Podiatry Blues?

[Dr MnM]

So I don't write often on the SDN forums, I just kind of watch from the sidelines. Anyway, I was shadowing a doctor today (MD) and I asked him what he thinks about podiatry because I told him that I just recently found out about it and didn't know there was a separate school for it. So he said to me that he knows a lot of podiatrists and that a lot of them are unhappy with their profession, so much so that one of the podiatrists he knew quite practicing and now does some work in construction. My question to everyone is what reasons could there be for so many podiatrists being unhappy with being one? And if anyone here is unhappy with podiatry, would you mind explaining why? (I'm curious because I'm seriously considering applying to podiatry school, I just need to have a better DPM shadowing experience where the doctor cares that I'm there)

---

Members don't see this ad.

 

[PADPM]

So I don't write often on the SDN forums, I just kind of watch from the sidelines. Anyway, I was shadowing a doctor today (MD) and I asked him what he thinks about podiatry because I told him that I just recently found out about it and didn't know there was a separate school for it. So he said to me that he knows a lot of podiatrists and that a lot of them are unhappy with their profession, so much so that one of the podiatrists he knew quite practicing and now does some work in construction. My question to everyone is what reasons could there be for so many podiatrists being unhappy with being one? And if anyone here is unhappy with podiatry, would you mind explaining why? (I'm curious because I'm seriously considering applying to podiatry school, I just need to have a better DPM shadowing experience where the doctor cares that I'm there)

I hardly think that this ONE MD's experience is a valid cross-section or sampling of the state of affairs regarding happiness in podiatry. I can tell you that I spend a lot of time at various hospitals, and there are a LOT of unhappy internists, cardiologists, surgeons, infectious disease specialists, etc., etc. Unhappiness is not unique to podiatry, nor is it unique to medicine. Interview enough in any profession and I'm confident you'll find unhappy campers. Just ask some attorneys, accountants, plumbers, and candlestick makers.

It's way to early in the process for you to listen to generalizations, therefore I would shadow several quality DPMs and make your own decision. Just because someone else is unhappy, doesn't mean you will be in that same situation or profession.

 

[Dr MnM]

So you took the word of one MD and made a generalization about the whole profession? Why don't you shadow several podiatrists first before you talk yourself out of applying to podiatry school.

I don't mean to be making any generalizations; I was just a little curious as to why something that this doctor said to me could be true. I do plan to shadow more podiatrists, as the one that I did shadow this week (my first podiatrist shadowing experience) did a horrible job of showing me what podiatry is about and what it has to offer.

I hardly think that this ONE MD's experience is a valid cross-section or sampling of the state of affairs regarding happiness in podiatry. I can tell you that I spend a lot of time at various hospitals, and there are a LOT of unhappy internists, cardiologists, surgeons, infectious disease specialists, etc., etc. Unhappiness is not unique to podiatry, nor is it unique to medicine. Interview enough in any profession and I'm confident you'll find unhappy campers. Just ask some attorneys, accountants, plumbers, and candlestick makers.

It's way to early in the process for you to listen to generalizations, therefore I would shadow several quality DPMs and make your own decision. Just because someone else is unhappy, doesn't mean you will be in that same situation or profession.

This question goes to both of you PADPM and Ankle Breaker, since you guys are in podiatry already, I was wondering if you could tell me what it is about podiatry that caught your attention and made you think "You know what, this is the right fit for me."?

 

[amaprez]

I don't mean to be making any generalizations; I was just a little curious as to why something that this doctor said to me could be true.

I've heard PA's tell me they know miserable Physical Therapists who don't like their salary.

I've heard Physical Therapists tell me they know miserable MD's who are working to death.

I've heard MD's tell me they know DO's who are miserable because they couldn't match into a prestigious specialty.

I've heard Occupational Therapists say they know miserable Pharmacists working at CVS.

I've heard Pharmacists tell me they know miserable Optometrists working in Walmart.

.
.
.

Sensing a pattern yet? I have actually heard all of the above in real life. After a while you wise up and realize that every profession has miserable people. And that everyone has a story about it.

 

[PADPM]

I don't mean to be making any generalizations; I was just a little curious as to why something that this doctor said to me could be true. I do plan to shadow more podiatrists, as the one that I did shadow this week (my first podiatrist shadowing experience) did a horrible job of showing me what podiatry is about and what it has to offer.



This question goes to both of you PADPM and Ankle Breaker, since you guys are in podiatry already, I was wondering if you could tell me what it is about podiatry that caught your attention and made you think "You know what, this is the right fit for me."?

I always wanted to be a dentist, from the time I was able to walk and talk. The college I attended had a dental school and I was accepted. However, it was recommended that I spend time with a dentist, podiatrist, D.O., MD, etc., prior to making a final decision.

After a few hours with the dentist, I thought I'd go crazy. Unless I was going to go into oral surgery, I couldn't see myself spending the whole day bent over looking inside a small area, while someone is simultaneously sucking out the saliva. Not my cup of tea.

I also was a very competitive/high level soccer player with an injury that none of the specialists were able to resolve. So, when I shadowed a particular podiatrist, not only did I enjoy his daily routine, since the vast majority of his patients walked out much happier than they walked in, but this doctor also diagnosed my problem and had me back on the field (pitch for you real soccer players) almost as good as new.

In addition to the fact that the majority of patients left the office with almost some immediate relief, I enjoyed the fact that with the foot/ankle you have the ability to be a neurologist, dermatologist, radiologist, surgeon, etc.

So for me it was almost "karma".

But realize that realistically in any profession, you're going to have good days and bad days, but that's universal unless you are a professional bikini fitter. I can't imagine those guys have ANY bad days.

 

[Dr MnM]

Sensing a pattern yet? I have actually heard all of the above in real life. After a while you wise up and realize that every profession has miserable people. And that everyone has a story about it.

That makes sense...I didn't think of that when I first heard it.

In any case, what grabs all of you about podiatry, or whats your favorite aspect about podiatry that helped you decide to become a DPM? I really want to absorb as much information as I can before I apply this summer. I have gone online and done research but nothing beats first-hand experience and since I wont be able to shadow another DPM for some time (need to find a different one because the one I went to didn't care if I was there or not), I was hoping you guys could help!

 

[flyhi]

(pitch for you real soccer players)

you mean 'football', right?

 

[bobdolerson]

I like systems, and enjoyed building computers, rebuilding my '69 Cutlass, and doing most anything that involves working with my hands. I spent a year in construction before my first year in pod school, and enjoyed it.

I liked the idea of medicine (specifically surgery) because it would allow me to work with systems and work with my hands, and involve my brain more than just building computers or cars. I like the organic element of medicine, moreso than working with physics.

I chose a DPM degree because I had plans to marry before school, and wanted to be able to have a set of priorities that I wanted and no be married to my job. Podiatry offers a bit more flexibility in being able to do other things that you want on the side, and having a family in addition to having a job.

If there existed a cardiology program that would ignore much of the information I didn't need to use, I would have looked at that, same with any other MD field that would have avoided me spending countless and useless years.

For example, a hernia clinic in Canada does only hernias, all day, every day. The doctors have demonstrated their proficiency by having the most successful surgical rates of any clinic worldwide (at least at the time of my reading about them a few years ago). I'd rather spend a few years focused on my specialty from the beginning and save some time in the long run. In 7 years, I'll have spend about 6 of them learning about my specialty, as opposed to spending 6 of way more than 7 years learning about it.

I can be out and practicing before I'm 30, and have a family and more time to spend with them than I could have in another field.

I don't have any real desire to specifically work on people's feet; it just allows me the opportunity to use my head, use my heads, practice surgery and work with people while allowing me a family on the side.

Not many professions can offer that.

I suppose additionally I had good scores for a podiatry program (3.6 cGPA, 31 MCAT) that pretty well guaranteed my admittance into whatever program I wanted, and I was able to choose a program that had 100% residency placement and higher than average board pass rates, which were a big deal to me. I wouldn't have had quite the flexibility in program choice with MD/DO schools. That being said, that wasn't nearly as big a factor as the small ring of metal I keep around my left-hand ring finger.

Having a podiatrist that fixed my horribly infected ingrown toenails years ago was what initially exposed me to the field, and it will be nice to be in a position where I can offer immediate relief. Ingrown toenails, 1 office visit, complete relief. Crohn's disease, dozens of office visits with no diagnosis, thousands of dollars spent on tests, and finally one doctor who took me seriously and did more than say "just take Prilosec...i think it's gastric reflux" turned me off to MD's years ago. I don't really want to ever be up at night pondering what my patient could have. Just come on in, I'll slice ya' up, and have a nice day.

 

[Podophile]

But realize that realistically in any profession, you're going to have good days and bad days, but that's universal unless you are a professional bikini fitter. I can't imagine those guys have ANY bad days.

Only the plus size days

 

[Ferocity]

Only the plus size days

Unless you're into BBW

 

[Organically]

I honestly didn't know much about podiatry until I read these threads.

 

[Dr MnM]

I appreciate everyone's input on this, and I'm all for anyone else explaining why they chose podiatry. Similar to what bobdolerson said, I'm also looking for something that'll allow me to spend time with my family and not be married to my job. I know some people are ok with working a whole lot, but family time is also pretty important to me. And I really wanna do surgery

 

[Organically]

a

 

[Organically]

a

 

[Organically]

a

 

[bobdolerson]

Unless you're into BBW

I had to google that to find out what it meant. Now for my response:

Ya' really had to go there? Really?!

And here I thought a shark attacking a whale would be a cool nature video. It was not cool, and I hold you solely responsible for permanently searing it into my brain.

 

[Ferocity]

I had to google that to find out what it meant. Now for my response:

Ya' really had to go there? Really?!

And here I thought a shark attacking a whale would be a cool nature video. It was not cool, and I hold you solely responsible for permanently searing it into my brain.

What? You don't like some meat on your bones?

 

[flyhi]

I had to google that to find out what it meant. Now for my response:

Ya' really had to go there? Really?!

Thanks, now I got suckered in. Was going to just leave it alone, but nooooooooo.

 

[Poisson]

Double post.

 

[Poisson]

So I don't write often on the SDN forums, I just kind of watch from the sidelines. Anyway, I was shadowing a doctor today (MD) and I asked him what he thinks about podiatry because I told him that I just recently found out about it and didn't know there was a separate school for it. So he said to me that he knows a lot of podiatrists and that a lot of them are unhappy with their profession, so much so that one of the podiatrists he knew quite practicing and now does some work in construction. My question to everyone is what reasons could there be for so many podiatrists being unhappy with being one? And if anyone here is unhappy with podiatry, would you mind explaining why? (I'm curious because I'm seriously considering applying to podiatry school, I just need to have a better DPM shadowing experience where the doctor cares that I'm there)

I recommend you take a good hard look at what the profession used to be and what it is today. I don't know much about podiatry, as I will be applying to DO programs as my plan, but from what I have heard its transformed dramatically. Look at Susanne Levene and other superstar podiatrists, I don't think they would be unhappy with their professions. My podiatrist has a hummer, and from what I have heard, multiple houses. I know one of his houses when the market was better was about 700K where the median home value is about 250K.

Podiatry has different scopes depending on the state. Some states may allow up to the hip. Other states restrict the ankle and only allow the forefoot. If I was in this type of field I would be pretty upset that I would be restricted from doing ankle reconstructions.

Problems I have heard are with insurance. I'm not sure on the numerics, but it is pretty clear that podiatrists have had a history of insurance issues. I have heard a lot of crime related to podiatrists and insurance. I'm sure this happens in the other fields of medicine, but I've frequently heard it pop up more in the podiatry field. In my opinion, maybe some podiatrists think they should get paid more then they have earned.

If you are passionate about podiatry, go for it. There are people with extraordinary academic records and life stories that go into this field. There are likewise people with bad academic records, and poor attitudes towards the profession. The bad apples, will not bring a good name to the field and not offer exceptional care. The good ones will offer the highest level of service. There are those in the traditional MD route that become burnouts, and there are those from the caribbean MD schools that worked from the bottom to the top, and have a servent mentality, strong work ethic, and performance to back it up.

I think podiatry has changed. Meaning, residencies are I think mandatory at 3 years surgical. This means these podiatrists looking to be in a surgically oriented part of podiatry are going to have a lot of training. These doctors will be highly prepared to do excellent work. Maybe these doctors you are talking to focus more on general podiatry. Maybe you yourself might be more interested in a foot / ankle surgery specialty where you might be part of a surgical DPM or MD/DO ortho practice. Some of these surgical podiatrists focus only on surgery, and do not mix there practice in with general podiatry. Other podiatrsits do general podiatry, but do highly advanced surgical procedures in there practices as well. Other podiatrists may do less advanced work, where clipping nails, not to give a negative connotation, but just a point, is mainly what they do.

At the university I attend, there used to be MDs in the foot and ankle, and 1 DPM, now the old head, the DPM retired. Who came in and was highly qualified with residency? 3 DPMs were hired. If you want to know, I could legally look up there salary in a few minutes.

Whether or not these doctors are happy probably has to do with their personal situations. I would seek out doctors with successful practices and ask for the low down on the field. They straight up will probably tell you if its good or bad, the pluses and minuses. You might even meet a sort of da Vinci podiatrist that will inspire you to go into the field.

 

[Dr MnM]

Interesting. Thanks for the answers everyone, I'll still take any more that I can't get. And thanks Poisson, great response!

 

[347932]

Look at Susanne Levene and other superstar podiatrists...

She has a "Boutique" practice in Manhattan and does mostly "cosmetic" procedures. I couldn't do that. Doing something for cash that can cause pain where there wasn't, isn't my personal definition of medicine. I make less money (much), but can sleep at night.

What is a superstar podiatrist anyway? There are some that I hold very high in that regard, but aren't considered "superstars". How do you get on that list? Earnings?

Problems I have heard are with insurance. I'm not sure on the numerics, but it is pretty clear that podiatrists have had a history of insurance issues. I have heard a lot of crime related to podiatrists and insurance. I'm sure this happens in the other fields of medicine, but I've frequently heard it pop up more in the podiatry field. In my opinion, maybe some podiatrists think they should get paid more then they have earned.

Here is the issue with that. Nail care is a multi-billion dollar expense to the federal government. There are very strict regulations on documentation and time frames of when this can be performed. This requires meticulous medical records, which frnakly, most couldn't be bothered keeping. So when they get audited, they get stung HARD. The rules also change frequently, and unless you look for the updates, they aren't so easy to find sometimes. What happens is, you think you're doing it correctly, aren't, get audited and once again, get stung HARD. With nursing homes, it is likely that a Podiatrist isn't a paid staff member at the facility like many of the MDs there are. What does a podiatrist do in the Nursing Home? Cut toenails. See my above comments. We are MUCH more open to scrutiny in this regard, and Medicare and Medicaid hire head hunters to find you, and you better be in compliance or else.

 

[Poisson]

Kidsfeet has made some excellent comments, and I will do my best at interpreting part of them. It seems that the field of podiatry has become a victim of insurance rules constantly changing. This may happen in other fields of medicine too, I am not sure exactly where and when though. I am really disappointed with the insurance aspect of medicine. Many patients in podiatry are looking for nail clippings and other relatively general procedures and are older. Could there be a way to offer these simple procedures for the podiatrist at a price the patient could afford to avoid "headhunters" from Medicare and Medicaid? Could podiatrists come to them?

One of the most sickening things I hear about in podiatry, is when these so called fraud cases are brought about against podiatrists. Lets say when I go on a law website, and I've gone on many, for different medical malpractices focuses, a lot of times there are sites focused wholly on decimating podiatry. The general public may not know about podiatry all that much and maybe the credentials involved. Lawyers really paint a terrible misrepresentation of podiatry all the time. They will start off with things like, "podiatrist do not have MDs" and are not real doctors. Then they might start naming off several cases they have won against podiatrists claiming that these doctors are meticulous criminals. Now don't get me wrong, some doctors are criminals in any field of medicine, but seeing the high volume of podiatry cases, it seems to me that podiatry is getting bullied. The system obviously needs some changes.

Talking about Dr. Levine and her boutique practice, yes that is something of debate. I don't know much about exactly what procedures she is doing, maybe toe tucks, foot makeovers and what not ... some of them sound elective. I have not read enough real scientific literature on this. When I think about biomechanics, it sounds risky to fix something beautification-wise while modifying structural components then to fix something that really desperately needs work done. The way these cosmetic doctors like to write their websites is that they only do cosmetic work when it is a combination of something that needs to be structurally fixed, but then made cosmetically beautiful at the same time, almost like an added benefit. Some patients may clearly want their feet changed to wear certain types of shoes. Well heck another debate would come up, where lets say somebody had some deformity in another area of the body that restricted them from doing something that they really wanted to do, I guess that's were the ethics comes in. If I was a podiatrist, the line would be strictly drawn that if somebody is coming in talking about wearing a vanity item, that being special shoes, and cannot wear them, I don't personally think that's a good enough reason to get a procedure. If however wearing any shoes caused significant pain, even going into as grandma as a shoe we could find, and there was still pain, then procedures would be warranted.

I know people in New York are all obsessed about their shoes, and many claim its for a career boost, but the last time I checked New York was more about substance then about style. When it comes down to it I think girls just want to wear the shoes to impress other girls. Coming to the substance point, anybody remember that African American Investment Banking movie with Whoopee Goldberg, haha that was really funny ... The Associate. That movie to me is all about substance over style, when she pretended that she had a man as a partner in her business, but was really just in the business with herself.

Well I like that Kidsfeet brought up the superstar podiatrist line. Well I think every field needs an ambassador, notably podiatry. Heck there are a lot of folks out there that don't understand what podiatry is. There are also obviously some insurance issues going on with the field, where doctors need some protection. A superstar podiatrist to me wouldn't be someone with earnings, but someone with a voice to further the field. Podiatry needs more integration with orthopaedics, maybe more of a merger with journals or something. More research needs to be conducted in foot and ankle surgery. The ACL has received so much research and improvement, maybe some things could be improved in the foot and ankle? Real doctors of every income level know that being a superstar doctor doesn't mean earnings; many of those big name doctors in beverly hills on tv seek advice from other doctors, and maybe these doctors they want to shadow and learn from are in the middle of nowhere, out of the limelight. But even though the docs on tv might be a bit more business savvy, they know as doctors that many of the true brains and people in medicine go on word of mouth, and are silent strong contributors in the field.

 

[347932]

Could there be a way to offer these simple procedures for the podiatrist at a price the patient could afford to avoid "headhunters" from Medicare and Medicaid? Could podiatrists come to them?

We absolutely do offer this service for less than what many of these same patients pay for a haircut. The issue is that these patients think that since they have insurance, it SHOULD cover the service, not realizing that it isn't use making the insurance rules. Each insurance has guidelines as to what THEY think is medically necessary. Forget about what WE think. They employ non practicing doctors (MDs mostly), to make these rules. These docs are paid to figure out a way to cut costs by making rules they don't understand. Nice, huh?

A superstar podiatrist to me wouldn't be someone with earnings, but someone with a voice to further the field. Podiatry needs more integration with orthopaedics, maybe more of a merger with journals or something. More research needs to be conducted in foot and ankle surgery. The ACL has received so much research and improvement, maybe some things could be improved in the foot and ankle? Real doctors of every income level know that being a superstar doctor doesn't mean earnings; many of those big name doctors in beverly hills on tv seek advice from other doctors, and maybe these doctors they want to shadow and learn from are in the middle of nowhere, out of the limelight. But even though the docs on tv might be a bit more business savvy, they know as doctors that many of the true brains and people in medicine go on word of mouth, and are silent strong contributors in the field.

In that case we have many superstars! Many of us champion podiatry at the state, national, congressional and senatorial levels. Those of us that do this, volunteer, and I agree with you 100%. The ones that do champion our cause are the TRUE superstars.

We have attempted in many ways to integrate into the MD world. There is resistance on so many levels you wouldn't believe. Try getting published in an MD journal as a DPM. Every state society has Physician "Clubs" (for lack of a better term), that specifically exclude DPMs. It's an ongoing fight (struggle?), but a worthy one in my eyes.