What I would do differently

[Flip-flop-flerpity]

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I often think about the scenario if I could travel back in time, knowing what I know now, what advice I would give to myself as a Resident. What would I do differently? I recently got back into SDN after 6 or 7 years. Reading a lot of your posts, especially the negative ones (and there are surpisingly a lot) inspired me to make this post.

I went to a "top tier" program and completed a "top tier" fellowship. I was an average student, I think I graduated around the 65th percentile in my class. But I busted it on clerkships and landed the best program that I rotated through. I know there were candidates with higher GPAs that wanted the same program that I beat for the spot by showing ip, working hard and being personable. I went into it as a first year with high hopes and a lot of naivity. To be honest it felt like I was drowning most of the time. Residency was tough. I had a young family- it was very difficult on my spouse. I don't know that my alarm ever got set past 4 am except maybe during some of the off-service rotations. It was rounding starting at 5 am, clinic/cases/ ED runs/post op checks all day long. If you had nothing to do and an attending was operating, you were there- even if you werent scrubbed in. You were helping put in orders, holding the pager, or more often than not just watching the case from the sidelines (especially 1st year). We NEVER left the hospital before 5pm. It was getting woken up constantly on your every 3rd night call, weekend coverage etc. Taking time off was frowned upon. My 1st and 2nd years I took a few days around new years and a couple days around Christmas respectively, that was it. Every one of us in the program did the same- it was the culture we signed up for and had been like that for a very long time. I deleted social media because everytime I logged in I saw my pod school classmates posting pictures of their vacations or spending time with family it made me feel depressed- I know for a fact that the majority of my classmates did not have a similar experience.

Fellowship was heavily encouraged by my director and turned out to be residency on steroids- the work of 9 residents all on me for 365 days. Graduating from a "top tier" residency and "top tier" fellowship certainly did not magically help me land a "top tier" first job. It wasnt as bad some that I read about on here, but it certainly was not my dream job either. It did however make me realize how incredible the training I had was, especially when I saw the quality of work other DPMs and Foot & Ankle orthos in my area were doing when their patients came seeking second opinions for revision surgery.

So now that I'm >5 years out, what advice would I give to myself as a resident or pre-pod? Would I go back in time and choose not to do the program I chose? Not do a fellowship? Or maybe not even podiatry at all? Absolutely not. What I WOULD change is my poor attitude that I had at times. I wouldnt wish It would "just be over" (and I did many times). I would read more. I would do more research (not just the one required JFAS publication). I would do more cadaver labs. I would go to more workshops. I would pick my attending's brains more. You have 3 years (maybe 4) to learn as much as you possibly can. It goes by FAST (especially when you're looking back from the other side). You don't get a chance to do it over. Once you're on your own there WILL be things you wished you did differently. Try to minimize these feelings while you can.

The first few cases will scary, they are for everyone no matter how good or bad your training is. Your first post op complication will make you lose sleep. But we really are the experts of the lower extremlty distal to the knee. We know more about the foot and ankle than anyone else. We have better skills than many F&A orthos. Take pride in your work. If you do quality work you will be recognized fast by the local MD/DO community. Take time with your patients. Make personal calls, spend the time to pre-chart. It pays off little by little.

Most of us have to take the typical private practice job out of training. Fine. What respectable positions are there for fresh grads? Extremely few. Do good work, do the cases to get board certified and get yourself out of there. The more of us that demonstrate our worth in ortho groups, MSG, and hospitals the faster we advance our profession. Podiary has already come a VERY long way. More than anything believe in yourself and your training and don't read too much into the doom and gloom. Everyone has to put in their time.

 

[Bored Snorlax]

Thanks so much for this. Best of luck with your endeavors.

 

[Feli]

...Fellowship was heavily encouraged by my director...

^^^Yes.... This essentially sums up podiatry right here.

Deans who never had $400k in compounding student debt tell students it'll be no problem.

Podiatrists who never even went to a osteopath-integrated school say podiatry students should take USMLE now.

DPMs who are attendings and directors who never did a fellowship themselves (or many without 3 year training) tell residents now that they need a fellowship.

Podiatrists who never did large hospital call or real med rotations tell associates they need to "pay their dues" and take call for the group.

Owner podiatrists who got into this pre-Obama 2007 crash when business loans were more available - and student loans less crippling - tell trainees how it's easy to buy or start up an office.

...eventually, we all realize the plain fact that there are far too many podiatrists. Income and jobs are limited relative to MD/DO - despite same debt loads. The extra training (2year then 3year, now fellowships) is just a hail mary to have a better chance at some of the better employed podiatry jobs (often an intern year for fellowship sponsor group). Our insurance contracts and job demand and transferability are hampered. We're saturated.

We largely do the work MDs don't want (toenails, DM ulcers). That's fine, but even if you are one of the podiatrists who wants to be a mini F&A ortho, the saturation of DPMs still has effect on your compensation and your job prospects. You can pretend the other 20k podiatrists or bad residencies or the two new pod schools don't exist... but I assure you that they do. 🙂

... We know more about the foot and ankle than anyone else. We have better skills than many F&A orthos...

No, not true at all.
Some of our best podiatry training programs give great F&A skills, but orthopedic docs on avg have tons more surgery time and were much better students on all the standardized tests. They did accredited and standardized residency +/- fellowship. They've been vetted many times over.

Let's get real: we all know the average (mean) ortho F&A has mich higher case volume and better skill/outcomes than over 90% of podiatrists (I'd say over 95%). Our pod training is still alllll over the board, and our schools take virtually anyone. Many of our best podiatry programs and fellowships are such because they have ortho dept/attendings cooperation. Oh, and don't forget the ortho F&A can fix radius, femur, shoulder disloc, BKA, and 500 things DPMs cannot. 😉

Saying stuff like that just sets us back and invites the AMA, AOFAS, AOA barbs in return.

 

[Hybrocure]

I often think about how much more successful I would be if I put the effort I did from pod school and residency into a simple business undergrad/masters.

I’d run circles around most of them tbh.

 

[msion]

You are lucky and in an unique position.
I am lucky and also in an unique position.
A lot of the frequent guests here are also lucky and in unique positions. It could be we find a niche, in a more rural area, get in at the right time before the competition heats up, etc.

For example Kaiser jobs in California now pretty much all prefer (require) fellowships. Just a few years ago you could still graduate from a Kaiser program and become a Kaiser attending. Not anymore.

In summary, we do not represent the entire spectrum of podiatry. I am glad you find passion in your work and make a good living. But a lot of DPMs don't and many are bitter.

The ones who post here a lot (me included) often are in more secure positions. Those who are truly bitter become trolls.

I still think it's a field with low ROI and I won't recommend anyone to go into it now. 4 years of school plus 3 years of residency and perhaps a now mandatory 1 year fellowship should not result in "word of mouth" good jobs, or "there will be light at the end of the tunnel." No, the graduates shouldn't need to cold call places to get jobs. The graduates shouldn't need to fight other DPMs to get privileges. But unfortunately that's the sad reality no matter how skilled you are.

 

[Flip-flop-flerpity]

D to start No, not true at all.
Some of our best podiatry training programs give great F&A skills, but orthopedic docs on avg have tons more surgery time and were much better students on all the standardized tests. They did accredited and standardized residency +/- fellowship. They've been vetted many times over.

To quote Goldmember: "I can see there is no pleasing you"

All jokes aside, at anytime as a student or resident I would have agreed with you. And yes, I agree that they are inherently capable of much more.north of us so to speak. However after routinely seeing their complications come in and looking at terrible xrays I had to start wondering- what are the chances that the only f&a orthos doing sub par work are the same three that work in my area? I'm not talking trauma here- I'm talking the bunion patient with varus, the over agressive weil with the floating toe, the TTC with the calcaneal gate and heel wound, the achilles rupture with no push off strength. With regards to fellowship- I'm glad I did one. I am a better surgeon than I would have been had I not, and I do believe the reason it was encouraged is because my director saw it as the wave if the future (which it clearly was then and is now) and wanted us to be the best that we could be.

That's fine, but even if you are one of the podiatrists who wants to be a mini F&A ortho, the saturation of DPMs still has effect on your compensation and your job prospects

I certainly dont see myself as a mini ortho F&A. But the extra year gave me a clear advantage over comparable applicants to my second job out of training that didn't have it. Say what you want about length of training but the cat's out of the bag now and there's no undoing it. With all other things equal, those with more training on their resume have an advantage in securing desirable employment, and that's how you beat the saturation point.

My goal in making this post was to be a light of positivity for the downtrodden resident or the doubtful student who is reading all of these bleak threads. SDN wasn't like this a while back.

 

[Hybrocure]

For example Kaiser jobs in California now pretty much all prefer (require) fellowships. Just a few years ago you could still graduate from a Kaiser program and become a Kaiser attending. Not anymore.

Everyone talked about Kaiser a decade ago but are they even a good job anymore? Even the associate jobs mostly in CA are paying over 200k not that it gets you anywhere there

 

[msion]

Everyone talked about Kaiser a decade ago but are they even a good job anymore? Even the associate jobs mostly in CA are paying over 200k not that it gets you anywhere there

Yeah I still think they are. For northern California Kaiser jobs you are starting out close to $300k a year plus the benefits. Southern California is a bit lower but I believe it's still over $250k.

There are still lots of 150k associate jobs here in CA.

 

[Robin-jay]

It was rounding starting at 5 am, clinic/cases/ ED runs/post op checks all day long. If you had nothing to do and an attending was operating, you were there- even if you werent scrubbed in. You were helping put in orders, holding the pager, or more often than not just watching the case from the sidelines (especially 1st year). We NEVER left the hospital before 5pm.

That's pretty brutal homie.

I round at 5-6 am because I want to, not because I have to.

I think I would get pretty frustrated always having to be on that schedule.

I think its a lot less stressful to push yourself, rather than be micromanaged. When I do extra work, I take satisfaction that I chose to, not because the program or culture there forces me to.

I've always had a great knack for pushing myself. Internally, being micromanaged 24/7 would slowly kill my soul tbh.

 

[HardRoadPaved]

The best thing I did after finishing residency and my first job was canning hospital work. For those that enjoy it, kudos! But I enjoy my warm bed at 2am.

 

[shadesofgrey]

Say what you want about length of training but the cat's out of the bag now and there's no undoing it. With all other things equal, those with more training on their resume have an advantage in securing desirable employment, and that's how you beat the saturation point.

That's why I am always sure to highlight and bold my podiatric dermatopathology fellowship on my CV!!! More training for the win!

 

[Feli]

To quote Goldmember: "I can see there is no pleasing you"

All jokes aside, at anytime as a student or resident I would have agreed with you. And yes, I agree that they are inherently capable of much more.north of us so to speak. However after routinely seeing their complications come in and looking at terrible xrays I had to start wondering- what are the chances that the only f&a orthos doing sub par work are the same three that work in my area? I'm not talking trauma here- I'm talking the bunion patient with varus, the over agressive weil with the floating toe, the TTC with the calcaneal gate and heel wound, the achilles rupture with no push off strength....

As you said, you are about 5 years out.

Follow up is the enemy of good surgery. You have to realize the sheer volume most orthos - F&A or otherwise - do. There will be complications. You will have plenty too. Some of your DM recons will end up in a bucket, some of your traumas will go on to major wound issues and/or eventual fusions, some of your amps will re-ulcerate, you will have non-unions with revisions that fail too, some of your recons will have deformity recur or develop CRPS. If you aren't having complications, you aren't doing surgery. Orthos operate nearly every day... much higher surgery volume than DPMs - and therefore many more complications overall. That does not mean "... We have better skills than many F&A orthos. ..."

I think you and I and anyone with their eyes open knows that if a family member had an ankle fx or severe PTTD or whatever, and all we knew of their town was that there were a few DPMs and one F&A ortho, we'd advise them to consult the F&A ortho every day and twice on Sundays. Sure, there is the the tiny chance one of the DPMs there is an all-star, but the orthos have higher volume and training by and large. They've passed harder tests. They've done more surgery. Most DPMs (myself included) do a couple surgery cases per week while most F&A orthos do a dozen or so. They are our colleagues, and they're typically quite capable. It is lowbrow and not wise to bash them.

...overall, msion said it well. Glad you got good training, glad you're confident in your skill. Yes, podiatry can be a good field. Yes, it's enjoyable if you frame it right (that is anything in life). The podiatry ROI is not there typically (not even for many elite DPMs), and the pod job market is very rough relative to other physicians and surgeons. The ROI for DPM grads continues to slide as tuitions rise and trainings lengthen and org jobs dry up (and/or get grinded down in pay by the 'foot and ankle surgeon' applicant floods). The fact that podiatry grads try to do a VA residency in hopes of VA job afterward, Kaiser residency in hopes of connections to work in Kaiser, fellowship to maybe get hired by the fellowship sponsor group is pathetic. The cold calling for jobs that we all do is inadequate for a professional surgeon. It's also quite sad that so many young DPMs have a goal of simply paying the minimum student loan pay for 20years or more and hopefully be forgiven by Uncle Sam. You'd simply never see that for MD surgeons (choosing training mainly to hope to get a fair job after, hunting high and low for a fair job or pay); they have the supply/demand and and compensation and training quality handled MUCH better than podiatry does.

Podiatry is a ok for people who love the job, can be flexible on locations, and aren't trying to be the family breadwinner. We're saturated. There is nothing wrong with realizing that and setting expectations and plans accordingly... then trying to put a positive spin on it all.

 

[Homo sapien]

To quote Goldmember: "I can see there is no pleasing you"

All jokes aside, at anytime as a student or resident I would have agreed with you. And yes, I agree that they are inherently capable of much more.north of us so to speak. However after routinely seeing their complications come in and looking at terrible xrays I had to start wondering- what are the chances that the only f&a orthos doing sub par work are the same three that work in my area? I'm not talking trauma here- I'm talking the bunion patient with varus, the over agressive weil with the floating toe, the TTC with the calcaneal gate and heel wound, the achilles rupture with no push off strength. With regards to fellowship- I'm glad I did one. I am a better surgeon than I would have been had I not, and I do believe the reason it was encouraged is because my director saw it as the wave if the future (which it clearly was then and is now) and wanted us to be the best that we could be.



I certainly dont see myself as a mini ortho F&A. But the extra year gave me a clear advantage over comparable applicants to my second job out of training that didn't have it. Say what you want about length of training but the cat's out of the bag now and there's no undoing it. With all other things equal, those with more training on their resume have an advantage in securing desirable employment, and that's how you beat the saturation point.

My goal in making this post was to be a light of positivity for the downtrodden resident or the doubtful student who is reading all of these bleak threads. SDN wasn't like this a while back.

But it's pathetic that we'd have to do that to try to beat the saturation. Basic skill MD/DOs can still go anywhere and get a well paying job. Meanwhile ****in dpm still tacks on extra fellowships and all this. You're still a podiatrist with limited scope at the end of all that, though, so what did it really get you. You shouldn't have to do residency +fellowships and market as a superorthoplastic foot and ankle surgeon-cum-podiatrist and cold call begging for decent jobs just to make it

 

[Forcewielder]

And not to keep beating a dead horse here, but the need for networking or cold calling to get a decent job is asinine compared to an MD/DO. I hear them talk about job opportunities or locum work for insane pay that they turn down because they're comfortable. There's a narrow path for success in podiatry but the vast majority are either unhappy with their location or compensation. Rarely do both get satisfied in the city of choice without a major connection (ie family member).

 

[air bud]

I often think about the scenario if I could travel back in time, knowing what I know now, what advice I would give to myself as a Resident. What would I do differently? I recently got back into SDN after 6 or 7 years. Reading a lot of your posts, especially the negative ones (and there are surpisingly a lot) inspired me to make this post.

I went to a "top tier" program and completed a "top tier" fellowship. I was an average student, I think I graduated around the 65th percentile in my class. But I busted it on clerkships and landed the best program that I rotated through. I know there were candidates with higher GPAs that wanted the same program that I beat for the spot by showing ip, working hard and being personable. I went into it as a first year with high hopes and a lot of naivity. To be honest it felt like I was drowning most of the time. Residency was tough. I had a young family- it was very difficult on my spouse. I don't know that my alarm ever got set past 4 am except maybe during some of the off-service rotations. It was rounding starting at 5 am, clinic/cases/ ED runs/post op checks all day long. If you had nothing to do and an attending was operating, you were there- even if you werent scrubbed in. You were helping put in orders, holding the pager, or more often than not just watching the case from the sidelines (especially 1st year). We NEVER left the hospital before 5pm. It was getting woken up constantly on your every 3rd night call, weekend coverage etc. Taking time off was frowned upon. My 1st and 2nd years I took a few days around new years and a couple days around Christmas respectively, that was it. Every one of us in the program did the same- it was the culture we signed up for and had been like that for a very long time. I deleted social media because everytime I logged in I saw my pod school classmates posting pictures of their vacations or spending time with family it made me feel depressed- I know for a fact that the majority of my classmates did not have a similar experience.

Fellowship was heavily encouraged by my director and turned out to be residency on steroids- the work of 9 residents all on me for 365 days. Graduating from a "top tier" residency and "top tier" fellowship certainly did not magically help me land a "top tier" first job. It wasnt as bad some that I read about on here, but it certainly was not my dream job either. It did however make me realize how incredible the training I had was, especially when I saw the quality of work other DPMs and Foot & Ankle orthos in my area were doing when their patients came seeking second opinions for revision surgery.

So now that I'm >5 years out, what advice would I give to myself as a resident or pre-pod? Would I go back in time and choose not to do the program I chose? Not do a fellowship? Or maybe not even podiatry at all? Absolutely not. What I WOULD change is my poor attitude that I had at times. I wouldnt wish It would "just be over" (and I did many times). I would read more. I would do more research (not just the one required JFAS publication). I would do more cadaver labs. I would go to more workshops. I would pick my attending's brains more. You have 3 years (maybe 4) to learn as much as you possibly can. It goes by FAST (especially when you're looking back from the other side). You don't get a chance to do it over. Once you're on your own there WILL be things you wished you did differently. Try to minimize these feelings while you can.

The first few cases will scary, they are for everyone no matter how good or bad your training is. Your first post op complication will make you lose sleep. But we really are the experts of the lower extremlty distal to the knee. We know more about the foot and ankle than anyone else. We have better skills than many F&A orthos. Take pride in your work. If you do quality work you will be recognized fast by the local MD/DO community. Take time with your patients. Make personal calls, spend the time to pre-chart. It pays off little by little.

Most of us have to take the typical private practice job out of training. Fine. What respectable positions are there for fresh grads? Extremely few. Do good work, do the cases to get board certified and get yourself out of there. The more of us that demonstrate our worth in ortho groups, MSG, and hospitals the faster we advance our profession. Podiary has already come a VERY long way. More than anything believe in yourself and your training and don't read too much into the doom and gloom. Everyone has to put in their time.

But this doesn't make any sense. You did everything right. "Better" than 99 percent. And look where are you are. So what does more get you? I did 20% of the work that you did. I put in the hours for surgery don't get me wrong but I didn't do any of the scut work and any of the rounding. My residency was purely outpatient the least possible amount of time inside of a hospital. I did zero research. I'm board certified in forefoot and rear foot. I have now had two MSG jobs an orthopedic job and a hospital job.... Who knows maybe even another hospital job is out there waiting for me.... Made plenty of money and I think I'm pretty good at my job. The answer for me was not doing more work in residency. Not trying to be a jerk. Luck and life circumstances just has a significant impact. At some point yes your training is resulting in your success, but not the first 5 years that's all just pure luck. Any ways, I think I am right here. The answer is not more.

Also wait to you guys hear about my experiences over the last year... That is going to be depressing as hell for you guys and crush lots of people's hopes... The real ones on here already know...

Edit:

To be clear, I am not saying my experience is different than yours so therefore yours is wrong. I am saying your experience had a result and I don't think that result is different if you did more.

Tldr podiatry is stupid.

 

[deleted1162946]

Also wait to you guys hear about my experiences over the last year... That is going to be depressing as hell for you guys and crush lots of people's hopes... The real ones on here already know...

🤔

 

[BubbaWub]

Also wait to you guys hear about my experiences over the last year... That is going to be depressing as hell for you guys and crush lots of people's hopes... The real ones on here already know...

Don't leave us in suspense!

 

[heybrother]

I think your post is pretty good / good story etc, but if I was strawmanning you I would potentially say -

1. Works tail off in residency and fellowship.
2. Would go back in time and work even harder with better attitude.
3. Skips over the next 5 years of life. <-that may not be fair to you since you told us about yourself elsewhere.
4. And is now relatively satisfied.

You do potentially fit a stereotype story that is sometimes talked about on this forum - super-star podiatrist who still ultimately takes blah job and then ultimately succeeds by going rural.

There is a tendency for the tone to be "negative" on this forum, but some of the stories should simply be taken for what they are. A description of possible post-residency practice patterns and lifestyle. I personally had a terrible post residency salary. I'm now quite busy / and own and therefore my income has increased ...though I face constant negative pressure from insurance companies, CMS, and inflation. My life's pretty good, but I'm not someone the profession is ever going to put in a "look at podiatry!" video. If I was an ENT I'd be the ENT who is doing more ear wax removals than free flaps.

 

[Hybrocure]

I would’ve worked less doing menial tasks and studied more. Been more assertive in surgeries rather than retracting. Definitely got too bogged down with trying to manage floor patients, being a workhorse for the attendings at the expense of my own personal growth.

I should’ve been greedy.

 

[air bud]

I think your post is pretty good / good story etc, but if I was strawmanning you I would potentially say -

1. Works tail off in residency and fellowship.
2. Would go back in time and work even harder with better attitude.
3. Skips over the next 5 years of life. <-that may not be fair to you since you told us about yourself elsewhere.
4. And is now relatively satisfied.

You do potentially fit a stereotype story that is sometimes talked about on this forum - super-star podiatrist who still ultimately takes blah job and then ultimately succeeds by going rural.

There is a tendency for the tone to be "negative" on this forum, but some of the stories should simply be taken for what they are. A description of possible post-residency practice patterns and lifestyle. I personally had a terrible post residency salary. I'm now quite busy / and own and therefore my income has increased ...though I face constant negative pressure from insurance companies, CMS, and inflation. My life's pretty good, but I'm not someone the profession is ever going to put in a "look at podiatry!" video. If I was an ENT I'd be the ENT who is doing more ear wax removals than free flaps.

If you were a podiatrist you'd be doing more nail Care than complex deformity correction.... Oh wait

 

[deleted1134196]

So all of this being said...why does no one try to do anything to fix it/make it better for future generations? If everyone on here is a wealth of knowledge and insight and they are always right, at least try and help the future associates you will be hiring for $80k/yr out a little bit. If our training and volume is not up to par with F&A orthos, why not change it? Where does it start, and who does it end with? Blaming the professional organizations in our field doesn't cut it. Sure, standardizing schools and residency is a good start. But if this is the way, and everyone on here knows this/says this, why not try to put yourself into a position to try and implement it? As a naive 4th year student, I do not see why our skills can't be similar to F&A orthos. Yeah so they passed "harder" tests, got better grades in undergrad etc, but that does not mean jack sh-t if they have zero hand skills and/or sloppy work, even if their volume is more than ours. Let me know if I'm way off here, but it just doesn't sit right with me.

(yes everyone is greedy, I get it)

 

[deleted1162946]

So all of this being said...why does no one try to do anything to fix it/make it better for future generations? If everyone on here is a wealth of knowledge and insight and they are always right, at least try and help the future associates you will be hiring for $80k/yr out a little bit. If our training and volume is not up to par with F&A orthos, why not change it? Where does it start, and who does it end with? Blaming the professional organizations in our field doesn't cut it. Sure, standardizing schools and residency is a good start. But if this is the way, and everyone on here knows this/says this, why not try to put yourself into a position to try and implement it? As a naive 4th year student, I do not see why our skills can't be similar to F&A orthos. Yeah so they passed "harder" tests, got better grades in undergrad etc, but that does not mean jack sh-t if they have zero hand skills and/or sloppy work, even if their volume is more than ours. Let me know if I'm way off here, but it just doesn't sit right with me.

(yes everyone is greedy, I get it)

Why can’t our skills be better than f&A ortho? Have you seen their residencies compared to ours? They do like 10x the volume of most pod programs. PLUS, their faculty is usually better and more open to teaching. Unlike podiatry residency where attendings just abuse residents for free labor.

 

[wakaflocka88]

So all of this being said...why does no one try to do anything to fix it/make it better for future generations? If everyone on here is a wealth of knowledge and insight and they are always right, at least try and help the future associates you will be hiring for $80k/yr out a little bit. If our training and volume is not up to par with F&A orthos, why not change it? Where does it start, and who does it end with? Blaming the professional organizations in our field doesn't cut it. Sure, standardizing schools and residency is a good start. But if this is the way, and everyone on here knows this/says this, why not try to put yourself into a position to try and implement it? As a naive 4th year student, I do not see why our skills can't be similar to F&A orthos. Yeah so they passed "harder" tests, got better grades in undergrad etc, but that does not mean jack sh-t if they have zero hand skills and/or sloppy work, even if their volume is more than ours. Let me know if I'm way off here, but it just doesn't sit right with me.

(yes everyone is greedy, I get it)

You are more off than just off. You’re still in school.

This parity talk is a joke. Stop comparing to MD/DO, let alone ortho. Their education, training, standardization, and selection is far beyond what podiatry dreams of achieving

Go visit a few bottom of the barrel programs and you will see how bad the training is. This doesn’t exist with ortho, foot and ankle or not.

There is minimal demand for podiatry. Multiple specialties can do what we do. We are not special. Let that sink in. Not too late to quit school

Vision 20xx is a false dream that lured many students in.

Maybe you are our chosen savior to reform our profession for the better and not have to call ourselves podiatrists anymore.

 

[deleted1162946]

You are more off than just off. You’re still in school.

This parity talk is a joke. Stop comparing to MD/DO, let alone ortho. Their education, training, standardization, and selection is far beyond what podiatry dreams of achieving

There is minimal demand for podiatry. Any specialty can do what we do. We are not special. Let that sink in. Not too late to quit school.

 

[Weirdy]

As a naive 4th year student, I do not see why our skills can't be similar to F&A orthos.

Hope the program you matched to lets you rotate with other departments. You will realize what you do know - which you will be pretty good at, and how much more you don't know.

Yeah so they passed "harder" tests, got better grades in undergrad etc, but that does not mean jack sh-t if they have zero hand skills and/or sloppy work, even if their volume is more than ours. Let me know if I'm way off here, but it just doesn't sit right with me.

(yes everyone is greedy, I get it)

It does mean something.
Hand skills can be taught. OR skill gets better with repitition.
There will always be outliers, but the majority of ortho residents I rotated with were solid people.
Smart, worked hard, did the right thing. Out of 20- maybe 2 or 3 had attitude problems or hand skills issues.
Their process in getting into medical school, matching into ortho, is more rigorous than ours.
They had competitive Step scores, did related research to match, were all around monsters.
Some have zero interest in foot and ankle because they would rather be operating on a different part of the body.
By the time I finished residency, I was tired of of the slog. Then I thought of my ortho friends who have another 2 years + fellowship to go.
Not all orthos are equivalent- I get that. There's good and bad orthos just like there are DPMs.


Keep an open mind. You are on top of the world right now as a 4th year student. That's fine, enjoy it for what it is. But don't look down other medical departments- surgical or not.

If you end up at a decent residency, you should know the foot and ankle very well.
You should be better than an equivalent 3rd year ortho resident in the foot and ankle by pure exposure.
But it is not an equivalent comparison in how you guys got there and your training.

 

[air bud]

So all of this being said...why does no one try to do anything to fix it/make it better for future generations? If everyone on here is a wealth of knowledge and insight and they are always right, at least try and help the future associates you will be hiring for $80k/yr out a little bit. If our training and volume is not up to par with F&A orthos, why not change it? Where does it start, and who does it end with? Blaming the professional organizations in our field doesn't cut it. Sure, standardizing schools and residency is a good start. But if this is the way, and everyone on here knows this/says this, why not try to put yourself into a position to try and implement it? As a naive 4th year student, I do not see why our skills can't be similar to F&A orthos. Yeah so they passed "harder" tests, got better grades in undergrad etc, but that does not mean jack sh-t if they have zero hand skills and/or sloppy work, even if their volume is more than ours. Let me know if I'm way off here, but it just doesn't sit right with me.

(yes everyone is greedy, I get it)

You are way off....you realize how much surgery Ortho does? Crappy hand skills? Lol

 

[Hybrocure]

Hand skills improve with repetition and staying active with surgery IMO. Unless you have some sort of nerve issue it’s not a genetically gifted thing. It can be a mental thing too. My hands do better in easy cases where I don’t have the stress compared to cases I have less experience with (see: repetition)

I learned that when my surg volume between residency and private practice dropped off hard. I got T Rex hands these days

 

[Hybrocure]

Hope the program you matched to lets you rotate with other departments. You will realize what you do know - which you will be pretty good at, and how much more you don't know.


It does mean something.
There will always be outliers, but the majority of ortho residents I rotated with were solid people.
Smart, worked hard, did the right thing. Out of 20- maybe 2 or 3 had attitude problems or hand skills issues.
Their process in getting into medical school, matching into ortho, is more rigorous than ours.
They had competitive Step scores, did related research to match, were all around monsters.
Some have zero interest in foot and ankle because they would rather be operating on a different part of the body.
By the time I finished residency, I was tired of it. Then I thought of my ortho friends who have another 2 years + fellowship to go.


Keep an open mind. You are on top of the world right now as a 4th year student. That's fine, enjoy it for what it is. But don't underestimate other medical departments.

If you end up at a decent residency, you should know the foot and ankle very well.
You should be better than an equivalent 3rd year ortho resident in the foot and ankle by pure exposure.
But it is not an equivalent comparison in how you guys got there and your training.

Attending now and still never have been able to identify a lumbrical or interossei intraop tbh. It’s all meat unless it’s important. But I rarely get blessed with perfect anatomy.

The important anatomy things to know is where not to cut to hit a nerve or artery, how to identify which major tendons are where and that they look like, but really more importantly which you’ll learn through trial and error in residency - how to dissect properly. A reckless slip with a 15 on an TMA will have you wondering if that was the DP you hit even though it might bleed like it (it’s still not the DP btw). Our patients in podiatry as a whole lean more towards non anatomic rather than anatomic anatomy. Lots of fat. Lymphedema. Weak bone. That stuff throws you off your game quick when it takes 3 inches of dissection til you hit bone and the foot resembles more of a football than a foot.

 

[MicroPod]

A majority of podiatrists (especially areas with F&A ortho) should stick to things that ortho doesn’t want to do such as diabetic foot and wound care, ingrowns, plantar fasciitis, forefoot surgery, etc. Nine out of ten times F&A ortho is better equipped to do bigger cases (think Rearfoot and ankle). If your area doesn’t have F&A ortho then I think pods are probably better than general ortho. I asked an F&A ortho I worked with in residency why some hate podiatry and he said it’s because there are pods out there doing cases that should never had been done (wrong surgery, high risk patient, poor technique) and they eventually make their way to ortho after the damage has been done. I know this happens both ways but I’d be willing to bet it happens more with podiatry than ortho, and that’s even with knowing that ortho does many more cases than podiatrists.

We have some valuable and needed skills in the diabetic foot realm that no other docs usually have and I think most pods should stick to that. It’s probably what we are best at and most likely will gain respect from MD/DO for. It’s nothing to be ashamed of, and hey, if you are capable and no competition in your area then do whatever you want.

 

[Hybrocure]

A majority of podiatrists (especially areas with F&A ortho) should stick to things that ortho doesn’t want to do such as diabetic foot and wound care, ingrowns, plantar fasciitis, forefoot surgery, etc. Nine out of ten times F&A ortho is better equipped to do bigger cases (think Rearfoot and ankle). If your area doesn’t have F&A ortho then I think pods are probably better than general ortho. I asked an F&A ortho I worked with in residency why some hate podiatry and he said it’s because there are pods out there doing cases that should never had been done (wrong surgery, high risk patient, poor technique) and they eventually make their way to ortho after the damage has been done. I know this happens both ways but I’d be willing to bet it happens more with podiatry than ortho, and that’s even with knowing that ortho does many more cases than podiatrists.

We have some valuable and needed skills in the diabetic foot realm that no other docs usually have and I think most pods should stick to that. It’s probably what we are best at and most likely will gain respect from MD/DO for. It’s nothing to be ashamed of, and hey, if you are capable and no competition in your area then do whatever you want.

The F&A orthos aren’t necessarily wrong. This is a podiatry problem with both old and new podiatrists.

Old guys being reckless and doing surgeries to generate money/stuff that passed for adequate work 40 years ago.

And new pods pressured by boards and their bosses to take on big cases they weren’t trained well enough for but prioritize their numbers over the patients safety.

Ive seen a lot of crappy ortho work too. Almost always though, not F&A. Usually trauma or poly trauma where the current mentality is fix this now rather than check the radiographic angles. It goes both ways. But I’d wager more often than not, bad post ops land in an orthos office from a podiatrist more than a bad F&A ortho post op lands in a podiatrist office

 

[Feli]

A majority of podiatrists (especially areas with F&A ortho) should stick to things that ortho doesn’t want to do such as diabetic foot and wound care, ingrowns, plantar fasciitis, forefoot surgery, etc. Nine out of ten times F&A ortho is better equipped to do bigger cases (think Rearfoot and ankle). If your area doesn’t have F&A ortho then I think pods are probably better than general ortho. I asked an F&A ortho I worked with in residency why some hate podiatry and he said it’s because there are pods out there doing cases that should never had been done (wrong surgery, high risk patient, poor technique) and they eventually make their way to ortho after the damage has been done. I know this happens both ways but I’d be willing to bet it happens more with podiatry than ortho, and that’s even with knowing that ortho does many more cases than podiatrists.

We have some valuable and needed skills in the diabetic foot realm that no other docs usually have and I think most pods should stick to that. It’s probably what we are best at and most likely will gain respect from MD/DO for. It’s nothing to be ashamed of, and hey, if you are capable and no competition in your area then do whatever you want.

I agree, but sometimes ortho doesn't want to deal with stuff either. Prep for that if you're in a rural area with few/no orthos... or ones that are just plain busy. 🙂

I got this one return-to-sender today... 40ish pt with hx rock climbing polytrauma fall about 10yrs prior. Pt functions pretty well with leg and ankle and foot pain (mostly nerve pains imo). So, I saw once and sent pt to trauma Ortho orig surgery team (they also have F&A ortho at the same Univ) for adv imaging and poss opinion on tx or revision of tibia. Well, they simply sent it back to me and told pt that the talus OCD is probably the cause of pain (fml ... tibia injury/non-union is clearly the major cause of the pain, OCD is basically an incidental finding in this case, and nail screws are in the way of medial mall osteotomy anyways).

I am going to try a diag ankle block (I predict "it helped but the leg still hurt"?!?) and brace and send to F&A Ortho next time. 😗

 

[air bud]

You are more off than just off. You’re still in school.

This parity talk is a joke. Stop comparing to MD/DO, let alone ortho. Their education, training, standardization, and selection is far beyond what podiatry dreams of achieving

Go visit a few bottom of the barrel programs and you will see how bad the training is. This doesn’t exist with ortho, foot and ankle or not.

There is minimal demand for podiatry. Multiple specialties can do what we do. We are not special. Let that sink in. Not too late to quit school

Vision 20xx is a false dream that lured many students in.

Maybe you are our chosen savior to reform our profession for the better and not have to call ourselves podiatrists anymore.

 

[deleted1134196]

This parity talk is a joke. Stop comparing to MD/DO, let alone ortho. Their education, training, standardization, and selection is far beyond what podiatry dreams of achieving

Go visit a few bottom of the barrel programs and you will see how bad the training is. This doesn’t exist with ortho, foot and ankle or not.

So every ortho residency under the sun is cream of the crop and can do no wrong and is incredible amazing sunflowers unicorns hugs and kisses? If you read my post, you will see that I mentioned a standardized podiatry residency system and/or schooling. People say these things with no supporting evidence as to why ours can not be standardized in the same manner (podiatry related, obviously). If you gave me a supporting reason as to why it can not be this way, then I am more willing to accept/see your point. Weak professional leadership? Money? SDN toxicity not allowing it? Obviously there are poor programs that are weak in podiatry, but why not try to reform them through a standardization process/axe them if apparently we already have too many schools and residencies as is?

You are way off....you realize how much surgery Ortho does? Crappy hand skills? Lol

So is it statistically impossible for orthos to have bad hand skills? 100%? Is that what you are implying? So you are telling me that every ortho you have ever met has godly hand skills and can do no wrong? You did not explicitly state it but it seems as though you are implying that.

So all of this being said...why does no one try to do anything to fix it/make it better for future generations? If everyone on here is a wealth of knowledge and insight and they are always right, at least try and help the future associates you will be hiring for $80k/yr out a little bit. If our training and volume is not up to par with F&A orthos, why not change it? Where does it start, and who does it end with? Blaming the professional organizations in our field doesn't cut it. Sure, standardizing schools and residency is a good start. But if this is the way, and everyone on here knows this/says this, why not try to put yourself into a position to try and implement it?

And yet, no one was able to answer my original question. Why not try to do something to fix it? It just looped back to apparently how sh-tty our field is.

Not too late to quit school

Not too late for you to career switch either if it's this doom and gloom lol

Maybe you are our chosen savior to reform our profession for the better and not have to call ourselves podiatrists anymore.

Not sure whats wrong with being called podiatrists? Someone has to be since no one on here or in our professional leadership is willing to have the gall to do it lol

Hope the program you matched to lets you rotate with other departments. You will realize what you do know - which you will be pretty good at, and how much more you don't know.


It does mean something.
Hand skills can be taught. OR skill gets better with repitition.
There will always be outliers, but the majority of ortho residents I rotated with were solid people.
Smart, worked hard, did the right thing. Out of 20- maybe 2 or 3 had attitude problems or hand skills issues.
Their process in getting into medical school, matching into ortho, is more rigorous than ours.
They had competitive Step scores, did related research to match, were all around monsters.
Some have zero interest in foot and ankle because they would rather be operating on a different part of the body.
By the time I finished residency, I was tired of of the slog. Then I thought of my ortho friends who have another 2 years + fellowship to go.
Not all orthos are equivalent- I get that. There's good and bad orthos just like there are DPMs.


Keep an open mind. You are on top of the world right now as a 4th year student. That's fine, enjoy it for what it is. But don't look down other medical departments- surgical or not.

If you end up at a decent residency, you should know the foot and ankle very well.
You should be better than an equivalent 3rd year ortho resident in the foot and ankle by pure exposure.
But it is not an equivalent comparison in how you guys got there and your training.

Thank you for being the only one to actually give an informative response.



Listen, I get it ortho is hard to match into, have to get into MD/DO yeah sure got it. But what is it saying if we are supposed to be the foot and ankle "experts" and this is how those in our field are acting and are the things they are saying? Is everyone just genuinely happy accepting that this is podiatry, the field that supposedly has evolved and became something totally different in the last 20-30 years, will ever be? Is it better that way? Genuine question.

I'm sure that ultimately I'll lose this discussion because there is no pleasing you people on here lol, but c'mon man. I really don't think this is a crazy assertion if schools and residency were to be standardized that things could be much much different.

 

[air bud]

So every ortho residency under the sun is cream of the crop and can do no wrong and is incredible amazing sunflowers unicorns hugs and kisses? If you read my post, you will see that I mentioned a standardized podiatry residency system and/or schooling. People say these things with no supporting evidence as to why ours can not be standardized in the same manner (podiatry related, obviously). If you gave me a supporting reason as to why it can not be this way, then I am more willing to accept/see your point. Weak professional leadership? Money? SDN toxicity not allowing it? Obviously there are poor programs that are weak in podiatry, but why not try to reform them through a standardization process/axe them if apparently we already have too many schools and residencies as is?


So is it statistically impossible for orthos to have bad hand skills? 100%? Is that what you are implying? So you are telling me that every ortho you have ever met has godly hand skills and can do no wrong? You did not explicitly state it but it seems as though you are implying that.


And yet, no one was able to answer my original question. Why not try to do something to fix it? It just looped back to apparently how sh-tty our field is.


Not too late for you to career switch either if it's this doom and gloom lol


Not sure whats wrong with being called podiatrists? Someone has to be since no one on here or in our professional leadership is willing to have the gall to do it lol


Thank you for being the only one to actually give an informative response.



Listen, I get it ortho is hard to match into, have to get into MD/DO yeah sure got it. But what is it saying if we are supposed to be the foot and ankle "experts" and this is how those in our field are acting and are the things they are saying? Is everyone just genuinely happy accepting that this is podiatry, the field that supposedly has evolved and became something totally different in the last 20-30 years, will ever be? Is it better that way? Genuine question.

I'm sure that ultimately I'll lose this discussion because there is no pleasing you people on here lol, but c'mon man. I really don't think this is a crazy assertion if schools and residency were to be standardized that things could be much much different.

It's ok. You are a student. You know what you know. And that is what the schools have told you. That is not the real world. You will get there. See you in a few years. You don't know what you don't know and that's ok.

Also, just like our federal government, the apma and other organizations are run by boomers and so we don't really stand a chance. We can't make any progress.

 

[Weirdy]

I'm sure that ultimately I'll lose this discussion because there is no pleasing you people on here lol, but c'mon man. I really don't think this is a crazy assertion if schools and residency were to be standardized that things could be much much different.

Hey PodDude, it has nothing to do about pleasing people on here.

You don't think we all at one point in our careers thought the same thing you did?
That we weren't angry about parity and lack of standardization across schools and residency programs?
That our tags said "podiatry resident" instead of "doctor"?
That we were bunched with "allied health" instead of "physicians?"
That other departments in the hospital didn't even know we could do surgery?
All the back handed comments from rotating medical students or other departments during residency?
How once we move states, those states we move into don't even allow us to do certain surgeries we were trained to do because of politics or someone in our field and outside of it ruining it for everyone else?

Come on man. I felt the same way you did as a prepod.
Lived the high during podiatry school, was even doing advocate stuff to increase enrollment numbers BEFORE there was an enrollment crisis. Spent my own gas money to drive hours to different places to give presentations and put on workshops with my class mates about podiatry.
Got into residency and its different.
Got into the real world and its different.

I'm happy where I'm at, but I absolutely hate ideologies that come on here saying its all bad or all good.

Your thoughts arent wrong.
You're at least questioning it instead of blindly believing everything you see and hear on here- both the pessimistic and overly positive.
But you need to give both sides some credit on this forum.

And regarding your comment about progress not being made because of "SDN toxicity"- this forum carries little to no weight regarding decisions in the real world.
The forum is anonymous (to an extent) for a reason- so people can come on here and share opinions- both positive and negative- without fear of repercussions in the real world.
Can you imagine putting your job and training at risk in the real world because you dared to question something someone else was glossing over?
Or because you shared a contradictory opinion to people in very high places that could make your life a living hell in the area you are at?

You overestimate the power of this website to exact change for a multitude of problems that would take years and hundreds of minds coming together to implement.

For example- all the people on here heard the doom and gloom, lived through the residency shortage back in 2015, all the problems even prior to that- which you did not have to face- and are still in the profession and doing well for themselves.

But to manipulate stories of only success or failure to represent the entire profession would be dishonest.

 

[podourology]

So every ortho residency under the sun is cream of the crop and can do no wrong and is incredible amazing sunflowers unicorns hugs and kisses? If you read my post, you will see that I mentioned a standardized podiatry residency system and/or schooling. People say these things with no supporting evidence as to why ours can not be standardized in the same manner (podiatry related, obviously). If you gave me a supporting reason as to why it can not be this way, then I am more willing to accept/see your point. Weak professional leadership? Money? SDN toxicity not allowing it? Obviously there are poor programs that are weak in podiatry, but why not try to reform them through a standardization process/axe them if apparently we already have too many schools and residencies as is?


So is it statistically impossible for orthos to have bad hand skills? 100%? Is that what you are implying? So you are telling me that every ortho you have ever met has godly hand skills and can do no wrong? You did not explicitly state it but it seems as though you are implying that.


And yet, no one was able to answer my original question. Why not try to do something to fix it? It just looped back to apparently how sh-tty our field is.


Not too late for you to career switch either if it's this doom and gloom lol


Not sure whats wrong with being called podiatrists? Someone has to be since no one on here or in our professional leadership is willing to have the gall to do it lol


Thank you for being the only one to actually give an informative response.



Listen, I get it ortho is hard to match into, have to get into MD/DO yeah sure got it. But what is it saying if we are supposed to be the foot and ankle "experts" and this is how those in our field are acting and are the things they are saying? Is everyone just genuinely happy accepting that this is podiatry, the field that supposedly has evolved and became something totally different in the last 20-30 years, will ever be? Is it better that way? Genuine question.

I'm sure that ultimately I'll lose this discussion because there is no pleasing you people on here lol, but c'mon man. I really don't think this is a crazy assertion if schools and residency were to be standardized that things could be much much different.

Type of resident who cuts the tendon or neurovascular bundle on every case and blames abnormal anatomy. Anyone who uses the word gall, takes themselves too seriously. Lighten up, relax the death grip, everything feels better when your hands aren't in a fist fighting with anons on SDN.

I like podiatry. Good paying job, will make more then my dad did even after taxes and 30k student loan payments yearly year 1 out of residency. Opportunity to do surgery/non surgical, no pressure. I passed every exam ABFAS Qualified in feet and diabetic ankles ortho doesn't want. I a don't agree with everything they say on here, but there is some truth to their logic and beliefs. If I could go back, I might pick DO and try to do Emergency Med, not because podiatry is bad, just fell in love with it. I still get the same excitement doing consults, but that's charity work to get me into heaven. If anything, SDN is good for podiatry, because it shows where we can improve.

 

[heybrother]

So all of this being said...why does no one try to do anything to fix it/make it better for future generations? If everyone on here is a wealth of knowledge and insight and they are always right, at least try and help the future associates you will be hiring for $80k/yr out a little bit. If our training and volume is not up to par with F&A orthos, why not change it? Where does it start, and who does it end with? Blaming the professional organizations in our field doesn't cut it. Sure, standardizing schools and residency is a good start. But if this is the way, and everyone on here knows this/says this, why not try to put yourself into a position to try and implement it? As a naive 4th year student, I do not see why our skills can't be similar to F&A orthos. Yeah so they passed "harder" tests, got better grades in undergrad etc, but that does not mean jack sh-t if they have zero hand skills and/or sloppy work, even if their volume is more than ours. Let me know if I'm way off here, but it just doesn't sit right with me.

(yes everyone is greedy, I get it)

This thread has somewhat devolved into an ortho love fest.

Here's the heart of it. Within reason, everything that happens in the profession is a response to the misbehavior of the schools. The behavior of the boards and organizations and what not is problematic, but its simply a juggling exercise to keep everything else in place without the system collapsing.

Consider - imagine if every podiatry resident was required tomorrow to perform 50 ankle fracture ORIFs as a 1st assist or they couldn't graduate. Chaos. Most residents couldn't graduate. Residencies do need to be tightened up, in many cases shutdown or at least reduced in resident volume, but there's always a river of students coming up the pipe who have to have a residency to practice. There are probably programs out there keeping their residents in a nail jail when could be scrubbing with outside attendings to generate their numbers, though that's not actually an ideal mechanism for training either. More on that. The standards as they are set are assuredly designed to simply increase residency availability to try and prevent/resolve unmatched students. Consider that many residencies exist at non-ideal residency locations as a bandaid to the massive failure of the profession in 2014 ie. the Western residency disaster. MD residencies do rotations at VA hospitals. They aren't based out of VA hospitals. There are residencies where the VA component increases the quality of the residency, but there is a reason that DVA programs fill the scramble list every single y ear.

The orthopedic residency in my town apparently achieves almost all of its case volume in house with core faculty. They have one orthopedic specialist who is co-employed by the across town hospital that opens up the ORs there, but that attending is a graduate of the same medical school and residency program. I'm not trying to knock podiatry programs that rely on outside doctors for cases, but my suspicion is most programs would benefit from more core faculty which is a problem because they aren't that many hospital employed podiatrists.

Consider that every time a new school opens (which cannot be regulated or stopped) there is no requirement for them to ensure residencies for their graduates. If the average residency size is 2 residents per class year, then a school of 50 students opening basically requires 25 hospitals to start residencies. If a residency needs 10 faculty (I'm just picking a number, but consider that a 2 resident class means 6 residents) then 250 podiatrists have to be available to participate in their educational process. You'll also need hospital medicine rotations, infectious disease, vascular surgeons etc. The act of starting a school produces a cascade of need down the road from these students where individual podiatrists have to navigate the bureaucracy. The schools get $50K a year to put you in a lecture hall. Your residency directory theoretically has to pass the blade and show up after hours. One of those things is a lot more intimate and involved than the other day. Down the road ask yourself - who shaped you, your school faculty or your residency faculty.

You could say - well then step up, but in my town if you took all the cases of all the podiatrists together - you could not graduate a single resident in 3 years even if you took 1 resident in year 1 and none in year 2-3. You would have to have orthopedics provide cases, and orthopedics is hostile to podiatry in my town. My town in fact already had a podiatry residency, and it died forever ago because it couldn't meet the rearfoot requirements. All of the hospitals that could fulfill an educational need already have medical students and residents at them.

Perhaps this is an anecdote, but my suspicion is that the new fellowship craze is negatively affecting residencies. Some of these locations that are starting fellowships would be doing the profession a greater service if theys started a residency, but fellows are much more useful than residents. Some of these locations are assuredly giving fellows cases that residents used to perform.

The schools have been entirely unwilling through time to regulate themselves. The low entrance standards and high attrition are a continuous black eye to the profession. The schools would say - we couldn't fill our classes unless we let in 10%th percentile MCAT, unqualified students. My opinion - the schools can't fill their seats with better students because strong students know something is broken anywhere a 10th percentile student is going to be a doctor. Feli has pointed this out repeatedly but the number of graduating podiatrists against the number of graduating orthopedists is unreal considering we have one body part to work on.

Last of all, while I agree private practice doctors are quite predatory - nothing is worth anything anymore. The other day a doctor on IPEDs solution for low reimbursing cases was a $50 CAM postop, selling the patient "shower bags", and x-rays every week (medically unnecessary).

-The schools need to be given 4 years to raise the minimum MCAT to 25.
-Decreasing student volume will create opportunities to improve residency standards and shut down sub-par programs.
-Most of the schools would benefit from a massive increase in surgical hands on teaching on cadavers. Podiatry routinely claims its superiority to orthopedics by stating that "we focus our entire training on the foot and ankle" but a massive amount of that training is the debridement of toenails and callus trimming. On -one- occasion when I was in podiatry school we did a cadaver lab where we performed basic forefoot surgeries. There are so many things a student could do to a pigs foot or cadaver feet that would improve hands skill and dexterity and that would improve your attendings confidence in you down the road.
-High reimbursing procedural specialities (think dermatology) are able to achieve their income by doing a higher volume of higher reimbursing procedures and dropping insurance that won't pay up. United paid a NP dermatologist that my wife saw more for a 99202 than they were paying my practice for a 99203. They know they can devalue our services because there are too many of us.
-Specialities that produce too many doctors always experience a pay cut. Only podiatry doesn't understand this.

 

[wakaflocka88]

So every ortho residency under the sun is cream of the crop and can do no wrong and is incredible amazing sunflowers unicorns hugs and kisses? If you read my post, you will see that I mentioned a standardized podiatry residency system and/or schooling. People say these things with no supporting evidence as to why ours can not be standardized in the same manner (podiatry related, obviously). If you gave me a supporting reason as to why it can not be this way, then I am more willing to accept/see your point. Weak professional leadership? Money? SDN toxicity not allowing it? Obviously there are poor programs that are weak in podiatry, but why not try to reform them through a standardization process/axe them if apparently we already have too many schools and residencies as is?


So is it statistically impossible for orthos to have bad hand skills? 100%? Is that what you are implying? So you are telling me that every ortho you have ever met has godly hand skills and can do no wrong? You did not explicitly state it but it seems as though you are implying that.


And yet, no one was able to answer my original question. Why not try to do something to fix it? It just looped back to apparently how sh-tty our field is.


Not too late for you to career switch either if it's this doom and gloom lol


Not sure whats wrong with being called podiatrists? Someone has to be since no one on here or in our professional leadership is willing to have the gall to do it lol


Thank you for being the only one to actually give an informative response.



Listen, I get it ortho is hard to match into, have to get into MD/DO yeah sure got it. But what is it saying if we are supposed to be the foot and ankle "experts" and this is how those in our field are acting and are the things they are saying? Is everyone just genuinely happy accepting that this is podiatry, the field that supposedly has evolved and became something totally different in the last 20-30 years, will ever be? Is it better that way? Genuine question.

I'm sure that ultimately I'll lose this discussion because there is no pleasing you people on here lol, but c'mon man. I really don't think this is a crazy assertion if schools and residency were to be standardized that things could be much much different.

Finish school, get the highest quality training you can hope to achieve, start the job hunt process in 2026-2027 then come back and let us know how it’s going.

The real world is going to bllllooooowwwwww your mind.

Also, I highly recommend not being aggressive towards anyone here because come job hunt time or networking, you want as many allies as possible. Good luck bro

 

[deleted1134196]

I'm genuinely not trying to be a jack ass, even if it may seem that way, but it just gets exhausting coming on here and seeing a lot of negativity towards the field. Maybe I'm just looking in the wrong places, but I do think SDN can be a good resource for podiatry, and at times, a bad resource because of negativity. I get it if the "negative" stuff I am reading is the reality of the matter, but it seems as though maybe the "negative" things I read have solutions to them, even if challenging.

I do really enjoy the day-to-day of this field, and am thankful to be where I'm at with it and with the change I feel as though I can extract from it one day for patient care, so forgive me for being uber passionate. It's not a matter of taking myself too seriously, it is more of the fact that as a student, reading about all of these issues, I question why nothing is being done about it in a field that I really really enjoy, especially when from what I have read, seen, and experienced (yes, haven't experienced much yet), is possible.

Maybe I'm biased or bushy tailed and wide eyed, but I just feel as though podiatry deserves more credit than it gets (with the exception of the bad seed schools and residencies that fuel into it not getting the credit it deserves).

 

[msion]

I do really enjoy the day-to-day of this field, and am thankful to be where I'm at with it and with the change I feel as though I can extract from it one day for patient care, so forgive me for being uber passionate. It's not a matter of taking myself too seriously, it is more of the fact that as a student, reading about all of these issues, I question why nothing is being done about it in a field that I really really enjoy, especially when from what I have read, seen, and experienced (yes, haven't experienced much yet), is possible.

No you have not experienced the real day-to-day for this field. The peak of your professional career will be residency years (assume if you match into a decent one). You will see lots of trauma and those can get your adrenaline going.

Then third year of residency will come. There is the dilemma of "Fellowship or no fellowship? That's the question." If you do a fellowship you will able to defer the suffering of real life for about another year.

You will start to apply for jobs or ask your attendings for jobs. The hospital based or multispecialty group jobs are so competitive that you may not even hear back from any of them. And finally you find out they hired another seasoned DPM who just had more years of practice than a fresh graduate. VAs are also more attractive now but they will drag their feet with the hiring process. Eventually you may settle into a private practice job or a community health clinic. After months of clipping nails finally you got a walk-in delayed Achilles rupture/Lisfranc/bimal malunion, and you will want to operate. But that patient just happened to have 9 allergies, with fibromyalgia and on psych meds. You push through the process and the day of surgery comes, the OR RN then asks you "Doc, this patient is allergic to tape, iodine and chlorohexadine, how would you like us to prep?"

Maybe then... you can let us know your thoughts.

Now, I still think it's a good field for the right people. You just have to stop thinking foot and ankle, and think more podiatry. I am happy doing my clinic injections, making braces and do wound care. I do elective forefoot surgeries once a week. The hospitals call me for some complex limb salvage stuff from time to time and I am fine with that.

 

[deleted1134196]

Maybe then... you can let us know your thoughts.

These are the thoughts of many of us coming up who will be the associates and residents you have to train (assuming you are affiliated with such).

 

[heybrother]

I'm genuinely not trying to be a jack ass, even if it may seem that way, but it just gets exhausting coming on here and seeing a lot of negativity towards the field. Maybe I'm just looking in the wrong places, but I do think SDN can be a good resource for podiatry, and at times, a bad resource because of negativity. I get it if the "negative" stuff I am reading is the reality of the matter, but it seems as though maybe the "negative" things I read have solutions to them, even if challenging.

I do really enjoy the day-to-day of this field, and am thankful to be where I'm at with it and with the change I feel as though I can extract from it one day for patient care, so forgive me for being uber passionate. It's not a matter of taking myself too seriously, it is more of the fact that as a student, reading about all of these issues, I question why nothing is being done about it in a field that I really really enjoy, especially when from what I have read, seen, and experienced (yes, haven't experienced much yet), is possible.

Maybe I'm biased or bushy tailed and wide eyed, but I just feel as though podiatry deserves more credit than it gets (with the exception of the bad seed schools and residencies that fuel into it not getting the credit it deserves).

Some of the negative things the field is experiencing are happening to lots of people. Houses are expensive everywhere. Inflation is everywhere. Podiatry though has problems that are other medical fields are shielded from. Other specialties are often paid out of facility fee money. So for example - it might surprise you to learn that anesthesiologists are very poorly paid by Medicare. There's actually a fairly enormous differential between commercial and CMS in most places. Surgery centers and hospitals though want the operating rooms to hum because the facility fee money is so good, so paying anesthesiologists whatever they ask is the price to keep the money-tree growing. In demand medical specialties can readily find hospital work - essentially shielding them from the poor reimbursement of the UHCs and Humanas or they can decline these insurances unless they pay up. Meanwhile, many commercial insurances devalue our work paying us less than Medicare rates for both MA/commercial plans. The end result is that our reimbursement and total collections are often stagnant or decreasing in a world of increasing cost and tuition. Some of this worsening has actually accelerated recently ie. UHC was bad 5 years ago, but it wasn't necessarily Satan. Old fat satisfied podiatrists already got paid. They bought their house when it was cheap. They aren't $300-500K in debt like new grads will be. They have no idea what you are going through and they are the people who would theoretically fight for change. To make matters worse though, some of them are well served by your suffering. There are literally people running this profession in bed with private equity waiting to exploit you when you graduate.

You are a small boat in a stormy ocean of macroeconomic waves. The value of your future work is being devalued. Your future is to bail water with a smaller and smaller bucket. You aren't feeling the weight of this yet, but its waiting for you on the horizon.

Stop feeling exhausted by the forum. Get exhausted bettering yourself. Learn everything you can to be the best podiatrist you can be and when the time comes - hunt for a hospital, VA, ortho job like your future depends on it - because it does. Past podiatrists had struggles but they aren't going to have the struggles that you will have and they aren't going to understand you.

 

[Flip-flop-flerpity]

Down the road ask yourself - who shaped you, your school faculty or your residency faculty

This 100%. Who trains you matters, and most of us become some variant of that person for better or worse.

 

[bloxxeeey]

What the incoming students/residents don't realize is that our education is absolutely terrible compared to other medical specialties. I was fortunate to go to a good residency program but I rotated at a lot and have friends who went to/graduated from a ton of different programs. The quality of our training isn't there. I would say 50% of programs are straight up terrible, 40% percent are proficient and 10% are good. This has been mentioned countless time but the quality of your residency program isn't likely going to impact your job opportunities. It will however impact how you practice which is extremely important. The surgery selection I see at some residency programs, or my colleagues do is mind blowing. The patient work-ups are absolutely abysmal. Anyways, back to training.

A ton of residency programs exist to have residents make their attendings money. This explains why there are so many "nail jail" podiatry residency clinics, even better for your director if the nail jail is his private office.

I've rotated at plenty of programs where the residents job is to prepare the OR, get the paper work signed and put dressings on. The resident's would be so excited when their attending let them close, these are the programs that would debate whether to throw a simple interrupted versus horizontal mattress because to them that was what made the big difference.

Yeah we're the experts on "Foot and Ankle" but we do a terrible job of training and making experts.

 

[bloxxeeey]

I don't even want to get started with fellowships. I know residents who received better training in their residency than they did their fellowships. I know some residents who took a pay cut to go to fellowship, yes their fellowship salary was less than their resident salary. I see people tout that their "fellowship" lets them see their own patients and board their own cases. Nice fancy way of saying attending without the attending salary.

 

[Hungry_Anxiety8703]

This 100%. Who trains you matters, and most of us become some variant of that person for better or worse.

Honestly this is so true. I'm so grateful my 2nd year was amazing. My personality as a doctor was dramatically shaped by them and I truly feel the way I practice now as an attending has a lot to do with what I observed from them when I was a 1st year. It scares me to think how if I had a dick head as a mentor how I would have turned out

 

[Robin-jay]

No you have not experienced the real day-to-day for this field. The peak of your professional career will be residency years (assume if you match into a decent one). You will see lots of trauma and those can get your adrenaline going.

Then third year of residency will come. There is the dilemma of "Fellowship or no fellowship? That's the question." If you do a fellowship you will able to defer the suffering of real life for about another year.

You will start to apply for jobs or ask your attendings for jobs. The hospital based or multispecialty group jobs are so competitive that you may not even hear back from any of them. And finally you find out they hired another seasoned DPM who just had more years of practice than a fresh graduate. VAs are also more attractive now but they will drag their feet with the hiring process. Eventually you may settle into a private practice job or a community health clinic. After months of clipping nails finally you got a walk-in delayed Achilles rupture/Lisfranc/bimal malunion, and you will want to operate. But that patient just happened to have 9 allergies, with fibromyalgia and on psych meds. You push through the process and the day of surgery comes, the OR RN then asks you "Doc, this patient is allergic to tape, iodine and chlorohexadine, how would you like us to prep?"

Maybe then... you can let us know your thoughts.

Now, I still think it's a good field for the right people. You just have to stop thinking foot and ankle, and think more podiatry. I am happy doing my clinic injections, making braces and do wound care. I do elective forefoot surgeries once a week. The hospitals call me for some complex limb salvage stuff from time to time and I am fine with that.

This is the type of way I want to live and practice tbh. As long as its 200k+.

 

[Robin-jay]

I don't even want to get started with fellowships. I know residents who received better training in their residency than they did their fellowships. I know some residents who took a pay cut to go to fellowship, yes their fellowship salary was less than their resident salary. I see people tout that their "fellowship" lets them see their own patients and board their own cases. Nice fancy way of saying attending without the attending salary.

I have to imagine fellowships end pretty quickly though. Only 12 months, that would go by so quickly. Plus it's less detrimental you successfully complete a fellowship vs a residency.

 

[Dermato Fight Club]

Just want to put some of my thoughts in here. @PodDude12345 brought up some good points. I"ll be brief.

-Schools accept anyone because they make more money. To my knowledge there is no way to change this. If someone thinks they can profit, then they will open a new school. In other words, there is nothing anyone can do.

-Most residents will never receive the training expected in a 3 year foot and ankle surgery program because there just aren't enough cases to go around. Residency spots need to be significantly decreased (in order to maximize quality) which would also mean that school seats need to be decreased.

-The big issue is that we have all these 3 year trained foot and ankle surgeons coming out and yet their real benefit to society i.e how they make money is going to be cutting toenails, treating warts, wound debridement, and for the most part just telling people no, your foot pain is normal, buy a better shoe/insert

-In the 12 years I've been out 6 pods have retired/left and 15 have come to the area

-After 4-6 months of not doing a flatfoot recon/Achilles tendon rupture etc. You ask yourself if you should be doing them?
-I had a good/great residency. When I graduated, I just did not have the patient population in private practice demanding those procedures. My patient population essentially wanted injections for their end stage PTTD etc.

- I'm not sure how you change this. @Feli has had some novel concepts with 1 year residencies for non surgical etc. That is likely the best idea and what I would do if I were made podiatry king tomorrow.

- The truth is and what I really wanted to get to you is that you will likely do fine. Get the best residency you can. Work hard. Make friends with IM/GP/ vascular docs.

- I have done absolutely amazing in the profession. I was incredibly lucky to have a practice handed to me, a community that knows me, a surgery center to buy into, and a wife that makes about as much as I do. I think people can still do well in this profession but we are certainly getting to the point of being over saturated. Even though I have done so well in this profession, and believe you will likely be just fine, I would not recommend this profession to any of my three children


-

 

[Hybrocure]

Just want to put some of my thoughts in here. @PodDude12345 brought up some good points. I"ll be brief.

-Schools accept anyone because they make more money. To my knowledge there is no way to change this. If someone thinks they can profit, then they will open a new school. In other words, there is nothing anyone can do.

-Most residents will never receive the training expected in a 3 year foot and ankle surgery program because there just aren't enough cases to go around.

-In the 12 years I've been out 6 pods have retired/left and 15 have come to the area

-After 4-6 months of not doing a flatfoot recon/Achilles tendon rupture etc. You ask yourself if you should be doing them?
-I had a good/great residency. When I graduated, I just did not have the patient population in private practice demanding those procedures.



-

I’m still not sold on flatfoot recons as commonly as in residency, having been working in private practice. I see too many patients from other docs still in pain from recons years ago.

Orthotics and weight loss with good shoes could’ve been the fix for half of them honestly. There’s really bad flatfeet that could benefit from it sure but I think there are a lot of docs out there being more aggressive than they should be when it comes to flat feet.


There’s also way too many podiatrists cutting on flatfoot patients who don’t have pain.