Pod to Population Ratio

[apollofx]

Hey everyone,
I've been trying to do some research to find a recommended healthy podiatrist to population ratio but I've come up short. Does anyone know where I can find the info?
Thanks

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[dtrack22]

25,000:1 is a good ratio if you were going to set up shop somewhere or if you're looking to join a practice where you have to essentially build up your own clinic.

 

[NatCh]

I've read 20,000:1 to 25,000:1 is ideal. In my city of 80,000 people we have 9 podiatrists and 4 foot and ankle orthopedic surgeons.



Yeah, I know…

 

[Nowehjose]

That's why this gringo learns languages. Most people who visit the podiatrists are the elderly, many recent immigrants parents do not speak English.
25,000 in your area with 4 podiatrists Bensonhurst/Gravesend Brooklyn:
-you don't speak spanish, you just lost almost 2,000 patients in
-you don't speak cantonese, you just lost another 2,000 patients
-you don't speak russian, you just lost 1,000 patients
-no arabic? 500 patients.

Just advice. My girlfriends family travels 45 minutes by subway to see their physician because he speaks Cantonese.

 

[Nowehjose]

Good points above but call me old fashioned or just another white guy but...

If I have to speak several languages to put food on my table and clothes on my back while working in America then something is drastically wrong.

Lastly, what is the likelihood that the patient in question who doesn't speak English in the country they have been living for quite sometime has real insurance? In my short experience as a resident most people who fit this demographic don't. That's why they come to the resident clinic and can't see the guy/gal with 20+ years of experience.

It's not just the language barrier you would be dealing with but also each person's cultural background/ tendencies which can complicate patient care goals. You would need ample experience with these patient populations to understand their background. Not for me... I mean starting out it could give you a better chance at building a patient base.


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It's easier than you think in NY. In my gf's neighborhood, everything is either in Chinese or Russian... My gf's parents brought over their families from China, many do not speak English but are citizens 15+ yrs... You don't need to speak English here to survive. Supermarkets? Chinese. Banks? Chinese. Lawyers, Doctors, Pharmacists, Veterinarians? Chinese. Of course these are always the exception, will it make or break you? No...

 

[Cranjis McBasketball]

Maybe by the time we graduate Alexa will be as advanced as basically being a translator. Thatd be an amazing investment..

 

[apollofx]

Thanks everyone for your responses!

I've read 20,000:1 to 25,000:1 is ideal. In my city of 80,000 people we have 9 podiatrists and 4 foot and ankle orthopedic surgeons.

Yeah, I know…

Wow, with numbers like that do you feel like or have you seen it impose a ceiling on your practice? I assume by your response that your a currently practicing pod not a resident.

 

[I post PRN]

Good points above but call me old fashioned or just another white guy but...

If I have to speak several languages to put food on my table and clothes on my back while working in America then something is drastically wrong.

Lastly, what is the likelihood that the patient in question who doesn't speak English in the country they have been living for quite sometime has real insurance? In my short experience as a resident most people who fit this demographic don't. That's why they come to the resident clinic and can't see the guy/gal with 20+ years of experience.

It's not just the language barrier you would be dealing with but also each person's cultural background/ tendencies which can complicate patient care goals. You would need ample experience with these patient populations to understand their background. Not for me...


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Pearls of wisdom here for sure.

 

[Wisco57]

If you calculate out that 350 million (US population) divided by 20,000 that leaves 17,500. If that is right and the current practicing podiatrist is over 16,000 then podiatry should be near saturation as well. Right?

 

[NatCh]

It's easier than you think in NY. In my gf's neighborhood, everything is either in Chinese or Russian... My gf's parents brought over their families from China, many do not speak English but are citizens 15+ yrs... You don't need to speak English here to survive. Supermarkets? Chinese. Banks? Chinese. Lawyers, Doctors, Pharmacists, Veterinarians? Chinese. Of course these are always the exception, will it make or break you? No...

You just keep on doing what you're doing. Even if it were to make no difference on your future career, learning about other cultures and their language is good for you. The Pacific Northwest is very Anglo, and learning the culture and how to speak the language has been beneficial to me. For example, when I go to Seattle I carry a 16 ounce coffee cup, scowl a lot, and also drive extra slowly in the passing lane to block other cars. I recently read a quote that I like: "While you're busy making fun of people who speak broken English, realize that it means they know at least 2 languages."

Wow, with numbers like that do you feel like or have you seen it impose a ceiling on your practice? I assume by your response that your a currently practicing pod not a resident.

There's sort of a ceiling. There are only so many ways to cut up the pie, after all. My group has learned to adapt to the limited patient population by running our business lean and efficient. My overhead expenses typically run about 30% of my collections, which is comparatively low. Therefore, I don't have the pressure to see 30+ patients per day just to meet overhead. Additionally, I've developed a niche seeing certain patient groups (ingrown toenails, sports medicine, elective surgery) and I don't do any diabetic foot care. Most of the other providers go to satellite offices out in the rural areas but I haven't felt the need to.

 

[dtrack22]

if I remember right natch also has a sugar momma...

 

[NatCh]

if I remember right natch also has a sugar momma...

LOL! My wife is a working woman, that's true. We're equal providers though. PADPM accused me of having a sugar mama because he didn't like the idea that I'm one of those "lifestyle podiatrists" who doesn't work east coast hours. Or maybe his wife was a spa-lady trophy wife who spends her days at yoga and the wine bar. I guess we'll never know though since he was banned.

 

[JewOnThis]

You just keep on doing what you're doing. Even if it were to make no difference on your future career, learning about other cultures and their language is good for you. The Pacific Northwest is very Anglo, and learning the culture and how to speak the language has been beneficial to me. For example, when I go to Seattle I carry a 16 ounce coffee cup, scowl a lot, and also drive extra slowly in the passing lane to block other cars. I recently read a quote that I like: "While you're busy making fun of people who speak broken English, realize that it means they know at least 2 languages."



There's sort of a ceiling. There are only so many ways to cut up the pie, after all. My group has learned to adapt to the limited patient population by running our business lean and efficient. My overhead expenses typically run about 30% of my collections, which is comparatively low. Therefore, I don't have the pressure to see 30+ patients per day just to meet overhead. Additionally, I've developed a niche seeing certain patient groups (ingrown toenails, sports medicine, elective surgery) and I don't do any diabetic foot care. Most of the other providers go to satellite offices out in the rural areas but I haven't felt the need to.

30% overhead is insanely low. How do you manage to keep it that low?

For residents - most overhead run about 50-65% of collection. Imagine that......

 

[NatCh]

30% overhead is insanely low. How do you manage to keep it that low?

For residents - most overhead run about 50-65% of collection. Imagine that......

It's all highly technical. You probably wouldn't understand. J/K.

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[bunNfxr]

I used to worry incessantly about the podiatry to population ratio. But now, I fall into the work where you want to live camp. Here is why: you just can't control what other people do. If you move to a remote area with no podiatrist to serve 50,000 people you may make a killing, you may also be miserable and have scarce access to shopping and recreation that suits you or your family. The other possibility is that the remote town is remote for a reason. it may be economically depressed and people are losing insurance, jobs and leaving the area. Another possibility is that 2 years after you have set up your office and borrowed 100K from the bank to start you practice, a husband and wife couple from the area opens up shop and suddenly you are the outsider, and have to market heavily to see 1/3 of the patients that you had the year before. If the hospital you are on staff at sees that you are bringing in money, they may suddenly recruit 2-3 DPMs or ortho foot and ankles and now you are out gunned in the marketing department. Moreover, nowadays the hospital controls all the primary care referral sources and you will see what they don't want and that is it.

You may also move to a town with only a few primary care doctors who do not care for or understand podiatry and refer patients 50 mils away for bunion corrections rather than send them across town to you.

The ratios don't tell the whole story. What you want to know is who is going to do what you do. a town of 90K with 10 retiring chip and clip DPMs is a great referral source for you if you bring surgical talent to the area where competition is scarce.

If you get hired by a hospital in a remote area that you would like to live in (or try to live in)-- that is another story and I would endorse that option.
But don't chase the ratio numbers, you are likely to get burned. It is not 1980!!

If you are not going back to where you will be practicing podiatry with neighbors you grew up with, you really should practice in a large growing city where you can grow with the town.

 

[NP 2 DPM]

If you calculate out that 350 million (US population) divided by 20,000 that leaves 17,500. If that is right and the current practicing podiatrist is over 16,000 then podiatry should be near saturation as well. Right?

Take into consideration a big number of that are older podiatrists that are soon to be retiring in the next 10-15 years. Opportunity is a plenty !

 

[TimmyTurner]

If I have to speak several languages to put food on my table and clothes on my back while working in America then something is drastically wrong.

You're right- it is wrong. As someone who has an intimate knowledge of immigrant communities in the US- the reality is, there is no selective pressure to learn English. There are microcommunities that pop up all over that become a self-contained economy. There are people living in the US for decades who haven't bothered to learn a word of english simply because there is no need to. Shop at the spanish grocery store, visit the bank with the tellers that speaks spanish, work for the spanish speaking employer, who's customer base is entirely spanish speaking... etc etc. I agree in principal but the reality is that if there is no selective pressure to learn (meaning, you need to know english in order to achieve tasks and function in society)- people won't learn.
I could stand on moral principal and not learn the basic tenants of other languages, or I could accept that this is the world we live in and tap into a patient pool that would otherwise be unavailable to me.

Lastly, what is the likelihood that the patient in question who doesn't speak English in the country they have been living for quite sometime has real insurance? In my short experience as a resident most people who fit this demographic don't. That's why they come to the resident clinic and can't see the guy/gal with 20+ years of experience.

Fairly true- BUT when you're living off the grid, paying minimal taxes, paid in mostly or all cash- these patients will visit and will pay cash when the need is there. Plus, given the intimate nature of these communities, word travels fast. Positive outcomes from treating one patient in that community likely leads to more subsequent patients than it would from the general population.

It's not just the language barrier you would be dealing with but also each person's cultural background/ tendencies which can complicate patient care goals. You would need ample experience with these patient populations to understand their background. Not for me...

No argument here, but I'm in the business of treating patients irrespective of all the above. If I can help someone, and increase my bottom line, count me in.

 

[NatCh]

Some of my favorite patients are Spanish-speaking-only Hispanics who are uninsured. They tend to arrive early, act respectful, listen to my advice, and carry a pocketful of cash to pay on the way out. Between their English and my high school Spanish we can usually communicate, but many of them bring their own English-speaking friend or family member to help interpret rather than rely on me to provide an interpreter at my expense.

 

[ExperiencedDPM]

Good points above but call me old fashioned or just another white guy but...

If I have to speak several languages to put food on my table and clothes on my back while working in America then something is drastically wrong.

Lastly, what is the likelihood that the patient in question who doesn't speak English in the country they have been living for quite sometime has real insurance? In my short experience as a resident most people who fit this demographic don't. That's why they come to the resident clinic and can't see the guy/gal with 20+ years of experience.

It's not just the language barrier you would be dealing with but also each person's cultural background/ tendencies which can complicate patient care goals. You would need ample experience with these patient populations to understand their background. Not for me...


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If you want your head to explode, wait until you have 5 new patients in one day, all speaking different languages, all Medicaid patients and none of them speaking a WORD of English......insisting upon a translator at your expense.

We had a deaf patient request a translator, which of course is at the expense of the practice. The translator (sign language) charges for total time, including travel time to and from the office and time in the office. You have to commit to a window of time as a minimum. Then the patient doesn't show for the appointment and you've made zero dollars but have to pay hundreds.

Seems fair, doesn't it??