I know this thread was a joke, but toenails are not going away from podiatry. Ever.
Why? Money.
Money, money, money.
It makes money... and podiatry is known by both the public and the medical community as the specialty that does toenails. Podiatry was founded on nails and corns and shoe fitting. This is true both USA and worldwide.
Podiatry's saturated and getting more saturated and more expensive tuition every year now in USA, so people need to eat. Grads need work. We complain of the many $100k jobs for $400k debt, but it can always get worse. Look at the wretched mobile podiatry jobs to cut toenails without tilt chairs in a room smelling of wee-wee... hey, those podiatry jobs get filled too.
There's no way DPMs are going to collectively get rid of a pathology (onycho/RFT) that is very easy and fairly lucrative and almost no risk for med mal or on-call. We are far too saturated to "call our shots" or be selective. Do we think all of the pharmacists
wanted to
work for Walgreens and CVS chain pharmacies? It was a way to survive. Also, DPMs busting crusties is the quintessential lobster work that no other specialist is going to try to do anytime
soon ever.
This has been best explained in meme forms back in 2022:
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orig meme post)
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orig meme post)
...Now, as for the somebody else being "the ones doing nail care," that someone has been - and will continue to be - podiatrists. It might be podiatrist associates in PP or the newest or least surgically-trained DPM guy in the hospital dept or whatever. Sometimes, it might be MAs with DPMs overseeing. Nurses and midlevels are far too expensive (relative to DPMs). They will get more expensive (relative to DPMs).
And yes, the pipe dream day that half the podiatry schools close and DPMs make decent doctor salary, maybe they will hire out techs or even RNs. Until then, podiatrists make too little. It makes no sense whatsoever for a hospital to have a $100k+ RN cutting nails (with nurse not billing nails solo) when they can hire a $200k-250k DPM to do that (and DPM can bill it without supervision) as well as DPM does much much more. Don't forget it's actually
MUCH easier for a hospital or MSG to recruit that DPM than recruit the RN (for a job
cutting nails). In PP podiatry, it is much cheaper to do the work oneself or to hire a DPM associate or have MAs do nails than to hire RN or NP or PA. Associate supply just keeps increasing thanks to new schools.
I am not saying there won't exist the
odd hospital or ortho employ DPM who can pretend to be too busy for nail care and get his group/facility to believe that (likely bring in a non-op DPM or midlevel to do the nails). This is maybe <5% or likely <3% right now. However, even in those situations, that risks job security and likely lowers their pay (owners will consider nail person as part of DPM's overhead). The nail person is likely to eventually quit, and refusing nails also risks the group/hospital management will continue to be bombed with applications and cold calls of 'fellowship-trained' DPMs who will do the surgical DPM's job...
and the nails too (and likely for less $$). Right now, we see job search nightmare threads; soon, we'll see threads of people losing their job or not getting the job because peers underbid (much like pharma and chiro).
In podiatry PP, assuming you don't love doing RFC visits (count me in), I think the best thing one can do is just not advertise or promote that nails/RFC part of their business (this
assumes you have enough other work... and assumes you don't want to hire another DPM, so two big assumptions for most PP pods). That'll limit them, or you can train MAs if you're overrun with RFC and want to try that route. You'd be crazy to refuse the RFC appointments when they are referred by PCPs or find you direct or through your existing patients, though. You would lose refer sources and income stream if you don't offer RFC, which podiatry is clearly expected to offer in 100% of localities.
It's a fun thought, but
toenails are not going away now or ever (nor should they) within podiatry. Money talks.
It's a saturation thing, but it's mainly money. New DPMs produced need work and need money.
Old DPMs aren't going to refuse money hiring associates or having work (many of old DPMs are still associates/employee also).
...economic realities force us into things. Airbud says there are other patients. I'm not so sure. We're up to 11 schools now, but not much else to be done for the foot. I cut toenails not because I choose to, but because I don't have any choice... The result would just be empty space on my schedule. So I continue on... 🦞👑
Yes.^^
