"new grads"

[icebreaker32]

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Look guys we made it

Applications to Podiatric Medical Schools in the USA plummeted in 2022 while numbers of allopathic medical school applicants reached an all-time high. | Doug Richie

Applications to Podiatric Medical Schools in the USA plummeted in 2022 while numbers of allopathic medical school applicants reached an all-time high. What's going on? I took a deep dive to investigate and here is what I learned: https://lnkd.in/g2SVb_j6 #podiatry #school #career #physician

www.linkedin.com

If more and more applicants are applying to allopathic medical school then more and more are not getting in. At the same time less and less are applying to podiatry school.

The applicants not getting in allopathic medical school are going somewhere else other than podiatry school for a reason. Where they are going instead and why is likely not a forum. For every student that is scared away due to this forum there is another one that is not as there are many doing well on here despite the honest drawbacks to this profession. Those drawbacks are not real until you live them and do not necessarily scare away applicants.....they scare students and residents.

A sustained decline in applicants is ironically one of the main things that would make this profession more desirable.

 

[Feli]

If more and more applicants are applying to allopathic medical school then more and more are not getting in. At the same time less and less are applying to podiatry school.

The applicants not getting in allopathic medical school are going somewhere else other than podiatry school for a reason...

Yep. The article also isn't considering that the vast majority of DO applicants are also MD applicants.

If one goes up, so does the other. But the total number is not as high as perceived.

...A sustained decline in applicants is ironically one of the main things that would make this profession more desirable.

Whatever do you mean?

You mean it would be good to be able to close down the crummy residencies, have some residencies take 5/yr instead of 10/yr, make the strong training programs stronger? You want each DPM to have more surgical volume and better training? You want to increase the demand for DPM services and make it harder or more expensive for facilities/groups to recruit them? Blasphemy.

 

[Feeter]

Doug Ritchie article is the most boomer thing I've read. Blaming negative comments on a forum and then asking people to advertise our profession in a positive light while ignoring the reality of so many new grads drowning in debt making less than a nurse practitioner.

I am certainly very happy with my career and it has been what I expected. However I acknowledge that experience of so many of my colleagues have been very negative in this field. It is not a surprise to see a decrease in podiatry application given PAs, CNPs, CRNAs and even some nurses are making what an associate podiatrist is making. Address that in your article boss.

 

[air bud]

Kind of like Michael Graham and his arthroereisis implant. It’s falling out favor in USA so he spends a lot of time oversees “educating” doctors in other countries to get them to use his implant.

I really don’t understand how people can’t see through these charades these providers build their whole careers around. Of course they will promote that multiple pathologies can be treated by their brace or implant.

Imagine if this was your life? To become a “physician” salesman and push something you invented. Create educational materials and scheme how your invention cures all foot and ankle complaints. Then just do that on a daily basis. Podiatry is crazy brother.

Bradley Bakotic became a favorite with podiatrists with his scare tactic presentations. I’m not saying he doesn’t know his stuff because he definitely does. He is very smart. But he was an even better salesman because his presentations were full of cases where podiatrists missed a diagnosis and patients ended up dying or suing them. He played with the audiences fears and they ended up utilizing his services without hesitation since majority are private practice and don’t work for hospitals. His relentless promotion of his lab worked and he made millions.

I still remember him coming to DMU as a 3rd year and scaring everyone about Amelonatic melanoma. "You may not see it, but it will see you...."

 

[heybrother]

"My message to anybody who has considered a career as a doctor is that podiatry offers the best opportunity compared to all other options when considering lifestyle, potential income and ability to consistently and positively affect patient lives . If you agree with me, please get this message out on social media platforms and dispel some of the recent myths which have negatively affected perceptions of our profession."​

There is something very humorous about referring to our discussions of the reality of the profession as myths, when the greatest false narrative myth ever told about podiatry is that its a "lifestyle-income-profession".

 

[CutsWithFury]

"My message to anybody who has considered a career as a doctor is that podiatry offers the best opportunity compared to all other options when considering lifestyle, potential income and ability to consistently and positively affect patient lives . If you agree with me, please get this message out on social media platforms and dispel some of the recent myths which have negatively affected perceptions of our profession."​

There is something very humorous about referring to our discussions of the reality of the profession as myths, when the greatest false narrative myth ever told about podiatry is that its a "lifestyle-income-profession".

What are you quoting?

 

[heybrother]

What are you quoting?

That's the closing paragraph from Ritchie's link on Linkedin.

 

[CutsWithFury]

That's the closing paragraph from Ritchie's link on Linkedin.

Ahh I didn’t even bother to read it because I figured it would be full of malarkey.

 

[Feli]

Ahh I didn’t even bother to read it because I figured it would be full of malarkey.

Can't wait for debates. I don't care who wins... love the theatrics tho.

 

[icebreaker32]

There are other professions that market how great their lifestyle is while offering little vacation and requiring evenings and Saturdays etc....podiatry is not alone there.

Podiatry is not the worst decision one can make. Most of the problems IMO are due to job saturation. A couple years of decreased enrollment is no where near enough to make a significant change.

When one evaluates the honest pros/cons of other healthcare professions, it is not surprising why many are choosing other careers such as CRNA, PA, NP, DO and Caribbean MD etc.

For many near misses to MD school there are certainly lots other career options along with one considering strengthening their application in some way and reapplying. There are certainly many who could not have gotten into many of other the programs mentioned, but got into podiatry school and some of those have done very, very well in podiatry.....for them and others who understand the pros and cons and chose podiatry anyways with an informed decision it makes sense.

Many MDs do work long hours and have higher stress than a podiatrist. With many specialities there is also the ability to work less hours and take off long periods of time and still make a very good income. There is also the ability to change one's work setting like switching to into academics, VA, corporate or even telemedicine in some specialities.

There is certainly no perfect profession. Podiatry markets itself as low hanging fruit to become a surgeon to medical school applicants. I am not sure given the current drawbacks/risks associated with the profession it can be even called fruit honestly.

Podiatry does work out eventually for the majority who choose this profession. Do not panic if you have already chosen this profession.....plan and have realistic expectations.

I again strongly feel lowering the numbers of students would solve many of the problems the profession has.......maybe it will happen on its own, I hope so. I wish this not for selfish reasons, but for what I feel is best for the profession and students who choose this profession. There has never been this shortage of podiatrists that our leaders promised us due to aging boomers and an increasing number of diabetics.....without these things I hate to imagine how much much worse things would be. This promise was used to argue for the self serving desire to increase enrollment and open more schools.

 

[CutsWithFury]

Look guys we made it

Applications to Podiatric Medical Schools in the USA plummeted in 2022 while numbers of allopathic medical school applicants reached an all-time high. | Doug Richie

Applications to Podiatric Medical Schools in the USA plummeted in 2022 while numbers of allopathic medical school applicants reached an all-time high. What's going on? I took a deep dive to investigate and here is what I learned: https://lnkd.in/g2SVb_j6 #podiatry #school #career #physician

www.linkedin.com

This thread is still going strong. Nice commentary by some younger podiatry attendings.

 

[AttackNME]

This thread is still going strong. Nice commentary by some younger podiatry attendings.

Agree. Great stuff and interesting points. Glad no one is flaming on there and is cordial.

Dunno if I should start a new thread but I have hospitalists begging me to admit some of the simpler diabetic patients with foot infections. In my training I did primary admit, and I did some basic management of diabetes and blood pressure as an attending when I was working for the VA. I consulted medicine every now and then, and asked them to take over once I had to start consulting other services. But I did remember as a podiatry resident having to consult nephrology vascular Endo and rheum before and it started getting really complex but we did it, and all these MDs didn’t care to say “hey should the podiatry team be managing all this?”. They would rather us keep these patients to the brink of our comfort level

Once I got into private practice and started seeing high volume I said hell no to any primary admit requests and have no interest in it personally. But if more podiatrists had interest in primary admit and doing medical and surgical management of mild-mod complex diabetes and foot complications, that’s a step towards true parity and increasing scope. Possibly doing outpatient diabetes management. Question i had is… should podiatry even be going in that direction?

 

[HardRoadPaved]

Question i had is… should podiatry even be going in that direction?

No. We are foot and ankle surgeons. Ortho doesn't admit sick patients to their service. I'm sure it's in AAOS mission statement.

 

[icebreaker32]

This thread is still going strong. Nice commentary by some younger podiatry attendings.

As much as I feel podiatry is a risk and there are other desirable options that really did not exist to the extent they do now many years ago like CRNAs etc that one should consider, I can see both points of view.

At least 20 percent of this profession has done and will continue to do extremely well. Those nearing retirement in the 20 percent likely hang around the other 20 percent doing well like them and their early years of struggle are long forgotten.

Most of this profession ends up doing well enough eventually. Just how many scars they have from those early years of struggle and how much they fade depends on just how traumatic those early years were and how much time has passed.

I would also say 20 percent of this professions struggles permanently, some of which will leave the profession. Why is that? The reasons could be many, but you are not guaranteed a soft landing in podiatry, especially if too many things are working against you. It could be anything from a series of bad breaks, a saturated job market you chose to live in or have to for family reasons, to one being a bit weird. Those factors would truthfully work against one in many professions, but in healthcare a weird RN for example in a saturated market can still make bank working the night shift. You don’t want to be in the bottom 20 percent of this profession. Unfortunately there will always be a bottom 20 percent and there are certainly not enough jobs to gurantee a respectable salary in an employed position in this profession like there are in many other healthcare professions.

The reality is in most professions, for most in them, you go with the tide. Podiatry is different…..with podiatry for way too many the tide is going the wrong direction the first few years and you have to ride the riptide out to sea then swim back to shore in your early years. You might drown, or be permanently traumatized by the experience. Most will end up having a nice life on the beach when they make it back to shore with those feelings of anxiety and stress of the early years fading significantly with time.

 

[Pronation]

No. We are foot and ankle surgeons. Ortho doesn't admit sick patients to their service. I'm sure it's in AAOS mission statement.

We are podiatrists

 

[PMG03470]

As much as I feel podiatry is a risk and there are other desirable options that really did not exist to the extent they do now many years ago like CRNAs etc that one should consider, I can see both points of view.

At least 20 percent of this profession has done and will continue to do extremely well. Those nearing retirement in the 20 percent likely hang around the other 20 percent doing well like them and their early years of struggle are long forgotten.

Most of this profession ends up doing well enough eventually. Just how many scars they have from those early years of struggle and how much they fade depends on just how traumatic those early years were and how much time has passed.

I would also say 20 percent of this professions struggles permanently, some of which will leave the profession. Why is that? The reasons could be many, but you are not guaranteed a soft landing in podiatry, especially if too many things are working against you. It could be anything from a series of bad breaks, a saturated job market you chose to live in or have to for family reasons, to one being a bit weird. Those factors would truthfully work against one in many professions, but in healthcare a weird RN for example in a saturated market can still make bank working the night shift. You don’t want to be in the bottom 20 percent of this profession. Unfortunately there will always be a bottom 20 percent and there are certainly not enough jobs to gurantee a respectable salary in an employed position in this profession like there are in many other healthcare professions.

The reality is in most professions, for most in them, you go with the tide. Podiatry is different…..with podiatry for way too many the tide is going the wrong direction the first few years and you have to ride the riptide out to sea then swim back to shore in your early years. You might drown, or be permanently traumatized by the experience. Most will end up having a nice life on the beach when they make it back to shore with those feelings of anxiety and stress of the early years fading significantly with time.

I think you are spot on… my first position scarred me. I won’t lie, I tried really hard to find a well paying job outside of Podiatry with my degree. Guess what? None really exist. Therefore I signed another PP contract

But my question is… how do you swim back to shore and make it? I feel at this point I’m drowning in debt. If I were to abandon ship and switch to a different career I would either put myself further in debt by requiring more education OR I would settle for a lower paying career (lower than PP) and not even be able to pay interest on my loans. I have also strongly considered opening a practice, but again, that puts me further in debt. I’m so terrified about the future that I cry most nights. Hospital and MSG gigs just don’t exist where I am and my family has settled in this area. We can’t just up and move to the middle of no where for a position that will pay me great financially.

If anyone has a productive response I’m all ears

 

[Boba Foot]

Question i had is… should podiatry even be going in that direction?

Just finished residency at a program that had admitting privileges. Podiatry has no business admitting anyone. We aren't trained for it, and the relevant education for it in pod school is subpar to say the least. Whenever podiatry admitted a patient, we were essentially babysitters who consulted every service to manage every minor comorbidity. It's literally medicine's job to manage all this stuff, I don't care if they're just there for a diabetic foot infection.

 

[Boba Foot]

If anyone has a productive response I’m all ears

Realistically, you only have 3 options:

1) Keep working for a crappy contract that's available in your current area
2) Take a short term financial hit, bring on a little more debt (what's another 30-40k when you're already 300k in the hole?) and open your own spot. Make sure you're comfortable running it before you do it though.
3) Be more receptive to moving where you can find a more financially lucrative job. Sucks, but beats crying most nights.

 

[CutsWithFury]

Doug Richie doesn’t get it. Honestly that’s fine. He represents a lot of podiatrists who don’t get it. This is why we are where we are.

 

[CutsWithFury]

My favorite thing about LinkedIn posts is the commentators who try to shoe-horn (pun intended) in their products. "Listen to my podcast to find out more. Are you sure this isn't because of DME reimbursement? Maybe if more people used our bone graft harvester they'd be signing up"

I agree it’s incredibly sad. Even the new practitioners are carrying on the same predatory theatrics just to sell their brand. The cycle of carnage continues.

 

[PointyNippers]

Possibly doing outpatient diabetes management. Question i had is… should podiatry even be going in that direction?

No, we are a specialty medical field. Yes we manage "all medical and surgical aspects of the foot and ankle" but in my eyes that does not mean systemic disease management. I am much more comfortable referring the appropriate pathology to the appropriate medical specialty for it.

podiatry - stay in yo lane. don't be a hero

 

[CutsWithFury]

No, we are a specialty medical field. Yes we manage "all medical and surgical aspects of the foot and ankle" but in my eyes that does not mean systemic disease management. I am much more comfortable referring the appropriate pathology to the appropriate medical specialty for it.

podiatry - stay in yo lane. don't be a hero

I agree but it’s this narrow scope which is also creating the hospital employed dilemma. Why should every hospital employ a podiatrist with such a narrow scope that does redundant things that can be done by general and ortho surgery?

 

[619]

I agree but it’s this narrow scope which is also creating the hospital employed dilemma. Why should every hospital employ a podiatrist with such a narrow scope that does redundant things that can be done by general and ortho surgery?

You are correct but then again ortho will rather fixing broken hips and knee while general surgeons will rather be deep in the gut taking out appendix and vascular will rather be handling internal bleeds etc. Point is, there is enough body parts to go around and keep everyone happy. Most hospitals don't have a podiatry on staff but then the solo PP pods take free calls at the hospital and take the load off ortho and gen surg. All goes back to the issue of saturation so why hire the cow when you can get the milk for free.

We have all gotten consults especially for diabetic foot wounds where ortho specifically said "consult podiatry".

 

[wakaflocka88]

You are correct but then again ortho will rather fixing broken hips and knee while general surgeons will rather be deep in the gut taking out appendix and vascular will rather be handling internal bleeds etc. Point is, there is enough body parts to go around and keep everyone happy. Most hospitals don't have a podiatry on staff but then the solo PP pods take free calls at the hospital and take the load off ortho and gen surg. All goes back to the issue of saturation so why hire the cow when you can get the milk for free.

We have all gotten consults especially for diabetic foot wounds where ortho specifically said "consult podiatry".

I’ll never understand why one is willing to take call for free.

 

[619]

I’ll never understand why one is willing to take call for free.

I agree. I take occasional consults from the hospital floor at my leisure but I am not on-call. Joy of being solo is picking and choosing as you wish and not having to answer to anyone. After seeing patients in clinic all day, the last thing I never want to do is go to the hospital to see a wound consult.

 

[Boba Foot]

I agree but it’s this narrow scope which is also creating the hospital employed dilemma. Why should every hospital employ a podiatrist with such a narrow scope that does redundant things that can be done by general and ortho surgery?

Diabetes and thyroid can be managed by IM but Endo is still very much needed. Specialists are around for a reason, my man.

 

[Feli]

Agree. Great stuff and interesting points. Glad no one is flaming on there and is cordial.

Dunno if I should start a new thread but I have hospitalists begging me to admit some of the simpler diabetic patients with foot infections. In my training I did primary admit, and I did some basic management of diabetes and blood pressure as an attending when I was working for the VA. I consulted medicine every now and then, and asked them to take over once I had to start consulting other services. But I did remember as a podiatry resident having to consult nephrology vascular Endo and rheum before and it started getting really complex but we did it, and all these MDs didn’t care to say “hey should the podiatry team be managing all this?”. They would rather us keep these patients to the brink of our comfort level

Once I got into private practice and started seeing high volume I said hell no to any primary admit requests and have no interest in it personally. But if more podiatrists had interest in primary admit and doing medical and surgical management of mild-mod complex diabetes and foot complications, that’s a step towards true parity and increasing scope. Possibly doing outpatient diabetes management. Question i had is… should podiatry even be going in that direction?

It comes down to what you're comfortable with and what your bylaws / privileges allow.

I think any DPM who admits or pre-op clears anybody who's not ASA I or II is nuts, but that's just me. It's one of those "can" versus "should" things.

I send even ASA I to their PCP office for clearance... gets your name out there and it's the right thing to do. I might do the odd clear H&P myself if it's non-elective and a healthy pt. I will do the overnight admit for a ASA I kid who had flatfoot recon that morning or I might put a healthy patient from ER in for IV abx overnight and OR next day for an open fx or something (if the facility privileges work that way). I always have IM or peds on consult... but I'd prefer they just do the primary admit them and consult me. They are typically happy to do so - and they're in-house or nearby 24/7 paid to do so!

There is nothing to gain on those clearances or admits, a lot to lose (mainly that you are not playing the team game and letting their PCP office clear them), and it's just not good medicine. General surgery does their own admits or clearances a lot, but we're not MDs. Ortho very seldom does it because they're too busy to be playing around with systemic conditions. Parity does NOT mean being a cowboy. It's far different if you're in the residency setting and off-service with attendings and fellows of IM/ID/Pulm/CC/Endo etc supervising you. After that's over, you'd have no legal ground to stand on if you pre-op cleared a pt for bunion who had a fairly predictable complication, admitted a "simple" diabetic who got septic or bad allergy to the abx, etc. Even if you're in a VA or some place where you have a bit less medical-legal worry, can anyone say with a straight face that a DPM is better than IM/FP/etc for those ASA III+ patients with multiple home meds, complications of their dz, etc? Nope.

And yeah, a diabetic with a foot infection is automatic ASA III (obviously not well controlled if having a complication of the dz). It doesn't matter if they only take metformin or if they have no other Rx or other major ailments; they clearly have a systemic disease not well controlled due to the foot infection. Proceed at your own risk on that. I would tell the hospitalists no way; blame the hospital if you wish. Tell them DPMs don't admit there if you wish. They are IM; admissions are what they do. They are simply being lazy. You don't typically want to associate yourself with docs who don't want to do their job in the first place. Surround yourself with the best and the brightest of all specialties (this includes your own group/hospital).. garner those referrals and send to those ppl; avoid the lazy and incompetent in your specialty/group and definitely outside it. You are hanging your rep on the quality of the specialists, hospitals, PTs, DME custom places, etc that you associate with. If you have any choices, make the right ones. Jmo.

 

[dtrack22]

I think there is a big misconception of what “clearing” a patient for anesthesia actually is. You’re just stratifying cardiac risk due to your procedure and planned anesthesia. I did my own H&P on a diabetic with gangrenous toes today. Getting a little sedation and local. The only surgery we do that is not considered low cardiac risk is that where the patient has cardiac disease. None of our procedures are considered moderate or high risk based on where we are operating from an anatomy standpoint and anyone not getting general anesthesia is essentially low risk without known cardiac disease.

Virtually all of the surgeons in our group do their own pre-op H&Ps outside of those cardiac patients in which case their cardiologist sees them and not a PCP.