Tell me why again its so good to be in this profession

[E E Smith]

How would you feel if you spent most of your life working, having children, and trying to make a difference, only to come to the conclusion in old age that it was all for nothing and that there was no meaning to your life at all?

I hate to say it but I felt let down by the educational experience. Tell me again why its so great to be in this profession, to be a doctor, to be in healthcare. My experiences in Podiatry thus far have made me wonder why go on.

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[theconzumer]

I'm the exact opposite, I worked in offices my whole life making good money but feeling I never made a difference. Here I can control my future, I can help guide patients, some won't listen, others will and some I will be able to help directly in-office. Now imagine working in a office setting and coming up with a great idea only to have it shot down because your not the boss, or qualified enough; you won't even have the chance to make a difference.

 

[Weirdy]

Couple questions based on your previous post history:

1) Were you able to transfer schools?
2) If not, what issues specifically about your current school are affecting your education?
3) What was your reason for going into healthcare? What incident sparked it?
4) How are you performing academically?
5) Have you utilized all support services available? Tutoring? Counseling?
6) Do you socialize or set aside time for yourself and take care of your body during school?
7) Are there any personal stemming problems or characteristics that might have contributed to this lackluster attitude about podiatry?
8) Have you talked to family members or close friends or mentors you look up to? Would this be more effective than SDN?

 

[E E Smith]

I don't think anyone comes into school committing time, money, and effort with a lackluster attitude that brings them unhappiness. Actually alot of people are discouraging/negative, not really ones who could look up to

 

[GregOrthotic]

Well E.E., I don't know their reasons for negativity, but maybe I can help you.

This August I will be practicing for 28 years, and I've seen many changes both medically and economically. This past year, with the passage of the Affordable Care Act, was an economic game-changer. Patient's copays and deductibles have gone significantly up, so a lot of them delay or don't seek medical care. When they do come in as a hot mess, they expect it to be fixed in one visit. Sometimes it's possible. It also stands to reason that since the majority of Podiatry is made up of elective procedures that less patients will be getting bunions, hammertoes, etc. fixed when they have a $5000 deductible. I'm not exaggerating about the amount either. It's very common. My wife and I both have a policy with a 5k deductible. And, an increasing number of my patients have $50-$75 copays.

My gross income has significantly dropped over the past year, due to the above and the proliferation of PAs and CRNPs, who now do a lot of the podiatry care, so my referral base is drying up. The PCPs who have these extenders keep podiatry in-house because it helps them with their expenses. The extenders also treat other bodily ailments that we can't with our limited license, so it's more cost effective to have them. I don't know where you're located, but my local hospitals have bought many of the PCP/Internal med/Ob-Gyn practices. Many of those docs don't want to be bothered with running a practice, and are content to be employees. So the physician extenders in those practices are also employed by the hospital, who not surprisingly keep a lot of the podiatry care in-house. I will occasionally see referrals from these folks, who quite bluntly, don't want to deal with that particular patient.

Reimbursements from third party insurance are also decreasing. As a podiatrist you most likely will participate with Medicare, which now has passed MACRA (Medicare Access and CHIP Reauthorization Act). This will change the whole landscape of how we're reimbursed. A lot of the "fee for service" is being morphed into "Merit based pay" (MIPS), with patient care managed by "teams". Podiatry was built on fee for service, and this will change. If you don't know what I'm talking about, it's in your best interest to Google it to find out what it means and how it will affect you. I don't think you'd want to read the actual bill that passed, it's almost 1000 pgs long. My Medicare reimbursements are slightly lower now due to not conforming to Medicare's "Meaningful Use" and "PQRS" requirements, which will be dropped Jan. 2017 when MACRA goes into effect. You may want to Google these acronyms as well, if you're interested. Also, whatever Medicare does, private insurance parrots. So again, private insurance reimbursements will come down to Medicare levels. After all, back in the day when Medicare would give us a 1%-2% raise under their SGR formula, private payers would follow suit. So they will come down too.

So, this is my reality. It's also every doc's reality, and will be yours when you graduate. It is what it is- more time spent in front of the computer for decreasing reimbursements. I guess you can view that in a negative fashion; I know I do. I bring up the subject of money to demonstrate to you that while you became a student for hopefully other reasons than primarily money you will be very concerned about it after graduation when you find yourself having to support your personal and business overheads. I don't know much about student loans now, assuming you have them, but I understand they have to paid back regardless of your financial status. They also cannot be discharged by bankruptcy.

If you have these feelings now, I have a suggestion. Call ten different podiatry practices around the country that you don't know, and see what their take of the landscape is. Some may be different than me, but I'll bet there are a lot of similarities. Call ten different podiatry residents (not directors), and talk to them about their programs. Call ten different PCP offices, and get their opinion on Podiatry. With so many opinions you'll find a common thread. At that point, it's up to you to decide if you're going to stay where you are or pursue something else. By the way, while you're making your calls, you may also want to call ten different medical/PA/RN schools, and see if your credits from Pod school are transferable. If not, (and I understand they aren't) you'll be starting from square one.

When I was a podiatry student, I and my fellow students were fish in the pod aquarium, sequestered from the real world. In this day and age, you can't afford to do that. You owe it to yourself to do some investigation outside that aquarium. After all, you deserve to live a meaningful and satisfying life, don't you?

All the best to you.

Greg

 

[dr.phoot]

Well E.E., I don't know their reasons for negativity, but maybe I can help you.

This August I will be practicing for 28 years, and I've seen many changes both medically and economically. This past year, with the passage of the Affordable Care Act, was an economic game-changer. Patient's copays and deductibles have gone significantly up, so a lot of them delay or don't seek medical care. When they do come in as a hot mess, they expect it to be fixed in one visit. Sometimes it's possible. It also stands to reason that since the majority of Podiatry is made up of elective procedures that less patients will be getting bunions, hammertoes, etc. fixed when they have a $5000 deductible. I'm not exaggerating about the amount either. It's very common. My wife and I both have a policy with a 5k deductible. And, an increasing number of my patients have $50-$75 copays.

My gross income has significantly dropped over the past year, due to the above and the proliferation of PAs and CRNPs, who now do a lot of the podiatry care, so my referral base is drying up. The PCPs who have these extenders keep podiatry in-house because it helps them with their expenses. The extenders also treat other bodily ailments that we can't with our limited license, so it's more cost effective to have them. I don't know where you're located, but my local hospitals have bought many of the PCP/Internal med/Ob-Gyn practices. Many of those docs don't want to be bothered with running a practice, and are content to be employees. So the physician extenders in those practices are also employed by the hospital, who not surprisingly keep a lot of the podiatry care in-house. I will occasionally see referrals from these folks, who quite bluntly, don't want to deal with that particular patient.

Reimbursements from third party insurance are also decreasing. As a podiatrist you most likely will participate with Medicare, which now has passed MACRA (Medicare Access and CHIP Reauthorization Act). This will change the whole landscape of how we're reimbursed. A lot of the "fee for service" is being morphed into "Merit based pay" (MIPS), with patient care managed by "teams". Podiatry was built on fee for service, and this will change. If you don't know what I'm talking about, it's in your best interest to Google it to find out what it means and how it will affect you. I don't think you'd want to read the actual bill that passed, it's almost 1000 pgs long. My Medicare reimbursements are slightly lower now due to not conforming to Medicare's "Meaningful Use" and "PQRS" requirements, which will be dropped Jan. 2017 when MACRA goes into effect. You may want to Google these acronyms as well, if you're interested. Also, whatever Medicare does, private insurance parrots. So again, private insurance reimbursements will come down to Medicare levels. After all, back in the day when Medicare would give us a 1%-2% raise under their SGR formula, private payers would follow suit. So they will come down too.

So, this is my reality. It's also every doc's reality, and will be yours when you graduate. It is what it is- more time spent in front of the computer for decreasing reimbursements. I guess you can view that in a negative fashion; I know I do. I bring up the subject of money to demonstrate to you that while you became a student for hopefully other reasons than primarily money you will be very concerned about it after graduation when you find yourself having to support your personal and business overheads. I don't know much about student loans now, assuming you have them, but I understand they have to paid back regardless of your financial status. They also cannot be discharged by bankruptcy.

If you have these feelings now, I have a suggestion. Call ten different podiatry practices around the country that you don't know, and see what their take of the landscape is. Some may be different than me, but I'll bet there are a lot of similarities. Call ten different podiatry residents (not directors), and talk to them about their programs. Call ten different PCP offices, and get their opinion on Podiatry. With so many opinions you'll find a common thread. At that point, it's up to you to decide if you're going to stay where you are or pursue something else. By the way, while you're making your calls, you may also want to call ten different medical/PA/RN schools, and see if your credits from Pod school are transferable. If not, (and I understand they aren't) you'll be starting from square one.

When I was a podiatry student, I and my fellow students were fish in the pod aquarium, sequestered from the real world. In this day and age, you can't afford to do that. You owe it to yourself to do some investigation outside that aquarium. After all, you deserve to live a meaningful and satisfying life, don't you?

All the best to you.

Greg

Dr. Greg:

Thanks for your well-written input. I intended to just quietly observe in the background, but I had to get in on the action.

Your points were mostly from the point of view of running a private practice, is that correct? For the aspiring podiatrist who just wants to work for a hospital or a multi-special group, is this career still advisable? Student loans are my primary concern when it comes to the subject of money. If there's an 87%+ certainty that I can earn enough to cover all my student loans, then I think this career is still very much worth it.

What I'm concerned about is that you mentioned some of the podiatry jobs are going to NPs and RNs. That's the part that worries me most. Will there be a decrease in the demand for pods then?

 

[heybrother]

I'm actually happier than I've ever been in podiatry. The transition from student to resident in my case means people suddenly give a crap about me and provide teaching and instruction.

Here's my comment on podiatry (and probably medicine in general) that has nothing to do with money and is just a weird observation. I grew up middle class (probably upper middle class, but that's irrelevant). The people I knew were clean and well groomed and well spoken and educated. I suspect this applies to many of my classmates. When I thought about bunions and hammertoes I assumed those were being done on vain young women. This is in no way meant as a knock towards our patient base (people deserve care), but in most places I've visited the majority of patients are very old or very obese and in many cases very poor. You see a patient with an ulcer - they often have holes in their clothes too. I don't intend to go anywhere with this line of discussion other than to say - I think medicine could be a culture shock for some people. Maybe there are some doctors out there with a clientele of the healthy elite, but in most of the places I've visited our education is supplied on the downtrodden. I'm rambling, but I've wanted to articulate something like that for awhile.

 

[bunNfxr]

Dr Gregg has laid out an accurate progression of events leading to a very challenging work environment. For the 15 years of my career, every change has been a challenge to care for patients and make a living. Never a step forward, always a step back. If past performance is any indication of what is to come, then it this profession will become a pool of severely oversupplied Hospital applicants leading to tightening of salaries and unemployment. Without private practice to retreat to, there will be a glut of DPMs. Moreover, there is no telling how the new health care changes will affect those hospital employed podiatrists. Wounds are being managed by wound care nurses and even physical therapist; Nails can be managed by nursing; gout, heel pain and ingrown toenails can be addressed by Nurse practitioners and PAs. If surgery gets taken up by ortho, as reimbursements shift from RVU and CPT basis to "quality measures", then DPMs are in real trouble. Ortho is presently restructuring to eliminate "General" orthopedists. They have to pick a subspecialty now, and the number of foot fellowships is increasing to accommodate this change. You have to start looking at a bigger picture than just podiatry to assess the situation. Finding 10 hospital DPMs with dreamy salaries, in no way means a similar fate awaits you. If you get the DPM degree you carry the risk entering a career with a limited and redundant scope of services. Hospitals down size every specialty, keep a few doctors and replace the rest with PAs and NPs, why would this not happen to podiatry?
Often it is not the right thing to do and fails to achieve their goals of saving money and maximizing resources. But, they do it anyway! Without private practices to pick up the laid off DPMs, a glut will develop.
People making money in private practice are stretching or downright misusing codes to keep money flowing in. They are about to be shut down if they do this. DPMs with high surgical volumes may unknowingly be establishing a profile with Medicare as a high resource user. You can go online today and see which doctors are on the high end of reimbursements, services per visit and most used codes. Even if your coding is legitimate you will spend lots of time and money fending off Auditors for Medicare if your in the top ten or twenty for your state. Audits of podiatry yield pervasive misuse of the most common codes used in the profession. This results in massive recoupments and jail time in some cases. Because these efforts are proving successful, Medicare continues to expand their audits of podiatry.
Couple this with the oppressive overhead requirements for any private practice to comply with MACRA, PQRS, HIPAA and whatever new gems they come up with in the next few years. If you have not lived this, here is an example: You are responsible for making sure 50% of your patients access your patient portal to review their medical records, while assuring their privacy and confidentiality under HIPAA. This takes 20-50K/year in staff folks!! and it is just one of the requirements you have to contend with. Don't plan to comply? You will accept less money and be labeled a Low Quality provider by Medicare on an online list.

 

[Weirdy]

Dr Gregg has laid out an accurate progression of events leading to a very challenging work environment. For the 15 years of my career, every change has been a challenge to care for patients and make a living. Never a step forward, always a step back. If past performance is any indication of what is to come, then it this profession will become a pool of severely oversupplied Hospital applicants leading to tightening of salaries and unemployment. Without private practice to retreat to, there will be a glut of DPMs. Moreover, there is no telling how the new health care changes will affect those hospital employed podiatrists. Wounds are being managed by wound care nurses and even physical therapist; Nails can be managed by nursing; gout, heel pain and ingrown toenails can be addressed by Nurse practitioners and PAs. If surgery gets taken up by ortho, as reimbursements shift from RVU and CPT basis to "quality measures", then DPMs are in real trouble. Ortho is presently restructuring to eliminate "General" orthopedists. They have to pick a subspecialty now, and the number of foot fellowships is increasing to accommodate this change. You have to start looking at a bigger picture than just podiatry to assess the situation. Finding 10 hospital DPMs with dreamy salaries, in no way means a similar fate awaits you. If you get the DPM degree you carry the risk entering a career with a limited and redundant scope of services. Hospitals down size every specialty, keep a few doctors and replace the rest with PAs and NPs, why would this not happen to podiatry?
Often it is not the right thing to do and fails to achieve their goals of saving money and maximizing resources. But, they do it anyway! Without private practices to pick up the laid off DPMs, a glut will develop.
People making money in private practice are stretching or downright misusing codes to keep money flowing in. They are about to be shut down if they do this. DPMs with high surgical volumes may unknowingly be establishing a profile with Medicare as a high resource user. You can go online today and see which doctors are on the high end of reimbursements, services per visit and most used codes. Even if your coding is legitimate you will spend lots of time and money fending off Auditors for Medicare if your in the top ten or twenty for your state. Audits of podiatry yield pervasive misuse of the most common codes used in the profession. This results in massive recoupments and jail time in some cases. Because these efforts are proving successful, Medicare continues to expand their audits of podiatry.
Couple this with the oppressive overhead requirements for any private practice to comply with MACRA, PQRS, HIPAA and whatever new gems they come up with in the next few years. If you have not lived this, here is an example: You are responsible for making sure 50% of your patients access your patient portal to review their medical records, while assuring their privacy and confidentiality under HIPAA. This takes 20-50K/year in staff folks!! and it is just one of the requirements you have to contend with. Don't plan to comply? You will accept less money and be labeled a Low Quality provider by Medicare on an online list.

Will greater parity fix any of this? Only to an extent?

Common bottleneck I've noticed seems to be the amount of politics and legislature involved to make any real change.

 

[dr.phoot]

@bunNfxr:

I'm slightly frightened by what you've said (although it's clear you're just being brutally honest). Outside of podiatry, there's really nothing else I'm interested in when it comes to medicine.

Indirectly, it's as if you're saying podiatry's future doesn't look so great. This is very heart breaking to hear.

 

[GregOrthotic]

Thanks Dr. Phoot, for your earlier reply.


You are correct, I am in private practice. I started as an associate, then a partner with six full-time employees. As the years went on and costs to run a practice continued to climb as reimbursements leveled out then started to go down we reduced our staff to three when we out-sourced our billing. My partner and I split in 2000 but continue to share an office; I also have another one myself. I gave up my surgery practice in 2002 when reimbursements were such that I was getting more for a pair of prescription orthotics than a hammertoe (for those insurances that still paid for DME), and the malpractice "crises" struck in PA where my surgical rates would've gone up 300%, despite a history of no claims. It's kind of ironic because right before that went down I had just gotten on staff at an amb. sx. center and was just certified to use an Ossetron (Google that blast from the past). But in retrospect, for me it's best thing I ever did. I found out since that time over the years that a lot of my classmates have done the same thing.


Now that our reimbursement model has changed I predict I'll be out of practice within the next two years. I won't be able to meet the documentation requirements under MACRA as a sole proprietor. In fact, the way MACRA is written supposedly physician groups under 45 docs will have the same problems. If you want to look at it this way, it seems like the government wants to eliminate private practice. The American Academy of Family Practice has said as much as well. I've been doing EMR since the mid 90's, and still couldn't keep up with the draconian requirements of the current "Meaningful (meaningless) use" and "PQRS", so at this point I'm getting roughly a 5% hit on my reimbursements for non-compliance, but my time isn't worth the 5% dock in pay. This will end in January 2017 when MACRA kicks in. You won't hear about the consequences right away, but during 2017 Medicare will be recording metrics for effectiveness of care vs. cost. By 2018-19 this will be applied and if I'm still around it will be an over 20% decrease in reimbursement for those who can't conform. The prediction is that most practices under 45 docs will be negatively affected. How can a practice be sustained with a decrease of 20%? Of course the private insurances will follow suit; they have to make their shareholders happy, right? (yeah, right).


After that background, now, more importantly to your concerns. Just one correction before I get started. I believe I stated that a lot of the podiatry "referrals" I've gotten in the past have gone by the wayside due to the proliferation of physician extenders. I didn't mean that podiatry "jobs" were taken by extenders/non-podiatrists. There's a difference between the two. If you inferred that, my apologies. As far as your questions of hospital employment concerns, I'm afraid I can't help you. I can tell you that in my geographic area there's no such thing as a podiatric hospitalist. Maybe this exists in other areas and may be worth a phone call. Multi-specialist groups: there is one orthopod group in my area that had a podiatrist, but I just saw her name on the resignation list for my local hospital where I'm on staff. Whether or not that pod is gone/replaced/not replaced I don't know.


But the whole net/net/net of this is your concern of being employed after school/residency. There was also a question brought up about parity. Excellent timing. Here’s my opinion based on 28 years of experience (and you know how that saying goes). We have a LIMITED license and aren’t part of mainstream medicine. The limited aspect of the license cannot be denied; foot and sometimes ankle (maybe leg depending on your state). I do know it’s reflected in our PA license number with a prefix of SC, which stands for Surgical Chiropodist. As far as I know, that designation is the same for newly licensed pods in PA even in 2016. In my state, MDs have MD in front of their number, DOs have DO, PAs have PA; you get my drift.


The second part is not being part of mainstream medicine. And here’s what I mean: If you go to an allopathic med school, either in the states or abroad, it’s part of the LCME (look it up). The osteopathic schools have their counterpart. Here’s the rub- it’s standardized education, and the accrediting body is neutral. PAs and RNs follow the same model. Then there’s podiatry. Our schools aren’t part of this system, they have their own. They fall under the CPME (Council on Podiatric Medical Education- I gave you that one), and it’s not neutral. When you’re out in practice, you’ll be required to maintain CME credits to maintain your state license. In my state it’s 50 every two years. The vast majority of them have to be podiatry CMEs (CPME), and only a small part may be AMA Cat I credits. AMA credits I can get for free; podiatry CMEs I have to pay for. I’ll let you draw your own conclusions. The same goes for residencies. DO/MD are under ACGME (again, look it up). Podiatry, so sorry, no. Go on the ACGME website and type “podiatry” in their search box… so sorry, thanks for playing. I don’t know anything about current podiatry residencies, other than their case numbers are probably being affected by the changes in insurance (in other words, going down), and they don’t seem to be standardized programs. So, given if you go through an allopathic/osteopathic program, no matter where you go your training is essentially the same/along the same guidelines. You’ll fit right in with the system when you pop out. Podiatry? Even if you did, it still doesn’t matter because of that pesky LIMITED license. So as far as parity goes, I would score 0 for podiatry. Where’s the parity if podiatry is not part of the “system”? Then there’s the numbers: 854,000 doctors, over 100,000 PAs (as of 2014), 222,000 nurse practitioners (2014). Then there’s podiatry: 9,500 (2015- US Bureau of Labor Statistics). I think it’s a little more, maybe around 13,000. But really, does that matter in the overall picture? So, there’s all these large numbers in the system, along with the hospitals which are also on the same page, also regulated and accredited. And, then there’s podiatry.


Go to the Indeed.com jobs site and type in “podiatry” under search, and see what your result is. Then type in “orthopedic foot and ankle surgeon”, and see what you get. If I’m an employer, would I hire a podiatrist or a physician extender with full licensure to not only do that ingrown nail but also give a flu shot and do a high school sports physical at the same exam? You can only do the first treatment of this exam because of your LIMITED license…do you see where this is going? It’s all about money, and the one who can do it for the least cost wins. If somehow you get into an orthopedic group it will be as an employee. I don’t think you’d make partner… how would you take call for the group? If someone comes to the ER with a hip fracture, what can you do for it with your LIMITED license… look at it? Treat it and you’re breaking the law, but not the PA or CRNP.


I don’t know what is told to you in school, but as I always have said “there’s school and there’s the real world”. I know my real world was much different than pictured. And when things started sliding down, I took it personally until I took a step back and looked at the big picture. Doing so, I realized there’s mainstream medicine/govt regs/insurances… then there’s podiatry. If you read Horton Hears a Who that’s what we’re up against; welcome to Whoville. We can play on mainstream medicine’s ballfield for a little while, until the lights are shut off and we’re told to go home. Sorry this ran a little long, but I felt it was important that you all have a foundation as to why things are as they are, as least how I see them.


So Dr. Phoot, I know what I would do if I were in your place, knowing what I now know. I would somehow parlay what I had now into the mainstream medicine tract in some capacity. But I’m not telling you what to do, rather I suggest the same thing for you as I did for E.E.- start making some phone calls outside your circle. Don’t take what I’m saying as 100% correct, either. It’s just a snapshot. Ask questions, collect facts. Talk to your fellow classmates. Talk to students from other schools. Talk to the administrators of your school. From there you can make a decision. In fact, every podiatry student should be doing this in their own best interest, as there are too many extrinsic changes being applied to our profession that are out of our control but will profoundly affect it in the very near future. I’m not trying to be Dr. gloom and doom, but these changes outside your aquarium are very real and should be dealt with by all of you proactively in a mature manner. One other resource you can read is a blog: Podpost.us . It’s not moderated, so posts can get a little vitriolic at times but I’ve found some truths there as well.


By the way Dr. bunNfxr, nice post. Very accurate and spot on.


-Greg

 

[CardsFan92]

"One other resource you can read is a blog: Podpost.us . It’s not moderated, so posts can get a little vitriolic at times but I’ve found some truths there as well."
Aaaaaaaaand you lost me....

 

[deleted690619]

"One other resource you can read is a blog: Podpost.us . It’s not moderated, so posts can get a little vitriolic at times but I’ve found some truths there as well."
Aaaaaaaaand you lost me....

He's been creating accounts and writing these doom and gloom essays for years now. I'm sure neither you nor I know of a single doc in successful private practice that has the time to ramble such long novels with no clear point. It's a common theme with him. You'd only have to check out the recent salary thread or talk to Residents and up to date Attendings to see that this profession has evolved to its best point yet in terms of salary (MGMA $290K/AFCAS $260K after 3+ years in practice), introduced legislation, actually being able to sit for the USMLE, Hospital privileges, hospital/Ortho group careers etc. etc. Every medical specialty is complaining about increased overhead, decreased reimbursements, and increased encroachment but that shouldn't scare you away from a great career if you think that you would truly enjoy doing it.

 

[GregOrthotic]

Too bad, CardsFan92. I didn't say that blogsite is the be all, end all either. Frankly, there's a couple of posters on there who rant, which gets tiring for me. But there are facts posted on that site that you won't find on the PM news daily e-blast. If you're relying solely on PM for news, you're still getting it from the aquarium mostly, as only very recently have a couple of critical thinking posts made their way onto it. And unfortunately, none of this will stop what's already been mandated by Medicare starting Jan 2017.

And for the record, I am a first time poster here. I've presented the facts as they have unfolded with me, and am doing this as I realize when you're a student all you have time for is studying, for the most part. So, as I wrote earlier, take this how you want it, and if you decide to continue with this course, so be it. When you get out into my aquarium, and you're requested by insurance for a chart note pre-payment audit after you've seen the patient, maybe you'll see I wasn't so off after all.

 

[CardsFan92]

Too bad, CardsFan92. I didn't say that blogsite is the be all, end all either. Frankly, there's a couple of posters on there who rant, which gets tiring for me. But there are facts posted on that site that you won't find on the PM news daily e-blast. If you're relying solely on PM for news, you're still getting it from the aquarium mostly, as only very recently have a couple of critical thinking posts made their way onto it. And unfortunately, none of this will stop what's already been mandated by Medicare starting Jan 2017.

And for the record, I am a first time poster here. I've presented the facts as they have unfolded with me, and am doing this as I realize when you're a student all you have time for is studying, for the most part. So, as I wrote earlier, take this how you want it, and if you decide to continue with this course, so be it. When you get out into my aquarium, and you're requested by insurance for a chart note pre-payment audit after you've seen the patient, maybe you'll see I wasn't so off after all.

Can you please elaborate on the size of your aquarium? Also, what pumps would you recommend for someone looking to purchase their first aquarium? I've seen combo deals in the pet stores, but I'm wary about the reliability of those "off-brand" pumps--especially in today's economy where everything is made in China.

 

[GregOrthotic]

Well ankle breaker, you are totally wrong.

But that's okay, no need to shut down the thread. I'm done wasting my time here.

Good luck to you all...

 

[dtrack22]

Regardless of who is posting as Gregg or Phoot or bunNfxr, they do bring up some valid points. It is getting harder and harder (nearing on impossible) to make enough money on collections alone to support a practice. You have to have ancillary services and streams of income to do well. This is exactly why hospitals can pay larger upfront salaries to new grads compared to smaller groups. In fact, most hospitals can afford to pay you more than you are actually collecting for E&M and CPT codes because they are profiting off of your cases, xrays, advanced imaging, DME items, etc. This leads into one of the many inaccuracies and flat out lies that these same posters have touted...for fun, I'll address those.

...and the proliferation of PAs and CRNPs, who now do a lot of the podiatry care, so my referral base is drying up...my local hospitals have bought many of the PCP/Internal med/Ob-Gyn practices. Many of those docs don't want to be bothered with running a practice, and are content to be employees. So the physician extenders in those practices are also employed by the hospital, who not surprisingly keep a lot of the podiatry care in-house.

Maybe cutting nails, which any smart podiatry practice has an MA do anyways (where allowed), as this too reimburses too poorly to justify the podiatrist doing himself. Otherwise, this is absolutely untrue. Especially in regards to any and all diabetic foot care. The second part leads credence to this when you understand how these "hospital networks" work. Those primary care physicians are employees, it makes little difference what they do and don't do for their patients and so they do the exact opposite of what Gregg suggests, they refer out anything and everything they can. So while the in-network podiatrist may be the ones getting all of these referrals and not Greg, the fact is that these referrals exist and are becoming increasingly abundant since it no longer behooves the PCP to take his/her time trimming a callus or taking out an ingrown when he/she doesn't get paid any more or less for doing it.

Wounds are being managed by wound care nurses and even physical therapist; Nails can be managed by nursing; gout, heel pain and ingrown toenails can be addressed by Nurse practitioners and PAs. If surgery gets taken up by ortho, as reimbursements shift from RVU and CPT basis to "quality measures", then DPMs are in real trouble. Ortho is presently restructuring to eliminate "General" orthopedists. They have to pick a subspecialty now, and the number of foot fellowships is increasing to accommodate this change. You have to start looking at a bigger picture than just podiatry to assess the situation. Finding 10 hospital DPMs with dreamy salaries, in no way means a similar fate awaits you. If you get the DPM degree you carry the risk entering a career with a limited and redundant scope of services. Hospitals down size every specialty, keep a few doctors and replace the rest with PAs and NPs, why would this not happen to podiatry?

Wound care centers have wound care nurses that will do much of the work but are overseen by plastic surgeons and podiatrists. These centers have an ever increasing need for podiatrists and subsequently most hospital systems and wound care centers are expanding the role of podiatry to cover days in these centers/clinics where they line up 20, 40, 60 diabetic foot ulcers in a day. 1 morning in a well run wound care center is a good way to supplement your income. Nails can be managed by nurses, heck nails can be managed by MAs, but to get money for nails (medicare) they have to have a qualifier (PAD, neuropathy, hx of amp). That means these patients who you actually get paid for are the same patients that PCPs, NPs, PAs dont want to touch. In ever growing hospital networks, these too are referred to podiatry. Ortho increasing the number of fellowship trained F&A surgeons is laughable. Again, simply untrue. Most foot and ankle procedures reimburse less (on a time/RVU basis) compared to larger joints and larger bones. Since they generally don't want to or just don't provide palliative care or wound care, their income is limited compared to their "joints", "sports", "hand", "peds" and "spine" colleagues. It's literally the opposite of what you suggest. Last, but not least, hospital systems are hiring more and more podiatrists every year. They do this for two reasons. 1) we make them $$$. 2) they have a glut of medicare patients that utilize their services as more and more private/group practices no longer accept Medicare patients. That patient population in particular has a large need when it comes to foot/ankle care. Care that PCPs, PAs, NPs won't or can't provide and care that is more "all encompassing" than what an Ortho is willing to provide. So, they hire podiatrists. They start with 1, see the benefit (and mostly $$$ signs), and then hire another one every year or two until they are saturated or they grow their ever expanding "network."

These doom and gloom guys aren't all wrong, but are certainly out of touch with modern day training and job prospects. They also have absolutely zero communication and certainly no working relationship with the Ortho community. Reimbursements suck, hospital systems cost more and are less efficient from a healthcare dollar utilization standpoint than most private and group practices, but podiatry is still a growing field with a growing reputation. Our trajectory is on a collision course with nearly every other specialties', which is so say, we too will be hospital employees too before long. You can debate whether that is a good thing or a bad thing...the above claims by Gregg and bunion? Not so much.

 

[ExperiencedDPM]

I agree with most of Greg's comments. His comments are truthful, though hard to "hear". It is like getting cold water splashed in your face. Don't take his word for it, Google "podiatry jobs" and you'll see 2-5 jobs pop up, most will be for a nursing home position. Then google foot and ankle surgeon and see the dozens of jobs for foot and ankle orthopods (not DPMs) starting at $350,000. Sorry, but this is VERY real.

Yep, everyone thinks they're going to work for an ortho group, multi-specialty group or hosptial. Once again, stop the fantasy and live in reality. Do a google search, or go on Monster.com or any job search engine. Then you'll see that we aren't being naysayers. We are simply speaking the truth.

Our professional organizations have failed us. The APMA is busy putting money in their pockets "selling" the "APMA seal of approval" for all kinds of crap products, instead of moving us ahead. I practiced in the days of the $1500-$2000 bunion, and now I'm happy when I make over $500 for a bunion.

Don't take my word, nor should you think all is rosy. Do your homework and spend time on your computer as if you were looking for a podiatric position/job, and then report back here. Anecdotal stories about all these folks doing great are nice to hear. But please take my "challenge" and start googling for podiatric jobs available.

Look at the APMA website. Look at the jobs available vs those seeking a position and that alone says it all.

 

[CardsFan92]

I agree with most of Greg's comments. His comments are truthful, though hard to "hear". It is like getting cold water splashed in your face. Don't take his word for it, Google "podiatry jobs" and you'll see 2-5 jobs pop up, most will be for a nursing home position. Then google foot and ankle surgeon and see the dozens of jobs for foot and ankle orthopods (not DPMs) starting at $350,000. Sorry, but this is VERY real.

Yep, everyone thinks they're going to work for an ortho group, multi-specialty group or hosptial. Once again, stop the fantasy and live in reality. Do a google search, or go on Monster.com or any job search engine. Then you'll see that we aren't being naysayers. We are simply speaking the truth.

Our professional organizations have failed us. The APMA is busy putting money in their pockets "selling" the "APMA seal of approval" for all kinds of crap products, instead of moving us ahead. I practiced in the days of the $1500-$2000 bunion, and now I'm happy when I make over $500 for a bunion.

Don't take my word, nor should you think all is rosy. Do your homework and spend time on your computer as if you were looking for a podiatric position/job, and then report back here. Anecdotal stories about all these folks doing great are nice to hear. But please take my "challenge" and start googling for podiatric jobs available.

Look at the APMA website. Look at the jobs available vs those seeking a position and that alone says it all.

I went on Indeed and looked up "Podiatrist Jobs" and got 770 hits. Let's be generous and say 270 of those aren't for podiatrists and are instead for surgical techs or assistants or receptionists working in a pods office.

That's ~500 or so current positions open, and that's just Indeed. I understand that you and Greg are bitter about the current state of the private practice climate, but it literally took me five minutes to look up exactly what you said to look up, and completely gut the belly of your argument.



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[ExperiencedDPM]

Ha. Please look carefully at those "hits". Don't look at how many hits appeared, look at the actual job description. You will see there are hundreds of the same ads for an Air Force DPM in a gazillion locations. Read thru very carefully and see how many are actually for a pod.

 

[CardsFan92]

I wouldn't have made my comment if I had seen hundreds of the same job listing being posted over and over again. You can very clearly read through yourself and see a variety of different positions available in different areas of the country.

For whatever reason, you choose to resort to lying and fear mongering on this forum and it's completely out of line. We aren't a big community like the allo/osteo/dent forums. Your posts (along with Greg's) remain on these threads for days at a time until your accounts are banned or the thread is eventually locked. People see them. Your words matter, and you are actively doing harm by continuing to post this nonsense.

Criticism of the field when you have facts to support those criticisms will always have a place on these forums. Saying that there are "2-5 available jobs" in the entire country for podiatrists is so blatantly false that I'm not sure how you managed to convince yourself that it was true.

I'm done engaging with the both of you. Take your posts to some other forum.


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[Weirdy]

Come on guys.

Both Greg and ExperiencedDPM had some pretty good things to say. As a pod hopeful, it was a nice look into what they're dealing with. When surgical procedures, even ones like bunion fixes are only bringing in 500 per on a good day....the amount of debt you take on doesn't seem worth it.

The fear mongering is more of them trying to give us un-experienced ones a realistic representation of what we'll see when we enter the workforce.

Now if they offered plausible solutions or ways in which we could better arm ourselves by the time we go into the workforce instead of continuing to cite the bad where we see, and already acknowledge, that might be a teeny bit more helpful.

Not gonna lie, I'm nervous reading all of this. Its expected but it sucks.

 

[dr.phoot]

Not gonna lie, I'm nervous reading all of this. Its expected but it sucks.

This is exactly how I feel. If it's going to be difficult to at least pay off the loans, then I don't see the point.

I'm roughly a year away from starting my applications. Now I'm not sure if I should go with clinical informatics for a few years and come back to podiatry later when I've saved something and payed off my undergrad loans.

But it's the chances you don't take that you'll regret though... podiatry or nothing else.

 

[Vask]

I feel like it's just a matter of the kind of jobs available for the job-searching podiatrist. The quality jobs, whether in the field of podiatry or not, are always tough to get. Always reasonable to temper your expectations.

Reading through the posts here though, it's a shame regarding the future of private practice. Yes there are thriving practices, but it seems much tougher than it used to be; definitely wasn't a good look when I shadowed a private pod. Medicine in general is getting screwed by insurance/government...

 

[ExperiencedDPM]

A

 

[ExperiencedDPM]

First of all, 2-5 was an obvious typo. It was supposed to be 25. And once again look through the ads to see how many involve nursing home care, assisted living facility care, military positions, etc. I assure you those jobs are the majority.

I'm not a troll, just look back at my past posts. I just think that the schools have embellished the current state of affairs, and many grads are going to be in for a rude awakening when they realize they will most likely not spend the majority of their time as "foot and ankle surgeons". Nor are there a plethora of ortho jobs for pods, hospital jobs or multi speciality group jobs. These jobs DO exist, but not in the quantity most believe.

I've got no dog in this fight. I've already been through the trenches and have had my highs and lows.

Medicine as a whole isn't in a good place, but we have a limited license, so when push comes to shove, we have no real back up plan. An MD/DO has a full scope of options. Look how many GPs left family practice due to low income, and have opened medical spas, offering weight loss, Botox, lasers, etc., all for cash. That's due to their unlimited license. We don't have that option.

If you don't already know about it, please read up on MACRA and MIPS, and research the implications on medicine and specifically podiatry.

You can't bury your head in the sand, simply because you don't like what you hear. Be a TRULY educated consumer and buyer beware.


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[CardsFan92]

First of all, 2-5 was an obvious typo. It was supposed to be 25. And once again look through the ads to see how many involve nursing home care, assisted living facility care, military positions, etc. I assure you those jobs are the majority.

I'm not a troll, just look back at my past posts. I just think that the schools have embellished the current state of affairs, and many grads are going to be in for a rude awakening when they realize they will most likely not spend the majority of their time as "foot and ankle surgeons". Nor are there a plethora of ortho jobs for pods, hospital jobs or multi speciality group jobs. These jobs DO exist, but not in the quantity most believe.

I've got no dog in this fight. I've already been through the trenches and have had my highs and lows.

Medicine as a whole isn't in a good place, but we have a limited license, so when push comes to shove, we have no real back up plan. An MD/DO has a full scope of options. Look how many GPs left family practice due to low income, and have opened medical spas, offering weight loss, Botox, lasers, etc., all for cash. That's due to their unlimited license. We don't have that option.

If you don't already know about it, please read up on MACRA and MIPS, and research the implications on medicine and specifically podiatry.

You can't bury your head in the sand, simply because you don't like what you hear. Be a TRULY educated consumer and buyer beware.


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No, it wasn't a typo. You knew exactly what you were typing. Furthermore, saying that there are only 25 current job openings in the entire country only furthers my point that you have no idea what you're talking about since you are seemingly unable to count.

I'm familiar with your post history. It involves pestering other docs about how to do their jobs to the point of being rebuked by other posters.

Again, I urge you to stop posting false information on this forum in the name of "education." As much as I want to believe you truly are ignorant and just simply misinformed about the current state of podiatry, I get the feeling that something went very wrong for you along the way and you feel obliged to "get back" at the field that's done you wrong. I have no other explanation for you telling prospective podiatrists that there are only "2-5 or 25" available jobs in the entire country.




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[dr.phoot]

You can't bury your head in the sand, simply because you don't like what you hear. Be a TRULY educated consumer and buyer beware.
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It sounds like we might just have to take a chance. I'll keep a watchful eye on how things progress in the upcoming year. I'll even defer an acceptance, if I have to, and go into something else before coming back to podiatry.

Is it just a case of increased competition though? Like someone who does really well on pod school, residency will have a good chance of landing a job? There was a thread where a former mentioned he failed his boards and that contributed to him not landing a residency.

Would you personally go into podiatry if you could do it all again?

 

[ExperiencedDPM]

No, it wasn't a typo. You knew exactly what you were typing. Furthermore, saying that there are only 25 current job openings in the entire country only furthers my point that you have no idea what you're talking about since you are seemingly unable to count.

I'm familiar with your post history. It involves pestering other docs about how to do their jobs to the point of being rebuked by other posters.

Again, I urge you to stop posting false information on this forum in the name of "education." As much as I want to believe you truly are ignorant and just simply misinformed about the current state of podiatry, I get the feeling that something went very wrong for you along the way and you feel obliged to "get back" at the field that's done you wrong. I have no other explanation for you telling prospective podiatrists that there are only "2-5 or 25" available jobs in the entire country.




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You are seriously delusional. Seriously. Why would or anyone write "2-5"? Why wouldn't I just write 2,3 4 or 5? You are so erred on so many levels. I've been more successful than the avg pod. Significantly so. I am not bitter at all, I'm simply stating the facts regarding the current state of podiatry.

Again you miss the point when you stated that I pestered docs how to do their job. I asked relatively simple questions. Simply wanted to know how a doc without an office can sterilize his instruments. Wow, that's really a horrible question.

I'm not "getting back" at anyone. Actually quite the opposite. I am attempting to cut thru the propaganda. I again challenge you to prove any of my comments are false.

Read thru that job list. Go ahead and report back to me how many are nursing homes, assisted living or military.

Jump right in and get that degree. And I assure you that you'll be the first to point fingers when you don't succeed.

Buyer beware. Or in your case....good luck.

 

[theconzumer]

You are seriously delusional. Seriously. Why would or anyone write "2-5"? Why wouldn't I just write 2,3 4 or 5? You are so erred on so many levels. I've been more successful than the avg pod. Significantly so. I am not bitter at all, I'm simply stating the facts regarding the current state of podiatry.

Again you miss the point when you stated that I pestered docs how to do their job. I asked relatively simple questions. Simply wanted to know how a doc without an office can sterilize his instruments. Wow, that's really a horrible question.

I'm not "getting back" at anyone. Actually quite the opposite. I am attempting to cut thru the propaganda. I again challenge you to prove any of my comments are false.

Read thru that job list. Go ahead and report back to me how many are nursing homes, assisted living or military.

Jump right in and get that degree. And I assure you that you'll be the first to point fingers when you don't succeed.

Buyer beware. Or in your case....good luck.

ExperiencedDPM you are much more knowledgable about MACRA and MIS than I and from what I hear MACRA and MIS will hurt private practices significantly, does this garner an advantage to podiatrist in hospital settings? Would this draw more podiatrist to move in that direction?

 

[ExperiencedDPM]

It sounds like we might just have to take a chance. I'll keep a watchful eye on how things progress in the upcoming year. I'll even defer an acceptance, if I have to, and go into something else before coming back to podiatry.

Is it just a case of increased competition though? Like someone who does really well on pod school, residency will have a good chance of landing a job? There was a thread where a former mentioned he failed his boards and that contributed to him not landing a residency.

Would you personally go into podiatry if you could do it all again?

I have minimal to no regrets with my career choice. However, if I had to choose today I would likely not choose the DPM degree. Medicine is much different and changing daily. I'm afraid of the roadblocks that may be ahead with a limited license.

NPs and PAs are infiltrating all aspects of care. And in some areas they are already performing palliative foot care, wound care and other foot/ankle care.

I did pretty well in my career professionally and financially. But that doesn't mean it was always smooth sailing. There are just to many unknowns at this time with the health care system.

Until DPMs TRULY provide a unique service, I think there may be issues. Orthopods can competently perform foot and a ol surgery, so don't think they can't. Wound care nurses can treat wounds. PAs and NPs are already doing palliative care. Dermatologists treat skin and nail disorders. Cpeds and orthotists make orthoses and sell/dispense shoes. And the list goes on.

All I ask is that you go in with eyes wide open and as an educated consumer.

 

[ExperiencedDPM]

ExperiencedDPM you are much more knowledgable about MACRA and MIS than I and from what I hear MACRA and MIS will hurt private practices significantly, does this garner an advantage to podiatrist in hospital settings? Would this draw more podiatrist to move in that direction?

Excellent question. Yes, the hospital setting will be a much safer haven. They are predicting that groups of 25 or less will take hits. Additonally, at a hospital your payment will likely be RVU based and you won't take an individual hit or penalty. So these jobs will be popular for many reasons. They usually pay fairly and have excellent benefits. You'll never be pressured by a boss to have to " buy in" while you are already in debt from loans. The hospital jobs are not a free ride and your numbers will be watched closely. They aren't paying you well if you slack.

Multi specialty groups and hospitals are where many are trying to land.

 

[ExperiencedDPM]

a

 

[theconzumer]

Excellent question. Yes, the hospital setting will be a much safer haven. They are predicting that groups of 25 or less will take hits. Additonally, at a hospital your payment will likely be RVU based and you won't take an individual hit or penalty. So these jobs will be popular for many reasons. They usually pay fairly and have excellent benefits. You'll never be pressured by a boss to have to " buy in" while you are already in debt from loans. The hospital jobs are not a free ride and your numbers will be watched closely. They aren't paying you well if you slack.

Multi specialty groups and hospitals are where many are trying to land.

Ah I see, private practice definitely will face some difficulties. I see where your coming from in your posts, people need to be aware of their future. There will be opportunities for podiatrist, the environment will change but we should be able to make a comfortable living onwards. A lot of medical specialties have been moving away from private practice lately (optometrist being one where big named stores have their own optometrists on site). A changing environment will provide new opportunities and I hope this leads to solid, stable and well-paying careers for podiatrist to come.

 

[ExperiencedDPM]

No, it wasn't a typo. You knew exactly what you were typing. Furthermore, saying that there are only 25 current job openings in the entire country only furthers my point that you have no idea what you're talking about since you are seemingly unable to count.

I'm familiar with your post history. It involves pestering other docs about how to do their jobs to the point of being rebuked by other posters.

Again, I urge you to stop posting false information on this forum in the name of "education." As much as I want to believe you truly are ignorant and just simply misinformed about the current state of podiatry, I get the feeling that something went very wrong for you along the way and you feel obliged to "get back" at the field that's done you wrong. I have no other explanation for you telling prospective podiatrists that there are only "2-5 or 25" available jobs in the entire country.




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Let's get this correct;

You have presumably graduated college
You are a podiatry student (according to your avatar)


I graduated college
I graduated podiatric medical school
I completed my residency
I obtained board certification by the ABFAS
I have been in practice 20+ years
I am chairman of the dept. at the local hospital
I work regularly with residents
My practice regularly has student externs rotate through the office
I have authored 9 peer reviewed and published articles in respected journals
I have co-authored 3 chapters in podiatric textbooks

And you state that I am currently misinformed regarding the current state of podiatry (and I believe you also stated that you believe I'm "truly ignorant".

And YOU are the student, who hasn't even graduated?

I'll let everyone else do the math.




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[Weirdy]

It sounds like we might just have to take a chance. I'll keep a watchful eye on how things progress in the upcoming year. I'll even defer an acceptance, if I have to, and go into something else before coming back to podiatry.

Is it just a case of increased competition though? Like someone who does really well on pod school, residency will have a good chance of landing a job? There was a thread where a former mentioned he failed his boards and that contributed to him not landing a residency.

Would you personally go into podiatry if you could do it all again?

From what I'm getting, seems to be legislation mostly. Will read up on MACRA and MIS but those 2 seem to be leading factors.

Every field will have increased competition and saturation.

The docs on here are trying to highlight the legislation giving us the shaft due to our limited scope of practice- which is explicitly stated in DPM license.

Wonder if I should bring up MACRA and MIS to school reps next week when I visit?

 

[croak]

Let's get this correct;

You have presumably graduated college
You are a podiatry student (according to your avatar)


I graduated college
I graduated podiatric medical school
I completed my residency
I obtained board certification by the ABFAS
I have been in practice 20+ years
I am chairman of the dept. at the local hospital
I work regularly with residents
My practice regularly has student externs rotate through the office
I have authored 9 peer reviewed and published articles in respected journals
I have co-authored 3 chapters in podiatric textbooks

And you state that I am currently misinformed regarding the current state of podiatry (and I believe you also stated that you believe I'm "truly ignorant".

And YOU are the student, who hasn't even graduated?

I'll let everyone else do the math.




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[CardsFan92]

Let's get this correct;

You have presumably graduated college
You are a podiatry student (according to your avatar)


I graduated college
I graduated podiatric medical school
I completed my residency
I obtained board certification by the ABFAS
I have been in practice 20+ years
I am chairman of the dept. at the local hospital
I work regularly with residents
My practice regularly has student externs rotate through the office
I have authored 9 peer reviewed and published articles in respected journals
I have co-authored 3 chapters in podiatric textbooks

And you state that I am currently misinformed regarding the current state of podiatry (and I believe you also stated that you believe I'm "truly ignorant".

And YOU are the student, who hasn't even graduated?

I'll let everyone else do the math.




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My point has remained the same since I made the mistake of questioning your first post.

You claim that there are currently about 25 jobs available for podiatrists in the United States. You say you know this to be true because you went on Indeed.com and counted the search results.

I went on a variety of different job websites to investigate your claim and concluded that you were lying about the current job climate for podiatrists because there are significantly more than 25 jobs posted on almost all of these websites.

You insinuate that I am imagining podiatry to be some magical fantasy land where everyone has their job handed to them on a silver platter immediately following residency. According to you, the current climate is not just poor for getting a job, but downright dangerous to anyone considering getting in the field because of how much debt students are taking on.

I have never once, in my entire history on this site, made a claim that podiatry is some kind of golden ticket to easy money and success. In fact, the current job market seems to be leaner than it has been in previous years. Obviously, medicine is changing and will continue to change in the future. But I'm just a student, so what do I know?

Reasonable people can make reasonable claims about the current job market. Your argument is not reasonable; it is in fact not even what I would consider an argument. It is a lie that you are actively pedaling as fact without a shred of supporting evidence.

 

[ExperiencedDPM]

Wake up and smell the toast. Or just keep drinking that KoolAid

 

[air bud]

Can most of you on this thread (non-attendings) quit whining and trying to justify your future in podiatry? The whole world of medicine is changing, not just podiatry. Take something useful from these comments and use to your advantage. Namely, read up on MACRA and MIPS. As somebody just graduated from residency and ready to start working, I just recently started learning about this type of stuff. It is important. I suggest you do the same.
Some other points...

1. 90% of those monster hits are worthless. they come up because they have "podiatry" somewhere in the description. Trust me, I searched any and all websites for the last 8 months.

2. Most good jobs are word of mouth or not advertised, it is that simple. So don't go by what you see online.

3. Some good jobs are advertised though. Technically my job was from an advertisement, but the person I am joining in the group knew my training and likely went to bat for me based on this.

4. What dtrack said is right. The future is in hospital systems/groups. It is the way medicine is evolving, and it is the way the new generation of residents think. They see 200k+ in debt and see an offer for 200k+ to start with full benefits. They want that security and are willing to give up control over decision making. Who knows how they will feel in 10 years when they are tired of being told what to do, but I am sure all types of doctors within those models feel likewise.

5. Ignorance is bliss. My generation doesn't care/complain that people use to get 5k for bilateral forefoot slams. Things change. We just know that you get 500 bucks for a bunion now. And those patients use to spend a week in the hospital after that....things change.

6. There are good jobs out there. Jobs that pay 200k+, 20k signing bonus, full benefits for you an family, 100% 401k matching, profit sharing, partnership, memberships to golf clubs...trust me. Yeah, they come with a price. Don't think you are going to get that job living in San Diego though. Everything has pros and cons.

7. Quit being little bitches and complain on forums when somebody with more experience than you offers a dissenting opinon. You wouldn't do that to an attending in real life, so don't do it here. Just like when you don't like somebody treats a patient, use it as a learning experience and build from it.

 

[air bud]

Also, those jobs you see posted online? They are on at least 3-5 other sites if not more.

 

[CardsFan92]

I have better things to do with my time than be called a "whiny little bitch" by a resident who thinks I don't have the right to question or even point out an obvious error in a post on this forum.

I have just as much a right to my opinion as you do on this site, as painful as that is for you to accept.

I'm done with this discussion.

 

[ExperiencedDPM]

Can most of you on this thread (non-attendings) quit whining and trying to justify your future in podiatry? The whole world of medicine is changing, not just podiatry. Take something useful from these comments and use to your advantage. Namely, read up on MACRA and MIPS. As somebody just graduated from residency and ready to start working, I just recently started learning about this type of stuff. It is important. I suggest you do the same.
Some other points...

1. 90% of those monster hits are worthless. they come up because they have "podiatry" somewhere in the description. Trust me, I searched any and all websites for the last 8 months.

2. Most good jobs are word of mouth or not advertised, it is that simple. So don't go by what you see online.

3. Some good jobs are advertised though. Technically my job was from an advertisement, but the person I am joining in the group knew my training and likely went to bat for me based on this.

4. What dtrack said is right. The future is in hospital systems/groups. It is the way medicine is evolving, and it is the way the new generation of residents think. They see 200k+ in debt and see an offer for 200k+ to start with full benefits. They want that security and are willing to give up control over decision making. Who knows how they will feel in 10 years when they are tired of being told what to do, but I am sure all types of doctors within those models feel likewise.

5. Ignorance is bliss. My generation doesn't care/complain that people use to get 5k for bilateral forefoot slams. Things change. We just know that you get 500 bucks for a bunion now. And those patients use to spend a week in the hospital after that....things change.

6. There are good jobs out there. Jobs that pay 200k+, 20k signing bonus, full benefits for you an family, 100% 401k matching, profit sharing, partnership, memberships to golf clubs...trust me. Yeah, they come with a price. Don't think you are going to get that job living in San Diego though. Everything has pros and cons.

7. Quit being little bitches and complain on forums when somebody with more experience than you offers a dissenting opinon. You wouldn't do that to an attending in real life, so don't do it here. Just like when you don't like somebody treats a patient, use it as a learning experience and build from it.

Excellent post. At least you understand my comments. You are 100% correct about the job search engines. Yes, it states there are hundreds, but when you actually look, many are repetitive, many are irrelevant and MANY are for large companies offering nursing homes, assisted living care or home care.

There are absolutely fantastic jobs out there, but at the present time in my opinion, those aren't the rule, they are the exception. As I also stated, hospitals and multi specialty groups will be the most sought after, but of course there are only a finite number of those positions.

Your last point was the best. Rather than sitting back and considering whether the concerns I discussed are valid, the immature response is a knee jerk response that we are all wrong, trolls, uninformed, etc.

I found the most recent cardsfan92 post the most transparent. He/she argues with me (an experienced attending) and argues with Airbud, a resident with experience. But everyone else is wrong and irrational.

If and when this student graduates, I'm sure he or she will really enjoy the hierarchy and structure of a residency.

 

[HR91]

Excellent question. Yes, the hospital setting will be a much safer haven. They are predicting that groups of 25 or less will take hits. Additonally, at a hospital your payment will likely be RVU based and you won't take an individual hit or penalty. So these jobs will be popular for many reasons. They usually pay fairly and have excellent benefits. You'll never be pressured by a boss to have to " buy in" while you are already in debt from loans. The hospital jobs are not a free ride and your numbers will be watched closely. They aren't paying you well if you slack.

Multi specialty groups and hospitals are where many are trying to land.

First of all, thank you for your insight! As an soon-to-be 1st year student, it is worrisome that our job prospects will be limited due to the phasing out of private practices and lack of unique services we provide. However, I hope there is still a place for podiatrists in healthcare and jobs that do pay respectably for the amount of education and training we have to endure. It would be a shame if that's not the case.

Since the profession is trending towards the hospital setting and multi-specialty groups, I'm curious as to what you think about the market for podiatrists in geographic areas where hospital podiatrists are not very common? Where I'm from (Texas), there is no such thing as hospital-employed podiatrists that I know of (heck, I barely even know any physicians that are hospital-employed: hospitalists, intensivists, ER docs, and occasional hospital-only neurologists are from employed by contracting companies from what I've heard, although I could be mistaken). Medicine is primarily private practice-based for pretty much all specialists and primary care here. Do you think the landscape will shift that dramatically where all these private practices will become obsolete and move towards to very large multi-specialty groups? All the podiatrists here in my city seem to be private practice-based with the occasional pod working for an ortho group or large family practice.

Thank you once again for your valuable input on the profession.

 

[ExperiencedDPM]

First of all, thank you for your insight! As an soon-to-be 1st year student, it is worrisome that our job prospects will be limited due to the phasing out of private practices and lack of unique services we provide. However, I hope there is still a place for podiatrists in healthcare and jobs that do pay respectably for the amount of education and training we have to endure. It would be a shame if that's not the case.

Since the profession is trending towards the hospital setting and multi-specialty groups, I'm curious as to what you think about the market for podiatrists in geographic areas where hospital podiatrists are not very common? Where I'm from (Texas), there is no such thing as hospital-employed podiatrists that I know of (heck, I barely even know any physicians that are hospital-employed: hospitalists, intensivists, ER docs, and occasional hospital-only neurologists are from employed by contracting companies from what I've heard, although I could be mistaken). Medicine is primarily private practice-based for pretty much all specialists and primary care here. Do you think the landscape will shift that dramatically where all these private practices will become obsolete and move towards to very large multi-specialty groups? All the podiatrists here in my city seem to be private practice-based with the occasional pod working for an ortho group or large family practice.

Thank you once again for your valuable input on the profession.

I don't think private practice is over or on the horizon to end. I do believe small group and solo practices are in trouble. As per prior posts, although hospital positions and multi specialty groups will be highly sought, these jobs won't be in abundance. A hospital may hire 10-20 new hospitalists, but I doubt they are hiring that many pods.

Private practice will survive, but groups will have to form and small practices may have to coalesce. They may be able to ultimately practice independently within the umbrella of the group.

Podiatry is not alone and all of medicine will be impacted. Traditionally, many podiatric practices are all about "the more you do the more you make". Those days are over. So the doc who brags that his average bill per patient/per visit is $428 when your average is $209, will be in for a rude awakening. You're no longer going to be paid on how much you can bill, but you will be paid on your outcomes. It will be performance based.

That's why I get nauseous when I hear about the podiatric practice management groups who preach to bill, bill, Bill and sell, sell, sell. They helped create this mess and hopefully their mentality will be extinct soon. It's ll hopefully weed out that trash.

 

[ExperiencedDPM]

I just found an interesting email from a recent resident, who fortunately landed a good job. But she sent me an email regarding her frustrations concerning job sites. When there was a drop down menu, the choice for podiatrist was often not there.

She sent me a link to a job site named Startwire.

After you fill out the initial page, it will ask your desired profession.

There is a drop down with healthcare/physician. If you choose that option it will say physician, surgeon, ER. So if you choose healthcare/allied professions you will see another drop down menu with many selections including audiologist, pharmacist, optometrist, but NO choice for podiatrist.

Enough said.

 

[HappyHobPod]

So with the bit of reading I've done on MACRA and MIPS inside/outside of this thread, I'm a bit confused on how quality is meant to be measured if anyone would care to help clarify. Certainly it relates to patient outcomes. But will there be arbitrary clinical markers or otherwise used to measure against to determine quality? Or is it up to the patient to report their satisfaction with their treatment? And how does this then relate to patients who aren't compliant with their treatment or are dealing with more chronic conditions to which their isn't necessarily an end in sight with the issues they are dealing with? From what I've read I'm assuming it's something that is a combination of these factors and others that will be continuously amended until they can get the ball rolling smoothly, but it's still less clear to me.

 

[ExperiencedDPM]

So with the bit of reading I've done on MACRA and MIPS inside/outside of this thread, I'm a bit confused on how quality is meant to be measured if anyone would care to help clarify. Certainly it relates to patient outcomes. But will there be arbitrary clinical markers or otherwise used to measure against to determine quality? Or is it up to the patient to report their satisfaction with their treatment? And how does this then relate to patients who aren't compliant with their treatment or are dealing with more chronic conditions to which their isn't necessarily an end in sight with the issues they are dealing with? From what I've read I'm assuming it's something that is a combination of these factors and others that will be continuously amended until they can get the ball rolling smoothly, but it's still less clear to me.

It 'ain't easy to follow or to understand. Podiatrists will likely fit under the MIPS model and not the MACRA model. It's all based on a point system, and momma bear knows what baby bear is doing ALL the time. Reporting is via your EMR system, and is not driven by patient feedback. You get points for doing this and points for doing that, etc. The model of do more and get more will be extinct. All these practice management organizations in my opinion were the beginning of the ruin for podiatry. They were like a pep rally for letting everyone know how to build a "million" dollar practice (though one of the head honchos filed bankruptcy.....google Ben Weaver, DPM and the word bankruptcy), by selling, hawking crap and selling and billing and selling and so on. I never heard them once promote quality care or outcomes. It was how many bags can your patient leave with during each visit. These guys will be in big trouble with the new system. It is really too hard and too confusing to truly explain on this site. You can go on the CMS website and read the 962 pages or try to find a synopsis of it online or possibly the APMA website if they have it. Please remember, this new system sucks for ALL involved, not just podiatrists. The system is based on metrics and points, and if you don't hit the points needed (you have to hit 100, though you can actually hit 130) you will be financially penalized. If you do hit the bullseye, you will actually receive a bonus. Let the games begin......

 

[bobtheweazel]

I'm a bit confused on how quality is meant to be measured if anyone would care to help clarify. Certainly it relates to patient outcomes. But will there be arbitrary clinical markers or otherwise used to measure against to determine quality? Or is it up to the patient to report their satisfaction with their treatment?

So let's say that you choose to do the PQRS diabetes measures group, which may be one of the easier ones for podiatrists. You have to make sure that 20 of your diabetic patients have:
1. Their Hemoglobin A1c checked
2. Their yearly influenza shot
3. Their yearly diabetic eye exam
4. Their yearly urine screening
5. Their yearly diabetic foot and ankle exam
6. Screening for tobacco use (if they do use then you have to counsel them on cessation)

You likely won't be performing some of these requirements yourself, but you do have to document that they were performed for the patient by someone. You can knock out these twenty patients in a few weeks, then sit back and relax a bit or it may take you the whole reporting period.

In an age where every patient has multiple physicians caring for them and communication between those physicians may not be the greatest, some of these things might fall through the gaps if there's not incentive for every doctor to make sure that all of these tests are getting done for every patient. So for right now, I suppose, it's more the intention of quality rather than the actual quality itself.

Also, if you have a genuine interest here I would recommend giving this a listen:
http://www.podiatricsuccess.com/speaker/jeffrey-lehrman-dpm-pqrs-mu-expert-02-16-2016/

 

[bobtheweazel]

First of all, 2-5 was an obvious typo.

No, it wasn't a typo. You knew exactly what you were typing.

Isn't it obvious that it was just a typo? I mean, the dash is right next to the...oh, wait...