Jan 13, 2015
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Pre-Health (Field Undecided)
Hello Docs, I post in pre-med forums and also in pre-pod forums. I consider myself a pre-med/pre-pod undergrad student, I absolutely love podiatry.

A few questions: are there too many or too less podiatrists and will there always be a demand for them? If I were to choose podiatry, how do you expect this field to hold up by 2022 (when I will most likely graduate podiatry school)? Will I struggle to find patients or have too many (more the better)? Will I be working in a hospital or a common private/group podiatry practice or ortho practice?

Thanks for the time, I do appreciate it all.
 

ldsrmdude

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are there too many or too less podiatrists and will there always be a demand for them?
Well, all of the things that bring in our business (diabetes, bunions, foot/ankle trauma, etc) aren't going anywhere so there will always be a demand for our services. People debate that question of whether there are too many podiatrists or too few. There will probably always be room for a well-trained podiatrist in almost any location you want to work.
If I were to choose podiatry, how do you expect this field to hold up by 2022 (when I will most likely graduate podiatry school)?
Like I said in the last question, there will always be a place for our service. By 2022 there might be another state or two that will include ankle that don't right now, podiatrists might get recognized as physicians under Medicaid, but I don't know if the field will be dramatically different than what it is right now.
Will I struggle to find patients or have too many (more the better)?
This all depends on you. I've worked with 2 different docs a few miles apart, one that barely made ends meet because they struggled to get patients, and one that worked more than they really wanted to because they were so busy they had to add more clinic time.
Will I be working in a hospital or a common private/group podiatry practice or ortho practice?
I hope you realize there is no way anyone can tell you what your practice would look like 10 years from now. All those options will still be around for you to choose from.
 
OP
M
Jan 13, 2015
44
5
Status
Pre-Health (Field Undecided)
Well, all of the things that bring in our business (diabetes, bunions, foot/ankle trauma, etc) aren't going anywhere so there will always be a demand for our services. People debate that question of whether there are too many podiatrists or too few. There will probably always be room for a well-trained podiatrist in almost any location you want to work.

Like I said in the last question, there will always be a place for our service. By 2022 there might be another state or two that will include ankle that don't right now, podiatrists might get recognized as physicians under Medicaid, but I don't know if the field will be dramatically different than what it is right now.

This all depends on you. I've worked with 2 different docs a few miles apart, one that barely made ends meet because they struggled to get patients, and one that worked more than they really wanted to because they were so busy they had to add more clinic time.

I hope you realize there is no way anyone can tell you what your practice would look like 10 years from now. All those options will still be around for you to choose from.
Awesome, thank you! For my last question, I didn't really clarify enough... I meant to ask: is a private practice podiatrist or hospital podiatrist more common? And if I may, why did one of the podiatrists you worked with "struggle" to find patients? Do you think surgery will become a bigger role for podiatry in the future?
 

ldsrmdude

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Awesome, thank you! For my last question, I didn't really clarify enough... I meant to ask: is a private practice podiatrist or hospital podiatrist more common?
Right now private practice is more common. In 10 years? Private practice will probably still be more common but there will probably be more hospital-employed podiatrists.
And if I may, why did one of the podiatrists you worked with "struggle" to find patients?
Lots of reasons. He wasn't as well trained, didn't market as well, wasn't as friendly or as talented.
Do you think surgery will become a bigger role for podiatry in the future?
I don't know. I don't think it will change all that much.
 
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OP
M
Jan 13, 2015
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Pre-Health (Field Undecided)
Right now private practice is more common. In 10 years? Private practice will probably still be more common but there will probably be more hospital-employed podiatrists.

Lots of reasons. He wasn't as well trained, didn't market as well, wasn't as friendly or as talented.

I don't know. I don't think it will change all that much.
Thanks a lot for your time idsrmdude! All of that makes a lot of sense to me. I have no problem working as a hospital, private or group podiatrist, whatever road gets me to be a practicing podiatrist and a damn good one is fine for me!
 
Sep 14, 2015
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Podiatrist
Success in podiatry may depend on salesmanship over medical and surgical talent. The extent of this varies in different parts of the country. Most podiatrist incomes are partially dependant upon selling orthotics, diabetic shoes, repackaged otc products, questionable laser services, questionable diagnostic services and other gimmics of low evidence based value.
Surgical services are also debateable as to their need vs the doctor's desire to do the procedure.
You tend to appreciate this concept the older you get and try and separate the false dogma from the real care you provide.
If you are not institutionally employed, without quotas on surgeries and sales, you can end up a slave to the Dr Oz side of health care.
Being "talented" medically means knowing when not to cut and evaluating the patient needs independent of your revenue cycle. In a world that squeezes every penny out of doctors, you have less time with every patient. Most doctors now default to the most profitable treatment.
This is slate to be turned on its head in 3 years. So having great surgical numbers today, might help you make partner status. In two years you may be forced out of thet ACO panel.
Lastly, the most billed codes for podiatry are for nail cutting. If you expect to make a living without sniffing some fungal nail dust, the odds are against you.
 

Pronation

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Evopod, did you happen to have your license revoked by any chance?
 
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Sep 14, 2015
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No, why do you ask? I am abfas in foot, never sued. Are you all really that snowed where all you see us sunshine and lollipops? I did leave private practice because of declining reimbursements and meaningful use. My license is clean.
Optimism is great. So is swimming in the ocean. But swimming at dusk, alone with bait fish in your pocket is about as dumb as opening a podiatry practice after the affordable care act, as icd 10 rolls in and ACO payments replace fee for service.
You sound like your preaching to the frogs to enjoy the warm water. Aren't the tiny bubbles refreshing?
If this forum is for students and residents, they should be well aware of the pitfalls so they can make responsible decisions. Not buy worthless practices based on goodwill. Nor should they strive to be partners in private practice, it is very risky right now. Chiropractors and optometrist have already gone through what we are heading into. Look at some of their blogs and you will the same trends, we are seeing.
 
Apr 7, 2015
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:troll:
 

ldsrmdude

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Why do you assume that Evopod is a troll? Just because someone has a viewpoint you don't agree with does not make them a troll. His view point is one that many podiatrists (and other medical practitioners) share. Maybe you could learn something from his posts.
 

heybrother

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We're suspicious because we have an active troll and most new low post count accounts that claim to be a podiatrist and immediately say derogatory things about the profession are the same person. I was skeptical after his first post. I'm more skeptical now. When questioned about credentials we get a long bizarre rant about how delusional we are. I wonder who else posts like that. But who knows. Perhaps he'll go on to to be another Natch and always provide sage and meaningful advice.
 
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ldsrmdude

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We're suspicious because we have an active troll and most new low post count accounts that claim to be a podiatrist and immediately say derogatory things about the profession are the same person. I was skeptical after his first post. I'm more skeptical now. When questioned about credentials we get a long bizarre rant about how delusional we are. I wonder who else posts like that. But who knows. Perhaps he'll go on to to be another Natch and always provide sage and meaningful advice.
Fair enough.

My suggestion (which has always been what we hope forum members do) is that if you see someone you think is trolling, use the report feature to bring it to the moderators attention. Don't engage them. Trolls seek after the attention and the reaction they can generate.

I don't think Evopod is here to troll. He's trying to give us his advice, and it sounds like it's advice he learned the hard way.
 

heybrother

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I don't think you are being unreasonable at all. Excessive moderation will drive people away from forums. I've definitely seen people on here referred to as trolls that clearly weren't and I'm pretty sure I was called a troll over in the pre-pod forum recently. There's definitely some false positives when people hit their troll button. I wish that we regularly got new podiatrists who wanted to share their experiences and it would be a damn shame to drive them away by accosting them. Brand new negative posters though? Historically sketchy.
 

ldsrmdude

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I don't think you are being unreasonable at all. Excessive moderation will drive people away from forums. I've definitely seen people on here referred to as trolls that clearly weren't and I'm pretty sure I was called a troll over in the pre-pod forum recently. There's definitely some false positives when people hit their troll button. I wish that we regularly got new podiatrists who wanted to share their experiences and it would be a damn shame to drive them away by accosting them. Brand new negative posters though? Historically sketchy.
We're totally in agreement here. But let me state just for the record that all reports are reviewed by the moderator team even if there's no visible action taken.

As for what Evopod said, he's clearly had more experience than I have. I'm much more optimistic than he is about medicine in general and podiatry specifically, but he's not alone in his experience. Medicine has clearly changed drastically over time and many (all?) doctors have had to change how they practice to adapt. Most have adapted and continue to practice, but the number who have retired early or switched careers is not insignificant. A lot probably comes down to the fact that many doctors who have been in practice several years couldn't adjust to the changing tides and got swallowed up. They look back on "the good ol' days" when they were making more money for seeing less patients and it's frustrating. Many have struggled to adopt EMRs. A lot of doctors got into medicine to be business owners and the current climate makes that very challenging. Most podiatrists coming out now don't have a desire to own their own practice. I really don't.

These are my good ol' days right now. I never experienced the medicine of 20 years ago. I never used paper charts. I never had to watch my reimbursement for my bread and butter procedures dwindle. I grew up in this current climate and I'm acclimated for it. That doesn't mean it's all gumdrops and unicorns.
 
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Sep 14, 2015
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I did EMR before MU. I would not say that I was swallowed up by the changes. The problem is that even if your practice management software and EMR is free, The changes that have been implemented do not allow for a single doctor to see enough patients to cover the extra staff needed to manage your portal, vitals, and yearly register/notifications. For these reasons I gave up on meaningful use. Moreover, many EMR functions like lab result review and PQRS tasks are things I already do, now add extra minutes to do the clicks that make it count. This means less patients, more staff for less reimbursement per patient.
I am not offended by the troll comment. I just hate snowjobs. Unfortunately, podiatry is riddled with self serving low/no evidence treatments. Much of which gets swallowed as dogma throughout podiatry. As the medical community and patient population associate the BS With podiatry, we are all brought down.
In 2-3 years our government had promised to reduce cost by reducing unnecessary treatment. No one thinks their treatments are unnecessary! But I promise you the wound care products, charcot x fix's, smart toes and other treatments that provide a modicum of improvement for many thousands of dollars will be deemed unnecessary and may push you out of an ACO, which is where the insured patients will be.
I belive this is happening already. But. Those claims may be embellished. I was in an ACO and did have software installed on my computer to track my coding and compare it to other providers. I was not penalized ever. But, I have always been price conscious, so I think I would have been low on the curve.
 
Apr 7, 2015
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My apologies Evopod, I thought your writing style was a little similar to that website known for posting super negative stuff and jumped to conclusions.

Thanks for the posts, I'm learning from what you have to say.
 

ldsrmdude

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I did EMR before MU. I would not say that I was swallowed up by the changes. The problem is that even if your practice management software and EMR is free, The changes that have been implemented do not allow for a single doctor to see enough patients to cover the extra staff needed to manage your portal, vitals, and yearly register/notifications. For these reasons I gave up on meaningful use. Moreover, many EMR functions like lab result review and PQRS tasks are things I already do, now add extra minutes to do the clicks that make it count. This means less patients, more staff for less reimbursement per patient.
I think that one area some doctors have trouble adapting to is the decrease in ability to maintain things as a solo practitioner. It's unfortunately the new reality as you point out that it is very tough for a solo doc to make it anymore.
I am not offended by the troll comment. I just hate snowjobs. Unfortunately, podiatry is riddled with self serving low/no evidence treatments. Much of which gets swallowed as dogma throughout podiatry. As the medical community and patient population associate the BS With podiatry, we are all brought down.
Totally agree. There are lots of examples of this.
In 2-3 years our government had promised to reduce cost by reducing unnecessary treatment. No one thinks their treatments are unnecessary! But I promise you the wound care products, charcot x fix's, smart toes and other treatments that provide a modicum of improvement for many thousands of dollars will be deemed unnecessary and may push you out of an ACO, which is where the insured patients will be.
I belive this is happening already. But. Those claims may be embellished. I was in an ACO and did have software installed on my computer to track my coding and compare it to other providers. I was not penalized ever. But, I have always been price conscious, so I think I would have been low on the curve.
I think we all need to be cost conscious. It's the only way physicians will be able to maintain some control over things like this is if we exercise some restraint and not always use the newest and coolest toy just because we can.
 
Apr 26, 2015
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I did EMR before MU. I would not say that I was swallowed up by the changes. The problem is that even if your practice management software and EMR is free, The changes that have been implemented do not allow for a single doctor to see enough patients to cover the extra staff needed to manage your portal, vitals, and yearly register/notifications. For these reasons I gave up on meaningful use. Moreover, many EMR functions like lab result review and PQRS tasks are things I already do, now add extra minutes to do the clicks that make it count. This means less patients, more staff for less reimbursement per patient.
I am not offended by the troll comment. I just hate snowjobs. Unfortunately, podiatry is riddled with self serving low/no evidence treatments. Much of which gets swallowed as dogma throughout podiatry. As the medical community and patient population associate the BS With podiatry, we are all brought down.
In 2-3 years our government had promised to reduce cost by reducing unnecessary treatment. No one thinks their treatments are unnecessary! But I promise you the wound care products, charcot x fix's, smart toes and other treatments that provide a modicum of improvement for many thousands of dollars will be deemed unnecessary and may push you out of an ACO, which is where the insured patients will be.
I belive this is happening already. But. Those claims may be embellished. I was in an ACO and did have software installed on my computer to track my coding and compare it to other providers. I was not penalized ever. But, I have always been price conscious, so I think I would have been low on the curve.
Evopod... How long have you been practicing?

So are you saying the future of podiatry looks bleak? So it is better to just go MD than dpm?

I know chiropractors and optometrists are having a hard time justifying operations already..

is that what will happen to pods?


would ACA affects pods more than MDs..

please give me some insight to some knowledge as to what might happen to the field based on you opinion ?


thanks
 
Sep 14, 2015
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Evopod... How long have you been practicing?>15 years

So are you saying the future of podiatry looks bleak? So it is better to just go MD than dpm? Yes. But even that is less secure than it used to be.

I know chiropractors and optometrists are having a hard time justifying operations already..

is that what will happen to pods? My issue was :. I could not make money ethically; Most people don't need elective surgery and definitely do not need Ameri-gel and tolnaftate toe nail solution. Couple that with plummeting reimbursements, high deductibles decreasing volume and making collections 3x more difficult and government required software, which requires additional staffing while slowing you down and conferring no treatment or economic advantage.


would ACA affects pods more than MDs..
I think
It will fail and force a single payer system. No one knows what that will do.

please give me some insight to some knowledge as to what might happen to the field based on you opinion ?
There is a lot of amazing work you can do as a DPM. However, Many ambitious grads will never be able to have a practice that pays well and engages exciting medically necessary procedures and medicine. Once you develop a patient base it is next to impossible to change direction within your career. You are type cast and hopes of "building rear foot and Ankle cases later" are not going to happen as your board eligibility slips away.


thanks
 
Sep 14, 2015
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3
Status
Podiatrist
Evopod... How long have you been practicing?>15 years

So are you saying the future of podiatry looks bleak? So it is better to just go MD than dpm? Yes. But even that is less secure than used to be.

I know chiropractors and optometrists are having a hard time justifying operations already..

is that what will happen to pods? My issue was :. I could not make money ethically. Most people don't need elective surgery and definitely do not need Ameri-gel and tolnaftate toe nail solution. Couple that with plummeting reimbursements, high deductibles decreasing volume and making collections 3x more difficult and government required software, which requires additional staffing while slowing you down and conferring no treatment or economic advantage.


would ACA affects pods more than MDs.. I think
It will fail and force a single payer system. No one knows what that will do.

please give me some insight to some knowledge as to what might happen to the field based on you opinion ?
There is a lot of amazing work you can do as a DPM. Unfortunately, many DPM'S don't get hired in a position that compliments their training. They hope their practice will grow and they will build a rear foot and Ankle practice. This is doomed to failure as you will be type cast by the practice you start in and board eligibility will eventually slip away.


thanks
 
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g squared 23

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Do you think surgery will become a bigger role for podiatry in the future?
Surgery will continue to take less and less of a role, as deductibles continue to absolutely sky rocket. Patients with a $5,000 deductible before any insurance benefits kick in are not going to get that bunion fixed unless it is seriously bothering them (and they've almost met their deductible because they had something else non-elective done earlier that year). It will obviously level out, and there will always be patients who want surgery and hungry surgeons who want to perform surgery, so it will never cease to be a part of most Podiatric practices. However, far fewer people are going to the OR to fix that hammertoe number five that gives them a painful corn in tight shoes. In office procedures will increase a great deal in lieu of the simple cases (extensor and flexor tenotomies will be attempted in the office instead of a PIPJ fusion in the OR).
 

ExperiencedDPM

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Evopod makes some excellent points. Medicine in general isn't headed in a good direction. It's no longer going to be "the more you do, the more you make". They will track data and those who provide care without high costs, and get good results will be rewarded. When Joe Shmo walks into your office with typical plantar fasciitis, many DPMs see this as a cash cow. The patient will get X-rays (statistically, how many plantar fasciitis patients ever really have a osseous pathology, especially since we know the "heel spur" is insignificant), the patients will get an injection, he will be sold a pair of orthoses for several hundred dollars, he'll get a night splint, he will be sold Biofreeze, etc. The next doctor may tape up the foot, demonstrate stretching exercises, tell the patient to use ice and sell the patient an inexpensive OTC insert (there is very little, if any literature to support the use of custom orthoses over a quality OTC device). So when the second doctor"s patient gets better at minimal cost, this WILL make a difference. When a surgeon uses 4 hammertoe implants at a cost of thousands of dollars, and the next guy uses 4 kwires at a cost of under a hundred bucks, who do you think will be scored higher by the insurers. Viewing the patient as a dollar bill will come to an end, and doctors will need to treat patients, and not their insurance.
 
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Apr 26, 2015
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Evopod makes some excellent points. Medicine in general isn't headed in a good direction. It's no longer going to be "the more you do, the more you make". They will track data and those who provide care without high costs, and get good results will be rewarded. When Joe Shmo walks into your office with typical plantar fasciitis, many DPMs see this as a cash cow. The patient will get X-rays (statistically, how many plantar fasciitis patients ever really have a osseous pathology, especially since we know the "heel spur" is insignificant), the patients will get an injection, he will be sold a pair of orthoses for several hundred dollars, he'll get a night splint, he will be sold Biofreeze, etc. The next doctor may tape up the foot, demonstrate stretching exercises, tell the patient to use ice and sell the patient an inexpensive OTC insert (there is very little, if any literature to support the use of custom orthoses over a quality OTC device). So when the second doctor"s patient gets better at minimal cost, this WILL make a difference. When a surgeon uses 4 hammertoe implants at a cost of thousands of dollars, and the next guy uses 4 kwires at a cost of under a hundred bucks, who do you think will be scored higher by the insurers. Viewing the patient as a dollar bill will come to an end, and doctors will need to treat patients, and not their insurance.

Thats no good! I want the cash cows!
 
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ExperiencedDPM

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I'm presuming you're joking, but unfortunately the doctors who did take advantage of cash cows are one of the primary reasons changes are taking place.
 
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of course I am joking :) going into medicine for money will result in the most dreadful and misery filled life... Trust me, I know. I have family who are in that position!

I am done for md or dpm... i just want to have a job were i can treat ppl at a level with knowledge and expertise