...With the "surgery-trained" podiatrist being a relatively new thing, do any of you fear a saturation point? How many residency spots are available for orthopaedic surgeons that perform on all bones/joints in the body?
It seems like there will be a disproportionate number of F & A surgeons if new pod schools are opening and more students are graduating as a surgical pod.
Has anyone else thought about this? What is the number of trained podiatrists graduating each year?
**** I hope this doesn't spin to the bottom and die in flames ****
I've considered this, and I think it's a
very valid concern. Good discussion.
30yrs ago, <25% of graduating DPMs were getting a residency at all, and even fewer found PG surgical training (and if they did, it was usually 1-2yrs). Even 10yrs ago, while most got a residency of one kind or another, few residencies were 3yrs and high quality/volume surgical. Today, almost every grad gets a 3yr residency program, and while some still aren't great, pretty much all PMS will teach you competency in foot surgery. I'd say roughly half the programs out there will prep you with good quality rearfoot and ankle surgery skills (and full ABPS RRA cert knowledge) as you proceed out into practice.
As was stated, ortho F&A fellowship grads are on the decline. That might be due to ortho resident interest, saturation, F&A ortho's income decline (partially because surgical DPMs will often do the same F&A work for lower salary), combo of factors, etc... who knows? However, graduation of highly trained surgical DPMs are rising at a significantly faster rate than F&A ortho is declining. Just for the sake of example, suppose that over the last 20yrs, the annual number of graduating surgical DPMs doing the full scope of F&A surgery went from 100 to 300, and annual number of graduating from approved AOFAS fellowships went from maybe 100 to 50. Those are just rough numbers, but probably ballpark... and you see rough annual increase from 200 to 350 overall. Well, if every DPM finishing traing and heading into practice suddenly decided to focus on mainly bone/joint surgery and refuse/refer most patients who need the other aspects of our training (diabetes, wounds, derm, peds, geriatric, etc), there would be definite oversaturation of F&A bone/joint surgeons in the coming years/decades.
You will notice that in some metro areas, there is already fairly stiff competition for F&A surgical patients, particularly bone/joint patients, and that causes tense politics regarding hospital staff consulting and op privileges. Some DPMs compete for surgical pts in those saturated areas, some avoid the surgical politics and just focus on other F&A subspecialties, and some choose to find another area of the country that has more pt supply and need for F&A surgery providers. This can really be said for any specialty, though: some docs compete and go for the gold of building/growing a booming, lucrative urban or suburban practice, and others are happy at smaller, more rural communities where they might find significantly less competition, lower overhead, less politics, etc with the tradeoff of less chance to expand their patient/referral base due to simply not enough general population around them to allow significant growth.
Shireiqiang said:
Not all podiatrists focus on surgery in their practice. This only relates to one side of podiatry....
Yep^
Also, even if a DPM does surgery, there are subspecialties. Programs like mine or jon's have literally dozens of attendings, which shows you the various DPM practice types and focuses. Some surgical DPMs do a lot of trauma call and garner those referrals. Some do more elective recon and are known for that. Some DPMs do primarily inpatient rounding, diabetic consults, wound care clinics, etc. Others, despite having surgical training, may choose to do mostly office and little surgery - or even refer it altogether to their partner or other area doc (to avoid hassles of OR scheduling, commuting to/from OR locations, liability associated with surgery, maybe they realize they just don't have natural ability at the level of their peers like JewMongous suggested, etc). There's never anything wrong with being "overtrained" for the patients you're treating, though... much better than the opposite situation.
The bottom line is that there will almost certainly continue to be a piece of the pie for every DPM, but it may not always be the piece you want. If you choose to focus on one F&A subspecialty, certain metro areas will definitly have poitics and be fairly saturated with providers who get referrals and calls for those patients. You then are at the crossroads of switching subspecialties, competing, moving locations, etc etc... and different DPMs will take different pathes. This is not a problem that's unique to our medical field, but it is worth consideration.
