States where Podiatry is less saturated?

[Santyl Claus]

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I'm noticing *almost anywhere I drop a pin, somehow there's a practicing podiatrist.
*except for desolate, uninhabited wilderness.

Some memes suggest Montana has some openings; some job listings/Feli's interesting anecdotes suggest New Mexico.
Are there states/regions left where there is a relative lack of Podiatrists?

 

[MicroPod]

Probably states that make it annoying to get a license there like Oklahoma or North Carolina.

 

[Adam Smasher]

American Samoa

 

[air bud]

American Samoa

Oh man I remember that thread that was a beauty

 

[heybrother]

Just show up and be better than the other podiatrists. Do a good job. People will tell you they love you.

Then, later that day on a phonecall with your EHR to review the finances of your private practice your account rep while reviewing your metrics and CPT codes will tell you "Wow, this is some of the lowest reimbursement I've ever seen for a practice per CPT code". Yes account rep. Screw my life indeed.

 

[Sendin_Toes_2market]

I'm noticing *almost anywhere I drop a pin, somehow there's a practicing podiatrist.
*except for desolate, uninhabited wilderness.

Some memes suggest Montana has some openings; some job listings/Feli's interesting anecdotes suggest New Mexico.
Are there states/regions left where there is a relative lack of Podiatrists?

Mississippi, Alabama, West Virginia, Oregon, Wyoming, Dakotas, Montana, Rural America. A lot of pods retiring in small 10-20k communities and not being replaced.

Even Saipan and most territories have a pod lol.

 

[AttackNME]

Probably states that make it annoying to get a license there like Oklahoma or North Carolina.

You should check out California, they have a fantastic fluoro exam you’d love

 

[Sole Badguy]

Number of Podiatrists in the USA

The number of podiatrists in the US based on the best available information is determined below. Please see the disclaimer below. Adding up the number of li ...

podiapaedia.org

This site has a nice table with the number of licensed podiatrists practicing in each state - but take into account that it hasn't been updated since 2022. In addition, it gives you a measure of saturation via population (aka the number of potential patients) per podiatrist. Yes there are smaller towns within bigger states that don't have their own podiatrist just yet. But in general, I agree with the prevailing thought that you'd have to move out of these bigger states in order to more consistently find places that are less saturated.

 

[air bud]

Number of Podiatrists in the USA

The number of podiatrists in the US based on the best available information is determined below. Please see the disclaimer below. Adding up the number of li ...

podiapaedia.org

This site has a nice table with the number of licensed podiatrists practicing in each state - but take into account that it hasn't been updated since 2022. In addition, it gives you a measure of saturation via population (aka the number of potential patients) per podiatrist. Yes there are smaller towns within bigger states that don't have their own podiatrist just yet. But in general, I agree with the prevailing thought that you'd have to move out of these bigger states in order to more consistently find places that are less saturated.

Every state has rural unsaturated areas without pods. New York, Texas, California etc

 

[Adam Smasher]

Another interesting calculation to run would be state GDP per podiatrist. This makes some really heavy assumptions about what % of gdp is healthcare across states, and what % of Healthcare spending is on podiatry services, but it gives a rough proxy estimate for how much money is to be made as a podiatrist in any given state.

In other words, don't pack your bags just yet to set up shop in Arkansas, there's probably a good reason why there's only 1 per 75k

 

[air bud]

Another interesting calculation to run would be state GDP per podiatrist. This makes some really heavy assumptions about what % of gdp is healthcare across states, and what % of Healthcare spending is on podiatry services, but it gives a rough proxy estimate for how much money is to be made as a podiatrist in any given state.

In other words, don't pack your bags just yet to set up shop in Arkansas, there's probably a good reason why there's only 1 per 75k

Not sure I'm following this here, but hey I'm just a dumb podiatrist. These more rural areas are oftentimes going to be critical access hospitals funding is different and it's kind of crazy town with these. These small community hospitals greater than 25 beds less than 100 or so they're the ones that are closing and shutting down but generally the critical access hospitals are okay.

 

[Sendin_Toes_2market]

Plenty of rural areas with catchment areas or 20-30k without pods. 1-2 hours outside of major people. I like not having neighbors. I have a few hospitals down south I was talking too if anyone was interested. Rural 1.5 hours outside of city of 400k. Plenty everywhere. Rural healthcare experience is gold.

 

[air bud]

Plenty of rural areas with catchment areas or 20-30k without pods. 1-2 hours outside of major people. I like not having neighbors. I have a few hospitals down south I was talking too if anyone was interested. Rural 1.5 hours outside of city of 400k. Plenty everywhere. Rural healthcare experience is gold.

Even in my new state and new job I am an hour from Costco, an hour from Target. Who cares, it's all crap that I don't need. Peace quiet outdoors, That's all that matters. No other podiatrists within 45 minutes of me. I am about an hour from a few different towns of 200-500k. Go there maybe once a month and get in and get out.

My county is about 55,000 between the adjacent two counties that I partially pull from about 80-100k.

Edit I forgot we now have another non-operative podiatrist in town Glad to have that person.

 

[GreenHousePub]

A state with less practicing podiatrists will have less population, and less patients for you. This is not the goldmine you are looking for.

 

[HaimFeldman]

A state with less practicing podiatrists will have less population, and less patients for you. This is not the goldmine you are looking for.

 

[Feli]

NMex is fairly open relative to most states: only one residency (mid) and one fellowship (also mid), but it's also a tiny state (population).
Right now, it's probably appropriately staffed with DPMs (in MD/DO terms)... which means that in podiatry terms, since DPMs are saturated nearly anywhere, NM is definitely "under-served."

It's all relative. It's not as cutthroat as Philly or NYC or Chi or many other places with pods tripping over each other and cannibalizing each other for refers or consults on a daily basis.

The largest NM pod group sold out and changed to VC this year, and their better docs quit (to other PP groups, small hospitals, etc).
You basically have 4 or 5 medium/large pod groups, that 10+ office VC group, a few pods hospital employed, a few DPMs in ortho group, one F&A ortho, and then some solo DPMs like me. There are a few IHS/VA pods, but they have their own patient populations and aren't hyper-productive in those setups obviously (many VA/IHS patients spill out to the the private office DPMs).

It's not a bad place to practice, but you will get a ton of MCA in most parts of the state and malpractice is very high and it NM very quickly become saturated/competitive if even 5 or 10 full time pods came in as it's a small population overall.

All in all, it'd be very easy to plant a flag here and start a PP compared to most other places.

 

[Hybrocure]

NMex is fairly open relative to most states: only one residency (mid) and one fellowship (also mid), but it's also a tiny state (population).
Right now, it's probably appropriately staffed with DPMs (in MD/DO terms)... which means that in podiatry terms, since DPMs are saturated nearly anywhere, NM is definitely "under-served."

It's all relative. It's not as cutthroat as Philly or NYC or Chi or many other places with pods tripping over each other and cannibalizing each other for refers or consults on a daily basis.

The largest NM pod group sold out and changed to VC this year, and their better docs quit (to other PP groups, small hospitals, etc).
You basically have 4 or 5 medium/large pod groups, that 10+ office VC group, a few pods hospital employed, a few DPMs in ortho group, one F&A ortho, and then some solo DPMs like me. There are a few IHS/VA pods, but they have their own patient populations and aren't hyper-productive in those setups obviously (many VA/IHS patients spill out to the the private office DPMs).

It's not a bad place to practice, but you will get a ton of MCA in most parts of the state and malpractice is very high and it NM very quickly become saturated/competitive if even 5 or 10 full time pods came in as it's a small population overall.

All in all, it'd be very easy to plant a flag here and start a PP compared to most other places.

I thought the NM fellowship was a banger? Has it changed?

 

[Retrograde_Nail]

I thought the NM fellowship was a banger? Has it changed?

Like all fellowships they are watering the training down. They used to only take one fellow now they take two per year. No idea why.

 

[Sendin_Toes_2market]

Like all fellowships they are watering the training down. They used to only take one fellow now they take two per year. No idea why.

Residents and Fellows are cheaper then Associates.

 

[Feli]

I thought the NM fellowship was a banger? Has it changed?

I mean, it was a pretty good one... but the former director Anderson and some main docs are getting older (interim younger director now who was one of their past fellows).

If you look at the job placements for the alumni of the fellowship (main thing any prospective fellow should do), it's basically nothing you could't get without a fellowship (mostly podiatry groups, some VC supergroups, occasional small ortho group in tinytowns). One of the recent ones joined the supergroup I was in when I was leaving that one.

Then again, that decreased job/money/surgery success is as much a function of the saturated overall DPM job market and the fact that most fellowships have "expanded" (this one doubled 1 to 2/yr spots in 2019... so half as many good cases for fellows). It's as much the state of podiatry (tons of "super surgeons" now) as it is a reflection on any fellowship or residency specifically that their alumni don't do as well as 10 or 20 years ago.

You could do worse for fellowship, they do get fellows from average/above typically, and it's and ACFAS accredited. Still, I would maintain there are really only about 5 or 10 fellowships (possibly) worth doing, though... I don't think NM is one.

 

[Hybrocure]

I mean, it was a pretty good one... but the former director Anderson and some main docs are getting older (interim younger director now who was one of their past fellows).

If you look at the job placements for the alumni of the fellowship (main thing any prospective fellow should do), it's basically nothing you could't get without a fellowship (mostly podiatry groups, some VC supergroups, occasional small ortho group in tinytowns). One of the recent ones joined the supergroup I was in when I was leaving. Then again, that is as much a function of the saturated overall DPM job market and the fact that most fellowships (this one doubled 1 to 2 spots in 2019... so half as many good cases for fellows). It's as much the state of podiatry (tons of "super surgeons" now) as it is a reflection on any fellowship or residency specifically that their alumni don't do as well as 10 or 20 years ago.

You could do worse for fellowship, they do get fellows from average/above typically, and it's and ACFAS accredited. Still, I would maintain there are really only about 5 or 10 fellowships (possibly) worth doing, though... I don't think NM is one.

What are the good ones these days? Despite all the fellowship talk I feel it’s been years since anyone actually mentioned what the good ones are post covid

 

[Feli]

What are the good ones these days? Despite all the fellowship talk I feel it’s been years since anyone actually mentioned what the good ones are post covid

The only ones I'd tell a student to consider doing are probably Hyer (OFAC), McAlister in Phx, CORE in Phx, Camasta in Atl, Cottom in Fla, maybe Nowak in Cali or a few others. It has to be a huge personal want AND a very unique opportunity of attendings/cases to even consider it imo. I'm biased due to when I trained and what I read, but those are top guys who get unique cases... although a couple are getting older (in surgeon eyes/hands terms).

Most of the ACFAS ones will probably improve your skills, but there is a huge price to fellowship. I would've 100% applied to Camasta if I was an ageless vampire who was going to do F&A surgery for the next 200 years... but that's not reality (I also don't think it was formed until a few years after my residency grad?). The training wheels just have to come of SOMEDAY, right? Assuming a decent residency, any grad has done a LOT of surgery. It's illogical to do another year of residency with low pay that adds very little. We are the only "specialty" that has the same specialty after a fellowship. We don't become a pedi or prostho like dentists, we don't go from int med to GI or cardiology with fellowship, and we sure don't become a sports ortho or retina ophtho or colorectal like MD surgeons do.

It's eventually time to get out there doing cases... and paying down loans. That 7+ percent interest is cooking you.
Every year lost has 600 more "foot and ankle surgeons" coming out that you'll need to compete with for the limited rural hospital jobs, VA jobs, even good large pod group jobs, PP areas that aren't totally cutthroat yet.

It's a big sacrifice to do another year just to likely get a job you'd get regardless. The bottom line is to do a good residency and not need fellowship (which, ironically, are the only people who can get top fellowships). The flat truth is that the vast majority of DPMs will be in PP of some sort, most of us do FAR more office than surgery time weekly, and that simply doesn't need fellowship. Most fellowships DPMs do warts and injects and insoles just like any other... and they get paid the same from MCR or BCBS or Upperline or Dr Moustache or whatever to do it.

I find it especially funny that probably half the fellowship directors and the majority of residency directors in podiatry didn't do a fellowship themselves. It used to be even more of them who did not. That tells you about all you need to know.

 

[Hybrocure]

The only ones I'd tell a student to consider doing are probably Hyer (OFAC), McAlister in Phx, CORE in Phx, Camasta in Atl, Cottom in Fla, maybe Nowak in Cali or a few others. It has to be a huge personal want AND a very unique opportunity of attendings/cases to even consider it imo. I'm biased due to when I trained and what I read, but those are top guys who get unique cases... although a couple are getting older (in surgeon eyes/hands terms).

Most of the ACFAS ones will probably improve your skills, but there is a huge price to fellowship. I would've 100% applied to Camasta if I was an ageless vampire who was going to do F&A surgery for the next 200 years... but that's not reality (I also don't think it was formed until a few years after my residency grad?). The training wheels just have to come of SOMEDAY, right? Assuming a decent residency, any grad has done a LOT of surgery. It's illogical to do another year of residency with low pay that adds very little. We are the only "specialty" that has the same specialty after a fellowship. We don't become a pedi or prostho like dentists, we don't go from int med to GI or cardiology with fellowship, and we sure don't become a sports ortho or retina ophtho or colorectal like MD surgeons do.

It's eventually time to get out there doing cases... and paying down loans. That 7+ percent interest is cooking you.
Every year lost has 600 more "foot and ankle surgeons" coming out that you'll need to compete with for the limited rural hospital jobs, VA jobs, even good large pod group jobs, PP areas that aren't totally cutthroat yet.

It's a big sacrifice to do another year just to likely get a job you'd get regardless. The bottom line is to do a good residency and not need fellowship (which, ironically, are the only people who can get top fellowships). The flat truth is that the vast majority of DPMs will be in PP of some sort, most of us do FAR more office than surgery time weekly, and that simply doesn't need fellowship. Most fellowships DPMs do warts and injects and insoles just like any other... and they get paid the same from MCR or BCBS or Upperline or Dr Moustache or whatever to do it.

I find it especially funny that probably half the fellowship directors and the majority of residency directors in podiatry didn't do a fellowship themselves. It used to be even more of them who did not. That tells you about all you need to know.

I think I’d agree w you on those programs. The people I’ve met/worked with/scrubbed either from those programs or the docs themselves have been absolute class