Saturation

[DogSnoot]

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If you’re in a city, go ahead open the Google app and pin different specialties like dermatology/plastic vs podiatry. It’s a 1/3 ratio with podiatry saturating the market.

 

[deleted285117]

If you’re in a city, go ahead open the Google app and pin different specialties like dermatology/plastic vs podiatry. It’s a 1/3 ration with podiatry saturating the market.

Yup…. thats when I searched for jobs I never searched for “podiatrist” on Google Maps. I searched “doctor”, “clinic”, “hospital”, etc. so I could make my desperate podiatrist cold-call list 😅

 

[Adam Smasher]

I had an attending in residency who told me everytime he went on vacation, he'd check the area listings to see if there was a podiatrist in the area. Sure enough, no matter how small the town, he'd find someone

 

[GreenHousePub]

I had an attending in residency who told me everytime he went on vacation, he'd check the area listings to see if there was a podiatrist in the area. Sure enough, no matter how small the town, he'd find someone

Well, I'd imagine if he's going to a desirable place for vacation, someone else thought it was a desirable place to open a practice.

 

[podiatryresident]

If you’re in a city, go ahead open the Google app and pin different specialties like dermatology/plastic vs podiatry. It’s a 1/3 ratio with podiatry saturating the market.

Keep looking! I found a place that I can't make any appointment for the next 3-4 weeks with infected ingrown paying cash. I called 6 offices in that area. But yes, podiatry is saturated for sure!

 

[icebreaker32]

Keep looking! I found a place that I can't make any appointment for the next 3-4 weeks with infected ingrown paying cash. I called 6 offices in that area. But yes, podiatry is saturated for sure!

Obviously this location needs a new podiatry school to help meet unmet demand.

 

[Feli]

If you’re in a city, go ahead open the Google app and pin different specialties like dermatology/plastic vs podiatry. It’s a 1/3 ratio with podiatry saturating the market.

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.

 

[dtrack22]

Next town over has a population of 17,000 and 2 podiatrists…only 1 orthopedic surgeon.

 

[eyeeye_captain]

ophtho

If I remember correctly, you guys have around 565 residency spots per year. We’ve been steady at around 465 for at least a decade.

 

[AttackNME]

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.

 

[HeySister]

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.

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.

 

[Feli]

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% ^^

 

[HardRoadPaved]

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.

Oh yay! More time to spend lotioning feet to beat out the competition!

 

[AttackNME]

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.

 

[Hybrocure]

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.

We aren’t brain surgeons. 99% of us are qualified to do 90% of the work our scope allows. The remaining 10% is the years people spend perfecting rearfoot surgery and reconstructive stuff to get a leg up. Patients who need those services will naturally seek out the doctors who specialize in that. It shouldn’t take stepping over our colleagues corpses just to inject a heel or debride a callus to earn a living doing bread and butter podiatry.

 

[Feli]

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.

I don't disagree in theory... but why do you suppose every single MD specialty regulates its training spots and grads?

Why do MDs almost universally do well, yet DCs resort to all sorts of newspaper articles, coupons, questionable OTC sales, social media?

Why is pharmacy now stopping new schools and closing some existing ones? Law schools had the same problem for awhile.

...the best interest of the patients is to have quality docs. End of story.
It is very hard to do quality decision making when income and making a living is not taken care of in a basic sense. For MDs, it is.
The majority of DPMs currently work associate PP jobs with fairly low income ROI for 7yrs post-grad, or they have a hospital job that'd be VERY hard to replace or require unemployed period and/or relocating to find same compensation. It has been that way awhile, and the hospital jobs are getting harder with the "everybody is surgical trained" mantra.

Podiatry has proven again and again and again that they can't find 500 good students and give them quality residency training and jobs. Now, they're trying for 700+. The end result is not going to be very surprising... likely residency shortage and/or questionable residencies, saturated job market (already have this), loan defaults, questionable ethics as DPMs compete for hospital jobs and PP patients.

 

[Adam Smasher]

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.

Oh so we're going to actually debate the pros and cons about saturation? Because up until a few days ago I thought we all spoke with one voice on this issue.

Yes being opposed to saturation is self-centered, we all have student loan debt, we all need to eat, we all want to reap the rewards of the sacrifices we made. None of us is Gandhi.

The dirty secret is that almost none of us is irreplaceable. I spend much of my day doing a lot of bread-and-butter low level podiatry that is very intuitive and anyone can do, there's not much difference between being "good" or being "satisfactory." In principle, school/residency was the "getting good" part. In fact, most states explicitly define it as professional misconduct for me to insinuate that I'm any better than anyone else. So, like lobsters scuttling about the ocean floor, the only checks against overpopulation is ferocious competition over resources and ultimately starvation.

 

[ExperiencedDPM]

A few weeks ago, I had to drop off and pick up a friend who was having some oral surgery.

His oral surgeon was in a professional complex of multiple one story buildings all accessed via one parking lot.

I drove around the complex and there were 6 different Podiatric practices in the same complex!

Two of the offices had doors adjacent to one another. So if you walked in the wrong door you’d be in a different DPM office.

Amazing.

 

[BubbaWub]

I'm not sure if there are enough podiatrists currently. In my city, we have more podiatrists than orthopedic surgeons (all sub specialists). Despite this, we usually stay very busy. I am usually booked out very far, and usually see 6 people an hour. The only issue is keeping my dremel clean at the end of the day.

The problem that most people here on SDN don't understand is, for every patient they have two feet and ten toes! Orthopedic surgeons only have two knees or hips or shoulders.

My president would agree with this sentiment. I believe in his mission until we have more podiatrists in every city than Orthopedic surgeons. Until then, we must continue to push forward and open schools in the interest of public health.

Thank you

 

[footshazam]

I'm not sure if there are enough podiatrists currently. In my city, we have more podiatrists than orthopedic surgeons (all sub specialists). Despite this, we usually stay very busy. I am usually booked out very far, and usually see 6 people an hour. The only issue is keeping my dremel clean at the end of the day.

The problem that most people here on SDN don't understand is, for every patient they have two feet and ten toes! Orthopedic surgeons only have two knees or hips or shoulders.

My president would agree with this sentiment. I believe in his mission until we have more podiatrists in every city than Orthopedic surgeons. Until then, we must continue to push forward and open schools in the interest of public health.

Thank you

Is this a joke or are you for real lol

 

[BubbaWub]

Is this a joke or are you for real lol

If you saw how busy myself and my colleagues are despite having almost the same number of PCPs in the city compared to podiatrists, you will realize why we need more schools. This agenda of saturation is way overblown.

Thank you

 

[deleted285117]

If you saw how busy myself and my colleagues are despite having almost the same number of PCPs in the city compared to podiatrists, you will realize why we need more schools. This agenda of saturation is way overblown.

Thank you

😉😉😉

 

[podiatryresident]

I'm not sure if there are enough podiatrists currently. In my city, we have more podiatrists than orthopedic surgeons (all sub specialists). Despite this, we usually stay very busy. I am usually booked out very far, and usually see 6 people an hour. The only issue is keeping my dremel clean at the end of the day.

The problem that most people here on SDN don't understand is, for every patient they have two feet and ten toes! Orthopedic surgeons only have two knees or hips or shoulders.

My president would agree with this sentiment. I believe in his mission until we have more podiatrists in every city than Orthopedic surgeons. Until then, we must continue to push forward and open schools in the interest of public health.

Thank you

May I know what city you are practicing ? I would love to know the area if you don't mind. Thank you so much

 

[Hybrocure]

May I know what city you are practicing ? I would love to know the area if you don't mind. Thank you so much

Time to put down the mcglamrys textbook and listen to some comedy podcasts my friend

 

[air bud]

A few weeks ago, I had to drop off and pick up a friend who was having some oral surgery.

His oral surgeon was in a professional complex of multiple one story buildings all accessed via one parking lot.

I drove around the complex and there were 6 different Podiatric practices in the same complex!

Two of the offices had doors adjacent to one another. So if you walked in the wrong door you’d be in a different DPM office.

Amazing.

Tell me you're in Philadelphia or New York City without telling me you're in Philadelphia and New York City.

 

[air bud]

I miss the good old days when it was me or drive two and a half hours no such thing as saturation LOL.

Continue to see all these fellowship trained people going into private practice and getting a job that a non-fellowship would get... All because of saturation. Saturation infects every aspect of our profession. Job prospects, reimbursement, scope of practice, everything.

 

[NatCh]

My city is so saturated that I crack open the door to my back office and literally see the competition.*


*we sublease to another group

 

[Adam Smasher]

Another symptom of saturation is "patient milking." You might not have enough patients to fill your schedule so you spread out treatment as much as you can over multiple visits. "Oh you want me to treat your toenail fungus? Well let's talk about that next visit, I want to focus on your heel pain today." Wouldn't be surprised if bubbawub's colleagues in town get themselves artificially busy that way.

Thank you

 

[HeySister]

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 a bad take. Tell this to the vast majority of the residency and fellowship graduations who just paid $300,000 or more do school and then dedicated 3 or 4 more years of post graduate training. Tell them that the reason they only got offers for 80k-120k that they need to get good and earn their patients first.

Then tell all other medicine and surgeon residency and fellowship grads that they need to get good and earn their patients. See what the urologist says. Or the interventional cardiologist. Or the family medicine doc. Do they need to get good added 300,000 of debt and 3+ years of post graduate training?

 

[footshazam]

This is a bad take. Tell this to the vast majority of the residency and fellowship graduations who just paid $300,000 or more do school and then dedicated 3 or 4 more years of post graduate training. Tell them that the reason they only got offers for 80k-120k that they need to get good and earn their patients first.

Then tell all other medicine and surgeon residency and fellowship grads that they need to get good and earn their patients. See what the urologist says. Or the interventional cardiologist. Or the family medicine doc. Do they need to get good added 300,000 of debt and 3+ years of post graduate training?

You stated this perfectly! I’m so tired of hearing people say that you have to “earn your dues” in podiatry. People in this profession have become so complacent in this type of attitude that it’s perpetuated as normal and people just accept it. Graduates shouldn’t have to fight for jobs and get low ball offers, because as stated the MD/DOs surely aren’t sitting around talking about earning patients.

 

[Feli]

This is a bad take. Tell this to the vast majority of the residency and fellowship graduations who just paid $300,000 or more do school and then dedicated 3 or 4 more years of post graduate training. Tell them that the reason they only got offers for 80k-120k that they need to get good and earn their patients first....

Yeah, I don't get it.

The "put in your time," "earn your dues," "market yourself," "your time will come" talk is for employers and owners looking to grind down employee salaries.

​

To hear other DPMs who are out grinding and working say that sort of "anti-competitive" and "just try harder" stuff is really disappointing IMO.

95% of the DPMs I know try pretty hard every day. Many try very hard as they are running a biz or doing marketing/networking or inpatient work or multiple locations/hospitals commuting as they don't have the demand and volume and income they want - or they're working hard not to lose volume they built to highly competitive nearby colleagues. Saturation is rough.

Even the "lucky" hospital employee DPMs make roughly 25-75% of what most MD surgeons make per RVU and have much fewer location choices as good podiatry jobs get HUGE application demand. I wonder if they should also be silent and happy with that? 🤐

People simply want to learn good skills, use their skills, and get paid for it.
Podiatry struggles on all three aspects. We need better training, more volume/patients per doc (esp surgery), and better pay/ROI.
Increasing our saturation just makes it all worse (training, patient demand, compensation all suffer). Everyone should eaaasily see that. 🙁

 

[ExperiencedDPM]

Tell me you're in Philadelphia or New York City without telling me you're in Philadelphia and New York City.

I’m not in Philadelphia or NYC.

 

[AttackNME]

This is a bad take. Tell this to the vast majority of the residency and fellowship graduations who just paid $300,000 or more do school and then dedicated 3 or 4 more years of post graduate training. Tell them that the reason they only got offers for 80k-120k that they need to get good and earn their patients first.

Then tell all other medicine and surgeon residency and fellowship grads that they need to get good and earn their patients. See what the urologist says. Or the interventional cardiologist. Or the family medicine doc. Do they need to get good added 300,000 of debt and 3+ years of post graduate training?

Bread and butter podiatry is easy, there’s a reason why there’s so many people doing this and why it’s saturated. It’s easy to just end up coasting and doing brainless things once graduated from residency. Saturation was gonna happen thanks to the low hanging fruit of “you get to do surgery”. I think APMA did a great job marketing that, and it’s true we do have the opportunity to do surgery. It brought a lot of people to the party, and now that we have reached a magical threshold where saturation is palpable but impossible to define, what do we do about it? None of this is gonna change due to the nature of the work and complaining about saturation isn’t going to make meaningful change. That why I choose to look at it from the patients point of view, it helps me appreciate the patients that I have and to treat them better than the bozo across the street

 

[footshazam]

Yeah, I don't get it.

The "put in your time," "earn your dues," "market yourself," "your time will come" talk is for employers and owners looking to grind down employee salaries.

​

To hear other DPMs who are out grinding and working say that sort of "anti-competitive" and "just try harder" stuff is really disappointing IMO.

95% of the DPMs I know try pretty hard every day. Many try very hard as they are running a biz or doing marketing/networking or inpatient work or multiple locations/hospitals commuting as they don't have the demand and volume and income they want - or they're working hard not to lose volume they built to highly competitive nearby colleagues. Saturation is rough.

Even the "lucky" hospital employee DPMs make roughly 25-75% of what most MD surgeons make per RVU and have much fewer location choices as good podiatry jobs get HUGE application demand. I wonder if they should also be silent and happy with that? 🤐

People simply want to learn good skills, use their skills, and get paid for it.
Podiatry struggles on all three aspects. We need better training, more volume/patients per doc (esp surgery), and better pay/ROI.
Increasing our saturation just makes it all worse (training, patient demand, compensation all suffer). Everyone should eaaasily see that. 🙁

Stated nicely. People see it, those that disagree with what you said are choosing to be delusional.

 

[Feli]

...Saturation was gonna happen thanks to the low hanging fruit of “you get to do surgery”. I think APMA did a great job marketing that, and it’s true we do have the opportunity to do surgery. It brought a lot of people to the party, and now that we have reached a magical threshold where saturation is palpable but impossible to define, what do we do about it? None of this is gonna change due to the nature of the work and complaining about saturation isn’t going to make meaningful change. ...

Again, MD surgery programs don't have this problem. They regulate their residency spots and standards.

Marketing podiatry's surgery aspect - or any aspect - is fine. It's good. It should then raise the applicant number and the average matriculant MCATs, gpa, talent levels. That would assume responsibility of leadership.
It has not raised the bar and the MCAT/gpa... the genius leadership just creates more pod schools and seats instead.

Agree 100% that complaining does little... but not $upporting an organization that adds needless new pod schools is eventually impactful.
Discussing the tremendous variance and overall lack of quality residencies is key info for students (and pre-pods).
Talking about how even ABFAS RRA podiatrists often can't get a callback for hospital jobs or that most DPM grads will be sent to the associate mills for $150k or much less is important. The grads and students are then less rattled by it, and they might figure out how to grind their way out of those. You still see a lot of disappointment of ROI, but there is less bona fide depression and rage.

...Again guys: look to PHARMACY for clues. See how saturation works. Do it. It's kinda frightening. Read their SDN Pharmacy and other PharmD forums and articles... even just scan the thread titles. See how saturation works:
Tuition went up, more schools opened, most grads ended up in progressively bad to worse retail CVS or Walgreens type jobs with low ROI (podiatry version = associate mill PPs and VC supergroups). Some PharmDs took out loans to start their own store... often to find it was usually very grindy with competition all around due to many grads. A few got hospital jobs, but still mediocre ROI and increasingly hard to get those (sound familiar, pods?).
These PharmDs are largely smart and well-educated people who did - and still do - struggle to make ends meet or were discarded like trash by employers since their peers would (had to) do the job for less. Most of them could have been podiatry students also. They aren't slackers or unintelligent, but their leadership let saturation hit hard. There were student loan defaults, walkouts and strikes for better pay or benefits or assistants, floods of applications for their better employed hospital jobs, pharma residencies springing up (podiatry version = fellowships), and eventually decreased pharmacy school applications as the bubble burst. Some grads left the field of pharmacy entirely despite their debt (sound familiar?). That recently forced some planned pharm schools being suspended and upcoming closures. They got to a serious saturation point ... and beyond it.

Think about this stuff the next time APMA is preaching rainbows and unicorns and asking for money and members.
Vote with your wallet.
Enjoy your career... but do complain about its obvious greed and shortcomings.
Don't think there is nothing you can do about it.

Chiro (DC) or therapy (counselor) is an ok example of saturation also, but they've always been that way with too many schools and a skill/service that is not fully medically/insurance accepted. Their saving grace for those is that it's relatively cheaper/shorter schooling with no residency, so they don't need a ton of patients to make ends meet. Pharmacy is the best example of a profession that was good and well-accepted... and is now in very rough shape due to rapid expansion of schools/seats and what became largely corporate employers of the grads. Optometry (OD) is reasonably similar.

"Those who cannot remember the past are condemned to repeat it." 🙂 🙁

 

[AttackNME]

Thanks to regulation, we have too little PCPs and specialists in many areas of the United States. Know how long it takes to see neurology, dermatology, rheumatology, neurosurgery, etc, in less popular states? It’s good for the doc’s pocketbook to have a demand for their services, they have the luxury of being flippant and short with their patients and their patients have no choice but to keep seeing that doc. Is this really good for the patients?

 

[Carbon13]

Nope. There's no good way to spin the Podiatry saturation problem.

No way I would recommend this profession to an undergrad. In fact, I would strongly weigh the option of turning back as a 1st year?, 2nd year pod student?

It's going to be extremely hard to service those high interest student loans when it takes you several years to get up to speed. ROI just isn't there for most people anymore.

After my first few yrs of solo PP I've now got 3 other pods and 2 F/A ortho within a mile away. 75K pop.

I had a 1st year ortho resident as patient a few months ago. She said that F/A fellowship is becoming very popular (in her program at least).

What could be done to better preserve the profession? Could the podiatry powers create a moratorium on residencies like MD specialities have in past ?
Truth is, it wouldn't matter if they closed 3 schools tomorrow.

I hate to see all the gloomy posts on here but it's an honest representation of the current state of affairs.

 

[AttackNME]

I’m not hating on the doom and gloom posts, I think saturation is a real problem as Feli so thoroughly summarized using pharmacy as a case study, but the winners are the patients especially in rural areas who now have access to foot and ankle surgical care thanks to saturation, where 3-year trained podiatrists are going to rural areas on a salary cheaper than ortho. The only reason we have this opportunity as a profession is people just hate dealing with feet. You bought into it when you joined the profession. I think you guys on SDN did a good job expressing the saturation problem and it got the leaders’ attention. 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. I think saturation is bad for us, but i also think single-sided thinking can be bad too, and if we over-regulate it could be bad for us too

 

[Hungry_Anxiety8703]

When you open the floodgates to a bunch of students with average GPA's and MCAT's and tell them they can be a surgeon this is what happens. It's fun for them to call themselves "foot and ankle surgeons" in their IG bio. And honestly a lot of them have no business doing some of these cases with the training they got. I bet a lot would have not even applied if they were told from the start the truth about surgery and the compensation you'll actually get

 

[Retrograde_Nail]

I’m not hating on the doom and gloom posts, I think saturation is a real problem as Feli so thoroughly summarized using pharmacy as a case study, but the winners are the patients especially in rural areas who now have access to foot and ankle surgical care thanks to saturation, where 3-year trained podiatrists are going to rural areas on a salary cheaper than ortho. The only reason we have this opportunity as a profession is people just hate dealing with feet. You bought into it when you joined the profession. I think you guys on SDN did a good job expressing the saturation problem and it got the leaders’ attention. 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. I think saturation is bad for us, but i also think single-sided thinking can be bad too, and if we over-regulate it could be bad for us too

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? I don't. Your wife doesn't. Your kids don't either. Come on man.

Any MD/DO right now can move anywhere in the country that is desirable and probably find a job. That does not exist for podiatry. Because anywhere that is desirable already has 10-20x amount of podiatrists that are actually needed. It is so abundantly clear I just don't even know what to say to someone like yourself anymore. It is pure denial.

Everywhere I have practiced (which has been two hospital employed positions thankfully) I have dealt with fierce pushback from local private and even fellow employed podiatrists because they were threatened about losing volume to me. Do you think MD/DO doctors act childish and feel threatened as easily as we do? It is rather pathetic.

We are over saturated. We have more fellowship programs than AOFAS does. New fellowship programs are being created on an annual basis. Not because it is about education but because it is about taking advantage of cheap labor. Our fellowship grads are ending up in private practice. This will continue to be the trend and it will get worse and worse. This affects everyone. It will affect you when your contract is up and you try and negotiate a better salary and your admin looks at you and says no because they know they can get 100 applicants the next day if they put your job out on the market. 300-500 if it is desirable hospital job.

I am hospital employed and my salary is half of what a foot and ankle ortho MD makes. My RVU dollar rate is probably $20 less as well. But I am racking up 900-1000 RVUs per month. Making good money for my family and I but when you add up all the bonuses and salary it may be a little more than the base salary of a foot and ankle ortho MD. I want more money. But what leverage do I really have with admin at my hospital? They know what the deal is. They can replace me if they want to.

 

[footshazam]

Nope. There's no good way to spin the Podiatry saturation problem.

No way I would recommend this profession to an undergrad. In fact, I would strongly weigh the option of turning back as a 1st year?, 2nd year pod student?

It's going to be extremely hard to service those high interest student loans when it takes you several years to get up to speed. ROI just isn't there for most people anymore.

After my first few yrs of solo PP I've now got 3 other pods and 2 F/A ortho within a mile away. 75K pop.

I had a 1st year ortho resident as patient a few months ago. She said that F/A fellowship is becoming very popular (in her program at least).

What could be done to better preserve the profession? Could the podiatry powers create a moratorium on residencies like MD specialities have in past ?
Truth is, it wouldn't matter if they closed 3 schools tomorrow.

I hate to see all the gloomy posts on here but it's an honest representation of the current state of affairs.

Drop the mic. Enough said right here. Facts.

 

[footshazam]

When you open the floodgates to a bunch of students with average GPA's and MCAT's and tell them they can be a surgeon this is what happens. It's fun for them to call themselves "foot and ankle surgeons" in their IG bio. And honestly a lot of them have no business doing some of these cases with the training they got. I bet a lot would have not even applied if they were told from the start the truth about surgery and the compensation you'll actually get

Bingo… you guys are on fire tonight!

 

[footshazam]

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? I don't. Your wife doesn't. Your kids don't either. Come on man.

Any MD/DO right now can move anywhere in the country that is desirable and probably find a job. That does not exist for podiatry. Because anywhere that is desirable already has 10-20x amount of podiatrists that are actually needed. It is so abundantly clear I just don't even know what to say to someone like yourself anymore. It is pure denial.

Everywhere I have practiced (which has been two hospital employed positions thankfully) I have dealt with fierce pushback from local private and even fellow employed podiatrists because they were threatened about losing volume to me. Do you think MD/DO doctors act childish and feel threatened as easily as we do? It is rather pathetic.

We are over saturated. We have more fellowship programs than AOFAS does. New fellowship programs are being created on an annual basis. Not because it is about education but because it is about taking advantage of cheap labor. Our fellowship grads are ending up in private practice. This will continue to be the trend and it will get worse and worse. This affects everyone. It will affect you when your contract is up and you try and negotiate a better salary and your admin looks at you and says no because they know they can get 100 applicants the next day if they put your job out on the market. 300-500 if it is desirable hospital job.

I am hospital employed and my salary is half of what a foot and ankle ortho MD makes. My RVU dollar rate is probably $20 less as well. But I am racking up 900-1000 RVUs per month. Making good money for my family and I but when you add up all the bonuses and salary it may be a little more than the base salary of a foot and ankle ortho MD. I want more money. But what leverage do I really have with admin at my hospital? They know what the deal is. They can replace me if they want to.

Not denial. Just delusion. Well stated.

 

[footshazam]

I’m not hating on the doom and gloom posts, I think saturation is a real problem as Feli so thoroughly summarized using pharmacy as a case study, but the winners are the patients especially in rural areas who now have access to foot and ankle surgical care thanks to saturation, where 3-year trained podiatrists are going to rural areas on a salary cheaper than ortho. The only reason we have this opportunity as a profession is people just hate dealing with feet. You bought into it when you joined the profession. I think you guys on SDN did a good job expressing the saturation problem and it got the leaders’ attention. 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. I think saturation is bad for us, but i also think single-sided thinking can be bad too, and if we over-regulate it could be bad for us too

I’m not sure how old you are but don’t you think it’s way more older podiatrist than you that are in line for those leadership roles I mean come on

 

[Hybrocure]

Yeah well guess what I bet those other pods in my area are still using dermal curettes to debride their calluses.

Imagine the shock on patients faces when they find out the blade I use.😉

 

[Hybrocure]

When you open the floodgates to a bunch of students with average GPA's and MCAT's and tell them they can be a surgeon this is what happens. It's fun for them to call themselves "foot and ankle surgeons" in their IG bio. And honestly a lot of them have no business doing some of these cases with the training they got. I bet a lot would have not even applied if they were told from the start the truth about surgery and the compensation you'll actually get

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.

 

[HardRoadPaved]

I can sleep well at night giving up a $300 reimbursement after insurance

Meanwhile in the 4-6 hours you're stuck in the hospital, you could have done ingrowns, warts, plantar fasciitis. Its no coincidence that PP owners dont ball out these cases and pass them along. The next day back pain also isnt worth it.

 

[air bud]

I’m not hating on the doom and gloom posts, I think saturation is a real problem as Feli so thoroughly summarized using pharmacy as a case study, but the winners are the patients especially in rural areas who now have access to foot and ankle surgical care thanks to saturation, where 3-year trained podiatrists are going to rural areas on a salary cheaper than ortho. The only reason we have this opportunity as a profession is people just hate dealing with feet. You bought into it when you joined the profession. I think you guys on SDN did a good job expressing the saturation problem and it got the leaders’ attention. 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. I think saturation is bad for us, but i also think single-sided thinking can be bad too, and if we over-regulate it could be bad for us too

Who the hell is "you guys"?

 

[Dermato Fight Club]

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.

 

[Hybrocure]

Meanwhile in the 4-6 hours you're stuck in the hospital, you could have done ingrowns, warts, plantar fasciitis. Its no coincidence that PP owners dont ball out these cases and pass them along. The next day back pain also isnt worth it.

Exactly