I’ve been lurking here for quite some time now on both the pre pod and attending forums. I have come across maybe a handful of positive things, and 100’s of negatives. As someone who is starting school this fall, I had a few questions for some other students and attendings:
1: Are there any positives to this career, or simply the fact that you get to help people and the gratification that comes with it?
2: if you were looking at going to school in todays financial climate, what would be the maximum loan amount to make the ROI livable?
3: I understand SDN has a sample size of n=20, but I have shadowed and discussed with ~10 pods who love what they do and are financially very well off. Where is the disconnect between this and sdn?
4: How much surgery do pods actually do? And I am not talking about the schools agenda that they push. Could a reasonably competent graduate who obtained a decent residency still practice in the OR once a week?
5: Are we heading down the same path as pharmacy with current saturation trends?
Thanks I’m advance!
1. Helping people is the main positive. However, you may not necessarily get to help people the way you want to ie. you have aspirations of sports medicine or reconstruction or teaching but instead you mainly offer ingrown toenail surgery and plantar fasciitis care (still enjoyable and honestly the backbone of even a successful moderately surgical practice). However, it is also entirely possible you find yourself doing way nail more cutting than you wanted. My partner was complaining to me the other day that he felt like the only thing he was getting was nailcare. To tease him I told him that his father was a podiatrist and that he knew what he signed up for. He didn't find this very funny, but the take home is that nailcare is often a sore spot for a lot of podiatrists. There's always someone trying to get into the office masquerading as something else but begging for their nails or calluses to be trimmed. In time, this may not bother you. You may simply resolve to find a way to make money from it. But you'll always remember in the back of your mind the years, the debt, the training only to be the person that nailcare and onychomycosis is always referred to first.
2. The problem with this question is there's probably very little you can control about it unless you already have money or are married. The Texas school is cheap by comparison, but unless something has changed it likely is required to take 90% Texans. DMU likely offers the lowest cost of living but is probably very similar to the other schools in cost. I used to believe you could control cost of living and - you can, but the other inherent costs and time are so large that the controllable variables are somewhat small by comparison. I personally graduated with a little over $100K in debt. Its a lot easier to borrow money than it is to pay it back.
3. Most of us are financially successful. The most common posters on this forum are now in general hospital or orthopedic employed. I co-own a private practice. The issue is - we're all very aware of the horrible jobs market because many of us got ripped off at some point. Those nice successful owners who seem so great to you will rip your face off when it comes time to work for them. Bases wages are low. Percent collections are often low. Practices expenses are routinely pushed onto the associate. And yet buyins are often astronomical. If you think you are done spending money after you graduate - you are likely wrong unless you get a hospital/VA job.
4. I don't have time to give you a great answer here, but I'll again offer you a twist - are you getting to do the surgery you want to do. Most podiatrists are not operating anywhere near what other surgical specialties are doing. You can potentially have higher volume if you are interested in "limb salvage", amputations etc. but this comes with its own issues (compliance, infections etc). Hacking dead meat off people may or may not give you joy. Most people aren't doing trauma or large recons and these cases come with their own downsides like large global post-op periods. The other issue is - surgery can actually work against the revenue of your practice. I believe I've told this story before on here but awhile back I went to a hospital to do a 1st MPJ fusion and a large bone/osteomyelitis resection. Both patients had some health issues. One was referred by my partner and the other from a WHC. Total revenue from the two cases was maybe just over $1000 and I spent hours at the hospital and rounded the next day. Easily, hands down, I would have made more money simply seeing patients in my clinic. Bunions with hammertoes is in fact some of the most lucrative work we do if the patient has commercial insurance.
5. We are already saturated based on the job market. The next few years may feature a bizarre period of instability. New unnecessary schools will be opening but the applicant pool is collapsing. No idea what will happen but if the matriculant pool doesn't normalize it may/will(?) collapse the residency system.
PS
Final usual comments. The schools are too inconsistent, take too many dumb students, are fixated on money. Residency surgical training is too variable. Hospital jobs that pay good starting wages are too rare. Private practices are essentially universally predatory. Practice environments are variable. Or board certification process is awful. State scopes are variable. Commercial insurances are reducing rates, reducing Medicare Advantage rates.
