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just so we are clear. You would describe airbud as a historic booster who led people into podiatry to their ultimate downfall.
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Is that before or after they suggest you use their own nail clippers they brought from home?
Well it was a different time. We were all younger and didn't know what we didn't know, and hope springs eternal for the podiatry student...
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For the record, those people were all in residency and early career I was a dumb preopod/student just regurgitating stuff. 2008 era was hard.... podiatry seemed like an easy out.
Podiatry was WAY better 15-20 years ago...
It's turned into a monstrosity since then. The whole fellowship training dynamic has accomplished nothing. The quality of fellowships are not great. Some of the best ones have lost attendings due to change of practice or retirement. The many new fellowships have now weakened historically strong residency programs as those attendings only want the fellow in the OR and not residents. It accomplished nothing. AOFAS does not recognize our fellowship training. They don't even mention it when they write defamation articles about us every 2-3 years.
Podiatry saturated the market with fellowship trained DPMs in the last 5 years. Now fellowship trained DPMs are just joining private practices. Great work
The only aspect of podiatry that isn’t oversaturated now is cutting nails and calluses. Medicare now recognizes, for billing purposes, the services of a certified foot care nurse.
I’m already seeing more and more hospital employed colleagues dissuading administrators from bringing on more pods but to instead bring in foot care NPs and certified foot care RNs.
What is podiatry going to do when NPs start opening up foot care clinics staffed with certified foot care nurses?
I’m already seeing more and more hospital employed colleagues dissuading administrators from bringing on more pods but to instead bring in foot care NPs and certified foot care RNs.
What is podiatry going to do when NPs start opening up foot care clinics staffed with certified foot care nurses?
Die, probably
Mid to late 2000s was the high-water mark for Podiatry optimism. Vision 2015, residency programs lengthened from 2 to 3 years, claims of better training, aspirations for full parity. If I recall correctly, 80% of podiatrists were dues-paying members of APMA at that time. But no one stopped to think, if all of us are special, none of us are. If all of us are intended to be surgeons, almost none of us truly can be.
Rural here. Don't see nails and calluses unless they sneak in for "ingrown nail" or "foot pain". Got my hospital to hire another nail tech out at their other location because the one currently there only does it 3 days per week and sees like 10 per day for cash. Exactly 0 of these that have snuck through have referred friends/family for anything other than what they just came in for. There's two sides to this though. 1) you don't need surgeons to cut your nails. Go ask ortho hand to cut your finger nails... let me know how that works out. 2) We've made insurance and the general public believe you do and thus have created a huge workforce for this task while also now saying wait, no, we're all surgeons go do fellowships and surgery. The jobs don't exist to have our current workforce do #2 (nor should a relatively large number of this workforce) so we're stuck in this in-between. If you don't want to do it don't market it. If you're PP its likely keeping lights on while allowing you to scoop up whatever else crawls through the door unless you have great referral pipelines.
hahah I was just talking to a friend who was above me in class that did a strong fellowship (we've all heard of it and the director) and their first job this year is at a small, solo practice in a "ghetto as hell city" (their words). The owner doesn't even operate. The patient and referral base aren't surgery patients lol. They haven't done a single surgery yet, its going to be 2026 in 2 days lmao.
All that fellowship work for what? Maybe the next gig, but if there aren't any jobs in their area of preference, what choice do they have other than finishing this contract out and starting their own, or leaving.
Gotta be a pretty big facility to need 2 pods. 100 percent we are telling admin I need a NP/PA no need for another pod. They can see the low acuity stuff and if you're really busy and you need more time for surgery you don't need another podiatrist doing surgery you just need more time on your schedule to do surgery and be able to offload post-ops and other follow-ups.... Just like retrograde is doing.
I I'm going to do about 9,000 RVs my first year in my new position. Probably will bump up to 10,000 going forward. I'm the only podiatrist in the hospital and only surgical one in the community... I'm going to get busier I'm going to need more help but the hell if I want another podiatrist in my office. Nothing about another podiatrist makes my job easier. A ton of things with an NP or a PA makes my job easierA ton of things with an NP or a PA makes my job easier
This already exists (don't even need to be an NP btw) and there's quite a few actually. I saw another one where the lady owns a school to teach and license people for diabetic foot care. There's a whole association for it and everything lol
While being forced to clip nails on the floor today cause the attending gets a whole probably $10 for that consult, I ran into a nursing instructor and asked her what my chances are if I decided to go toward that route. She was very sweet and said that she would vouch for me if I were to apply cause I think she saw the despair on my face.
Spoke with a CAA and considered that route too but I don't like anesthesia.
Might become and RN, work remotely and do insurance review or something.
Spoke with a CAA and considered that route too but I don't like anesthesia.
Might become and RN, work remotely and do insurance review or something.
God, what a demeaning name for a practice. Sarah needs to have some self-respect.
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You are in too deep now. You will probably end up doing better going forward with podiatry than going back and doing nursing school in my opinion. I can’t even imagine all the compounding debt you will accrue over that time.
Oh if she's wilfully marketing routine foot care the self respect has fled
samesies
Aren’t those accelerated nursing degrees 1 year long? Seems like a similar commitment as doing a podiatry fellowship.
So the current state of affairs for the saturated podiatry job market is that less and less hospital jobs will be available because established pods will push for foot care NP/RN to support their growth and then the basic income generator for private practices is going to be eviscerated by the growth of Medicare certified foot care nurses. New grads will barely even have foot care to fall back on. Seriously, what will be left for the 500+ unnecessary yearly graduates over the next few years as the podiatry job market continues to devolve?
Nothing. They can get ****ed. Try other profession, maybe. One of my residency mates became an office jockey. A classmate of mine became a nurse and another went back to his family business
Best bet unfortunately is to find a community hospital that has no podiatrist and get in contact with someone in admin to create a hospital employed podiatry job. This may also work with MSG that has no podiatrist as well.
Other than that it’s play the PP associate game while trying to find a better opportunity or open up your own practice.
On average PP associate position you will be out earning or similar to NP or PA. In the long run you stand to make much more once you find the right opportunity (PP owner/partner, hospital employed). People on here like to glorify NP/PA route because it’s more predictable while most of them make 3x or more what they make.
I’m only 1.5 years out and myself and two coresidents all found hospital jobs right out the gate. Also I don’t live rural at all. Suburb of a large city. There is actually another hospital system in the area that doesn’t have an employed podiatrist I recently found out, just PP pods who go there to operate. I’m considering seeing what they would offer me in the future but I would hate kinda starting over.
For what it’s worth, what I’m saying is directed at podiatry residents and probably 3rd/4th years students because you are already in too deep at this point. Better to stick it out. For those who have not started yet I would definitely recommend NP/PA, CRNA, CAA, MD, DO, etc. over podiatry easily. ROI is better and much more predictable compensation and jobs for all those fields at this point in time.
Other than that it’s play the PP associate game while trying to find a better opportunity or open up your own practice.
On average PP associate position you will be out earning or similar to NP or PA. In the long run you stand to make much more once you find the right opportunity (PP owner/partner, hospital employed). People on here like to glorify NP/PA route because it’s more predictable while most of them make 3x or more what they make.
I’m only 1.5 years out and myself and two coresidents all found hospital jobs right out the gate. Also I don’t live rural at all. Suburb of a large city. There is actually another hospital system in the area that doesn’t have an employed podiatrist I recently found out, just PP pods who go there to operate. I’m considering seeing what they would offer me in the future but I would hate kinda starting over.
For what it’s worth, what I’m saying is directed at podiatry residents and probably 3rd/4th years students because you are already in too deep at this point. Better to stick it out. For those who have not started yet I would definitely recommend NP/PA, CRNA, CAA, MD, DO, etc. over podiatry easily. ROI is better and much more predictable compensation and jobs for all those fields at this point in time.
This is an RN. No podiatrist is associated with this business.
I don't see a podiatrist associated with the 2 schools I found either, but maybe. lol
But anyways, I went down this rabbit hole and discovered something called podology.
A whole field dedicated to nail care, fungal debridements, skin checks, ingrowns (non-procedural)......sounds like what we do, but no grad school required.
These are in the US, just so we're clear.
The North American School of Podology is in Ontario, Canada, probably a crossover term from the Quebecois. "Podologist" is a pretty common term for Podiatrists in continental Europe. LCR will probably be chiming in soon about this.
Sorry, please address him by his formal title: "Lord LCR of the Queens Podiatry Guard" or something like that
My residents currently..
I bought lunch for the scrub techs yesterday after my block.
They asked if I wanted them to use some of the money to buy for the CRNA and locums circulator RN too.
"Nope, they make more than I do... so they're all good. Get what you guys want, thanks."
(they probably thought I was joking)
This worked fairly well when I came out of training a dozen years ago.
It was fairly easy to cold call for hospital jobs or MSG jobs... and they might overpay you thinking we make MD money.
Rural hospital jobs or ortho group jobs were even easier to find if willing to go to small towns or CAH.
With good training, it was very easy to become "the guy" in a DPM group doing most of the big surgery.
(nobody wanted VA jobs as the pay hadn't been bumped).
Now, there are 4 more pod schools since then (and tuition/loans have basically doubled).
Most hospitals won't even call you back... they've been bombarded. Those mines have mostly become tapped out.
If they do happen to call or email back, they usually want fellowship and experience or board cert ABFAS.
They also know DPMs can be paid a lot less than MD surgeons in RVU rate and salary. They don't tend to fall for that anymore.
Ditto for MSG and ortho group office managers... very hard to get a response, much less a visit or a job. They've been called by many podiatrists.
Even podiatry groups worth working for are tough... word is out on which ones pay fair and which just do the normal PP/supergroup 30% trap.
Friggin VAs have even become competitive for podiatry despite adding tons of DPM jobs.
...I would say another decent strategy is to just go to the area where you want to be - or at least near there. Take an associate job or whatever you can get. Once you get on staff at hospitals, meet people, meet MDs, meet other pods at meetings. That is the best way to learn the area, who's who. If you're likeable and you get known, job offers in and around the area naturally follow. People want to hire people they like and who are comfortable in the area. That's more familiar to hire someone already on staff in the area, already liked... versus some random grad resident or disgruntled associate doc from out of state. I sure know I've gotten more hospital and group job offers that way than (being local, being liked) than I was ever able to create cold calling and browsing classified ads. You can always start your own office too (with or without support of a facility); not as hard as it's made out to be. It's really funny that when you don't care and don't need job offer, you will get some good offers you would've loved to have had early career.
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I know this is getting off topic, but buttering up the right hospital staff with food is one of the smartest things you can ever do.
When I go to the hospital OR, there’s a senior anesthesiologist notorious for canceling cases at any opportunity, and this is a relatively small spot so I see them often. We share some ethnic ties, so I brought in some really good homemade stuff along those lines. I can probably count on one hand the number of cases that have been same day canceled in the years since, and I work on a lot of sick folks.
If you get the OR on your side, lower chance of getting bumped or them closing a room early.
Sendin_Toes_2market
Full Member
Eye bro, you have starbucks money, we are 7-11 gross coffee bros. I live right next door to my head of anesthesia. He just spent more than I make a year replacing his pool and installing hardscaping.
I do most cases emergent after hours under local and will do revisions in the AM under anesthesia. Do I have to woo the scheduler romantically for a 7:00am start too? lol
*raises hands* Was just saying. I can barely get an add on case within my block time, and they release any openings a week ahead. I don’t think I’ve seen the pods there with any kind of normal start time. Anesthesia shortage in my area, so getting favors is a big deal.
If gas bro is spending that much on a pool and you’re living next door, I think you’re doing ok, and he’s insane.
If you live next door to the head of anesthesia ur doing alright
Ahh you're right. I was just going based off the map of "find a CMP near you" cause it showed a few hundred in the US.
Shoot, there's 3 within 20 miles of me. lol
Looks like some work at nail salons, some have their own medical nail spas, a small few work at a podiatry office, some part of bigger med spas.
I have seen some of y'all on here say that podiatry is saturated for MSK, but is not saturated for RFC. This could change that if patients and PCP's catch on and just go to these people for their nail care. I don't see why they would choose us over a CMP since they can make it prettier and do all the "feel good" spa stuff too like massages, polish, cuticles etc lol
Why it's hard to take some complaints on here seriously, though there is plenty valid too. If you drink 7-11 coffee but live next to head of anesthesia, you just like ****ty coffee bro.
Sendin_Toes_2market
Full Member
When you don’t live in large metros, homes $500k-2million are occasionally near each other. Where I am a 500k house is a renovated 4-5000sqft home with new appliances on 1-2 acres. My anesthesia neighbors house is a little over $2 million 8k sqft w/ nicer everything.
I have friends in NJ and Cali buying condos for 600-800k making less than me… Just depends where you want to live and how you want to live. You act like I am the only podiatrist with a built in sauna and yoga room. Basically lower middle class. Do you even know how expensive gas for a ride on is or how expensive river rocks are for a sauna?
LCOL with high incomes are dope.
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I'm pretty sure patients don't want the spa experience. I think they just want the toenail equivalent of a Supercuts haircut, and I'm pretty sure I've argued on here before that anyone should be able to go in for a nail trim from a licensed nail tech for the price of a Supercuts haircut. But DPMs bill patients' insurance, and the patient's out-of-pocket cost for the visit is often close to $0. That means podiatry has crowded out all competitors--no business can compete with free.
Another thing to consider is that if you're the one providing the spa experience, how long does a visit take? The pedicurist is pending half an hour with this person massaging their feet, soaking them, applying lotion, trimming and filing the nails, applying a coat of lacquer even if it's just a base coat. Yeah I guess there's no charting afterwards, but still I'm typically in and out with a pt after about 5min.
Final consideration on what's shaping up to be a rambling post: from time to time, people are worried about losing jobs to automation and a lot of articles get written about it humanity being replaced by machines. The late Walter Williams had a perfect counter argument to this concern, which is that no matter how efficient technological progress becomes, it's productive capacity will always be finite. Meanwhile, human wants needs and desires are infinite, and this create a market for humans to address those desires that the machines can't. I think a parallel claim can be made about nail techs, pedicurists, and foot care nurses: elderly diabetics' desire for nail care is infinite, and so there will always be a marketplace for podiatrists to address the desires that the nail techs can't 😉
On a serious note, I think these professionals have potential to be an amazing referral base for a podiatrist. I imagine a good working partnership with a foot care nurse could generate plenty of leads for good reimbursing procedures and DME.
Happy New Year, gang!
How did you find that rural job? Those opportunities are pretty hard to come by in podiatry. Thank you
I worked in more rural hospital jobs, built skillz and experience.
As above, much easier years ago when podiatrists with 3yr surgical training were more rare and there were a less DPMs graduating and out there.
But it's the same as it ever was: call and email your tail off, use recruiters for leads, network... welcome to the real
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Did you know as a PA working for hospital podiatry your first year salary is probably more than most podiatry associate jobs?
Private equity private podiatry groups are not even offering first year resident graduates this much money....
This should be a major WAKE UP call to APMA, ACFAS, etc that if the profession can't offer at least 200K starting salary for our graduates then maybe we should not be graduating this many podiatrists every year...
It's not entitlement. Don't accept and graduate as many podiatrists as we are doing if we are going to pay PA/NPs more money than our own residency graduates...
Private equity private podiatry groups are not even offering first year resident graduates this much money....
This should be a major WAKE UP call to APMA, ACFAS, etc that if the profession can't offer at least 200K starting salary for our graduates then maybe we should not be graduating this many podiatrists every year...
It's not entitlement. Don't accept and graduate as many podiatrists as we are doing if we are going to pay PA/NPs more money than our own residency graduates...
But we’re just like real doctors… not
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If you can’t get a podiatry job in Texas just buy an oil rig. It’s easy money I’ve seen Landman
Wow. Absolutely unacceptable and despicable. There's podiatry attending positions hiring in Norcal offering less than 155K right now.
How do you tag people on here lol. The deans, the APMA stats guy and others, whoever else you all know of in leadership on SDN, someone should tag them all. All the students and pre-pods. This is not okay.
That health organization alone already has 122 DPM's. Factoring in all the Kaisers, all the private practices, MSG's and PE-owned groups in the northern half of CA, how many hundreds of pods are there in just one-half of the state? lol
I get that it's a big state with a huge population (and they owns lots of clinics and hospitals), but man, seeing 122 DPM's at just one company that only covers half the state is mind boggling.
Yep, they're working in their own self interest.
Counting on any podiatry leaders/dean/apma to do what's in the best interest of the average DPM out practicing would be sorta like thinking a stripper really likes you and your quick wit.
Well aware of that.
I bet most don't even know what's going on at ground-level since they are so far removed or "retired" from actual practice. They aren't looking up jobs, reading the posts from scared 3rd years looking for jobs, or associates getting forced to join PE, from new grads asking what to do about the 120-150K offers, the lack of jobs in *insert city here*, etc.
Do I think they are going to do anything about it? Absolutely NOT. But they should be aware and ashamed of what this field has become. The more evidence they have the better imo.
And this hurts them too ultimately. No ones going to apply to podiatry schools in this climate, and no one should.
