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Question Regarding The Negativity Surrounding Podiatry in SDN

GAMING4FUNN

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Hey everyone, I was just curious if the negativity surrounding Podiatry is unique to SDN? With interests in pursuing Podiatry this year I have looked for more information about the future of this career path within the SDN forums. There are posts made all the way back to 2018 where Podiatric Residents and those finished with Podiatric Residency struggle to find stable or financially rewarding jobs. There is a lot of number crunching going on about where it is best to work and how to go about working in/owning a private practice with issues about saturation in the job market. Is this normal to many healthcare fields or just Podiatry?

My question: Are these just general concerns with the field just as with any other higher tier healthcare job? Meaning are there similar issues going on with Pharmacy, Optometry, PA, NP etc...? Or should I really be concerned about my future as a Podiatrist. Thank you!
 
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DexterMorganSK

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Hey everyone, I was just curious if the negativity surrounding Podiatry is unique to SDN? With interests in pursuing Podiatry this year I have looked for more information about the future of this career path within the SDN forums. There are posts made all the way back to 2018 where Podiatric Residents and those finished with Podiatric Residency struggle to find stable or financially rewarding jobs. There is a lot of number crunching going on about where it is best to work and how to go about working in/owning a private practice with issues about saturation in the job market. Is this normal to many healthcare fields or just Podiatry?

My question: Are these just general concerns with the field just as with any other higher tier healthcare job? Meaning are there similar issues going on with Pharmacy, Optometry, PA, NP etc...? Or should I really be concerned about my future as a Podiatrist. Thank you!

Every field/every specialty have its issues.
There are more than 18K working DPMs in the US, and we have roughly 15-20 (probably less), active DPM users on SDN.
That said, don't make a decision based on what we say here, rather reach out to working Pods in your area.
 
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El-Rami

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To tell you the truth, I've only seen a few posters, on SDN, say anything negative about podiatry. Shadowing people who you actually know are podiatrists would be the best way to gather information. I've shadowed a private practice podiatrist (he was the owner and didn't employ other podiatrists) and saw him do a bunch of nail trimming and the like. Honestly, it was boring work, but at the end of the day he helped relieve his patients' suffering. He lives well enough to only have to work a half week, 9-5, and sees plenty of patients.

I think a lot of outcomes vary by region. If you work on the coasts in areas with a large number of podiatrists, you may have a rough time finding something you enjoy doing. Apparently there are pod clinics at malls in those areas. They are everywhere.

The majority of the jobs for podiatrists would be in private practice (either working as an associate for a podiatrist that may or may not take advantage of you, or you could simply create your own practice from the floor-up). However, depending on region, you may also find hospital, ortho, or multispecialty clinics to work at. Those are the higher paying jobs (besides outright owning a clinic).

Consider this. The VA recently changed the salaries that they pay podiatrists (same for all VA hospitals), and salaries improved dramatically (low 100k to 200k-300k range). If podiatry was in a downward spiral like pharmacy, this would not have happened. The VA needs podiatrists, and this is a victory for podiatry as a whole.

Some people may hate the idea of working for the VA, but the pay is great, and you have good benefits and job security working for the federal government.

I would take negativity on SDN with a grain of salt. You see the same negativity regarding primary care (MD/DO) regarding declining reimbursement from Medicare/Medicaid/Private insurance as well as "mid-level creep." I would be very skeptical about posts saying it's not worth it. This isn't to say that you shouldn't be careful in weighing the pros and cons of a profession, but you have to remember that people on this site may or may not be who they say they are. People may or may not have ulterior motives in turning people away from their own profession.
 
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MidnightSpart3n

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To tell you the truth, I've only seen a few posters, on SDN, say anything negative about podiatry. Shadowing people who you actually know are podiatrists would be the best way to gather information. I've shadowed a private practice podiatrist (he was the owner and didn't employ other podiatrists) and saw him do a bunch of nail trimming and the like. Honestly, it was boring work, but at the end of the day he helped relieve his patients' suffering. He lives well enough to only have to work a half week, 9-5, and sees plenty of patients.

I think a lot of outcomes vary by region. If you work on the coasts in areas with a large number of podiatrists, you may have a rough time finding something you enjoy doing. Apparently there are pod clinics at malls in those areas. They are everywhere.

The majority of the jobs for podiatrists would be in private practice (either working as an associate for a podiatrist that may or may not take advantage of you, or you could simply create your own practice from the floor-up). However, depending on region, you may also find hospital, ortho, or multispecialty clinics to work at. Those are the higher paying jobs (besides outright owning a clinic).

Consider this. The VA recently changed the salaries that they pay podiatrists (same for all VA hospitals), and salaries improved dramatically (low 100k to 200k-300k range). If podiatry was in a downward spiral like pharmacy, this would not have happened. The VA needs podiatrists, and this is a victory for podiatry as a whole.

Some people may hate the idea of working for the VA, but the pay is great, and you have good benefits and job security working for the federal government.

I would take negativity on SDN with a grain of salt. You see the same negativity regarding primary care (MD/DO) regarding declining reimbursement from Medicare/Medicaid/Private insurance as well as "mid-level creep." I would be very skeptical about posts saying it's not worth it. This isn't to say that you shouldn't be careful in weighing the pros and cons of a profession, but you have to remember that people on this site may or may not be who they say they are. People may or may not have ulterior motives in turning people away from their own profession.
Could you please explain what you mean by "downward spiral of pharmacy"
 
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El-Rami

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Pharm schools tripled the number of graduates/year over a span of about 15 years or so, they got screwed by the 2008 financial crisis, jobs are insanely hard to get and pretty much the only people with jobs at graduation are people who do residencies/internship. Interns seldomly get hired by the companies they intern for. Residencies are becoming more competitive year after year, and even residency-trained pharmacists have trouble getting jobs (retail or hospital/clinical). Pharmacy is a real s***show with no real prospects, expensive, deadend degree. Apparently "passion and drive" mean little. You can work as hard as you want, but pharmacies don't care about hard work in school. Everyone is the same to corporate pharmacy chains, so it's impossible to stand out. There's no job security whatsoever, and basically the 6-figure salaries you hear about don't exist because the average hours/week is 32 at $40-50/hr.

The pharmacy schools keep opening up year after year, and you're even starting to see "online only" programs open up (not related to COVID). Pharmacists have no political power, and their representative organizations don't care for them. Standards have decreased to the point of waiving PCAT for poor-quality students with barely above a 3.0 GPA. Overall acceptance rates are 80-90%. Anyone who can secure loans and has a pulse can get into pharmacy school these days.

I know a guy who was a bigwig at a pharmacy school I applied to and was accepted at. Even he urged me to run the other way when I told him I knew about the job market, saying "You pretty much hit the nail on the head."

If you look at enrollment at many of the pharmacy programs, they are at something like half-capacity. They are getting hit pretty hard by people suddenly losing interest in their profession, which serves them right I guess for opening so many schools in order to get short-term financial gains. You reap what you sow.

In short, pharmacy was a decent profession with a peak in the early-to-mid 2000s. It went to hell in a hand-basket around 2010-onwards and is racing to rock-bottom as we speak. Be wary of people that want to increase the number of schools (for any profession) due to "need to meet demand." They said there would be an aging population needing meds, so they increased the number of pharmacists in a very reckless fashion, leading to a huge oversupply of pharmacists and many people in 6-figure debt and unemployed with no other option but to get a different degree in order to make a living.

There is a new pod school opening in Texas (not sure when its inaugural class starts). It's worth keeping an eye on this space because anyone wanting to suddenly increase the number of schools should be looked at with suspicion.
 
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heybrother

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I wanna touch on something that I saw on another thread but didn't get to respond to. VA pay is NOT near $300k

(1) VA salaries are public record.
(2) There are little search engines that can be used to search ALL VA PODIATRIST salaries. Like literally you set the pay search to VA and podiatrist and everyone shows up. Then you search by filtering the pay column. Feel free to take a gander - I did the other day and no one broke $170K that I saw.
(3) Podiatrists were previously on a different separate pay scale and it essentially capped in the like ..$150-160K region. I'm not VA but you got there in ..10-15 years. You started low too. I hesitant to make up a number but it seemed like $90-100K range albeit with VA benefits.
(4) The new pay theoretically helps starting pay and puts people on a scale where they can grow. That said a lot of VA podiatrists were super angry when it came out and that it would be a bigger deal. Time will tell.

I've said my thoughts on VAs elsewhere. I've seen great thing at VAs and I've seen the WORST OF THE WORST. Most VA docs have a LARGE nail load and some of them have to put up with bullcrap like inpatient nail cutting consults.

I don't mean this unkindly, but this "VA is near $300" is drawn from misinterpreting the pay schedule chart. Podiatrists are in a certain category with other types of doctors. The category has 3 tiers with the higher tiers being associated with higher ...responsibility/leadership levels. The highest # on the table was $280K. That does not mean that people start there.


Spend time shadowing. See what you can see. Set realistic expectations. Realize that some of those things you think are SO great aren't.

Like trauma?
The other day a 50ish woman showed up at my clinic. In a taxi. Can't walk. "Something popped" 3 weeks ago, but walking on it. Diabetic - adequately controlled, but neuropathic like crazy. Legs as big as an elephant. Like enormously swollen. High grade chronic kidney disease. Not on dialysis. No insurance. 300-400 lbs. We could barely get on her on the X-ray, but I saw enough to know it was a blown up ankle fracture and she's kindly breaking the fracture fragments into pieces. All yours podiatric trauma reconstructive surgeon.

I like this "profession" well enough. Lot of stupid stuff. Sadly a lot of people who can't be helped. Destroyed, Diabetic. Unreconstructable though surgeon dependent.

Number one issue I see is new people can't get paid.
Secondary issue is I suppose is hoops and garbage to jump through to deal with it all. Insurance companies just denying everything just to do it so we have to fight to get paid for things that are supposed to get paid.
-You'll see our fights about the 25 modifier. If you inject a patient for plantar fasciitis and then they want to talk about nail fungus or whatever, the insurance company may turn around and not pay you for the 10 minute conversation you had after you injected the patient.

Last of all, a lot of what is taught in podiatry school and at certain residencies is junk (ie. most things relating to the big toe) and I think there's a lot of people living a hardlife wondering their whole career why their surgeries suck / why their patients are unhappy.
 
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El-Rami

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Point taken about the VA, but I never said that podiatrists make "near 300k" starting salary in the VA. You were correct that I get this from the chart with the different tiers of salaries for VA physicians. A DPM working with the VA would be the best person to weigh in on this, as you yourself say that you don't work for the VA.

This does seem to corroborate what you say. As for the tables showing maximum compensation in the 200k-300k range, podiatrists without a doubt fall into this band along with other physicians as well as dentists. What you see when searching VA is probably base pay and not necessarily yearly income. It still leaves something to be desired, especially starting out, but from what I gather, there is opportunity to advance into leadership roles with the VA.

Screen Shot 2020-06-17 at 6.42.26 PM.png

I found a post from 2010 (yes, that is really old), in which a user, VHADOC, gives an example of how starting salary works for an IM physician. Essentially you take that base salary (~107k) and add onto it to get the true yearly income. You add market pay and performance pay onto that number, and at least at the time of that guy's post, the VA offered 50k/year (5 year period via EDRP) for people to pay back student loans. Of course, that was 10 years ago and things would have changed by now, but that certainly does sound a lot better than the gloom and doom posts with people talking about crappy private practice associate pay. Also, if I am not mistaken, PSLF is another way that you can pay back loans and have them forgiven in 10 years without the "tax bomb." VA would qualify for that.

It's a good middle-of-the-road option, IMO. I would rather work for the government than in the dead-end associate jobs that you hear about on this site. It gives a half-decent salary, rewards longevity, good benefits and a retirement package. Most importantly, it gives job security. It won't give you the best pay that you could potentially earn, but it's simply another option for people to consider.

 
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J29622

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Speaking from what I've seen personally, at the Cleveland VA the salaried young pods usually bring in around $120,000 and the older more seasoned pods bring in closer to $180,000. These numbers are public record and I've seen them myself. I would also note that VA pays lower on average compared to private hospital systems, which often pay 200,000+. I know based on first hand info that Kaiser and Legacy out in Oregon start off new grads at 200,000 and go up to 300,000+. Largely region dependent and position dependent, I would imagine.
 
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hailey6565

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From experience I've recently shadowed 2x Podiatrist and their bringing in bank but then again they're in Cali soooo this could play a part in this too. Also they started their own practice and both are making above +300K! So don't let goggle or anything else let you think Podiatrist does not make much, as you get to know more people in the field they will tell you more about their salary income + bonuses!
 
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Weirdy

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From experience I've recently shadowed 2x Podiatrist and their bringing in bank but then again they're in Cali soooo this could play a part in this too. Also they started their own practice and both are making above +300K! So don't let goggle or anything else let you think Podiatrist does not make much, as you get to know more people in the field they will tell you more about their salary income + bonuses!
Hey Bobbiii,

Those numbers are possible but I promise you they are not the norm and will not be attainable immediately after residency.

You probably know this better than I do after working a 6 figure job before entering, but overheard expenses, insurance coverage, equipment costs, leasing space, EMR, hiring competent workers, getting referrals etc are all things you need to factor in with private practice.

Businesses are expensive to run when you are footing the bill or taking out a business loan to do it.

This is assuming all of the DPMs in your area play fair and aren't doing things behind your back like non-compete clauses that kick you out of the city you want to be in.

Appreciate your enthusiasm and feel like it is warranted, but only if pre-pods come in knowing both the good and UGLY of this profession.
 
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hailey6565

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Hey Bobbiii,

Those numbers are possible but I promise you they are not the norm and will not be attainable immediately after residency.

You probably know this better than I do after working a 6 figure job before entering, but overheard expenses, insurance coverage, equipment costs, leasing space, EMR, hiring competent workers, getting referrals etc are all things you need to factor in with private practice.

Businesses are expensive to run when you are footing the bill or taking out a business loan to do it.

This is assuming all of the DPMs in your area play fair and aren't doing things behind your back like non-compete clauses that kick you out of the city you want to be in.

Appreciate your enthusiasm and feel like it is warranted, but only if pre-pods come in knowing both the good and UGLY of this profession.
I agree! Every profession has the good and ugly :/!
 
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thatguyinschool

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I know an older pod who works in New York (a saturated area) and still makes $400k a year. That said, he's a workaholic who runs two practices with minimal staff, and has regular OR privileges and nursing home visits.
is he actively doing surgeries? or is he doing basic work like ingrowns, casts, etc
 
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Weirdy

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is he actively doing surgeries? or is he doing basic work like ingrowns, casts, etc


Highly encourage you to do well and fix your study habits first.

Podiatry school is not med school lite. Do not be fooled into thinking it is.

Wish you the best.
 
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thatguyinschool

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Highly encourage you to do well and fix your study habits first.

Podiatry school is not med school lite. Do not be fooled into thinking it is.

Wish you the best.
never said or thought it was, i am working incredibly hard this semester just genuinely interested, had a serious ankle injury so began to enjoy the profession and was considering thats all
 
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