Podiatric Specialties

[PodasaurusRex]

I am curious to hear what current physicians, residents, or students have to say about podiatric specialties. With today's residencies is it possible to be specializing in wound care, sports med, pediatrics, etc. while in residency or is this exclusively saved for a fellowship? I know you can market yourself as a "fellowship trained pediatric podiatrist" but can someone who has had a lot of exposure in a certain residency be considered as competent without the additional year(s)?

I have a huge passion for peds as I have been working in a large pediatric hospital system since I graduated undergrad. I know I have a long time until that point but I think it would be my dream job to work in a pediatric hospital as an on-staff podiatrist. I know some of the big name ones such as Philadelphia Children's have them on staff but mostly I think the job is going to the fellowship trained orthopods.

Thank you for your time.

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[ExperiencedDPM]

The entire idea of podiatric specialties is really silly. You can focus your practice to an area of interest, but you're already a specialist. In my opinion, realistically making an income in today's environment as podiatrist who specializes in one "thing" is not practical. Let's be realistic and do some comparing. An ophthamologist is a specialist who can further specialize. He can do a fellowship in retina, etc., and that's all he does. In reality, podiatric fellowships are predominately surgical, which may allow you to obtain referrals from some lesser trained pods. There are a few sports medicine fellowships, but the idea of being an expert in pediatrics is really a joke and almost insulting. You may like the idea of focusing on pediatrics, but there is no real fellowship for pediatrics in podiatry at this time. I don't know where you obtained your information, but I can assure you that there are no podiatrists at Children's Hospital of Philadelphia or at Boston Children's Hospital, etc. ALL pediatric foot and ankle surgery at these facilities are performed by pediatric orthopedists. And that is reality. Yes, I know a handful of DPMs who perform a decent amount of pediatric surgery, but I assure you that no major children's hospital know these DPMs. Yes, you can have a very successful practice and focus on one area, but very few DPMs can pay the bills limiting themselves to one sub specialty. These DPMs do exist in small numbers, and are the exception, not the rule. I pseudo specialize in a particular type of surgery, and have patients come from near and far to have me perform this procedure in the hospital. But despite the fact I have a good reputation for this procedure, I still provide care for the entire spectrum of foot and ankle pathology. I assure you that my comments are factual and unbiased and based on experience.

 

[PodasaurusRex]

You must have taken time out of your busy specialized day to make an SDN account for your first post. I think you took what I was saying too whole-heartedly by assuming being an on-staff pod at a children's hospital would be my only job. You in no way answered any of my questions and I could feel the resentment you have for some aspects podiatry bleeding from your post. Thanks.

 

[ExperiencedDPM]

You can take it personally and reply with sarcasm, or you can be mature and understand what I wrote was factual. And I did answer your question. I know of zero pediatric hospitals that employ a podiatrist. I believe your exact quote was "I believe some of the big name ones such as Philadelphia Children's have them on staff......." Unfortunately that's simply not true.

I've been at this for many years, and I can sugarcoat my replies or answer honestly to prevent those who are interested in receiving misinformation. There's a lot of money invested in a podiatric education and a lot of years, so you really need to know the truth prior to taking on a profession to specialize in something that may not be realistic.

Yes, I read the post and created an account because I felt that you may have been given inaccurate info, and it's not the first time I've heard similar questions. I have no ulterior motive, but don't take my word for it, contact any major children's hospital and ask for the staff podiatrists.

I have NO resentment for any aspects of podiatry. I do have resentment for young potential podiatrists to be sold a bill of goods by recruiters, schools, etc. There are too many students who were told they would be "surgeons" or other similar sub specialties without being told the entire truth. Yes, you will have the opportunity to perform surgery snd practice with any special interest you desire (i.e. peds) but you should realize that it may be difficult to make a living ONLY doing surgery, peds, etc. Not all patients require surgery, and keep an open mind that although you will perform surgery, it's likely your week won't be filled daily with surgical cases. I have no agenda here, other than to tell it as I've seen it, to prevent unrealistic expectations. If that offends you, you can simply choose to skip my posts.

 

[PodasaurusRex]

http://www.childrenshospital.org/di...:["{4BEAFC7F-4094-441D-B489-C1C9FF7582D8}"]}}

Three rows down from the top and one will discover a DPM on staff at Boston Children's.

I apologize if I was rude but any time I've seen someone create an account I interpret their post as being negative and I am always apprehensive. I have spent many hours shadowing podiatrists and I have enjoyed all aspects of what I've seen. The particular practice I spent most of my time at was more heavy on clinic rather than surgery and I still enjoyed it. Switching my focus from an MD/DO route was one I took very seriously and I did all the research necessary before I chose to not even apply to any of those programs. Any of our medical professions these days have a questionable future with how congress is handling issues revolving around medicine but I still view podiatry as an incredible opportunity. I view it as being 1980 and I'm buying Apple stock. Statistics do not lie and the job market is going to be awesome when I complete school. From what I hear there is already a great upward trend.

 

[ExperiencedDPM]

I stand corrected now that you've found 1 DPM at Boston Children's. I may be mistaken but I believe she is part of the sports Med program, and although she is surgically trained, I don't believe she does surgery at Boston Children's.

Regardless, as per your shadowing the overwhelming majority of podiatrists have a relatively general practice, which includes palliative care, surgery, sports medicine, etc, even if the doctor has a special interest in peds, sports medicine, etc.

There are a handful of podiatrists who were able to truly sub specialize, but for most that could mean economic suicide. As per a prior post, I have a special interest in a particular surgery that has eventually allowed me to obtain referrals from peers, patients and other medical professionals. However, although that's my special interest, my daily schedule covers the full spectrum, though I don't do a lot of palliative care. I have no problem doing palliative care, but there's an old saying that "like refers like". So if you have a strong palliative care practice, many of those patients will refer you the same. If you do a lot of bunion surgery, and do it well, you'll see that those happy patients will send you the same. And this is true for those who do a lot of biomechanics or any aspect of practice. If you like peds, and are good at what you do, that will build referrals for the same. But to actually focus on only one thing from day one, could have a serious impact on the early success of your practice. It takes years to prove yourself in your chosen area of interest, and you can't just chose that special area, but you have to excel in that area to remain successful. The proof will be in your outcomes.

 

[PodasaurusRex]

Going back to my original question can residency alone be enough to really get the experience you need to go into public and market yourself as having an emphasis? Also, is it true that a fellowship is a fellowship for anyone? In this I mean is it true an MD and a DPM could technically do the same sports medicine fellowship if whoever found the candidate fit? Not sure where I read this.

 

[ExperiencedDPM]

To answer your question, in depends on your actual training. If your program is heavy on diabetic limb salvage and Charcot recon, you'll be prepared. If your residency is heavy on rearfoot recon, you'll be prepared. If not, you'll have to learn the old fashioned way and that's see one, do one, teach one. There are a handful of fellowships that accept DPMs, DOs and MDs. Most podiatric fellowships are for DPMs. There are exceptions such as Chris Hyer's fellowship in Ohio. They accept DPMs, DOs and MDs. That's really the exception and not the rule at the present time.

 

[jellybean2020]

You will probably see some pediatric patients in your practice. As far as exclusively seeing 100% only kids, that is near impossible. You would starve to death for lack of patients. It would require a unique situation where the neighboring podiatrists refer all of their peds patients to you. I can think of maybe 2 DPM's who have that kind of setup in the whole country. Also, there is not really a 'pediatric fellowship' for podiatrists out there currently. It's great that you're passionate about peds, but be prepared for peds to not be a huge % of your practice.

 

[heybrother]

Without even touching the future vision, I think the first battle will be finding a residency program with strong pediatric training (especially the lower end of the 0-18 spectrum).

 

[NatCh]

It would require a unique situation where the neighboring podiatrists refer all of their peds patients to you.

Even if that were to happen, it's hard to picture filling one's entire schedule with peds patients. It's hard to picture even filling half of one's schedule with peds. I wonder how many pediatric cases per day the podiatrists who have special interest in pediatrics see on average?

 

[PodasaurusRex]

I guess the situation I am envisioning is that Children's Hospital X has a sports and medicine clinic and they have a DPM that has 2 or 3 days in their clinic in addition to being on-staff at Hospital Y in the same city. Not sure how many of these situations exist. Thanks for everyone's input.

 

[NatCh]

Another forum member privately messaged me to inform me about one of our colleagues who has a peds-only practice. If you're seriously interested in something similar, it might be worth your time to contact Dr. Goad directly to ask him your questions. You'll probably get 1000x more useful info from him than from this forum.

http://www.sw.org/Dr-Richard-N-Goad

 

[PodasaurusRex]

Another forum member privately messaged me to inform me about one of our colleagues who has a peds-only practice. If you're seriously interested in something similar, it might be worth your time to contact Dr. Goad directly to ask him your questions. You'll probably get 1000x more useful info from him than from this forum.

http://www.sw.org/Dr-Richard-N-Goad

That's incredibly helpful. Thank you NatCh.

 

[ExperiencedDPM]

I know Dr. Goad and assure you that he is very unique regarding his peds only practice. I actually only know of one other DPM with a similar practice. So although it's obviously possible, 2 or 3 out of 12-15,000 podiatrists is certainly an extremely low number. Once again, there are many DPMs who refer to themselves as pediatric specialists, but in reality it's simply a focus of their practice, not their entire patient base. And as previously stated in a prior post, a doctor such as Dr. Goad excels at what he does and has obviously proven his worth. It ain't easy!