We have our own problems. Saturation is most common in cities where podiatry schools are (and probably busier geographic areas ie. desirable places haha).
-A lot of pods are in private practice and in general the pay and benefits are not generous. Jokingly, when I read the other attendings talking about board fails I think - I'm too poor to fail boards!
-We have all manner of problems simply built into our professions training and educational stages - overpriced blah schools, too many bad residencies that are really just slave labor for attendings clinics, potentially decreasing surgical volume due to changes in the healthcare system, a stupid board certification process, a shortage of residencies, questionable interaction with orthopedics.. I could keep going.
-Just my opinion - a highly variable idea/mindset throughout the country of how the foot should be fixed with imo a lot of the procedures people often push being garbage. I've got friends who told me they received no training in procedures I would tell you are the most powerful and useful procedures we do. Many of them asked for help and were rebuffed. Some were taught these things in a horrible manner - a friend sent me some of his outcomes and I feel bad for his patients and even worse ... I feel bad because he thinks its the patients fault for how things turned out. If you know a procedure ..wrong, wrong when to do it, wrong how to rehab it, wrong when its indicated things just get bad.
-A lot of the people running our profession are scammers and junk. Your reputation is bound to theirs.
-Decreasing reimbursement - the same procedures and codes of the past don't pay what they did. But everything about life gets more expensive.
-EHRs don't actually make anyones's lives easier. I have almost all my most common diagnoses down to smart phrases, but there's still just so much clicking.
-Everyone's deductibles and insurance rules are getting more complicated. I lost at least one patient today because there was some sort of complication with his referral and he had like an HMO that required that to fall into place or he'd have to pay. He was definitely sent by his PCP but somehow the right button didn't get clicked.
-Sick complicated patients with lots of problems. Yesterday I saw a patient who is an uncontrolled diabetic vasculopath. My partner did a matrixectomy that deteriorated into gangrene. The patient then developed 2 new ischemic wounds elsewhere. But his vascular surgeon says he has sufficient healing potential and blood flow. He wants to tell me about a bunch of random pains he's experiencing. Also he wants to talk about nail fungus. I cannot stay in business seeing people like this everyday. Yes, I will continue to work on my workflow and how I relate and discuss with people make encounters more efficient, but I'm in private practice (perhaps that's part of my problem!) which means I don't have anyone else's notes or testing or studies. Talking to people can be the most complicated part of our job. Jokingly, my favorite encounter is when the patient really doesn't want to talk and I just touch places - they say it hurts and then I tell them what we are going to do.
-Nails and calluses. Love them or hate them. Everyone else sees us as the place for these (cause no one else will touch them). These often tend to be sick people. There's not a lot of glory to them. They are HIGHLY regulated and everyone has had their nails and calluses cut by some other podiatrist in the past who told the patient them they qualified even if they didn't. I've seen a lot of demanding people through the years, but inevitable you will meet some super demanding person who barely qualifies or doesn't qualify who wants to fight you for the right to get their nails cut so you can charge out ... $30. Already out of the room - the nurse is asking you to come back in because a nail is too short or long.
*someone will probably come along and say - why are you cutting the nails yourself - I'm currently getting supplies I need - one battle at a time.
-My practice only takes commercial insurance and medicare. Cool I thought. Yeah, there are definitely some upsides. People pay for their matrixectomies before I do them. But there's a price consciousness to these patients that I didn't experience in my 75% medicaid residency. I saw a string of people who already had an X-ray performed by their PCP being referred to me. I don't have those films. All of those patients basically begged me not to repeat their films - I told them what I thought was medically necessary.
-In general, as above on the nails and calluses, podiatrists are often expect to treat ulcers. You may love this or you may hate this. A lot of these patients have a problem that has nothing to do with their foot, diabetes or.. insanity!
-There's a lot of talk about the surgery aspect of this field. The simple truth - a lot of the easy stuff pays way better than the complicated stuff. Matrixectomies pay well, have a tiny global, don't have to be NWB, and do great. Same for flexor tenotomies performed in the office (two Medicare flexor tenotomies done in the same session in the office I believe pay better than a 1sts MPJ fusion done an the OR and the globals and aftercare is easier. I saw a bunch of complicated forms of deformity causing discomfort today - several of the patients had significant comorbidity. I would feel like a big deal if I fixed them, but I'm going to be following those patients through a long global hoping my surgery will heal and the patient will do what I say. You never know how crazy a person is until you operate on them. Jokingly, awhile back I booked a case on a patient we knew was crazy. My attending told me the day I booked it that he knew he'd be following this person long after I was gone. They called 7 times the day the surgery was performed. They called from the post-op area to tell us their foot was numb. Until you do this you will not realize just how crazy the people out there are. Most pre-med types grew up in a world of healthy normal people. The people presenting to your clinic often will not be those people!
That's enough for now.
