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Whats the deal with Podiatry, why a separate school?

Discussion in 'Topics in Healthcare' started by justskipee, Dec 2, 2005.

  1. justskipee

    justskipee Senior Member
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    I sound like Jerry Seinfeld... "What's the deal with lampshades? I mean if it's a lamp, why do you want shade?"

    Why a separate school for feet doctors?? I don't get it. Shouldn't there be separate schools for hand doctors only, or eyes, or knees...
     
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  3. Turkeyman

    Turkeyman Trickster Poultry
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    I wanna be a right handed index finger's fingernail doctor. Nothing more.

    Nothing wrong with your right index finger's fingernail? Go away.
     
  4. Law2Doc

    Law2Doc 5K+ Member
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    There are several areas of the body that physicians opted not to lock down a monopoly in - dental being the big one, and podiatry being another. Optometrists, phychologists and chiropractors are other big areas where non-physicans have their own schools and administer quasi medical care. None of these areas are physicians, so eg the phrase "foot doctor" is perhaps misleading to the lay person. Scraping caluses and bunions and pulling hang nails wasn't something high on the interest list of the AMA I imagine, so they let this field go without much fight, I think.
     
  5. Elastase

    Elastase StanfUrd bound!!!
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    I got a podiatry brochure in the mail a while back(which I was subsequently made fun of by my family)...but I took the time just to look at it, because I believe some of these specialities outside medicine can be important for some people/patients. Anyways...they mentioned surgery...can podiatrists do surgery? Or do you need an additional M.D. for that...anyone know? I am just wondering, I found that kindof odd...
     
  6. DrMike24

    DrMike24 eat, drink, and be merry
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    My uncle is a podiatrist and does surgerys, amputations, etc.
     
  7. Law2Doc

    Law2Doc 5K+ Member
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    My friend had a hangnail removed and they called it "surgery". It's not really the same thing.
     
  8. justskipee

    justskipee Senior Member
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    hmm. well put law2doc.
     
  9. PurpleHaze

    PurpleHaze Takin it day by day
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    HA HA HA HA HA HA HA HA HA.

    I never realized that podiatrists had their own school. Wow. You learn new things every day.
     
  10. LizzyM

    LizzyM the evil queen of numbers
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    Podiatrists do real surgery. Bunion repair can involve fracturing and reangling bones. :eek:

    Patients tend to be very grateful because foot problems are so disabling.

    The folks who go to a podiatrist for nail clipping & so forth are most often diabetics who can not risk having a wound in the foot (a risk of amateur nail clipping).

    And yes, they carry the title "doctor" and are licensed to practice medicine & surgery of the foot & ankle.
     
  11. 63768

    63768 Guest
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    interesting. i've always wondered this myself.
     
  12. Law2Doc

    Law2Doc 5K+ Member
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    FYI lots and lots of patients (probably most) who go to podiatrists for hangnails and nail clippings do not have diabetes or other ailments, those little procedures are actually a big part of a lot of podiatrists business. (I know a number of them). I wasn't aware of the real surgery you describe, though I believe you, but as I mentioned before they freely term (and bill) less surgical things as "surgery".
    While podiatrists carry the title of doctor of podiatric medicine awarded from their podiatric medical colleges, it is not an MD or DO. As such isn't it is a bit midleading to the public who equates someone providing health care and going by the title "doctor" with medical doctor? If so, this is probably a bad thing, because non-foot related ailments can manifest symptoms in the foot, so people really need to be aware of the training limitations of their caregivers. But my view of podiatry is admittedly tainted by the handful I know very superficially.
     
  13. totalcommand

    totalcommand Senior Member
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    An orthopaedist who focuses in the lower extremeties is just as good as a podiatrist in "surgery"....
     
  14. LizzyM

    LizzyM the evil queen of numbers
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    A podiatrist does college work equivalent to premed (biology, organic chem, physics) and four years of professional school. Podiatrists are a health care professionals with a doctoral degree. Professionally and often socially, they hold the title of "Doctor".

    Try to find an orthopedist who specializes in the foot. There are thousands of board certified podiatric surgeons.

    Failing to respect other health care professionals (other than MDs) is, IMHO, a sign of immaturity and false pride.
     
  15. Law2Doc

    Law2Doc 5K+ Member
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    Perhaps, but what is the medical profession's various professional organizations' position on podiatry? I believe and seem to recall that they at one time were somewhat hostile toward chiropractors and lobbied against that field's use of the title of "doctor" (I guess the AMA etc is immature and falsely proud, by your thinking).
     
  16. LizzyM

    LizzyM the evil queen of numbers
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    Yes, the AMA was hostile toward chiropractors. I don't recall a comparable animosity toward podiatrists or an AMA opinion that they were quacks (the opinion they held of chiropractors). That happens to be ancient history now having gone all the way to the Supreme Court (as a violation of anti-trust laws) in a case that spanned from 1976-1990.
     
  17. chaeymaey

    chaeymaey 1K Member
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    We have a course at my university that teaches that chiropractors are alternative medicine health providers. Maybe that's why the AMA is wary to call them doctors. :shoulder shrug:
     
  18. angietron3000

    angietron3000 *black magic soul power*
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    I agree. I'm not a huge fan of feet so the more podiatrists the merrier! :)
     
  19. Law2Doc

    Law2Doc 5K+ Member
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    If they hadn't lost agains the chiropractors I suspect they would have moved against some of the other fields. But at any rate, your point was that it was immature and disrespectful to be hostile to other health care providers and my point was that the profession (not just SDN premeds) in fact has a long history of this. (And 1990 is hardly "ancient" history -- the same players are still alive.)
     
  20. Flopotomist

    Flopotomist I love the Chicago USPS
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    who goes to a professional to have a hangnail removed? Since I have removed my own many times before, am I guilty of practicing medicine without a license?
     
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  21. jonwill

    jonwill Podiatrist
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    I'm a 3rd year pod med student. It's the real deal folks. 4 years of undergrad, 4 years of pod school, 3 years of surgical residency. Our major employers are multispecialty groups and orthopaedic groups. Ya, I've removed ingrown nails but I've also scrubbed various foot and ankle surgeries. Any of you guys that make it will be sending plenty of your patients to us. We are the medical & surgical specialists of the foot and ankle. Don't worry Flopotomist, I won't sue!!!!!
     
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  22. TheSecret

    TheSecret Junior Member
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    Wow, for being a group of some of the most anal researchers around, I'm amazed at how few of you know about podiatry. Perhaps the "brand *****" mentality that makes people need to get their MD from Hotshot U and do there residency at Massachutsetts General is in effect here, but if you want a career treating patients and practicing medicine and surgery, podiatry is a fantastic option.

    Someone said something about podiatrists being "called doctor professionally and sometimes socially." Well, they earn their D.Pod. degree - they go to 4 years of podiatric medical school, the second two years of which they rotate through clinics right alongside med students (perish the thought!). They then go on to do 2-3 year residencies, and many opt for fellowships after that. Depending on the state, they can be licensed to practice medicine and surgery for anything below the knee (some states limit it to below the ankle).

    Don't discount these guys - ortho don't do a lot of training in the foot anymore, since podiatrists can do anything they can in the region of certification, and compete for the same patients. If you laugh at them now, just don't forget that after a long week of "I have a runny nose, give me antibiotics" cases and the podiatrist's boat in the marina is bigger than yours...
     
  23. emedpa

    emedpa GlobalDoc
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    we have dpm residents where I work who do many of the foot/ankle surgeries both elective and emergent; lis franc fxs, open distal tib/fib, etc...don't fool yourselves folks, these guys are foot and ankle surgeons 1st and diabetic foot specialists second. they have independent o.r. priviledges and their own dea#s. they admit their own pts to the hospital and follow tham as inpts....that being said they are terribly underpaid. many specialty pa's make more than a typical dpm.
    some dpm's in private practice do very well but many make less than 150k despite 4 yrs of premed coursework/4 yrs pod school and 3+ yrs of surgical residency.
     
  24. thinknofu3

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    Just adding my two cents...I'm a allopathic premed (who has been accepted) and I spent one of my undergrad summers in an unpaid internship at one of the top podiatry practices in the country. Podiatrists go to 4 yrs of podiatry school, take boards and do residencies and fellowships the same as MDs. I was in surgery everyday, and saw everything from bunions to tendon transfers. Podiatric surgeons do reconstructive surgery, and some pretty nifty things, pretty much everything an orthopaedic surgeon would do for the foot and ankle (including internal fixation for fractures, which I saw plenty of too). The major difference between them and foot orthopaedics is essentially the techniques they use for their procedures (essentially, a giant male ego contest - which I can say cause i'm a girl :) ) So if you're really interested in feet and ankles, there's absolutely nothing wrong with being a podiatrist - and they have way better hours than ortho surgeons. I just wish all these specialties could learn to get along a little better, I'm sure it would work out better for everyone, especially the patients.
     
  25. emedpa

    emedpa GlobalDoc
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    "and they have way better hours than ortho surgeons."

    Don't know about this...they have inpt rounds, office hours, surgical clinic and night/weekend call just like the ortho guys...they probably get fewer calls when on call but your weekend is still ruined if you are on call for 48 hrs straight regardless of how many cases you have to scrub for
     
  26. jonwill

    jonwill Podiatrist
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    The whole pay issue is a bit complex. Because pod med has changed so much over the past 20-30 years, you are partially right. Some of the old-school docs that have part-time practices and just do a lot of basic foot care don't make a lot. However, the docs coming out of residency these days are starting between 120k and 150k. The 3rd year resident here in Des Moines just got a job with a multispecialty group for 150k. Last years resident went with a orthopaedic group for a little less. Anyway, after 10 years of practice or so, most are making high 100's to low 200's. fyi
     
  27. IlizaRob

    IlizaRob IlizaRob-erator
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    Wow, are you sure you want to go to medical school? I mean, Im not sure you would fit in with all the smart people. The removal of an ingrown toenail can be coded one of two ways. If it is cut out without killing the nail bed, it is not a surgery and podiatrists dont call it such. If they kill the nail bed then it is coded as a surgery, that is how it is classified with medicare, other insurance companies. This is the same whether an FP, Ortho, or Pod does it. I had my toenail removed by an ortho and an FP so if you "pre-meds" (and trust me, its always the pre-meds) think that these precedures are below your level of training, your patients will not be in favor of your condensending attitude. To give you an example of how serious something like a hangnail can be: A podiatrist I know had to remove a big chunk of a 15 yr old kid's big toe because he neglected to do anything about his ingrown nail that eventually ended up eating away his bone by infection. Im sure the next time he gets one he wont think its as petty as you say it is. As stated in previous posts, Podiatrists are very much involved in trauma and reconstruction of the foot and ankle. Please take the time to be educated before making fools of yourselves on SDN.
     
  28. njbmd

    njbmd Guest
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    Hi there,
    Podiatrists are worth their weight in gold when it comes to the management of the feet of diabetics. Many times these folks are unable to correctly take care of even ingrown toenails because of lack of sensation. Regular evaluation by a podiatrist can do wonders for keeping these folks out of the hospital and walking on their own two feet. I often recommend that all diabetics see a podiatrist regularly right along with an opthalmologist for retinal evaluation.

    On the other hand, I have seen people with severe peripheral vascular disease who ended up with bilateral below the knee amputatations because the podiatrist did not properly refer the patient to a vascular surgeon for revascularization and continued to try to treat an infected foot ulcer. If you do not have good blood supply, you are not going to be able to heal an ulcer no matter how many topical agents or antibiotics are applied. Once these non-healing ulcers get to the point of osteomyelitis, amputatation is the only option and it can end up being above the knee which likely means that this person will never walk again.

    Many podiatrists will do toe amputations but again, in a patient with poor run-off, amputation of the toes will not solve the problem. These folks need a recan and stenting or the amputatation wounds will not heal. If they have inflow disese, they will need bypass. These are the realm of the vascular surgeon (me). ;)

    I have seen podiatrists do an excellent job with correction of bunions and club feet. Many orthopedic surgeons have little interest in treating these diseases. The best podiatrists know when to refer to ortho and vascular and have no problems doing so. In the elderly diabetic or patient with peripheral vascular disease, these decisions can be tricky. Knowing how to do ABIs and know how to interpret them is a very valuable skill for podiatrists, internists and family medicine practictioners who are more likely to be managing the on-going care of patients with peripheral vascular disease and diabetes mellitus.

    njbmd :)
     
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  29. jonwill

    jonwill Podiatrist
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    NJBMD is right. Within medicine in general, you see a hesitancy to refer sometimes. I think it's an ego thing. It's like you're admitting that you are not a competent doc or something. Medicine is a profession of specialties. In working together, we can help a lot of people. As a rotating pod student, I see podiatric physicians actively referring to other specialties. However, I'm positive that this is not always the case. On the other hand, we often get referrals from other specialties that, if referred earlier, would have had a much better outcome. In the words of an infamous LA citizen from the 90's, "Can't we all just get along?" :)
     
  30. cosmicstarr

    cosmicstarr Senior Member
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    :clap: :clap: :clap:

    For all those who provided REAL insight into the field of Podiatry. As pre-meds, it's hard to believe that one would not do complete research into other fields of health care.
     
  31. mchobson

    mchobson New Member
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    njbmd,

    You have probably heard of my dad, Robert W Hobson, II. He is chief of vascular surgery at UMDNJ. I have been told he is pretty good at what he does.

    Matt
     
  32. jonwill

    jonwill Podiatrist
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    I have heard that the podiatry residency at UMDNJ is a very good program. I believe Dr. Wallace is the residency director. Have you had much interaction with them?
     
  33. Law2Doc

    Law2Doc 5K+ Member
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    I apologize for any prior comments that may have offended, although my contact with your brethren in the podiatric field to date has been less than impressive. But I'm curious about your latter sentence -- why exactly would someone bound for med school and not even contemplating going into podiatry or another health related field research those fields? Clearly you research the specific career you plan to go into, by why others? :confused:
     
  34. IlizaRob

    IlizaRob IlizaRob-erator
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    Usually one does research before they can know the "specific career plan" they want to go into. 90% percent of med students go into med school not knowing the specialty they desire to enter. Since podiatry is medicine, it would be a possible candidate for research by one interested in medcine in general.
     
  35. Law2Doc

    Law2Doc 5K+ Member
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    Fair enough, but most med students change their minds about specialties they are interested in several times before the end -- not sure you have as much flexibility in podiatry.
     
  36. cosmicstarr

    cosmicstarr Senior Member
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    No problem Law2Doc. Your posts on the med forums in the past have always been insightful, so I was surprised by the negative and somewhat uninformed comments on podiatry. I guess you've had bad experiences with other podiatrists?

    I think it's valid to fully look into podiatry as a field of study for any pre-med. I agree that most will not know what to specialize in, so that is the one thing I find unappealing about podiatry. You're stuck in it, so a pre-med would have to be almost 100% certain about the field prior to entering school. But with the increase and emphasis on surgical podiatric residencies, it seems to be a challenging and rewarding field for someone interested in this type of surgery.
     
  37. Footfxr

    Footfxr Footfxr
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    Your ignorance frightens me... Want to see what a podiatrist does? I challenge you to shadow me. I know you will decline because it's easy to hide behind your ignorant, down right stupid remarks.

    Hopefully, you are not as stupid as you are ignorant. Let's see what witty retort you can formulate.

    Now, if you're smart, you'll choose to educate and take my challenge. Let's see.

    I am a third year resident in NYC.
     
  38. jays2cool4u

    jays2cool4u Senior Member
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    I guess you miss that Footfxr. Law2Doc made a few ignorant comments but then he acknowledges his mistake. There is no need to prove yourself to someone you do not know. Unless you [insert comments here] about your profession.

    Jays2cool4u :cool:
     
  39. Doctor Bagel

    Doctor Bagel so cheap and juicy
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    what would you call a bunionectomy? sawing through bones counts as surgery in my book.

    with the surge of diabetics in this country, i wonder if podiatrists are going to be in growing demand. it's certainly not pretty work, but it's important, especially if you can save someone's foot.
     
  40. fpr85

    fpr85 "newbie"
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    I'm a bit confused here. What is a "foot & ankle" doc classified as? I know that s/he went to medical school whereas a podiatrist went to a separate school. One of our top referral docs is a "foot & ankle" doc, and I hear a lot of patients throw around "podiatrist" loosely. Do orthopaedic docs that specialize in foot and ankle perform the more difficult surgeries whereas pod's perform more basic and routine surgeries? I guess I should research this for myself but any clarification would be much apprecitaed.
     
  41. jonwill

    jonwill Podiatrist
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    With the training that pods now get, the foot and ankle orthopod is a dying breed (there were never many of them to begin with. Those poor docs have enough to deal with). I would assume that's why their fellowships sit vacant every year. Podiatrists are "foot doctors" or "foot and ankle physicians" or "foot and ankle specialists" (whatever you want to call them). They medically and surgically manage the foot and ankle. The majority of foot surgery in the country is done by them. Pods do reconstruction, trauma, etc. In fact, one of our biggest employers are orthopaedic groups. Hope this helps.
     
  42. Orthodoc40

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    I've shadowed a podiatrist in clinic and in the OR.
    They do surgery. Bunion surgery is not simple. Tendon transfers for things like clubfoot... They do surgery.
     
  43. Orthodoc40

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    Lighten up! All Law2Doc said was that "THEY CALLED IT SURGERY" - it IS kind of funny to think of it as surgery. When you see the word surgery most people don't really think of something like that. Heck, I had an ingrown eyelash once (strange but true!) and couldn't believe that taking it out was called surgery! But anyway, there was nothing mentioned about it being all that encompasses the podiatrist's practices, training or skill!
     
  44. Law2Doc

    Law2Doc 5K+ Member
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    Ok -- thx. I gathered that from the posts above too. I stand corrected. Cool.
     
  45. Orthodoc40

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    Sorry - didn't mean to overdo it - I hadn't seen all the other posts before mine...
     
  46. Orthodoc40

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    I believe you are - you should sue yourself!
     
  47. diabeticfootdr

    Podiatrist 10+ Year Member

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    I see you have since appologized for some above insensitive comments. But just to clarify, DOCTOR is in fact an academic title based on your degree. Physicians robbed this title from the educators. Doctor comes from latin meaning "to teach", hence doctrine (teachings).

    Also, you state that the AMA isn't so concerned about what DPMs do. Did you know that a few years ago Lee Sanders, DPM was president of the Amer. Diabetes Association??

    Lawrence Harkless, DPM is chair of the TX Diabetes Council. Vincent Mandracchia, DPM is Chairman of Department of Surgery at Broadlawns Medical Center, Des Moines, IA, he will soon be President of the Medical Staff.

    Just a few examples (if anyone else has any more, let me know)

    LCR
     
  48. Dmayor22

    Dmayor22 Member
    7+ Year Member

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    Are you stating those numbers as a gross income or net income? Also, do Pods get bonuses like some other docs?
     
  49. jonwill

    jonwill Podiatrist
    Podiatrist Moderator Emeritus 10+ Year Member

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    I'm not talking business gross income (like if you owned your own private practice and net is 50% of gross etc), these are their base salaries. So ya, they will get taxed but think of it as a normal paycheck. Bonuses depend on where you're employed. I know docs that are employed by multispecialty and ortho groups and they do get bonuses.
     
  50. LanceFrench

    LanceFrench Junior Member
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    http://www.epodiatry.com/

    Podiatrists are incredible! Surgeries, medications, gait analyses, etc. Check out their website, and some podiatry school websites.

    GO SHADOW ONE! They are great!
     
  51. toofache32

    15+ Year Member

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    Huh? This sounds like some cheap advertisement for a furniture store.
     

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