The question on many Podiatrist’s minds over the past month or two is will Podiatry return to normal following the Coronavirus or COVID Pandemic. This is a great question. The last decade in Podiatry has seen probably one of the largest growths and enlarging of Podiatry in the last one hundred years. We have seen Podiatrists being rarities in medical and orthopedic groups to now being common. Podiatrists have evolved from single practices to group practices with increasing speed. The average Podiatrist’s salary in 2010 was $133,000; in 2019 it was 172,000. That is a $40,000 dollar increase over ten years. This greatly outpaced the rate of inflation. So many things drove this increase: technology allowing Podiatrists to see more patients in a day, more aggressive billing and coding regimens, and as stated before the migration of Podiatrists into more profitable arrangements such as orthopedic groups and Medical groups.

But now over the course of the month, Podiatrists that were making 15k/month are now making 1k/month. Needless to say this has been a shock to the system. Now obviously there is a chance that a vaccine for COVID or the Coronavirus is created next week and everything goes back to normal next month. But generally speaking, events such as the COVID Pandemic have long ranging consequences for the entire countries economy. As we speak right now hospitals and medical groups are furloughing and laying off half their staff. Some hospitals only have one week of operating expenses left. To think this is not going to impact Podiatry is probably somewhat naive at this point. But how will it effect the Podiatry that will be the new normal?

The first thought about how it will effect Podiatry will be what others do. There are already whispers of changing the way Medicare and Insurance companies reimburse doctors. This is an attempt to get away from everyone being dependent on elective procedures. The idea is to get away from fee based services. This article goes into further detail on how health care will change, but needless to say fee for service maybe dead or change a lot.

https://www.modernhealthcare.com/opinion-editorial/therell-be-no-back-normal-healthcare-after-covid-19-crisis

The fact is one of the reasons Podiatrists make money is I and D, Debridements, injections and dispensing orthotics. Podiatrists did not increase their salary by $40,000 over the last decade by billing a bunch of office visits. And if fee for service goes away, are Medical Groups and Orthopedic groups really going to want to keep Podiatrists on staff, when you cannot differentiate yourself from Physician Assistants and Nurse Practitioners? That will be a problem.

The growth of Physician Assistants and Nurse Practitioners has exploded over the last decade as well. There are about 50% more of these physician extenders now in the United States. If Podiatrists are limited in billing for I and Ds and getting in the Operating Room, it would makes some sense that PAs and NPs, who are less expensive for groups to employ, may replace Podiatrists. 

What of Podiatric surgery? How long does the ban on elective surgeries last? There might be some Podiatrists that don’t perform elective surgery for a year. This is going to have massive financial implications. Additionally, what is the demand for elective Podiatric surgery going to be after this Pandemic? People are not going to just flick the switch from fearing for their life to think they need their bunion fixed. Most people think it will take three to five years for people to resume their previous consumer habits and this will probably be the same for Podiatrists. They are looking at a three to five year drop in demand for elective surgery. This is going to influence finances as well as residency training.

The recession. Let’s be honest, it’s a whole lot easier to sell orthotics when unemployment is not 20%. But if unemployment is 20% all the add ons for Podiatry business, Amerigel, orthotics, and topical anti fungals are not going to be a priority anymore. We have yet to even discuss people on high deductible plans. Are those people going to get their ingrown toenail fixed or attempt to do it in the bathroom by themselves? These are real questions Podiatrists need to ponder going forward.

Podiatry companies: PICA, Gill, Amerigel, every single ortho company, Zimmer, Stryker, every single company that markets to Podiatrists should not be seen as being financially troubled and may have trouble coming back from the COVID shutdown. These companies also help paid and underwrite many a conference in Podiatry. These companies were the lifeblood for the PM News, APMA conferences, AAPPM, ACFAS all of them. Those conferences could not and would not happen at such reduced rates without their corporate partners. What happens to these conferences and organizations if the corporate partners fail to exist or do not have the funds to spend? Will Podiatrists even be able to afford CME conferences post Coronavirus shutdown? With the success of online conferences to obtain CMEs during the COVID shutdown, will this be the model that conferences follow over the next 3-5 years while the economy and Podiatry recover?

Are Nursing Home Podiatrists even going to exist or allow Podiatrists in after the Coronavirus Pandemic? As of right now in Europe 50% of the deaths are of Nursing Home patients. We are probably going to see similar numbers in the United States. Without a Podiatrist being able to take a test at the entrance to a Nursing Home proving they are COVID negative, how will any Nursing Home let a Podiatrist in to see patients? When are COVID tests going to be available enough to even offer that? How many nursing homes will decide that they can just have an in-house nurse to do the toenail trimming? The outlook for Podiatrists that depend on Nursing Homes for income is very poor to say the least.

Podiatry is at a cross roads like many industries due to the Coronavirus or COVID Pandemic. Where Podiatry is headed nobody can accurately predict, but all we can do is ask questions of where, what and how Podiatry will be.