Relevancy of PM News

[Feli]

I love the "campus of the proposed Orlando College of Osteopathic Medicine (OCOM)...".

As if they don't approve whatever makes $$$.

I think it's amazing the MDs have at least taken unilateral control of the MD/DO residency creation/flow/approval. That will be the saving grace for MD/DO saturation: the ACGME and the ABMS boards can keep post-grad training spots throttled. If AOA goes bonkers and signs off on schools left and right to the point that they ever get lesser quality students and/or too many USA grads for USA medical residencies and board pass rates falter, they don't control residencies anymore. ACGME can still force a limit and make nonsense schools lose accreditation if they recklessly cause residency shortages for their grads.

...podiatry should be so lucky. Maybe the CPME and APMA at the same mailing address is a coincidence. Me thinks knows better.

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[Adam Smasher]

Again, recycling old talking points here...

I don't think it's all bad for new schools to be created if they want to innovate the way they train DPMs and put pressure on the older schools to improve or go extinct. I have predicted the podiatry matriculation crisis will be a lasting trend.* Because of this we will see an increasing number of schools charging higher tuition to smaller classes. So I for one welcome the future Orlando College of Podiatric Medicine (haha the new OCPM).

*Of course if I'm wrong, the bottom falls out of the podiatry job market

 

[Feli]

Again, recycling old talking points here...

I don't think it's all bad for new schools to be created if they want to innovate the way they train DPMs and put pressure on the older schools to improve or go extinct. I have predicted the podiatry matriculation crisis will be a lasting trend.* Because of this we will see an increasing number of schools charging higher tuition to smaller classes. So I for one welcome the future Orlando College of Podiatric Medicine (haha the new OCPM).

*Of course if I'm wrong, the bottom falls out of the podiatry job market

This is a good way to look at it, but MD and DO schools are hundreds of seats. Hundreds... especially at the new for-profit DO schools.

Dental schools and even vet school class sizes are bigger than pod schools on average. They share the professors, the libraries, the labs, research, the clinic rotations among the pod and other health grad student. That cuts costs.

Having more pod schools will just shrink the class sizes at each as they fight for limited demand (due to low ROI on DPM degree/jobs). That will mean less money per school and even worse professor pay, clinic budgets, etc. Quality will suffer. The podiatry-specific classes can't be teaching to 15 or 25 kids. They can try to charge more per student if they want, but ROI (and student apps) will really just go down even faster if they do... and they're limited by max federal student loan limits. The lack of pre-podiatry students should theoretically mean pod schools lower tuition or offer more scholarships to attract prospective students, and that is the only good I can see from new schools... but we all know that won't happen. As you said, they'll find a way to attract more, charge more, keep more students on 5yr program, etc.

I would say make an east, west, central pod school, have fairly big ~100 student classes with good professors, and make the few schools GOOD... with good volume/diversity academic residency spots to follow also (wash out the many, many crummy DPM residency spots and non-teaching hospitals). So, basically the opposite of what we have now with more schools and many crap residencies

 

[msuDPM]

Nobody touching this?

 

[Shiyuan]

Nobody touching this?

Cash only - $500 per 1/5 supinatory twist of the wrist.

 

[heybrother]

Nobody touching this?

I think this problem is going to sort itself out really soon in ways the original author has never considered.

 

[Adam Smasher]

This podiatrist seems like a decently intelligent guy, fellowship trained, doing well for himself professionally. Such a shame that the first thing the lay media wants to interview him about is sock advice.

 

[HardRoadPaved]

View attachment 376240
This podiatrist seems like a decently intelligent guy, fellowship trained, doing well for himself professionally. Such a shame that the first thing the lay media wants to interview him about is sock advice.

Glad a high powered medical journal needed his input too.

 

[Adam Smasher]

...there's about to be a lot of wailing and gnashing of teeth in the comment section...

 

[Shiyuan]

View attachment 376309

...there's about to be a lot of wailing and gnashing of teeth in the comment section...

Lobsters unite! It’s out of her scope!!!!!! Report report!!!! 😂

 

[BubbaWub]

View attachment 376309

...there's about to be a lot of wailing and gnashing of teeth in the comment section...

This is incredibly upsetting. We need to fight this! Our livelihoods are at stake!

I'll contact my president regarding this.

Thank you for bringing this to my attention.

 

[Adam Smasher]

Honestly if more nurses took on this role, we wouldn't need to keep on opening schools.

 

[Boba Foot]

View attachment 376309

...there's about to be a lot of wailing and gnashing of teeth in the comment section...

If she wants that $30 from Medicare for "debriding mycotic nails", by all means.....

 

[shadesofgrey]

What we ought to do is get it clarified that pods don't have to perform the nail care themselves. That way I can just supervise an army of nail techs, like my dentist does with his hygienists.

 

[Adam Smasher]

That way I can just supervise an army of nail techs

Haha yes and whoever has the biggest army will put the solo mustache doc out of business and conquer the land of the toenails. This is going to be a great meme

 

[PlainsPod]

If she wants that $30 from Medicare for "debriding mycotic nails", by all means.....

She probably has no idea, and will soon be billing a lot of 11730s

 

[NatCh]

Two separate nurse-owned groups in my city do nail care. They have been a godsend, and we stock their business cards at our front desk. They don't bill insurance though, and apparently none of the podiatry groups accept new nail care patients, so the hospital has hired a couple of RNs to do billable nail care in their wound care clinic. Hallelujah.

 

[Retrograde_Nail]

If she wants that $30 from Medicare for "debriding mycotic nails", by all means.....

It's in the eye of the beholder. They probably see it as good money for minimal amount of work. It beats wiping butts on the inpatient floor.

 

[DYK343]

I would jump all over the opportunity to have this clinic next door to mine.
Pays wRVU garbage and its nothing I can cure.
They can have it.

I've always wanted a nail tech. Its dumb we cant have someone do it and supervise. Pay them $10 a patient so they have some incentive to bust as many crumblies as possible.
Could make $60 an hour pretty easy with minimal certification.
Hospital would still collect that facility fee. I could collect about $40/patient for "supervision".
Its a perfect setup. But it wont happen because dumb laws.

 

[dtrack22]

What we ought to do is get it clarified that pods don't have to perform the nail care themselves. That way I can just supervise an army of nail techs, like my dentist does with his hygienists.

Did you guys know hygienists in many cities now get paid more than your average podiatry associate? They are well above $50 per hour all across the country. I had no idea. And it makes Podiatry an even dumber career choice in retrospect.

 

[Adam Smasher]

But it wont happen because dumb laws.

That's not how the saying goes

 

[Adam Smasher]

She probably has no idea, and will soon be billing a lot of 11730s

It's in the eye of the beholder. They probably see it as good money for minimal amount of work. It beats wiping butts on the inpatient floor.

To my knowledge, nurses can't bill insurance for doing this. They have to have a direct pay arrangement ("cash for keratin").

This is why podiatrists will always be stuck with nail cutting. Nothing to do with expertise or patient safety, it's all about money. Patients weather nails clipped and don't want to pay a dime for it.

 

[Retrograde_Nail]

To my knowledge, nurses can't bill insurance for doing this. They have to have a direct pay arrangement ("cash for keratin").

This is why podiatrists will always be stuck with nail cutting. Nothing to do with expertise or patient safety, it's all about money. Patients weather nails clipped and don't want to pay a dime for it.

All is takes is a little nurse lobbying to demonstrate that this is an area of medicine that is not being managed by dumb podiatrists and the laws will get changed. It will most likely happen.

 

[Utvolsdpm]

To my knowledge, nurses can't bill insurance for doing this. They have to have a direct pay arrangement ("cash for keratin").

This is why podiatrists will always be stuck with nail cutting. Nothing to do with expertise or patient safety, it's all about money. Patients weather nails clipped and don't want to pay a dime for it.

And you can thank the APMA for that!

/s

 

[HardRoadPaved]

And this is why billing services suck

 

[Hybrocure]

View attachment 376414

And this is why billing services suck

The location is New Jersey. We all know they should be using the nail debridement code for those slantbacks

 

[Adam Smasher]

A rare in-touch letter

 

[Hybrocure]

View attachment 376521

A rare in-touch letter

Disagree. Nurses won’t be working for podiatrists. The pay is too similar between us and them. Just like with wound care centers a retiring surgeon MD or DO will step in to manage an army of nurses who do foot care.

People say we don’t have young podiatrists doing routine care. Give it a year or two with this horrible job market and over saturation. They’ll be fighting over nails and calluses.

 

[diabeticfootdr]

So oversaturated with podiatric surgeons that other healthcare providers have to do our work? Something doesn't add up ....

(That was just to provoke the SDN crazies)

In reality, I support nurses doing this work. As I've said before, it doesn't take a doctor. It probably doesn't take a nurse either.

It should get changed to "incident-to" billing by CMS, then any physician could supervise it. Patients would get better access and better care.

 

[icebreaker32]

A rare in-touch letter

He is correct that many younger podiatrists are not doing nursing homes. Reason though is not because there are not enough podiatrists to do it. The reason is it pays like $20 per patient and there are only so many facilities in an area (outside of the largest cities/metros) without spending the night out of town. A lot of paperwork and not a lot of money without extreme volume. Follow the money....if it paid better, more podiatrists would be doing it.

All but the sickest nursing home patients can be seen in the office also as patients from nursing homes see other specialists in the office. The nurses can see most of patients and refer out the few they can not handle that are not bed bound. Not that most doctors are thrilled about nursing home patients in the office, but they see them. Why does podiatry always feel like it is a national issue when a toenail can not be trimmed?


Mobile podiatry has learned home visits and assisted living centers have less volume but the ability to charge for a lot more services like ultrasound, vascular testing and DME etc that one can not bill for at nursing homes.

 

[HardRoadPaved]

So oversaturated with podiatric surgeons that other healthcare providers have to do our work? Something doesn't add up ....

(That was just to provoke the SDN crazies)

In reality, I support nurses doing this work. As I've said before, it doesn't take a doctor. It probably doesn't take a nurse either.

We are not oversaturated with jobs that need a 4+3or4+1 training model. We dont need more DPMs doing as you said work that "probably doesnt take a nurse either"

That would be contradicting yourself....

Nice try (That was just to provoke you)

 

[Hybrocure]

So how about those $3500 cash pay orthotics being argued over in the last couple emails

 

[Adam Smasher]

So how about those $3500 cash pay orthotics being argued over in the last couple emails

I for one respect the hustle. If I had the showmanship to move $3k worth of plastic, I'd be living in Beverly Hills too

 

[footshazam]

Did you guys know hygienists in many cities now get paid more than your average podiatry associate? They are well above $50 per hour all across the country. I had no idea. And it makes Podiatry an even dumber career choice in retrospect.

Damn I just looked it up and you’re right. Sad sad state of affairs for podiatry.

 

[Hybrocure]

I for one respect the hustle. If I had the showmanship to move $3k worth of plastic, I'd be living in Beverly Hills too

I’d be curious to know what justifies it to be that expensive. I know some stores will sell 1k orthotics but I haven’t heard 3k ones

 

[Adam Smasher]

I’d be curious to know what justifies it to be that expensive

Because his name is Ivar MotherTrucking Roth, that's why

 

[HardRoadPaved]

It's usually rougher there without finishing with lotion.

 

[Shiyuan]

I love PM News. Kinda like the Sunday newspaper comics.

 

[Hybrocure]

View attachment 376850

It's usually rougher there without finishing with lotion.

Lol I saw this one. Very cringe. These old school pods lotioning up and massaging a patients foot (probably without gloves) is why people think podiatrists have a foot fetish.

So creepy.

 

[GreenHousePub]

Love these old guys saying that they wished they could've worked until their 80s. Especially by not hiring a podiatrist, but a nurse.

Unlike a lot of professions where you retire at a reasonable age and let the next generation come in.

 

[Adam Smasher]

Imagine graduating in 1974 and doing a zero-year residency.

Your student loans are probably about $10k. You go straight into solo practice in a 1970s regulatory environment. You understand biomechanics in and out, you believe you could cure anything with a well designed custom foot orthosis--and so does everyone else! The diabetes epidemic is just a dot on the horizon, and the pus bus doesn't stop in your neighborhood. Paper charting is crude but your notes are only 5 lines long anyway. PAs and NPs had only been created a decade prior and are basically nonexistent. You don't know much about surgery but that doesn't stop you from doing it in your office. You career spans the CPT bonanza of the 1980s and 1990s. You amass your fortune clipping nails and generally doing a whole lot of nothing for people.

Half a century later you shake your cane at the computer complaining about "kids these days" and how they don't want to lotion patients' feet

 

[heybrother]

Imagine graduating in 1974 and doing a zero-year residency.

Your student loans are probably about $10k. You go straight into solo practice in a 1970s regulatory environment. You understand biomechanics in and out, you believe you could cure anything with a well designed custom foot orthosis--and so does everyone else! The diabetes epidemic is just a dot on the horizon, and the pus bus doesn't stop in your neighborhood. Paper charting is crude but your notes are only 5 lines long anyway. PAs and NPs had only been created a decade prior and are basically nonexistent. You don't know much about surgery but that doesn't stop you from doing it in your office. You career spans the CPT bonanza of the 1980s and 1990s. You amass your fortune clipping nails and generally doing a whole lot of nothing for people.

Half a century later you shake your cane at the computer complaining about "kids these days" and how they don't want to lotion patients' feet

I've joked about this elsewhere, but I have the meeting logs for a historic conference/meeting in my area that occurred back into the 1950s. Its very interesting and includes notes on the transition from Chiropody to Podiatry. Very interestingly in several of the meetings notes are brief discussions of attempts to negotiate with BCBS to get chiropody services covered. Each year of the notes - it hadn't happened yet ie. BCBS was still looking into it. Its weird to think how potentially excited they were at the time to be covered by insurance and how over 60-70 years that excitement has changed into both mainstreaming us but also maiming us like the rest of medicine as insurance and hospitals have devoured everything.

 

[Retrograde_Nail]

View attachment 376850

It's usually rougher there without finishing with lotion.

This guy was Grand fathered into board certification by ABFAS while there is a 50% fail rate currently for 3 year trained and our beloved fellowship trained podiatrists. Think about this....

This guy in his prime probably could NOT fix a hammertoe right. THINK ABOUT THAT FOR A MOMENT.

 

[icebreaker32]

View attachment 376850

It's usually rougher there without finishing with lotion.

Real mustache podiatrists only finish with Gormel Cream.

In all honesty some practices are opening nail salons and getting into aesthetic podiatry, where not all of the services are performed by the podiatrists.

 

[air bud]

This guy was Grand fathered into board certification by ABFAS while there is a 50% fail rate currently for 3 year trained and our beloved fellowship trained podiatrists. Think about this....

This guy in his prime probably could NOT fix a hammertoe right. THINK ABOUT THAT FOR A MOMENT.

Where is DPM Truth when we need him ...

 

[Sweatshirt]

This is truly the ideal podiatry mustache. You may not like it, but this is what peak podiatry mustache performance looks like

 

[Boba Foot]

This is truly the ideal podiatry mustache. You may not like it, but this is what peak podiatry mustache performance looks like

View attachment 377014

 

[RollingstonePod]

This guy was Grand fathered into board certification by ABFAS while there is a 50% fail rate currently for 3 year trained and our beloved fellowship trained podiatrists. Think about this....

This guy in his prime probably could NOT fix a hammertoe right. THINK ABOUT THAT FOR A MOMENT.

You have no idea what you’re talking about but I would not expect you to know since you are not privy to accurate information. Nobody gets grandfathered into board certification. The individual you’re referring to achieved BC by ABPS at that time. ABPS certified individuals prior to 1990 always had a lifetime certificate in foot and ankle surgery which is a status that is no longer offered. After 1991 certification became time limited and required a recertification test every 10 years up until LEAD began two years ago. Certification status at that time was also separated into foot and RRA requiring separate testing and recertification.

Your claim of a 50% pass rate is also inaccurate. Last year’s cumulative pass rates for foot and RRA case review we’re both above 80%. Foot surgery didactic was above 80% and foot surgery CBPS was above 90%. The lowest pass rate was for RRA didactic and CBPS both at 65%. Certain people on SDN (LCR) like to skew the numbers to push a narrative of unfairness or elitism. If you know your stuff, and you do good work, you should have no problem passing the ABFAS process. THINK ABOUT THAT.

 

[air bud]

This is truly the ideal podiatry mustache. You may not like it, but this is what peak podiatry mustache performance looks like

View attachment 377014

Excellent

 

[Hybrocure]

You have no idea what you’re talking about but I would not expect you to know since you are not privy to accurate information. Nobody gets grandfathered into board certification. The individual you’re referring to achieved BC by ABPS at that time. ABPS certified individuals prior to 1990 always had a lifetime certificate in foot and ankle surgery which is a status that is no longer offered. After 1991 certification became time limited and required a recertification test every 10 years up until LEAD began two years ago. Certification status at that time was also separated into foot and RRA requiring separate testing and recertification.

Your claim of a 50% pass rate is also inaccurate. Last year’s cumulative pass rates for foot and RRA case review we’re both above 80%. Foot surgery didactic was above 80% and foot surgery CBPS was above 90%. The lowest pass rate was for RRA didactic and CBPS both at 65%. Certain people on SDN (LCR) like to skew the numbers to push a narrative of unfairness or elitism. If you know your stuff, and you do good work, you should have no problem passing the ABFAS process. THINK ABOUT THAT.

Found the ABFAS plant