Podiatry Doubts?

[Bobby Mercer]

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I am a podiatry student with not too far to go until I graduate. I am slowly starting to realize what appears to be the reality of what podiatry is...Toe clippings, disgusting wound dressing changes, vascular referrals, arts and crafts with cheap foam to offload areas, the response "Sorry, not much we can do for that", an occasional orthotic for those who can actually afford it, and an injection here and there. Of course there are some of the basic surgeries for 1st ray and hammer toes and all that stuff and we get to feel like big shots when we pull out our pads and prescribe cephalexin.

But seems to me a lot of the idea of podiatry is just a hoax. Yes, the schools and APMA definitely have great marketing and suckered us podiatry students into believing we are essential and all the surgeries we do. But think about it...you really think you are going to be doing these reconstructive rearfoot procedures or seeing tumors in the foot, applying ex fixes on every other patient, and all this other crap that is so rare. Unless you work at a school or a high trauma area which will be about 3% of us...you will never see this kind of stuff and your whole life is just the stuff I mentioned above.

We spend so much time studying everything that MD's need to know just to give us the illusion we are real medical doctors. But in reality, when the hell do we ever use the intricate knowledge taught to us in school? Honestly, 80% of the stuff we learn is just for our knowledge and we will never use it. What if the patient has a vascular issue? Can't treat that must refer. What if they have nerve pain and lyrica or neurontin doesn't work...now what? Refer to neurologist. There is really nothing we can do to really help someone...other than the offloading and debriding nails, etc.

Does anyone else feel this way? I always see podiatry forums filled up with people asking about MD/DO programs etc because I feel like they have realized this too. We are so easily replaceable. Just not a good feeling. yes of course there will always be podiatrists and we will have patients who need nails cut, but basically patients referred to us are the patients that nobody else wants to deal with. The malodorous ulcers, calluses, fungal nails. But if we didn't exist, vascular surgeons, neurologists, orthopedic surgeons, dermatologists could easily do what we do. Lets face it, we all know we will never get the respect we "deserve" from other medical students or colleagues. I say deserve in quotation marks because I do feel we deserve it with the education we go through, it is similar to medical school....But the reality of podiatry and what we do does not reflect that education at all like I mentioned before. No wonder others don't have much respect for us...all they see us do is clip nails and do very very minor procedures. That is the reality of podiatry. It is not treating pilon fractures in level 1 trauma centers like our teachers make us believe....maybe in residency, but not afterwards when we are ready to start our own careers and open a practice.

Anyone else feel in trouble and like there is no way out since we are already so much in debt? Seems to late to start over with 200,000 bucks flushed down the toliet.

To all my fellow podiatry students, this is not an insult to you, I am one of you. Just saying some stuff that I have picked up from many of you along the way and I know I'm not the only one. So what are your opinions on podiatry and the life of a podiatrist? Really think they make 150k? especially with obama constantly nagging to cut medicare which will cut our reimbursements by 50%? What are your honest opinions...To those who feel the need to verbally attack this post...think about why you are doing that...is it because you feel a little defensive and unsure of yourself and are just trying to compensate by getting angry? If you believe in the profession, God bless you, I'm sure its what I will be doing too, and I would be happy to hear from those of you who feel the same way and those of you who are confident about our profession.

What are your opinions?

 

[MaseratiGT]

Bobby -

I guess I can understand where you are coming from, but there is another way of looking at it...

So yeah, you see nasty ulcers and do chip and clip, but the patients we do this for really need this service. No one takes care of the foot ulcers better than we do. And if we didn't, would we see a rise in foot amputations and further complications? We might.

There will always be overlap between professions. FPs can do some things that NPs and IMs and PAs do. As for consults, think about it as working as a team for the patient, not your ego (no offense intended). Who knows vascular better than vascular? Let them perform the job they were trained to do. The same for any other specialist.

As for respect - the only person who you need to care about is your patient. It doesn't matter what everyone else around you is doing. And I disagree that our medical colleagues don't respect us. A lot of the time, they just need a little education on what we can do.

As for the money, I can't worry about that now. All I know is that it IS possible to sustain yourself as a pod.

Every profession has it's bread & butter/horses. Are you going to see zebras sometimes? Yeah, but it probably won't be everyday. I just want a healthy balance of the horses; nails, wound care, etc. If you want to be doing trauma, get in a lvl 1. But you can't expect that each and everyday...

So you're probably a 3rd or 4th year? Make the best of what you have. I understand your position, but keep chugging away...GL


MGT

 

[165007]

I am a podiatry student with not too far to go until I graduate. I am slowly starting to realize what appears to be the reality of what podiatry is...Toe clippings, disgusting wound dressing changes, vascular referrals, arts and crafts with cheap foam to offload areas, the response "Sorry, not much we can do for that", an occasional orthotic for those who can actually afford it, and an injection here and there. Of course there are some of the basic surgeries for 1st ray and hammer toes and all that stuff and we get to feel like big shots when we pull out our pads and prescribe cephalexin.

Sounds about right. If you don't like it, leave.

 

[janV88]

I am 52 year old board-certified and recertified anesthesiologist with no malpractice suits.

Over the past several years I have come to hate my job. Let me open and state that to a large extent this is my own fault. I have always been of the mind that if you dont like something, you complain. If your complaints are not resolved, you walk. Well at age 52 I am hesitant to walk away from a good-paying job.

The problems with my job are that I get no respect from the hospital staff or administration. I have been told by an OR nurse in the past year, "I dont need to help you, you are only an anesthesiologist." I have no call room although all other physicians who stay overnight do. My input on clinical aspects of care are ignored. They are overruled by a nurse somewhere in the system. My input on OR nurses/Pacu nurses/outpatient nurse hiring is not asked for or solicited. I have to put up with CRNAs that think that they have the same education and ability as I do (I have both a M.D. and Ph.D. in pharmacology, and both clinical and research fellowships) all from top universities; and am board-certified, and recertified 2009.

I think that the lack of respect for me comes down from the top levels of the hospital chain which really does not respect physicians; although I believe I am mistreated more than any other physician in the hospital. The fact that the hospital payor mix is so poor means that my billings do not support an anesthesiologist. Therefore, the hospital views me as a liability since they supplement my income each month. Therefore I am treated as an employee. After years of this treatment from the adminstration, the attitude is carried over to everyone else that the anesthesiologist can be treated like sh.. Thus I am to a large extent to blame for putting up with this crap. So I have finally gotten to the point where no amount of money is worth one's own self-respect.

I am hoping that my situation is specific to the hospital where I am. I will be hiring another MDA to work for me. I will only work part-time. This will give me an opportunity to work at other hospitals to see if I can find the enjoyment that I once had for this job.

I found this in another thread in the physicians forums by sheer coincidence...I did not search for this.

Being unhappy about a profession seems to exist everywhere. I think it really depends on how you look at your situation. The above can be found in any of the forums you visit on SDN. The grass always seems greener on the other side...

 

[hyperpodia]

I am actually amazed at the many cool things that Pods do. If you did not know what Pods do, that is your fault, you should have shadowed and found out before.

I can not guarantee the Pod profession is legit because I am still a student, but I have my own ways of determining whether it was hoax or not.
If I pass my Part one boards first time- then Podiatry is not a hoax
If I land a PMS 36 residency with tons of surgery numbers- then Podiatry is not a hoax
If after residency I get an offer making six figures- then Podiatry is not a hoax

I can't think of a job out there where one will always get the respect they "deserve"

 

[jonwill]

Wow, kind of a depressing post. I don't think podiatrists are repleacable. No one does or has the training to do what we do. There is plenty of overlap in many specialties in the medical field. That doesn't mean that all of those doctors are replaceable. Sure, some docs are trained to do some of the things that we do. But no one is trained like us. And of course we refer things out. I'm not sure how much experience you've had in the medical field but all doctors do a lot of referring. And I'm sure most podiatrists will tell you that the majority of their patient base comes FROM referrals from MD's. So it goes both ways.

I think the nice thing about podiatry school is that it gives you a huge amount of knowledge and training that will allow you to choose what you want to do. If you only want to do palliative care, there is a market for that. If you only want to do wound care, there is a market for that. You find a job based on what you want. Obviously, if you were to open your own practice, you would be a lot less picky in the beginning but you would also build your practice on what you enjoy doing. For instance, I'm finishing residency in a couple of months. I found in residency that I enjoy doing a lot of the basic forefoot surgeries as well as the trauma and reconstruction. I am not crazy about palliative care or wound care. So, I found a practice that focuses on the things I like. I will take trauma call at two ER's. I will see a various array of foot deformities from bunions to charcot. However, if palliative care comes in, I know how and am more than will to handle it. If a wound comes in, I can handle that too. I'm just not planning on building my patient base around these things.

The more knowledge and training you have, the more opportunity you'll have. I'm glad that I learned all of the medical knowledge in pod school and applied it in residency because I will having admitting privileges at the hospitals I'm on staff at so I'll need it.

Respect is earned, not merely given. I've met and worked with many doctors of all specialties that I respect and some that I don't. Respect is not given based on a couple of letters after your name, whether it be MD, DO, DDS, DPM, etc. The bottom line is that if you work hard and learn everything you can, you'll be fine and you'll be respected because you'll be good at what you do. I know the "grass is always greener" but I know plenty of people in other specialties that struggle as well. There are no easy answers and there are no free rides.

 

[singingfootdoc]

Yeah...I'm graduating too and you are seriously deranged for even believing that BS.

You obviously went to poor clerkships that are stuck in the "C&C phase" of podiatry.

As far as your remarks go are extremely ignorant. Ortho actually loves us at hospitals because we take the foot and ankle from them and they can concentrate on bigger joints. We are NOT replaceable..there's a reason why we take bio-mechanics and learn to do "arts and crafts." I dont' know how many endless patients are "cured" because of a 2 second met pad I made for them. What other profession takes the time to do that!

Negativity...such a powerless thing. I hope you leave our profession. It's people like you that make it what it is.

 

[Feli]

Yeah...I'm graduating too and you are seriously deranged for even believing that BS.

You obviously went to poor clerkships that are stuck in the "C&C phase" of podiatry...

I would tend to agree. Pod, or any medical profession, is what you make of it. I'm not sure if you got the more mundane 3rd year rotations or picked low level clerkships or both, but there are a lot of opportunities out there in podiatry.

Might I ask if you are 3rd or 4th year and which school you go to... hunch says 3rd year at NYCPM? I would really suggest that you start reading the literature (J Foot Ankle Surg, etc) and attend an ACFAS or Podiatry Institute conference while you get cheap/free admission as a student. That might really open your eyes to the opportunities out there and sway your opinion of the "podiatry practice norm."

With today's residency training for DPMs, you will know how to treat a whole lot more than just the nails, wounds, and pad offloading described in the original post...
http://www.foothealthfacts.org/Content.aspx?id=1571
A lot of the "limited" treatment scope of the practicing DPMs you may have worked under is because the particular podiatrist effectively themself based on training level, marketing, referral base, etc. As jonwill said, in the beginning, you want it all. When I start my practice, I want to treat everything on that list. As I grow, I might choose to focus on some areas more than others, but I will have the skills for any of those foot conditions.

You will see during your residency that there is definetly not a perfect specialty in medicine. Every specialty has their boring or routine conditions that they have to treat, but patients need those services and they pay the bills and buy the food for your family. In the end, it basically just depends if you take the glass half empty or half full approach.

 

[NatCh]

I found this in another thread in the physicians forums by sheer coincidence...I did not search for this.

Being unhappy about a profession seems to exist everywhere. I think it really depends on how you look at your situation. The above can be found in any of the forums you visit on SDN. The grass always seems greener on the other side...

Interesting find from the anesthesiologist. One such anesthesiologist working one of my cases voiced similar sentiments. He referred to his profession as the "red-headed stepchild" of medicine. From my vantage point, anesthesiology would be a great career. Nice schedule, low overhead, high income...but like you said, "the grass is always greener." It's funny, no matter who I talk to in whichever field of medicine, they can find something "wrong" with their line of work.

I hate to be negative, but this sucky economy is starting to really hit my local medical community, so I think people are hurting all over. Even the large MS and Ortho groups, and especially the hospital, are in crisis mode. When I talk to other health professionals around town, it seems everyone is scared right now. I don't know how anyone is hiring anybody at any salary. Scary, I know. Sorry.

 

[Bobby Mercer]

I was expected some replies like these. Thank you to those who actually give honest, constructive criticism. As I predicted in my original post, we will have people like broadway singingdoc who just seem to get defensive and feel the need to personally attack. Very common and very predictable. But I do hope you folks that are so confident about the profession are right. I would love to make a great living. But I hope you aren't just mindlessly repeating what you have heard from teachers or the APMA. I have a feeling that is the case and you don't have any real experience...you are just speaking in what you HOPE will happen. I know what they say, I dont need brainwashed students saying the same thing. And if you read my original post you will clearly see that I did say we do the big cases and reconstructions and all that big stuff IN THE RESIDENCY....which is what some of you keep referring to. Again, I am talking about life after residency. I would love to hear from you guys who are doing the kind of stuff in a private practice that you do in residency.

singlingdoc fore example is saying what he said in the HOPES of what it will be like, but you have no proof. You are speaking in future tense about when you open your practice you will do whatever....good luck with that, I have yet to see a podiatry office that specializes in one specific thing. I dont care what you have seen in clerkships, I have seen it too we all have, and I have done great cases....AGAIN THIS IS NOT ABOUT THE CLERKSHIPS, so dont make an reference to them...i know what they do and what goes on, but this is about AFTER residency which you have no experience with.

I am not going to mention specific clerkships I have done, but whether you want to believe it or not I couldn't care less, but I went to some great ones. The original post was not about the clerkships or residencies, I know what they do and do things well. But again if you READ what i said, i am aware these clerkships and residencies do great podiatric cases. Again I am speaking about after that...yes you are trained to do all that stuff...but go open a practice after residency and then you can tell me about how many of those cases you do. Its completely unrealistic.

Anyway thank you to the residents for your honest opinion and everyone else for their posts. I realize some people are just not open to actually think for themselves and will just become defensive and uselessly attack some more. I really am not interested in getting into a 6 year old bickering match like most other threads on sdn. Comments like singingdoc really have no place here and just shows how immature and defensive people can get. I think you got a rude awakening coming after residency singer. You can hope and dream and think you will be doing amazing surgeries...but THAT is what is ignorant and naive....You dont believe me now, but when you are fighting for a teacher's salary when you get out...you will see I'm right.

Again, let please post some more constructive opinions, and its great to disagree I would love to hear your opinions, but no need to act like a 13 year old and start personally attacking because you dont believe in the exact same thing.

But all of you, with the exception of singingdoc who will again reply with some defensive little kindergarden tantrum, have been very helpful.

 

[that1guyfromFL]

1. "Unless you work at a school or a high trauma area which will be about 3% of us...you will never see this kind of stuff and your whole life is just the stuff I mentioned above."

Seriously? If you don't want to be in the 97% of pods you say do the things you hate, DON'T SETTLE! MAKE SURE YOU END UP IN THE 3% WHO DO THE THINGS YOU WANT TO DO! Fact: nothing is going to be handed to you in this profession or any other.

2. "Again I am speaking about after that...yes you are trained to do all that stuff...but go open a practice after residency and then you can tell me about how many of those cases you do. Its completely unrealistic....You can hope and dream and think you will be doing amazing surgeries...but THAT is what is ignorant and naive...."


Wrong. You can hope and dream or you can GO OUT AND MAKE IT HAPPEN!

How do I know? Because I work 3 days a week in the office of a Pod who does. I see it with my own eyes every single day.

 

[NatCh]

I am a podiatry student with not too far to go until I graduate. I am slowly starting to realize what appears to be the reality of what podiatry is...Toe clippings, disgusting wound dressing changes, vascular referrals, arts and crafts with cheap foam to offload areas, the response "Sorry, not much we can do for that", an occasional orthotic for those who can actually afford it, and an injection here and there. Of course there are some of the basic surgeries for 1st ray and hammer toes and all that stuff and we get to feel like big shots when we pull out our pads and prescribe cephalexin.

In private practice you can tailor your practice towards how you want it. If there's some aspect you hate, for example wound care, you can refer it out. If there are certain things you like, then you can steer your practice to those. If you don't like anything podiatric, well...

But seems to me a lot of the idea of podiatry is just a hoax. Yes, the schools and APMA definitely have great marketing and suckered us podiatry students into believing we are essential and all the surgeries we do. But think about it...you really think you are going to be doing these reconstructive rearfoot procedures or seeing tumors in the foot, applying ex fixes on every other patient, and all this other crap that is so rare. Unless you work at a school or a high trauma area which will be about 3% of us...you will never see this kind of stuff and your whole life is just the stuff I mentioned above.

I think most DPM's do "bread and butter" podiatry: bunions, hammertoes, neuromas, ingrown nails, plantar warts, tinea pedis, onychomycosis. Even most of those who do the RRA stuff do it only as a small portion of their practice. Some guys do the glory work as a majority of their practice, but most of us don't so I suppose you're correct there.

We spend so much time studying everything that MD's need to know just to give us the illusion we are real medical doctors. But in reality, when the hell do we ever use the intricate knowledge taught to us in school? Honestly, 80% of the stuff we learn is just for our knowledge and we will never use it. What if the patient has a vascular issue? Can't treat that must refer. What if they have nerve pain and lyrica or neurontin doesn't work...now what? Refer to neurologist. There is really nothing we can do to really help someone...other than the offloading and debriding nails, etc.

MD's too will never use 80% of what they learned in school. I don't think anyone uses 100% of what they learned in school. Everyone ends up in their area of specialty and the rest becomes foundation knowledge. MD's also refer out a lot. It's not a big deal. The idea is to get the patient to whomever can treat them best.

Does anyone else feel this way? I always see podiatry forums filled up with people asking about MD/DO programs etc because I feel like they have realized this too. We are so easily replaceable. Just not a good feeling. yes of course there will always be podiatrists and we will have patients who need nails cut, but basically patients referred to us are the patients that nobody else wants to deal with. The malodorous ulcers, calluses, fungal nails. But if we didn't exist, vascular surgeons, neurologists, orthopedic surgeons, dermatologists could easily do what we do.

I think that's how the profession started. Our forefathers did what nobody else wanted. You're right that if we ceased to exist then others would fill the gap, but if we can do those things better then we'll continue to fill that niche.

Lets face it, we all know we will never get the respect we "deserve" from other medical students or colleagues. I say deserve in quotation marks because I do feel we deserve it with the education we go through, it is similar to medical school....But the reality of podiatry and what we do does not reflect that education at all like I mentioned before. No wonder others don't have much respect for us...all they see us do is clip nails and do very very minor procedures. That is the reality of podiatry. It is not treating pilon fractures in level 1 trauma centers like our teachers make us believe....maybe in residency, but not afterwards when we are ready to start our own careers and open a practice

Lack of universal respect is a fact. I agree with that. Some folks understand that we have skills but others will look down upon us no matter what. I can't let that bother me. You have to be at least somewhat secure. What bothers me is that surgical complications are a fact of life, and when it happens to an MD it's written off as "just a complication." But if it happens to a DPM then some people blame the entire profession. That's not right. Realize though that most specialties are looked down upon by some other specialty. There's lots of turf battles, plus you have to factor in egos, hubris, narcissism...

Anyone else feel in trouble and like there is no way out since we are already so much in debt? Seems to late to start over with 200,000 bucks flushed down the toliet.

I think a lot of the general public feels trapped this way, not just podiatry students. Take whatever field you happen to be in, add debt and a lousy economy, and it's ugly.

To all my fellow podiatry students, this is not an insult to you, I am one of you. Just saying some stuff that I have picked up from many of you along the way and I know I'm not the only one. So what are your opinions on podiatry and the life of a podiatrist? Really think they make 150k? especially with obama constantly nagging to cut medicare which will cut our reimbursements by 50%?

I still like the work I do and my quality of life. $150K is not unusual, but EVERY health care field is looking at possible decreased reimbursement, not just us. Still, I think health care is a fairly strong field compared to real estate, the food industry, and just about anything else except for maybe the entertainment industry. Things are bad pretty much all over.

 

[janV88]

Interesting find from the anesthesiologist. One such anesthesiologist working one of my cases voiced similar sentiments. He referred to his profession as the "red-headed stepchild" of medicine. From my vantage point, anesthesiology would be a great career. Nice schedule, low overhead, high income...but like you said, "the grass is always greener." It's funny, no matter who I talk to in whichever field of medicine, they can find something "wrong" with their line of work.

It was a pretty interesting read. If you want to check out the rest of the thread, heres the link. http://forums.studentdoctor.net/showthread.php?t=705735

There is always something wrong with every specialty. It's funny though because a lot of times the "negatives" that one person complains about in their specialty are seen as "positives" by others outside of that specialty and vice versa. My brother is an EM resident and what he sees as positives - the variety, fast paced, quick and dirty diagnosis and refer out style of emergency medicine, others see as negatives - non-continuous care, jack of all trades...master of none, referral machine.

 

[NatCh]

It was a pretty interesting read. If you want to check out the rest of the thread, heres the link. http://forums.studentdoctor.net/showthread.php?t=705735

There is always something wrong with every specialty. It's funny though because a lot of times the "negatives" that one person complains about in their specialty are seen as "positives" by others outside of that specialty and vice versa. My brother is an EM resident and what he sees as positives - the variety, fast paced, quick and dirty diagnosis and refer out style of emergency medicine, others see as negatives - non-continuous care, jack of all trades...master of none, referral machine.

Thanks for the link. I found it interesting that so many of the respondents felt that the OP was trolling, and were unable to appreciate the possibility of career dissatisfaction. It happens to most people to some degree at some point. I know it's happened to me before.

You know what I think the keys to career satisfaction are?

1. Meaningful work
One has to feel as if he or she is doing something that makes a difference to somebody somewhere. If one's work has no inherent value, then it does not feel worthwhile so why bother? This category trumps both #2 and #3.

2. Feeling of control over one's destiny
One has to feel as if he or she has some say over what direction he or she is heading. Otherwise, he or she is just a pawn in someone else's game, which leads to a feeling of helplessness. Having a feeling of control makes up for having less of #3.

3. Adequate income
This one depends on how much one feels he or she needs to be comfortable. If one is always coming up short at the end of the month, then that's an unhappy situation. Of course some people will never have enough no matter how much they make. Having more income takes the sting out of having less control, but eventually everyone gets used to however much income they make, at which time #2 becomes an issue.


Whenever I've worked for someone else, I was lacking in all three categories. I did not like it. Now I have what I perceive to be an adequate amount of each, so I'm happy, but things can change.

 

[singingfootdoc]

Bobby, you replied, "Thank you to those who actually give honest, constructive criticism."

Then you go onto criticizing my name and calling me a child. Constructive? I disagree.

The bottom line is that your unilateral thinking in what is offered is completely skewed. I would highly suggest, if you enjoy surgery, to check out some high profile DPMs who participate in the Baja Project, or folks from NCVA who work a ton on clubfoot and ex fix, or finding a job that allows you to make your profession what it is.

Your comment that compares me to a kindergartner and then go on to say that "things are unrealistic" is true for someone like you. You say that I have no idea what it is like after residency and NEITHER DO YOU! Healthcare is going to change tremendously with Obama and his Administration. Yet, no matter what changes are made I know what I want to do and I will do it no matter what it takes. You, sadly, have already limited yourself in a small scope by defining what you THINK most pods are doign after residency.

If you want to do nails adn callouses than so be it. But if you want to do more then don't generalize what you THINK others are doing out there. Find out. And if you see that someone is not doing what you want to do, then more power to you to initiate it.

[FONT=Arial, Helvetica, sans-serif]
"If you believe that some day it's going to happen, some day it probably will happen. You just have to make sure you're there when it's happening, and ideally you're at the front of the parade, and the principle beneficiary of when it happens, but it's not a kind of thing where you just sort of sit back and wait.".

 

[Bobby Mercer]

Singingdoc,

I hope you aren't confusing my intelligence and ability to do well in podiatry with what I am actually talking about. The general vibe I am getting from your messages is that you think you have it all figured out simply because you are "optimistic." There is a difference b/w optimism and child like dreams. I want to be an astronaut and go to the moon one day. I swear if I work really really hard I know it will happen for me, I just know it! Or I will totally win the lottery, I play all the time and I just am so optimistic about it, I know it has to happen for me, I mean I totally believe in myself! Hell, I will be a professional baseball player! I try really really hard and I just know i will make it....

These are child like unrealistic dreams and they sound a lot like you. Just because you "believe" things will happen and you are "optimistic" doesn't mean they will happen for you...just makes you sound naive and immature. Believe me if you can do it, I can do it 20x better. I am in the top of my class in podiatry, graduated summa cum laude from college, I know everything I need to know about podiatry...its not an intelligence issue, its an issue that affects all of us as podiatrists. So you believing in something won't make it true for you alone. I hope you are correct and we are all rich and famous...and we can argue about that, but it is completely pointless and only time will tell. So hope you understand the difference.

But at least your 2nd post did sound more mature than your first which honestly did make you sound like a kindergardener. But thank you for your more constructive 2nd post. Hope you keep it up.

 

[that1guyfromFL]

It sure is good to have you back Whiskers. 😉

 

[Shireiqiang]

It sure is good to have you back Whiskers. 😉

I was beginning to miss whiskers too!

 

[janV88]

Bobby Mercer,

I am only a pre-pod so I do not know the ins and outs of this profession but after reading your posts it seems like you are a pessimist. Like most have mentioned, you will find negatives in any profession. I think you have to ask yourself is the glass half full or half empty?

You mentioned in your first post that..."the reality of what podiatry is...Toe clippings, disgusting wound dressing changes, vascular referrals, arts and crafts with cheap foam to offload areas, the response "Sorry, not much we can do for that", an occasional orthotic for those who can actually afford it, and an injection here and there. Of course there are some of the basic surgeries for 1st ray and hammer toes and all that stuff and we get to feel like big shots when we pull out our pads and prescribe cephalexin." This may indeed be the reality for the majority of practicing pods...but is that really a bad thing? The bread and butter of any field can seem depressing if you are pessimistic. Take for example Pharmacy. It is a very important field. They make sure meds are dispensed properly and a lot of times catch mistakes in scripts that could have injured a patient. But if you see the glass half empty then you might say they "count pills all day". Another example is primary care. They are the gate keepers of medicine. First line defense for non-emergent medical complaints. Or you can say they just treat the common cold, flu, and ear infections. The only scripts they write for day in and day out are amoxicillin and penecillin. Even something like Ortho could seem boring and useless to a pessimist. I bet doing all those knee replacements gets old after a while.

 

[JackedUp]

Hey Bobby (I don't think this is whiskers),

2nd year student here and I find it hard to believe that you are about to graduate and have now slowly started to realize this, a lot of the things that you mentioned as far as the "mundane and boring" aspects of podiatry you should have noticed before you applied during your shadowing experiences. I think if you really were thorough and you discussed your concerns with DPM's during your shadowing a lot this could have been avoided. There is no way that it should have taken you so long to realize what podiatry is all about (even though i don't agree with your assessment).

So far during my clinical training i feel like I've seen some interesting cases along with some very simple run of the mill cases, but what makes me happy and satisfied is that the pt is better off when the leave. Even if all I am doing is trimming nails, debriding HPK's, cleaning up ulcers, or applying orthoses it gives me satisfaction knowing that the pt feels better.

Also I have to disagree with you that podiatry is giving the illusion that we are medical doctors. I think that illusion is all in your head. Listen, when you graduate from school and complete residency training you will be a lower extremity expert, and you will be able to diagnose and treat as such, and no one can take that away from you.

I seriously hope that in your final externships and throughout residency training you change your mind about podiatry, because if you are not 100% positive about your choice than you will be miserable.

Good Luck

 

[hyperpodia]

Even if all I am doing is trimming nails, debriding HPK's, cleaning up ulcers, or applying orthoses it gives me satisfaction knowing that the pt feels better.

What is HPK's?

 

[podpal]

Singingdoc,

Just because you "believe" things will happen and you are "optimistic" doesn't mean they will happen for you... I am in the top of my class in podiatry, graduated summa cum laude from college, I know everything I need to know about podiatry...its not an intelligence issue, its an issue that affects all of us as podiatrists. So you believing in something won't make it true for you alone. I hope you are correct and we are all rich and famous...and we can argue about that, but it is completely pointless and only time will tell. So hope you understand the difference.

Bobby,
Schools do tend to lead students to believe that we will all get fantastic surgical residency programs and do this type of work in practice. In school we meet these high powered practitioners who do surgery day in and day out. These are definitely the exception to the rule.

Here's more of a reality check: most pods do a lot of conservative care. Even pods I know who did 3 year surgical residency's have mostly conservative care patients with occasional surgical corrections. The surgical training is good to get privilages at hospitals and thus a larger patient referal base.

In my location, I'm getting calls out the ying yang for elder care, mostly nails, that other health professionals do not do. Most of the pods in my region do have surgical training and are overwhelmed with the number of conservative care patients here. I enjoy doing nail care; nail and skin integrity of the foot is very important so that the patient AS WELL AS the staff/family members are comfortable.

When I graduated I too thought that I'd be doing bunions and hammertoes but this training wasn't available for me. In school we were taught that surgical training was so vital to practice when in reality it is often about nail care, ulcers, ingrown toenails, plantar fasciitis, shoes/orthotics, and the fungus among us. Before entering pod school, I spent time with podiatrists and pod patients, mostly conservative care. I really liked all aspects of the field and have no regrets. So the hospitals will not let me treat their nail fungus patients...so what? So instead of traveling to the hospitals for their "consult" I can do a housecall and make a whole family happy. 😀

Whatever you do, you have to be content. Podiatry allows me to work part time so that I can be more involved in my church, community service, and family. This gives me great joy. I'd have loved to learn surgical corrections, in a hands on manner in podiatry, but I'm also satisfied with what I learned. You have to be happy. Don't ever take anything for granted. No one owes you a residency and you may not get one. No one owes you a job, either. Podiatry allows us to make our way in the world, be self employed, help other people, and have a good life outside of work!

The grass may not be greener anywhere else....at least here thick, long, dystrophic, fungal nails abound and work is plentiful!

 

[dpmgrad]

What is HPK's?

HPK = Hyperkeratosis

 

[Feli]

HPK = Hyperkeratosis

^You haven't posted in a couple months, and this is all we get? 😀

 

[krabmas]

^You haven't posted in a couple months, and this is all we get? 😀

I second that motion!😛

 

[krabmas]

To Bobby,

I agree with Feli that it sounds like you are at NYCPM. This sounds very much like some of what happens/happened in the clinic their. In the end I got a good education regardless of Clinic A. I too was worried about what podiatry was really going to be. I wondered if I made a terrible decision. I never let anyone know this though, as you now have.

I know I am not out practicing yet but I see the cases that 30 of my attendings bring to the hospital and surgery centers every week. If they are doing it why won't I be? I am talking about the DPM attendings, not the other shared attendings.

Not only do all specialty's have their bread and butter cases, but they all also have their gross cases that are turfed to them, that no one else wants to treat and turfs them as "I don't treat that", like when the trauma team turfs and I&D to ortho or gen surg or ortho turfs the DM foot infx to podiatry, or infx disease turfs cellulitis to podiatry...

You may be interested in the big cases now (some one told me this not too long ago) as a student or resident when it is not your butt on the line but when you get out some days you may really want some mundane things to do, you aren't going to always want to do a big ex-fix or pilon fx recon. And all the trauma and ex-fixes come with big pussed out infx and gross dirty wounds even on healthy young people and not just diabetics.

And, fungus, orthotics, P and A's, paddigngs and strappings pay the bills and you!

If you ultimately decide that you are not happy with this choice then redirect and find something else to do. Life is too short to spend it doing something that makes you misserable.

Podiatry has many facets to it as well and if you are creative enough you should be able to find something that you like to do, that you can do well and market yourself to be successful doing it.

 

[Bobby Mercer]

Hey guys,

Thanks for all the feedback. Some of you guys made some excellent points and I do agree with many of them. I should probably say I was having a pretty crappy week when I posted that, so although I do obviously feel like that sometimes, I'm certainly not miserable and anti-podiatry.

And the climax.....Hell no, I don't go to NYCPM. But that is irrelevant, many of you guys keep saying how "oh you must not have seen this or that, you must be at NYCPM", etc. Folks, I have seen everything you have if not more. I have participated in many amputations, ex fixes, ORIF, trauma, open fractures, charcot cases, pilon fractures, prosthetics cases, arthroscopic sx, I have even followed a case where one of our patients has a tumor in their foot...how many of you can say that? everything you name it. For some reason some of you are acting like you have a leg up cause you have "seen" things and are assuming I haven't....no, not at all. I am well aware what goes on in hospitals and what podiatrists do, I work with some of the best. I work with and was taught by many of the doctors that wrote the textbooks you guys are probably reading at your school. But again, my original post was about life after residency, when all the trauma and excitement drastically decreases. Some of us may work at these trauma centers, but not many. There are not many hospitals that hire full time podiatrists, and anyone that says otherwise is just completely out of it.

So again you guys keep bringing up hospitals and what podiatrists do there. Yes I know, but there aren't many podiatrists that do that...I mean out of the 70,000 podiatrists or whatever, how many work in hospitals? a couple thousand if that....most are in private practice or nursing homes doing the mundane things...that is all I was bringing up, but for some reason everyone keeps going back to the hospital thing...I know, I know, I know, I have seen and done all that stuff, all the big cases everything. I was referring to private practice and no podiatrist in private practice does those types of surgeries often at all.

Anyway, thanks again for all the posts...I def was having a bad week and was kind of taking it more out on podiatry than necessary. I am certainly excited for the future, I am just hoping it is as exciting and lucrative as you all think. Take care.

 

[JackedUp]

I mean out of the 70,000 podiatrists or whatever, how many work in hospitals? a couple thousand if that....most are in private practice or nursing homes doing the mundane things..

There are approximately 12,000 total D.P.M's in the country.

 

[Feli]

...You may be interested in the big cases now (some one told me this not too long ago) as a student or resident when it is not your butt on the line but when you get out some days you may really want some mundane things to do, you aren't going to always want to do a big ex-fix or pilon fx recon. And all the trauma and ex-fixes come with big pussed out infx and gross dirty wounds even on healthy young people and not just diabetics....

Bingo.

Most of the complex trauma and RRA stuff holds a LOT more allure for students/residents than it does for attendings. Everyone likes to think they'll do those cases and feed their ego, but you have to be pretty careful what you wish for and make sure you have the skills, manpower, and mental fortitude. When you are a resident, a retrograde IM nail you scrubbed on that you later hear through the grapevine had caused the patient a massive fatal PE is a simple "oh, that's too bad." The pilon that you are told later developed a hardware infection requiring an amp is "a good learning M&M." When those are YOUR patients having those complications and it's your lawyer leaving you more voicemails than your spouse, it's probably not quite so attractive anymore.

When we as residents are anxious or excited about an inpatient's progress, wanting to add a new consult on for surgery that day, etc, one of my very successful attendings likes to tell us over the phone "well, I will get there when I get there... back here in the real world, I have an office full of patients." He's definitely right. There's nobody stopping you from doing that complex stuff in solo or partner practice, but if you don't have residents, I don't think you'll be quite as hyped up about doing evening/weekend add ons or leaving/rearranging an office full of private patients to go see an ER pt or do a trauma case with a high chance of a no-pay. It's definitely good that we get those skills at better quality programs; your patients from the office will have train wrecks every now and again, and you'll know how to help them out. However, there's also a reason most of those high demand cases are done in the teaching settings: they have residents to work the bad hours and the hospitals get subsidized by the govt for being trauma centers and taking a lot of no pay and Medicaid cases. If you look at a lot of general/ortho/trauma/pod/etc surg ER call schedules, esp in non-teaching private and community hospitals, it's not as if the attendings are fighting tooth and nail over those high liability and general low/non pay cases... they are usually on the call schedule simply because it's been required to take their turn as part of their staff physician agreement.

I'm not saying that I don't plan on working some weekends and doing neat cases if the area where I end up has that need, but I'm not planning on going overboard and risking my neck just to say I can do it. The trauma and big infection cases are neat, and somebody has to do them... but honestly, the noncompliance of a lot of the patients sorta frustrates me at times. I know it sounds pretentious, but it's taxing to spend hours of your time and tons of hospital/taxpayer money to fix up noncompliant people who generally contribute little to society. The patients who walk into clinic with a broken cast and asking for more Vicodin ES or the infection patients who are d/c and never seen again until they have their next infection/keto/amp get pretty old. You can't save someone from themself, and you can only try to help so many patient in a day, JMO. I think there's plenty of patients in need of complex reconstruction and interesting work you can do mostly in the outpatient setting also. I tend to find the elective surgery, rheumatoid foot rebuilds, flatfoot, OA desis, athletic injuries, etc more rewarding since the patients are generally more compliant, willing to be educated, grateful for the help, and focused on results.

 

[g squared 23]

I have a question (not a judgmental or sarcastic one) for Bobby Mercer: were you able to receive a residency program this year? (This of course is assuming that you are currently a 4th year.) Did your externship experiences and/or your chances of getting a residency at those places contribute to your lowered opinions and pessimistic attitude towards podiatry?

What were your expectations going into podiatry school as a 1st year and how do they differ from where they are currently?

 

[krabmas]

Hey guys,

I have even followed a case where one of our patients has a tumor in their foot...how many of you can say that? .

I know this was not aimed at me but:

Pt seen with foot tumor:

1. synovial sarcoma x 2
2. PVNS x 2
3. osteochondromatosis x 2
4. chondroid lipoma
5. desmoid tumors (fibromas not of the plantarfibromatosis type)
6. schwannoma
7. angiolyeomyoma
8. angiosarcoma
9. melanoma x 2
10. SCC

that is all I can think of at the moment.
Just wanted to let you know that it is not that uncommon to see tumors in the foot. Not all soft tissue masses are ganglions, do not asparate or inject a soft tissue mass unless you are sure you know what you are sticking a needle into.

 

[g squared 23]

I know this was not aimed at me but:

Pt seen with foot tumor:

1. synovial sarcoma x 2
2. PVNS x 2
3. osteochondromatosis x 2
4. chondroid lipoma
5. desmoid tumors (fibromas not of the plantarfibromatosis type)
6. schwannoma
7. angiolyeomyoma
8. angiosarcoma
9. melanoma x 2
10. SCC

that is all I can think of at the moment.
Just wanted to let you know that it is not that uncommon to see tumors in the foot. Not all soft tissue masses are ganglions, do not asparate or inject a soft tissue mass unless you are sure you know what you are sticking a needle into.

Get many bone tumors? Did the radiologists bring up FOG MACHINES when you rotated?

I only ask because I just got done studying some of those fun guys for a sweet exam I get to take tomorrow!

 

[krabmas]

Get many bone tumors? Did the radiologists bring up FOG MACHINES when you rotated?

I only ask because I just got done studying some of those fun guys for a sweet exam I get to take tomorrow!

I've heard of FOG MACHINES but don't remember what the letter stand for, so not real useful to me.

no too many bone tumors. I like the soft tissue tumors better anyway. most of these we seen either on the orthopedic oncology rotation or with the orthopedic oncologist. sine we have one at our hospital things are readily referred to him.

I am finding out that the larger the hospital with more specialties, the more likely patients are to be referred to the specific specialist. If you are out in the middle of no where the pod may be more likely to get some more interesting pathology.

 

[PharoPod]

Bobby,

I am not going to criticize your post.. If this is the way you feel, then no advice would change it. But please do your self and others a favor and do not go out into practice with this attitude and low self esteem about your career. You are not just going to be torturing your self every single day and feel low for the rest of your life, but you wont be able to care for people who need care. May be what podiatrists do seems like "illusion" to you, but there are people out there who need it. Go to a country where podiatry does not exist and you will see the quality of care a diabetic foot would get and if you get involved in practice, you would see how many surgeries would be done and could have been avoided with a simple orthotic.

In each specialty there are ups and lows. Not all orthopedic MDs get the appropriate training in top notch procedures. Not all Internists get to be cardiologists. You can get to med school and end up as a big shot plastic surgeon or as a family practitioner seeing 50 patients a day to make a living. You can be with the ups or with the lows based on how much hard work are you willing to invest in your school and getting into a good residency program.

Some people would not choose to go to podiatry school cuz they donot wanna be "Foot Doctors" but others would get into school cuz the wanna be "The Foot Doctors". Believe me, BOTH are right cuz they chosed a path they believe in.

My advice to you, "flush" 200K into the toilet and change career before it is too late, but donot "flush" yourself into a career you donot like or believe in.

Good Luck

 

[Podfather]

Bobby,
I read between the lines and everyone has anxiety about the line of work they have chosen. It's natural and probably normal. It's a honorable career and it's what you make of it. You make the bed you sleep in. If you want the complex deformities, trauma, etc. then go for it. It's what you want and do to get it that's most important. Those who chose palliative care and like it have been a success and those who chose charcot reconstruction and like it the same.

Yes we are often looked upon as second class citizens. I know better and have seen the almighty MD who couldn't even stay close with me academically. There are awesome MDs and well some scary ones. As long as you know you are the best and do the best who cares what others think.

You obviously have a good head on your shoulders so have a drink relax and make your bed.

 

[cool_vkb]

Bobby,

I am not going to criticize your post.. If this is the way you feel, then no advice would change it. But please do your self and others a favor and do not go out into practice with this attitude and low self esteem about your career. You are not just going to be torturing your self every single day and feel low for the rest of your life, but you wont be able to care for people who need care. May be what podiatrists do seems like "illusion" to you, but there are people out there who need it. Go to a country where podiatry does not exist and you will see the quality of care a diabetic foot would get and if you get involved in practice, you would see how many surgeries would be done and could have been avoided with a simple orthotic.

In each specialty there are ups and lows. Not all orthopedic MDs get the appropriate training in top notch procedures. Not all Internists get to be cardiologists. You can get to med school and end up as a big shot plastic surgeon or as a family practitioner seeing 50 patients a day to make a living. You can be with the ups or with the lows based on how much hard work are you willing to invest in your school and getting into a good residency program.

Some people would not choose to go to podiatry school cuz they donot wanna be "Foot Doctors" but others would get into school cuz the wanna be "The Foot Doctors". Believe me, BOTH are right cuz they chosed a path they believe in.

My advice to you, "flush" 200K into the toilet and change career before it is too late, but donot "flush" yourself into a career you donot like or believe in.

Good Luck

👍