Podiatry Bipolar

[icebreaker32]

In many ways podiatry has come a long, long ways. Residency training for all, with a much higher percentage getting good or great training.

As much as we justifiably knock the job market, there are mid size cities, often in fly over states where the majority of podiatrists are employed by ortho groups or hospital systems. If there is private practice it is usually not solo and a group with no mustache podiatrists. Sure they push Tolcylen, lotions, orthotics and laser toenail treatments to up their daily charges but they are not into the more scammy things and well trained. If one was from an are like this as a pre pod they would be convinced podiatry was a mainstream medical specialty. They would even see a good number of local doctors practicing and assume it would be easy to find a job. Although in the markets like this the reality is a locally raised and well trained applicant stands a decent chance of securing a good job, there are also fellows competing for these jobs. Not too long ago if one could time travel they would not believe podiatry had come so far in markets like this.

The rest of the country is not like this. Some areas it is mix with a bit of everything. Some areas of the country it is mainly solos or small groups with most doing well eventually and often opening their own practice after starting out as an associate. The scammy factor is a bit higher. There are also the saturated large cities often near schools with a podiatrist on every corner and the scammy factor through the roof and the worst of the worst associate jobs.

If only the first scenario was the norm and we can only dream that there will ever be an open unfilled organizational job that no one applied to. I see a slow continued growth in organizational jobs, but these often cutoff referral sources to private practice also. I still believe there will not be enough job growth for podiatry for anywhere near most to get organizational jobs. As it stands you have to hope for a good organizational job, but be willing to create your own job or be an associate. If enrollment stays down hopefully the poor associate jobs become less common. I do not think most going into podiatry school though they would be recruited for an organizational job, they just underestimated how competitive it would be to get one and how poor the associate jobs are in many areas. I think less also thought going in they might have to open their own practice. In years past many knew they would have to start their own practice or take over a retiring doctor's practice.....a good number still need to go this route even today to leave a bad associate job with no route or no fair route to partner.

---

Members don't see this ad.

 

[Pronation]

tldr; pod job market blows huge donkey balls

Hot take: now is the time to start opening up your podiatry associate mills and make a killing off of these poor suckers that won’t find any jobs better than $80k.

 

[icebreaker32]

tldr; pod job market blows huge donkey balls

Hot take: now is the time to start opening up your podiatry associate mills and make a killing off of these poor suckers that won’t find any jobs better than $80k.

Definitely as a whole and also if compared to any healthcare profession that requires the length and cost of podiatry.

 

[Adam Smasher]

The whole thing has a ponzi scheme feel. You work and generate $ for owner, then become owner and hire someone to generate $ for you. Problem is ponzi schemes collapse, whoever can't find an associate will be left applying for NP school

 

[wakaflocka88]

It’s unfortunate this requires an online forum to expose the truth, both the good and bad side of the profession. Podiatry has great potential, if only we had stronger, more ethical leadership. All this parity talk is just a smoke for our governing leaders to continue to scam the system below them.

 

[NatCh]

tldr; pod job market blows huge donkey balls

Hot take: now is the time to start opening up your podiatry associate mills and make a killing off of these poor suckers that won’t find any jobs better than $80k.

Hey, I like that. Lean in. If you can't beat 'em, join 'em.

 

[Adam Smasher]

Hey, I like that. Lean in. If you can't beat 'em, join 'em.

More like you either die the hero or live long enough to become the villain

 

[Bored Snorlax]

In many ways podiatry has come a long, long ways. Residency training for all, with a much higher percentage getting good or great training.

As much as we justifiably knock the job market, there are mid size cities, often in fly over states where the majority of podiatrists are employed by ortho groups or hospital systems. If there is private practice it is usually not solo and a group with no mustache podiatrists. Sure they push Tolcylen, lotions, orthotics and laser toenail treatments to up their daily charges but they are not into the more scammy things and well trained. If one was from an are like this as a pre pod they would be convinced podiatry was a mainstream medical specialty. They would even see a good number of local doctors practicing and assume it would be easy to find a job. Although in the markets like this the reality is a locally raised and well trained applicant stands a decent chance of securing a good job, there are also fellows competing for these jobs. Not too long ago if one could time travel they would not believe podiatry had come so far in markets like this.

The rest of the country is not like this. Some areas it is mix with a bit of everything. Some areas of the country it is mainly solos or small groups with most doing well eventually and often opening their own practice after starting out as an associate. The scammy factor is a bit higher. There are also the saturated large cities often near schools with a podiatrist on every corner and the scammy factor through the roof and the worst of the worst associate jobs.

If only the first scenario was the norm and we can only dream that there will ever be an open unfilled organizational job that no one applied to. I see a slow continued growth in organizational jobs, but these often cutoff referral sources to private practice also. I still believe there will not be enough job growth for podiatry for anywhere near most to get organizational jobs. As it stands you have to hope for a good organizational job, but be willing to create your own job or be an associate. If enrollment stays down hopefully the poor associate jobs become less common. I do not think most going into podiatry school though they would be recruited for an organizational job, they just underestimated how competitive it would be to get one and how poor the associate jobs are in many areas. I think less also thought going in they might have to open their own practice. In years past many knew they would have to start their own practice or take over a retiring doctor's practice.....a good number still need to go this route even today to leave a bad associate job with no route or no fair route to partner.

Insightful read and thank you for broadening my horizon. I'd also like to add that within a decade from now, the minimum age for baby boomers will be 65+, and statistically speaking there should be a substantial increase in the number of diabetics and need for geriatric care.

According to the ADA:

• Prevalence in seniors: The percentage of Americans age 65 and older remains high, at 29.2%, or 15.9 million seniors (diagnosed and undiagnosed).

Statistics About Diabetes | ADA

Learn overall diabetes numbers, in youth, by race/ethnicity, deaths, cost of diabetes and additional information.

diabetes.org

Cost of diabetes​

Updated March 22, 2018

$327 billion: Total cost of diagnosed diabetes in the United States in 2017
$237 billion was for direct medical costs
$90 billion was in reduced productivity

This is a great opportunity for America to reduce healthcare costs by promoting and integrating podiatric care into chronic disease prevention policy. The podiatric leaders should be mindful of the upcoming opportunities to outline and execute a plan that will move podiatry forward by creating more applications for podiatry in healthcare.

 

[icebreaker32]

Insightful read and thank you for broadening my horizon. I'd also like to add that within a decade from now, the minimum age for baby boomers will be 65+, and statistically speaking there should be a substantial increase in the number of diabetics and need for geriatric care.

According to the ADA:

• Prevalence in seniors: The percentage of Americans age 65 and older remains high, at 29.2%, or 15.9 million seniors (diagnosed and undiagnosed).

Statistics About Diabetes | ADA

Learn overall diabetes numbers, in youth, by race/ethnicity, deaths, cost of diabetes and additional information.

diabetes.org

Cost of diabetes​

Updated March 22, 2018

$327 billion: Total cost of diagnosed diabetes in the United States in 2017
$237 billion was for direct medical costs
$90 billion was in reduced productivity

This is a great opportunity for America to reduce healthcare costs by promoting and integrating podiatric care into chronic disease prevention policy. The podiatric leaders should be mindful of the upcoming opportunities to outline and execute a plan that will move podiatry forward by creating more applications for podiatry in healthcare.

Certainly lots of healthcare dollars will be spent....don't count on it to significantly change podiatry as a profession. If it does great, but we have heard this for decades already.

 

[HardRoadPaved]

Cant wait to take advantage of my 3 year surgical training for "geriatric care"...

 

[Adam Smasher]

Cant wait to take advantage of my 3 year surgical training for "geriatric care"...

And herein lies the true problem with our profession. It's completely divorced from reality.

We increase the number of schools in the face of decreasing applicants.

We're supposed to increase student recruitment in the face of a projected (per bls) slow job growth.

We're a little over 10 years out from lengthening our training to the standardized 3 year residency while mid-level providers with shorter training render care that is in some ways more complex than what we do. We make it harder for our people to do easy work, they make it easier for their people to do hard work.

Our schooling is heavily focused on surgery and perioperative medicine, while 90% of what I do in my workday (and I'm sure many of you do the same) involves nonoperative care for my patients or non-medical administrative decision making for my business.

Our medical board thinks it's a surgical board, and our surgical board doesn't want to certify anyone.

I really don't know where we go from here, we've created a mess

 

[heybrother]

And herein lies the true problem with our profession. It's completely divorced from reality.

We increase the number of schools in the face of decreasing applicants.

We're supposed to increase student recruitment in the face of a projected (per bls) slow job growth.

We're a little over 10 years out from lengthening our training to the standardized 3 year residency while mid-level providers with shorter training render care that is in some ways more complex than what we do. We make it harder for our people to do easy work, they make it easier for their people to do hard work.

Our schooling is heavily focused on surgery and perioperative medicine, while 90% of what I do in my workday (and I'm sure many of you do the same) involves nonoperative care for my patients or non-medical administrative decision making for my business.

Our medical board thinks it's a surgical board, and our surgical board doesn't want to certify anyone.

I really don't know where we go from here, we've created a mess

haha. Great post.

I'm a broken record, but negative payor trends are going to continue.

I just got a major Medicare Advantage plant to admit that they were underpaying me based on the contract. During the email exchange they basically admitted that the reason they didn't think I was being underpaid is that their policy henceforth is that podiatrists are only to be paid 85% of Medicare. That's the "correct" amount and basically they never checked the contract to see otherwise. The contract stating 100% is in fact is a "mistake". Their words. The practice has been in business for greater than 30 years. I've got like 7-8 years of data and this MA plan never paid less than Medicare in the past until the last few years.

 

[icebreaker32]

haha. Great post.

I'm a broken record, but negative payor trends are going to continue.

I just got a major Medicare Advantage plant to admit that they were underpaying me based on the contract. During the email exchange they basically admitted that the reason they didn't think I was being underpaid is that their policy henceforth is that podiatrists are only to be paid 85% of Medicare. That's the "correct" amount and basically they never checked the contract to see otherwise. The contract stating 100% is in fact is a "mistake". Their words. The practice has been in business for greater than 30 years. I've got like 7-8 years of data and this MA plan never paid less than Medicare in the past until the last few years.

The profession really needs someone like you working for APMA or some other organization fighting for podiatry. Sadly for most that do get a job like that, after about a year they do not have same perspective or drive. It is why term limits are so important in just about everything.

 

[AttackNME]

There’s no money to be made from being in leadership. To make big changes requires a lot of uncompensated time spent working on rewriting the bylaws, and the effort it takes to having all the other volunteer board members to agree it it. No thanks

 

[Bored Snorlax]

It's depressing and insulting. In Texas podiatrists can't even administer vaccination shots, but pharmacists, nurses, pas, etc are authorized to give shots.

We take the MCAT, we have the privilege of dissecting full human bodies and learning from our donors, share the same rigorous curriculum as our MD/DO colleagues, sit for 3 medical national board exams to assess our medical and clinical competency, but we're not authorized to give vaccination shots during a national pandemic? Yet at the same time we undergo residency training to become podiatric physicians and surgeons. I practically lived in the anatomy lab and missed meals to learn every bone, muscle, and vasculatures of the human body.

Podiatry needs better leadership if anything is going to get done correctly this decade. At the moment it's a total unorganized mess.

Mid-level providers are constantly increasing their scope, but the profession that shares the most in common with MD/DO training are heavily limited in many areas. Patients deserve better than this.

Prohibited Acts and Procedures - Podiatry - Texas.gov

This document outlines acts and procedures that are prohibited by the Podiatry scope of practice. Refer to the statute and rules for complete details.

www.tdlr.texas.gov

 

[icebreaker32]

Makes no sense during the pandemic we could not give vaccines. This would have been a a good side job during the pandemic for those interested.

Makes no sense we can not even clear a healthy patient (ASA 1) for a minor surgery on our own at many facilities.

Podiatry as a profession has made some progress over the years, but it is amazing how far DOs and NPs have come as a profession. PAs lobbying is not as strong as NPs, but they continue to move forward also. Privileges for NPs and PAs can still vary a bit hospital to hospital though even in the same state, just like DPMs.

 

[deleted1138023]

RN's/NP's/PA's fight for each other.

We hold each other down.

it's truly a shame.

 

[Pronation]

There’s absolutely no reason a podiatrist needs to be giving out vaccines shots since everybody now knows that ivermectin is much more gooder.

Google Image Result for https://upload.wikimedia.org/wikipedia/en/thumb/9/9a/Trollface_non-free.png/220px-Trollface_non-free.png

 

[heybrother]

The profession really needs someone like you working for APMA or some other organization fighting for podiatry. Sadly for most that do get a job like that, after about a year they do not have same perspective or drive. It is why term limits are so important in just about everything.

I don't think there is a solution for this other than what we advocate on this board (50% reduction in the podiatry population). Unless its illegal for a large insurance company to decide that the Medicare Advantage fee schedule for a podiatrist should start at 85% we're going to continue to see things like this because we're over saturated. They can set our value and say our services are worth less - that we're not really delivering or that in truth everything we do is really us cutting nails/callusing and claiming its something else. Consider some of the fee schedules king22 used to write about in NYC. Insurance could pay what it wanted because of the number of doctors and the number of podiatrists which is a perfect refutation of the garbage the new LECOM dean was spewing about prosperity through saturation.

My plans to leave a large payor went awry this year through a mixed story but when I leave next year there will only be 2 PPs that accept that insurance in a town of several hundred thousand. How it will affect our office I cannot say - my partner has already changed the schedule to see fewer patients - if he's going to see fewer people we need to try and corral higher paying insurance or control costs.

 

[msion]

My plans to leave a large payor went awry this year through a mixed story but when I leave next year there will only be 2 PPs that accept that insurance in a town of several hundred thousand. How it will affect our office I cannot say - my partner has already changed the schedule to see fewer patients - if he's going to see fewer people we need to try and corral higher paying insurance or control costs.

Love it. I was in a similar situation that we were the only office seeing a particular managed medicaid plan. There was one day we received a direct referral from that insurance company regarding a patient needing cavus surgery. Actually patient was from another county. The insurance company saw that I was in the network, and then picked an outpatient GI surgery center that was 90 miles away from where I live, then told the patient to see me for surgery work-up and surgery was already authorized. Funny thing is that they were actually pretty spot on with the CPT codes, but then said "authorization doesn't equal reimbursement." And of course there was no way I was ever going to do it, in a GI place.

There is a special place in hell for all insurance companies.

 

[shadesofgrey]

We regularly have Medicaid patients driving an hour to see us because no one else accepts it in our area. Our office has had to limit the new patient Medicaids to one visit per provider per day. We were just getting inundated with them. I feel bad for these folks but their insurance just doesn’t reimburse enough to make it worth seeing. Also, it inevitably feels like half of them are chronic pain patients with limited potential for improvement.

 

[pod squad]

One of the huge underlying issues of our field is the inability/unwillingness of DPMs to work together in order to improve their circumstances. In order to change things even at a small community hospital (let alone nationally), podiatrists need to join forces and present a unified front to the powers that be. Problem is, the ones who have 'made it' in our field (aka making a fair salary at a respectable organization) don't want to upset the apple cart. This is what happens when a growing number of people need to compete for ever-shrinking resources

 

[padeheer]

As a leader of the profession, I can speak firsthand on why giving back to the profession is essential. My career has exceeded my expectations and provided me with numerous opportunities. I think it is important to pay it forward by leaving the profession better than we find it. As a residency director with 12 residents and 4-6 students rotating through our program every month, I try to lead by example and show the importance of giving back to the profession. APMA's leadership works hard to advance the profession while serving the needs of podiatric physicians, residents, and students. If you think changes should be made, getting involved is the way to foster change. We all have reasons for giving our time to the profession, but I think those who do give back do so because of their love of podiatry.

 

[dtrack22]

APMA's leadership works hard to advance the profession while serving the needs of podiatric physicians, residents, and students.

APMA’s leadership was a direct contributor to the continuation of license restrictions in the state of Oregon. Why didn’t anyone decide to work hard to advance the needs of podiatrists on that one?

For the regulars here, we aren’t talking about APMA failing to speak up, or support, or fund something. The APMA actually drafted a letter recommending against the proposed language change that would have removed some license/scope restrictions at the state level. They essentially lobbied against podiatrists in the state of Oregon. And what’s great is that the state medical board cited the opposition from the APMA and OPMA as the reason they did not accept/recommend the proposed changes.

 

[padeheer]

I understand the confusion on the Oregon matter; it is complicated. APMA is a membership organization, and once OPMA's Board voted to withdraw their request APMA followed. APMA's written testimony clearly stated our policy on board certification as it relates to state licensure. Here are two key segments from the written testimony of which I was one of the two cosigners.
“ however, APMA maintains that scope of practice legislation and associated regulations should not include requirements about performance of specific procedures or treatments. Such credentialing should be done at the level of the hospital or other facility where such procedures will be done.”
“APMA’s long-held stance has been that hospital privileges will be determined by the type of residency training, but that board certification should not be the sole determining factor. Additionally, APMA holds that all podiatrists are able to treat patients independently both medically and surgically regardless of residency training.”

 

[dtrack22]

I understand the confusion on the Oregon matter; it is complicated.

It is not complicated. A few state board members were scared of what ortho might think because there was some push back. They decided they wanted time to negotiate or compromise with ortho. Turns out the medical board didn’t really care what ortho thought…

APMA's written testimony clearly stated our policy on board certification as it relates to state licensure. Here are two key segments from the written testimony of which I was one of the two cosigners.

If that is the position of the APMA then the APMA should have supported that position. Which you did not. The very beginning of the written testimony…

“we write in support of the Oregon Podiatric Medical Association’s (OPMA) decision to withdraw its request to change the Oregon Medical Board’s (OMB) administrative rule requiring American Board of Foot and Ankle Surgery (ABFAS) Reconstructive Rearfoot/Ankle surgery (RRA) certification to perform ankle surgery in Oregon.”

All the APMA had to do was write a letter stating the organizations position regarding licensing. But they didn’t. They actively supported the withdrawal of the rule change.

NPs are about to be able to do endoscopies and colonoscopies. While our leadership is still scared of what orthopedic surgeons might think. After realizing the OPMA and APMA were the primary reason our licensure still has unnecessary restrictions on it, I’m very happy with my decision to no longer contribute financially to organizations who do not actually support podiatrists. Maybe the APMA could have a joint meeting with some Nurse Practitioner organizations to learn how to actually stick up for and support the advancement of their profession? Because NPs have gone from needing supervision to having full autonomy and being able to do procedures in an OR in about a 5-10 year time frame. Meanwhile the APMA can’t even get a single state scope issue resolved/changed/improved.

Just stop being cowards and start acting like nursing organizations.

 

[padeheer]

It is not complicated. A few state board members were scared of what ortho might think because there was some push back. They decided they wanted time to negotiate or compromise with ortho. Turns out the medical board didn’t really care what ortho thought…



If that is the position of the APMA then the APMA should have supported that position. Which you did not. The very beginning of the written testimony…

“we write in support of the Oregon Podiatric Medical Association’s (OPMA) decision to withdraw its request to change the Oregon Medical Board’s (OMB) administrative rule requiring American Board of Foot and Ankle Surgery (ABFAS) Reconstructive Rearfoot/Ankle surgery (RRA) certification to perform ankle surgery in Oregon.”

All the APMA had to do was write a letter stating the organizations position regarding licensing. But they didn’t. They actively supported the withdrawal of the rule change.

NPs are about to be able to do endoscopies and colonoscopies. While our leadership is still scared of what orthopedic surgeons might think. After realizing the OPMA and APMA were the primary reason our licensure still has unnecessary restrictions on it, I’m very happy with my decision to no longer contribute financially to organizations who do not actually support podiatrists. Maybe the APMA could have a joint meeting with some Nurse Practitioner organizations to learn how to actually stick up for and support the advancement of their profession? Because NPs have gone from needing supervision to having full autonomy and being able to do procedures in an OR in about a 5-10 year time frame. Meanwhile the APMA can’t even get a single state scope issue resolved/changed/improved.

Just stop being cowards and start acting like nursing organizations.

Simply not accurate. We did state our policy while supporting our state component's decision. APMA collaborates with the state components on these matters to make changes.

If you want to participate in the profession's future, you should get involved.

Do you mean to support the podiatric physicians like when CMS was going to create separate E&M codes for podiatry? Not only separating podiatry from other physicians but also paying us less. That was APMA, and that was one small example.

BTW I am not a coward, nor are my fellow Trustees. We are volunteers giving tremendous time and effort to move the profession forward. We are not perfect, but we are doing the work of the profession for the profession with the best of intentions.

 

[AttackNME]

APMA’s leadership was a direct contributor to the continuation of license restrictions in the state of Oregon. Why didn’t anyone decide to work hard to advance the needs of podiatrists on that one?

For the regulars here, we aren’t talking about APMA failing to speak up, or support, or fund something. The APMA actually drafted a letter recommending against the proposed language change that would have removed some license/scope restrictions at the state level. They essentially lobbied against podiatrists in the state of Oregon. And what’s great is that the state medical board cited the opposition from the APMA and OPMA as the reason they did not accept/recommend the proposed changes.

Dude what happened there? What restrictions are you/they having?