What are your thoughts on this youtuber's comment about podiatry?

[goblin]

Hey guys, I was watching a promotional video for one of the podiatry schools and came across someones comment which I've pasted below. What are your opinions of his statement? Is there any truth to what he claims about podiatry being "reduced in the coming years" as a profession or is this a trolling attempt? Your opinions are appreciated. Thanks!

"Prospective students. I urge you to do your homework. Beware of glossy advertising promotional's and YouTube videos with expansive views of the New York skyline. The reality of podiatry today is quite different. I graduated in the early 80s and I have nothing to gain or lose by telling you the following. Podiatry schools today are a money making scheme and the only people getting rich are the administrators? the schools that are taking your money. Do some homework on my unmatched residency graduates 2013. But more to the point be aware of the ICD 10 coding/ACO/ACA coming down the pike in 2016. Private practice is dead by 2018. The article written by the president of the ACFAS, a quite mainstream and traditional board, probably the most "prestigious" board in podiatric medicine and re-what he has to say about the death of private practice in 2018. The point is this podiatry cannot survive without CPT coding. It is the life blood of a podiatric practice. Podiatrists will be losing almost all CPT coding options which put in layman's terms means that you cannot bill for services that you perform on the patient. All of the services will be bundled into one code. Podiatric practitioners today are virtually giving their practices away or financing their practices to any "willing" residency graduated was willing to sign on the dotted line… Podiatry will be reduced in the coming years to "job placement" at clinics in VA's and the like. You will be an indentured servant, have no autonomy and certainly will not be able to be an entrepreneurial provider of medical services. Be aware that three-year surgical resident graduates today are having a very difficult time finding any kind of job placements. The statistics are not all in but the outlook is grim. I have three friends that completed a three-year surgical residency and none of them, not one has been offered a job. The statistics nationally are that those that are offered jobs are getting somewhere between 35,000 and 70,000 per year. Don't believe me. Check it out for yourself. Don't talk to the administrators and the teachers of the students at these institutions. The students are brainwashed in the first place the administrators have a vested interest in selling you their wares. My best advice would be to ignore all of them and contact a third-year resident currently graduating from a program and see what their job prospects are. Did they even receive an offer for a job. Think about it. I have not met one three-year surgical residency graduated that is even considering opening up a private practice no less purchasing one That's seven years of your life. There are close to 90 students in 2013 that's close to 10% of the graduating classes in the US that today are unlicensed and cannot make a living. They have no chance or hope of getting licensed either as there are not enough residencies for current grads moving forward. It's a big risk and the payoff is that there. Use your head do your homework before putting in those seven years. But again my advice to you would be to absolutely contact third-year residence around the US and that's when you really got to know the real deal on the game. Regardless of what response you may read regarding my post be aware that I am a podiatrist that has no vested interest one way or the other as to what decision you make. I retired many years ago but I feel a moral compunction to if not warn you in regards to what you're getting into, at least give you something to think about. Good luck"

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[selldrugs22]

Whoah thats some serious stuff. Can someone verify if this is accurate

 

[ldsrmdude]

Well, there are a lot of assertions in that post. Most are totally bogus.

"Prospective students. I urge you to do your homework. Beware of glossy advertising promotional's and YouTube videos with expansive views of the New York skyline. The reality of podiatry today is quite different. I graduated in the early 80s and I have nothing to gain or lose by telling you the following. Podiatry schools today are a money making scheme and the only people getting rich are the administrators? the schools that are taking your money. Do some homework on my unmatched residency graduates 2013.

Yes, there is a well-known residency shortage in podiatry, not just in 2013. There are many, many threads in on SDN about this topic, look them up.

But more to the point be aware of the ICD 10 coding/ACO/ACA coming down the pike in 2016. Private practice is dead by 2018. The article written by the president of the ACFAS, a quite mainstream and traditional board, probably the most "prestigious" board in podiatric medicine and re-what he has to say about the death of private practice in 2018. The point is this podiatry cannot survive without CPT coding. It is the life blood of a podiatric practice. Podiatrists will be losing almost all CPT coding options which put in layman's terms means that you cannot bill for services that you perform on the patient. All of the services will be bundled into one code.

I don't think anyone will argue that things are changing, but private practice is not dead, or going to be dead in 2018, it's simply not true. And I don't know what article an ACFAS president wrote that the poster is referring to, so I can't comment on that.

Podiatric practitioners today are virtually giving their practices away or financing their practices to any "willing" residency graduated was willing to sign on the dotted line… Podiatry will be reduced in the coming years to "job placement" at clinics in VA's and the like. You will be an indentured servant, have no autonomy and certainly will not be able to be an entrepreneurial provider of medical services.

Again, this is doom-and-gloom speculation of the worst kind. And it's simply not true. There certainly are many practitioners retiring and selling their practices, but there are a whole lot more who are keeping their practices. I have yet to see or hear of a podiatrist "giving" their practice away. Most are probably asking way too much for their practices - that's a different topic.

Be aware that three-year surgical resident graduates today are having a very difficult time finding any kind of job placements. The statistics are not all in but the outlook is grim. I have three friends that completed a three-year surgical residency and none of them, not one has been offered a job. The statistics nationally are that those that are offered jobs are getting somewhere between 35,000 and 70,000 per year. Don't believe me. Check it out for yourself. Don't talk to the administrators and the teachers of the students at these institutions. The students are brainwashed in the first place the administrators have a vested interest in selling you their wares. My best advice would be to ignore all of them and contact a third-year resident currently graduating from a program and see what their job prospects are. Did they even receive an offer for a job. Think about it. I have not met one three-year surgical residency graduated that is even considering opening up a private practice no less purchasing one.

Maybe this disgruntled ex-podiatrist really does have three friends who finished programs and couldn't find jobs, who knows. My guess is that it's more likely this guy only has three friends total, as I can assure you that I don't know of any of my classmates who didn't find good jobs. I finished my residency about a month ago, so I would consider myself to be a little more in-tune with the current job situation than our friendly "retired podiatrist" posting on YouTube videos.

That's seven years of your life. There are close to 90 students in 2013 that's close to 10% of the graduating classes in the US that today are unlicensed and cannot make a living. They have no chance or hope of getting licensed either as there are not enough residencies for current grads moving forward. It's a big risk and the payoff is that there. Use your head do your homework before putting in those seven years. But again my advice to you would be to absolutely contact third-year residence around the US and that's when you really got to know the real deal on the game. Regardless of what response you may read regarding my post be aware that I am a podiatrist that has no vested interest one way or the other as to what decision you make. I retired many years ago but I feel a moral compunction to if not warn you in regards to what you're getting into, at least give you something to think about. Good luck"

Like I said, the residency shortage is a real issue, and it's a big deal. Anyone considering going into podiatry should do so with their eyes open and with a full understanding of what they are getting into. I would guess the shortage will be over by the time any current pre-podiatry students would graduate, but that's just a guess. I agree with their advice to contact current residents or students or recently graduated podiatrists. Anybody is free to PM me at any time with questions. I am usually much more specific via PM than I am in the open forum (simply for the sake of keeping some semblance of anonymity) and there are several other current residents and attendings on the forum, so don't just take my word for it.

Hope that helps

 

[selldrugs22]

Can you please elaborate what he means by no more CPT coding

 

[ldsrmdude]

Can you please elaborate what he means by no more CPT coding

I believe he's talking about the shift from a fee-for-service model where a doctor gets paid for each procedure they do to a model where payments are more tied to quality and cutting costs. Medicare has set a goal for 2018 to have 50% of their payments in these "alternative methods" of payment such as accountable care organizations (ACOs). The poster is, I assume, stating that podiatrists won't survive because it can be a procedure-heavy specialty (think ingrown nail removals, wound debridements, etc). Medicine is certainly going to be different in 2018 than it is now, but that applies to all specialties not just podiatry. I'm no health policy expert by any means, but that's how I interpret it.

 

[selldrugs22]

y

 

[selldrugs22]

Thanks for the reply. So will podiatrists still be able to get paid for individual procedures such as in grown nail procedures or will everything be grouped into a common fee? I see this scenario really hurting the private practice model.

 

[ldsrmdude]

Thanks for the reply. So will podiatrists still be able to get paid for individual procedures such as in grown nail procedures or will everything be grouped into a common fee? I see this scenario really hurting the private practice model.

Well, this is only a goal and the goal is for 50% to be value-based by 2018. There are a lot of ways fee-for-service could change. It could be where doctors are paid for a procedure, but at a lower rate with some sort of a bonus based on their outcomes. I'm by no means an expert, but I do know how to Google something. Here's an article that discusses this: http://www.medscape.com/viewarticle/812672

 

[bobtheweazel]

Seems like by 2018 there will be four methods that Medicare will use to pay:
(1) Standard fee-for-service.
(2) Reduced fee-for-service with potential bonus based on certain outcome measures.
(3) Alternative payment models, for instance (a) one lump payment for an entire treatment episode, including all visits, tests, procedures, etc. or (b) a fee-for-service approach similar to 2, but population based. If CMS has saved money on that population by the end of the year you will get a cut of the savings, if CMS spent excessive money on that population by the end of the year, you will owe CMS money.
(4) Long term payment model, for instance a family practice physician taking care of a patient for an entire year, whether that patient is seen 0 times or 100 times the physician receives the same lump sum of money to cover that patient.

10% will be accounted for by (1)
40% will be accounted for by (2)
50% will be accounted for by (3) & (4) combined, CMS hasn't been more specific than that

Thanks for the reply. So will podiatrists still be able to get paid for individual procedures such as in grown nail procedures or will everything be grouped into a common fee? I see this scenario really hurting the private practice model.

I'm not sure if anyone will be able to answer this question specifically yet because I don't think CMS has released a list of which services/procedures/populations will fall into which payment categories. It looks like the end goal is to be partially fee-for-service based and partially quality based, so we can say that there will definitely be certain procedures where payment will just be fee-for-service or at least something very similar to it, we just don't know which procedures those will be.

CMS is trying to cut costs by paying more lump sums—as opposed to almost none now—to discourage providers from wasting time/money by performing unnecessary care events/procedures. If a large percentage of the fees are based on outcomes then the providers will find the most efficient ways to get the desired outcomes, ordering as few tests as possible, performing the fewest most effective procedures possible, etc.

It will be a different system but it's certainly not the end of the world. Technically, all of this is only for Medicare anyway. Medicare accounts for about 30% of all payments to providers, so they are pretty influential but whether/when the private insurances might follow suit is anyone's guess. If you were at a private practice that didn't accept Medicare, then this would all have very little, if any, effect on you since private insurances will still be primarily on fee-for-service models.

Also, on some level they will be tracking individual provider outcomes to see which providers have better outcomes and why. The only thing I would be interested to know that I haven't seen addressed in any of the articles I've read is how much credentials will play a part in all of this (e.g., DPM vs MD). In states where DPMs are paid less than MDs for the same procedure/treatment episode, will this shift towards quality and away from fee-for-service close that gap, widen it, or not change it much. If this system levels the playing field for all provider types, then we should be all for it. That is unless any of y'all think you can't get the outcomes.