Job Market

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I, like many graduating residents are heading to ACFAS 2026 in hopes for recruitment / job opportunities. The job market is bleak and none of the attendings at my program are helpful with job assistance (they're all hospital employed and have worked there 10+ years. They all live in their own bubble not understanding the struggles of many of their DPM colleagues). The offers we are getting are typically by Upperline Health and big private equity group in the region with some PP offering sub 150k. I looked into the military as I've seen multiple healthcare recruitment advertisements with sign on bonuses / loan repayment program that sounds like a sweet deal but as soon as I get in contact with them they tell me "Podiatry is not part of the medical or dental corps so the offer does not apply or Podiatry services are not needed". It is frustrating to see MD, DO, DDS, DMD, OD, PharmD, PT, OT, PA, NP, CRNA jobs in demand in the military with lucrative sign on bonuses yet Podiatry is not even considered? To add to insult, Podiatry is considered as allied health care in the military sharing ranks and pay with non-doctorate or no residency required fields.

Because I'm originally from an urban/suburban city and my program also is located in that demographic area, it is my desire to be employed at the similar setting. Knowing how saturated my hometown or any other city that seems desirable, I am so discouraged that I may end up either at some rural place or working low salary at PP struggling to pay off over$250K debt I have... I am in my mid 30s and have no $$$ or energy to switch careers, become any actual physician, or even do Caribbean online MD. What's honestly out there for 7 year trained DPMs to do at his point if our skillset can be done by every other speciality?

It doesn't matter Wear your desire is to be employed. If you want to be employed where you currently are you're going to work for upper line if you want a better job than that you're going to have to move it's that simple. I did, many others have done
You can have your location, you can have your ideal job or you can have something else I don't remember how the saying goes. But you can't have all three. One is good too is better three is impossible.

I mean a lot of your complaints are valid. But your job is to get a good job and set yourself up to leverage that into a better job in the future. Nothing is forever. Unless you're hometown is Dickinson North Dakota
 
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Is that in CA or something and how many extra shifts are they pulling? Most I’ve ever heard PA/NP getting paid was ~200k and they were picking up extra shifts regularly. Nurses most I have heard of around my area was ~85k.
Very sad nursing has been mentioned so many times in our forum and comparing their salaries to a starting new grad salary

Profession needs a complete reset.
 
Is that in CA or something and how many extra shifts are they pulling? Most I’ve ever heard PA/NP getting paid was ~200k and they were picking up extra shifts regularly. Nurses most I have heard of around my area was ~85k.
It gotta be California pr Washington
 
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I think it’s kind of disingenuous when we prop up the extreme upper limits of nursing or PA/NP salary as if it’s normal. Then at the same time act as if the extreme low ball podiatry associate offers are the norm.

We have several pods in this forum making above 300k, some above 500k.
 
I think it’s kind of disingenuous when we prop up the extreme upper limits of nursing or PA/NP salary as if it’s normal. Then at the same time act as if the extreme low ball podiatry associate offers are the norm.

We have several pods in this forum making above 300k, some above 500k.
Agree. A lot will eventually do well in a couple years. I wouldn’t compare podiatry to PA/RN in regards to money alone.

I would say that those degrees do offer the ability to change jobs frequently/move across the country/increase salary vs podiatry. They also allow for potential remote positions.

As a second generation pod I would highly discourage any of my kids to go into podiatry and would recommend CRNA instead.
 
RNs do have an easier time getting non-clinical work too; I've seen them on the lecture circuit for vendors in conferences, and as part of hospital/healthcare admin. I'm sure NPs/PAs are just as capable of doing this if not more so. There's just much more flexible degrees compared to DPM where you're largely locked into clinic/surgical work and any other kind of work beyond that feels extremely niche - you have no escape or any way to leverage your experience after you get "done" with patient-facing care unless you've been consistently doing it beforehand.

Also - I don't think going to conferences (ACFAS or otherwise) is a good use of your time when trying to get jobs. My experience is that you'll only get private practice offers at best - and if that's what you're looking for, better to go to regional/local conferences instead if you have a particular location in mind.
 
Agree. A lot will eventually do well in a couple years. I wouldn’t compare podiatry to PA/RN in regards to money alone.

I would say that those degrees do offer the ability to change jobs frequently/move across the country/increase salary vs podiatry. They also allow for potential remote positions.

As a second generation pod I would highly discourage any of my kids to go into podiatry and would recommend CRNA instead.

RNs do have an easier time getting non-clinical work too...
For sure.

I really think even basic RN is pretty good (make more than a tradesman on averaged, not so hard on the body, student loans very minimal, jobs EVERYWHERE).

It depends what one's long term plan is (prestige, challenge, etc... versus simple ROI and job options and maybe FIRE). It is hard to be in school so, long come out negative... AND have pretty limited job options in most areas as podiatry. You basically figure BSRN route finishes school at 21 or 22 with maybe $50k 7% debt and $100k-$150k earn power... or DPM finishing training around age 30 with $300k+ 7% debt and maybe $150k-$250k earn power. That lost time and compounding interest is a backbreaker. The $300k or $400k podiatry student loan easily turns into $500k-750k in total or more once it's actually paid off. Interest is a mofo.

I know I'd absolutely have hit my FIRE goal of about 2.5M stock/cash (no kids and some real estate paid off, so we can do that) a whole lot faster with RN and probably lived in better places along the way, and that's simply due to the flipping the lever from debt to stocks gaining at a lot younger age. It still works out anyways with podiatry as long as you live fairly frugal and pay the big DPM debt (which now gets bigger every single year, though). If you make $200k, live $150k lifestyle, and pay loan minimums with the DPM route, you are toast (but same could be said for RN or anything).

And again... high income spouse ftw. Every time, twice on Sundays.

... I don't think going to conferences (ACFAS or otherwise) is a good use of your time when trying to get jobs. My experience is that you'll only get private practice offers at best - and if that's what you're looking for, better to go to regional/local conferences instead if you have a particular location in mind.
For sure. ACFAS, in Feb or Mar, is also basically too late for 3rd year residents (which are who most programs send to ACFAS).
It's a cool meeting, but you are more likely to just meet other residents/fellows you are applying against for the maybe 4 podiatrist jobs that pay ok listed on podiatrycareers than you you are to meet a legit job lead or posting.

Unless it's fully paid for, you are better just visiting your target area and going to a state/local pod meeting... or better yet, set up visits with a few groups or a hospital(s) there during a week or long weekend pgy2. I heard the "find jobs at ACFAS" a few times as a student - even at good programs - but I sure don't see it (your residency program is either connected, or it isn't). Some programs get a good amount of letters for job posts sent to director/office (variable quality jbos), and others don't... most are on their own.

ACFAS is mostly students/residents/fellows and hospital pods. Most hospital/msg pods only want to control who among interviews gets hired (they don't decide who applies or when to hire). The PP pods there are usually just relaxing and enjoying the city and a break, not really looking to hire... although you never know.
 
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For sure.

I really think even basic RN is pretty good (make more than a tradesman on averaged, not so hard on the body, student loans very minimal, jobs EVERYWHERE).

It depends what one's long term plan is (prestige, challenge, etc... versus simple ROI and job options and maybe FIRE). It is hard to be in school so long come out negative... AND have pretty limited job options in most areas. You basically figure finish school at 21 or 22 with maybe $50k 7% debt and $100k-$150k earn power... or finish around 30 with $300k+ 7% debt and maybe $150k-$250k earn power. That lost time and compounding interest is a backbreaker. The $300k or $400k podiatry student loan easily turns into $500k-750k or more once it's actually paid off. Interest is a mofo.

I know I'd absolutely have hit my FIRE goal of about 2.5M stock/cash (no kids, I can do that) a whole lot faster with RN and probably lived in better places along the way, and that's simply due to the flipping the lever from debt to stocks gaining at a lot younger age. It still works out anyways as long as you live fairly frugal and pay the big DPM debt (which now gets bigger every single year, though). If you make $200k, live $150k lifestyle, and pay loan minimums with the DPM route, you are toast (but same could be said for RN or anything).

And again... high income spouse ftw. Every time, twice on Sundays.


For sure. ACFAS, in Feb or Mar, is also basically too late for 3rd year residents (which are who most programs send to ACFAS).
It's a cool meeting, but you are more likely to just meet other residents/fellows you are applying against for the maybe 4 podiatrist jobs that pay ok listed on podiatrycareers than you you are to meet a legit job lead or posting.

Unless it's fully paid for, you are better just visiting your target area and going to a state/local pod meeting... or better yet, set up visits with a few groups or a hospital(s) there during a week or long weekend pgy2. I heard the "find jobs at ACFAS" a few times as a student - even at good programs - but I sure don't see it (your residency program is either connected, or it isn't). Some programs get a good amount of letters for job posts sent to director/office (variable quality jbos), and others don't... most are on their own.

ACFAS is mostly students/residents/fellows and hospital pods. Most hospital/msg pods only want to control who among interviews gets hired (they don't decide who applies or when to hire). The PP pods there are usually just relaxing and enjoying the city and a break, not really looking to hire... although you never know.
Residents - if you are going to ACFAS to find a job....you are doing it wrong
 
autocorrect of "plus procedure"

I love me my 25 modifiers. You gotta keep your notes compartmentalized though, separate ICD-10 codes, separate paragraphs, separate sections, and I have a macro that says "this is a new problem in an established patient requiring a significant and separately identifiable evaluation and management service beyond the procedure described below." Tedious AF but that's the game. Never been audited on this but I feel like that's adequate preparation. IDGAF what the PCP thinks when I forward the notes to them, like the commercial says, it's my money and I want it now!
All due respect. The number podiatrists billing vist plus procedure is staggering. It’s looked at fraud, waste or abuse. I have from comparative billing review, Medicare review agency,over 10 percent is high.
 
All due respect. The number podiatrists billing vist plus procedure is staggering. It’s looked at fraud, waste or abuse. I have from comparative billing review, Medicare review agency,over 10 percent is high.
The number of patients I have who try to milk multiple complaints out of their visits is staggering. I'm not sure if you're suggesting "don't bill 25 mods more than 2-3x daily," but it would be more instructive for all of us if you could give more concrete guidance on when it is and is not appropriate. Because in my eyes it's almost always appropriate, just very tedious to document, and therefore an easy target for Medicare to go after for incomplete documentation when they're trying to retract money from doctors.
 
The number of patients I have who try to milk multiple complaints out of their visits is staggering. I'm not sure if you're suggesting "don't bill 25 mods more than 2-3x daily," but it would be more instructive for all of us if you could give more concrete guidance on when it is and is not appropriate. Because in my eyes it's almost always appropriate, just very tedious to document, and therefore an easy target for Medicare to go after for incomplete documentation when they're trying to retract money from doctors.
What other problems are you actually treating/fixing while you talk to them while trimming their toenails and calluses doctor?
 
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The number of patients I have who try to milk multiple complaints out of their visits is staggering. I'm not sure if you're suggesting "don't bill 25 mods more than 2-3x daily," but it would be more instructive for all of us if you could give more concrete guidance on when it is and is not appropriate. Because in my eyes it's almost always appropriate, just very tedious to document, and therefore an easy target for Medicare to go after for incomplete documentation when they're trying to retract money from doctors.
Yep 2-3 months between visits is plenty of time for people to have new things happen to their feet. Particularly people in a “high risk” podiatry category.

New wounds, foot pains, sprains, fractures, ingrowns, stubbed toes with subungal hematomas.

It happens a lot
 
Yep 2-3 months between visits is plenty of time for people to have new things happen to their feet. Particularly people in a “high risk” podiatry category.

New wounds, foot pains, sprains, fractures, ingrowns, stubbed toes with subungal hematomas.

It happens a lot
Hey does that dry skin on your foot itch?
 
Hey does that dry skin on your foot itch?
IMG_7501.webp
 
Yep 2-3 months between visits is plenty of time for people to have new things happen to their feet. Particularly people in a “high risk” podiatry category.

New wounds, foot pains, sprains, fractures, ingrowns, stubbed toes with subungal hematomas.

It happens a lot
Hey does that dry skin on your foot itch?
Airbud is very anti crusties.

I mean, so am I. I hate my life when im doing it.

But once you see the 99213 + 11721/1.8 wRVU every 10min light its hard to turn it down.

Equivelent to >500k a year doing nothing.

Only accept patients with neuropathy and DM. They have to be trainwrecks. This is a goldmine. They have problems. Everytime.

Class A/B/C findings are not a goldmine. Thats a 11721 and nothing else. Waste of time.
 
What other problems are you actually treating/fixing while you talk to them while trimming their toenails and calluses doctor?
90% sure this is a troll post, but you pose a good question. It's been a long time since I've written anything long-form here, so I'll definitely put up a different thread about common 25 modifier scenarios. I've got something else in the pipeline for the holidays though.

Suffice to say, the bar for a 99212 is VERY low. The published e/m guidelines explicitly mention "warm compresses" as an example of straight forward medical decision making, and many times the recommendations I'll make for pts are on that level. People come in for their toenail appts, they often have additional concerns, often minor, sometimes major. I address the complaint, and I bill their insurance for the consultation. I believe it is 100% appropriate that all of us are reimbursed for all of the care we provide to our patients and not solely for trimming their toenails. I did an internal audit of a random week of my own schedule and if I'm remembering correctly I had about 20-25% of RFC visits with additional e/m services.
 
90% sure this is a troll post, but you pose a good question. It's been a long time since I've written anything long-form here, so I'll definitely put up a different thread about common 25 modifier scenarios. I've got something else in the pipeline for the holidays though.

Suffice to say, the bar for a 99212 is VERY low. The published e/m guidelines explicitly mention "warm compresses" as an example of straight forward medical decision making, and many times the recommendations I'll make for pts are on that level. People come in for their toenail appts, they often have additional concerns, often minor, sometimes major. I address the complaint, and I bill their insurance for the consultation. I believe it is 100% appropriate that all of us are reimbursed for all of the care we provide to our patients and not solely for trimming their toenails. I did an internal audit of a random week of my own schedule and if I'm remembering correctly I had about 20-25% of RFC visits with additional e/m services.
I understand. From comparative billing review review- Medicare. Beneficiaries with more than 1 service- National average 8.27 percent. Bill being aware of this. I told Apma they don’t care.
 
Airbud is very anti crusties.

I mean, so am I. I hate my life when im doing it.

But once you see the 99213 + 11721/1.8 wRVU every 10min light its hard to turn it down.

Equivelent to >500k a year doing nothing.

Only accept patients with neuropathy and DM. They have to be trainwrecks. This is a goldmine. They have problems. Everytime.

Class A/B/C findings are not a goldmine. Thats a 11721 and nothing else. Waste of time.
11721 is 0.18 wRVU. 99213 is 0.97. Total is like 1.15 wRVU
 
11721 wRVU is 0.54 on my metrics… I average

8am-10am two days a week is when I do nails. If they can’t make it I tell them next week. That’s 15-16 patients in 2 hours. Mostly they have a secondary 99213-25, always something they love talking. These are sickly patients who are Q8s or high risk diabetics. Always have different foot issues…I don’t cut toenails on healthy 50 year olds with thick nails. I won’t lie on notes. Our PCPs are non existent, no neuro, no vascular… very very good for wRVU and 99213s….

99213-25 1.3 wRVU
11721 .54 wRVU
Is 1.84 wRVU. 50% have 2 or more calluses… I think these hours my metrics like 1.75 a patient. 24.5 wRVU 2 days a week… 2.3k wRVU having a 2-3 hour nail clinic… Limb-salvage generates more and I get 99204 from referrals for surgical bookings from PA or ortho colleagues.

Any new ulcer exam is a 99204… cellulitis 99204 or 99214….. not my choice pushed by our hospitals biller… I get paid based on “BILLED wRVU, not collected”. I just smile, wave and save emails if we get audited.
 
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I don't actively lobster in clinic because its ~20 patients per day of fracture follow ups, ingrowns, and elective surgery referrals. But, I've kicked around the idea of adding some 5 minute nail/callus visits for a half day during my "wound clinic" just to boost the numbers on my slowish wound mornings. My staffing is currently what's holding that back... It'll take my one MA longer to room these patients than the visit will be. CFO is happy to not have me see people that don't translate to more OR time but has also mentioned that it would increase the number of Medicare/medicaid visits per year at our CAH.
 
I don't actively lobster in clinic because its ~20 patients per day of fracture follow ups, ingrowns, and elective surgery referrals. But, I've kicked around the idea of adding some 5 minute nail/callus visits for a half day during my "wound clinic" just to boost the numbers on my slowish wound mornings. My staffing is currently what's holding that back... It'll take my one MA longer to room these patients than the visit will be. CFO is happy to not have me see people that don't translate to more OR time but has also mentioned that it would increase the number of Medicare/medicaid visits per year at our CAH.
Correct on everything here. Jamming that many people through for 5 mins appts is stress on limited staff.
 
I don't actively lobster in clinic because it’s ~20 patients per day of fracture follow ups, ingrowns, and elective surgery referrals. But, I've kicked around the idea of adding some 5 minute nail/callus visits for a half day during my "wound clinic" just to boost the numbers on my slowish wound mornings. My staffing is currently what's holding that back... It'll take my one MA longer to room these patients than the visit will be. CFO is happy to not have me see people that don't translate to more OR time but has also mentioned that it would increase the number of Medicare/medicaid visits per year at our CAH.
I walked into a non surgical program. Only doing 10-15 cases a month in my first year. I want the 60k wRVU bonus lol. When I get more busy I’ll be more selective.

[edit] my staff is also a pain in my ass. They take 10+ minutes rooming patients and slow me down for new patients. I have 20-25 patients waiting for booking and my January electives is bare because everyone is slacking off in December not doing any paperwork. I sit here doing my authorizations for a few of them, because I’m tired of waiting. Had a long talk with the CEO/Surg admins this week about metrics and my concerns. I should be nearing 7.5k wRVUs this year but will lucky to make 6.5k. Again their expectations were 5k year 1 and 7k year 2. They are happy and confused why I am annoyed lol. I am annoyed that I’m out >50k+… lol… union won’t let me pick my own MAs/LPNs it’s ass. But that’s what I signed up for… in private practice my LPN was 1000x better than 2 of my MAs….
 
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I don't actively lobster in clinic because its ~20 patients per day of fracture follow ups, ingrowns, and elective surgery referrals. But, I've kicked around the idea of adding some 5 minute nail/callus visits for a half day during my "wound clinic" just to boost the numbers on my slowish wound mornings. My staffing is currently what's holding that back... It'll take my one MA longer to room these patients than the visit will be. CFO is happy to not have me see people that don't translate to more OR time but has also mentioned that it would increase the number of Medicare/medicaid visits per year at our CAH.
You are fine just doing the MSK and some of the DM slop. No need to add anything you don't want to do (4% of all pods and 0% of hospital pods want to do nails?).

As long as you keep meeting PCPs and other docs, you will be plenty busy soon enough soon enough with that MSK/DM work unless the area is really too small. If they'll pay you well for 20/day, no reason to ever change a thing. That good money for reasonable workload, along with having decent boss/admins, is as good as it gets employed. Congrats. 🙂

They should just market for arthritis, deformities, injects, "injuries - old or new" and continue to give it time if you need to fill a few spots... that stuff will turn into surgery or at least DME and injects. There will be some natural callus care and pads and insoles for RA and deformity pts... and some nail care for DM pts... but you don't ever want to market to that stuff unless truly needing to fill the schedule. That RFC stuff finds you naturally when you're a podiatrist.
 
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I'm just finishing this out and then leaving. I have nothing left in me. Didn't want to quit just yet because I worked so hard to get to this point but it's not fair to ask my SO to continue to play this ridiculous game any longer.

Might even pivot to being an RN, honestly. My SO is a nurse and they're making 80/hr. Been discussing about doing the accelerated program and we can travel together. Either way, Podiatry isn't it and I don't want to invest into this nonsense any longer.
So sorry it’s false promise oh podiatry
 
I should've took SDN more seriously. I didn't want to believe hybrother, feli and at the time cutwithfury. But they were all right because I see everything they're saying being played out in front of me.
All the PGY3 gangsta still they start looking for jobs.
 
The whole "Oh it'll be ok, you're overthinking it." or "I worked my ass off for the past 10 years, you think you can just walk in and ask for over 200K starting?!"

It grind my ass when older attendings out there thinks its so insulting when asked how much we think we should make starting out after 11 years of schooling.
 
I should've took SDN more seriously. I didn't want to believe hybrother, feli and at the time cutwithfury. But they were all right because I see everything they're saying being played out in front of me.
What about Air Bud? What about going rural ...?

Don't worry new and prospective students. It will be different for you. Trust the process, trust the administratora, trust the powers that be.
 
You know the profession is down bad when their only supposed saving grace is " try going to BFE to get a quality paid job."
All you city slickers.... There's tons of people who want to go rural for a million reasons. It's not a bad thing. And again lots of professions require moving for your first job. You don't just walk in being the senior vice president of sales, sometimes you got to go be the local manager for the Avis car rental in Scranton Pennsylvania.
 
All you city slickers.... There's tons of people who want to go rural for a million reasons. It's not a bad thing. And again lots of professions require moving for your first job. You don't just walk in being the senior vice president of sales, sometimes you got to go be the local manager for the Avis car rental in Scranton Pennsylvania.
If we're to be residency trained physicians i think we should be able to expect a better deal than starting on the dealership floor as a flunky
 
If we're to be residency trained physicians i think we should be able to expect a better deal than starting on the dealership floor as a flunky
ALL doctors go rural. This is not a podiatry thing. Wah wah I want to live in the city. Who do you think works at these rural hospitals?

Was going to talk about live music and IPAS and dog spas but I don't want @Boba Foot to come at me.
 
ALL doctors go rural. This is not a podiatry thing. Wah wah I want to live in the city. Who do you think works at these rural hospitals?

Was going to talk about live music and IPAS and dog spas but I don't want @Boba Foot to come at me.
Suburbs, yeah... but not bona fide rural.

Among MD/DO, the waaay rural or VA and IHS is mostly ones who fail boards and get license discipline. Or a few ones who want to "see the world," get loan forgive, or just make a whole lot doing locums.

For podiatry, it's a lot of our best and brightest... going rural to just get a decent pay job or not have competition all around them. That said, it is the way to go. 🙂


Drunk John Wayne GIF by GritTV
 
The fact that having to go rural for a decent job is the issue, not necessarily choosing to go rural though. I thinks that's the key distinction between us and all other fields of healthcare. Its forced for pods, and not a decision (in the abstract sense).

For the people asking about nursing salaries. Here's 2 examples I quickly found. Neither are in seniority positions.

Go onto nursing or salary forums/sites and take a look. There's tons of examples of 1-2 YOE RN's getting 150K+, and 3-5 YOE RN's getting 180-240K. They get huge overtime, night, weekend, shift differentials.Can work just 3-4 days per week to make these numbers. An associate pod can be working 6 days per week, 10 hours per day, taking call, doing night cases, and still not break 200K.

Nurses are also starting their careers atleast 7 years earlier than us. Longer if a pod took a gap year or 2 or 5 lol.

This info should be blasted at every pre health club and college campus and podiatry school so people can see how screwed up this field is lol.

Screenshot 2025-12-29 at 11.00.42 AM Medium.jpeg



Screenshot 2025-12-29 at 11.02.59 AM Large.jpeg


The left column is taxable SS income, and the right column the actual income for that year.
 
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All you city slickers.... There's tons of people who want to go rural for a million reasons. It's not a bad thing. And again lots of professions require moving for your first job. You don't just walk in being the senior vice president of sales, sometimes you got to go be the local manager for the Avis car rental in Scranton Pennsylvania.
Bro Scranton Pennsylvania is saturated
 
There are plenty of pods not going rural and doing just fine, they just don't feel the need to advertise it and sell it because living civilized life doesn't need to be sold. Meanwhile rural folks are "trust me, bro"-ing about the greatness of driving 2 hours to go to a methed out Wal-mart.
 
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There are plenty of pods not going rural and doing just fine, they just don't feel the need to advertise it and sell it because living civilized life doesn't need to be sold. Meanwhile rural folks are "trust me, bro"-ing about the greatness of driving 2 hours to go to a methed out Wal-mart.
Civilized life.... That hazy peach IPA while listening to your favorite ALT post modernist Bob Dylan influenced garage band really slaps.
 
What about Air Bud? What about going rural ...?

Don't worry new and prospective students. It will be different for you. Trust the process, trust the administratora, trust the powers that be.

If it makes you feel better, I've hated you and this forum for the past 10 years. You, DrFeelGood, JonWill, Krabmas (sp?), and some of the other old time crew were just positive enough about the profession to make me think I should be a podiatrist. Just had to work hard enough and it would work out. Now I internally curse you guys every time I see an old lady complaining about her nails, or perhaps even worse are the ones who really enjoy it. I feel demeaned enough, don't need to hear you moan about how much better your feet feel and no I'm not rubbing any lotion on your foot...
 
It doesn't matter Wear your desire is to be employed. If you want to be employed where you currently are you're going to work for upper line if you want a better job than that you're going to have to move it's that simple. I did, many others have done
You can have your location, you can have your ideal job or you can have something else I don't remember how the saying goes. But you can't have all three. One is good too is better three is impossible.

I mean a lot of your complaints are valid. But your job is to get a good job and set yourself up to leverage that into a better job in the future. Nothing is forever. Unless you're hometown is Dickinson North Dakota
How about some honesty from podiatry schools and APMA how messed up this profession is..