What is currently being done to advance the scope of Podiatry?

[McGG55]

So I'm pretty set on applying to Podiatry school in the future. However, something that seems a little disheartening is the lack of consistency with state laws in terms of what a Podiatrist can and cannot do. For starters, I don't believe that a Podiatrist in any state is allowed to amputate beyond the tarsometatarsal, most only allow amputation of toes and some don't allow amputation at all. This sucks quite a bit, I've read a few stories of podiatrists being frustrated that they were unable to amputate a patient's entire foot (and ankle, sometimes) in desperate need while the local orthopedist was simply too swamped with work and was unable to do so. What was the solution? Relocate the patient to a new healthcare provider several hours away, basically cause great inconvenience to the patient while a capable provider was right in their face from the start. Is anything being done to work on the scope of amputation a podiatrist can do? I can't seem to find much about this.

Some states do not even give Podiatrists the right to perform any work above the ankle, which is frustrating because all of the lower leg muscles and bones are connected to foot function in some way or another. Three states don't even allow podiatrists to work on the ankle! A podiatrist can work on a patient's hands and hip in one or two states, but can't work on the ankle in another? That's ridiculous. I shouldn't have to become an orthopedist to do what a Podiatrist should already be able to do. I don't want to work on anything on the Knee or above, all I want to work on is the lower extremity. Also the obvious bias I've seen on various orthopedic websites with their articles/statements about Podiatrists is both sad and laughable, however I've seen Podiatrists try to 1-up orthopedists in ways that are equally both sad and laughable, too.

There are multiple spreadsheets/PDFs available which explain each state's podiatry regulations, but I don't believe any of them are fully up to date, especially considering the new regulations Connecticut and South Carolina recently passed when it comes to Podiatry's scope of practice in their respective states. These changes are not reflected in any of the available Podiatry state law lists I can find.

It really just feels all tiresome, I believe this could be a great field and I do have a lot of interest in it, but why in the world would anyone want to live in a state that basically considers you a glorified toe-nail clipper? Hyperbole I guess, but a podiatrist is capable of so much with that they can do on the lower leg, only to be told by the government what they aren't good at doing.

This topic came out a little bit as both my overall question and me of me venting my frustration in the field. Feel free to comment on both. I'm very excited to become a podiatrist and I know I would love the profession, provided I have a fairly free scope of practice on everything below the knee. What can be done for new podiatrists to expand the scope of practice for Podiatry? What would you do, work in a state with far more practice rights and enjoy applying what you spent years to learn, or bite the bullet and move to a state with limited rights and do what you can there to promote the practice?

To be honest, I'm slightly indifferent to anesthesia administration state rights for Podiatrists, but I guess that's just my inexperienced self not realizing the importance of this topic in the grand scheme of things.

As far as income is concerned... eh. I'm not trying to be filthy stinking rich. If I get a net gain of 140k-150k, I'll be happy. Money has, thankfully, never been one of my problems in life, nor am I too concerned about it. I live simply and I would prefer to live in a rural area as well. I think Podiatrists aren't doing too bad when it comes to money based on what I've looked into, but I think me saying that will cause a few of the more experienced guys here to roll their eyes.

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[air bud]

Now wait until your state gives you full scope, you got great training, landed a sweet gig in a multi specialty group.......and Ortho decides you can't do certain procedures and you can't do anything because they are the president of the medical group and head of credentialing and chief of staff at the hospital. Welcome to the real world bro.

 

[CutsWithFury]

So I'm pretty set on applying to Podiatry school in the future. However, something that seems a little disheartening is the lack of consistency with state laws in terms of what a Podiatrist can and cannot do. For starters, I don't believe that a Podiatrist in any state is allowed to amputate beyond the tarsometatarsal, most only allow amputation of toes and some don't allow amputation at all. This sucks quite a bit, I've read a few stories of podiatrists being frustrated that they were unable to amputate a patient's entire foot (and ankle, sometimes) in desperate need while the local orthopedist was simply too swamped with work and was unable to do so. What was the solution? Relocate the patient to a new healthcare provider several hours away, basically cause great inconvenience to the patient while a capable provider was right in their face from the start. Is anything being done to work on the scope of amputation a podiatrist can do? I can't seem to find much about this.

Some states do not even give Podiatrists the right to perform any work above the ankle, which is frustrating because all of the lower leg muscles and bones are connected to foot function in some way or another. Three states don't even allow podiatrists to work on the ankle! A podiatrist can work on a patient's hands and hip in one or two states, but can't work on the ankle in another? That's ridiculous. I shouldn't have to become an orthopedist to do what a Podiatrist should already be able to do. I don't want to work on anything on the Knee or above, all I want to work on is the lower extremity. Also the obvious bias I've seen on various orthopedic websites with their articles/statements about Podiatrists is both sad and laughable, however I've seen Podiatrists try to 1-up orthopedists in ways that are equally both sad and laughable, too.

There are multiple spreadsheets/PDFs available which explain each state's podiatry regulations, but I don't believe any of them are fully up to date, especially considering the new regulations Connecticut and South Carolina recently passed when it comes to Podiatry's scope of practice in their respective states. These changes are not reflected in any of the available Podiatry state law lists I can find.

It really just feels all tiresome, I believe this could be a great field and I do have a lot of interest in it, but why in the world would anyone want to live in a state that basically considers you a glorified toe-nail clipper? Hyperbole I guess, but a podiatrist is capable of so much with that they can do on the lower leg, only to be told by the government what they aren't good at doing.

This topic came out a little bit as both my overall question and me of me venting my frustration in the field. Feel free to comment on both. I'm very excited to become a podiatrist and I know I would love the profession, provided I have a fairly free scope of practice on everything below the knee. What can be done for new podiatrists to expand the scope of practice for Podiatry? What would you do, work in a state with far more practice rights and enjoy applying what you spent years to learn, or bite the bullet and move to a state with limited rights and do what you can there to promote the practice?

To be honest, I'm slightly indifferent to anesthesia administration state rights for Podiatrists, but I guess that's just my inexperienced self not realizing the importance of this topic in the grand scheme of things.

As far as income is concerned... eh. I'm not trying to be filthy stinking rich. If I get a net gain of 140k-150k, I'll be happy. Money has, thankfully, never been one of my problems in life, nor am I too concerned about it. I live simply and I would prefer to live in a rural area as well. I think Podiatrists aren't doing too bad when it comes to money based on what I've looked into, but I think me saying that will cause a few of the more experienced guys here to roll their eyes.

Podiatry is only worth it if you land a hospital gig, ortho gig or you have balls to open up your own office and you hit it big on your own.

You will spend the rest of your career proving yourself to orthopedics. Ortho will never respect you. They might tolerate you if you prove you are competent surgeon but you will never be "one of the boys".

Ortho runs the world. They can keep you from doing ANY procedure because....you didn't go to medical school, you didn't sit for USMLE, you didn't graduate from a MD/DO residency, you didn't sit for the orthopedic board exam regulated by the american board of medical specialties.

Nobody cares you are ABFAS certified. ABFAS is only "accepted" because the DPMs before you got it written into the hospital bylaws. It's not because some MD/DO signed off on it and thinks it is a great board certification.

If you don't get any of the above jobs and don't open up your own practice you will spend the rest of your days bouncing around from private practice to private practice being some old DPM's associate. Getting scammed out of money and collections.

140-150K is nothing. See how much that is after taxes. Plus you probably won't be even making that in a private practice podiatry group. 7 years of education and residency training to be just getting by? No thanks...Pathetic.

If you are on somebody's $hit list in podiatry there will be rampant defamation of character. Podiatrist love trashing other podiatrists. They love preventing others from getting board certified, getting privileges at hospitals, prevent others from getting a job.

Podiatry is a bad profession. We will never get out of each other's way. We will never move forward as a specialty. We will always be chasing our tail focusing on things that don't matter. The biggest problem in this profession is that diversity of training in the current profession. The profession is still currently made of practicing DPMs whoe have 0, 1, 2, 3, years of residency training. Some are fellowship trained. Some like wounds and only wounds. Some like charcot reconstruction. Some are forefoot DPMs. Some are nails and calluses. Some like doing total ankle replacements. Some can do everything. You have all these different types of DPMs who can't make up their mind on what is good for the profession and what isn't. If we, as a profession, move in one direction it will alienate one group of DPMs. If we move in another direction it alienates another group of DPMs. In the end nothing gets accomplished.

You have APMA, ACFAS, ASPS. Different organizations of podiatrists who are not unified. You have ABFAS and ABPM board certifying organizations who are not unified. Then there are a host of other subspecialty organizations in a profession that is already very specialized.

Are you confused yet? I am. Jesus

 

[McGG55]

Podiatry must be the most confusing medical profession on the planet lol

I'm grateful I live in the United States where podiatric medicine is on the doctoral level and good enough to be deemed worthy of the role "physician", rather than the rest of the world where it basically is just nothing but a low-end bachelors degree. If we're doing bad here, IDK how the guys in Australia and the UK are fairing. Those guys truly are getting nowhere, but I do feel like somewhat of a difference is being made in the US, slow as it may be. Unfortunately, It seems to be mainly a few people doing the bulk of the work. I do hope this old fart mentality of every man for himself in podiatry dies off, but that may be asking for too much. At least job saturation doesn't seem to be THAT big of an issue in this career. I don't see it becoming like the Pharmacy job market anytime soon... poor guys...

I completely agree that the training must be standardized, at least 3 years of residency should be a bare-bones requirement. A non-standardized residency only provides more ammunition to the orthos saying that we are unqualified for what pods were educated for. It looks like this will definitely become the norm with the next generation of podiatrists, thank goodness. I have no intention to work for other pods. Based on my research and a little bit of common sense, I've got a good feeling working for those guys wouldn't be worth it at all. I would love to get any type of hospital job, primarily in underserved areas, mainly cause that's the type of area (rural) I'd like to live in and because of the potential for (slow) loan forgiveness, but those opportunities do seem tough to get. Guess I'd better bust my butt off to get that 3.8+ GPA in podiatry school to be qualified for the residency of my choosing, but easier said than done, I guess.

Regarding the respect I would or would not be given by my peers: It's my view that the people who could only deem me "tolerable" after having proven myself more than competent of performing the tasks they throw at me aren't worth it in my eyes. I couldn't give a damn about what they think. I'll lick their boots for as long as needed then roll my eyes at them later, My only worry is that, being aware that I am a basically a kid in the big world thinking I can predict my future outlook on life, I might actually take it personal what any rude orthos say to me. That's been my outlook on life for several years so far though, I'm doubting it'll change that much. Besides, I don't care what the orthos care if they're paying me a buttload of money. It just sucks that I can't do everything I was trained to do, but at least I'm doing the bulk of it.

The two orthos I've talked to about podiatrists had different opinions. One was quite obviously trying to struggle by dancing around his belief that they were 2nd-rate doctors, while the other one said that they were excellent health-care providers at what they work at and sounded sincere. I really do think the orthopedic "anti-podiaty" viewpoint really isn't a universal trait orthos have, but the ones that do have this outlook are powerful enough to call the shots. Should I go the ortho group route, I hope I'll work with the orthos that actually think we're useful. In short, I don't give a rat's ass what the cynical orthos think of me, provided they tolerate me enough to pay me a good chunk of money. They don't have to be my friends, I've got my own groups I can be "one of the boys" at, I don't need to be part of theirs. I would value the patients I work with and the enjoyment I would get from seeing them satisfied after my work, not what my boss says. Even if it's limited, it's good enough work.

As for the taxes on my proposed ideal salary, I already took that into account. What's a good number to guess that 150 would be after tax, normally around 100k? I grew up living in crappy apartments for several years, learned the value of the dollar and the best way to work with it. I'm a man of simple needs, I don't mind starting out small. Most of my hobbies are cheap haha. I'm also hoping to intentionally live in the middle of nowhere, both because I prefer rural environments for living and because of the lower cost of living. 100k, or hell even 90k, is good enough for me. "But your mortgage, health insurance, your car, your pedicure!" Yes, I know. More likely than not, the money won't be great starting off, maybe not even that great period, but I'm not complaining. It's a decent enough version of the American Dream. I don't want yachts or a mansion, I want to be middle to middle-upper class. If I get the house, the car, the rest of the necessities, I'm happy. There will be enough for savings, there will be a little bit for personal hobbies, and that's all I need. If I went the DO route, I'd only be a primary care physician (Trying to be an Ortho and even being an ortho sucks half the time from what I've seen). There are plenty of pods making more than those guys and plenty of pods with less debt than those guys. I'm not doing this for the money. If an opportunity for a lot of money is there, ya sure, why not? But if it's not there, whatever. I never cared that much about it.

Admittingly, I am concerned about how a potential family life would impact my viewpoint, however. That's really the only thing I'm concerned about, but I have no intention to marry an obvious gold digger.

I've got a good feeling my post will get ripped apart by the more experienced pods here, but I'd like any outlook on it regardless.

 

[DR.phil99]

I've got a good feeling my post will get ripped apart by the more experienced pods here, but I'd like any outlook on it regardless.

Don't forget. There are more 10,000 practicing pods around the US and most of the replies on Podiatric Residents & Physicians forum are usually by the same 4-6 users.

 

[DYK343]

Don't forget. There are more 10,000 practicing pods around the US and most of the replies on Podiatric Residents & Physicians forum are usually by the same 4-6 users.

This. Podiatry is not bad. Ortho calls me all the time to help them "Can you bail me out? I got this calc fracture that I think needs fixed but its out of my comfort zone" was my call Friday from our local trauma doc. Different areas will have different relationships and opinons of podiatry. IMO If ortho is busy they could care less what you are doing. If they are looking for work then you might run into some problems as they are more powerful legislative wise.

I do agree that hospital/MSG/Owning own practice is the only way to go.

But calling podiatry a bad profession is false. Its a great profession. I would recommend against the northeast. I could be wrong but a lot of podiatrists who practice up there seem to not be happy with their career. I dont think the ortho-podiatry relationship is very good up there.

Regarding amputation levels: A transmetatarsal amputation is fairly stable construct but any further back on the foot and it will fail. Basically if a transmetatarsal amputation fails the next best option is a below the knee amputation which podiatry can not do. That is the one procedure I feel we should be able to do as I agree dumping the patients on vascular surgeons/gen surgeons/ortho to do the BKA isnt good for the patient.

There are only a couple states that have ankle restrictions. Avoid those states if you want to do ankle surgery. I do 5 forefoot surgeries for every rearfoot surgery. Bunions and hammertoes is not a bad life. Big reconstructive/rearfoot surgery sounds fun until its you in there doing it. I continue to take on these cases but I could see myself transitioning to a more "simple" surgical career here in the coming years.

You will likely end up clipping toenails. That's part of being a podiatrist.

Anesthesia laws do not affect us. Beyond local anesthetic administration which we do daily an anesthesiologist is needed for pretty much everything else.

 

[heybrother]

Lot to reply to here, but as far as extending scope. Work in progress in some places. My understanding is the goal is to avoid future protracted legal battles. Go in asking for what you need already having negotiated with ortho at the state/national level so there's less pushback. Obviously that comes up with it's own difficulties.

 

[McGG55]

This. Podiatry is not bad. Ortho calls me all the time to help them "Can you bail me out? I got this calc fracture that I think needs fixed but its out of my comfort zone" was my call Friday from our local trauma doc. Different areas will have different relationships and opinons of podiatry. IMO If ortho is busy they could care less what you are doing. If they are looking for work then you might run into some problems as they are more powerful legislative wise.

I do agree that hospital/MSG/Owning own practice is the only way to go.

But calling podiatry a bad profession is false. Its a great profession. I would recommend against the northeast. I could be wrong but a lot of podiatrists who practice up there seem to not be happy with their career. I dont think the ortho-podiatry relationship is very good up there.

Regarding amputation levels: A transmetatarsal amputation is fairly stable construct but any further back on the foot and it will fail. Basically if a transmetatarsal amputation fails the next best option is a below the knee amputation which podiatry can not do. That is the one procedure I feel we should be able to do as I agree dumping the patients on vascular surgeons/gen surgeons/ortho to do the BKA isnt good for the patient.

There are only a couple states that have ankle restrictions. Avoid those states if you want to do ankle surgery. I do 5 forefoot surgeries for every rearfoot surgery. Bunions and hammertoes is not a bad life. Big reconstructive/rearfoot surgery sounds fun until its you in there doing it. I continue to take on these cases but I could see myself transitioning to a more "simple" surgical career here in the coming years.

You will likely end up clipping toenails. That's part of being a podiatrist.

Anesthesia laws do not affect us. Beyond local anesthetic administration which we do daily an anesthesiologist is needed for pretty much everything else.

Nice to see some optimism on the Podiatry forums here for once, a lot of what I've seen so far has been pretty pessimistic. Sometimes for good reasons, other times I'm not so sure.

Regarding amputations, so would you never recommend a ankle disarticulation then or are there cases where you believed such a procedure would be necessary?

 

[CutsWithFury]

Nice to see some optimism on the Podiatry forums here for once, a lot of what I've seen so far has been pretty pessimistic. Sometimes for good reasons, other times I'm not so sure.

Regarding amputations, so would you never recommend a ankle disarticulation then or are there cases where you believed such a procedure would be necessary?

Nobody does this. BKA prosthesis are very functional


Sent from my iPhone using SDN

 

[McGG55]

Nobody does this. BKA prosthesis are very functional


Sent from my iPhone using SDN

I think I can imagine a few ideas why an ankle disarticulation would be less than ideal than other amputation procedures, but could you elaborate further?

 

[air bud]

I think I can imagine a few ideas why an ankle disarticulation would be less than ideal than other amputation procedures, but could you elaborate further?

Patients hate them. I remember rotating with a well known pod in Phoenix who did them at a VA facility....patients literally begged you to take their leg, but he loved them.

 

[CutsWithFury]

I think I can imagine a few ideas why an ankle disarticulation would be less than ideal than other amputation procedures, but could you elaborate further?

Dude. You think you are going to walk better with an amp at the level of the ankle vs a below knee amputation where the prostheses are cutting edge? I don’t even know what the prostheses options are for an ankle disarticulation are


Sent from my iPhone using SDN

 

[heybrother]

Brief thoughts since I am on the phone. Additional considerations, why was the amputation done in the first place. PVD? In general, blood flow will be better proximally. Infection? I have seen a plural number of cases in which a guillotine amputation demonstrates pus significantly above the ankle. Soft tissue coverage - it atrophies but the BKA incorporates the gastroc.

 

[DexterMorganSK]

So I'm pretty set on applying to Podiatry school in the future. However, something that seems a little disheartening is the lack of consistency with state laws in terms of what a Podiatrist can and cannot do. For starters, I don't believe that a Podiatrist in any state is allowed to amputate beyond the tarsometatarsal, most only allow amputation of toes and some don't allow amputation at all. This sucks quite a bit, I've read a few stories of podiatrists being frustrated that they were unable to amputate a patient's entire foot (and ankle, sometimes) in desperate need while the local orthopedist was simply too swamped with work and was unable to do so. What was the solution? Relocate the patient to a new healthcare provider several hours away, basically cause great inconvenience to the patient while a capable provider was right in their face from the start. Is anything being done to work on the scope of amputation a podiatrist can do? I can't seem to find much about this.

Some states do not even give Podiatrists the right to perform any work above the ankle, which is frustrating because all of the lower leg muscles and bones are connected to foot function in some way or another. Three states don't even allow podiatrists to work on the ankle! A podiatrist can work on a patient's hands and hip in one or two states, but can't work on the ankle in another? That's ridiculous. I shouldn't have to become an orthopedist to do what a Podiatrist should already be able to do. I don't want to work on anything on the Knee or above, all I want to work on is the lower extremity. Also the obvious bias I've seen on various orthopedic websites with their articles/statements about Podiatrists is both sad and laughable, however I've seen Podiatrists try to 1-up orthopedists in ways that are equally both sad and laughable, too.

There are multiple spreadsheets/PDFs available which explain each state's podiatry regulations, but I don't believe any of them are fully up to date, especially considering the new regulations Connecticut and South Carolina recently passed when it comes to Podiatry's scope of practice in their respective states. These changes are not reflected in any of the available Podiatry state law lists I can find.

It really just feels all tiresome, I believe this could be a great field and I do have a lot of interest in it, but why in the world would anyone want to live in a state that basically considers you a glorified toe-nail clipper? Hyperbole I guess, but a podiatrist is capable of so much with that they can do on the lower leg, only to be told by the government what they aren't good at doing.

This topic came out a little bit as both my overall question and me of me venting my frustration in the field. Feel free to comment on both. I'm very excited to become a podiatrist and I know I would love the profession, provided I have a fairly free scope of practice on everything below the knee. What can be done for new podiatrists to expand the scope of practice for Podiatry? What would you do, work in a state with far more practice rights and enjoy applying what you spent years to learn, or bite the bullet and move to a state with limited rights and do what you can there to promote the practice?

To be honest, I'm slightly indifferent to anesthesia administration state rights for Podiatrists, but I guess that's just my inexperienced self not realizing the importance of this topic in the grand scheme of things.

As far as income is concerned... eh. I'm not trying to be filthy stinking rich. If I get a net gain of 140k-150k, I'll be happy. Money has, thankfully, never been one of my problems in life, nor am I too concerned about it. I live simply and I would prefer to live in a rural area as well. I think Podiatrists aren't doing too bad when it comes to money based on what I've looked into, but I think me saying that will cause a few of the more experienced guys here to roll their eyes.

As far as the scope of practice is concerned, I think it's best to check the State's medical board directly for current info. The stuff you see in those PDFs/excel sheets is very old and not up-to-date. You can also check the APMA site for new news or work in progress. For example, legislation is being passed soon for Pods to treat not only the foot but also the lower leg in Massachusetts (another example of getting the scope of practice better from a region to another).