Podiatric Physician Workforce Analysis

[Dean’s Chat]

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Congrats to Drs. Meyr and Elagha for this publication on Podiatric Physician Workforce Analysis. Below is the discussion section of the article and a link to the article.

2025 podiatric physician workforce analysis based on Health Resources & Services Administration (HRSA) projections​

Andrew J. Meyr, DPM FACFAS1 Send email to [email protected] ∙ Jeneen Elagha, DPM2

Discussion​

As with any scientific investigation, critical readers are encouraged to review the study design and specific results to reach their own independent conclusions, while the following represents our conclusions based on the preceding results. We also never consider data to be definitive, but do think that these results might be worthy of interest and future investigation to the specialty of foot and ankle surgery. This analysis provides relatively unique information in the form of a rudimentary workforce analysis of podiatric medicine and surgery in 2025. Studies of this type are relatively lacking in our specialty, and it is our hope that these prefatory results lead to future and more advanced analyses.
First, we can affirm and further objectify a US podiatric physician workforce shortage both currently and projected in the future. Our analysis further indicates that the HRSA projections of a shortage of 1,810 podiatric physicians in 2025 and 4,680 podiatric physicians in 2035 might be underestimated based on the number of podiatric physicians with an active NPI observed in 2025 [18]. Either way, these results are potentially concerning, particularly when considering contemporary podiatric student recruitment stresses. Podiatric medical school enrollment numbers and projected degrees conferred have and are expected to continue to decrease in recent years, and the 2025-2026 academic year saw over 50 residency spots go unfilled [22]. There is little doubt that the demand for podiatric services are increasing, but the ability to meet the supply for this demand is likely in question [13–15].
Second, we can provide a geographic component to any discussion of both absolute and relative US podiatric workforce shortages and surpluses. New York and New Jersey appear to be the only states with a substantial surplus of podiatric physicians, and these surpluses might be expected to continue over at least the next 10 years. Many states are experiencing substantial shortages of podiatric physicians, with these shortages expected to grow in the future. Texas, California, Florida, Georgia, and North Carolina appear to be the states most at risk for not meeting the demand for projected patient access to podiatric care.
Third, an approximate target for student recruitment efforts in order meet HRSA demand projections might be estimated. The derived target of approximately 550 annual graduates to maintain current shortage projections is in line with recent historical patterns in podiatric medical education, but not contemporary class enrollment numbers.
All scientific investigations have limitations, and this one has several important limitations to consider. First and importantly, workforces analyses by definition represent an imperfect science based on projections and estimations as opposed to definitive statistics. It is not hyperbole to say that these numbers would be expected to fluctuate on a daily basis. We chose to primarily utilize shortage/surplus data from the Health Resources & Services Administration, but it is likely that other findings would have resulted utilizing another organizational data set. Similarly, the NPI data relies on an active NPI and therefore likely does not capture the entirety of the podiatric specialty. An NPI number is required for billing with Medicare/Medicaid and electronic health information exchange, so it might be assumed that an overwhelming majority of podiatric physicians in active practice have one, but it is certainly possible that a small number of concierge practices do not. This should therefore be considered a confounding variable of this investigation.
It is our hope that this information might be utilized by local, state, and national podiatric organizations to assist in student and physician recruitment in active anticipation of future trends pertaining to patient access to podiatric care.
-IRB approval not required for deidentified database methodology.
-No funding was required or received for this manuscript.

https://www.jfas.org/article/S1067-2516(26)00302-9/fulltext

 

[shadesofgrey]

I will have to check later, but how did the study define demand? Let's pretend that Apple created an AI device called Ipodiatrist that could somehow manage to trim toenails safely. How much of the demand goes away? I can 100% agree with the fact that there is a increasing need for geriatric nail/callus care. However, that's not the high skill/compensation demand that warrants the 4 years of expensive schooling and 3 years of residency podiatry is currently doing. We are training at a a surgical specialist level while demand is for a nail technician certificate level. Meanwhile the powers that be, continue to recruit students based on presumption of high paying surgical positions. I think that disconnect is the major contention this forum continues to point out.

 

[NTT123]

Interesting paper, but I think we need to be very careful about what this actually proves.

There is a major difference between a shortage of access to podiatric services and a shortage of podiatrists in the employment market.

HRSA’s shortage number is not saying there are 1,810 open podiatry jobs sitting around that nobody can fill. It’s a model comparing estimated supply with how many podiatrists they think would be needed based on utilization.

And the methodology is worth looking at.

HRSA basically saw that podiatry employment went down compared with 2019 and treated that decline as evidence of a supply shortage. But fewer employed podiatrists does not automatically mean there aren’t enough podiatrists.

It could also mean there are fewer jobs, more consolidation, reimbursement issues, other specialties doing some of the same work, or employers simply not creating more positions.

HRSA even admits there is very limited data to actually quantify this supposed shortage.

What I would really like to see is actual job market data.

• How many good podiatry positions are sitting unfilled?
• How long are they staying open?
• How many applicants does each position get? 100 or 200 applicants in a week? Why is that?
• How many hospitals or large groups are saying they literally cannot find a podiatrist to hire?

Because that would actually show a labor shortage.

Instead, BLS is projecting only around 200 podiatry openings per year nationwide and only 2% job growth through 2035. At the same time, HRSA is using roughly 545 new podiatry graduates per year in its model.

That seems like a pretty important disconnect.

California is one of example. The paper says California is projected to be short hundreds of podiatrists.

Okay, but where are those hundreds of jobs?

If there is supposedly this massive shortage, you would expect to see hospitals and health systems desperately recruiting DPMs everywhere and PE will pay more than 150k in high cost of living area.

Instead, the good employed jobs are extremely competitive and even PE job are become competitive for poor pay due to job saturation.

You can absolutely have rural areas with poor access to podiatry and still have a saturated job market in the places where most people actually want to live and work.

Those two things can exist at the same time.

Another thing I don't see addressed is what exactly they mean by a shortage of "podiatric care."

When you look at the HRSA methodology, the demand driver is basically the projected number of "podiatrist visits." It doesn't appear to separate routine foot care from complex medical or surgical foot and ankle care.

So is the projected shortage in California because there aren't enough DPMs to manage fractures, total ankle, Charcot, limb salvage and reconstructive surgery?

Or is it because an aging diabetic population is projected to generate more nail care, callus care and routine diabetic foot visits?

Do we need more 8 years “fellowship trained reconstruction ankle and foot surgeon” to cut toenails or we need foot care RN?

Those are very different workforce problems.

 

[NTT123]

BLS is already clearly telling us there is limited demand for podiatrists. I’m not sure why this is so difficult to address.

Instead of addressing the elephant in the room, we keep finding data guys to justify the salary numbers, and now podiatric educators to write papers saying there’s a shortage.

It takes 5 seconds to read the BLS numbers.

They project about 200 job openings per year, while we have 500–700 new residents plus fellows graduating every year. And that doesn’t even include all the associates already practicing who are looking to switch jobs.

Podiatrists

Podiatrists provide medical and surgical care for people with foot, ankle, and lower leg problems.

www.bls.gov

 

[Adam Smasher]

I can 100% agree with the fact that there is a increasing need for geriatric nail/callus care.

Do we need more 8 years “fellowship trained reconstruction ankle and foot surgeon” to cut toenails or we need foot care RN?

This.

AJM is thoroughly rigorous as an academic and well-respected, so I'm hesitant to criticize him on such a methodologically obvious distinction. But it is a necessary distinction--between toenail and callus procedures and actual doctor work that we all lump together in the same basket as "podiatric services."

Also, I still don't want to discuss this on anyone's podcast.