Love some of podiatry, strongly dislike some of podiatry

[PW96]

I have done internships at two podiatry schools and have shadowed a couple podiatrists, but all dealt some with diabetes. I love the aspects of podiatry in sports medicine and the more orthopedic surgery side of the field along with biomechanics, but I really don't want anything to do with diabetes/ulcers/wound care etc. I have much respect for people that do and realize it is a very important part of health care, but it is just something I am not interested in myself or could see myself doing the rest of my life. I understand that getting through school and residency I will have to deal with it because it is part of what is learned, but what about after? I have been told is is possible to practice whichever parts of the field you like, which is a huge benefit of the field I think, but is it unrealistic to try and cut the diabetic population out? Are there jobs out there such as joining an ortho group where I could not deal with the diabetic population and focus on sports med and the more othro surgery side of the field? Again I love this half of the profession, but couldn't see myself doing the other side of the profession for the rest of my life.

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[AttackNME]

Absolutely, there are a lot of people that enjoy successful practices doing only a particular thing. You will have to deal with diabetic feet as a student and in residency, but what you do afterwards is up to you. There are also more fellowships in everything else and only a few in limb salvage. In priv practice, if you want to take call at a hospital to make extra money, most of those calls will be diabetic infection related. Ortho MDs typically get first dibs, which is why if you want to get more trauma call then joining an ortho group will get you fed their lower extremity trauma.

On the flip side, if you decide to pursue podiatry, as you grow older and wiser you will also discover why podiatrists deal with diabetic feet. As our population is surviving longer and growing older, so is the population of people with diabetes. When I started podiatry school, I only wanted to do sports medicine, but now as an attending, I only want to do limb salvage. Point is, you can choose what type of practice you want when you come out and practice, but don’t completely shut out limb salvage because it’s a big part of what we all do.

 

[TimmyTurner]

Keep an open mind. Your sample size of experience at this point is not enough to make an informed decision about what you're really interested in. The positions you're describing are out there, but they're competetive. Everyone loves the glamour of sports medicine but athletes make really bad patients and are harder to monetize than diabetics. Ortho sounds great too until you realize what level of malpractice you'll need and have a life long battle with MD/DOs for cases. just keep an open mind and don't place any contingencies.

 

[air bud]

Ortho group jobs and pods are going away. I have multiple fellowship trained (Brigido, Hyer etc...) Friends who could not get Ortho jobs. They still got very good jobs however. Some of my attendings are in the largest Ortho group in a major city and they have been expanding and bringing in more foot and ankle Ortho and their caseload and complexity has been decreasing.
As others have stated, keep an open mind. You have no idea what you will like. The reality is that more and more complex foot and ankle is being done by more Ortho. Yes there is still room for pods. Also remember that even Shannon Rush and Chris Hyer started by busting some nails. It takes a long time to get that crazy referral stuff. Be patient. If you do choose to go down this road ( maybe see some other recent posts....) make sure you know that your training will include all aspects and that it will be years into practice before you would ever be able to say hey I just want to do x or y and not z.

 

[TimmyTurner]

Wow, I am actually surprised orthopedic surgeons even want to do foot/ankle fellowships. They already have the training to do all the big ticket ($) items like knees, hips, spines, and broken bones. What's the point of wasting another year for a fellowship on a part of the body that podiatrists already cover? It's not like there's more money for them to be made in F/A. Plus we would be cheaper for ortho groups too. Kind of weird.

As I understand it, F/A fellowship for ortho MD's is the bottom of their barrel. Their crem de la crem all specialize in knees, hips, shoulders. IF you don't get one of those, better to have a F/A fellowship than no fellowship.

 

[AttackNME]

That can't be true. What the hell are they learning for 5 years if they don't know how to do hips, knees, and joints. They can't be spending 5 years looking at x rays and putting on casts. I think those things are the standard ortho things. I only know of fellowships for advanced things like spine, hand, and sports. So it does seem better to have no fellowship than waste time for F/A.

It’s harder than you think. In 5 years they learn ortho surgery of the entire body including foot and ankle, and the basics of joint replacement surgery. But to be good, for example in joints, you need the fellowship to handle the complications of it, and if you are gonna be doing joint replacement surgery as a career, you better know how to manage complications such as fractures and infections that go into the pelvis. That is why they need a fellowship. The reason why podiatry has expanded as much as we have is because of the amount of foot problems and the little interest from ortho to take care of feet.

Ortho group jobs and pods are going away. I have multiple fellowship trained (Brigido, Hyer etc...) Friends who could not get Ortho jobs. They still got very good jobs however. Some of my attendings are in the largest Ortho group in a major city and they have been expanding and bringing in more foot and ankle Ortho and their caseload and complexity has been decreasing.
As others have stated, keep an open mind. You have no idea what you will like. The reality is that more and more complex foot and ankle is being done by more Ortho. Yes there is still room for pods. Also remember that even Shannon Rush and Chris Hyer started by busting some nails. It takes a long time to get that crazy referral stuff. Be patient. If you do choose to go down this road ( maybe see some other recent posts....) make sure you know that your training will include all aspects and that it will be years into practice before you would ever be able to say hey I just want to do x or y and not z.

Thanks for sharing your insight. I think it’s great that those guys like Hyer and Rush are pushing the boundaries of podiatry, but they are amongst only a handful. I think the direction for most of podiatry would be in limb salvage. It doesn’t make sense for me to have to “fight” to get those trauma/recon cases when there is tons of limb salvage cases just begging for someone to take on. That is how I’m “thinking bigger”.