Podiatry Jobs?

There is essentially no "market" for new podiatrists, whatever their training. Most opportunities would be generated from individual research and networking ( a successful relative in the field is always the best). The schools and APMA like to tout examples of pods working for HMOs and ortho groups, but at best this would only generate a few dozen slots per year, for the most highly trained. It's mostly about finding a niche in the market where you can carve out a successful practice on your own, and you will get little real help in doing so. For the less brave and lesser trained, you can be an associate doing the scutwork for other docs at subsistance wages for years if you are so inclined. Then the loans come due.

BTW, the residency situation is improving, but only because of the reduction in applicants. Podiatry has always exaggerated the demand for its surgical services, and the biggest problem for most surgical programs has always been generating sufficient cases, so you have the scenario of 3 residents scrubbing a surgery, each doing part so they can log the procedures (usually on a welfare patient). I have seen this. My own training consisted of an RPR for which the stipend was $4800, in 1992. It was the best program I could find at the time.

 

Hey, Footdoc. We sound like kindred spirits! Your post sounds like one of mine. Some people on this forum get rather bent out of shape when the world of podiatry is disparaged in any way so I'll need to preface this with a disclaimer:

THIS IS AN OPINION.

It's funny this question came up today. My fiance' was asking about a colleague of mine last night and wondered how he was doing with his podiatry career (he finished his 3rd year of a PPMR/ PSR 24 in June 2001). I told her that he was doing what every other new grad is doing. Cutting nails, dispensing inserts, scrambling for scraps and subjugating his dignity and hopes just to pay the rent (no way he owns). He has been out of his 3 year surgical program for 14 months now and has not done ONE SINGLE SURGERY. Not only that, but he hasn't even done a matrixectomy. I said the same thing to her that footdoc said. There is NO market for new pods. There are no jobs for new pods. If a health plan happens to cover podiatry, they have very few on the plan. When you finish your residency, you're not just thrown out of the nest, you're shot out of a cannon and the force of the explosion disorients you and blinds you for quite some time. You wander around the weird place that the cannon deposited you and when you start to get hungry, you do things you never thought you'd do before. You never thought you'd be doing free foot screenings at a mall or laying on a stinky carpet in a rest home to cut someone's toenails while they curse and spit at you (personal experience). You never thought you'd be supplementing your measly income by selling vacuum cleaners (someone I know). You never thought you'd quit in despair after two years of fruitless work (2 people I know). You never thought you'd hear a PA say that you don't have a broad enough license to prescribe compressive stockings above the knee (personal experience). All of this is because you ASSUMED that you would graduate a respected physician. Remember, when you assume you make an "ass" out of "u" and "me".

Footdoc is correct when he says that most opportunities are going to materialize from who you know and how much effort you're going to put into knowing them. If you're willing to live in a God-awful area of the U.S., you'll probably make a decent living.

The crap that you hear about how much the average salaries are and how wonderful the lifestyle is is based on skewed statistics. The are a good number of pods who are making very good money. But, these are the people who went to school in the 70's and 80's, did not rack up heinous amounts of student loans, were able to get onto plans because of a different health care environment and got themselves established. There are very, very few exceptions to this. There are literally a handful of new grads who find jobs that would be commensurate with the training and investment that they put forth. Find out how many job openings there are for pods in a Kaiser Hospital. Maybe one or two in the whole country. And, even if there were job openings that paid something close to 100k with benefits, they are going to go to the 5 people who did the utmost top residencies in the country. Try and find a job opportunity with ANY medical group in the country that pays anywhere close to 100k (which is the minimum a FP or pediatrician might make. And they would be offered outrageous perks like vacation, matching 401k, health coverage). Frankly, I've never heard of one. I'm not saying they don't exist, I'm just saying that I've never heard of one. The only "job opportunities" from MD's that I've heard of in Los Angeles are the kind where they want you to commit fraud in multiple ways. They're never legit. This is a fact from personal experience. I heard through someone that an MD was looking for a pod in L.A. I told a friend of mine (who, by the way, had finished his RPR/PSR-12 about a year prior and was still just cutting nails in nursing homes). He went by, spoke with the MD, worked for about two weeks and quit because he was deathly afraid of losing his license.

Footdoc is also correct when he says that most new pods will get hired as an "associate" and do the nasty scutwork that some other pod doesn't want to do (re: nursing homes). Podiatrists are very jealous of their territory and are loathe to share the pie since the pie is getting smaller every month.

He is also correct when he says that podiatry has always exaggerated the need for its surgical services. Most pods do not perform as many surgeries as you might imagine. Most pods, whether they did a PSR infinity or not, do basic chip and clip. The rare ones who do a lot of surgery will gladly tell you from their perch on Mount Olympus. My residency director doesn't do a whole lot of surgery. Sometimes it isn't financially worth it.

You gotta love that podiatry stipend of $4800. I graduated in 1998 and I remember seeing that figure. I think it was in Ohio. My stipend was 10k in Los Angeles. What adult can live on 10k? Dishwashers make more than that. I waited tables on the weekends. My dignity had already been excised prior to this latest podiatry fiasco so, while it wasn't fun and almost caused a nervous breakdown, I was able to do it.

I'm sure there are some who are sick of me saying these things, but everytime I read or hear someone complaining about the same garbage, I feel compelled to vent.

I'll just close by telling you the ultimate example of how bad I think podiatry is. I've reapplied to medical school despite the fact that I still owe 170k and have a hard time imagining taking all of the same basic science classes again (medical schools will recognize absolutely nothing that you've done in podiatry school. It might as well been a course in kindergarten). The thought of going back for 4 more years and doing another residency is almost surreal, but quite frankly, the thought of being a PPMR trained podiatrist for the rest of my life is beyond the pale.

 

I don't want to start a long back and forth thread, so I'll keep my response short. From what I have seen things look quite a bit different than what is described above.

To give a partial answer to the original question:

You might want to look on the net for Podiatry Online. They have archives of their old postings, but more importantly they have a regular e-mail newsletter. They frequently include job offers. This isn't the only place, but it is posted on a regular basis, so it is quite likely the most up to date.

 

Just had to chime in here. Thank you for prefacing your comments ToeJam. And Efs is right, we don't need the back and forth diatribes. Just do the homework and the research and make an informed OPINION for yourself.

 

At the risk of stating the obvious, Reality is where you are most of the time. A pod student's reality is as different from the reality of a busy, successful recently minted pod as it is from one that is struggling. It's just my opinion that if you could get an honest poll of new pods that was statistically significant it would show a few that were doing quite well, a few that have quit , and the rest divided evenly between those making enough to get by and those who aren't and are praying for a miracle.

I also want to compliment this forum for its apparent lack of censorship, and encourage the thoughtful individuals that lurk at the podiatry forum to move their relevent discussions here.

 

OK, Temple.

This is a link to a page of the Graduate Services at CPMS. It might be a little out of date. I think most of the listings were from this spring. I suspect the other schools might have similar sites, but I haven't looked for them and I am not personally aware of them.

http://www.uomhs.edu/cpms/graduate/practice.htm

Hope this is closer to what you were looking for.

 

The APMA News has a classified section with job listings, but you have to be a member or student member to subscrobe. The ads tend to be a bit outdated.

 

I don't know how helpful it would be, but you might want to try some on line job hunters like Monster.com. You could also try a headhunter specifically for the medical field.

From my own personal experience, there really and truly isn't any sort of comprehensive job board for podiatrists. It's something that is accomplished through word of mouth, who you met during residency, etc. If you're really aggressive you could cold call pods or send resume's in the mail with a follow up phone call. I would bet that you'd get somebody who would want to use you for something. You could also cold call medical clinics. One thing you need to be aware of, though, is that pretty much nobody will want to hire you until you have all of the right credentials. This means that you'll need to have your Medicaid and Medicare provider numbers, your x-ray supervisor license, etc. Getting the provider numbers is difficult and takes a long time. When I applied for mine, it took 4 months to get both. Few know about this before they embark on their adventure. The x-ray supervisor license exam is offered something like twice a year and you can't bill for x-rays under your provider number until you have it. I knew nothing about this either. Frankly, it isn't a slam dunk test. It's not tough, but it's probably a little harder than the podiatry boards. Some pods will be willing to hire you and bill under their provider number, but you'll make a lot less money. It's a matter of liability.

I got my first and only job by responding to a 3x5 card on the last day of my residency. Some pod called the residency and said that he was looking for an "associate". Since you're not interested in hearing about it, I won't waste your time.

Good luck.

 

Look on America's Job Bank ( i believe it's www.ajb.org). It not only lists jobs but employment trends through 2010. Also, the federal government has positions listed (www.usajobs.opm.gov). Another site is physicianswork.com and medicalwork.com. There are probably less than 10 jobs listed on each site but I guess it's better than none.

 

Oops! It's Physicianwork.com.

 

And these are just posted jobs.

Keep in mind that many podiatrists are opening their own practices, which are obviously not posted positions.

Many more are finding positions through word of mouth, or contacts made though their residencies, and so on.

Don't think for even a minute that you would need to flip though the want ads in search for a job. If you did you would be wasting your time. But, not because you couldn't make some money. Just that that is not the place to find a position.

I have heard of a couple of people that put together some pretty convincing material, and presented it to a hospital. The short end of it was that they convinced the hospital administrators that adding them would be profitable. In essence they created their own hospital based jobs.

This profession is wide open, you can do what you want to, but it may require some work on your part. Don't expect anyone to hand you anything, but force your way into what you think will work.

 

I'm sorry Eric, but I think that it is PATHETIC that a "doctor" would have to go to such lengths to obtain employment. I usually don't jump on the anti-podiatry bandwagon but how essential is a doctor if they have to CONVINCE a hospital that they are a valuable resource?

Having to "force your way into what you think will work" is hardly how I would want to start my medical career. I know that I may not get the job of my dreams after a residency, but I know that my MD degree will pretty much assure me that I will not have to go to hospitals and beg for them to create one for me. I would argue that if a DPM degree cannot do the same, then that should be a consideration in choosing one's medical education.

One of the reasons I am pursuing an MD is that the greater Philadelphia area (and this corridor between TUSPM and NYCPM) is so supersaturated with old school pods that it is virtually IMPOSSIBLE for a new grad to find work. I am willing to work hard to become a doctor, but I am not willing to "hustle" to find work. But hey, that's just me.

 

Just one of the reasons that I'm leaving.

It IS pathetic that someone who has put in as much time, effort and money should have to stoop to "creating" a job in a hospital. I know, Eric, that this is what needs to be done in order to succeed in podiatry, but this will gradually erode anyone's dignity over time. Doctors deserve some respect when they finish their training. They deserve a salary commensurate with their education, responsibility level and skills.

 

Apparently some of you see this in a different light than I did. Or, I just did not get it to come across as I intended.

I did not see it as "stooping" to anything. I did not think that it was pathetic. I do not see this as "hustling".

A couple of students want to live and work in an area where podiatry is not well know, or is not visible. They put together a business plan, (which is essentially what they would have had to do in order to finance a private practice), and they convinved a hospital to set up a clinic for them. (Hospital has more money than they do). Not just a job, but a practice.

Yes it is different than other professions. But this is only an example of what some did. Everyone has different options.

 

It is commonplace (or is becoming more so among MDs, DOs, DMDs) to network and search out the better jobs -- jobs with greater pay and greater benefits. This is entirely different than what podiatry graduates must do -- they must network and hustle just to find a job PERIOD. Forget about finding something with better hours or pay. If you have a DPM license and you find a job, then congrats, because you just found the BEST job you can: employment.

Bottom line: opportunities are next to none, and the profession is a dying one. The services of DPMs are not needed currently (or not thought to be needed), and if nobody needs your service you don't make an income. There is nothing difficult about this debate. We can throw opinions around as much as we want, but a listing of 20 jobs on a website hardly constitutes a profession or service that is in high demand. The only saving grace that a DPM might have left is satisfaction in their work, but in order to have that you have to actually be working. This, my friends, is not an opinion.

 

Off target once again.

Not thought to be needed is only by some, apparently you are among those.

Many more people could benefit from the services of a podiatrist than realize it.

Awareness is the first step.

 

Glad I could help.

 

That didn't come out properly, Eric, but my point was just that! People don't think they need podiatric services! Regardless of whether the service is not needed, or whether people don't know that they need it, it still equals no work, which equals no income.

We can bicker about education all we wish, but awareness is not going to magically turn into profit, or a greater job satisfaction among prodiatrists, or opportunities for new podiatrists.

Further, until podiatry schools value their students as more than just a source of cashflow, the general public isn't even going to think about utilizing podiatric services.

 

I think this may be part of where we disagree. I do agree that bickering about education is non-productive. I also don't think there are any magical answers.

Greater awareness of what podiatrists are, and more importantly what the training and capablities are the better off everyone will be. Podiatrists have a lot to offer, but if nobody knows about it, it doesn't do anyone any good. If people do know, this creates a greater demand. Demand increases profit in a round about way. So the opportunities are there, but we need to work on them.

 

Podiatry's been around for a really long time.

How is it that the general public is STILL ignorant about the schooling, training and capabilities?? How is it possible that with our supposed high level of training and clinical competence we are still perceived as superfluous by many insurers and are often paid less than our MD and DO colleagues? Why are we still referred to as "health practioners" by many and are rarely included with MD's and DO's as "physicians"? Why is there a pervasive feeling among the public and health care industry that podiatrists are not exactly "real doctors"? How is it possible that there aren't enough people in the Western Hemisphere who want to be podiatrists? You'll note that there are literally tens of thousands of hopeful students who would beg, borrow, steal or, otherwise, sell their soul to go to an MD or DO school. Why the extreme disparity? It is not a lack of understanding or knowledge of podiatry. If the public actually KNEW the reality of podiatry (no admission standards, not enough applicants, lack of full-time faculty, faculty that is not qualified to teach any class, much less a MEDICAL SCHOOL class, uneven clinical training, many weak residencies, relatively high unemployment or underemployment, a great deal of bitterness and anger among many) it would make matters even worse! What is it, exactly, that you want the public to know? And, while you might think that getting the word out about the select positive issues with podiatry, it's not going to affect the bottom line for insurance companies. Nor will it all of a sudden cause a stampede of "baby boomers", "athletes" or older folks to bust down your door. If they don't get referred or you are not on the plan, your door will remain pristine.

They exclude us and pay us less for a reason. Money. They don't always think of us as "real doctors". Education and training.

I think that the general public DOES know more than you think. If you weren't a pod student or a podiatrist would you really and truly trust your lower extremity health to someone who may very likely have inferior medical school training or who got "C's" in school and barely completed a PPMR?? When you go to see this unknown DPM you will have no idea how much training they had or how many of "X" procedures they've done. I'm a DPM and I sure as hell wouldn't feel comfortable (as it is, I'll see a DPM, but only someone I know and trust). At least MD's and DO's are REQUIRED to go through a very rigorous training process both in school and in residency. And, they are REQUIRED to pass several levels of a VERY DIFFICULT exam just to get their degree. I took the podiatry "boards" and, in a nutshell, it was an embarassing joke.

Now, before you get hot under the collar, I'm not implying that all podiatrists are educationally inferior or clinically incompetent. Some are, though. This fact coupled with the lack of admission standards (and lack of applicants), the quasi-medical school training and incomplete residency training will forever leave a general impression among health care workers and the public at large that DPM's aren't quite up to snuff. If there is even the SLIGHTEST doubt as to the competency or knowledge of someone who is going to screw with your health, the knee-jerk reaction of the potential referring physician is going to be "MD or DO" as well as the lay public. Get my drift?

I know that podiatry has made some inroads in being more recognized and respected. I know all about the years when you couldn't get on plans and there weren't any residencies. The APMA pushed and pushed and eventually won some battles to include podiatry as real medicine. There was some progress, but podiatry still exists as the bastard child of medicine (in my opinion). Podiatry still fails to help the graduating resident with finding employment. Podiatry still fails to provide an adequate clinical education. Podiatry still fails to guarantee a minimum, uniform residency training program that is essential for survival (STILL!!). Podiatry school still charges exhorbitant fees that are not commensurate with your earning power upon graduation. Podiatry is still severely limited on health plans and often not reimbursed as a normal physician. Podiatry does not have any sort of reasonable loan repayment options. Podiatry offers no real jobs and little job security.

I hardly ever run across someone who knows what I do, what I did to get there and what my level of responsibility is. Frankly, I feel that this is never going to change. I think that podiatry is a dying profession and, at best, will shrink back into chiropody. We're never going to join mainstream medicine unless we raise the standards for admission, lower the cost of attending, vastly improve the education to mirror a traditional medical education, standardize and improve the current residency system and spend a whole lot of money on lobbyists to make sure that podiatry doesn't fade away into the night. Do you think this is going to happen? I don't. That's why I'm abandoning ship before I sink.

 

Be wary of some of the posters on this board. One poster in particular claims he is a pod, but post on other sites and answers his own posts like he is someone else answering his own post. I doubt he is even a pod. By the way, he also has more than one screen name on this board. Its sad the way some losers have to pretend they are something they are not just to get attention.

 

Sorry to disappoint, cg2a93, but I am a DPM.

You must be psychic. How is it that you know if someone is answering their own post if they use a fictitious name? You need to bring that talent to the racetrack. Who is it that has more than one screen name on this board? Me? What's my other name, Nostradamus?

Calling me a loser only brings you down a notch on the maturity pole. Since you've never met me, I won't take offense.

Rather than acting like an infant, why don't you engage in a meaningful debate and either agree or disagree with my comments. efs does this admirably.

 

I dont recall mentioning your name, but if the shoe fits. Do you deny that you have posted on the podiatry forum with numerous screen names and do you deny you reply to your own posts on that forum?
You claim you practice in cali, but it one were to do a search for your license the search would be fruitless.
You bitch and moan about the profession, but what have you done to help it beside whine and bash it like some spoiled brat. You dont even belong to the APMA, so again you are part of the problem.

 

I actually did a search and found Toejam's license information. Even though I have lots of Histo to read, I still found the time to find this.

 

I dont think it would be a waste of time rotating in psych because depending where you practice you may come in contact with these types of patients. It is helpful to know what you are dealing with. Ob would just be a interesting experience.

 

It wouldn't be a waste of time to rotate through psych. Especially if you do your residency at a bit inner-city hospital. I still believe that pod students should go through everything that an MD or DO student does. In the end, we're still treating patients with all available modalities and have the same responsibilities.

 

None of the rotations would be a waste of time -- they all would have some benefit, even if it were minimal.

That's why MD/DO students do them, and that's why DMDs can choose to do a GPR (post-grad hospital based residency) if they choose.

In regards to OB (since that was mentioned), I'm assuming quite a bit could be learned for instace, from female patients/pregnant patients who have diabetes and hence altered blood flow and poor circulation to extremeties such as the feet.

 

I would agree that just about any rotation can be a benefit. Something can be learned form anything you do. The question comes down to a cost/benefit type ratio. Which are more useful? At what point is the benefit outrun by the timeinvoled? At what point is your time better used in other rotations?

It would be great if every podiatrist could take the time to do rotations in OB/GYN and Psych. On top of radiology, vasuclar surgery, dermatology, general surgery, orthopaedics, internal medicine, endocinology, and so on. There is a limit to the time available, and at some point limits must be set. The OB/GYN and Psych are at the low end, and other rotations are more relevant. Sorry, but time is a limiting factor. Other rotations take precedence.

While podiatry students do not do all of the same rotations that DO or MD students so, they do spend more time in rotations that are relevant to what they do.(Radiology, vasuclar, derm, ortho, surgery, etc). As such, they are better educated in their field.

Something I noticed in my current rotation is that the radiology people are leary of trying to educate the podiatry residents. Seems like they feel that the residents have more experience in evaluating foot and ankle films than they do. (This may not be the same everywhere, but it has not been much different in my other rotations.)

 

The order in which this happens is up for debate. I do think it will happen, though it will take time, and effort.

I think the education does mirror a traditional medical education, at least at some schools. I think you should also look into what a traditional medical education entails. If you look at it historlically, the current podiatry schools far surpass what a medical education covered less than 50 years ago. In fact, what was taught in medical schools 50 years ago is almost no longer applicable.

The current podiatric residency program is beingrevised. It should make a fair difference. I think it will only be a few more years before you see an integration of podiatry with "mainstream" medicine.

Of course this issue will remain up for debate.

 

I for one am glad we do other rotation. I learn alot , I have rotated with Plastics and ortho and the experiences were excellent they also reminded me why I dont want to do general medicine.
Medicine might be glamourous on tv, but in real life its a whole different story. God bless those of you who do it, but I will stick with my stinky feet and lower legs.

 

What's strange about podiatry, in part, is that we are called doctors (and physicians in some states), yet I always hear this thing about "you can practice medicine, I'm going to stick to feet". Why is it that podiatrists don't need to have the same all-encompassing training that MD's and DO's have? Why shouldn't we have all of the same didactic and clinical exposure that they have? We're entrusted with these people's lower extremities, doing surgery, injecting, prescribing, immobilizing them just like other physicians. Other doctors are entrusted with whatever part of the body they have just like us. Physicians who eventually become psychiatrists rotate through the same services that future brain surgeons do. What makes us different?? I could never understand the mindset of someone who thinks it's ok that we don't have the same training. I know that we focus on the LE early on and the education is geared towards that, but so much of it is superfluous and repeated over and over. So much of it is nails, calluses, ingrowns, biomechanics over and over. You know that we all had certain things repeated to us over and over and over and it almost seemed like their was little else to know in medicine. Of course we were going to DPM's and we had to know these things cold, but again, at the detriment of other medical topics. I was so sick of biomechanic lectures by my 3rd year, I thought I was going to pass out from lack of mental activity!! All of these techniques don't take very long to learn. Do you think that MD and DO students spend this much time on just a handful of aspects of medicine? Do you think that when an MD or DO student rotates through vascular, neuro or dermatology they just gloss over the LE? Do you think that when they are faced with something below the knee they just turn their heads and hope there's a pod student nearby? They learn EVERYTHING! But what happens with pod students and pod residents (like efs mentioned) the MD and DO attendings and residents sometimes leave us out of the loop because they figure that we're going to be podiatrists and we "don't need to know it". I can't tell you how many times I heard that. I heard it all through school, into my externships and right into my residency. More times than not in my residency, I was treated well, but looked at as slightly or much less inferior than the "real" medical students. They figured that, since I was going to be a podiatrist, I didn't need to have any real responsibility or deeply understand the CHF patients or AID's patients. I hated it.

I guess the point that I'm trying to make is that podiatry training in incomplete and we spend too much time on relatively simple topics like nails, calluses, ingrowns, etc. at the detriment of learning more general medicine. I know that everyone's educational experience is different, but mine lacked any meaningful hospital exposure not to mention seeing or treating any truly sick people. My one year residency had me cutting pounds and pounds of nails and calluses for 6 months as if I needed even MORE training on these techniques!

When you look at podiatry from outside the DPM/student bubble, it looks suspicious. That's one of the major points I was trying to make. Suspicious in that there are schools separate from MD schools (I also think that DO's might look a little suspicious to some people because THEY also have separate schools), there are only 7 of them, the entry requirements are similar, but the standards are non-existent, the courses are similar, but many topics are left out or glossed over (and it's not just OB/GYN and psych...I know in anatomy our professor didn't require us to know very much about the head and neck, in pharm they didn't really focus on heart meds, etc, in phys diag the MD treated it like it was just some course that we had to take and that we didn't have to kill ourselves over it, etc., etc.) and the "residencies" are incomplete. Overall, I think that med students look at pods as people who had inferior undergrad grades, may or may not have been required to take the MCAT, did not have to work as hard in pod school, know very little about hospital based medicine and basically came through some secret back door to become doctors. I'm just saying what I think most of them think. And these med students obviously go on to be medical doctors and continue with this biased thinking.

 

Do you really think this is true?
Are you sure?

I prefer to take a more pro-active approach. Rather than just hanging out and "going thorugh" a rotation, take the opportunity to show them what podiatry is about. E.g. when you do a radiology rotation, you are probably more informed about foot and ankle films than the they are. Take the opportunity to teach them. Seek out opportunities. They are there.

 

Medical students certainly have a greater opportunity to learn more about medicine than we do. In their basic science years, NOTHING is glossed over like in pod school. You NEVER hear a professor saying "do you guys need to know this"?? And, not only do they rotate through more services, they spend more time in each one and are given more responsibilities than us. In their 3rd and 4th years, they are rotating through a wide variety of disciplines and spend a solid one to two months in each one. As I recall, I spent the majority of my time on my ass in the 3rd year and in the 4th year, rotated mostly through clinics, offices and nursing homes (seeing only feet) with the exception of derm where they didn't know what to do with me for the 1st week. I know that everyone's experience is different, but you'll have to prove to me that a podiatry student's clinical years even approach a medical student's in terms of variety, intensity and level of responsibility.

I know you've heard this before and you're probably a little bit tired of it, but I still don't believe that the educational processes are at all similar. When a pod student goes to something like a clinic or something general like that, they are often relegated to seeing the LE patients and are steered away from everything else. Med students see, evaluate and treat EVERYTHING including LE patients. Even if you are allowed to see patients for something other than LE problems, you are often monitored much closer than the medical student. You are rarely looked at as an equal. This doesn't happen everywhere, but it does happen. Another MAJOR difference between med students and pod students is that med students are LIVING in a hospital in their last two years. They might spend a couple of months in a clinic or an office, but otherwise, they are seeing, evaluating and treating ALL KINDS OF SICK PEOPLE. What are pod students doing? At best, we're in a clinic somewhere seeing nothing but LE patients. We might get a couple of bones thrown our way and get to do something like plastics or ER, but nothing close to what medical students are offered and required to do. I have also seen a few posters on the podiatry forum who left podiatry and went to medical school. They ALL say that there is no comparison.

I feel that podiatry started out as chiropody and gradually added things like surgery and prescription rights. Chiropody education didn't require any hospital experience or any kind of "residency". As podiatry progressed, the exposure to traditional medicine also increased, but at a very slow rate. The educational experience also increased, but, again, at a slow rate. In my opinion, the two are not meshing very well and are both inadequate. They've kind of reached a zenith and are no longer moving forward. At the very least, if we are going to be inside a hospital as an intern, the schools need to PUT us in hospitals like the med students are and at least teach us how a hospital functions and what to do with an ICU patient (for example).

It's ridiculous to say that, as a podiatrist, you don't need to rotate through certain services or be taught certain courses. This is only justification for our inferior education. A doctor needs to be exposed to ALL aspects of medicine because it's ALL interrelated. Clearly, psych can easily play a role with a podiatry patient. That's not even a question. Why don't we have psych rotations? Having some knowledge of and experience with a woman's hormonal cycle or what happens to the LE during pregnancy is obviously withing our scope of necessary understanding. Why don't we have an OB/GYN rotation? Why don't we rotate through G-surg like other med students? There are a number of post-op problems that can manifest in the LE. And, as for all of the other branches of medicine (internal medicine, ER, peds, rheumatology, derm, surgery, neurology, etc.) our exposure and experience with these, on the whole, is embarassing. I probably saw 3 peds patients in my derm externship. I never rotated through neuro. I rotated one month in the ER, but I was relegated to the slower, simpler part of the ER because I was podiatry. I never saw any kind of general surgery, never rotated through rheumatology, never rotated through rehab medicine, never rotated through physical or occupational therapy (which, obviously, should be required), never rotated through infectious disease, etc. I did have one month of radiology, but they tended to single me out when the ankle films came up. I also had two tough months of internal medicine, in which, for some reason, they treated me exactly like a regular intern and worked my ass off. I loved it!

Bottom line is that even if you do somehow secure a medicine rotation as a pod student, it will likely not be as intense as it would be for a regular med student. You may or may not be treated like a medical student. And, the number and quality of your clinical experiences fall far short of a medical student, thus robbing you of a well-rounded medical education.

 

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"It's ridiculous to say that, as a podiatrist, you don't need to rotate through certain services or be taught certain courses. This is only justification for our inferior education. "
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Not to offend anyone, but I disagree that pod students should have the same rotations that MD/DO students have. The DPM curriculum focuses on a specialist education as a condition of obtaining the degree; the MD/DO curriculum focuses on a general medical education, with the acquisition of the degree as a requirement for specialization. I think that any DPM student who wants a more generalist medical education should strongly consider the MD/DO route instead of the DPM one.

Feel free to disagree.

 

I understand your line of thinking, Rose13, but it still doesn't jive with what a podiatrist actually does and what a podiatrist is responsible for. If we have the right and responsibility to admit a patient into a hospital, have the skills and license to perform any type of surgery below the knee and can prescribe any sort of medication that an MD or DO can, why on earth should we have a different education?! We are, for all intents and purposes, an orthopedist of the lower extremity (at least in function).

How is it any different for, say, an ophthamologist who is going to do a corneal transplant vs. a podiatrist who is going to perform a below the knee amputation? Neither of them are psychiatrists, dermatologists or general surgeons, but the ophthamologist went through a lot of training that the podiatrist didn't. They're both responsible for the post-op complications. They're both responsible for the general anesthesia. They're both responsible for the post-op care. The patient can expire in both cases. Why did the ophthamologist go through a more rigorous clinical experience than the podiatrist? Why should the ophthamologist be trained more as a "physician" than the podiatrist?? The podiatrist cannot "pass the buck" because he/she is a podiatrist. They have the exact same level of responsibility as any other doctor.

In my opinion, those three rights (ability to admit into a hospital, ability to use any modality of treatment, and prescription rights) demarcate doctors from health practioners. Doctors are unencumbered in their professional lives when it comes to decisions and treatment plans. In this light, I also feel that it is completely essential for a doctor to be exposed to ALL facets of medicine. Clearly, the mind and body are inextricably linked. If you leave out one or more aspects of human anatomy or human physiology and you fail to have direct experience with all human maladies (or at least most of them) you fall short of being a true physician.

Of course, this is only my opinion.

 

Perhaps that ophthamologist is over-educated for the work he performs?
Perhaps it has something to do with the point at which each selects their specialization?

I think you have made some interesting comments. I also think they do not have any easy or simple answers.

 

Podiatry certainly started as chiropody and gradually added things. But there were some other things that were going on in medicine at the same time, that greatly affected the timing. Think about PCN and the antibiotic revolution after WWII. This factor is why there was not much "elective" surgery of ANY type prior to that. Surgery carried huge risks. Changges in anesthesia since that time has also played a role. The OA principles were not developed until later either. It is not as though MD surgeons and Orthopaedic surgeons have successfully been doing this stuff for hundreds or even thousands of years and it is only recently that DPMs caught up. In 1910 there really wasn't anyone doing elective foot surgery.

As far as the rest of the education process, it might be interesting to look into what a medical education really meant in the US, since it's founding. For a long time, it didn't take anything more than hanging out your shingle. Or, maybe serving an apprenticeship for 2 years first, and then opening a practice. This was changed long ago, but it wasn't that long ago that a High school diploma and 2 years of college was all that was needed. (Of course, in high school they had a different education than you might expect to get these days.)

We spent a few months in the hospital in our third year. Our fourth year can vary, as we are responsible for arranging our schedule (within certain criteria). So far this year 3 of 4 months have been hospital based. My next 5 months will all be hospital based as well. Some of us are functioning quite well in the hospitals. I'm not sure what you would expect for podiatry in an ICU setting. Yes, you could learn a lot there, but most of it would not be relevant, and your time might be better spent elsewhere. (BTW, I worked in ICUs for 4 years, I still can't think what you might expect a podiatry student to gain from a month there.)

Lots to think about. I just don't see it as bad as what you describe. My experience has been much different.

 

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"How is it any different for, say, an ophthamologist who is going to do a corneal transplant vs. a podiatrist who is going to perform a below the knee amputation? Neither of them are psychiatrists, dermatologists or general surgeons, but the ophthamologist went through a lot of training that the podiatrist didn't. They're both responsible for the post-op complications. They're both responsible for the general anesthesia. They're both responsible for the post-op care. The patient can expire in both cases. Why did the ophthamologist go through a more rigorous clinical experience than the podiatrist? Why should the ophthamologist be trained more as a "physician" than the podiatrist?? The podiatrist cannot "pass the buck" because he/she is a podiatrist. They have the exact same level of responsibility as any other doctor."
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I think it still goes back to the inherent nature of one's education; the generalist to specialist approach versus the specialist to generalist approach, the former being the most widely accepted as for the training of a physician. The ophthamologist is trained as a physician first and as an ophthamologist second, whereas the podiatrist is trained as a podiatrist from day one. The ophthamologist spends the entire 4 years of medical learning the entire body; the podiatrist spends that time focusing on the lower extremity, the tradeoff being the lack of a more generalist education about the entire body. If podiatrists spent more time learning about the whole body and less on podiatry, would it still be a podiatric education?

Do you think it would be better if podiatry became a subspeciality of allopathic/osteopathic medicine?

 

I understand what you're trying to get at, Eric, but medicine has never been restricted in what they do. Medical students have studied pharmacology, histology, physics, chemistry, etc. in order to be a well-rounded scientist/physician. I know that some of this training was rudimentary (such as pharm) in the beginning of the century, but my point is that they approached medicine as a complete art and science and were educated with that in mind. Chiropody was barely a science when it began.

Physicians in 20th century (at least European and U.S. based) have had very similar and very comprehensive training. Chiropody was extremely limited in what it taught and what practitioners could do up until the 60's. It was basically shoes, nails and calluses. Podiatry didn't even begin to experience anything close to a medical education until the 1970's. And the most rudimentary style of residency didn't appear until the early 80's. As it stands, the schools are STILL trying to cobble together something resembling a medical education, but are STILL failing. Frankly, I still can't figure this out. Osteopathic medicine formed separate schools over a century ago and very soon after began to incorporate all teachings and modalities of traditional medicine.

I don't want this to sound negative because it's not my intention. I'm just trying to express my opinions on what I feel a podiatry education is and how it compares with a traditional medical education. I know you don't like to hear it and I'm sure a lot of others will cringe when they read this, but I still think that podiatry is a back door way for many to become doctors. I'm not the only one who feels that way, either.

For me and many others, becoming a physician an almost sacred achievement. It signifies that you have proven that you are exceptionally competent, academically, intellectually and socially. You are the cream of the crop. You have earned the right to enter this rare world of human medicine and be trained as complete physician. To be called "physician", in my opinion, is something that is earned through long years of toil and sacrifice and only a handful of people are given this incredible reponsibility.

To me, podiatry does not live up to all of these ideals. I know that the vast majority of podiatry students have the desire and commitment to become doctors and they have just as much compassion and empathy for their patients that medical students do. That's not even something to compare. The problem is, is that a prospective podiatry student could have almost any kind of academic background and have otherwise shown no promise, yet still be offered a position in school. And, if they do get in, they don't have to go through the same grueling training that MD and DO students do. I'm definitely not saying that a lot of pod students didn't work their asses off and do a lot of admirable things before they got in. I'm saying that not everyone who wants it should be able to be called doctor. It seems to me that someone who wants to go to pod school just needs a bachelor's degree and have taken the pre-req classes. The GPA isn't much of a concern nor is the MCAT score. It's not too difficult to get a college degree and take those classes getting "C"s. And I know that it's easier to get in than to get out, but, really, what's the actual attrition rate for students who just couldn't hack it in podiatry school? I don't think it's very high. Probably not much different than med schools, but I have no idea.

To me, it's a little bit like these other peripheral health practitioners like PA's, Nurse Practitioners and chiropractors who are constantly trying to increase their scope. Like I said, not everyone can be a doctor. You have to draw the line somewhere.

Don't take anything I say personally. It's just my opinion and I'm open to changing my opinion if someone can offer a good rebuttal.

 

Don't worry about me taking anything personally. I tend to stay pretty objective. I think there are a number of places we disagree and others where we may agree in whole, but vary in part. I think your experiences have given you a partial view of some things, and from that I think you have drawn some conclusions that may be a bit unrealistic. (But this is only my opinion. You may be right. Of course you may also be wrong.) I only wish you the best of luck in your endeavors, and I think that many of your opinions will change with greater experience.

I, on the other hand, do not place physicians in any sacred category. I do not believe that completing a "medical" education gives anyone any special attibutes. I don't think this gives anyone any special "rights" either. (I am a libertarian, and have spent a fair amount of time thinking about rights and ethics.) In particular, with the current atmosphere of "minority rights", "patient's rights", and the ensuing discrimination and anti-discrimination policies many things have been skewed. As part of this, many "PC" and "cultural" and "social" engineering policies have radiaclly changed what was.

There are many "physicians" out there who have completed a medical education that I wouldn't trust one bit. (There are also a great many whom I would trust.) But I cannot and will not do so based on what papers they have. Neither will many other people. (At times these people will be termed "patients".) Many no longer have any choice in who their care providers are because of insurance, HMO, PPO, etc. The whole system is out of kilter. How do you propose that these problems be addressed?

I cannot put any person on a pedestal on the basis of their degree or education. Just doesn't work. And I am not alone on this.

 

Actually, I said "almost sacred achievement". I still think, however, that earning the right to evaluate, diagnose and treat someone with any modality you feel is optimal and, possibly, having their lives in your hands IS a sacred responsibility. It also demands a great deal from the individual including intelligence, ethics, a great sense of responsibility, stamina, compassion and the ability to "think out of the box". This is, of course, an example of an excellent physician. I know that there are a number of unitelligent, ethically challenged, irresponsible, lazy and dispassionate doctors hovering in our midst who couldn't work their way out of a cardboard box with a howitzer.

There really aren't too many jobs in the world that have this level of responsibility coupled with the many factors that go into making a good physician. I just personally believe that to be a great physician you must possess a number of high level characteristics, which separate you from most others. This is, in part, what bothers me about podiatry. Pretty much anyone who applies can get in and getting out isn't THAT difficult. The training isn't uniform and many have learned surgery through apprenticeships and assisting, not through a formal residency program (in the old days). To me, podiatry school just isn't rigorous enough in terms of admission standards and exposure to clinical pathology to be considered a school that graduates doctors. This is why I think it's a backdoor way to be a doctor.

Just my opinion

 

I think the biggest problem that you hit on is that the training is not uniform. Whether you are talking about the residency programs or at the school's level, they are both problems. I think this is pretty well recognized by the APMA, AACPM, CPME and the schools. And I think they are working on it. I just wouldn't expect any overnight fixes. It is a complex issue, and the answer will take some time. But it is being worked on.

 

It might be a complex issue, but I don't see it that way.

When I was a 3rd year student, a few of my colleagues and I were so upset at our lack of clinical training that we set up a meeting with the then Dean of Students. He was nice enough, but basically said that the reason we didn't have more clinical training (mostly in hospitals) was because of money and not all hospitals would welcome podiatry students as regular medical students. This really deflated me, to say the least. At that point I really began to feel like a second-class citizen. I kept thinking to myself, "if it's money, why do other med students who are paying the same tuition as me and sometimes less have the opportunity to rotate through hospitals during their final two years"? And, if it's because we're podiatry students, then are we really being trained to be doctors, or some peripheral health care provider"?

The money explanation made me angry. The school doesn't even pay the instructors the same kind of salaries that other med school professors get and they certainly didn't give the students a whole lot of perks. Some of the schools are located in the hinterlands, so the leasing cost can't be an issue. So, how is it that after all these years, they still haven't managed to pay to get us into hospitals? The only thing I could come up with was horrible mismanagement. I'm talking about CCPM and I'm sure many of you are aware of the checkered financial history of the school. Several past Presidents and CEO's etc. absconded with some funds, which damaged the school significantly. But, I don't know. I don't know if this is the reason.

The explanation that some hospitals were reluctant to have podiatry students as regular medical students REALLY ticked me off. I felt some serious indignation at this thought because I knew that our coursework in the first two years was at least 90% identical of what a medical student experienced. I started to think that part of the reason was that the doctors and administrators who ran the hospitals knew of the relatively low admission standards for podiatry school and felt that we would be more of a liability than an asset. They probably also didn't even know what our education entailed and likely equated it to something that a chiropractic student might go through.

So, I see it as maybe two or three broad issues. The money issue is pure bunk if you ask me. If we're paying 20+k every year for our education, then they certainly should have the funds to put us in hospitals. The other issue, which I believe is the main issue, is the low standards for admission to pod school. This, coupled with the ignorance of most MD's and DO's as to what pod students study keeps them thinking that we would make things more difficult for the hospital rather than adding another viewpoint. They persistently look at pod students and podiatry as some kind of ancillary branch of medicine, but not as medical students and physicians.

I still don't buy the argument that, as podiatry students, we need to spend so much time on podiatry related issues, which leaves less time to study general medicine and see gen med patients. Biomechanics training is total overkill. We spent so much time learning the same crap over and over, I was beginning to resent the very idea of biomechanics. I still have yet to meet a working podiatrist who uses all of those time consuming techniques to cast or strap a patient. And, what in the hell were we taking classes in Sports Medicine, Psychiatry (only a couple of weeks as I remember), Emergency Medicine, Pediatrics, Podiatric Trauma and Rehabilitation Medicine without even seeing any patients??!! I'm sorry, but that's just ridiculous. By that time, I was boiling mad. I resented this weak attempt to pacify us into thinking we were getting a medical education. As it is, I only saw a handful of biomechanics patients during that rotation. And my supposed junior surgery rotation? I scrubbed in on two cases and only observed. What's that all about??!! Bottom line is that it doesn't take a whole lot of training (didactic and clinical) to be reasonably skilled in debriding nails, calluses and wounds. And since very few podiatrists actually go through all of the B.S. biomechanic gesticulations and gait analyses in real life, the schools don't need to occupy two years of our education on this topic. If you want to pursue that then do a biomechanics fellowship. What else is there? Surgery? We can learn all we need to know in a residency program. God knows they don't give us enough real experience in school. I think it's all a front to hide the real reasons that pod students are not allowed access to hospital based rotations. Meaning, they fill your time in the 3rd and 4th years with inconsistent, often repetitive courses and some clinical exposure to save money and justify it by saying that this is specialized podiatry training. Let me ask you this. Why is it that every other specialty in medicine doesn't start training in their field until they are residents? All med students go through the same 4 years with only slight variations (when they pick their elective rotations) and don't even start to focus on their chosen field until AFTER they've graduated. Why should podiatry be any different? You'd think that the public and the health care system would recognize us as even MORE educated than MD's and DO's since we are continually focusing on our specialty. Unfortunately, this isn't true. And, I don't care if you already know that you're going to be a podiatrist when you graduate. You're also supposed to be a doctor. You'd think that it would be kind of important for students to actually SEE some patients before they graduate and have experiences with actual patients that have diseases that can manifest in the LE (which is almost every disease). And, aside from that, if we are supposed to be doctors, we should be seeing ALL KINDS OF SICK PEOPLE! Like I said, future dermatologists, brain surgeons, cardiologists, etc. do and see everything. They are completely trained to be physicians before they start their specialty training.

Focusing the education towards the lower extremity early on and continuing with superfluous classes and repetitive lectures is just a ruse to obscure the fact that pod students don't have the same opportunities as medical students in their education. There isn't any rationale behind it. This is where I think that chiropody and podiatry are still married at the hip. It's as if podiatry is trying to break out of its chiropody cocoon, but something's blocking its exit (mismanagement, lack of public awareness, the AMA, lack of money). Current podiatry education is a weird blend of chiropody and medicine. Chiropody isn't tough to master, but medicine is.

The way I see it, podiatry is either going to be a part of mainstream medicine or it isn't. As it stands today, I don't feel that it is a part of mainstream medicine. I think it's caught in a gray world between practitioner and doctor. How deeply should podiatry be allowed in to the world of medicine? With the current admission stats and educational standards, not very far. This haphazard education and inconsistent training isn't going to cut it. And the current admission standards are only pushing us further back into the Stone Age of medicine.

So, what needs to be addressed? Several things. First, I feel the education needs to be significantly expanded while concomitantly reducing the detritus that they call necessary courses. I think that this is the root of the problem. The schools are preparing us to be a chiropodist/doctor. Not enough doctor and, frankly, not enough chiropodist. Everyone's coming out half-baked. They need to do one or the other. Or, they need to streamline the chiropody education (like debridement, strapping, padding, orthotics) and adopt a traditional, all-inclusive medical education. If they're going to be charging us such obscene fees, they need to train us like physicians so we can integrate into the world of medicine like other doctors. Once this is done, the public and health care industry will eventually see us as equals just as they see DO's equal to MD's (in the vast majority of cases). If this doesn't change, podiatry will forever lurk in the backwaters of medicine. Next, they need to raise the admission standards at least to the level of a DO school and not a trade school. And, lastly, they need to create a standard residency, which trains all DPM's to be physicians and surgeons. It's beyond me why they haven't been able to achieve this as of yet.

I really don't see how this is so complicated. Hundreds of medical schools around the world are doing it and, many, charging students less fees than podiatry schools.

Aside from those main issues there are others. The APMA and the schools appear to be impotent when faced with the realities of the profession. Podiatrists tend to turn their backs on the profession once they get out. Why is this? Are they upset at the lack of job opportunities? Do they feel that the schools gave them little in return for their money? Do they feel that they were sold a bill of goods?? The schools aren't screening the applicants stringently enough. They're offering admission to people who have little promise of even finishing the first semester much less the entire 4 years. They aren't actively searching for people who might be able to contribute to podiatric research (there is a tremendous dearth of good material). The organizations fail to help the struggling DPM's in the country. The list goes on and on.

But, you've heard all of this before, huh?

 

Similar, yet not quite the same. Dentistry is a medical specialty in its own right, and students entering the profession are assumed to have chosen dentistry as their profession based on their knowledge and previous exposure to dentistry.

Medical students rotate through their MS-3 and MS-4 years PRIOR to matching to a specialty. The rotations do serve a strong clinical purpose, but they are also fundamental in giving students a taste of what specialty they wish to pursue.

Dental students, in a broad sense, chose their specialty when they applied to dental school. Of course, there are post-grad specialties, some of which DO rotate in OB/GYN, Psych, Rads, Anesth., Medicine, and Plastics.

 

To add to my last post, based on this, it appears that the education of dental students vs. podiatry students ought to be compared, since both have in essence chosen their "specialties" just by applying to the respective schools.

But to further complicate matters, those MDs who practice medicine, as well as other specialties, perform functions and treatments which overlap (and often absolve) the duties and fucntions of a podiatrist.

In contrast, the functions of a dentist are not in any way infringed upon by an MD (with the exception of some surgery cases), and so the educational requisites of the two educations (DMD/DDS vs DPM) perhaps aren't as similar as they might appear.

 

I do not mean to offend you, but podaitry students are not medical students, though podiatry students are trained according to the medical model (PA students are also trained according to the medical model, but this does not make them medical students, either). Check out www.ama-assn.org, click the "Patients" tab, and go to "Becoming a Physician."

Many people who are not physicians are called "doctor," but this does mean they are physicians; it means they earned a terminal degree in their field. Physicians are those who are trained to diagnose and treat the entire body (i.e., MD's and DO's).

Podiatrists are specialists, from day one of their education and training; because of this specialization, podiatrists are trained to be non-physician health care providers. As long as podiatry does not follow the physician training model, it will always be non-physician health care provider degree.

Just out of curiousity, were you told that you would be a physician upon the successful completion of podiatry school?