Lobster Podiatry Explained

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Adam Smasher

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I was writing a lengthy reply to the fellowship thread which got locked before it got posted. Thanks mods!

I don’t know what LCR means…or TFP or lobster for that matter. If anyone wants to fill me in….

If you don't understand these then I doubt you've read 2 years worth of posts as you claim.



LCR refers to Lee C Rogers. Aka diabeticfootdoctor. Outgoing prez of ABPM, one-time candidate for US congress, Feli's arch nemesis. He holds many opinions with which we strenuously disagree. At the same time, he's generally upbeat and pro-podiatry, and keeps these forums interesting, so we need him more than he needs us.



TFP is typical f-ing podiatrist. Someone practicing since the germ-theory of disease was accepted. Someone who works nursing homes and affixes felt pads to patients' feet to offload their hammertoes and bunions, then sells them for $2 a strip. Along with lotions and potions and cure-alls. Someone who builds their podiatric fortune nickle and dime by nickle and dime.



Which brings me to lobster podiatry, an expression I've coined. I don't know how they're marketing podiatry to pre-health students now, but many of us started p-school in the late 00's. It was a very optimistic time, we created the uniform PMSR residency so all of us were supposed to get surgical training. Plus vision 2015 was supposed to have us on parity with the allo/osteopaths. By my reckoning, it was a massive bait and switch.



The reality of podiatry is that your referrals come not because of your expertise, but because it's pathology no one else wants to treat. You feed on what sinks to the bottom. Like a lobster. And then it hits you, lobsters have been around 260 million years making them one of the most successful species in the history of evolution. So that's how podiatry will survive, not retrograde nails, but toenails.



Bottom feeders are an important part of every ecosystem, but we still look down on them (no pun intended). I guess it's human nature to seek challenges and aspire for a successful career. This is where fellowships come in (see I'm bringing us back on topic Weirdy), you don't want to be a lobster, you strive to rise to the higher strata of the medical ocean, to be...




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First, thanks for the explanation.

Second, I really have read about 2 years of posts going back; probably more. Let me prove it to you....

Here are some of the things I've read here that are still freely available for any student to read. You tell me how any of it can remotely be sold under the guise of "trying to help others avoid the mistakes we made" as is the main narrative from the more vocal here.

....posting photos of other doctors mocking them and calling into question their ethics
.... attacking the personal appearance of your patients
....posting the real names of other posters including how many kids they have and where they live
.... comments about withholding treatments because you don't like a person
**** I know this issue is nuanced but most students won't.
.... countless, endless attacks on the few people who show enough respect to ask to have an open dialogue. Even. When. The. Agree. With. You. Including the texan professor who I now understand is LCR.

Let's replace the word "student" with the words "other medical professionals" who visit here in greater numbers. Nah, easier to just blame the system for the lack of respect and "being looked down on".


Lobster though....that's funny. Can you even afford lobster though on those salaries? :)
 
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I really have read about 2 years of posts going back; probably more. Let me prove it to you....
I agree with you we can be harsh. Also agree we should be more tactful in our posts (i’m guilty too). I’m a big fan of LCR and the “job” of podiatry. Just not the politics and job market of podiatry.

On the other hand… Instead of arguing with a bunch of random podiatrists… go play Red Dead Redemption 2 or something. Have a blessed day 😇
 
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I agree with you we can be harsh. Also agree we should be more tactful in our posts (i’m guilty too). I’m a big fan of LCR and the “job” of podiatry. Just not the politics and job market of podiatry.

On the other hand… Instead of arguing with a bunch of random podiatrists… go play Red Dead Redemption 2 or something. Have a blessed day 😇

I'm not arguing, I'm procrastinating. Big difference haha

I think some of can be harsh and should be harsh; the seriousness of medicine demands it. That said there is a difference between being harsh and being abusive.

There are GLARING problems that someone on the outside can see with Podiatry. I am fully aware of that and would be happy to discuss what I think on those as well.

Not much of a gamer these days...they have become too complex.
 
....posting photos of other doctors mocking them and calling into question their ethics
BASED
.... attacking the personal appearance of your patients
EVEN MORE BASED
.... comments about withholding treatments because you don't like a person
INCREDIBLY BASED
**** I know this issue is nuanced but most students won't.
.... countless, endless attacks on the few people who show enough respect to ask to have an open dialogue. Even. When. The. Agree. With. You. Including the texan professor who I now understand is LCR
BASED AND REDPILLED
 
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posting photos of other doctors mocking them and calling into question their ethics
We only do this to docs who put themselves out there and proudly do things that are...dubious.
posting the real names of other posters including how many kids they have and where they live
I think I know who you're talking about, he left a trail of breadcrumbs. Again, he put himself out there, that was his choice.
.... attacking the personal appearance of your patients
R46.1 is a real diagnosis code that we're all licensed to make.

Is any of this conducive to our messaging to students, admittedly no. But young attendings still need to band together and figure out how we're going to make it, because we all still benefit from mentoring no matter how far along we are. As such not all commentary is with pre-health students in mind.

Anyway I wish you the best of luck on your journey.
 
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Is any of this conducive to our messaging to students, admittedly no.

On that, we agree.

But young attendings still need to band together and figure out how we're going to make it

I'm confused: I thought other podiatrists were predatory?

we all still benefit from mentoring no matter how far along we are.

Unless it's via a fellowship. Then it's indentured servitude.

See how this works when every point raised is countered with hyperbole an inch deep and a mile wide? Nothing was actually gained, changed or considered, right?

Anyway I wish you the best of luck on your journey.

Thank you. I have the utmost respect for the work you all do.
 
First, thanks for the explanation.

Second, I really have read about 2 years of posts going back; probably more. Let me prove it to you....

Here are some of the things I've read here that are still freely available for any student to read. You tell me how any of it can remotely be sold under the guise of "trying to help others avoid the mistakes we made" as is the main narrative from the more vocal here.

....posting photos of other doctors mocking them and calling into question their ethics
.... attacking the personal appearance of your patients
....posting the real names of other posters including how many kids they have and where they live
.... comments about withholding treatments because you don't like a person
**** I know this issue is nuanced but most students won't.
.... countless, endless attacks on the few people who show enough respect to ask to have an open dialogue. Even. When. The. Agree. With. You. Including the texan professor who I now understand is LCR.

Let's replace the word "student" with the words "other medical professionals" who visit here in greater numbers. Nah, easier to just blame the system for the lack of respect and "being looked down on".


Lobster though....that's funny. Can you even afford lobster though on those salaries? :)
MDs eat lobster, podiatrists eat crawfish.

hold on meme incoming
 
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What was his response?


With respect: what's the point in saying?

If was complimentary the crowd will decry it as a fluke. If it's not they will claim vindication on their opinion of systemic oppression.

Better question since you seem to be rational: what do you think he said?
 
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With respect: what's the point in saying?

If was complimentary the crowd will decry it as a fluke. If it's not they will claim vindication on their opinion of systemic oppression.

Better question since you seem to be rationale: what do you think he said?
ok, this guy knows how the world works.
 
With respect: what's the point in saying?

If was complimentary the crowd will decry it as a fluke. If it's not they will claim vindication on their opinion of systemic oppression.

Better question since you seem to be rationale: what do you think he said?
“Love those guys. Wish I was one.”

😇
 
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Uh, you guys do realize you're talking to a LCR fake account?
...or one of his ABPM appointees / fellows / buds who is charged up on the APMSA marketing or promises of special treatment?

School doesn't nor should it cost 400k...

...complaining...sorry warnings...

...anticompetitive...

...you all never fail to mention how well you are doing....

.....oh yea, patients...

... board infighting ...

... this is only an internet forum, that you all are 10ish out of 16000ish podiatrists and that nobody should make life choices based on words on a screen. ...

...Back to the chicken little show....
Those 8 recycled quotes are all from one single post (thread this one came from). That verbiage is NOT a coincidence or originality there...
That's previous LCR propaganda eaten up and re-hashed above by the kid. It was likely an attempt to get the fellowship thread locked ("success").

It happens: people gobble up the podiatry recruiting talking points, and that's fine. They can do what they do.
This @Mental_Managment_97 one reminds me of the apmsa kid who LCR stood up (clearly pre-selected and groomed) at the 2023 fake board town hall to ask him if there should be one board and if UTSA was a good residency. He logically agreed with the "leader." It was sad to see.

There is no fixing this thinking... they can choose for themselves if and when they ever change their mindset. For the people not even out of training, It probably will persist until they have more perspective: maybe a bad residency match, realization of the debt, and firsthand experience with the podiatry job market. Then, they'll be lobstering around doing nails and wounds for $125k or asking their spouse about living in Spearfish, SD to make a fair living.

As always, I hope he does better than most. Tune back in years? Sure. Until then, LCR Junior is, right next to LCR, on ignore for me.
All they will do is cause drama and attempt to try to get people frustrated or disciplined. We have seen dozens come and go. :)

sep 2022 abpm.jpg
 
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This is the lobster thread. I'm going to ask that we stay on the topic of lobsters.
 
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I love you guys. I don’t know what I would do without SDN podiatry entertainment. We are lobsters. It’s just like I tell my patients when they ask why I would want to do this when I’m balls deep in their infected pus filled foot, “someone’s gotta do it.” A true lobster of an answer.
 
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Lobster podiatry is real, but everything is being devalued so its all a volume game.


With respect, isn't that what you signed up for? It may be less meaningful for you but is it any less meaningful for your patients?

Don't get me wrong: I can understand that you are all trained in a wide field of things that the market doesn't necessarily let you do all the time. That has to be frustrating especially for those of you who are good at it.

There are a lot of feet out there though.....

Not every day is good but there is good in every day.
 
What a fun morning. I say medicine is a volume game and a pre-pod/troll/whatever tells me to see more feet. Yeah, that's what I just said.

No one around me wants to cut nails. I get it, but I've literally had patients drive from out of state to see me asking for their nails to be cut. No one would do it where they were. The mood on here is very prevalent in my neck of the woods. We increased our price for nail/callus cutting but its sort of irrelevant because unless you make it absurdly high its just another visit. Podiatry needs more "valuable" services. That was classicly nail surgery to the tune of $350-500, but there have just been so many cuts through the years. Everyone in my area essentially pays $100+ less than they used to within the last 3-7 years.

I go back and forth on 2 things. The first is that non-operative podiatry would make a great cash pay service. The second thing is that insurance reimbursement for podiatry is so low now that essentially patients don't need insurance. If $40-75 is what an office visit is supposed to cost the world should be better dropping insurance for outpatient and just being disaster care only.
 
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Uh, you guys do realize you're talking to a LCR fake account?
...or one of his ABPM appointees / fellows / buds who is charged up on the APMSA marketing or promises of special treatment?


Those 8 recycled quotes are all from one single post (thread this one came from). That verbiage is NOT a coincidence or originality there...
That's previous LCR propaganda eaten up and re-hashed above by the kid. It was likely an attempt to get the fellowship thread locked ("success").

It happens: people gobble up the podiatry recruiting talking points, and that's fine. They can do what they do.
This @Mental_Managment_97 one reminds me of the apmsa kid who LCR stood up (clearly pre-selected and groomed) at the 2023 fake board town hall to ask him if there should be one board and if UTSA was a good residency. He logically agreed with the "leader." It was sad to see.

There is no fixing this thinking... they can choose for themselves if and when they ever change their mindset. For the people not even out of training, It probably will persist until they have more perspective: maybe a bad residency match, realization of the debt, and firsthand experience with the podiatry job market. Then, they'll be lobstering around doing nails and wounds for $125k or asking their spouse about living in Spearfish, SD to make a fair living.

As always, I hope he does better than most. Tune back in years? Sure. Until then, LCR Junior is, right next to LCR, on ignore for me.
All they will do is cause drama and attempt to try to get people frustrated or disciplined. We have seen dozens come and go. :)

View attachment 380569
I am not going to let you spout blasphemy about Spearfish. And for the record the dude there is killing it and making more than 98 percent of pods and living a great life with year round outdoor adventures.
 
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I think we need to some sort of crustacean stratification here. One one hand you have a very private practice based view with nails, calluses, diabetic shoes, leg swelling, nail fungus, neuropathy. This person is driving the lobster mobile delivering diabetic shoes and doing home visits. Nobody wants to do anything of that...
Lobster life.

But then people start throwing in Pus Bus activities. @Feli likes to diminish it as first year resident level stuff, but myself, @Retrograde_Nail @DYK343 and many others would push back at that. It gets stated that nobody wants those amps, I&Ds l, wounds etc thus it is a lobster activity. This can't be further from the truth. This will increasingly become more desired and competitiveness. Hell, the apma actually got something right. The increasing prevalence of diabetes is going to lead to more amputations and limb salvage needs. Although maybe they need to go on some type of anti-ozempic crusade., Walmart apma and other people who benefit from people eating too much can band together...More to discuss on this topic later.

Tldr: pus bus is not lobstering.
 
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I think our working definition of lobstering is activities that non-DPMs do not do because it is not worth their time, and ensure the long term survival of podiatry as a profession while being unprofitable for individual DPMs.

Nails/calluses/mycosis: definitely lobstering.

Diabetic shoes: lobstering, my local orthotics/prosthetics providers do everything but Diabetic shoes.

Pus bus cases: sorry fellas, this is lobstering. Just because you enjoy it doesn't mean non-DPMs should too. And for those of us in the dark deep ocean of private practice (and not the aquarium of RVU compensation), it's generally not the most profitable use of anyone's time. Which is why we're stuck with it.

Wounds: as long as there are Wound clinics run by NPs and ID specialists and other non-surgeons, this is contentious territory for lobsters to scuttle into.

Bunions/hammertoes/easy elective forefoot cases. Reimbursement is unimpressive, though with the new lapiplasty unbundling rules in play, this may be enticing for some FA orthos. Not lobstering. Floundering?
 
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I think our working definition of lobstering is activities that non-DPMs do not do because it is not worth their time, and ensure the long term survival of podiatry as a profession while being unprofitable for individual DPMs.

Nails/calluses/mycosis: definitely lobstering.

Diabetic shoes: lobstering, my local orthotics/prosthetics providers do everything but Diabetic shoes.

Pus bus cases: sorry fellas, this is lobstering. Just because you enjoy it doesn't mean non-DPMs should too. And for those of us in the dark deep ocean of private practice (and not the aquarium of RVU compensation), it's generally not the most profitable use of anyone's time. Which is why we're stuck with it.

Wounds: as long as there are Wound clinics run by NPs and ID specialists and other non-surgeons, this is contentious territory for lobsters to scuttle into.

Bunions/hammertoes/easy elective forefoot cases. Reimbursement is unimpressive, though with the new lapiplasty unbundling rules in play, this may be enticing for some FA orthos. Not lobstering. Floundering?
Limb salvage is not worthy PP podiatrists time because it is usually non insured or medicaid. It's not worth your time or energy. For employed docs we get paid a lot for these cases no matter what the insurance is because we are on RVU model. It is really that simple. That is why you consider it lobster activity but employed docs do not.
 
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I think our working definition of lobstering is activities that non-DPMs do not do because it is not worth their time, and ensure the long term survival of podiatry as a profession while being unprofitable for individual DPMs.

Nails/calluses/mycosis: definitely lobstering.

Diabetic shoes: lobstering, my local orthotics/prosthetics providers do everything but Diabetic shoes.

Pus bus cases: sorry fellas, this is lobstering. Just because you enjoy it doesn't mean non-DPMs should too. And for those of us in the dark deep ocean of private practice (and not the aquarium of RVU compensation), it's generally not the most profitable use of anyone's time. Which is why we're stuck with it.

Wounds: as long as there are Wound clinics run by NPs and ID specialists and other non-surgeons, this is contentious territory for lobsters to scuttle into.

Bunions/hammertoes/easy elective forefoot cases. Reimbursement is unimpressive, though with the new lapiplasty unbundling rules in play, this may be enticing for some FA orthos. Not lobstering. Floundering?
I've reached a new height of enlightenment with lobsters in podiatry, and I'm certain this knowledge will make me a better podiatrist someday. This insight is surely worthy of JAPMA!
 
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Guys, it's ALLLLL lobster medicine. 100% of podiatry. If podiatrists do it, it's lobster aka bottom-feeder stuff. Sorry. :)

All DPMs and what they do/treat = lobster of medicine.
Law Judge GIF

Every single thing we do is also done by MDs, DOs, nurses, pedicure shops, orthotists, PTs, or other health professionals already.

Everything we do, and all of our 'bread-and-butter' derm and nail stuff, falls to us because it is neglected by other general and specialist MD/DOs:
  • Nail care in nursing homes and inpatient units is what MDs (and even most nurses and nsg assistants) who work or go there don't want to do. DPMs scrape it up.
  • Wound and amp surgery is what gen/vasc MDs don't want... in step DPM "salvage" heroes to take the jobs and the work.
  • Even in Ortho groups/dept, the MD partners want the TKA, THA, shoulders, and other stuff based on their training. They have little time for bunions or met fractures and orthotics. The DPM will gleefully take the foot/ankle stuff if it's offered to them (and not just a PA), and DPM in ortho group will probably get mainly non-op and lesser work if F&A ortho is in the group. Like any situation, podiatry gets the trickle-down stuff.
  • For podiatry PP or MSG, we take it all. The only stuff generally refused is stuff that won't pay. Most PP podiatrists will take non-urgent same-day appointments so that those ingrowns, new nail care patients, warts, or heel pain don't go down the street to the next DPM. Heck knows the patients and PCPs have options for podiatry providers! All of those patients are available because the PCPs don't have time or desire for those complaints. If ankles are available to DPMs, it's 99% because ortho is not in that area or that hospital much/any. If the podiatrist gets excess business or tries to exclude some F&A pathologies, more pods will come in as associates or to the nearby area to quickly take the lobstering work.
Lobster medicine is not a bad thing.
Podiatry likely started because people were embarrassed to ask the family doc to cut their toenails.
It is relative job security that other docs don't want or hardly any want our lobster work.

On the flip side, one major problem is reimbursements. Much of what we do is an easy target for insurances to cut or reduce. It's hard keeping nail care "medical" forever. As @Retrograde_Nail hit on, there is also the issue of getting hospitals to continue pay DPMs fairly well for wound/amp and trauma that has poor payers or no insurance and would not pay in PP.

Last, the debt and saturation with 500+ and soon 600+ grads/yr is also getting to be an increasingly glaring issue... lobsters do eat other lobsters (so do large corporate employers!).

I am not going to let you spout blasphemy about Spearfish. And for the record the dude there is killing it and making more than 98 percent of pods and living a great life with year round outdoor adventures.
Ha! The way we are going, there will be 4 DPMs in Spearfish in a few years. Let's open some new schools.
 
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I mean this whole thread is silly, and while I get what you mean, it’s also much broader than podiatry. Surgery used to be performed by barbers and were looked upon as a task beneath the skill of physicians, obviously it’s since evolved but I choose to see what I do as a valuable service that I provide for my community, not as a service that is replaceable because other doctors think they’re above it. But I don’t think you should mistake “being above” something for actually knowing how to take care of those problems you claim they’re “above”. There are no surgical specialties including podiatry that really know how to take care of complex lower extremity problems with wounds and infections, it’s the individual
 
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Here’s another example, ER medicine, they’re known as chief residents of every specialty, not really specializing in anything. Some fellows in critical care or other medical sub specialties would moonlight some shifts in the ER to make some extra money while in fellowship after they’re board certified in internal medicine. Is emergency medicine replaceable? Sure you could argue that it is, but ER docs who have actually done a residency in ER medicine are better equipped to handle all the nuances that comes with the territory. Same with podiatry, sure what we do is replaceable by other surgical services who feel like dabbling in foot and ankle pathology, but we are in the position to focus on our nuances and be better at it than any other surgical specialty. I feel sorry for those podiatrists who truly feel what we do is replaceable, it shows how little they value their skillset, nor their desire to improve it
 
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Here’s another example, ER medicine, they’re known as chief residents of every specialty, not really specializing in anything. Some fellows in critical care or other medical sub specialties would moonlight some shifts in the ER to make some extra money while in fellowship after they’re board certified in internal medicine. Is emergency medicine replaceable? Sure you could argue that it is, but ER docs who have actually done a residency in ER medicine are better equipped to handle all the nuances that comes with the territory. Same with podiatry, sure what we do is replaceable by other surgical services who feel like dabbling in foot and ankle pathology, but we are in the position to focus on our nuances and be better at it than any other surgical specialty. I feel sorry for those podiatrists who truly feel what we do is replaceable, it shows how little they value their skillset, nor their desire to improve it
Bro, I am awesome at what I do and I know I can make a huge difference. My job is to make sure chronic wounds don't come back again. The hard part is just convincing hospitals and administration your value even to this day. Because Podiatry.
 
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Bro, I am awesome at what I do and I know I can make a huge difference. My job is to make sure chronic wounds don't come back again. The hard part is just convincing hospitals and administration your value even to this day. Because Podiatry.

I think with hospitals they know the value of podiatry, but some hospitals just don’t need to hire in house, it’s a business after all and they need volume to justify the cost, and some hospitals just don’t have the volume. In my state, the hospitals rely on outside contractors for almost all specialties including hospitalists, and a lot of them don’t get paid to be on call because they just don’t have the volume to justify it. I think the tactic do organized boycotts of serving hospitals until you get paid for call isn’t going to work for most places, it’ll just prove that they don’t have the volume to need to pay you and that they can manage to go without podiatry. Hospitals that pay for podiatry call IMO reflects the financial health and volume of the hospital
 
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Just gotta wait it out bros. Just like how lobsters used to be considered a nuisance, eventually they became a delicacy. We will eventually become a delicacy in medicine (when all the other specialties become extinct)
Screen Shot 2024-01-06 at 7.18.39 PM.png
 
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Initially it was bottom feeders and those memes went on for a bit but then lobsters took off.

Remember to take your vitamins boys..

715CA4F0-B7B2-4C7B-8607-A1A9E26876FA.jpeg



I gotta dig it up out of storage boxes but I also have the Adam smasher magic the gathering card sitting around somewhere lol

D3888766-B47A-4CAC-859D-568A5653B79E.jpeg
 
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I searched "lobster monster" and came up with this avatar. It was either that or the crab people to stay consistent with our South Park theme. Problem is crabs aren't lobsters so the magic card won.

Anyway, I'm not ashamed of lobstering, it is important work. Ecosystems need bottom feeders. These are facts. I'm just not proud of it either. I'm not going to make believe I've got some unique ability to dispense shoes or grind toenails, I just do it really efficiently.
 
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I searched "lobster monster" and came up with this avatar. It was either that or the crab people to stay consistent with our South Park theme. Problem is crabs aren't lobsters so the magic card won.

Anyway, I'm not ashamed of lobstering, it is important work. Ecosystems need bottom feeders. These are facts. I'm just not proud of it either. I'm not going to make believe I've got some unique ability to dispense shoes or grind toenails, I just do it really efficiently.
The hullbreaker horror lobster, terror of the seas during the CME cruises
 
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I thought the lobster thing was because nail nippers resemble lobster claws. Here I was impressed that you guys worked with a nipper in each hand.

Anthony Johnson Applause GIF by Originals
 
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Just realized the irony that it is called a lobster clamp and yet a podiatrist is rarely able to fix a fracture that will require the use of this instrument.
 
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The people that went into this profession to be ortho of the foot and ankle will likely never be happy. Thankfully I didn’t become a podiatrist for that reason.
 
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The people that went into this profession to be ortho of the foot and ankle will likely never be happy. Thankfully I didn’t become a podiatrist for that reason.
Right, you did it because you wanted a backdoor way to be a doctor. It's ok. This is a safe space.
 
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The people that went into this profession to be ortho of the foot and ankle will likely never be happy. Thankfully I didn’t become a podiatrist for that reason.

Was this the reason?

"The day that the rain smelled like ice cream, my bunny went to heaven in front of my eyes. The day that the copper pipes in the old building smelled like burnt food, my brother went to heaven in front of my eyes. I couldn't save them. It's sad. Neither one had the chance to become an adult. They should have become adults. They should have had children of their own and loved those children and I want to make that possible for other people. And I want to make a lot of money so that I can have a television."

 
I went to school with a guy who flat out admitted that he chose podiatry because he wanted “to make as much money doing as easy of work as possible.” Was he wrong?
 
I went to school with a guy who flat out admitted that he chose podiatry because he wanted “to make as much money doing as easy of work as possible.” Was he wrong?
Well since you are a man of a certain age and people used to make 5k for a forefoot slam....he's not wrong.
 
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Well since you are a man of a certain age and people used to make 5k for a forefoot slam....he's not wrong.
The $5000 era was a little before my time (dammit). I can still think of harder ways to make a six-figure living.
 
I went to school with a guy who flat out admitted that he chose podiatry because he wanted “to make as much money doing as easy of work as possible.” Was he wrong?
Isn't this true of literally every job ever? Who wants to make less money for harder work?
 
Holy **** this thread is hilarious 🤣 I’ll never get tired of the crustacean memes
 
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