What is the deal with podiatry?

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SoleScholar

SoleScholar

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I shadowed in podiatry and I loved it, I can see myself practicing podiatry for the rest of my life. I would love to own a solo PP. The podiatrists I shadowed are happy, have families, and they make good money. But then I go on here and it everyone acts like it is the worst career choice possible.
I'm going to apply to podiatry school now, with the intent to go into private practice when I graduate. This is obviously a field for private practice and I can't understand why people would even go into it without that intent. That being said, is the situation so bad and the profession so saturated that if I open a clinic when I get out I won't get enough patients to live and have a family?
Also, these jobs that say 100k a year plus 30% collections- do people really get the bonus?
I want to do podiatry. I think I would be happier practicing podiatry than internal medicine, family medicine, or general surgery. But not if I'm going to be poor like some of you make it sound like.
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I'll bite.

The issue is high student loans to rather poor average salary. Combining average undergraduate loans, cost of schooling/living expenses, and the associated interest, its not unusual for students to graduate with student loans approaching 400k. With that amount of debt, starting a new private practice from scratch is not for the faint of heart, as it will likely require at least an additional 100k+ in loans to get going/survive the first year. Do you want to live in a house now that your a doctor? Add another 300-500k (depending on the area). Starting a practice becomes daunting coming out of residency with the above factors, so most look for an employed position.

The most desirable positions (generally) are hospital employed. This is for several reasons: a) Salaries tend to be higher, normally starting 200k+ with good insurance/benefits. b) Most hospitals are nonprofits which allows use of the PSLF program. If a new pod starts payments in residency, 3 years of minimal payments + 7 years of payments as an attending and that massive student loan amount is gone after 10 years. However, positions are limited while there are more podiatry schools than ever before, but how many podiatrists does a hospital really need? Not that many, which has created intense demand and competition for a finite number of positions. This is fueling the creation of fellowships, which require an additional year of training, so that new pods have a leg up when applying for a hospital position.

The most common employed position, is as an associate, working for another podiatrist. Unfortunately, many pods have a reputation for poorly compensating their associates and provide poor benefits and limited vacation. Salary wise, I would say most associate podiatrists are below or barely above 200k in income. I think these low offers are a result of 1) the saturation in our profession (why pay 200k if someone will do the job for 130k). 2) a general lack of awareness of loan burden by employing podiatrists. Hopefully, if it's a good private practice opportunity there will be an offer to buy in, but unfortunately these buy-ins are often priced with an elevated practice estimate, resulting in a steep buy in. The end result is associates that often times are constantly job hopping, trying to find a financially viable opportunity.

An additional problem is that the training in this profession is variable. The schools have some issues but the true problem is at the residency level. One program may do surgery 8 hours a day, 4-5 days a week, while the next program double scrubs simple surgeries. Residency selection often times aligns with academic success but not always, especially when there are more graduates than residencies, creating a shortage. This means it's not uncommon for good students to end up getting poor surgical training which furthers new practitioner frustration. Variable training worsens the permeating inferiority complex that is instilled in this profession. The inferiority complex causes some well trained providers to become very arrogant, while others are constantly trying to validate their belonging to the medical community. This need for validation, comically, causes people to title themselves "Fellowship trained Foot and Ankle Surgeon" rather than podiatrist or to add an ever increasing number of letters after their name.

I am not going to touch on the board certification mess or the amount of time spent trimming toenails but they could certainly be added to any list of problems within this profession.

All in all, most in this profession, seem to enjoy the work and you can truly help people. However, there are serious challenges for new podiatrists that are likely to worsen, especially if the number of graduates increases. From a purely financial standpoint, I think podiatry is objectively a poor choice for most students, especially when compared to similar professions (NP, PA, MD, DO).

Just my 2 cents, do with this what you want.
 
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SoleScholar said:
I shadowed in podiatry and I loved it, I can see myself practicing podiatry for the rest of my life. I would love to own a solo PP. The podiatrists I shadowed are happy, have families, and they make good money. But then I go on here and it everyone acts like it is the worst career choice possible.
I'm going to apply to podiatry school now, with the intent to go into private practice when I graduate. This is obviously a field for private practice and I can't understand why people would even go into it without that intent. That being said, is the situation so bad and the profession so saturated that if I open a clinic when I get out I won't get enough patients to live and have a family?
Also, these jobs that say 100k a year plus 30% collections- do people really get the bonus?
I want to do podiatry. I think I would be happier practicing podiatry than internal medicine, family medicine, or general surgery. But not if I'm going to be poor like some of you make it sound like.
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Being fresh to the field you see everything as positive and flowers everywhere because it's what you are striving for (you have an end goal, which is good). You have the ambition, but that only lasts so long. But being a student, then a graduate into residency, and then being an attending, you will see how much your mind changes with the profession. You will then see everything. Shadesofgrey's point are the reality, and Weirdy is correct. Each level of the way your opinions and experiences with podiatry will change. When you really see it, it's too late to go back, especially with the debt and time spent in getting the degree and training. Make sure you shadow plenty and really ask the questions before committing to this profession. You haven't seen everything yet. Best of luck.
 
I understand your somewhat ackward feelings attempting to balance your real life experience against what you are being told on the forum. Sometimes this forum seems like pre-pods asking a question is akin to pirranhas sensing blood in the water. You ask a question and bam - all sorts of people responding aggressively and sometimes insultingly telling you - don't.

Within reason - I derive a fair amount of enjoyment from my job.

(a) I -always- enjoy nail removals. No matter how "simplistic" it is, no matter what other people might think - I love it. Its like being an artist. The patients are satisfied. Its fun. I'm great at it.
(b) I love diabetic offloading surgeries like flexor tenotomies and watching ulcerations close that have been open months, years.
(c) I love people coming back after a subtalar joint injection who were in pain for years and can suddenly move again.
(d) I never tire of a well done lapidus or 1st MPJ fusion that looks perfect.
(e) and I love the feeling of an Achilles tendon lengthening when I do a gastrocnemius recession.

I won't waste your time talking about the things I don't like.

Private practice is hard though. A lot of the people who will tell you how great it is are basing their feedback on a financial situation that doesn't exist anymore. The already made their money.

There is no connection between what insurance and Medicare will pay us and what a practice costs to run and what school costs to complete. Medicine is a volume business.

(a) I'm experiencing essentially constant payor deterioration. There is less meat on the bone every day. No one wants to pay anymore.
(b) Tuition has exploded at podiatry schools. When some old podiatrist tells you how great it is - they weren't $400K in debt after school.
(c) Costing of living, nursing salaries, health insurance just keep going up in cost. Meanwhile there isn't a single health insurance plan my office has that includes yearly cost of living increases. Meanwhile the health insurance my office buys for our staff went up 8% this year.
(d) The other day a patient who owes us $100 was called asking to make payment. The patient immediately knew that even if we send him to collections nothing will happen because his debt is under $500. We rendered the service and we have nothing to show for it, but no one out there cares about what happens to small medical practices.

I own a private practice. I have a partner. That is a whole other can of forms. But leaving him aside - I have a LOT of uncompensated time on my hands. Our IT people think we need a new server - I think they are selling us an overpriced boutique crap. My insurers don't want to pay at the contracted rates we just negotiated - I'm spending my nights going back through EOBs seeing if we're being paid in line with them. I contact the insurers. I have my IPA contact the insurers - no response. Meanwhile a visit that should be paid at $100 pays at $30. No one pays you to make sure your contracts are being paid appropriately - its all on you. Insurers routinely process and pay claims months after the fact so you are stuck pursuing a patient who you have already discharged. My staff want more money. A bottle of steroid costs substantially more than Medicare/insurance will pay for the steroid in the shot.

Its tough out there. The responsibility weighs on you. Meanwhile hospitals receive substantially more compensation for delivering often the exact same service. Hospital employed doctors paid in RVUs are often paid directly to them more than my office receives for the entire service.

There's some money to be made. There's good service to be rendered. But the same can be said for other medical professions with far better return on investment.

A final joke. People talk about Medicare for all. I have plural contracts that pay dramatically less than Medicare. Aetna, United, BCBS market place, etc all pay less than Medicare. Not only does Medicare pay better than these insurances but Medicare pays 80% of the bill and most Medicare patients have a supplement to pay the rest. I essentially am like 1/2 way to worse than Medicare for all and the patients will still owe me money.

Its tough out there.
 
Podiatry as a job is awesome. Career choice… well, there are better ROI options IMO.

Look into CRNA or PA. CRNA I know makes 250k+ with awesome bennies. Another CRNA posting I came across was mid-200s salary with 10 weeks PTO.
 
shadesofgrey said:
Combining average undergraduate loans, cost of schooling/living expenses, and the associated interest, its not unusual for students to graduate with student loans approaching 400k.
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I honestly don't know how people go over 200k in podiatry school.

Maybe instead of choosing a California, New York, or the Philly school, one could choose a place that's actually reasonable with COL.

I paid less than 1k an month on expenses (rent, food, wifi, everything). Yes I had to budget well, but I heard many students paying 4k+ a month and I'm just like "how...wtf...are you eating gold"?
 
Robin-jay said:
I honestly don't know how people go over 200k in podiatry school.

Maybe instead of choosing a California, New York, or the Philly school, one could choose a place that's actually reasonable with COL.

I paid less than 1k an month on expenses (rent, food, wifi, everything). Yes I had to budget well, but I heard many students paying 4k+ a month and I'm just like "how...wtf...are you eating gold"?
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It's actually pretty easy to go over $200K nowadays with the high interest rate and compounding interest while in school. Even when you attend let's say Iowa or even the Ohio school where living expenses are lower. Let's say $40-50K for undergrad, $35-40K per year for podiatry tuition, plus 15-20K for living expenses. You can expect $240K lowest and $290K on the higher end. The school financial aid actually allows around $70-75K maximum for total cost of attendance budget. I'm shocked when someone actually took out that maximum amount per year. The above and you tack on 6.8-7+ % interest, you can expect it to balloon very fast after residency. Podiatry degree is not cheap unless you have scholarships, 4.0 with reduced tuition for some schools, rich parents, or saved money somehow for school, etc.
 
MoostashPod said:
It's actually pretty easy to go over $200K nowadays with the high interest rate and compounding interest while in school. Even when you attend let's say Iowa or even the Ohio school where living expenses are lower. Let's say $40-50K for undergrad, $35-40K per year for podiatry tuition, plus 15-20K for living expenses. You can expect $240K lowest and $290K on the higher end. The school financial aid actually allows around $70-75K maximum for total cost of attendance budget. I'm shocked when someone actually took out that maximum amount per year. The above and you tack on 6.8-7+ % interest, you can expect it to balloon very fast after residency. Podiatry degree is not cheap unless you have scholarships, 4.0 with reduced tuition for some schools, rich parents, or saved money somehow for school, etc.
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That’s true, I had no undergrad debt and was able to pay tuition for my first year of podiatry school. But in any case, I would have still been below 250k no matter what, no where near 400k.
 
Robin-jay said:
That’s true, I had no undergrad debt and was able to pay tuition for my first year of podiatry school. But in any case, I would have still been below 250k no matter what, no where near 400k.
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I agree 400k may be a bit of a high estimate. This was mainly due to me using my own experience (prior IBR programs) with the current student costs. However, I still don't feel I am to far off the mark. To further clarify:

1) My estimate of near 400k was based on Kent State's own estimate for cost of attendance which earlier this year was listed at 85k per year or 340k over 4 years. Their website has since changed and says they are planning on lowering the cost. It currently only lists tuition cost (43k per year for out of state tuition). However, Kent is not alone, Midwestern lists a tuition of 50k with cost of living per year ranging from 27k-35k. Samuel Merrit tuition alone is 50k per year. Scholl tuition 45k. Barry estimated cost of attendance (tuition +on campus room and board) 63-75k per year. NYCPM COA is 65k-80k per year. Western COA is 77-80k per year. DMU COA is 75k.

I also was including a undergrad student loan of 30k, which is slightly below national average. I think in general it's fair to say that many students will be over 300k upon school graduation.

2) The estimate was also based on interest accumulation after 3 years of residency and should not have implied 400k loans after graduating school. This admittingly is not as big of an issue with the new SAVE program or with the prior pandemic student loan pause. It is likely what caused my estimate to be higher than normal as this was not an option during my residency. Prior to the pause/SAVE program, average interest of 6% on a 300k loan is 18k per year. By the time a resident graduated, even paying the minimum, they are in another 50k. The SAVE program prevents podiatry from being completely nonviable.

In conclusion, my estimate was a bit high, and individuals can make it through much cheaper by living cheaply. However, I still think podiatry remains a poor investment when compared to alternatives (PA, NP, DO, MD).
 
shadesofgrey said:
I agree 400k may be a bit of a high estimate. This was mainly due to me using my own experience (prior IBR programs) with the current student costs. However, I still don't feel I am to far off the mark. To further clarify:

1) My estimate of near 400k was based on Kent State's own estimate for cost of attendance which earlier this year was listed at 85k per year or 340k over 4 years. Their website has since changed and says they are planning on lowering the cost. It currently only lists tuition cost (43k per year for out of state tuition). However, Kent is not alone, Midwestern lists a tuition of 50k with cost of living per year ranging from 27k-35k. Samuel Merrit tuition alone is 50k per year. Scholl tuition 45k. Barry estimated cost of attendance (tuition +on campus room and board) 63-75k per year. NYCPM COA is 65k-80k per year. Western COA is 77-80k per year. DMU COA is 75k.

I also was including a undergrad student loan of 30k, which is slightly below national average. I think in general it's fair to say that many students will be over 300k upon school graduation.

2) The estimate was also based on interest accumulation after 3 years of residency and should not have implied 400k loans after graduating school. This admittingly is not as big of an issue with the new SAVE program or with the prior pandemic student loan pause. It is likely what caused my estimate to be higher than normal as this was not an option during my residency. Prior to the pause/SAVE program, average interest of 6% on a 300k loan is 18k per year. By the time a resident graduated, even paying the minimum, they are in another 50k. The SAVE program prevents podiatry from being completely nonviable.

In conclusion, my estimate was a bit high, and individuals can make it through much cheaper by living cheaply. However, I still think podiatry remains a poor investment when compared to alternatives (PA, NP, DO, MD).
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Ya, I can see how some may have 250-300k, but if you play your cards right, you really shouldn't hit much higher than 200k...

I know so many people paying 2500+ for rent each month, when I was doing closer to 600-800 a month. I would also eat ramen noodles, never went anywhere fancy, and would at most use the mcdonalds app to get 2 dollar meals.

Some people really want to live like doctors as students and push 300-400k+.

I've had friends enter their first year already 200k+ in debt from undergrad, dropping out of carribeans/DO/MD schools, etc.

Those people are probably pushing 500k+.
 
Practicing outside of nail jail and nursing homes podiatry is an enjoyable specialty for most. As long as you shadowed and enjoyed what you saw you will not hate the speciality itself clinically.

Unfortunately just saying all professions have their pros and cons fails miserably to address the magnitude of risks involved with this profession and its long, difficult and expensive career path.

You are wise not to go in expecting an organizational job. If it happens great, but don’t go in expecting that.

The reality of just how poor the job market is in regards to the number of jobs, location of jobs, compensation as an associate, poor benefits and poor potential for partnership can not be fully appreciated until one is finishing their residency. It will be depressing and a real hard gut punch at that point for most.

If you choose podiatry you almost need to ignore this site until the end of your first year of residency even though we speak the truth. It will only distract and depress you.

Make sure you are in the top half of your class, preferably the top 25 percent. Grades alone are not everything though, so work hard on all rotations and remain humble. Hopefully you get a top 25 percent residency also. It really helps if you are geographically open. If you open an office eventually hopefully you have a high earning spouse or family money.

So to summarize roadmap to success in podiatry:

Top half of class (preferably top 25 percent)
Top 25 percent residency
ABFAS RRA (google percent that obtain this)
Remain geographically open
Network and if you have connections absolutely use them

and/or

Have high earning spouse/family money and open an office.

I do know some that got a great organizational job in their hometown immediately after residency and will likely work that job their whole career (usually serious connections or true standouts). No doubt podiatry worked out great for them and they can tell others with a straight face how wonderful the profession is.

Most I know just stayed by their residency even though they swore they were moving somewhere trendy and desirable or back to their home city/state, With no relocation money and already having an apartment and a significant other or spouse they just took the bad associate job that mislead them with partnership or was not busy enough for an associate. They eventually opened up their own office or were geographically open and left for an organizational job (usually not somewhere trendy and desirable). These were the ones that actually ended up doing well and were the better students that did above average residencies. The rest did worse on average, but some from all residences and all ranks in class will be successful by opening their own office. Some will try to open their office and fail or keep it going barely but have serious financial problems (poor credit as a result). There are very few good jobs to fall back on as a safety net.

Everyone's individual path will be different. It will be even more difficult on the coasts, and desirable locations. Even a non desirable city with a population under 100K can get real saturated if there is a single residency there. The best opportunities are typically in bear country, near swamps or fly over states in a city with a population of 100,000 or less far from schools and residencies. If you land an organizational job and are an hour from a large city and/or less than two hours from family you have hit the jackpot in this profession. Some will only consider jobs in large cities in California.....good luck.

Most really do start off at a crap associate job that in no way justifies the length and cost of education. Many, but certainly not all will somehow, someway eventually find some measure of success. This success will not come just by having experience. Most opportunities are self made in this profession. Most other professions the opportunities were self made by becoming a professional in the first place. In my opinion the most stressful part about entering this profession is the job search.

Roadmap to success for RN/NP/PA/AA/ CRNA/DO/MD

Have a pulse and a state license and get a good job wherever you want within two weeks. You could even move first and find a job later. Live somewhere desirable and trendy if you want for a few years and easily move back to you home state/city later if you want to settle down and raise a family or be near your aging parents. Most jobs will have great benefits, signing bonuses, relocation, and often have loan repayment assistance of PSLF.
 
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SoleScholar said:
I shadowed in podiatry and I loved it, I can see myself practicing podiatry for the rest of my life. I would love to own a solo PP. ...
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Podiatry can be great. For the majority, it is not, though... ROI, limited good jobs, saturation capping income... and making private practice competitive.

  1. Hospital employed DPMs = good income (not near MD surgeon, though), high avg to very hard hours, admin headaches and ortho discrimination/abuse "politics", hard to get those few DPM hospital jobs - esp in any reasonably desired area
  2. Admin/"academic" jobs = pretty good income, fair hours, admin and ego nonsense, very rare
  3. Private practice owner = fair to great hours, no admin struggles, staffing/reimburse issues, need loans or wealth or big savings to start PP, competition all around you from hospital DPMs and others DPMs in PP
  4. Nursing homes = garbage job quality, fair income and hours, easy to get
  5. Private practice associate = low to low avg income, fair to poor hours, easiest DPM job type to get

The problem lies in that most people end up in the bottom category, number 5. The vast majority do. Some go to much less than optimal locations to find the higher order jobs (hospital or PP area without tons of competition or startup cost). We are not just talking about poor students; some well-trained people in podiatry take low pay jobs or jobs in far rural areas also. Most DPMs start their career as PP associates... and a fair number of them stay associates awhile or even end the career there also. 🙁

The needless new podiatry schools increase saturation, and who knows if more schools are in sight. Either way, just Google podiatrists in any area and check out how many there (versus ENT or Derm or even orthos or most legit types specialists). It's not as bad as chiro since podiatry is fairly insurance-covered and fairly accepted in the medical community, but podiatry is NOT good in saturation terms. We have the fraud, sleazy wound "grafts" and nerve stimulators and weird over-the-counter products, pods talking poorly of other pods, too many applications for any good job posting, poor ROI versus tuition, and everything that saturation brings.

I am PP owner. I have good training also, so technically I've won the podiatry game, right? Yes and no. I like it. I do pretty well. I have my loans almost paid off roughly 10yrs out of training. I have rockstar office staff and the trust of area primary care docs. I do surgery. Still, I do much marketing, angling, networking, take occasional walk-in or same day appts, and other things that area procedure MDs (ENT, derm, rheum, etc) just don't need to do. They are naturally busy and making a lot more income... because they're far from saturated. I absolutely have to work for it... and to maintain it. Saturation sucks.

...in the end, think about if you'd like podiatry. You. Not the guy you shadowed. Not some rando on SDN. You know yourself.
If you are just tunnel vision due to not being competitive enough for MD school but are wanting something fairly "doctor" similar, think twice... there are better options than DPM in terms of ROI and less loans (mentioned above). If you legitimately do like podiatry, then work HARD in school to get one of the limited strong training programs... but know that you still will have to kinda make your own luck and you won't get the office loans or income or job choices that MDs do (not even close). That is much more due to saturation of podiatry and much less standardized residency skill/competence of DPMs than DPM vs MD/DO degree discrimination, so realize that. You will get just as much debt, but you won't get the income when supply of DPMs faaar exceeds demand (and therefore income). Good luck
 
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I've concluded that I'm going to apply to podiatry school.
I know for sure I like the day to day work. I am very entrepreneurial and enjoy doing business. I don't know of other procedure based healthcare fields that allow you to own a practice besides dentistry (teeth give me nightmares), dermatology (insanely competitive and also doesn't interest me), or plastic surgery (also insanely competitive and doesn't interest me as much as podiatry).

I've shadowed four different general surgeons, an emergency medicine doctor, a family doctor, and two podiatrists. The podiatrists undoubtedly were the happiest.

Thankfully I do not have undergrad to pay for, I've been very lucky to have parents who are willing and capable of paying for it. I will be paying for podiatry school. Are there podiatrists out there starving? I don't think so.

Sure NP, PA, AA, CRNA etc are great careers with a high ROI but I don't think I would be happy being under someone all the time.

The biggest draw to this profession for me is the ability to significantly improve people's quality of life, the procedural nature of the work, and the ability to be your own boss. Unless I can't afford to feed my kids doing this profession, then I'm all for it.

Am I wrong in this thinking?
 
Feli said:
Podiatry can be great. For the majority, it is not, though... ROI, limited good jobs, saturation capping income... and making private practice competitive.

  1. Hospital employed DPMs = good income (not near MD surgeon, though), high avg to very hard hours, admin headaches and ortho discrimination/abuse "politics", hard to get those few DPM hospital jobs - esp in any reasonably desired area
  2. Admin/"academic" jobs = pretty good income, fair hours, admin and ego nonsense, very rare
  3. Private practice owner = fair to great hours, no admin struggles, staffing/reimburse issues, need loans or wealth or big savings to start PP, competition all around you from hospital DPMs and others DPMs in PP
  4. Nursing homes = garbage job quality, fair income and hours, easy to get
  5. Private practice associate = low to low avg income, fair to poor hours, easiest DPM job type to get

The problem lies in that most people end up in the bottom category, number 5. The vast majority do. Some go to much less than optimal locations to find the higher order jobs (hospital or PP area without tons of competition or startup cost). We are not just talking about poor students; some well-trained people in podiatry take low pay jobs or jobs in far rural areas also. Most DPMs start their career as PP associates... and a fair number of them stay associates awhile or even end the career there also. 🙁

The needless new podiatry schools increase saturation, and who knows if more schools are in sight. Either way, just Google podiatrists in any area and check out how many there (versus ENT or Derm or even orthos or most legit types specialists). It's not as bad as chiro since podiatry is fairly insurance-covered and fairly accepted in the medical community, but podiatry is NOT good in saturation terms. We have the fraud, sleazy wound "grafts" and nerve stimulators and weird over-the-counter products, pods talking poorly of other pods, too many applications for any good job posting, poor ROI versus tuition, and everything that saturation brings.

I am PP owner. I have good training also, so technically I've won the podiatry game, right? Yes and no. I like it. I do pretty well. I have my loans almost paid off roughly 10yrs out of training. I have rockstar office staff and the trust of area primary care docs. I do surgery. Still, I do much marketing, angling, networking, take occasional walk-in or same day appts, and other things that area procedure MDs (ENT, derm, rheum, etc) just don't need to do. They are naturally busy and making a lot more income... because they're far from saturated. I absolutely have to work for it... and to maintain it. Saturation sucks.

...in the end, think about if you'd like podiatry. You. Not the guy you shadowed. Not some rando on SDN. You know yourself.
If you are just tunnel vision due to not being competitive enough for MD school but are wanting something fairly "doctor" similar, think twice... there are better options than DPM in terms of ROI and less loans (mentioned above). If you legitimately do like podiatry, then work HARD in school to get one of the limited strong training programs... but know that you still will have to kinda make your own luck and you won't get the office loans or income or job choices that MDs do (not even close). That is much more due to saturation of podiatry and much less standardized residency skill/competence of DPMs than DPM vs MD/DO degree discrimination, so realize that. You will get just as much debt, but you won't get the income when supply of DPMs faaar exceeds demand (and therefore income). Good luck
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icebreaker32 said:
Practicing outside of nail jail and nursing homes podiatry is an enjoyable specialty for most. As long as you shadowed and enjoyed what you saw you will not hate the speciality itself clinically.

Unfortunately just saying all professions have their pros and cons fails miserably to address the magnitude of risks involved with this profession and its long, difficult and expensive career path.

You are wise not to go in expecting an organizational job. If it happens great, but don’t go in expecting that.

The reality of just how poor the job market is in regards to the number of jobs, location of jobs, compensation as an associate, poor benefits and poor potential for partnership can not be fully appreciated until one is finishing their residency. It will be depressing and a real hard gut punch at that point for most.

If you choose podiatry you almost need to ignore this site until the end of your first year of residency even though we speak the truth. It will only distract and depress you.

Make sure you are in the top half of your class, preferably the top 25 percent. Grades alone are not everything though, so work hard on all rotations and remain humble. Hopefully you get a top 25 percent residency also. It really helps if you are geographically open. If you open an office eventually hopefully you have a high earning spouse or family money.

So to summarize roadmap to success in podiatry:

Top half of class (preferably top 25 percent)
Top 25 percent residency
ABFAS RRA (google percent that obtain this)
Remain geographically open
Network and if you have connections absolutely use them

and/or

Have high earning spouse/family money and open an office.

I do know some that got a great organizational job in their hometown immediately after residency and will likely work that job their whole career (usually serious connections or true standouts). No doubt podiatry worked out great for them and they can tell others with a straight face how wonderful the profession is.

Most I know just stayed by their residency even though they swore they were moving somewhere trendy and desirable or back to their home city/state, With no relocation money and already having an apartment and a significant other or spouse they just took the bad associate job that mislead them with partnership or was not busy enough for an associate. They eventually opened up their own office or were geographically open and left for an organizational job (usually not somewhere trendy and desirable). These were the ones that actually ended up doing well and were the better students that did above average residencies. The rest did worse on average, but some from all residences and all ranks in class will be successful by opening their own office. Some will try to open their office and fail or keep it going barely but have serious financial problems (poor credit as a result). There are very few good jobs to fall back on as a safety net.

Everyone's individual path will be different. It will be even more difficult on the coasts, and desirable locations. Even a non desirable city with a population under 100K can get real saturated if there is a single residency there. The best opportunities are typically in bear country, near swamps or fly over states in a city with a population of 100,000 or less far from schools and residencies. If you land an organizational job and are an hour from a large city and/or less than two hours from family you have hit the jackpot in this profession. Some will only consider jobs in large cities in California.....good luck.

Most really do start off at a crap associate job that in no way justifies the length and cost of education. Many, but certainly not all will somehow, someway eventually find some measure of success. This success will not come just by having experience. Most opportunities are self made in this profession. Most other professions the opportunities were self made by becoming a professional in the first place. In my opinion the most stressful part about entering this profession is the job search.

Roadmap to success for RN/NP/PA/AA/ CRNA/DO/MD

Have a pulse and a state license and get a good job wherever you want within two weeks. You could even move first and find a job later. Live somewhere desirable and trendy if you want for a few years and easily move back to you home state/city later if you want to settle down and raise a family or be near your aging parents. Most jobs will have great benefits, signing bonuses, relocation, and often have loan repayment assistance of PSLF.
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Shiyuan said:
Podiatry as a job is awesome. Career choice… well, there are better ROI options IMO.

Look into CRNA or PA. CRNA I know makes 250k+ with awesome bennies. Another CRNA posting I came across was mid-200s salary with 10 weeks PTO.
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heybrother said:
I understand your somewhat ackward feelings attempting to balance your real life experience against what you are being told on the forum. Sometimes this forum seems like pre-pods asking a question is akin to pirranhas sensing blood in the water. You ask a question and bam - all sorts of people responding aggressively and sometimes insultingly telling you - don't.

Within reason - I derive a fair amount of enjoyment from my job.

(a) I -always- enjoy nail removals. No matter how "simplistic" it is, no matter what other people might think - I love it. Its like being an artist. The patients are satisfied. Its fun. I'm great at it.
(b) I love diabetic offloading surgeries like flexor tenotomies and watching ulcerations close that have been open months, years.
(c) I love people coming back after a subtalar joint injection who were in pain for years and can suddenly move again.
(d) I never tire of a well done lapidus or 1st MPJ fusion that looks perfect.
(e) and I love the feeling of an Achilles tendon lengthening when I do a gastrocnemius recession.

I won't waste your time talking about the things I don't like.

Private practice is hard though. A lot of the people who will tell you how great it is are basing their feedback on a financial situation that doesn't exist anymore. The already made their money.

There is no connection between what insurance and Medicare will pay us and what a practice costs to run and what school costs to complete. Medicine is a volume business.

(a) I'm experiencing essentially constant payor deterioration. There is less meat on the bone every day. No one wants to pay anymore.
(b) Tuition has exploded at podiatry schools. When some old podiatrist tells you how great it is - they weren't $400K in debt after school.
(c) Costing of living, nursing salaries, health insurance just keep going up in cost. Meanwhile there isn't a single health insurance plan my office has that includes yearly cost of living increases. Meanwhile the health insurance my office buys for our staff went up 8% this year.
(d) The other day a patient who owes us $100 was called asking to make payment. The patient immediately knew that even if we send him to collections nothing will happen because his debt is under $500. We rendered the service and we have nothing to show for it, but no one out there cares about what happens to small medical practices.

I own a private practice. I have a partner. That is a whole other can of forms. But leaving him aside - I have a LOT of uncompensated time on my hands. Our IT people think we need a new server - I think they are selling us an overpriced boutique crap. My insurers don't want to pay at the contracted rates we just negotiated - I'm spending my nights going back through EOBs seeing if we're being paid in line with them. I contact the insurers. I have my IPA contact the insurers - no response. Meanwhile a visit that should be paid at $100 pays at $30. No one pays you to make sure your contracts are being paid appropriately - its all on you. Insurers routinely process and pay claims months after the fact so you are stuck pursuing a patient who you have already discharged. My staff want more money. A bottle of steroid costs substantially more than Medicare/insurance will pay for the steroid in the shot.

Its tough out there. The responsibility weighs on you. Meanwhile hospitals receive substantially more compensation for delivering often the exact same service. Hospital employed doctors paid in RVUs are often paid directly to them more than my office receives for the entire service.

There's some money to be made. There's good service to be rendered. But the same can be said for other medical professions with far better return on investment.

A final joke. People talk about Medicare for all. I have plural contracts that pay dramatically less than Medicare. Aetna, United, BCBS market place, etc all pay less than Medicare. Not only does Medicare pay better than these insurances but Medicare pays 80% of the bill and most Medicare patients have a supplement to pay the rest. I essentially am like 1/2 way to worse than Medicare for all and the patients will still owe me money.

Its tough out there.
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MoostashPod said:
Being fresh to the field you see everything as positive and flowers everywhere because it's what you are striving for (you have an end goal, which is good). You have the ambition, but that only lasts so long. But being a student, then a graduate into residency, and then being an attending, you will see how much your mind changes with the profession. You will then see everything. Shadesofgrey's point are the reality, and Weirdy is correct. Each level of the way your opinions and experiences with podiatry will change. When you really see it, it's too late to go back, especially with the debt and time spent in getting the degree and training. Make sure you shadow plenty and really ask the questions before committing to this profession. You haven't seen everything yet. Best of luck.
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shadesofgrey said:
I'll bite.

The issue is high student loans to rather poor average salary. Combining average undergraduate loans, cost of schooling/living expenses, and the associated interest, its not unusual for students to graduate with student loans approaching 400k. With that amount of debt, starting a new private practice from scratch is not for the faint of heart, as it will likely require at least an additional 100k+ in loans to get going/survive the first year. Do you want to live in a house now that your a doctor? Add another 300-500k (depending on the area). Starting a practice becomes daunting coming out of residency with the above factors, so most look for an employed position.

The most desirable positions (generally) are hospital employed. This is for several reasons: a) Salaries tend to be higher, normally starting 200k+ with good insurance/benefits. b) Most hospitals are nonprofits which allows use of the PSLF program. If a new pod starts payments in residency, 3 years of minimal payments + 7 years of payments as an attending and that massive student loan amount is gone after 10 years. However, positions are limited while there are more podiatry schools than ever before, but how many podiatrists does a hospital really need? Not that many, which has created intense demand and competition for a finite number of positions. This is fueling the creation of fellowships, which require an additional year of training, so that new pods have a leg up when applying for a hospital position.

The most common employed position, is as an associate, working for another podiatrist. Unfortunately, many pods have a reputation for poorly compensating their associates and provide poor benefits and limited vacation. Salary wise, I would say most associate podiatrists are below or barely above 200k in income. I think these low offers are a result of 1) the saturation in our profession (why pay 200k if someone will do the job for 130k). 2) a general lack of awareness of loan burden by employing podiatrists. Hopefully, if it's a good private practice opportunity there will be an offer to buy in, but unfortunately these buy-ins are often priced with an elevated practice estimate, resulting in a steep buy in. The end result is associates that often times are constantly job hopping, trying to find a financially viable opportunity.

An additional problem is that the training in this profession is variable. The schools have some issues but the true problem is at the residency level. One program may do surgery 8 hours a day, 4-5 days a week, while the next program double scrubs simple surgeries. Residency selection often times aligns with academic success but not always, especially when there are more graduates than residencies, creating a shortage. This means it's not uncommon for good students to end up getting poor surgical training which furthers new practitioner frustration. Variable training worsens the permeating inferiority complex that is instilled in this profession. The inferiority complex causes some well trained providers to become very arrogant, while others are constantly trying to validate their belonging to the medical community. This need for validation, comically, causes people to title themselves "Fellowship trained Foot and Ankle Surgeon" rather than podiatrist or to add an ever increasing number of letters after their name.

I am not going to touch on the board certification mess or the amount of time spent trimming toenails but they could certainly be added to any list of problems within this profession.

All in all, most in this profession, seem to enjoy the work and you can truly help people. However, there are serious challenges for new podiatrists that are likely to worsen, especially if the number of graduates increases. From a purely financial standpoint, I think podiatry is objectively a poor choice for most students, especially when compared to similar professions (NP, PA, MD, DO).

Just my 2 cents, do with this what you want.
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This post was meant as a reply to the users above:
SoleScholar said:
I've concluded that I'm going to apply to podiatry school.
I know for sure I like the day to day work. I am very entrepreneurial and enjoy doing business. I don't know of other procedure based healthcare fields that allow you to own a practice besides dentistry (teeth give me nightmares), dermatology (insanely competitive and also doesn't interest me), or plastic surgery (also insanely competitive and doesn't interest me as much as podiatry).

I've shadowed four different general surgeons, an emergency medicine doctor, a family doctor, and two podiatrists. The podiatrists undoubtedly were the happiest.

Thankfully I do not have undergrad to pay for, I've been very lucky to have parents who are willing and capable of paying for it. I will be paying for podiatry school. Are there podiatrists out there starving? I don't think so.

Sure NP, PA, AA, CRNA etc are great careers with a high ROI but I don't think I would be happy being under someone all the time.

The biggest draw to this profession for me is the ability to significantly improve people's quality of life, the procedural nature of the work, and the ability to be your own boss. Unless I can't afford to feed my kids doing this profession, then I'm all for it.

Am I wrong in this thinking?
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Thank you all for the replies, it is appreciated.
 
SoleScholar said:
I've concluded that I'm going to apply to podiatry school.
I know for sure I like the day to day work. I am very entrepreneurial and enjoy doing business. I don't know of other procedure based healthcare fields that allow you to own a practice besides dentistry (teeth give me nightmares), dermatology (insanely competitive and also doesn't interest me), or plastic surgery (also insanely competitive and doesn't interest me as much as podiatry).

I've shadowed four different general surgeons, an emergency medicine doctor, a family doctor, and two podiatrists. The podiatrists undoubtedly were the happiest.

Thankfully I do not have undergrad to pay for, I've been very lucky to have parents who are willing and capable of paying for it. I will be paying for podiatry school. Are there podiatrists out there starving? I don't think so.

Sure NP, PA, AA, CRNA etc are great careers with a high ROI but I don't think I would be happy being under someone all the time.

The biggest draw to this profession for me is the ability to significantly improve people's quality of life, the procedural nature of the work, and the ability to be your own boss. Unless I can't afford to feed my kids doing this profession, then I'm all for it.

Am I wrong in this thinking?
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You are not wrong, but remember podiatry will become a job soon enough and not a career choice.

General surgeon....difficult when on call, live across the street from the hospital, have a non working partner/spouse so you don't have to deal with the appliance repair person etc, make $$$

ER....have to have the right personality, shift work, make $$. Pick where want to live and sometimes can work as few as 30 hours per week with full time benefits.

Family medicine....personally yah the specialty itself is meh but their pay has gone up (demand) and hospitalists take care of inpatients now

Do not underestimate midlevels as a god career.

If you really have the stats for MD/DO think long and hard before choosing podiatry.

Podiatry as a specialty other than being saturated is fine. The saturated part really sucks though. Remember everyone is optimistic going in.....you have a profile picture of an ankle we were all there once. Podiatry is much harder when at bottom half of class.....soon half of all these optimistic new students will be at the bottom half of their class. Not a death sentence just you are less on track for the good fellowships andnorganizational jobs most will not get anyways and you training might actually be subpar also.

Podiatry is very procedure oriented for sure if you consider minor office procedures like warts, nail avulsions, tenotomies and even nail trimming and calluses are considered procedures. Most are not doing as much surgery in the OR as you would expect.

Most will struggle their first couple of years and then at least be doing well enough to "feed their kids". Loan repayment minimums have become lower. A nice house and nice vacations well that might have to wait longer. The midlevels and engineers your age already have these things and all the MD/DO/CRNA got them instantly when they finished.

You might not be living in your desired location and you might be making money doing scammy things you never thought a doctor would have to do (saturation sucks). You also might have a thriving practice or snag a good organizational job. It is good you are open to opening an office. Many will soon say once they get beyond the negative cash flow period of opening an office (do not underestimate how stressful that can be) that motivating, retaining and dealing with employee drama is often more exhausting and stressful than patient care most days. A good number in podiatry are not so much choosing to open an office for any reasons other than being able live where they want and/or have a chance to make more than an associate. The reason will not typically be I could have made the same amount working down the road at the hospital, but simply wanted more control over hours and my staff.

Just remember if you choose podiatry. You will soon have class rank and residency stress, but the real stress is the job market. It is far away when you start, but there will come a day. I hope that part works out better than expected for you when the time comes, it does for some, but unfortunately not for most.
 
Take a long hard look at all these responses. If I were you, I wouldn’t pursue this career. Like many have said above, it’s very easy to think every thing is all good until you get further along. Your attitude and thoughts will change. As a 3rd year student, I’m not happy with this career so imagine what this may feel like down the road into residency. The posters on here have really opened my eyes to things I didn’t even previously know or think about when it came to the profession. The choice is ultimately yours but I would steer clear of podiatry. Just my 2 cents. I wish you the best of luck.
 
SoleScholar said:
I've concluded that I'm going to apply to podiatry school.
I know for sure I like the day to day work. I am very entrepreneurial and enjoy doing business. I don't know of other procedure based healthcare fields that allow you to own a practice besides dentistry (teeth give me nightmares), dermatology (insanely competitive and also doesn't interest me), or plastic surgery (also insanely competitive and doesn't interest me as much as podiatry).

I've shadowed four different general surgeons, an emergency medicine doctor, a family doctor, and two podiatrists. The podiatrists undoubtedly were the happiest.

Thankfully I do not have undergrad to pay for, I've been very lucky to have parents who are willing and capable of paying for it. I will be paying for podiatry school. Are there podiatrists out there starving? I don't think so.

Sure NP, PA, AA, CRNA etc are great careers with a high ROI but I don't think I would be happy being under someone all the time.

The biggest draw to this profession for me is the ability to significantly improve people's quality of life, the procedural nature of the work, and the ability to be your own boss. Unless I can't afford to feed my kids doing this profession, then I'm all for it.

Am I wrong in this thinking?
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If you've concluded you're going to apply, then everything else is a moot point.

You come off as young an naive. That's not an insult. Nearly everyone is young and naive once.

You talk about how you are very entrepreneurial and enjoy doing business. What businesses have you built? What were your sales last year? Navigating the healthcare system is different than selling candy in high school, flipping items on ebay, or enjoying watching Shark Tank.

A major problem with podiatry is it is a a combination of saturation and being not truly needed for a hospital or clinic to function, worsening the job market. Can a hospital function with radiologist? No. Anesthesiologist? No. General surgery? No. The list goes on an on. Can a hospital function without a podiatrist? You betcha, and most do. Does it seem wise to specialize in the field that is both saturated and not needed?

You are trading desirability now for lack of desirability later. It feels pretty good getting an instant acceptance and scholarship to every podiatry school. Everyone wants you and you don't have to deal with all the BS of applying to get a MD (and there is a lot). But then you graduate residency, and now you're faced with the opposite situation -- no one really needs you or wants you, at least not enough to give you a great job. Going the MD route is the opposite experience -- no one wants you at first (schools could care less if you apply or not, they have countless apps), but EVERYONE wants you after you graduate. Seems better to me to go the route that results in you being desirable for the rest of your life, even if you are undesirable now.

I hope that helps and good luck on whatever you decide, though it seems you've made up your mind. No one here knows you but you are getting a lot of good advice.
 
diabeticfootdr said:
I only know 10-12 people (who claim to be podiatrists) who are generally unsatisfied with their career choice. You can read from them on SDN. Every other DPM I know IRL is happy and doing fine.
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Simply put people are voicing the real concerns and problems in podiatry and letting others know about the job saturation, outlook, etc. I can say a lot of my colleagues from school and residency are not happy with their job IRL, and they're not on here to vent that. They don't have the time nor care to do that. They just stick with what they have and make the most out of it. They are a few years out just like me.
 
diabeticfootdr said:
I only know 10-12 people (who claim to be podiatrists) who are generally unsatisfied with their career choice. You can read from them on SDN. Every other DPM I know IRL is happy and doing fine.
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False. Us 10-12 are happy with current income and practice and are still practicing IRL. I encourage students to re-read our posts. Please refrain from spreading false information.
 
The education is great. I feel like I'm learning and being pushed to become a skilled Podiatric physician in the future. People in the field are usually down-to-earth, humble, and supportive of each other.

The problem is the disarray of leadership which makes it hard for collaboration. Podiatry has some major issues like conflicts of interest affecting our profession progress (ex. CPME accreditation committee). As we head towards 2030 with the youngest baby boomer being 65 or older, there's a big chance for podiatry to contribute and broaden our scope. To make the most of this, it's important for everyone in the field to focus on what's good for the profession rather than just themselves. I hope the right people start running for these positions and navigate us toward the right direction.

Here’s a nice article written by Dr. Levy about the elderly population growth trajectory in the US and the increasing role of podiatrists:

 
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Bored Snorlax said:
The education is great. I feel like I'm learning and being pushed to become a skilled Podiatric physician in the future. People in the field are usually down-to-earth, humble, and supportive of each other.

The problem is the disarray of leadership which makes it hard for collaboration. Podiatry has some major issues like conflicts of interest affecting our profession progress (ex. CPME accreditation committee). As we head towards 2030 with the youngest baby boomer being 65 or older, there's a big chance for podiatry to contribute and broaden our scope. To make the most of this, it's important for everyone in the field to focus on what's good for the profession rather than just themselves. I hope the right people start running for these positions and navigate us toward the right direction.

Here’s a nice article written by Dr. Levy about the elderly population growth trajectory in the US and the increasing role of podiatrists:

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oh yeah snl GIF by Saturday Night Live


The article opens with ABMSP (fake board) info, and it closes with "slippers make you slip."

Go find the JFAS and FAI articles of quality instead, man. Those will actually help you learn and pass boards and match better.

The USA itself has negative population growth, just like every other first world country. Immigration keeps USA appearing stable or ever-so-slightly growing, but it's not. It is halting. We can call it "fertility declines" (as the article author does) or birth control or educated women or decrease in popularity of religion or whatever you like... populations are shrinking. Bottom line. People aren't having big families anymore. Those uber-religious families with the uneducated SAHM with solo breadwinner dad and 5+ kids are increasingly rare. The dual income professional couples with 0-2 kids and little interest in creation myths are the modern norm statistically. Same-sex couples don't produce kids, and that is now more popular and accepted than ever in USA. It's not hard to figure out what the population will do; simply look at Europe or any first world nation which gets less immigration.

I agree the podiatry education is great (if you get a top quarter residency)... it's good if you get a top half one. It's otherwise kinda scary (particularly for surgery and inpatient aspects). The education is also more expensive every year, and it's very fraught with competition DPMs for jobs, income, patients, etc due to the saturation. We opened 4 new pod schools in the last 20yrs... more than in the prior 100 years.

A temp growth in the age 65+ population due to Boomers (then followed by an overall decrease in population) is not going to fix that ROI and oversaturation for podiatry. APMA has been doing those talking points for years (geriatric need, diabetes need, "you get to do surgery," etc). You don't see Endocrinology or PM&R or Geriatricians or MDs overall drastically increasing training programs due to Boomers.

It pays relatively little to clip 80 year old grandma toenails and tell people "slippers make you slip" ... or to go to nursing homes and do C&C with "wound care" and "ingrown" procedures. That is not the panacea for podiatry. MCR will just stagnate or cut RVU rates as more and more people need coverage... and they already have seesawed on that for many years. C&C is an easy target as it's barely ever truly medically necessary and much fraud has happened historically; don't hang your hat on C&C or seniors. Learn all of the skills that you can, and hope they stop adding needless podiatry schools. The ideas that people are living longer or USA populations are growing are false.
 
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SoleScholar said:
...Unless I can't afford to feed my kids doing this profession, then I'm all for it.

Am I wrong in this thinking?
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It depends on what you mean by that, honestly.

If you are planning on DPM degree making you a strong solo breadwinner for a family of 4+, that may or may not work.
MDs' avg incomes can bank on that nearly always, yes.

DPMs? You might end up living at a drastically lower standard or in a location you or partner/spouse did not want - yet went to, just to find a decent job. Back as a pre- or pod student, I never thought I'd have worked for IHS out in the middle of nowhere, and many well-trained and ABFAS qual/cert SDN regulars had to resort to similar rural gigs since good hospital or other employed DPM jobs in desired areas are pretty rare and veeery heavily applied to.
Also, a good amount of DPMs with young kids and a non-working spouse apply for social services, food stamps, etc during school or residency... and they live very frugal afterwards at associate PP jobs and/or have to relocate their family multiple times to find a better job.

Be aware of very real possibility of any or all of that. No joke.

Ask yourself if you can "feed my kids" (and pay your loan payments) making about $150-225k/yr gross as a podiatry associate or small/govt hospital employ... because that is a very probable outcome during most/all of your/spouse childbearing years - or beyond. Again, there are a good many podiatrists who earn roughly what ICU nurses do... but with 3-5x the student loan burden and less locations hiring for their skill.

It can be a cool career as a DPM, but the income is highly variable and roughly half of what MD/DO is on avg (yet same student loans). Your odds of living a decent lifestyle or more easily affording kids as a DPM are much better with a financially competent partner... RN, scientist, MBA, MD, simply from a wealthy family, PhD, entrepreneur, computer science, various professional degree, whatever.

It is always easy to think you will do well in pod school, meet a high-earner partner, match a top DPM residency, get a hospital job (and like it) that pays big bucks, and ride off into the sunset. Statistically, you will not... especially the job part. Podiatry schools and residencies have grown to churn out nearly as many "foot and ankle surgeon" grads as orthopedists (head to toe) finish every year. Foot & ankle orthopedic fellowships put out well under 100 per year.. and their compensation/demand is substantially more than DPMs with 600+ created annually for same reason. Consider that, and proceed accordingly.
 
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OP, there are many good posts in this thread; I hope you read them and are aware of the situation. You seem to have shadowed a few DPMs and seem content otherwise from the experiences. This is a good sign. Let us know if you have any questions in the future about the application process.
Good luck!
 
Podiatry is a very bipolar profession in many ways.
The good and bad are fortunately and unfortunately both true.

Believe that good and bad quality residencies exist.

Believe that there are some making over a million dollars a year and many jobs paying 100K or less with poor benefits and little vacation.

It is easy to quantify compensation for most specialties because there are many open jobs that remain unfulfilled for long periods of time at hospitals, academic institutions and government. Some of these jobs exist for podiatry, but they never go unfilled. There are various salary surveys for podiatry which gives an idea, but whether the numbers are too high or low is up for debate. Know the difference between the mean and median salaries for podiatry is larger also than most specialties....which is again both good for the haves and bad for the have nots. You might make 300K and good benefits immediately after residency in a low cost of living area or 80K and poor benefits in a very high cost of living area. Most make somewhere in the middle. Plenty on here have posted on their recent job search. Most jobs are in private practice. A couple recent residency graduates on here have landed some nice organizational jobs...again minority of jobs. No one has been bragging about their good private practice offers.

Podiatry is a long and expensive career path that is riskier than many other healthcare professions. How much riskier it is certainly up for debate and again hard to prove.
 
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wakaflocka88 said:
You wanna make 187k, living in any city of your choice, or take the gamble that 90% of grads will accept a 100k offer?
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I'd rather sleep under a bridge than work for a physician in a role that isn't just a lesser physician (resident, associate).

So I'd take the gamble.
 
This is ridiculous, might as well not do anything; leave the country and live in the mountains somewhere.
 
I recently went to a conference where 2 different APMA representatives told me its terrible what's being done to podiatry by big insurance companies, Medicare Advantage plans etc. One of them was insistent that CMS should be pressing charges against companies like United and Aetna. But you share on SDN that the insurance payor environment is deteriorating you're just a "dissatisfied" podiatrist. Anyone who applies right now is like 7-8 years away from being an attending. Maybe more with a fellowship *wink*. When I went to podiatry school it started at $28K. My school is like mid-$40s now. You are paying for an entire "extra" 2 years (I used to say an extra year, but now its 2) of tuition compared to what I paid. My podiatry school was historically adding $1-2K to tuition a year. When I was a first year resident my 2nd and 3rd co-residents were $270-300K in debt. At current rates, new graduates in identical situations would be at least $40-60K more debt in debt now. After practicing for 2.5 years and making sub-$100K my first year I ultimately bought 1/2 a practice for $90K. Depending on who you ask that may or may not be good value, but the take home is new associates may be asked to bring additional money to the table - your spending doesn't stop when you stop attending school. I met a podiatrist at the same conference above who is $500K in debt and owns a much smaller percentage of their practice (they were also like 6 years ahead of me which is cringe). I am forever grateful that I walked away from the guy who wanted $800K from me. I would have gone under during Covid. In 2016 when I graduated, my practice was paid $349 for a matrixectomy by the most common good health insurance. We are now paid $244 by that insurance because of changes in the underlying Medicare fee schedule (which in general goes down every year). There are numerous relevant podiatry codes that have been dramatically slashed over the last 20 years. Many insurances base their rates on what Medicare pays and as Medicare decreases their rates you can see diminished returns on other insurances and overall reimbursement. You can even see insurances that pay dramatically less than insurance.

I have mixed feelings towards some of my professions leadership organizations, but I'm also grateful to them. CMS wanted to separate podiatry off on our "Evaluation and Management Codes". They were going to create podiatry only codes which were going to be worth nothing. It would have been an epic slaughter. APMA fought it by pointing to language in like, not kidding, the Social Security Act that states that you can't discriminate on any specific physician based on their specialty. Instead we continue to use the same codes as everyone else and the recent 2021 coding change allowed us to dramatically increase our use of 99204/99214 recognizing the complexity of the treatments we provide and the patients we see. That said, APMA, podiatry leadership etc have green lit the opening of new schools and the profession has not even begun to grasp the complications and problems this will cause.

I'm repeating myself, but leadership type people who come here and boast on the profession already lived through a few decades of it. Their overlap with you as a future podiatrist will be minimal. In 10 years when you are practicing many of the APMA people who came here and told us how happy they are will already be on the way out or long gone. They will not experience your tuition debt. They will not experienced the reduced reimbursement that you will experience though they were along for the ride down, satisfied or not. Everything goes up except medical reimbursement.

Several years ago there was an epic movie called "Gone Baby Gone". One of the best parts about it is that the actress who plays Holly from "The Office" plays the most repulsive character. That said, it also has an excellent ending confrontation and a discussion about what someone would say to you 20 years in the future based on what you did to them. In 10 years, if you come back to this forum and you are successful I think you will know how hard it was to be successful. But in 10 years if you come back and you are struggling and you say "why did no one tell me how hard this was going to be be, how little I'd be paid, how deep in debt I'll be, how corrupt insurance is, how overpriced practices are" - I will not be the person who blew smoke at you. Its already bad right now. It will be worse in 10 years.
 
heybrother said:
I recently went to a conference where 2 different APMA representatives told me its terrible what's being done to podiatry by big insurance companies, Medicare Advantage plans etc. One of them was insistent that CMS should be pressing charges against companies like United and Aetna. But you share on SDN that the insurance payor environment is deteriorating you're just a "dissatisfied" podiatrist. Anyone who applies right now is like 7-8 years away from being an attending. Maybe more with a fellowship *wink*. When I went to podiatry school it started at $28K. My school is like mid-$40s now. You are paying for an entire "extra" 2 years (I used to say an extra year, but now its 2) of tuition compared to what I paid. My podiatry school was historically adding $1-2K to tuition a year. When I was a first year resident my 2nd and 3rd co-residents were $270-300K in debt. At current rates, new graduates in identical situations would be at least $40-60K more debt in debt now. After practicing for 2.5 years and making sub-$100K my first year I ultimately bought 1/2 a practice for $90K. Depending on who you ask that may or may not be good value, but the take home is new associates may be asked to bring additional money to the table - your spending doesn't stop when you stop attending school. I met a podiatrist at the same conference above who is $500K in debt and owns a much smaller percentage of their practice (they were also like 6 years ahead of me which is cringe). I am forever grateful that I walked away from the guy who wanted $800K from me. I would have gone under during Covid. In 2016 when I graduated, my practice was paid $349 for a matrixectomy by the most common good health insurance. We are now paid $244 by that insurance because of changes in the underlying Medicare fee schedule (which in general goes down every year). There are numerous relevant podiatry codes that have been dramatically slashed over the last 20 years. Many insurances base their rates on what Medicare pays and as Medicare decreases their rates you can see diminished returns on other insurances and overall reimbursement. You can even see insurances that pay dramatically less than insurance.

I have mixed feelings towards some of my professions leadership organizations, but I'm also grateful to them. CMS wanted to separate podiatry off on our "Evaluation and Management Codes". They were going to create podiatry only codes which were going to be worth nothing. It would have been an epic slaughter. APMA fought it by pointing to language in like, not kidding, the Social Security Act that states that you can't discriminate on any specific physician based on their specialty. Instead we continue to use the same codes as everyone else and the recent 2021 coding change allowed us to dramatically increase our use of 99204/99214 recognizing the complexity of the treatments we provide and the patients we see. That said, APMA, podiatry leadership etc have green lit the opening of new schools and the profession has not even begun to grasp the complications and problems this will cause.

I'm repeating myself, but leadership type people who come here and boast on the profession already lived through a few decades of it. Their overlap with you as a future podiatrist will be minimal. In 10 years when you are practicing many of the APMA people who came here and told us how happy they are will already be on the way out or long gone. They will not experience your tuition debt. They will not experienced the reduced reimbursement that you will experience though they were along for the ride down, satisfied or not. Everything goes up except medical reimbursement.

Several years ago there was an epic movie called "Gone Baby Gone". One of the best parts about it is that the actress who plays Holly from "The Office" plays the most repulsive character. That said, it also has an excellent ending confrontation and a discussion about what someone would say to you 20 years in the future based on what you did to them. In 10 years, if you come back to this forum and you are successful I think you will know how hard it was to be successful. But in 10 years if you come back and you are struggling and you say "why did no one tell me how hard this was going to be be, how little I'd be paid, how deep in debt I'll be, how corrupt insurance is, how overpriced practices are" - I will not be the person who blew smoke at you. Its already bad right now. It will be worse in 10 years.
Click to expand...
 
heybrother said:
I recently went to a conference where 2 different APMA representatives told me its terrible what's being done to podiatry by big insurance companies, Medicare Advantage plans etc. One of them was insistent that CMS should be pressing charges against companies like United and Aetna. But you share on SDN that the insurance payor environment is deteriorating you're just a "dissatisfied" podiatrist. Anyone who applies right now is like 7-8 years away from being an attending. Maybe more with a fellowship *wink*. When I went to podiatry school it started at $28K. My school is like mid-$40s now. You are paying for an entire "extra" 2 years (I used to say an extra year, but now its 2) of tuition compared to what I paid. My podiatry school was historically adding $1-2K to tuition a year. When I was a first year resident my 2nd and 3rd co-residents were $270-300K in debt. At current rates, new graduates in identical situations would be at least $40-60K more debt in debt now. After practicing for 2.5 years and making sub-$100K my first year I ultimately bought 1/2 a practice for $90K. Depending on who you ask that may or may not be good value, but the take home is new associates may be asked to bring additional money to the table - your spending doesn't stop when you stop attending school. I met a podiatrist at the same conference above who is $500K in debt and owns a much smaller percentage of their practice (they were also like 6 years ahead of me which is cringe). I am forever grateful that I walked away from the guy who wanted $800K from me. I would have gone under during Covid. In 2016 when I graduated, my practice was paid $349 for a matrixectomy by the most common good health insurance. We are now paid $244 by that insurance because of changes in the underlying Medicare fee schedule (which in general goes down every year). There are numerous relevant podiatry codes that have been dramatically slashed over the last 20 years. Many insurances base their rates on what Medicare pays and as Medicare decreases their rates you can see diminished returns on other insurances and overall reimbursement. You can even see insurances that pay dramatically less than insurance.

I have mixed feelings towards some of my professions leadership organizations, but I'm also grateful to them. CMS wanted to separate podiatry off on our "Evaluation and Management Codes". They were going to create podiatry only codes which were going to be worth nothing. It would have been an epic slaughter. APMA fought it by pointing to language in like, not kidding, the Social Security Act that states that you can't discriminate on any specific physician based on their specialty. Instead we continue to use the same codes as everyone else and the recent 2021 coding change allowed us to dramatically increase our use of 99204/99214 recognizing the complexity of the treatments we provide and the patients we see. That said, APMA, podiatry leadership etc have green lit the opening of new schools and the profession has not even begun to grasp the complications and problems this will cause.

I'm repeating myself, but leadership type people who come here and boast on the profession already lived through a few decades of it. Their overlap with you as a future podiatrist will be minimal. In 10 years when you are practicing many of the APMA people who came here and told us how happy they are will already be on the way out or long gone. They will not experience your tuition debt. They will not experienced the reduced reimbursement that you will experience though they were along for the ride down, satisfied or not. Everything goes up except medical reimbursement.

Several years ago there was an epic movie called "Gone Baby Gone". One of the best parts about it is that the actress who plays Holly from "The Office" plays the most repulsive character. That said, it also has an excellent ending confrontation and a discussion about what someone would say to you 20 years in the future based on what you did to them. In 10 years, if you come back to this forum and you are successful I think you will know how hard it was to be successful. But in 10 years if you come back and you are struggling and you say "why did no one tell me how hard this was going to be be, how little I'd be paid, how deep in debt I'll be, how corrupt insurance is, how overpriced practices are" - I will not be the person who blew smoke at you. Its already bad right now. It will be worse in 10 years.
Click to expand...
Great response
 
You have done your research on here, IPED and elsewhere.

You like the profession and know the pros and cons. Living the cons is different, but that is any profession.

One of the most important pieces of advice is to do well as you can in school, keep debt low and be geographically open to get a good residency.

Then for a job be as geographically open as you can, but mental health/happiness matters also at that point. Once it is time to get a job you need to be honest with yourself where you will be happy. A certain region, certain state, only one specific city or a certain sized city etc. Most won't really go anywhere for more than a couple years. If you are wide open great, but life is more than podiatry.

When podiatry works out I feel it is probably better than being a PCP. The job market for podiatry is nothing like that of other specialties at all, not even close. Once you choose podiatry that kind of job market is in the rearview mirror. That being said it only takes one good opportunity whether through an add (beware but there are a few good ones), networking, cold calling or opening your own office (not for everyone).

Getting into to podiatry school is the easy part and the job market is the hard part. Like others have said very much the opposite is true of medical school, PAs, CRNAs etc.

I have seen those that do a top 25 percent residency and are not from a saturated region of the country do pretty well in the job search if living a few hours from their family was good enough and living in a city under 100,000. I have seen many of all class ranks find a way to make an office work even in saturated areas. A few will fail. The level of things that might be considered fraudulent and unethical is probably higher in those saturated practice situations, but that is another discussion.

You have been given good and honest advice here and elsewhere. Everyone complains about their profession and seems to tell others to do something else. Podiatry definitely has a few challenges and concerns one should be aware of, but you are aware of those now. If podiatry did not have those issues it would certainly be more competitive to get in.

Best of luck
 
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Adam Smasher said:
I've acknowledged (for students' info, not gloating) I happened to gross 300k last year, but that's business, it might have been a good year, hopefully my best years are still ahead.

I want to emphasize it comes at a price. I literally had to buy my job. What series of wrong life decisions led to this? I work to pay the debt I owe on the place where I work to pay the debt I owe.

In theory, it's an investment, I recoup my practice equity when I sell to the next poor soul, (like a ponzi scheme, haha) but numerous commenters have said it's better to start fresh.

Also not to mention I regularly work 55+ hours/week, I spend a good chunk of my day grinding nails and prescribing magic shoes for welfare recipients, and to take this job I relocated to a part of the country utterly unfamiliar to me, away from everyone I've ever known.
Click to expand...
@SoleScholar

Lots of great replies above, I don't have much new advice lately so I just re-quote some of my better posts from the past. Private practice can be interesting. It can also be frustrating. I wish you the best for the road ahead!
 
Robin-jay said:
I honestly don't know how people go over 200k in podiatry school.

Maybe instead of choosing a California, New York, or the Philly school, one could choose a place that's actually reasonable with COL.

I paid less than 1k an month on expenses (rent, food, wifi, everything). Yes I had to budget well, but I heard many students paying 4k+ a month and I'm just like "how...wtf...are you eating gold"?
Click to expand...
I had a full time working spouse that provided all living expenses for us so I only took out tuition, fees, and all the other direct expenses like equipment. Don't forget the expenses associated with 3rd and 4th year rotations. I got to pay monthly rates for AirBnB while my spuse moved back in with her parents to save money (man that was ridiculous. Sending your spouse to live with her parents for 2 years at 24yo while you live out of state for 2yrs) All that to say I did my best to keep my expenses to a bare minimum, never used loans for partying, a new car, etc and I graduated school with $230k in grad school loans. A better question is how anyone graduates with less than that as a single person. Add in the fact that for 3yrs of residency you accrue interest. My loans were accruing interest at over $1,000/month before the COVID pause. So yeah, 400k is very normal and I'd imagine 300k is closer to the median.
 
I don't believe it's an exaggeration to say Podiatry, currently, might be the worst financially compensated medical profession based on cost, time, and quality of life to get through training and the salary/lifestyle as an attending.

I am a younger attending so I recently ran the job market gauntlet along with many of my peers. The vast majority of associate jobs pay 90-120k with a kicker after bringing in 3x salary. There's also a lot of straight commission positions which sound fine until you get paired with an owner that cherry picks consults and/or has you assist their surgeries for less than you'd make at Walmart hourly (yes I fell for such a gig for awhile). Even the "good" associate jobs that pay base of 150k with bonuses that can get you to 200k will often require a lifestyle similar to residency. The best jobs all seem to be hospital based, VA, or MSGs. You'll have a tough time getting one of those in a major city without connections. If you're okay with living in a rural setting then you can find those jobs more regularly. Even still, when you consider 7 years post-undergrad with 300k in loans and very little choice on where you work if you want to be appropriately compensated, it's a rough choice. Consider being a traveling nurse for those 7 years making what you'd make as an attending without the loans. Or consider an MD/DO would be hard pressed to find a job under 250k and they get to choose their city. Just saying it's not a savvy choice but if it's your passion go for it
 
Forcewielder said:
I had a full time working spouse that provided all living expenses for us so I only took out tuition, fees, and all the other direct expenses like equipment. Don't forget the expenses associated with 3rd and 4th year rotations. I got to pay monthly rates for AirBnB while my spuse moved back in with her parents to save money (man that was ridiculous. Sending your spouse to live with her parents for 2 years at 24yo while you live out of state for 2yrs) All that to say I did my best to keep my expenses to a bare minimum, never used loans for partying, a new car, etc and I graduated school with $230k in grad school loans. A better question is how anyone graduates with less than that as a single person. Add in the fact that for 3yrs of residency you accrue interest. My loans were accruing interest at over $1,000/month before the COVID pause. So yeah, 400k is very normal and I'd imagine 300k is closer to the median.
Click to expand...
Those numbers are absurd and if I would have had loans over 200k, I would have never done podiatry. But to each their own.

But with tutition where it's at now, I might not consider podaitry if I was pre-pod, but who knows.

I paid like 650 a month for most of my time at a pod student for rent, and overall paid less than 1k on average per month. So I still don't understand how numbers could get 300-400k level nonsense unless people do what I have seen quite a bit of -- which is go to a coastal school, pay 2.5k rent a month, and pay big bucks for everything else because the area COL is horrendous.

Go to a fairly rural school and you could literally be saving 50% of expenses you'd pay else where.
 
Forcewielder said:
I had a full time working spouse that provided all living expenses for us so I only took out tuition, fees, and all the other direct expenses like equipment. Don't forget the expenses associated with 3rd and 4th year rotations. I got to pay monthly rates for AirBnB while my spuse moved back in with her parents to save money (man that was ridiculous. Sending your spouse to live with her parents for 2 years at 24yo while you live out of state for 2yrs) All that to say I did my best to keep my expenses to a bare minimum, never used loans for partying, a new car, etc and I graduated school with $230k in grad school loans. A better question is how anyone graduates with less than that as a single person. Add in the fact that for 3yrs of residency you accrue interest. My loans were accruing interest at over $1,000/month before the COVID pause. So yeah, 400k is very normal and I'd imagine 300k is closer to the median.
Click to expand...
It's a ridiculous amount and podiatry is just not worth it for the price anymore. The interest that accrues during school and residency is a killer and people don't consider that when they initially take out the loans and factor that in for the total. For anyone going into podiatry, be prepared to be in debt for a very long time.
 
Robin-jay said:
Those numbers are absurd and if I would have had loans over 200k, I would have never done podiatry. But to each their own. ...
Click to expand...
It all depends on what the end result is imo... the ROI (money and job quality).
Podiatry unfortunately has ROI of 1:2 or 1:3 (at least early on), sometimes even 1:4+ for grads finishing training. That is turrible.

Oh My God Omg GIF by NCAA March Madness


  1. It's not ideal to do $250k-300k debt for DPM training... but it's acceptable if you finish podiatry school graduating high, secure good residency, pass boards... and fairly soon after training, you can get a ~225k VA or rural hospital job or start your own office and make around $300k/yr net (ROI = 1:1... eventually).
  2. It's a great result to end up with $400k debt if you get a great residency, maybe a top DPM fellowship or flex residency connects, and land a 250k+ hospital DPM job (with RVU bonuses) right out of training and end up making $350k+ with great job quality that you like (ROI 1:1 almost immediately).
  3. It's an awesome result to do $300k debt for DPM if you have a parent podiatrist who can help you step into a podiatry career making $300k or even $500k+++ if there are associates (1:1 ROI instantly... and it only gets better and better).
  4. If's a bad result at even $200k-250k debt if one bumbles in pod school, scrambles to a crummy program, fails boards, ends up doing menial chriopody or underpaid associate or mobile podiatry with very limited job options for $100k or $125k or so (ROI = 1:2 and job quality low indefinitely).
...Would you pay $500k for a job that makes $500k+ per year (MD path for most surgery or procedure specialty trainings, especially if they do private school or OOS tuition at any stage)... of course we all would. It's all about ROI in financial and satisfaction and job option terms.
 
Last edited:
Feli said:
It all depends on what the end result is imo... the ROI (money and job quality).
Podiatry unfortunately has ROI of 1:2 or 1:3 (at least early on), sometimes even 1:4+ for grads finishing training. That is turrible.

Oh My God Omg GIF by NCAA March Madness


  1. It's not ideal to do $250k-300k debt for DPM training... but it's acceptable if you finish podiatry school graduating high, secure good residency, pass boards... and fairly soon after training, you can get a ~225k VA or rural hospital job or start your own office and make around $300k/yr net (ROI = 1:1... eventually).
  2. It's a great result to end up with $400k debt if you get a great residency, maybe a top DPM fellowship or flex residency connects, and land a 250k+ hospital DPM job (with RVU bonuses) right out of training and end up making $350k+ with great job quality that you like (ROI 1:1 almost immediately).
  3. It's an awesome result to do $300k debt for DPM if you have a parent podiatrist who can help you step into a podiatry career making $300k or even $500k+++ if there are associates (1:1 ROI instantly... and it only gets better and better).
  4. If's a bad result at even $200k-250k debt if one bumbles in pod school, scrambles to a crummy program, fails boards, ends up doing menial chriopody or underpaid associate or mobile podiatry with very limited job options for $100k or $125k or so (ROI = 1:2 and job quality low indefinitely).
...Would you pay $500k for a job that makes $500k+ per year (MD path for most surgery or procedure specialty trainings, especially if they do private school or OOS tuition at any stage)... of course we all would. It's all about ROI in financial and satisfaction and job option terms.
Click to expand...
This is akin to saying :"It's worth it if it works out, it's not if it doesn't".

I would rather have less than 200k debt and be unsure of my residency than have 400k debt for a guaranteed "good" residency. In my experience doctors are horrendous with monetary decisions.

At some point, you really have to question how much student loans are worth. I would never ever pay 400k for professional schooling. Ever.


Of course I would pay 500k for a job where I would earn 500k a year BUT I would not take that risk, because your scenario is mostly based on some level of risk. I wouldn't risk 500k of debt for the "chance" of a 500k year job. Since no scenario guarantee 500k debt for 500k per year without some uncertainty, I can't say I would take that offer up.
 
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