Where can I find podiatrists

A rare commodity - the podiatrist

The health care system in Germany is affected by supply bottlenecks. Anja Stoffel has collected data and facts from the field of podiatry. What about the shortage of skilled workers?

Podiatry is one of the health professions. Since the new creation of the profession in 2002, significant increases in the area of ​​training and therapeutic care for patients have been recorded every year. At the same time, there was a demonstrable decrease in amputations in those affected with diabetic foot syndrome in regions with good podiatry. The assessment of the podiatry care is consistently positive. Only a few reliable key figures are available for the podiatry sector. On the one hand, this is due to the relatively young age of the job, which is why professionalization in terms of research and evidence is still developing. On the other hand, the demarcation of the professional affiliation between podiatrists and other podiatrists is probably not always clear, which means that medical and cosmetic foot care companies are statistically summarized - although the target group and care mandate are fundamentally different.

The shortage of skilled workers is considered certain
Currently, a relative shortage of skilled workers can be regarded as certain for podiatry: Many professionals who work part-time - or in marginal employment - are compared to relatively few, highly busy podiatrists. A survey confirms the high occupancy rate and the currently unused potential for improvement in patient care. Practitioners' assessment of the need for treatment and opportunities for improvement becomes even more acute when the increasing prevalence of diabetic foot syndrome is factored in. In order to maintain and further reduce the amputation rate at the same level, podiatry care must be expanded.

Strategies against deficiency
Strategies against the relative shortage of skilled workers should, in the short and medium term, be geared towards bringing marginal and part-time employees into overtime. In addition, the Germany-wide qualification of young skilled workers should be expanded in order to prevent a long-term impending absolute shortage. Promising measures for increasing the number of hours worked are on the employer's side to improve the attractiveness of overtime through higher remuneration, additional offers and tax-free bonuses. An individualization and flexibilization of the working hours enable the compatibility of family and work. Further measures are to recruit skilled workers from abroad, to keep older employees in the company, to include the low-skilled, men, the disabled and those willing to change in the recruiting process in order to expand the selection of employees and to promote diversity. Due to the special age structure in podiatry, the consideration of different phases of life and the horizontal development are of particular importance. Professional migration from other health professions to podiatry should be specifically promoted.

More qualifications and more remuneration
The responsibility of politics, the social security agencies and the representatives of the podiatrists are the qualifications of the offspring and the remuneration of podiatry services. In order to increase the number of trainees, the measures for exemption from school fees, training allowances, flexibilization, digitization and modularization of training and the compatibility of family and work should be implemented for lifelong learning. Here, the special concerns of adult education and the older age of the trainees must be taken into account. In order to implement podiatry across the board in medical care, jobs should be created in inpatient and semi-inpatient areas.

The skills shortage in podiatry in key figures
The shortage of skilled workers is defined as the market imbalance between vacancies and available skilled personnel. There are two reliable instruments for making job-related forecasts: the key figures from the Employment Agency and the skilled workers indicator from the Federal Institute for Vocational Education and Training (BiBB). The Employment Agency uses the vacancy time of vacancies and the unemployment rate in the job to assess. The focus is exclusively on the assessment of the job market in the salaried and job-seeking sector; the agency does not record the self-employed. The Federal Institute for Vocational Education and Training (BiBB) has defined a skilled labor indicator (FKI) (Maier et al .: Indicators for assessing the skilled labor situation in occupations. 2018) to assess the shortage situation in occupations. This considers more complex interrelationships and enables more targeted solutions

It consists of the addition of three key figures

  • the volume indicator VI (the work volume potential of the occupational group. How many professional members provide how many hours of work, and how great is the potential for improvement?),
  • the qualification indicator QI (the training activity) and
  • the substitution indicator SI (whether the activity could be substituted by unskilled personnel, and how much effort is required to qualify in order to be able to work in a job).

The skilled worker index can have values ​​between 0 and 100, with a mean value of 50.5. The higher the value, the higher the competition and the saturation on the job market, the lower the more difficult it is to fill a position. Up to a value of 46 there are bottlenecks in the job-specific recruitment of skilled workers. The specialist index for podiatry is 55, which is surprisingly above average. A precarious shortage of skilled workers, as is the case from the perspective of the professional, cannot therefore be proven. Why is that? Probably because of two things: On the one hand, a large number of professionals work part-time. This relative deficiency can be remedied more easily and more quickly than an absolute one, and is therefore weighted less heavily in the calculation of the indicator. On the other hand, it is possible that the health personnel accounts are falsified by an improper registration of medical podiatrists, which would distort the number of podiatrists. However, this is an assumption that cannot be clearly verified. A summary of all training graduates since the podiatry law was enacted results in a figure of 16,000 therapists, while the health personnel calculation of the Federal Statistical Office assumes 20,000 podiatrists. The difference of 4,000 people (that would correspond to every fifth podiatrist!) Supports the assumption that the data collection is distorted. Clarity in the key figures on podiatrists and podiatrists could only be provided by a professional certificate.

What do podiatrists say about the deficiency?
In order to assess the interprofessional view of the professional, a survey on the shortage of skilled workers in podiatry practices was carried out in spring 2019. A total of 387 responses were used. What additional insights could be gained from the interprofessional survey?

  • Most of the respondents are organized in practices with health insurance approval. The clear majority is self-employed.
  • 87 percent of podiatrists say they work with health insurance.
  • The proportion of employees in podiatry practices of 15 percent in the survey is lower than expected.

This is diametrically opposed to the assumptions made by the federal government, according to which 70 percent of all drug providers are employed and 3000 podiatrists work in inpatient facilities. This confirms the assumption that the data collection is still insufficient.

  • None of the respondents works in a public or inpatient facility - i.e. an acute clinic or rehabilitation facility. In contrast to all other drug providers, podiatrists do not seem to play a role in inpatient care. It is not possible to determine where the above information on 3000 podiatrists in inpatient care comes from. What about other professional groups here? In comparison, the figures from physiotherapy and occupational therapy: Almost 75 percent work there in outpatient facilities, 16 percent in inpatient or semi-inpatient facilities. Around 70,000 physiotherapists and masseurs were employed in practices in 2012 and 2013, and around 36,000 physiotherapists and masseurs in inpatient and semi-inpatient facilities (hospitals, rehabilitation clinics and care facilities) (Reinhardt: Economic and professional situation of outpatient physiotherapy and occupational therapy in Germany, 2018). Podiatry is theoretically envisaged in the coding guide of the DRGs (Diagnosis Related Group) for psychosocial services in acute somatic hospitals for the care of patients with diabetes mellitus under item 8-984 (“Multimodal complex treatment for diabetes mellitus”), but in reality it is so rare present that it is not sufficient to determine key figures. Currently only selected special clinics with DDG certification, such as Bad Mergentheim, employ podiatrists in the interdisciplinary team.
  • The workload and workload of the surveyed podiatrists can be assessed as high overall. The course of podiatry therapy as long-term therapy is a unique selling point. Around 50 percent of all active podiatrists treat 10 to 15 patients on a regular working day. Almost 90 percent of the workforce is in full-time employment. A 6-day working week on the patient (without administrative effort) is a reality for 12 percent of podiatrists.
  • The number of patients in podiatry practices is increasing sharply. Almost 75 percent of those surveyed have up to five new inquiries a week, and more than a quarter even have up to five new inquiries a day. Since long-term therapies result from the first contact more than average in podiatry, the workload is quickly achieved (in contrast to the duration of therapy offered by the other medicinal products providers, the PKB as a long-term treatment is "usually" a specialty).
  • 57 percent of the survey participants are looking for employees. If the result were extrapolated to the number of IK numbers (5620 companies), there would be 3203 vacant jobs in German podiatry practices. The vacant vacancies comprise a high number of hours. In the differentiated survey, even 79 percent of podiatrists needed additional work, which would correspond to 4440 vacancies in an extrapolation. In contrast, there are only 300 vacancies registered with the Podiatry Employment Agency. Around the same number can be found in internet job portals. Among the information on the number of hours of the searched employees, a third of the practices had to offer a full-time position, also a third part-time with half a position. If all the requirements were put together, only the podiatrists surveyed could occupy almost 8,000 working hours per week! The prognosis for all practices cannot be measured. What is certain is that the need for employees must be immense.

What measures do expert panels recommend?
The Federal Employment Agency, the Competence Center for Securing Skilled Workers at the Institute of German Economy and the Federal Ministry for Economic Affairs and Energy have published various strategy papers, the measures of which are already being used in the health professions. Since, based on the key figures, there is a disproportion between the workforce and the number of hours worked (i.e. many part-time workers to relatively few full-time workers), priority is given to quickly effective measures that increase the number of hours worked in the "hidden reserve". Medium and long-term strategies should make the job more attractive and increase the number of trainees.

Recommendations for podiatry

  • Part-time employees and marginal employees should be brought into overtime. Since mostly women work as podiatrists, and the proportion of women in part-time jobs is much higher, instruments to increase the volume of working hours must be specifically designed for women. Promoting the compatibility of family and work and making overtime financially attractive are necessary prerequisites for overtime. Women or spouses are in a tax-disadvantaged situation, especially in part-time jobs with few working hours and a better-earning partner. An increase in hours can fall victim to tax progression, so that extra work is not worthwhile. Here, other offers can be used to recognize work, such as assuming childcare costs. It would also be useful to employ older workers beyond retirement age with the highest possible number of hours. This also promotes the preservation of knowledge and diversity in the team.
  • The low remuneration prevents podiatrists from entering into an employment relationship or from working more than marginally as an employee. The remuneration is in a positive process of change. The treatment prices have risen noticeably through the HHVG and the Appointments Service and Supply Act (TSVG), the framework conditions have been at least partially unbureaucratised and the position of the therapeutic agent providers has been sustainably strengthened, which is positive in further compensation adjustments every July will make noticeable. In the next one to two years, the effects will be clearly noticeable in the practices. Due to the transparency agreement, practice owners are obliged to provide information on salaries, which strengthens the situation of the employees in the long term - to mutual benefit.
  • Podiatrists should distinguish themselves as an employer. Podiatrists behave in an ambivalent manner. From the practice's point of view, the need for employees seems to be immensely high - but there is still a lack of public communication in the form of job advertisements. It is advantageous to profile yourself as an attractive employer and to explicitly communicate the added value of employment in your own practice in job advertisements, regardless of the medium. Podologists willing to change should feel addressed. An expansion of the target group (men, the physically handicapped and skilled workers from abroad) should also be considered. In spite of frustration and financial losses due to inadequate or unsuitable applications, advertising may not be discontinued. However, the employment agency must also not be released from its responsibility for searching the labor market: In order to be able to realistically map needs, key figures and statistical data are essential. When the categorization of podiatry under the therapeutic occupations is completed (possibly 2020), career counseling and placement will probably also change and be more targeted. The strongest argument against the employment agency and thus also against the federal government would be to report all vacancies in podiatry practices.

The training situation is facing a period of upheaval
In this legislative period, the process for exemption from school fees in the health professions should be completed, the amendment of the professional law and the training and examination regulations should go into legislative deliberations next year. The reaction of those interested in training is waiting and waiting in large parts of Germany, which further exacerbates the situation on the labor market and puts private vocational schools in financial need. If the demand for podiatry training then increases, a bottleneck in teaching is to be expected, as the resources of the schools are limited. In spite of the uncertain economic situation, training providers should consider the forecast of increasing numbers of trainees as a result of the exemption from school fees, and keep an eye on the human and spatial resources for offering additional training positions.

Can the increasing demand be realistically assessed?
In order to ensure future care for patients with DFS, podiatry would have to grow by 44 percent over the next 20 years to cover the care of the forecasted 3.1 million patients with DFS. In podiatry practices, around half of all medically indicated foot treatments are self-pay. It remains to be seen what additional increases in working hours will occur here. What is certain is that demand will exceed supply.

Podiatrists should be transferred to a public sector.
Inpatient and day-care employment that is subject to social insurance is not available for podiatrists. Although the treatment of patients with diabetic foot syndrome in the inpatient area is a major economic burden, podiatrists are certified to have a significant share in reducing amputations and there is the possibility of DRGs (Diagnosis Related Group), there is no transfer to employment in the clinical area. Podiatry has not yet arrived in the interprofessional clinical team.

Everyone has to implement it
In summary, the assumption that there is a shortage of skilled workers is confirmed. Even if the key figures provide differently clear results, the recommendation is clear: Podiatry should continue to grow significantly in order to be able to cover the medical needs in patient care in the future.The continuously improving embedding in the therapeutic professions and the differentiation from other podiatrists will clean up the key figures for the job description and make forecasts more reliable. Solution strategies with a high degree of effectiveness are sufficiently available and are in some cases already implemented, which is why there is a prospect of an improvement in the shortage of skilled workers. The responsibility for implementation lies with all those involved: Practice owners are responsible for communicating their needs on the labor market, publishing their job offers and making a name for themselves as an employer. It is the responsibility of politicians to ensure and expand patient care through the promised improvements in the qualification of young people, the increases in remuneration for podiatry work and control over the increase in staff salaries in podiatry practices. Training providers also have a responsibility to keep an eye on personnel acquisition and resource planning for teaching with a view to increasing the number of trainees, despite the current tense situation of upheaval.