viewpoint and people at the working levels contextualize trends they're seeing in their work. I'm not a podiatrist, podiatry hasn't been my professional world, that's 100% why I try and take chances like this to talk to people like you and @footpainhealer to try and understand and validate what the data is saying.
I will say, I don't think that I've tried to posit that the profession has no faults. All professions do. In the context of this conversation, while I can't make jobs appear where they aren't and I can't make a place that a particular person doesn't want to live be more appealing, I can try and help people target locations where opportunities might lie based on their personal preferences. The other side of that is, if a new student is considering podiatry and these results indicate that the particular geographic regions where they are set on eventually practicing are utterly saturated? THAT is useful information for them to have in deciding if the profession is for them.
EDIT: FWIW @Retrograde_Nail, I can't give any specifics yet, but the survey data does bear out the assertions here and elsewhere of consolidation in the profession with shrinking rates of ownership and substantial increases in the proportions of DPMs working as employed in some capacity without ownership/equity. I want to reiterate here, I (and current APMA leadership) am looking to actually understand what's going on with the profession, whether it's necessarily positive or not. These are the things we need to know!
Warmly,
Sam
@footpainhealer sure, I'll likely put it out for comment or something at some point. Mostly I was curious to see if what I'm seeing jives with what you (and others in your position, looking for places to setup) have seen in your ad hoc searches. I'm equal opportunity here. I'm a staunch proponent of quantitative measures for validating work of course, but the "ask people who actually are doing X if it matches what they see" method will always be critical, even if it's anecdotal.
@Retrograde_Nail you're right, I don't know what it's like out there as a podiatrist. I'm a statistician, I look at the numbers and try and help people at the leadership levels understand things better outside of their filtered viewpoint and people at the working levels contextualize trends they're seeing in their work. I'm not a podiatrist, podiatry hasn't been my professional world, that's 100% why I try and take chances like this to talk to people like you and @footpainhealer to try and understand and validate what the data is saying.
I will say, I don't think that I've tried to posit that the profession has no faults. All professions do. In the context of this conversation, while I can't make jobs appear where they aren't and I can't make a place that a particular person doesn't want to live be more appealing, I can try and help people target locations where opportunities might lie based on their personal preferences. The other side of that is, if a new student is considering podiatry and these results indicate that the particular geographic regions where they are set on eventually practicing are utterly saturated? THAT is useful information for them to have in deciding if the profession is for them.
EDIT: FWIW @Retrograde_Nail, I can't give any specifics yet, but the survey data does bear out the assertions here and elsewhere of consolidation in the profession with shrinking rates of ownership and substantial increases in the proportions of DPMs working as employed in some capacity without ownership/equity. I want to reiterate here, I (and current APMA leadership) am looking to actually understand what's going on with the profession, whether it's necessarily positive or not. These are the things we need to know!
Warmly,
Sam
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If you want to know what's going on with the profession.... Tell them to hang out here on SDN instead of creating a new anonymous accounts to refute everything we talk about.....
sdupre_apma
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Is that a thing?
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Nah, probably just random that lots of new accounts would pop up when we specific talked about the APMA in some threads, would be pro APMA then disappear.
Wait you are a statistician.....do you believe in randomness🤔
sdupre_apma
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I’m sure… it’s… unrelated…? Yeah. 👍 I got nothing.
Ditto... 7 jobs in my first 9 years out for me (one was mobile pod while working out a non-compete, but at least three jobs were 2+ years).
I don't even want to estimate how many interviews or cold calls or applications... insane.
Started my own PP in 11th year out. It was a want all along... but became more of a necessity after awhile.
It is is indeed ruff for podiatrist job market (and that's even back when I graduated: four pod schools ago now).
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Fact: The vast majority of doctors looking for a job are absolue trash at demonstrating to possible employers the value which they could bring to a practice. Zero ability to sell their skillset. Sure, some specialties require just a pulse and a degree to get busy and make money. Podiatry is not that. Our profession, especially in some markets, requires skills you dont learn in school or residency. Sidenote, I love what @sdupre_apma is doing. Data drives good decisions. He's a great asset to APMA and our profession, Frankly, the CPME could use him and his skillset to help them see that adding more podiatry schools is not currenly beneficial to our profession. I see too many people complain that do not take the time to look at what they can do to make their situation better. The grass is green where it's watered. Sometimes you have to water it yourself. I am aware of saturation, and aware that terrible jobs are plentiful, I practice in an incredibly saturated market and drive past SEVERAL podiatry practices on the way to my own every day. If you do good work AND have certain entrepreneurial/sales skills which are not taught in school you can be sucessful anywhere.
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On the private practice setting They don't want your Liam Nissan very special skill set.... They want you to follow their "protocols". On the hospital side.... One way to get a good hospital job in a bigger city is to have a hospital job in a rural city... Oops I said the rural thing again.
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I get what you're saying and agree with the premise, but passing "several" of any sub-specialty service on the way to your own office (of that same specialty service) is not normal lol. An OMFS or vascular or whatever surgeon isn't passing multiple, if any, of his colleagues practices during his commute lol.
There are 5-10 podiatry practices in a 10-15 mile radius at any random point on a map in the metros of PHX or MIA or Bay Area for example. Most of the practices have 3+ pods in them, some have 6+.
Is there really that much need for podiatry in these places? And that's without taking ortho F/A (or even general ortho that does sports med) into account yet.
IDK. I could be wrong and business is booming for everyone in some of these places with 20 pods in a 10 mile radius.
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The need for pods has been met many times over nearly anywhere in the USA. If anything, we have 2x the nail cutters we need and 20x the "surgery" needed. There is noooo way we should be graduating well over 5x as many podiatry "surgeons" as ortho F&A does every year (closer to 10x actually). It is insane to have almost as many DPMs out there in practice as orthopedists total (all sepecialties). And don't forget: gen orthos and other specialties of ortho and gen/vasc surg can do F&A cases too, lol.
The scary part is that the effects of the new podiatry schools and the all grads doing 3yr "surgical" residencies are still not into full effect. It continues that most retire pods are doing minimal or no surgery... yet pod grads replacing them nearly all want to do surgery. Happy day.
...He was just trying to humble brag above that if you hustle and market, you can still do ok (true, aside from the problems common to all medicine of reimburse stagnant yet overhead costs steadily increase). The downside of saturation is that, even if you are very good, you will rapidly lose any market share in podiatry; there are a ton of options to replace you. Your only options are expand or work harder or plateau. If you can't get people in or primary care hears you didn't see them promptly, then you will lose those to other pod competitors in most urban or suburb areas (even some rural areas). For employed jobs, saturation is evident when you see TONS of apps for any good pod job and salaries or RVU values low in comparison to any MD/DO surgery.
Basically, we are chiropractors (but with maybe 10-20% of us hospital employed). We have all the other saturation issues, though:
- marginalized in many areas due to abundance of us
- acceptance varied by public and med community variable due to not being MD/DO
- everything we do can be done by other medical fields (PT, OT, ortho, gen surg, derm, midlevels, PCPs, pedicurists, etc)
- HIGHLY variable and often low income and ROI
- highly variable training quality
- infighting is frequent (multiple boards, fake boards, wound vs surgery vs RFC vs etc podiatrists)
- few job options, adding training to try for jobs (fellowship fad, "sub specialty" podiatrists)
- many hospitals that hire MD/DO don't hire DPMs (simply look at how many of us venerate VA jobs, MDs laugh at those)
- hospital "politics" of DPMs commonly trying to limit or block privileges and referrals and hire of other DPMs
- cutthroat in PP, pods generally mistrust fellow pods, non-competes, people are cloak and dagger on plans/hires, etc
- wacky OTC products
- aggressive marketing
- go to great lengths to get/keep refers (as opposed to most MD specialists just show up and get BUSY)
- questionable services/billing is common... coming up with new codes and "ancillary services" often
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Mic drop
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Ok, I read posters on SDN claim podiatry is oversaturated. But what is that actually based on beside personal opinion and anecdote?
The US has the lowest Podiatrist : Population ratio of the countries with larger populations and advanced podiatric education.
Granted, we don't do all the same things, however, in each country, the need for a podiatrist starts with a patient with a foot or ankle problem.
There are fewer podiatric surgeons in the UK and Australia with a more restricted scope. But podiatry isn't only about surgery.
In Spain, the scope is as broad as the US and the profession is thriving.
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This is so wildly apples to oranges I’m surprised you’re going down this road.
1) Most obviously, kids aren’t going into 350k debt to practice in Europe and down under.
2) Entirely different scope, as you’ve acknowledged.
3) In the US we overlap scope with ortho who can also do every other extremity +/- spine but representation is not proportionate.
4) Entirely different reimbursement systems between the US and other first world countries.
5) Student debt is almost equal to MD/DO but ROI is significantly less
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To be fair, Podiatry doesn’t fall under the national healthcare system in Spain and private insurance doesn’t cover all Podiatric services. So they have mostly cash pay patients; earn, on average, less than $100k per year; and don’t go $300k into debt to get their degree (equivalent to a bachelors here in terms of years of schooling). If we had the same system, we would also have more podiatrists, with an even higher % of us who are glorified pedicurists who also sling orthotics.
A better question or comparison would be, how many podiatrists in Spain have a Masters (which allows them to do surgery) versus the number who only have the 4 year degree and do primarily routine foot care? It’s like comparing number DPMs in the US to the total number of pedicurists. I don’t know those numbers but I bet it would make those numbers in that chart a lot closer.
As far as saturation, sure, it’s largely anecdotal. But you have to be somewhat willfully ignorant to look at job postings for virtually every MD/DO specialty, compare it to podiatry, and then think to yourself “I think we could use more Podiatrists.” I just went to doccafe. In the state I practice in there are 2 jobs listed (well there are 4 but 3 are the exact same job). One of which is nail care at nursing homes. There are zero jobs in San Antonio. The entire state of Texas only has 1 job listed that isn’t nursing home work. Upperline has 15 different job openings across the country...for Nurse Practicioners. But hey, they have a whopping 21 listings for an actual DPM across the country so I guess we win that round lol. One of our orthopedic surgeons submitted his resignation and the next week had a job. I can confirm he started looking at the same time he gave his notice. Our job market is not the same. And anyone who has signed up for a recruiting service (you aren’t getting emails/texts every day like your MD/DO counterparts) or has had to find a new job, would agree. I mean, a “podiatry” specific job board has more postings for F&A Ortho than it does Podiatrists.
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I think we need to arrive at a consensus definition of "oversaturation." Strictly speaking, nothing can be oversaturated, because once it's already saturated, by definition, it can't be concentrated any higher than it is. We're talking about a job market not heating sugar in water. 😉
To answer the question, this is an internet message board, which is precisely where one goes for opinions and anecdotes. One might also refer to the bls which projects job growth to be 2% or "slower than average for all occupations." Hopefully Dr Dupre has an even more precise analysis. So if you truly want to know, you should be asking him directly and not posting on an internet discussion board because all we have to offer here is...discussion.
One aspect of the saturation question that is reflected by my personal work environment: every hospital system in my average population density community already has a fellowship trained foot and ankle surgeon employed. Further, every pp office in my area is mainly doing lasers and other chicanery. Dunno if they're thriving or just getting by. But patients tell me and my partner that they have such a hard time finding a place to go to get their nails ground down, and they're busting down my doors for that service.
This is why everyone needs to mean the same thing when they speak of "saturation" and even "oversaturation." While my anecdotal opinion is we're at the saturation point for surgeons, we are definitely not saturated for toenail cutting. Ultimately, toenail cutting is not what posters here are talking about when they are hunting for jobs, nor is it what the apma promotes as it markets the profession to pre-health students. So I hope this clarifies the discussion. 👍
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How much would you make seeing 30 patients a day five days a week only doing toenail cutting? Lets pretend its all medicare. Please answer.
So you went through 4 years of college, 4 years of podiatry school, three years of a "surgical" residency to do that?
My nurse practitioner probably cuts toenails just as good or even better than you. She burrs them down too. My hospital pays her probably 120-130K a year to do that. Her scope is also rather broad so she can see patients for different ortho specialties if we were in a jam and their NP were out of town. She could leave me altogether and do something else on her own or work in an entirely different branch of medicine. How nice for her.
Did APMA, ACFAS, ABPM, ABFAS, ASPS, etc sell this version of podiatry to you when you were a student? Would have you agreed to take this path if you knew?
I hate your argument. Your services will eventually be taken over by NPs willing to do nail care at a nominal fee. Insurance carriers will continue to decrease reimbursement or cut it out completely.
Bro we are saturated. Toenails is not an argument. There is no way you can continue to survive throughout your career just offering and doing that.
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I don't know what you think my argument was. Maybe you need to reread my post or maybe I wasn't clear. All we have left are toenails. So definitely society needs something to meet that demand, but it ain't 7-8 year trained foot and ankle surgeons.
Take a xanax before you post again.
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BLS stats:
Job Outlook:
CRNAS, ARNP, Nurse Midwives: 35% Much faster than average
PA: 20% Much faster than average
PT: 11% Much faster than average
Chiropractor: 10% Much faster than average
Pharmacist: 5% faster than average
RN: 5% Faster than average
Podiatrist: 2% slower than average
Yeah. I think we are saturated, oversaturated, supersaturated.
I have been super fortunate in my podiatry career mainly because I was able to inherit a practice and also have a wife that crushes it. Even though my children have the ability to come in and take over my practice and do very well I will strongly advise against it. I realize this is completely anecdotal but don't the leaders of the profession typically state that the job market is all word of mouth? Isn't that anecdotal?
Job Outlook:
CRNAS, ARNP, Nurse Midwives: 35% Much faster than average
PA: 20% Much faster than average
PT: 11% Much faster than average
Chiropractor: 10% Much faster than average
Pharmacist: 5% faster than average
RN: 5% Faster than average
Podiatrist: 2% slower than average
Yeah. I think we are saturated, oversaturated, supersaturated.
I have been super fortunate in my podiatry career mainly because I was able to inherit a practice and also have a wife that crushes it. Even though my children have the ability to come in and take over my practice and do very well I will strongly advise against it. I realize this is completely anecdotal but don't the leaders of the profession typically state that the job market is all word of mouth? Isn't that anecdotal?
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This is 100% the crux of the issue. I could fill my schedule all day and everyday with toenails/calluses if I wanted. The demand for podiatry is truly demand for chiropody. Our retiring docs tend to be mainly chip and clip, making the problem worse and worse as they get out and the population ages. Meanwhile our national organizations are selling the surgeon image to pre-pods.
I'm not trying to do that. The nails find me, I'm just lobstering through life that's all. However, don't confuse my acceptance with happiness. If I could trade them for well paying orthopedic conditions I would.
It makes me sad to say this, but no ****ing way...
Can roughly figure:
11721 pays $40 x30 = 1200
11055 pays $60 x 10 = 600
11056 pays $72 x 5 = 360
Total: 2160
Throw in a few visits/new patients/DM shoes/ and other useless office product your probably between 2.5-3k per day. Not advocating this, but as a student/resident, I moonlighted at clinics that would charge a visit every other nail appointment to bring up billing. "Miss Jones, your legs are slightly swollen today lets talk about that for 2 mins so I can bill a 99213." Should be pretty easy to collect 600k, figure overhead is 50-60%.
Again, not advocating for this type of nail based practice. I'm ABFAS certified and own shares in a surgery center. In addition, our practice budgets quite a bit of money for advertising toward surgical patients. We don't market for nails but somehow they just keep coming, like a horde of elderly zombies...
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The sun comes up and they keep coming
The problem with NPs doing podiatry work is they already have so many other better paying and easier alternatives available to them that don’t require smelly manual labor.
They settle for podiatry. Most NPs I know even in good paying NP specialties switch jobs constantly. From a hiring perspective you’ll get rewarded better hiring a podiatrist over a NP even for nonsurgical foot care. Podiatrists will stay around longer (because we have so few other options) and do a better job. Period. And there are podiatrists out there who would do it for what they would pay the NPs or PA. NPs and PAs don’t learn anything about the foot in their training outside of surface level general anatomy. Their experience is equal to that of a shadowing student.
They settle for podiatry. Most NPs I know even in good paying NP specialties switch jobs constantly. From a hiring perspective you’ll get rewarded better hiring a podiatrist over a NP even for nonsurgical foot care. Podiatrists will stay around longer (because we have so few other options) and do a better job. Period. And there are podiatrists out there who would do it for what they would pay the NPs or PA. NPs and PAs don’t learn anything about the foot in their training outside of surface level general anatomy. Their experience is equal to that of a shadowing student.
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I could train an ARNP or PA or even my MA to handle 99% of what I see on a daily basis in 2 weeks.
Even if that was true, which it isn’t (we still have ABFAS cert docs arguing over what a jones fracture is and whether a met fx needs operating), they just Do. Not. Want. To. Work. With. Feet
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Yes I could easily train any person willing to learn what I do on a daily basis in 2 weeks.
I mean 99% of my income comes from office visits, ingrown toenails. Injections, DME, DFC
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Facts. My NP is just as smart as any podiatrist I know. The more experience she gets the better she gets. Annnnnddd her scope of practice is broader than me. She helps me in wound care. Theoretically she could step in and see a sacral wound ulcer if we were in a jam. She never did a residency. How does that make you feel??????
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It is true. You are at max/peak denial.
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I was going to wait a bit to post about this but I have, in fact, hired a NP. Full story to come in a few weeks.
Might take her a little longer than 2 weeks to learn our icd10 and cpt codes but hopefully not much.
Might take her a little longer than 2 weeks to learn our icd10 and cpt codes but hopefully not much.
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Idk. I just live in a world where my primary source of referrals are NPs and PAs who don’t even want to take a patients shoes off so they send them to me
Yes, this is the issue.
People brag about how it's easy to fill the schedule with nails, but that is because the pathology is so easy. That is pathetic with the $200k debt I had or the $300-400k+ grads have now. With the insane student loan burdens of today's podiatry school + residency (+/- fellowship year), that is a LOT of nails RFC visits to see. We think it's competitive for the relatively rare refers and new pts for surgery podiatry, but it will soon be a race just to see the most nail care (like NYC and some places are already). It doesn't take a NP to do that... MA, pedicurist, anyone can do nail care. They have little or no student loans. Sure, hospitals like to have RN or NP do nails, but it does not matter in PP... doc just pops in for 1min at visit end to do a cursory exam... or for 3min at the end to do the calluses or shoe Rx (like dent cleaning visits, basically).
If I had more rooms and/or needed more income, I'd probably get another MA and do more RFC. It would be logical to make more revenue. As it stands, I market more to the MSK stuff and only have about one third of my visits RFC most days. However, the nearby supergroup already does this... at least half are RFC visits, MAs cut basically all nails except the most rams horny of rams horn nails and the the most vascular of PVD nails (I know this as I worked there a year... they try push associates to add ABIs, nail "biopsy," toecelyen, enfd nonsense, etc). I also worked multiple small/medium group pod associate jobs after training with same... MAs do nearly all nails visits.
It won't take payers forever to realize that docs are not really needed for thesee visits. With dental, I don't think they scare as the visits are mostly or all cash pay, and the care is preventative of more major and costly issues. With nail care, what are we preventing? Ingrowns? 🙂
...I also don't know about you guys, but I've been getting more and more MCR adv plans asking for charts for RFC pts this year. There is no way that is good. I am a tiny office with nothing to worry about, but bigger offices are easier targets for rejections and big clawbacks. Best case, they're just asking for charts wasting time and making an additional requirement, more likely is they are trying to deny some codes.... worse case = ???.
But yeah, sure would not tout the need for a "medical service" that a high school kid can perform, and we do it after so many years of school and so much debt. No way. At best, it's a community service that pays the bills... can help a few ppl with DM prevent exams while doing the RFC. It's nothing that takes even 1yr of residency, though (and it did not need that for decades and decades and decades).
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They collect charts to squeeze more money out of the federal government, not to claw back money from you.
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That's true. They even make up diagnoses. Including our favorite insurer, UHC. The increase in chart request may be to justify their inflated diagnoses.
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Obviously, anyone can cut nails, and I don't see how anyone who's paid any attention to anything I've written on this forum for the past 3 years could misinterpret what I wrote a few posts up as "bragging" about how easily a podiatrist can fill their schedule with toenail pts.
So while the MAs can do the cutting, they are not licensed to diagnose pad or neuropathy. They aren't even licensed to diagnose onychauxis. That's why we onboarded a NP, to move certain nailcare pts off my and my partner's schedule completely.
So while the MAs can do the cutting, they are not licensed to diagnose pad or neuropathy. They aren't even licensed to diagnose onychauxis. That's why we onboarded a NP, to move certain nailcare pts off my and my partner's schedule completely.
Sole Badguy
Loathsome Fung Eater
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Agree with nails/calluses being the easiest thing to fill up my schedule. Don't get me wrong - I get paid decently to do it and it's good to provide a medical service that patients want, but it's definitely soul-sucking and existential crisis-inducing after a time.
Podiatry as it stands now seems to have painted itself in a corner. Nails are pretty much the guaranteed thing to see in practice and basically dictates our job market - more mobile podiatry/heavier outpatient clinic jobs, fewer surgery jobs. Reconstruction surgery is just not as in-demand - good connections and/or the willingness to go to BFE in order to practice full training is a must. But IMO, even being able to offer surgical options feels like a trap - all of us could be trained to the top of the podiatry license and we still would be dictated by what other surgical specialties (especially ortho, even more especially F&A ortho) want to do, making pursuing that feel like a waste of time too. All of this makes me feel that the best way to get out of this corner is to formally come into the ACGME fold as a properly trained semi-specialized PCP that can help fill an actual demand vs being a niche pseudo-surgeon that nobody wants or asked for.
Podiatry as it stands now seems to have painted itself in a corner. Nails are pretty much the guaranteed thing to see in practice and basically dictates our job market - more mobile podiatry/heavier outpatient clinic jobs, fewer surgery jobs. Reconstruction surgery is just not as in-demand - good connections and/or the willingness to go to BFE in order to practice full training is a must. But IMO, even being able to offer surgical options feels like a trap - all of us could be trained to the top of the podiatry license and we still would be dictated by what other surgical specialties (especially ortho, even more especially F&A ortho) want to do, making pursuing that feel like a waste of time too. All of this makes me feel that the best way to get out of this corner is to formally come into the ACGME fold as a properly trained semi-specialized PCP that can help fill an actual demand vs being a niche pseudo-surgeon that nobody wants or asked for.
