Saturation

[NatCh]

How many rural areas do you think there are in America? Do you want to live somewhere terrible in New Mexico or near an Indian reservation or somewhere where there is hardly any patient population just to make a living?

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[Retrograde_Nail]

If you have something to say then say it.

 

[NatCh]

If you have something to say then say it.

I'm thinking about what you said.

 

[DYK343]

Do you think MD/DO doctors act childish and feel threatened as easily as we do? It is rather pathetic.

Ehhhh, PCPs no. OB/GYN probably not. Physical med and rehab probably not.

But when a well trained DPM comes to town ortho starts to care - quite a lot.

 

[heybrother]

Its funny not having to post anymore because other people say the things I used to say.

 

[Hungry_Anxiety8703]

As one of those students, now practicing, I can honestly say the primary joy I get day to day is from bread and butter clinic work. Easy stuff that I can do well and that makes patients happy. Had big crazy cases as a resident but the reality is I don’t see myself doing any of those cases for the rest of my life. No desire to do rearfoot/ankle trauma or recons, and simply put there are 5 podiatrists/FA orthos within a 5 mile radius that could give the patient a better outcome for that type of work than myself.

I can sleep well at night giving up a $300 reimbursement after insurance and PP associate cut if it means not dealing with a lawsuit, ruining a patient for life, or midnight and weekend calls if it means sending that patient to the guy down the street.

Unfortunately many don’t realize their limitations or simply don’t care, and will hurt a patient to get their numbers just because they retracted for an IM nail a couple times as a resident.

Yeah I practice similarly. I actually got good training in several areas of complex surgery. But I honestly didn't enjoy it all that much. And it's even less enjoyable if you have to do the whole case by yourself and on top of that get a ****ty associate cut for it. The risk reward for surgery is just not there for me anymore. Amps, I&Ds, mass removals, simple bunions/hammertoes, halgunds. I'm fine with just stuff like that at this point. Anything more complex is better off being done by someone who does a ton of those cases and it's better for the pt too. If our profession required us to perform cases to make a living I'd definitely sing a different tune but it's just not reality

 

[air bud]

I'm not sure why the low reimbursement from insurance companies isn't brought up more regarding saturation. It's simple supply and demand. Do you think the ortho down the street is getting 60% of medciare from the medicare advantage plane for a knee replacement?

I know that the increase in the reimbursement is a top concern of the podiatry community/leadership. But no one wants to admit that the reason is because of saturation? It makes no sense.

SATURATION

 

[msion]

Just gotta start saying no to free and low-valued work.
Got a text from ED asking me to debride a nec fasc case at night. Nope, thank you. Call the gen surg guys who are actually supposed to do it.
Also stopped performing surgeries on patients with a specific medicaid HMO and referred them out to Ortho or hospital groups. The medical director of the insurance called 6 months later asking me why I stopped providing surgical service to their members. She said I was very cost-effective. LMAO.

Anyway, back to studying for my HVAC certification.

 

[Carbon13]

Just gotta start saying no to free and low-valued work.
Got a text from ED asking me to debride a nec fasc case at night. Nope, thank you. Call the gen surg guys who are actually supposed to do it.
Also stopped performing surgeries on patients with a specific medicaid HMO and referred them out to Ortho or hospital groups. The medical director of the insurance called 6 months later asking me why I stopped providing surgical service to their members. She said I was very cost-effective. LMAO.

Anyway, back to studying for my HVAC certification.

HVAC is probably the hottest trade right now. In my area at least.
I wonder how much it would cost to start up. Rent small shop ? Phone? Inventory? Truck?
Probably easier than starting my pod office.

How could I transition?

Pooordiatry 2 days a week and HVAC the other few.

 

[Xcy999]

There are over 18k podiatrists working in USA... more practicing podiatrists than nearly any MD specialty besides the head-to-toe and primary care ones (FP, ER, OB, gen surg, rad, anesthesia, psych, etc):

Number of People per Active Physician by Specialty, 2021 (click 'Total Active Physicians' to sort by number)

There more DPMs practicing than ENTs, derm, plastics, uro, Endo, GI, ophtho, PM&R, and many others.

Podiatry's current grad classes are far exceeding the classes of ~35yrs ago (replacing rate of retiring DPMs with many more). We have opened 4 schools in the past 20 years (only opened 3 in the 100 years before that).

We will soon overtake orthos (all types) and probably gen surgeons after that with the new podiatry schools ramping up their class sizes. That makes very little sense, given they treat the entire body and far more pathologies than DPMs do.

What we are doing that may be most concerning is replacing C&C docs with DPM "surgeon" grads. The job market is going to get very tough there for "surgeon" podiatry jobs (it already is), and RNs or midlevels will likely take most of the RFC work in offices, hospitals, nursing homes, wherever. By the time podiatry "leadership" realizes there is not a need for 600 or 700+ "foot and ankle surgeon" grads per year, that fallback RFC work will be somewhat dried up. Even pus bus DPM jobs will be hard for new grads to sniff due to backlog of DPMs who graduated in prior years vying for such spots.

Now and always, best defense is to work hard, get good grades and options, get a good residency.
There will always be good jobs or owner opportunities out there, but the avg DPM's financial ROI is going to continue to go down, though... no two ways about that. Simply look to pharmacy, chiro, optometry to see what saturation does. Increasing podiatry tuition, increasing numbers of graduating DPMs - particularly "surgeon" types - to go along with USA population growth flatline (soon to be negative, like any other first world country) are just not hard to figure out.

 

[Hybrocure]

Just gotta start saying no to free and low-valued work.
Got a text from ED asking me to debride a nec fasc case at night. Nope, thank you. Call the gen surg guys who are actually supposed to do it.
Also stopped performing surgeries on patients with a specific medicaid HMO and referred them out to Ortho or hospital groups. The medical director of the insurance called 6 months later asking me why I stopped providing surgical service to their members. She said I was very cost-effective. LMAO.

Anyway, back to studying for my HVAC certification.

It hurts when you see the HVAC guys from high school who didn’t go to college living in big houses with 100k trucks and no student loan debt.

Good for you though. Unless you’re on a paid call schedule you should have the right to refuse stuff like that. We should all be doing that. Unfortunately there are too many owners taking advantage of associates and forcing them to take the low hanging fruit to the detriment of our profession as far as bargaining for appropriate compensation goes.

 

[diabeticfootdr]

To fix it means waiting for old leadership to retire and for us to take leadership positions, create meaningful policy, and enact change for the future generation. I won’t be surprised if one of us on SDN here becomes the future president of APMA, ACFAS, or CPME.

Why wait? It’s a serious question. If the profession sorely needs good leadership now, which I believe it does, why not work to be in the leadership (or on the path to) now?

 

[NatCh]

Why wait? It’s a serious question. If the profession sorely needs good leadership now, which I believe it does, why not work to be in the leadership (or on the path to) now?

That sounds hard

 

[Adam Smasher]

There's a Max Planck quote to the effect that the in order for new ideas to be accepted, you need for the established thought leaders to die off first so their beliefs can die with them.

I don't know why quantum mechanics is easier for some DPMs to understand and accept than market saturation.

 

[heybrother]

There's a Max Planck quote to the effect that the in order for new ideas to be accepted, you need for the established thought leaders to die off first so their beliefs can die with them.

I don't know why quantum mechanics is easier for some DPMs to understand and accept than market saturation.

Rather, as German physicist Max Planck somewhat cynically declared, science advances one funeral at a time. Planck noted “a new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents die, and a new generation grows up that is familiar with it.”

 

[prepod2016]

HVAC is probably the hottest trade right now. In my area at least.
I wonder how much it would cost to start up. Rent small shop ? Phone? Inventory? Truck?
Probably easier than starting my pod office.

How could I transition?

Pooordiatry 2 days a week and HVAC the other few.

This post is ultra cringe for a variety of reasons.

I pray for all of you

 

[msion]

HVAC is probably the hottest trade right now. In my area at least.
I wonder how much it would cost to start up. Rent small shop ? Phone? Inventory? Truck?
Probably easier than starting my pod office.

How could I transition?

Pooordiatry 2 days a week and HVAC the other few.

Know how to repair and service these systems. Full system install requires a lot of labor and may not be suitable for a one-man shop.
Enough business just in the neighborhood. Spray paint your van/truck with the business info on there. Bet you will get a few calls just from a drive to the gas station.

Also sign up for Square or other credit card transaction systems. Bring the tablet and turn the screen back to the client and have him/her pick a tip% at the end of the service call.
Nah, just kidding on that one. Tip is getting insane though. I bet someday the HVAC supergroups will implement the tip options.

Why am I even thinking about supergroups in a different field? God, I guess that podiatry will never leave me.

 

[air bud]

Yeah, PE is doing HVAC roll ups just like they are Podiatry office roll-ups.

 

[PTPuser]

I was a plumber before I entered this scam. It's not unheard of to demand 300/hr.

 

[msion]

I was a plumber before I entered this scam. It's not unheard of to demand 300/hr.

I have some side handyman jobs that I enjoy to do and recently installed a water heater for $600. A licensed plumber would have charged around $1k for this work in my area.

Still though, paid better than a medicare Lapidus. Took me about the same amount of time to do the work, without the 90-day global.

 

[PTPuser]

I have some side handyman jobs that I enjoy to do and recently installed a water heater for $600. A licensed plumber would have charged around $1k for this work in my area.

Still though, paid better than a medicare Lapidus. Took me about the same amount of time to do the work, without the 90-day global.

If it wasn't so physically demanding which was the reason I left, I would go back. Could make a call right now and start tomorrow.
Can never say the same about podiatry.

 

[Retrograde_Nail]

If it wasn't so physically demanding which was the reason I left, I would go back. Could make a call right now and start tomorrow.
Can never say the same about podiatry.

Most of the plumbers I've treated were rich. Why would leave a trade where there is so much demand to do podiatry???

 

[Feli]

I'm not sure why the low reimbursement from insurance companies isn't brought up more regarding saturation. It's simple supply and demand. Do you think the ortho down the street is getting 60% of medciare from the medicare advantage plane for a knee replacement?

I know that the increase in the reimbursement is a top concern of the podiatry community/leadership. But no one wants to admit that the reason is because of saturation? It makes no sense.

Yes, exactly. ^^
Sadly, I think most of the "leaders" in podiatry are fine with that perpetual loop:

1. Decry podiatry wages, training, low insurance payments, lack of job acceptance in comparison to MDs...
2. Start a new school they profit from, increase DPM saturation --> wages, insurance, jobs, training naturally suffer...
3. (repeat back #1)

As long as the checks from the APMSA monies at the new schools, the Jublia and Crosc sponsor fees, and the catered dinners paid for with PAC monies are continually flowing, there is not a reason for APMA to improve.

People need to vote with their wallet. I will never give another dollar to APMA. That's too bad; some of the state xPMA components try do good things. Overall, I just see no need to support the "leadership" that has started 4 new podiatry schools in 20 years and coddled a fellowship push instead of standardizing and improving residency training so that all DPMs have good skills and demand for their services (as MD/DO specialists do). We are setting the majority of DPM grads up for major disappointment and major debt, and that will get worse as venture capital supergroups become a more and more common podiatrist employer (as retail pharmacy chains did for PharmD grads).

...MDs, on the other hand, really don't have the constant need for "leadership" and "change" and "improvement" because they simply control the supply/demand and the saturation. Even when venture capital steps in (TeamHealth for ER and anesthesia docs, locums for surgeons, etc), they are still paid darn pretty well. They have a finite amount of residency programs with standarization, teaching hospitals, good attendings, and high quality results.

AMA % of MDs and other MD/DO society memberships pale in comparison to APMA's % of podiatrists, but that's not a problem for them. MDs controlling their saturation and having excellent admissions + training makes everything else fall into place (income, job options, insurance fee schedules, demand, quality school/residency admissions). Podiatry needs to wake up.

 

[icebreaker32]

What is possible without saturation.

This is a good ROI for a masters program.

Makes over 200K

Paid off loans in 2 years.

Invests about $15,000 every month

Was still able to spend over $3,000 in a given month on travel. Admittedly frugal in other ways (rent/car),

https://www.cnbc.com/amp/2023/10/31/-28-year-old-anesthesiologist-assistant-earns-over-210000-dollars-a-year.html.

If you figure many in podiatry are now putting in 8 years this person will probably have 1 million in liquid assets with appreciation over the 6 year longer career path to become a fellow.

 

[DestinyMakers]

If she makes 210K per year, after taxes and health insurance etc. her monthly pay would be around 12K because she lives in FL (no state income tax).

"Her monthly income was higher than usual in September because she received three paychecks, which covered a raise as well as overtime and hazard pay. Rodriguez keeps her monthly costs relatively low by paying lump sums for things like her car and renters insurance, which she pays at six-month and annual intervals, respectively."

Of course it is an excellent deal, but let's put those numbers in context.

 

[NatCh]

Wow, total subscriptions is only $11??? Damn, I have too many movie streaming services. And, I spend more for gas than she does for transportation in only a couple of days. Actually, I'm at least double if not triple the rest of her expenses (except for travel). Maybe I should tighten my belt a little...

 

[icebreaker32]

If she makes 210K per year, after taxes and health insurance etc. her monthly pay would be around 12K because she lives in FL (no state income tax).

"Her monthly income was higher than usual in September because she received three paychecks, which covered a raise as well as overtime and hazard pay. Rodriguez keeps her monthly costs relatively low by paying lump sums for things like her car and renters insurance, which she pays at six-month and annual intervals, respectively."

Of course it is an excellent deal, but let's put those numbers in context.

She has already saved/invested $85,00 this year thus far and has 2 more months left in the year.

 

[DestinyMakers]

She has already saved/invested $85,00 this year thus far and has 2 more months left in the year.

That again does not add up as numbers (unless she only eats rice and beans and walks to work), you have to always take these articles with a grain of salt (they had to add that September paragraph after getting objections from their readers). I will just tell you this. If you compare yourself with others for the rest of your life, you will be miserable. She is 28, single and lives in Tampa. I know realtors in Miami her age who barely have a degree and they are already millionaires. Let's move on.

 

[air bud]

Yeah I want zero financial advice from someone without kids. And I want zero parenting advice from someone without adult children.

 

[air bud]

Yeah I want zero financial advice from someone without kids. And I want zero parenting advice from someone without adult children.

Small exception for Feli....

 

[PODIATRYCRAZE]

First I agree that saturation in podiatry is out of control.

Secondly I have many friends in pharmacy. Yes they say it is saturated but believe me when I say they have no idea what saturation is. Google any city in the entire nation and search (Insert city) pharmacist jobs. Dozens to hundreds come up. Do the same for podiatrists. Very few real opportunities pop up.

Which leads to my next question. How do you calculate saturation? Do you do it the simple way like I just proposed by doing a google search? Google maps? or are you more analytical with it checking the number of podiatrists in an area on FPMB and comparing to the census bureau?

 

[LossToFollowUp]

Average salary is a strong metric. Higher the saturation, lower the compensation offers.

DO NOT compare hospital salaries to private practice offers.

 

[HardRoadPaved]

Which leads to my next question. How do you calculate saturation? Do you do it the simple way like I just proposed by doing a google search? Google maps? or are you more analytical with it checking the number of podiatrists in an area on FPMB and comparing to the census bureau?

Pharm is totally saturated. Ton of schools opened up. Look how bad annual wage has gotten but they dont have as much debt and residency which makes it more palpable than podiatry. Our field has PP owners which dont report accurate salaries as they have owners draws and other frindge benefits as a business owner. Most PharmD are employees and hard to just open a pharmacy compared to starting a PP DPM office

 

[Feli]

... Google any city in the entire nation and search (Insert city) pharmacist jobs. ...

Having jobs is NOT the same as having good jobs.

Pharmacy ROI went from ok to terrible with added schools.
They are finally closing schools and froze some new ones that were in process of opening and they have "admissions crisis" (sound familiar?).
Do you really think pharmacists would be quite literally boycotting jobs, walking out on the jobs if the jobs were any decent treatment and quality and ROI? There is such a glut of pharmacists that employers can even fire them... and then they are allowed to apply for their jobs back (with lower pay/benefits). It's not pretty, man.

It's like saying podiatry is great because we have $100k-150k small group associate and $150k-180k supergroup associate jobs in most big cities.
...That's great for $300k-$400K+ at 7% interest... and seven or eight years of grad work and residency with compounding interest? Hmm.

Saturation is about ROI and choice of locations for jobs for grads (and those out practicing).
Podiatry's bad ($300k-400k+ for under $200k job typically), and pharmacy is very bad ($200k+ debt for under $100k job typically).
The caveat is PharmD is trying to recover (was forced to)... podiatry's still busy sliding lower.

 

[MicroPod]

I didn’t ever think about how saturated podiatry was until I realized how recruiters are constantly contacting physicians and graduating residents of other specialties. I’m a PGY3 and have had only one recruiter reach out. Maybe it’s different as a well established attending? Maybe part of it is podiatry being not as well known?

 

[air bud]

I didn’t ever think about how saturated podiatry was until I realized how recruiters are constantly contacting physicians and graduating residents of other specialties. I’m a PGY3 and have had only one recruiter reach out. Maybe it’s different as a well established attending? Maybe part of it is podiatry being not as well known?

Narrator: it's not

Stupid mobile version won't let me bold "maybeits different as an attending"

 

[air bud]

I didn’t ever think about how saturated podiatry was until I realized how recruiters are constantly contacting physicians and graduating residents of other specialties. I’m a PGY3 and have had only one recruiter reach out. Maybe it’s different as a well established attending? Maybe part of it is podiatry being not as well known?

A podiatry resident not realizing terrible job options for the field until they are actually looking because of the echo chamber within schools no waaaaayyy.

 

[ReaganomicsLamborghini]

From an extremely narrow and self-centered point of view yes saturation is bad because you can’t just be fed patients just by having a license. Is that in the best interest of the patients seeking help for foot and ankle problems? No. “Saturation” isn’t going away, if you wanna make a meaningful difference for your pocketbook, get good and earn your patients.

This is ridiculous and what bothers me about podiatry and health care in general. We should not have to be martyrs. It’s a job, to make a living. I want to be compensated well for my hard work and time invested.

 

[MicroPod]

A podiatry resident not realizing terrible job options for the field until they are actually looking because of the echo chamber within schools no waaaaayyy.

Luckily I landed one of them decent hospital type jobs. I had to cold call them though, recruiter probably never heard of podiatry lol.

 

[Hybrocure]

Luckily I landed one of them decent hospital type jobs. I had to cold call them though, recruiter probably never heard of podiatry lol.

Podiatry? You work with kids?

 

[icebreaker32]

First I agree that saturation in podiatry is out of control.

Secondly I have many friends in pharmacy. Yes they say it is saturated but believe me when I say they have no idea what saturation is. Google any city in the entire nation and search (Insert city) pharmacist jobs. Dozens to hundreds come up. Do the same for podiatrists. Very few real opportunities pop up.

Which leads to my next question. How do you calculate saturation? Do you do it the simple way like I just proposed by doing a google search? Google maps? or are you more analytical with it checking the number of podiatrists in an area on FPMB and comparing to the census bureau?

Personally I also don't feel pharmacy is more saturated than podiatry, but too many schools have definitely hurt their job market. Wages have decreased or at least signing bonuses have largely gone away etc. There are retail jobs for pharmacists in most areas, but many don't end up liking retail pharmacy for various reasons and want to go elsewhere for more pay or even the same or less pay More are now doing an additional one to two year residency trying to get those competitive desirable jobs in other settings. All things considered being a midlevel is now a more desirable alternative with the saturation and increased years many are putting into their training. Sound familiar?

As far as calculating saturation for podiatry why do you want to know this? If it is to open an office it is more complex than it seems. Probably census for the state level. Population and number of podiatrists is easy to find at the state level and just google for a specific area.

Lots of other things matter also.

Is the area growing or shrinking?

What is the average age of area?

What is the insurance mix like?

Do people travel to the area with good insurance for healthcare from surrounding areas or is it the opposite?

What are referral patterns like? Many PCPs refer within their hospital system/MSG, especially if they have a podiatrist, or just to an ortho group that already has a podiatrist etc. Hopefully there will be at least a few PCPs willing to refer to you. In a competitive environment PCPs might actually steer you to "their" podiatrist even if you have a podiatrist.

If a small town is the economy dependent on one factory that would be hurt if it shut down?

Remote areas considered less desirable far from schools and residencies obviously have less saturation, but that does mean it is an environment a private practice will do well or where you will be happy. Like has been mentioned these are areas where hospital jobs are desirable not just for podiatry but most specialties. If the closest hospital only had an ortho that is hospital employed there is probably your answer.

I have seen many do well by opening an office in the farthest small growing suburb near a large or medium city. That usually works out in the long run if you can weather the storm. There is not a lot of competition yet, unless satellite offices, because there is not a lot of population. The downside is you often have to wait to grow your practice as the population grows. It might be slow for a couple years and eventually the competition will come and it will be "saturated", but hopefully by being established first you can continue to do well. These areas are often fairly desirable areas to live in also with decent schools, decent crime rates, etc.

Sometimes one can do well lobstering and just live where they want regardless by taking bad insurance and lots of nails and wounds. You may or may not be able to get more selective later as you get busier. In some areas even lobstering can be hard. From what I have seen lobsters often live in either very urban areas/declining older suburbs or small towns under 10,000 (just large enough for a Super Walmart).