Practicing Pod w/ Partial/no Residency

[DedosdelosPies]

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This topic has been discussed a few times as I have found. But I want to know for sure (a lot of uncertainty I’ve detected in past posts) if one can practice podiatry w/o residency in one of the four states which don’t require a residency : Hawaii, Connecticut, Kentucky, and Pennsylvania. Two main issues to be discussed: competing with residency-trained DPM’s and being reimbursed from insurance companies. I wouldn’t think many resident trained DPM’s would want to compete for a spot in a nursing home. Will Medicaid reimburse DPM’s w/o a residency for DFC? Is the DPM degree w/o a residency as useful as an associates in fine arts? Any intelligent and tactful input will be appreciated.

 

[Scrantonicity]

I guess it's not really tactful input...but this just sounds like hell. 300K in debt and your only hope is to cut enough toenails in a nursing home to scrape by and make a living. I certainly couldn't have done it. Plus, I learned next to nothing in pod school...residency is where I learned everything (or at least, that's when it all clicked). Not sure how you could practice without it--even doing nursing homes I'd feel inadequate...

Sorry, I don't know any of the answers to your questions in terms of reimbursement--but I do visit a few nursing homes and they really don't pay much even if you have done a residency (unless there's some creative billing that I don't know about).

 

[dtrack22]

Before I give my intelligent and tactful input...Foregoing residency training with the plan of moving to one of four states and cutting toenails in nursing homes, or maybe setting up a mobile home visit nail cutting practice is an awful idea. Now, on to the input:

Two main issues to be discussed: competing with residency-trained DPM’s and being reimbursed from insurance companies.

I wouldn't be worried about competing with residency trained DPMs for nursing home jobs...nobody will be fighting you for those. Commercial plans may be impossible to get on. Medicare and Medicaid may only require a state license? But I didn't do my own credentialing so I'm not sure on that

I wouldn’t think many resident trained DPM’s would want to compete for a spot in a nursing home.

You are absolutely right

Will Medicaid reimburse DPM’s w/o a residency for DFC?

Again, if all they require is a state license in order to sign up to be a medicaid provider, then of course they will. I imagine Medicaid pays you around $20 at best for a 11721 in a facility setting. But I'm sure someone here who has busted nails knows better. Of course medicaid reimbursements vary from state to state.

Is the DPM degree w/o a residency as useful as an associates in fine arts?

The only way you could make it more useful is if you are savvy enough to start a business of some sort related to podiatry. For example:

1. Instead of cutting nails at nursing homes forever, you get in with a few of them and work for a year or two yourself making enough to live and pay back some loans.
2. Figure out how nursing home contracts are established and find markets where regional or national companies that provide nursing home services don't exist.
3. Get those contracts for yourself/your company and hire an army of DPMs to cover those facilities for you
4. ...
5. Profit

 

[DedosdelosPies]

Before I give my intelligent and tactful input...Foregoing residency training with the plan of moving to one of four states and cutting toenails in nursing homes, or maybe setting up a mobile home visit nail cutting practice is an awful idea. Now, on to the input:


I wouldn't be worried about competing with residency trained DPMs for nursing home jobs...nobody will be fighting you for those. Commercial plans may be impossible to get on. Medicare and Medicaid may only require a state license? But I didn't do my own credentialing so I'm not sure on that


You are absolutely right


Again, if all they require is a state license in order to sign up to be a medicaid provider, then of course they will. I imagine Medicaid pays you around $20 at best for a 11721 in a facility setting. But I'm sure someone here who has busted nails knows better. Of course medicaid reimbursements vary from state to state.


The only way you could make it more useful is if you are savvy enough to start a business of some sort related to podiatry. For example:

1. Instead of cutting nails at nursing homes forever, you get in with a few of them and work for a year or two yourself making enough to live and pay back some loans.
2. Figure out how nursing home contracts are established and find markets where regional or national companies that provide nursing home services don't exist.
3. Get those contracts for yourself/your company and hire an army of DPMs to cover those facilities for you
4. ...
5. Profit

Why would you say working at nursing homes is an awful idea? I mean if that’s all I want to do... I don’t think it takes 3 years of residency to do that. It certainly didn’t take podiatrists from 30 or 40 years ago 3 yrs of residency to chip n clip. I could do wound care as well I’m sure, don’t see why not.

 

[air bud]

Yeah like dtrack said, follow this chart

 

[dtrack22]

Why would you say working at nursing homes is an awful idea?

Because you could make as much money giving pedicures at a local nail salon and not go $200k into debt

 

[heybrother]

I'm sorry, but your judgement in this situation is so colossally flawed that I can't help but wonder if there's some additional detail you are not sharing with us. Theoretically, we all shared at least some experiences in seeing the podiatry spectrum. We all visited residencies as students and if we had any introspection we recognized that the residents and attendings at programs knew more than we did. Somehow you've experienced that (yes?) and walked away with that idea that you don't require that professional training and development.

-You'll be missing judgement.
-You'll be missing experience.
-You will not develop as a professional.
-You are signing up for the least rewarding part of this profession.
-You are signing up for an overly regulated part of this profession.
-If its all Medicare/Medicaid you'll need an EHR to avoid the penalty. So much clicking for so little money.
-This part of our field is ripe for fraud and ripe for being audited.
-An attending of mine did it in the past when he was hungry to pay off his student loan - his nurse would run ahead of him - shoes off, feet out, I don't enter the room if you aren't ready. Clip, paperwork, out of room. Do 20 in 2 hours. Does that sound rewarding to you?
-Have you been to a nursing home? I've been to too many and no one wants to be there - I've literally walked into nursing homes where the residents are all piled around the door somehow believing that if they sit there long enough they'll escape.
-Nursing home care is built upon the idea that everyone qualifies for nailcare. Plenty of people don't. Have fun having that conversation over and over again. Except you won't, would slow the flow. They'll all have been told they qualified by someone else - who are you to say they don't!
-11720 and 11721 in my area pay $15 and $25 in facility for Medicare.
-11055 and 11056 pay $16 and $22 in facility for Medicare.
-They pay almost identical in Pennsylvania and my area is lower cost of living and lower taxes.

I did a little light forum stalking and saw you looking at a similar thread to this from 9 years ago. Looked to me like a former ultra-experienced poster on here made very clear how the insurance market and Medicare are changing with Medicare Advantage being run by private payers who require their providers to be certified/credentialed etc.

Last of all, my program interviewed a poor person who was a nursing home podiatrist desperately trying to break the cycle and get training. Poor thing didn't know anything. Maybe they are where they are because they didn't know anything. Maybe its what happens when you let yourself atrophy or you never develop.

But by all means - pursue this diamond in the rough.

 

[DedosdelosPies]

I'm sorry, but your judgement in this situation is so colossally flawed that I can't help but wonder if there's some additional detail you are not sharing with us. Theoretically, we all shared at least some experiences in seeing the podiatry spectrum. We all visited residencies as students and if we had any introspection we recognized that the residents and attendings at programs knew more than we did. Somehow you've experienced that (yes?) and walked away with that idea that you don't require that professional training and development.

-You'll be missing judgement.
-You'll be missing experience.
-You will not develop as a professional.
-You are signing up for the least rewarding part of this profession.
-You are signing up for an overly regulated part of this profession.
-If its all Medicare/Medicaid you'll need an EHR to avoid the penalty. So much clicking for so little money.
-This part of our field is ripe for fraud and ripe for being audited.
-An attending of mine did it in the past when he was hungry to pay off his student loan - his nurse would run ahead of him - shoes off, feet out, I don't enter the room if you aren't ready. Clip, paperwork, out of room. Do 20 in 2 hours. Does that sound rewarding to you?
-Have you been to a nursing home? I've been to too many and no one wants to be there - I've literally walked into nursing homes where the residents are all piled around the door somehow believing that if they sit there long enough they'll escape.
-Nursing home care is built upon the idea that everyone qualifies for nailcare. Plenty of people don't. Have fun having that conversation over and over again. Except you won't, would slow the flow. They'll all have been told they qualified by someone else - who are you to say they don't!
-11720 and 11721 in my area pay $15 and $25 in facility for Medicare.
-11055 and 11056 pay $16 and $22 in facility for Medicare.
-They pay almost identical in Pennsylvania and my area is lower cost of living and lower taxes.

I did a little light forum stalking and saw you looking at a similar thread to this from 9 years ago. Looked to me like a former ultra-experienced poster on here made very clear how the insurance market and Medicare are changing with Medicare Advantage being run by private payers who require their providers to be certified/credentialed etc.

Last of all, my program interviewed a poor person who was a nursing home podiatrist desperately trying to break the cycle and get training. Poor thing didn't know anything. Maybe they are where they are because they didn't know anything. Maybe its what happens when you let yourself atrophy or you never develop.

But by all means - pursue this diamond in the rough.

Not sure why so many here are harsh posters. But if it gets you off... I’m just trying to get clarity out of things. It’s conclusive that the DPM degree is nothing in comparison to the MD/DO/DMD/DDS degrees. I hear/read an extremely diverse spectrum of chip and clip fees. Many say it’s worth more financially than sx. 20 in 2 hrs: not everyone in podiatry is hungry to do sx as close to the knee as possible. I feel a sense of attempt to ridicule: completely unnecessary. Again, I’m just trying to get clarity on things. So sorry if this disturbs you so much.

 

[G0dFather]

To the OP:

This type of work is fine! ... Like someone stated above, look what you can do in 2 hours ! Those will be the MOST profitable 2 hours of your entire DAY now matter what else you do ... from a purely financial perspective it is further compounded by the fact that THERE IS VIRTUALLY NO OVERHEAD! Every time you hear that clipper in your hand just think of DOLLAR SIGNS. There will also be an ever increasing demand of this and not enough of a supply. Form a purely financial perspective it makes all the sense in the world .... very importantly also THERE IS VIRTUALLY NO RISK! from a risk management perspective.

All that being said its good to mix things up so you can get more reward and benefit out of your degree... just get through residency, youve already come this far.

 

[Scrantonicity]

Not sure why so many here are harsh posters. But if it gets you off... I’m just trying to get clarity out of things. It’s conclusive that the DPM degree is nothing in comparison to the MD/DO/DMD/DDS degrees. I hear/read an extremely diverse spectrum of chip and clip fees. Many say it’s worth more financially than sx. 20 in 2 hrs: not everyone in podiatry is hungry to do sx as close to the knee as possible. I feel a sense of attempt to ridicule: completely unnecessary. Again, I’m just trying to get clarity on things. So sorry if this disturbs you so much.

I didn't read his post as harsh. Harsh truths, yes. Harsh tone? No

 

[Creflo]

The question is can you get on Medicare without a residency and can you get a license without a residency. Then if you can, and for some reason you can't do a residency, then you must know your limitations when practicing. There will always be others who make fun of you or think less of you, whether they be pods or orthopedic surgeons. Ignore them. Getting a facility is not easy, there is a lot of competition because it can be financially rewarding. Be careful that you understand Medicare guidelines for at risk foot care, it is in my opinion highly abused still today, and Medicare apparently feels the same way because they like to audit these services. Study Dr. Michael Warshaw's billing guidelines for at risk foot care, he can personally consult for you as well. If it's at all possible to do a residency, then I would recommend doing that first.

 

[DedosdelosPies]

The question is can you get on Medicare without a residency and can you get a license without a residency. Then if you can, and for some reason you can't do a residency, then you must know your limitations when practicing. There will always be others who make fun of you or think less of you, whether they be pods or orthopedic surgeons. Ignore them. Getting a facility is not easy, there is a lot of competition because it can be financially rewarding. Be careful that you understand Medicare guidelines for at risk foot care, it is in my opinion highly abused still today, and Medicare apparently feels the same way because they like to audit these services. Study Dr. Michael Warshaw's billing guidelines for at risk foot care, he can personally consult for you as well. If it's at all possible to do a residency, then I would recommend doing that first.

Thank you so much for this advice. This is the advice/input I’m looking for. I did call Pennsylvania and Mississippi state board of podiatry. No residency required for PA and only one year required for MS (one year of a three year program is fine, I verified). Couldn’t get a hold of anyone else yet. The plan is to work perhaps in nursing homes for now, then possibly get into the match to complete a residency, if not then try the business route in the nursing home. Working without a full 3 yr residency is temporary in my plan.