Choosing Your Specialty

[Adam Smasher]

For Love or Money: How Do Doctors Choose Their Specialty?

Does every doctor feel a calling to a certain specialty? How much does money factor into the decision?

www.medscape.com

Interesting article about how medical students choose which specialty they want factoring money vs doing what you enjoy. They interviewed a doctor who subspecializes in adolescent medicine and is the lowest paid subspecialty. Reminds me of an internist told me why he respects ID docs, they do a fellowship so they can earn less money. The takeaway is chase your passion because chasing money will burn you out.

It got me wondering how this parallels podiatry. We talk a lot about ROI here (justifiably so) and going to extremes so we can make sense of all the time and training we take on. (Troll meme suggestion: in podiatry you don't have to choose between job satisfaction and financial success because you'll have neither!) I think a lot about reconfiguring my schedule so I'm treating problems I actually want to treat, turning away the rest, and what kind of financial hit would I take doing so.

You hear about these pods who just treat a lot of kids or a lot of runners and eventually become "pediatric experts" and "sports medicine specialists." Honestly, more power to them that they have tailored their practice to their interest. As for me, I don't want to target any subpopulation so much as I'd like to eliminate a lot of the lobster work so I might actually enjoy podiatry.

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[air bud]

I want to specialize in procedures with a high RVU/low global period ratio.

 

[Hybrocure]

I want to specialize in procedures with a high RVU/low global period ratio.

Sounds like a TTR fellowship is in your future

 

[Hybrocure]

For Love or Money: How Do Doctors Choose Their Specialty?

Does every doctor feel a calling to a certain specialty? How much does money factor into the decision?

www.medscape.com

Interesting article about how medical students choose which specialty they want factoring money vs doing what you enjoy. They interviewed a doctor who subspecializes in adolescent medicine and is the lowest paid subspecialty. Reminds me of an internist told me why he respects ID docs, they do a fellowship so they can earn less money. The takeaway is chase your passion because chasing money will burn you out.

It got me wondering how this parallels podiatry. We talk a lot about ROI here (justifiably so) and going to extremes so we can make sense of all the time and training we take on. (Troll meme suggestion: in podiatry you don't have to choose between job satisfaction and financial success because you'll have neither!) I think a lot about reconfiguring my schedule so I'm treating problems I actually want to treat, turning away the rest, and what kind of financial hit would I take doing so.

You hear about these pods who just treat a lot of kids or a lot of runners and eventually become "pediatric experts" and "sports medicine specialists." Honestly, more power to them that they have tailored their practice to their interest. As for me, I don't want to target any subpopulation so much as I'd like to eliminate a lot of the lobster work so I might actually enjoy podiatry.

Becoming a pediatric or sports med specialist (with the exception of the heavy ortho type practices) I would imagine is a great niche to make big $$ on orthotics. People in sports likely to pay cash for orthotics, being a peds specialist may mean a lot of your patients orthotics will be covered by insurance. Also, a huge amount of ingrowns if you’re known as the peds guy in town.

 

[air bud]

I

Becoming a pediatric or sports med specialist (with the exception of the heavy ortho type practices) I would imagine is a great niche to make big $$ on orthotics. People in sports likely to pay cash for orthotics, being a peds specialist may mean a lot of your patients orthotics will be covered by insurance. Also, a huge amount of ingrowns if you’re known as the peds guy in town.

Guy who trained me partnered with a peds guy with 3 clinics. literally does 15 ingrowns a day. Heaven.

 

[Feli]

I agree it is very limiting to reject anything in podiatry.
Between the already limited scope and the serious saturation, it's a pretty sure way to lose pts/refers.

Being picky might be ok in normal or good times/economy, but it is razor's edge when times get tough.
It was said that in the great depression, urologists were doing general practice to make ends meet... now that's tough times.
Another COVID-type event or a just plain poor economy with major employers continuing to lay off or downgrade insurance for their employees is not at all unlikely, so it's always good to have surplus of pts/refers.

Some DPMs can trick the hospital for paying them to do narrow scope (no surgery, no trauma, no nail care, no wounds, nothing but wounds, etc). That's probably easiest at 'academic' jobs where there can be excuses to only see 10-15pt per day and have many days off.
That stuff very seldom works in PP. It takes a large metro patient pool or large pod group to even consider it (other partners/associates have to still take the appts the 'specialist' doesn't in order to keep the pt flow and refers happy). I think some DPM groups certainly have the one or two bigtime surgical DPMs in them, but that's a bit of a dying breed as nearly all DPM associates want to be surgical themselves these days.

...But yeah, if we could, specialize in ingrown or verruca... fast easy RVUs/pay, few issues.

...You hear about these pods who just treat a lot of kids or a lot of runners and eventually become "pediatric experts" and "sports medicine specialists." Honestly, more power to them that they have tailored their practice to their interest. As for me, I don't want to target any subpopulation so much as I'd like to eliminate a lot of the lobster work so I might actually enjoy podiatry.

I think those are <0.1% of DPMs, man.
I think it is mostly just a marketing effort among a few legit (and many wannabe) authors and speakers within podiatry to be a podiatric derm wizard, flaps master, Charcot king, etc. A lot of them aren't very busy seeing actual patients at all. They mostly just teach and read and write and travel more than seeing patients. It's 100 miles from real practice.
We hear of the podiatric radiologist or podiatric nerve surgery specialist of podiatry infectious disease guru, but it's mostly talk. Tiny fraction of DPMs.
Even the ones literally running sports fellowships or major recon surgery fellowships will still typically see ingrowns or tinea pedis or wounds to make ends meet.

It's fine having a preferred niche to market to (peds, TARs, sports, wounds, whatever... I market mainly to forefoot recon + flatfoot typically), but actually closing the refers on other bread and butter stuff is HIGHLY uncommon for DPMs - of any practice type. Every PP guy I know with an 'ankle institute' will not refuse a blue cross ingrown either.

 

[Retrograde_Nail]

For Love or Money: How Do Doctors Choose Their Specialty?

Does every doctor feel a calling to a certain specialty? How much does money factor into the decision?

www.medscape.com

Interesting article about how medical students choose which specialty they want factoring money vs doing what you enjoy. They interviewed a doctor who subspecializes in adolescent medicine and is the lowest paid subspecialty. Reminds me of an internist told me why he respects ID docs, they do a fellowship so they can earn less money. The takeaway is chase your passion because chasing money will burn you out.

It got me wondering how this parallels podiatry. We talk a lot about ROI here (justifiably so) and going to extremes so we can make sense of all the time and training we take on. (Troll meme suggestion: in podiatry you don't have to choose between job satisfaction and financial success because you'll have neither!) I think a lot about reconfiguring my schedule so I'm treating problems I actually want to treat, turning away the rest, and what kind of financial hit would I take doing so.

You hear about these pods who just treat a lot of kids or a lot of runners and eventually become "pediatric experts" and "sports medicine specialists." Honestly, more power to them that they have tailored their practice to their interest. As for me, I don't want to target any subpopulation so much as I'd like to eliminate a lot of the lobster work so I might actually enjoy podiatry.

Podiatry is not what you make of it. There are so many factors that go into "What you make of it". A lot of it is dictated by geography. If you want to work in a highly desirable area but there are no hospital jobs available then you have to go private practice. Sure then you could be a peds guy or sports guy but you are still an associate getting raked over the coals by your PP owner/master.

I personally believe in treating all pathologies. The more you can reasonably treat the more volume you can do and the more money you can make. This is why getting good residency training is paramount and most likely why more are doing fellowships because they come from lack luster programs and just want to be able to do "more".

If you have the courage to sub specialize in podiatry then you are better off starting your own practice in a highly desirable location where you want to live and going for it. Sub specializing working as an associate is a poor decision.

Sub specializing in hospital gigs is not possible as admin will certainly be looking at your numbers and wondering why you are referring certain pathology out. That won't last very long.

It is nice to romanticize about sub specializing but for majority it is not going to be possible as an employed doc (PP or hospital). Start your own practice and do it.

 

[newfeet]

For Love or Money: How Do Doctors Choose Their Specialty?

Does every doctor feel a calling to a certain specialty? How much does money factor into the decision?

www.medscape.com

Interesting article about how medical students choose which specialty they want factoring money vs doing what you enjoy. They interviewed a doctor who subspecializes in adolescent medicine and is the lowest paid subspecialty. Reminds me of an internist told me why he respects ID docs, they do a fellowship so they can earn less money. The takeaway is chase your passion because chasing money will burn you out.

It got me wondering how this parallels podiatry. We talk a lot about ROI here (justifiably so) and going to extremes so we can make sense of all the time and training we take on. (Troll meme suggestion: in podiatry you don't have to choose between job satisfaction and financial success because you'll have neither!) I think a lot about reconfiguring my schedule so I'm treating problems I actually want to treat, turning away the rest, and what kind of financial hit would I take doing so.

You hear about these pods who just treat a lot of kids or a lot of runners and eventually become "pediatric experts" and "sports medicine specialists." Honestly, more power to them that they have tailored their practice to their interest. As for me, I don't want to target any subpopulation so much as I'd like to eliminate a lot of the lobster work so I might actually enjoy podiatry.

I don't think there is an idealized version of podiatry that will give me job satisfaction. The closest is my current job which an academic job. I am out of the hospital by 330/345. That is working because of the chaos of my home life. All my burn out is from home and not work. In the past it was a mix of work and home. The max was when I was going to 4 different locations, taking diabetic foot call, doing amputations after or before clinic. Then going home to a stressed out wife and two demon children. Then having to do 30 plus notes after everyone was asleep.

This is a much better situation but I still don't love podiatry.

 

[icebreaker32]

It is a job.....with a limited scope and saturation. Also many others (even mid levels) can do most of what we do and many offer better hours.....urgent care, and ortho clinics run by PAs etc.

The best most podiatrists can realistically strive for is to do a little more of what they like, a little less of what they don't like when established and drop a couple poor insurance plans.

Most will not have the option to easily switch geographic locations once established, switch settings (private practice to academic etc) or exclusively sub specialize.

 

[Hybrocure]

It is a job.....with a limited scope and saturation. Also many others (even mid levels) can do most of what we do and many offer better hours.....urgent care, and ortho clinics run by PAs etc.

The best most podiatrists can realistically strive for is to do a little more of what they like, a little less of what they don't like when established and drop a couple poor insurance plans.

Most will not have the option to easily switch geographic locations once established, switch settings (private practice to academic etc) or exclusively sub specialize.

Thankfully most mid levels don’t want to do what we do, well because feet. Same reason why all these midlevels refer to us.

If you’re a midlevel making salary why get covered in fungal dust and blood when you can stay clean and chat about medications instead and still make the same $$?