What does podiatry really look like?

[Hoping2makeit]

I am just a lowly pre-pod looking for some clarification. I have shadowed several different podiatrists in several different states. In one state, the scope of practice is relatively restricted and the podiatrist was pretty doom and gloom. He said that the field is dying, reimbursement is lacking, residency shortage, no parity, over-saturation, blah blah blah. Then I shadowed a podiatrist with a completely different attitude. She talked about Vision 2015, market growth, how new grads are the best trained in the history of podiatry, pay is going up, we have podiatrist in congress, and so on. I suspect that reality falls somewhere in the middle. I am just looking for an accurate picture before I jump in feet first.

---

Members don't see this ad.

 

[PMSIII]

I am just a lowly pre-pod looking for some clarification. I have shadowed several different podiatrists in several different states. In one state, the scope of practice is relatively restricted and the podiatrist was pretty doom and gloom. He said that the field is dying, reimbursement is lacking, residency shortage, no parity, over-saturation, blah blah blah. Then I shadowed a podiatrist with a completely different attitude. She talked about Vision 2015, market growth, how new grads are the best trained in the history of podiatry, pay is going up, we have podiatrist in congress, and so on. I suspect that reality falls somewhere in the middle. I am just looking for an accurate picture before I jump in feet first.

A few things...
1) Scope of practice/state does not necessarily equate to the quality of the practice - In other words, just because the state does not have ankle privileges, allow for soft-tissue procedures of the leg, external fixation, or total ankle replacements then that does not equate to a poor practice. A lot of "forefoot" practices are very busy and their providers do well professionally and financially. The reason behind the success of the practice is the person running the practice, not the state where that individual practices.

2) Diversity - Not all DPM's are trained with the same background and experience, and not all of us choose to practice every element of skill that we acquired from our training. Therefore, our practices are naturally "diverse". Some of us practice in very busy surgical practices where we see a lot of patients, handle complicated cases daily, carry plenty of call, and essentially have very little to no free time. On the other hand, some of us choose to practice in settings where they have less call, less complicated patients, and still provide excellent foot/ankle care.

3) Health care - The issues of reimbursements and the consequences of the affordable healthcare act have been discussed repeatedly on this forum and almost daily by my other physician colleagues at the hospital. The fact of the matter is healthcare is changing and the rules are changing for everyone not just us (DPMs). As a result, we learn to adapt and move on.

Becoming a physician/healthcare provider is a calling built on a passion to serve others regardless of what the system brings. Those of us who practice made a choice and took an oath to serve - for that I am grateful for every opportunity I have. I will tell you that from my experience, I do not know of anyone in my field who is starving, jobless, or unemployed. So you'll do well if you choose to do well.

Hope this helps and good luck!

 

[Hoping2makeit]

1) I understand that scope of practice is not the sole factor that determines success. However, I have seen hospitals that list podiatrists as physicians and I have also seen hospitals that list them as allied health professionals. I would imagine that it is more difficult to be successful in an environment that appears to to be working against you.

2) At the moment, there is a large amount of diversity among the profession. Do you think that is going to disappear now that everyone is doing a three year surgical residency? Is there going to be a need for all of the Foot and Ankle Surgeons floating around by the time I get out?

3) Vision 2015. Is it happening or not? I am told that this will play a major role in how the profession is reimbursed. True/False?

4) I see that you are a fellow. Why did you choose to do a fellowship?

 

[PMSIII]

1) I understand that scope of practice is not the sole factor that determines success. However, I have seen hospitals that list podiatrists as physicians and I have also seen hospitals that list them as allied health professionals. I would imagine that it is more difficult to be successful in an environment that appears to to be working against you.

2) At the moment, there is a large amount of diversity among the profession. Do you think that is going to disappear now that everyone is doing a three year surgical residency? Is there going to be a need for all of the Foot and Ankle Surgeons floating around by the time I get out?

3) Vision 2015. Is it happening or not? I am told that this will play a major role in how the profession is reimbursed. True/False?

4) I see that you are a fellow. Why did you choose to do a fellowship?

1) Hospital bylaws and staff privileges are relatively independent of scope of practice. Politics, available staff, and level of training play a role in how physicians are designated with respective privileges. For example, my hospital 5-6 years ago did not have DPM's performing ankle procedures. Today, the standard has changed and they amended their privileges to allow us privileges and ER call provided that we demonstrate board qualification/certification in reconstructive hindfoot/ankle surgery. Also, finances play a role in this too because the hospitals are getting paid for our procedures on both elective and non-elective cases.

2) There is always a demand and will continue to be a demand. The level of care will continue to improve as it has over the recent years because of the three-years. I don't believe that everyone with three years of training, however, is qualified to handle EVERY complicated hindfoot/ankle case.

3) I'm not aware of the "status" of 2015 and to be quite honest with you, I really don't care. Reimbursements are low for everyone across the board regardless of specialty so that issue is not going to drastically change. I have no problems practicing with what I have today - I'm three years surgically trained with added fellowship and get to surgically manage foot/ankle pathology without resistance from the hospital.

4) I should probably change my status on the profile but I just completed my fellowship over the summer and I'm in private practice now. I chose to pursue added fellowship for multiple reasons: Experience with more complicated pathology - i.e. Charcot ankles, Total ankle replacement surgery, etc.; Efficiency; Publications; and Practice management. We had a thread somewhere on this forum about fellowship and a lot of good points were brought up. My opinion: No, you don't "need" an extra year of fellowship to practice but if you invest your time and resources properly, you can get a lot out of your education and training. My humble opinion at least.

Hope this helps.

 

[FluffyKittyLuv93]

Hello,

I am a pre-pod and am really interested in the podiatry profession.
I have a lot of family relatives in California and I see myself living and practicing there in the future.
1) Would your recommend I attend a podiatry school in California? WesternU's curriculum including the quality of pre-clerkship training really appeals to me.
2) Do California residencies prefer students who graduated from a California podiatry school?

Thank you.

 

[JR2011]

Hello,

I am a pre-pod and am really interested in the podiatry profession.
I have a lot of family relatives in California and I see myself living and practicing there in the future.
1) Would your recommend I attend a podiatry school in California? WesternU's curriculum including the quality of pre-clerkship training really appeals to me.
2) Do California residencies prefer students who graduated from a California podiatry school?

Thank you.

No. Go to the school that you feel will get you the very best education. I'd look at how competitive class profile GPAs and MCAT scores are. Look at the residency placement percentage and board pass rates. Look at facilities. I'd also be more concerned getting a residency that will get you the best training, not one that is simply located in California. Basically don't limit yourself to CA.

 

[Creflo]

There is a post in the pre pod section talking about choosing a pod school based on how many clerkships you are allowed to do, I agree this is one of the more important factors. For me location, town, and weather were important factors so I chose based more on these factors. For others, other factors are more important. Choose based on what matters the most to you.

 

[dtrack22]

2) Do California residencies prefer students who graduated from a California podiatry school?

I did not run across a CA program during my externships that favored students from any school. The bigger name Kaiser and SoCal programs have plenty of residents that graduated from non-CA schools. There are probably more CA school grads in CA residency programs, but "math" is the only reason. What I mean by that is when you have a majority of externs coming from CA schools, it only makes sense that there would be more residents who graduated from CA schools. Just like many of the Philadelphia area residency programs are comprised mostly of Temple grads. When 90% of the students (just an example) rotating through are from Temple, of course a majority of residents will be Temple grads. Even though most of those programs state that they don't give preference to Temple grads.

Getting as many clerkship months as possible is most important IMO (followed closely by FIRST time board pass rates and attrition rates). I still believe that 3rd year clerkships (see Scholl and Western) are not nearly as valuable as the June-December (4th year) months, but Ankle Breaker or someone else can comment on their experience getting a program they went to in February, March, April, and May of 3rd year. I just haven't heard much that would make me change my opinion that Scholl's (for example) "we give 8 clerkship months" line, but don't bother mentioning 3 of them are before your 4th year even starts, is anything but a sham.

 

[PeaJay]

I would argue that the third year rotations are valuable, just in a different way. In the third year you are most likely going to underwhelm the residents with your skills, but you do have the chance to make huge improvements. In addition, if you have a solid knowledge base you can possibly do some "wowing". There have been plenty of stories passed down where residents are surprised by the knowledge of a third year. In the end if the third year rotations are a bust you are at least a little more seasoned and ready to put on a higher level performance fourth year.

 

[dtrack22]

I just wanted you to post your thoughts on the Scholl schedule. How you performed and liked your early externship months. So thanks for discussing that.

I don't think anything more than a slightly above average knowledge base is required to do well on a clerkship and get a program to think highly of you. knowing more than everyone else certainly helps, but I said "I don't know" once a day my first month out in June and I've gotten more positive feedback from that program than anywhere else. You really just need a good foundation of pod med/surg, the schools just have different philosophies regarding how to give their students that foundation. Some do the teaching themselves on campus and at local clinics. Others ship the students off and let residency programs do the teaching. It's really the same outcome and I didn't see a huge difference between myself and most of the students I ran across from other schools. 2nd semester of third year is pod med/surg for pretty much everyone, the only difference is being at a residency program vs. on/near campus.

I don't know how useless December is or not, but after going through most of 4th year I like Barry's schedule the best. May-Nov externships, December off/back on campus. 7 clerkship months and you can use December practically however you want in terms of studying. I know my time would be better spent if it were my own to spend this month...

Only thing I would disagree with is July putting the student at a disadvantage from the program's perspective. At least it didn't seem to put me at a disadvantage based on feedback and keeping in contact with the program. The difficult thing about July based on my experience was the student's perception of the program can be negatively affected. Which is why I kept in touch with other students I knew were going to my July externship in other months. To see if there experience was vastly different than mine.

 

[ldsrmdude]

Only thing I would disagree with is July putting the student at a disadvantage from the program's perspective. At least it didn't seem to put me at a disadvantage based on feedback and keeping in contact with the program. The difficult thing about July based on my experience was the student's perception of the program can be negatively affected. Which is why I kept in touch with other students I knew were going to my July externship in other months. To see if there experience was vastly different than mine.

I think it depends on the program and residents too. One of my co-residents asked the clerkship director if we could refuse to take students during July this upcoming year because they thought it was too much of an inconvenience and that we don't get to really evaluate the students because we are trying to get the new residents going. I disagree with that thought process, but it's out there.

One other thing to throw out there is that as a resident, I'm aware if a student on their first rotation as a 3rd year or last rotation as a 4th year and tend to adjust my expectations accordingly. If a student is smart and proactive as a 3rd year and we're impressed by them, if they keep in touch and we can tell that they're continuing to improve, we get a pretty good idea that they'll continue to improve as a resident. That's somewhat comforting to know. Personally, I like Scholls schedule the best just because it seems like the majority of the Scholl students coming through are ahead clinically compared to other schools. Some of that is probably due to bias since we get a lot of Scholl students (along with DMU and Kent State).

 

[janV88]

I'm from Scholl and with my schedule I had 11 months of podiatry in a 12 month time period, 5 of which were core podiatry rotations. My 1st clerkship was back in February and I got interviews at all clerkships except for my March clerkship which I think is because I didn't keep in contact...stupid mistake.

Having early clerkships has its pros and cons. Yes it is more likely that a program will forget you due to time factor but that can easily be fixed by keeping in touch. Nice thing is during the May-August months you feel "seasoned" while most schools are just starting out. Did I feel like I had an advantage during these months? Maybe slightly but like Dtrack said you only need slightly above average knowledge to do well. Everyones first month out is a little rocky but like ldsrmdude said, I would think most attendings and residents are cognizant of this.

One thing I noticed from being so far removed from the classroom was my knowledge of podiatric minutia went down considerably. On the other hand, I feel more confident in my working knowledge. It's a trade off I guess.

As for the July issue. I think July can work to the students advantage, especially in programs that rely a lot on resident input. It's a time to really shine with the 1st yr residents. It's their 1st month in therefore my thought process in July was - let me make this transition as easy as possible for them.

 

[air bud]

This is great lol 2014

 

[GreenHousePub]

Wonder what happened with this guy?

 

[JustAPedicurist]

Podiatry is mycotic nails, pressure ulcers, and necrotic toes

 

[icebreaker32]

Wonder what happened with this guy?

He said he was accepted to DO school. Liberty….LUCOM.

 

[Shiyuan]

He said he was accepted to DO school. Liberty….LUCOM.

 

[DexterMorganSK]

Not sure why we are bringing back a thread from the crypt.

Closing!