You know if people just refused to do nail care except on truly at risk patients....
Many, many good points above.
Podiatry, as a profession overall, basically has
two options to be legit and lucrative as a profession:
- #1: Have only about 6-8k podiatry docs practicing with midlevels/RN/assistants to do nail care and easy stuff and see post-ops (make it like ENT, urology, plastics, ophtho, derm, ortho, etc etc run an office)
- #2: Have maybe 10k-12k general podiatrists (office and wound stuff) and then 3k-5k or so surgical podiatrists who went on to longer training and who get funneled all of the real OR recon cases (dental type model)
I'd vote for #2 (mainly since you can't just suddenly eliminate two thirds of current pods).
In the real world we live in, with new podiatry schools opening and about 20k podiatrists and counting, you can bet that
nearly all DPMs will do nail/callus care. 99% will. They need to eat. The group owner or VC or hospital or MSG demands RVUs and revenue. It's that simple. Sure, some podiatrists will do more or less nail routine foot care, but that stuff and ingrown or warts or wounds are how the bills get paid.
As it stands, you will have all of the DPMs averaging one or two OR surgery cases per week (average... some totally non-op and some hospital/ortho etc DPMs doing a bit heavier volume). However, we all know the demand for F&A surgery is far oversupplied.
It's plain to see that the vast majority of us are overtrained... and we're all undervalued due to saturation. The answers are not hard, but they're not palatable.
...Most residents will never receive the training expected in a 3 year foot and ankle surgery program because there just aren't enough cases to go around. Residency spots need to be significantly decreased (in order to maximize quality) which would also mean that school seats need to be decreased.
-The big issue is that we have all these 3 year trained foot and ankle surgeons coming out and yet their real benefit to society i.e how they make money is going to be cutting toenails, treating warts, wound debridement, and for the most part just telling people no, your foot pain is normal, buy a better shoe/insert
-In the 12 years I've been out 6 pods have retired/left and 15 have come to the area
-After 4-6 months of not doing a flatfoot recon/Achilles tendon rupture etc. You ask yourself if you should be doing them?
-I had a good/great residency. When I graduated, I just did not have the patient population in private practice demanding those procedures. My patient population essentially wanted injections for their end stage PTTD etc. ...
Yes, 100% agree. ^
My experience is completely similar (pretty good training, but use it fairly rarely as I don't push surgery on ppl, they typically don't need it). My volume - both clinic pts and surgery cases - is probably lower as I am solo as opposed to busier group office (although I don't have much ortho presence nearby).
Finishing residency, I was told by one podiatrist I liked and considered working with that, "
to do a good amount of surgery as a podiatrist, you need to see a LOT of patients in the office. Most people do NOT need surgery."
As our training evolved, the option used to be that a podiatrist with solid surgical training could come out and his own group and those nearby would feed him because their training/pref was minimal surgery (the guy who said that was in that refer-to surgeon role). He got not only triples referred to him, but also bunions, met fx, and other basic stuff. There are still a few DPMs who function this way, and I thought I might also... but it's a dying breed. Now, most group owners are not C&C pods anymore... but ones who do surgery. It's the same with associates, most modern VA pods, etc. Nearly every DPM coming out of training thinks they are a bigtime recon surgeon... they refer out very little if any surgery.
The math and demand just doesn't support that with 20k podiatrists (and roughly 2.5k F&A orthos doing high volume, most gen orthos doing at least ankle fx and some F&A). There are absolutely not enough cases to go around - for podiatry training or for continued competence. PRR and PLS logs would confirm this. The fact that many pods don't even try for ABFAS confirms this.
I got a few recon and other refers from other DPMs in my early career. More recently, the only stuff I might get from other DPMs is from friendly ones IF they're out of town or OON for pt insurance... or I get pts from competition ones if they upset the pt so bad on outcome/bill that the pt finds me on their own. Every podiatrist is trying to do their own surgery - or at least keep it in their group - to get numbers or revenue or keep a full schedule. It's not sustainable, and it also causes 100% of us $50k or more of student loan interest to learn stuff most of us will very seldom use.