Why I want(ed) to do podiatry [warning: venting]

[Xelb]

The recent thread about why we all want(ed) to go into podiatry inspired this post.

-I'm going to be brutally honest and say that, from the get-go, I wanted to go to podiatry school because I wanted to be a foot and ankle surgeon.

-I wanted to be the only guy who worked at a high-end orthopedic group doing all of the foot and ankle surgical cases while also providing comprehensive non-surgical podiatric care.

-I wanted to graduate podiatry school and get into a top 4-year surgically based residency program and then do a foot and ankle surgery fellowship right afterwards so that I could have the numbers and the training necessary to do cases that other podiatrists and even other foot and ankle orthopods can't/won't do because they simply don't have the training, the numbers, and the experience that I would have.

-I wanted to be the doctor who trains others, foot and ankle orthopods and aspiring podiatrists alike.

-I wanted to go to podiatry school because anyone who denies the excellent training of today's podiatric residency grads, simply has his/her head in the sand. The argument that orthopods are more qualified is simply obsolete.

-To add to that previous bullet point, I wanted to go to podiatry school because 7-8 years of training solely in all surgical and non-surgical aspects of foot and ankle care *should* be better than one year of a foot and ankle orthopedics fellowship, right? Apparently not.

-I wanted to go to podiatry school because I recently had surgery done on my ankle by a podiatrist (yes, in a hospital) and realized that there was indeed another way to go into surgery without having to literally break my back in traditional medical school.

-I wanted to go to podiatry school because I wanted to be a doctor and a specialist.



But the more I learn about this field, whether it's from reading these forums or from practicing podiatrists, the more I realize that all of the reasons I wanted to go to podiatry school are incredibly unrealistic.

Every time I read a post on this forum, I'm learning more and more about just how *limiting* this specialty is in terms of the scope of practice and autonomy. Every single time I learn something new about this field in general, it has honestly always been *limiting*.

Whether it's learning about how everyone and their mother wants to be the only specialist doing foot and ankle surgery all day every day in an orthopedic group practice and how it is statistically unlikely that I will be able to achieve this. Whether it's learning about how a podiatry grad can go about attaining a high surgical volume residency, only to later find out that they can't even utilize half of what they learned from residency during practice. Whether it's learning about how the few pods who do end up working for orthopedic groups always end up doing non-surgical or even 'simple' surgical stuff while the F&A orthopods do the more complex cases that pods were only 'allowed' to do during residency. Whether it's learning that podiatrists, despite being highly qualified physicians, are not legally allowed to hire PAs unless they're being supervised (read: babysat) by a 'real' doctor. Whether it's learning that people will consider you on the same level as a midlevel or a chiropractor. Whether it's people not recognizing that the first two years of podiatry school are effectively the same as 'real' medical school. Whether it's learning that autonomy in this field is essentially non-existent and that podiatrists working with other physicians in different specialties are constantly supervised and babysat because they didn't have what it took to become a 'real doctor'. Whether it's constantly having to explain to others that I'm not going to school to just learn about how to cut other people's toenails. Whether it's seeing that this profession loves to constantly shoot itself in the foot (no pun intended) when it comes to the complete lack of unity and organization in residency training - seriously, how is it that we can even HAVE four year/high surgical volume residency programs and 2 year residency programs with essentially all elective or little to no surgery? Whether it's seeing the disparity between school curricula and the (lack of) support for graduates who go unmatched. Whether it's seeing that admissions standards are so laughably atrocious that it seems to justify the stereotypes of going to podiatry school because you were a 'bottom of the barrel' premed.

Every. single. thing. I read about this profession is always a limiting factor. Always. Want to be the only guy doing foot and ankle surgery at an orthopedic group? Tough s***, so does everybody else. Want to have autonomy in the operating room? No dice...the 'real' foot and ankle orthopods need to sign off on the procedures you do. Want to perform ankle surgery in New York? ABSOLUTELY NOT. You're not allowed. Want to work in an orthopedic group and never touch a scalpel and essentially act as a completely non-surgical foot specialist while making barely enough to pay back your loans? SIGN ME UP!!!

Unfortunately, for people like me who legitimately wanted to do podiatry, there just seems to be no rhyme or reason behind it. Looks like I'll need to apply to a 'real' medical school so that I can end up going through an orthopedic surgery residency (which is lacking in foot and ankle training anyway) and doing a fellowship after that. Lucky me.

I just needed to vent.

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[jellybean2020]

Many of the things you state are either false or based on premed naivete. You need to shadow or meet some successful podiatrists who have accomplished every one of those things you stated in the beginning of your post.

 

[Xelb]

Many of the things you state are either false or based on premed naivete. You need to shadow or meet some successful podiatrists who have accomplished every one of those things you stated in the beginning of your post.

Why do I keep reading on this forum, however, that podiatrists who are like are extremely rare then, and that if you go into podiatry expecting to be that successful and doing surgery all day every day, then you'll be sorely disappointed?

Trust me, I am really hoping that everything I'm saying is wrong.

 

[arez10]

-I wanted to be the only guy who worked at a high-end orthopedic group doing all of the foot and ankle surgical cases while also providing comprehensive non-surgical podiatric care.

This should not have been the second reason on your list of why to go into podiatry in the first place. There are way too many variables and too many milestones to pass before getting to that point. Also, the graduating residents who choose to go into a group podiatry practice are not inferior.

-I wanted to graduate podiatry school and get into a top 4-year surgically based residency program and then do a foot and ankle surgery fellowship right afterwards so that I could have the numbers and the training necessary to do cases that other podiatrists and even other foot and ankle orthopods can't/won't do because they simply don't have the training, the numbers, and the experience that I would have.

There are maybe five 4 year residencies, and the only two that people really talk about are Temple (so you have to go to TUSPM for this one) and Presby (also most likely Temple). Do you even know anything about these 4 year programs? Why 4 years? This, again, does not make you a superior resident.

-To add to that previous bullet point, I wanted to go to podiatry school because 7-8 years of training solely in all surgical and non-surgical aspects of foot and ankle care *should* be better than one year of a foot and ankle orthopedics fellowship, right? Apparently not.

I truthfully don't think this is always true, as ortho residents do get foot and ankle cases during their 5 years of general residency. I think it depends on the individual's competencies when comparing a F/A ortho vs a pod. But that's just my opinion.

Whether it's learning about how everyone and their mother wants to be the only specialist doing foot and ankle surgery all day every day in an orthopedic group practice and how it is statistically unlikely that I will be able to achieve this.

Yeah, no s*** these jobs are competitive, they are first going to hire their own, especially without knowing our training.

Whether it's learning about how a podiatry grad can go about attaining a high surgical volume residency, only to later find out that they can't even utilize half of what they learned from residency during practice.

I'm sorry, but you're not going to see pilon fractures and gun shot wounds every day in practice. Who is saying you can't utilize what you're learning in residency? You're just typically going to see more elective forefoot stuff plus palliative care in practice, unless you get a job at a level 1 trauma teaching hospital.

Whether it's learning about how the few pods who do end up working for orthopedic groups always end up doing non-surgical or even 'simple' surgical stuff while the F&A orthopods do the more complex cases that pods were only 'allowed' to do during residency.

That is probably a lot of the ortho practices, but not all. Then don't sign a contract with an ortho group that won't let you do more complex cases.

Whether it's learning that podiatrists, despite being highly qualified physicians, are not legally allowed to hire PAs unless they're being supervised (read: babysat) by a 'real' doctor.

You really want to hire a PA for $80,000 so you can see less patients?

Want to have autonomy in the operating room? No dice...the 'real' foot and ankle orthopods need to sign off on the procedures you do.

I don't know where you got this from. I've never heard of a foot and ankle orthopod "signing off" on a surgical procedure a podiatrist did.

So basically you want to be a foot and ankle orthopod and that's it. You're right, you're going into podiatry for the wrong reasons, and you are also very misinformed about the training and job opportunities. If you have a "ortho group or bust" mentality, this is not the profession for you, sorry. You CAN be successful matching at a 3 year residency and then entering a podiatry group practice, assuming you become a partner eventually.

 

[arez10]

Why do I keep reading on this forum, however, that podiatrists who are like are extremely rare then, and that if you go into podiatry expecting to be that successful and doing surgery all day every day, then you'll be sorely disappointed?

You will be disappointed, because even orthos don't do surgery "all day every day." How are you going to find patients to do surgery on without having an office or clinic???

 

[Xelb]

Also: http://forums.studentdoctor.net/threads/the-drawbacks-of-orthopedic-surgery.890591/

 

[mcja]

OP, you should find a wider variety of podiatrists to shadow. Sounds like you are very much misinformed.

 

[Xelb]

The replies here so far seem to be contradictory. On one hand, there's one response right now saying there are podiatrists who essentially do everything I mention in the first part of my post, yet the response right under it is saying that's not really the case. Which is it?

 

[Claveaut]

Also: http://forums.studentdoctor.net/threads/the-drawbacks-of-orthopedic-surgery.890591/

I laughed so hard at this thread. The fact that you are using it as a reason NOT to go into podiatry is enough for me to tell you right now that you don't belong in podiatry school. Obviously, you have been very misinformed and need to further research the field outside of what you read on Student Doctor Network. As others have said I could point you into the direction of some very successful podiatrists (one in my family) who not only do wound care but also do orthopedic surgeries.

The field of podiatry is changing and people with your mentality are the reason old stereotypes and derogatory remarks are made toward podiatrists. Unfortunately, for better or worse, podiatry has accepted students with "less than stellar" academic achievement. But, they also accept students with far greater statistics than needed for MD/DO schools. Because students do get in with that 3.0 GPA and midlevel MCATs the MD/DO students will always have a reason to see DPMs as inferior and threads like this will continue to exist. These threads are nothing but individuals claiming superior intelligence over each other when instead all fields should be working together to promote the common good for ALL.

Hopefully, you can job shadow or talk to a few more podiatrists and reexamine why you are considering the field. I would be more than willing to get you in contact with a current practicing DPM if you would like. But please, don't base entire life decisions based on what you read on Student Doctor Network or from one job shadow experience.

 

[Robert De Niro]

To the OP,

If your goal is to be the "F/A Surgeon" within a large Otho group, then you are better served to go the MD/DO route. As other people of pointed out, that position is the exception not the rule for a DPM. With that said, picture yourself in school (MD/DO) and you just received a below average USMLE 1 score. More than likely, your chances to become the F/A orthopod are gone. Are you ok going into Family Med? (personally I feel it is a great field but others may disagree)

The point I am trying to make is even becoming a MD/DO doesn't guarantee you'll become a F/A surgeon within an ortho group. As for the thread you posted earlier, I watched a MD Family med doc get into it with a MD orthopod about post-op treatment while rounding with residents. My point here is that medicine is filled with big egos, and as long as you're happy with what you want, just ignore them. Shadow more Podiatrists and if that's what you want to do, then go for it!

Finally, you will have your support group as well. All the MD/DO attendings I shadowed were excited for me when I got into Pod school, along with my buddy who's currently working towards his MD.

 

[MaxillofacialMN]

Also: http://forums.studentdoctor.net/threads/the-drawbacks-of-orthopedic-surgery.890591/

That thread......we shall never speak of that thread again.

 

[Xelb]

You're just typically going to see more elective forefoot stuff plus palliative care in practice, unless you get a job at a level 1 trauma teaching hospital.

I will do this then.

 

[jellybean2020]

I will do this then.

I sense that you're in the mindset of "surgery=prestigious" right now, and that's totally understandable because you're still premed. Surgery is certainly a huge part of our training, but it's not the only thing. Being in a surgical specialty is just as much about learning when NOT to cut someone open. Once you attend podiatry school or talk to enough attendings, you'll learn that surgery should generally be reserved for the right patient or for when conservative measures fail. And guess what? As a podiatrist you will have to know how to do all of those more conservative measures because you're expected to be the foot & ankle authority. Nail clipping and palliative care isn't something to turn your nose at; they make up a large part of your patient base and you don't treat them with any less care than you'd treat a patient who needs total ankle reconstruction.

In conclusion, this notion that nonsurgical matters are beneath you because you're a surgeon is ill-advised and dangerous to your patients. Not to mention that you can earn plenty of money, respect, & prestige outside of the OR. Just be good at what you do. You can probably make more money in a day if you sat in a room and did 40 office procedures than going to the OR.

Also, I don't know where you got the idea that a DPM is not in charge of the OR when she/he is operating. This is false. Additionally, please do not choose podiatry if you think it's a shortcut or "easier to do." With the residency shortage going on I would not enter this profession unless I was prepared to work my butt off. There's no room for coasting or leaving things to chance in this climate. There's a lot more things you said that I disagreed with, but I'm too lazy right now to address them all individually

 

[Spindoctorfccm]

Although considered by many a "curative field of medicine", podiatry (in my experience) is more of a "preventive medicine" than curative. 90% of your time is in the office evaluating and educating. More podiatrists, that are worth their weight in gold, perform the most important skill we have available and the least utilized, educating patients on preventive measures to improve their quality of life. Amputation was a given for diabetics for eons! Today, we take another look and actually use preventive medicine to prevent amputations. What a thought! "An ounce of prevention is worth a pound of cure". Thus, we are working with our patients to improve their quality of life through a multidisciplinary approach to total wellness. That 10% I haven't mentioned is the surgery and operative procedures. Most of my desire is to use "ALL OF MY TOOLS" to give my patients all of the options available before using the scalpel. More people go to podiatrists for a "quick tune up in comfort" than to "fix me and make me better at any and all costs"! I also see podiatry not as a solo flying pilot doing it "MY WAY"! I see it as a spoke in the wheel of medical knowledge. I believe (for me anyways) that I am a part of something much bigger than me, not a part from the rest. NO MAN IS AN ISLAND, nor is any podiatrist an island. If I have a belief system that I want to be THE MAN, I'm in the wrong field. Maybe I should get an MBA and start a Fortune 500 business and try to eliminate the competition...AIN'T GONNA HAPPEN! I'm an old man and have seen a lot through my eyes. The good, the bad and the ugly in man. Podiatry is a way to help those who want it, as well as those who need it. Be it a baby with bad feet, a teenaged athlete needing to make their arches less inflamed, a middle aged person wanting to make the back more comfortable through education and properly fitted shoes, and the diabetic old aged person who has it in their mind you have to cut off their toes and you give them a possible alternative (and hope) that they may keep the only toes that God gave them. God bless the profession.

 

[Gigantron]

I never post on these kind of threads, but I feel that it is necessary. To all the pre-meds/pre-pods our there, the origin post is greatly misguided and ill informed. Please make sure to seek for information outside of this thread, and this site for that matter. Shadowing is the best way to figure out if this specialty is right for you.

Agreed. However, a quick glance at the ortho forum and you'll see it's not just premeds/prepods who think what the OP thinks. It's sad when you have residents/dinosaur attendings with the same mentality.