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Eric Please comment

Discussion in 'Clinicians [ RN / NP / PA ]' started by Temple1st, Nov 1, 2002.

  1. Temple1st

    Temple1st Member
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    I am trully worried about educational debt and ability to pay back the loans. The reason why I posted a thread about the Carribean is b/c it cost about the same as US pod schools but u get a degree with more options for repayment not to mention much higher strating salaries. Since you were in NC for a while you probably know that NC residents get $8500 per year from the state to pursue Podiatry if we return there for each year we received the $. Plus there is an additional $2500 per year from a private fund with the same obligation. I called the granting asociation in NC and ask were u would have to practice to qualify for repayment and they pretty much said the whole state is underserved in podiatry. With this in mind is it a good decision to accept the $40,000 for 4 years of service in NC?
     
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  3. ussdfiant

    Physician Moderator Emeritus 10+ Year Member

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    Join me on Broad Street with the rest of Temple's Health Care Professional schools. Come over to the dark side!
     
  4. efs

    efs SDN Advisor
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    I'll apologize up front, because this is a difficult question to answer. There are a lot of individual variables.

    I am aware of the NC grants, but have not spent much time looking into them, as they most likely won't apply to my situation. I picked up NC residency while I was there with the military, and do not know if I will end up back there. If I do, and it is with the military then the NC grants won't apply for me.

    The first questions I would ask are where in NC are you from?, and what types of connections do you have there? Basically, are you likely to go back to join an established practice? What are you considering for residency? NC does not have any residency programs other than through the military, and that carries other obligations (probably won't stay in NC past residency). The NC podiatry community (from my limited understanding) is fairly closed, so it can be difficult to go there to open a new solo practice. When you go back to NC, talk to the local pods and find out what they think the opportunities look like. THey are much more likely to have a handle on what things look like there.

    My personal opinion is not shared by all. I really don't care too much about the debt load, as I believe that the opportunities exist if you look for them or create your own. Yes, there are DPMs out there who are having a hard time, but I think there are a number of factors that may be influencing any individual case. The vast majority of DPMs that I have had contact with are doing quite well.

    Since you seem to be considering the MD vs. DPM options I would also ask what you really want to do. If you are just considering podiatry because it s easier to get into the schools, I would re-think what your interests are. If you really want to do something other than foot and ankle, you might be better off considering your other options. I think the DO programs have as much to offer as the MD programs as far as payback options. My personal opinion is that I would consider that before looking offshore. On the other hand, podiatry offers what I am interested in (might not be the same for others).

    If you want to talk about more specifics, contact me privately off the forum. I'll be glad to give my opinion.
     
  5. Temple1st

    Temple1st Member
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    I don't want to give the wrong impression. I only apllied to Pod school. I am not a MD wanna be. I was trully concerned about income after grad. I saw the APMA's latest stats. They really arent that bad if you don't have $150k in loans to pay back. However, I talked to one of my friends a new dentist who isn't doing well -----yes believe it or not someone outside of Podiatry who is not making $100k. (that comment was for the neg. posters). He told me that he was able to obtain a hardship foreb. on his loans. Then he said that as long as you are in school u won't have to start paying. His plan: After foreb. ends enroll in local MPH program which gives a distant learning option via web. tuition is only $4k/year. That gives him another 2 or 3 years not having to worry about full loan repayment -but paying interest. Then hopefully after all this run a round he will make enough to pay off loans. I'm not saying to follow this plan but it does give hope if you are not doing well your 1st few years out. You can prevent the "Atomic Loan Bomb" from exploding for a few years. I wish starting incomes were equivelant with our MD counterparts.

    as always ignore spelling and grammer. Eric I also PM'ed u.
     
  6. efs

    efs SDN Advisor
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    There are certainly ways of going into forebearance and delaying repayment of loans. The problem with that is that you will still be accruing interest, so it will cost even more when you do get around to paying them.
     
  7. TomOD

    TomOD Senior Member
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    Temple1st,

    I am an OD in North Carolina. I received the loan you are talking about called "The North Carolina Health, Science and Math Loan Program?" or something like that. I will have to look it up to remember.

    In a nutshell, they pay you for working in an "underserved" area of NC. For Optometry, that includes 50 out of 100 counties in the state even though the county I am in is only considered underserved by the state.....certainly not by the 37 OD's and 15 OMD's bumping into each other. I don't know about Podiatry but I image it's possibly better.

    All I have to do is have "2 influential" members of the community write a letter once a year (banker and whomever else I can find at the time). Fairly stupid but easy to do. This forgives $8,500/year for 4 years. So it's a really easy way to get a $34,000 discount on your education.;)

    http://www.cfnc.org/paying/loan/career/career_hsm.jsp

    I looked into Podiatry prior to going to OD school in 1996. The DPM I visited actually told me to go into orthopedic instead. I visited him last month trying to find a DPM to join me in a rural clinic I was working at but he was TOO busy.....Seemed like he was doing pretty well for himself. ON another note, I had one of my patients tell me that her DPM (who I don't know) is leaving the profession. I ask if he was retiring but she said he was only about 50 and just decided to do something else. But on a similar note, my mothers OB/GYN just suddently decided last year to quit her very successful private practice at the age of 38 and become a stay-home mom. She just got burned out ........So I guess there is dissatisfaction all around. And of course, Optometry certainly has our own problems......but thats another forum....

    If your going to practice in NC and can settle on a desirable area, then by all means take advantage of the NC Loan Program......little hassle for easy money.

    Here is a great site that will tell you just about everything you ever wanted to know about NC healthcare trends and statistics.

    http://www.shepscenter.unc.edu/DATA/NCHPDS/nchptoc.html
     
  8. Temple1st

    Temple1st Member
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    Thanx Tom. I was just wondering where a underserved area was in NC for POD since I looked over the info u supplied I think I know just about everything I need. In comment to the DPM that discouraged u: I have talked to many DPM's and found that before I entered POD school some said stay away from podiatry, now that I am a student they say how r classes, study hard, if u need a reference give me a call. Wow, what a change! I also noticed that the Pods that say stay away have a $60k car in the lot. With the change in response to a prospective student to a current student, I would have to ask; Do current Pods who r doing well discourage future Pods in order to keep competition down? I noticed the same response a few months ago talking to a Philly DPM-- he said why Podiatry? Then i told him I was returning to the south and his reply was oh, u will be fine. It seems like DPM's r trying to keep the field small. Is this the same in all professions?
     
  9. efs

    efs SDN Advisor
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    It's an interesting response. I have heard and seen similar with reqards to some trying to keep the competition down.

    Personally, I think they are only hurting themselves. More podiatrists will increase the visibility, and this will increase demand. It is not a zero sum field, where there is only so much to go around.

    For a contemporary example, look at Starbucks. They would open stores practically across the street from an existing store. Business at the first store would drop off temporarily when the second store was opened, but within months both would be up and doing well.

    Also interesting to see that these same people are doing well (or at least they appear to be doing well).

    It's really not as bad as some people would like you to believe.
     
  10. TomOD

    TomOD Senior Member
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    Hi Temple1st,

    You guys think Podiatry is tough......look at Optometry. We are without a doubt our worst enemies. Knuckleheads running to Walmart, Costcos, Sam's Club etc. to make a quick buck (but I guess it's good to have the opportunity??). At least Podiatry isn't there (yet?). Hopefully you will never see the day when you have to work inside Walmart next to Isle #7 between the cigarettes and the beauty salon.

    There is a growing movement within Optometry to split. It is assumed by many that Opticians will eventually gain the right to refract (for glasses) independently. Then ALL the commercial OD's will be replaced with cheaper Opticians. I opened my own private practice in NC 2 years ago. My practice is 75% pathology (lots of glaucoma and diabetics) in addition to glasses and contact lenses. Optometry has fought for many years to gain therapeautics and to become "real doctors" and we have *******es running to Walmart and making us look like idiots.

    OD's have it tough too. We have competion from Ophthalmologists (who started to sell glasses to supplement falling surgical fees......Cataract surgery now goes for around $600 per eye) , Opticians (who want to refract), Family docs, PA's, NP's, Pediatricians (who call every red eye "bacterial conjunctivitis" and rx sulfacetamide).

    Yea, there is crap in every field. I was observing a Ophthalmologist during a cataract surgery. He was telling me about another local Ophthalmologist who chastised him and other OMD's because they did cataract surgery in only 15 minutes when he thought they should take 1 hour (old guy).

    Sorry to vent on the Podiatry forum. I thought you guys could use some "grass ain't necessarily greener on this side" view. :laugh:

    Tom
     
  11. efs

    efs SDN Advisor
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    Tom,

    I for one, greatly appreciate your comments. There are many in our field who think this our problems are unique to podiatry. A great many of them are students or freshly out of residency and can't see beyond podiatry. Many think things are better elsewhere. (Most think their problems would be solved by being an MD or DO). Little do they realize that these things go on in every field. Although you only speak for optometry, I get the sense that you know this is everywhere. The same things go on among the MDs and DOs, they just aren't as ready to air it. I think most of them have the feeling that if they have a problem it is with something they are doing rather than within the system. With the smaller numbers in podiatry, optometry, and some other fields it may be more likely that people will criticize the profession rather than take personal responsibility. I'd find the whole mess somewhat amusing if it weren't such an issue. It is almost unbelievable as to some of the things people will say or do.

    For those who want to act as professionals, do the right things, put some effort into it and take responsibility for what they do podiatry can be a very rewarding field. For those who expect things to be handed to them simply bcause they got into school and completed the courses - it can be a shock.

    These are only my opinions though.

    As a side note it is interesting that I have an uncle named Tom who is an OD. Grandad was a pharmasist, greatgrandad was a dentist. I've heard all sorts of things about the problems of the various professions. And everyone seems to have a higher opinion of the other professions.

    Do what you enjoy. Don't worry about what others are saying. To a large extent it is a matter of perspective.
     
  12. Toejam

    Toejam Terminal Student
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    Hey, Eric.

    I'll have to disagree with you on a couple of points.

    There are several problems in podiatry that are completely unique to the field. Obviously, you need to have a category to compare so let's choose physicians (even though the Student Doctor Forum has demoted us to "health practitioners"). I would further say that professions such as P.A.'s, nurses, N.P.'s, chiropractors, DDS, etc. all have their own, unique hurdles to cross.

    Here are some examples of some unique problems with DPM's compared with MD's and DO's: DPM's have no reasonable way to get their loans paid off through the government. MD's and DO's do. DPM's oftentimes need permission to manage patients because of our limited licenses. MD's and DO's don't. DPM's earn far less out of the gate compared with MD's and DO's. There are few jobs available to DPM's when they finish their training compared with MD's and DO's. DPM's have uneven training. DPM's can be barred from insurance plans if they don't have the right training. Practically every health care field can compete with DPM's; there are comparitively fewer specialties for MD's and DO's where competition is much of an issue (nephrology, general surgery, plastic surgery, oncology, ENT, ortho, cardiology/cardiac surgery, pathology, etc., etc.). MD's and DO's can practice outside of the United States. DPM's can't. MD's and DO's can practice many types of medicine (they can change their specialty and do another residency or fellowship, they can cross over and treat other maladies even if it isnt' specifically in their field). DPM's cannot.

    The list is likely larger, but I think you get my point.

    I think it's also wishful thinking on your part when you say "The same things go on among the MDs and DOs, they just aren't as ready to air it". What sort of explanation do you have for this difference? You intimate that it's the relative size of the fields. I don't follow. I frequently go on DO and MD forums and I have yet to see a single thread that contains so much apprehension, griping, fear and outright anger as you'll find on any podiatry forum. There was even an entire website devoted to the "lies" and other myths about podiatry. http://www.angelfire.com/on/podiatry/index.html?main=news.html Why do you suppose someone would go to such extreme lengths to badmouth an entire profession? This person appears to be very rational and intelligent to me. He has backed up nearly every assertion with hard facts. To me, it's difficult to see it as some isolated curmudgeon who has a vendetta against podiatry.

    You also state that, for MDs and DOs, "most of them have the feeling that if they have a problem is is with something they are doing rather than within the system". Huh?? This sounds like the kind of statement that I might make and you would later tell me that I'm just spouting gibberish with no basis in fact (no offense). Are you telling me that DPM's, for some unknown reason, are more likely to blame the system for their problems compared with MDs and DOs?? This doesn't make a whole lot of sense to me.

    I, for one, completely disagree with your opinions on this topic, but I certainly respect and enjoy your comments. I'm scheduled to interview tomorrow at my 1st DO school. I'll let you know how it goes.
     
  13. efs

    efs SDN Advisor
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    Toejam,

    Sorry for offending your sensebilities. I know we often disagree, but I do respect your right to have a different opinion. Mine may not be 100% right, but I don't think yours is either. My comments were also painted with a rather broad brush.

    I did not intend to come across as meaning that ALL of the problems are shared. However, a vast number of them are to one extent or another. As you also pointed out, each of these other fields also have THEIR unique problems. My main point was that things will not always be better because you are in a different field. I think the individual has a greater role. Some people will have problems no matter what field they go into. I don't know, maybe for some reason podiatry finds a greater share of these folks.

    I don't have time to address all of the items you brought up but will hit a few.

    DPMs have uneven training. Yes, I would definately agree with this. In fact, I think this may be one of the biggest problems we have. The extent of it could be argued as well. Also, CPME is working on changing this. The current proposed model will reduce the residencies to 2, with 2 year and 3 year being the options. All will cover medical issues and forefoot surgeries, the 3 year would also cover rearfoot. If this works out, I think it will be an improvement. And, do you really think this issue is not a problem for other professions as well?

    DPMs can't practice outside of the US? Are you sure? Ask Dr. Haverstock. I'm sure he would disagree. I have also heard of (and don't recall a name) a DPM who returned to their home overseas (I think India) and practices a full scope medical practice due to shortages of physicians. We also have people here who have gone to Austria, Italy, England, etc. I don't know to what extent they were accepted, or allowed to practice, but it can certainly be done.

    I don't have any explanation as to why some MD hasn't put out their version of the PodiatryBytes site. The only thing that I can come up with is that it is due to the difference in sizes of professions. If 1 person doesn't make it as an MD does it seem reasonable to attribute that to the profession or to the individual? If 1 person doesn't make it as a DPM ask the same question again. I think that person might be more likely to see it as a system problem rather than an individual problem. (Yes, I know more than 1 person didn't make it as a DPM.) This is a concept question, though. (Oh, and people with MD and DO degrees do sometimes fail.) My thought is that they tend to view it as something they did though, and not blame the profession. It's a lot harder when so many more people are making it work.

    You also quote a part of a statement I made, leaving off the first 2 words "I think", which clearly identifies this as an opinion rather than a fact. It is not based in fact, but rather in my views. I think the basis for that is explained a bit more in the previous paragraph. I hope that helps clarify it. It is a fact that there are MDs and DOs who fail. Some have problems finding jobs, or are forced out. Unlike podiatry, most of them do not openly air this. Why? My guess is that they tend to see the individual problems rather than blame the system. I also don't think all of those in podiatry with problems have individual problems, some are due to the system. But not all, and probably not the majority. If you doubt my comments about the MDs and DOs, do a quick search on the Semmelweis Society. I also think my views on the differences among individuals is well based. Do you trust every MD or DO you know based on their degree? I know a lot of them I wouldn't ask advice from even for minor issues. I also know NPs and PAs that I would trust implicitly. I also know that these individuals will tell me to see someone else, if they don't have a sure answer. Most likely they would also direct me to someone whose jugement they value.

    I hope this clears up my views a little for you. I would also hope that I can sway your opinion a bit.

    Good luck on your interview. We'll be waiting to hear how it went.
     

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