I think the saturation isn’t a terrible thing, it’ll force us to be better with the competition. We develop better relationships with our patients than the other undersaturated specialties that rely on PA/NPs to see their patients for them. While it might feel good to be so needed that you have assistants help you see your patients, it reduces your touch points with the patients and doesn’t allow you to build meaningful relationships.
I would tend to agree, and I actually structure my practice that way (all new pts get 30min, most f/u get 30min also unless really easy stuff).
However, it's just
not financially viable to do that in most areas. I can offset it with finishing school when debt was about half what it is now (yeah, that was only 10yrs ago!), I do a good amount of surgery, and I picked a spot with pretty good payers. Mainly, the fact that my partner kills it and we keep our standard of living average with no kids to pay for certainly helps, so I just don't need to work myself or my staff very hard or rush through patient visits. I could probably gross twice what I do and net over 2x what I net, but I just don't feel like working late and double and triple booking. My staff and I love our office, and we help plenty of ppl.
...To
many most DPMs, particularly with the increasing tuition loan burdens, they absolutely
do need to see 20-25 or even 30+ per day to be reasonably profitable. If they don't, they will be minimally profitable, fail to keep good staff, or even struggle to make rent and loan payments in some areas and payer mixes. I know many trying to see 40/day in small or solo office.
With saturation of podiatry, that patient volume is harder and harder to get... or it takes longer to build up to.
You see dingleberries bringing pts back every 1-2wks for heel pain, monthly for nails, etc... "to fill up the schedule."
You will have $500k debt associates burned out and stressed, trying to make ends meet grinding and commuting for 30% pay.
Worst of all, if the volume isn't there (and even if it is), you will see docs trying to get "a liiiittle more out of each visit."
So, if a doc can't get the volume, then enters the fraud, OTC snake oils, overbilling, accepting lower and lower pay from insurances or hospitals/MSG/supergroups, questionable patient care, and wacky (desperate?) marketing tricks that you see in chiro and some other saturated health professions. That is not good patient care, and it's not good for the profession's overall rep.
We already see some of this in podiatry (trying to waive copays, aggressive blogging and social media, coupons, questionable OTC or cash services), and it will likely get worse for podiatry in years to come. You will definitely see the pod VC supergroups grind DPM pay and benefits down in just the way corporate pharmacies did to the glut of PharmD grads (despite their tuition going exponential). They don't care about patient relationships or doc hours/week being reasonable; they want max profits. Not good.
It's good to try to put a positive spin on saturation, but
saturation is just never a good thing for the profession. It is really not good for the consumer (patient), either, because despite same/lower price or docs having a lighter schedule, the people entering the profession will get less talented as the income/job is less coveted. The docs will be more stressed due to financial squeeze. You also have each of the doc doing less procedure volume (particularly the surgery), and you can't tell me I'm as good doing 5 or 10 Lapidus per year as 25 annually. That's why F&A ortho stays relatively scarce with ~70 fellowship spots: they want their grads to be
highly competent and busy and in demand with employers (and they almost always are).
Besides the obvious income detriments from saturation, you also run into a too-many-cooks-the-kitchen thing with DPMs in saturated areas competing cutthroat, disparaging one another to PCPs or patients, making tx and f/u and other decisions on money and not patient welfare, and other stuff we'd rather not see. It's confusing to patients when there are 4 podiatrists in a small town, each telling them a different bunion operation, different recovery timeline, one says no surgery just orthotics (since they don't do surgery), and all tell them why they're better than the others. That is not a good look.
Nobody will say us having hundreds of apps for jobs at the same hospitals who can't find a dozen apps for an ortho or GI job is a
good thing??? It's hard for hospital FTE podiatrists to negotiate raises when dozens of DPM grads call or even visit their facility annually, with many offering to do the same job for less. The podiatry dog-eat-dog mentality already happens in popular areas and metros, but it will get more common everywhere. It's good to think that people will do longer/better visits with lower volume due to saturation, but that's not how it works out. People will
always do what it takes to $urvive and thrive in both the hospitals and PP, and the greed of podiatry increasing supply of DPMs will continue to make that competition unfortunately more and more apparent.
It is a terrible thing because it drives down payer reimbursement and overall pay in general. It is the reason why after 4 years of undergrad and 4 years of podiatry school at the cost of 300k or more, and at least 3 years of post graduate training, a starting salary of $150,000 is usually considered "good."
Saturation is bad and can destroy a profession that relies on fee for service payments. This concept is so basic that it is not even worth arguing.
100% ^^
