Why not podiatry?

[the10isplyr]

For those of you who want to do orthopedic stuff...why not just get a DPM? What's the difference, besides the income?

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[87138]

What's the difference, besides the income?

Uh, for starters, the parts of the body you're allowed to operate on.

 

[TexPre-Med]

You need to do some research here. These are completely different career paths. A podiatrist is a foot specialist. An ortho surgeon is a surgical specialist of everything but the head. If I needed surgery on my foot, I'd call an ortho surgeon. If I get an ingrown toe-nail, I'll call a podiatrist.

 

[bozz]

You need to do some research here. These are completely different career paths. A podiatrist is a foot specialist. An ortho surgeon is a surgical specialist of everything but the head. If I needed surgery on my foot, I'd call an ortho surgeon. If I get an ingrown toe-nail, I'll call a podiatrist.

lol

 

[TheRealMD]

I like the idea of being able to explore other specialties before spending the rest of my life training in it. Honestly, it's like picking your specialty before you even start medical school. I would HOPE that podiatry schools are even more stringent on making applicants know what they want, otherwise you're going to have to unhappy doctors.

 

[kypdurron5]

You need to do some research here. These are completely different career paths. A podiatrist is a foot specialist. An ortho surgeon is a surgical specialist of everything but the head. If I needed surgery on my foot, I'd call an ortho surgeon. If I get an ingrown toe-nail, I'll call a podiatrist.

I've actually been curious about this as well, and I haven't found much in the way of commentary on the subject. My questions are- what is so darn special about the foot that it takes a special degree, special school, and 4 years of medical-school-like curriculum to work with ingrown toenails? Why can't a GP treat an ingrown toenail? Let's say you have ingrown toenail plus infection come into the ED; would the EM physician handle this, or call in a podiatrist? Are podiatrists to medicine what chiropractors are to medicine...or is podiatry more legitimate? Would it perhaps be more comparable to optometry in the optometry vs. ophthalmology realm? Is there any CAM/homeopathic/osteopathic component to podiatry education? Where does a GP draw the line between treating or referring to a podiatrist?

 

[HumidBeing]

I've actually been curious about this as well, and I haven't found much in the way of commentary on the subject. My questions are- what is so darn special about the foot that it takes a special degree, special school, and 4 years of medical-school-like curriculum to work with ingrown toenails? Why can't a GP treat an ingrown toenail? Let's say you have ingrown toenail plus infection come into the ED; would the EM physician handle this, or call in a podiatrist? Are podiatrists to medicine what chiropractors are to medicine...or is podiatry more legitimate? Would it perhaps be more comparable to optometry in the optometry vs. ophthalmology realm? Is there any CAM/homeopathic/osteopathic component to podiatry education? Where does a GP draw the line between treating or referring to a podiatrist?

It depends on what state they're in. I think most states it's at the ankle and below, and some states the knee and below.

That's only half jest because of your closing line.

 

[kypdurron5]

It depends on what state they're in. I think most states it's at the ankle and below, and some states the knee and below.

That's only half jest because of your closing line.

It can't be that clear-cut. It's not with other issues- GP's manage acne/rashes/dermatitis until/unless derm referral is necessary (chronic, worsening, really bad case, etc.). They manage diabetes-related foot/hand issues. Don't GP's even do routine pelvic exams? I'm pretty sure they do.

 

[Picklesali]

<-- doesn't like feet

 

[HumidBeing]

It's late. You're tired. I even told you it was a JOKE. You asked where they "drew the line".

The answer wasn't to what a GP can't do. It was the limit of the podiatrist's territory. For what a GP can do, think of it just like you did the dermatology example that you gave. Most GP's aren't going to take impressions for orthotics, or grind down bunions and such, but they may treat plantar warts or ingrown toenails or nail fungus. They may treat diabetic ulcers. Individual GP's are likely to have their own limits to what they are comfortable treating and who they refer. Rarely would they have a foot bath machine in the office so that they can have clean feet to work on. The lack of things like that and proper tools for procedures would be limiting factors in what they chose to do.

Take my answer for what it's worth - a guess from another undergrad. My first answer was just "pulling your leg".😛

 

[XerxesMD]

For those of you who want to do orthopedic stuff...why not just get a DPM? What's the difference, besides the income?

I'm not planning to be an orthopedic surgeon, but I know a bit about this so I'll try to answer.

The main difference between podiatry and orthopedic surgery is that orthopedic surgeons are physicians (holders of an MD or DO) who have a very wide scope of practice with regards to treating and operating on the musculoskeletal system. Orthopedic surgery is one of several medical specialties and requires that you attend a allopathic or osteopathic medical school.

Podiatry is a separate health profession with a more limited scope of practice on the foot and ankle. Podiatrists earn a DPM degree after four years of podiatry school. They can treat and operate on the foot and ankle, with slightly different rules as to the extent of their precise scope of practice in different states.

Unlike orthopedic surgeons, podiatrists are not physicians and therefore have restrictions on doing certain things that orthopedic surgeons do not have. For example, in some hospitals, podiatrists are not allowed to perform a preoperative history and physical or may have to have a physician (usually the anesthesiologist) check/sign-off on their pre-op H and P. In contrast, an orthopedic surgeon can perform his/her own pre-op H and P. I may be wrong about this, but I am pretty sure podiatrists can only prescribe medications related to the treatment of a foot or ankle disorder but can't prescribe a medication to treat something else (say, writing a prescription for an allergy medication for a friend who suffers from allergies). An orthopedic surgeon can prescribe any medication, whether it is Fosamax for a patient's osteoporosis, Nasonex for a friend with allergies or Paxil for his wife's anxiety disorder.

Are podiatrists to medicine what chiropractors are to medicine...or is podiatry more legitimate? Would it perhaps be more comparable to optometry in the optometry vs. ophthalmology realm? Is there any CAM/homeopathic/osteopathic component to podiatry education? Where does a GP draw the line between treating or referring to a podiatrist?

Podiatry is very legitimate. They perform surgeries that alleviate problems for a lot of people, many of whom have diabetes and other serious diseases. I won't pass judgment on chiropractors, but I think it is safe to say that physicians hold podiatrists in higher regard that they do chiropractors.

Regarding comparisons, I think the optometry vs. ophthalmology comparison is pretty accurate. Optometrists are also non-physicians with a more limited scope of practice than ophthalmologists. The tension between these two professions is intense, with optometrists engaging in heavy lobbying efforts to increase their scope of practice and ophthalmologists lobbying to prevent them from doing so. The optometrists have been much savvier than the opthalmologists in this regard and have even managed to win themselves the right to perform ~200 scalpel procedures in the state of Oklahoma. Personally, I don't think that's such a good idea as it might result in serious harm to patients, and ophthalmologists agree.

Some orthopedic surgeons do a fellowship in foot and ankle surgery after their residency, so you can see how similar tensions would exist between them and podiatrists over scope of practice. Predictably, podiatrists lobby to expand their scope of practice while orthopedic surgeons oppose such expansions.

 

[Law2Doc]

It depends on what state they're in. I think most states it's at the ankle and below, and some states the knee and below.

That's only half jest because of your closing line.

May be in jest but not really accurate. Orthopedics is happy to deal with knees or ankles, but you will find no podiatrists who will deal with the knee. I think because podiatrists largely work in an area physicians have less interest in, they haven't drawn the ire that eg chiropractors have. (That and the fact that more folks die when something spinal goes undiagnosed, compared to pedal).
The AMA spent decades in litigation against chiropractors, publicly calling them "quacks". There is a lot of bad blood there that you won't find with other health professions.

 

[HumidBeing]

May be in jest but not really accurate. Orthopedics is happy to deal with knees or ankles, but you will find no podiatrists who will deal with the knee. I think because podiatrists largely work in an area physicians have less interest in, they haven't drawn the ire that eg chiropractors have. (That and the fact that more folks die when something spinal goes undiagnosed, compared to pedal).
The AMA spent decades in litigation against chiropractors, publicly calling them "quacks". There is a lot of bad blood there that you won't find with other health professions.

What I said was not accurate because podiatry is usually only the foot, not the ankle. The area they are allowed to treat, and how much they are allowed to do, varies from state to state. Podiatrists, like many other professions, keep pushing for broader privileges. In some areas, they can get hospital surgical privileges, but it's far from everywhere. Some podiatrists are trained in surgery. Others aren't. Some do orthopedic foot and ankle fellowships.

"Under current statutes, podiatrists in Florida can perform surgery below the knee and can provide nonsurgical treatment up to the hip. Last year (2006), the FOS proactively proposed legislation to restrict all podiatry treatments to the foot and ankle. Although the bill had limited success, it did prompt the Florida Podiatric Medical Association to begin negotiations with the FOS." from an aaoa bulletin last year.

I'm not arguing with you, Law2Doc because I KNOW you know way more than I do. (That's sincere, not joshing.)

 

[TexPre-Med]

I've actually been curious about this as well, and I haven't found much in the way of commentary on the subject. My questions are- what is so darn special about the foot that it takes a special degree, special school, and 4 years of medical-school-like curriculum to work with ingrown toenails? Why can't a GP treat an ingrown toenail? Let's say you have ingrown toenail plus infection come into the ED; would the EM physician handle this, or call in a podiatrist? Are podiatrists to medicine what chiropractors are to medicine...or is podiatry more legitimate? Would it perhaps be more comparable to optometry in the optometry vs. ophthalmology realm? Is there any CAM/homeopathic/osteopathic component to podiatry education? Where does a GP draw the line between treating or referring to a podiatrist?

Podiatrists found a niche. There are a LOT of foot problems and someone capitalized on that. Do podiatrists do anything the medical profession can't or isn't doing: No. In my opinion, podiatry just allows FP's to handle other things. I once went to a podiatrist and made the mistake of telling my PCP this.......he basically told me that if I ever have problems with my feet again, he'd fix it that day.

Few emergency dept. would call in a podiatrist. I have heard of a couple pretty well-known podiatrists who were able to get on an ED's call schedule. It is rare. An ED doc would probably call down the FP resident to handle it - not worth the ED doc's time.

Take it for what its worth but here is the advise from the 1 podiatrist I know well. He told me NOT to go to podiatry school. He regretted not getting better grades in undergrad and doing the med school route. He said that opening a podiatry practice that makes a profit is incredibly difficult (even in Houston where he was located). He graduated #1 from his class (I think it was the NY pod school - not positive), did an internship in surgery, and still had trouble finding a niche. His wife was a pod also and together they opened a practice. They were having so much trouble that he went to law school at night (and graduated UH law) so that if the practice continued to fail, he could feed his family. After about 5 years, his practice did come around and he makes roughly $100,000 a year now.

Compare that to an ortho surgeon that makes $250,000 min. fresh out of residency.

 

[Freddy Pharkas]

<-- doesn't like feet

 

[pride4jc727]

The reason I am not considering podiatry is because I don't have a foot fetish!!!

 

[Cegar]

HAHAHAHAHAHAHAHAHAHAHAHAHA THATS SO FUNNY

 

[Vihsadas]

I've asked a DPM and a few MDs about this and the answer I've gotten basically boils down to "Because that's how its always been". There really isn't a physiological/medical reason why the DPM is a separate degree, or why Podiatry isn't just a specialty underneath the MD umbrella.

 

[Law2Doc]

I've asked a DPM and a few MDs about this and the answer I've gotten basically boils down to "Because that's how its always been". There really isn't a physiological/medical reason why the DPM is a separate degree, or why Podiatry isn't just a specialty underneath the MD umbrella.

Medicine came first. Podiatry saw an underserved niche and grabbed it. Medicine didn't attack them for it (perhaps stick licking it's wounds after losing in litigation trying to stomp out chiropracty), or try to bring them into the fold. So it is separate; a separate degree, separate schools, separate field, separate licensing requirements.

 

[45408]

Honey, I saved a man's life today when I fixed his toenails.


Eh, I'll pass. Besides, I'm not sure what I want to specialize in yet. That would be like going to gynecology school right off the bat.

 

[MossPoh]

You need to do some research here. These are completely different career paths. A podiatrist is a foot specialist. An ortho surgeon is a surgical specialist of everything but the head. If I needed surgery on my foot, I'd call an ortho surgeon. If I get an ingrown toe-nail, I'll call a podiatrist.

You need to do some research here. Many surgically trained podiatrists are MORE qualified than an orthopaedic surgeon to do surgery on your foot. They do A LOT more than cut nails all day, although that is where much of the easy money is for them. Go look at some of the surgeries they do.

If I needed surgery on my shoulder, knee, wrist, or anything else then I'd go to an orthopaedic surgeon. If I had a really messed up foot/ankle required surgery, diabetes, nail problems, bunions, or a bunch of other things then I'd go to podiatry. Really, podiatry gets a bad rap, but I mainly think that is because it is the foot. It is a solid 9-4 job that can be catered to wound care, surgery, or just about anything else. There are guys that spend as much time in the OR as other surgeons and there are ones that stay in the office all day. There is a variety of medicine involved, derm, some anesthesia training, basic rads training, surgical and so on. Many schools actually have the pod and med students in many of the same classes for the first two years, and I believe some schools even have the students rotate together. I feel many people who are currently premeds would actually fit better into podiatry. It has a nice lifestyle and allows you to cater your practice to how you want after residency. Unless you have some dreaded foot phobia it is nothing to frown upon and worth the hour or two of checking out and maybe shadowing.

 

[GoldShadow]

I have a better question.

Why not poetry?

 

[Maxprime]

Hahahahaha! Oh, you're serious?

 

[Quadratic]

Do realize that you wont be just working on your local magazine foot models. I think after a few old men and 2 instances of athletes foot, you'll throw in the towel.

 

[Snake Doctor]

You need to do some research here. Many surgically trained podiatrists are MORE qualified than an orthopaedic surgeon to do surgery on your foot. They do A LOT more than cut nails all day, although that is where much of the easy money is for them. Go look at some of the surgeries they do.

If I needed surgery on my shoulder, knee, wrist, or anything else then I'd go to an orthopaedic surgeon. If I had a really messed up foot/ankle required surgery, diabetes, nail problems, bunions, or a bunch of other things then I'd go to podiatry. Really, podiatry gets a bad rap, but I mainly think that is because it is the foot. It is a solid 9-4 job that can be catered to wound care, surgery, or just about anything else. There are guys that spend as much time in the OR as other surgeons and there are ones that stay in the office all day. There is a variety of medicine involved, derm, some anesthesia training, basic rads training, surgical and so on. Many schools actually have the pod and med students in many of the same classes for the first two years, and I believe some schools even have the students rotate together. I feel many people who are currently premeds would actually fit better into podiatry. It has a nice lifestyle and allows you to cater your practice to how you want after residency. Unless you have some dreaded foot phobia it is nothing to frown upon and worth the hour or two of checking out and maybe shadowing.

Totally agree. Most pre-meds don't even realize that at some schools medical students and podiatry students takes the same courses together the first two years. Chances are, if a patient is a diabetic, podiatrist and MDs/DOs work together as a team to treat the patient.

 

[smq123]

Chances are, if a patient is a diabetic, podiatrist and MDs/DOs work together as a team to treat the patient.

Yep - have had to consult podiatry many times for, basically, "Should we amputate or not? When can that happen?"

The podiatrist at our hospital was a great guy to work with.

 

[smq123]

Do realize that you wont be just working on your local magazine foot models. I think after a few old men and 2 instances of athletes foot, you'll throw in the towel.

You do understand that, as a doctor, you'll ALSO be touching, examining, and treating some of nastiest feet in the world? 😕

 

[Quadratic]

You do understand that, as a doctor, you'll ALSO be touching, examining, and treating some of nastiest feet in the world? 😕

Not on a daily basis.

 

[smq123]

Not on a daily basis.

No - although I'd say 4 days out of 6. Anybody who comes in with any kind of vascular compromise is going to get a foot exam - usually by the doctor.

If you do vascular, this is what you'll get consulted for all the time. (We think he has a gangrenous foot/he has foot cellulitis/"cold and dusky foot" - can you come and take a look?)

And, true, it won't be on a daily basis - but you'll fill in the rest of the time with other things that are equally unpleasant. (Like trying to put in a femoral line on a homeless guy who hasn't showered since Reagan was president, but has no other access, except an IJ that blew a few days ago.)

 

[Quadratic]

No - although I'd say 4 days out of 6. Anybody who comes in with any kind of vascular compromise is going to get a foot exam - usually by the doctor.

If you do vascular, this is what you'll get consulted for all the time. (We think he has a gangrenous foot/he has foot cellulitis/"cold and dusky foot" - can you come and take a look?)

And, true, it won't be on a daily basis - but you'll fill in the rest of the time with other things that are equally unpleasant. (Like trying to put in a femoral line on a homeless guy who hasn't showered since Reagan was president, but has no other access, except an IJ that blew a few days ago.)

That's why God invented Opthalmology.

 

[MossPoh]

. After about 5 years, his practice did come around and he makes roughly $100,000 a year now.

Compare that to an ortho surgeon that makes $250,000 min. fresh out of residency.

That guy is doing something wrong then. The average is higher than that starting. Also, no trauma normally, so you don't have to get up at 3 a.m. and cruise into the hospital to fix a femur.

There are a lot of half-truths going around about podiatry. There was a point where it was an inferior degree. Now, they are more than qualified. I know a few people that chose DPM over a DO/MD. They liked the 9 to 5, the variety, the solid pay, and the benefit to patients. A family practice guy could never do what a podiatrist does. That speaks loads more about what kind of pcp he is than anything else. I highly recommend that people actually spend time with a 3 or 4 year residency trained DPM before passing judgement on hearsay. Hell, go have civil conversation with some of the people in the DPM boards. I have talked to numerous doctors in various specialities that have said in hindsight they WISH they went to DPM, so the story can go both ways. It is a valuable part of the health field like everything else.

 

[smq123]

That's why God invented OpHthalmology.

Fixed. (Seriously, some ophthalmologists get super-pissed if you don't spell it with the H.)

If you're one of the few who can cut into a cornea without getting freaked out, and don't mind practicing almost exclusively outpatient medicine - congratulations. 🙂

I have to say for the record, though, that rotating through ocular oncology was fascinating, but kind of disgusting. The highlight was when one guy was having some infections after his enucleation - and lifted up his eyepatch to reveal a hollow in his face where his eye should be. The hollow was oozing and weeping pus and some weird fibrinous exudate.

Oh, no wait! The ophtho ER was worse! The guy who banged his eyeball up, didn't bother to take out his contact lens because it "hurt" to open the eyelid - so he just smushed some tissue on it, and then taped his eyelid shut. The next day, he opened his eyelid to reveal an eyeball full of green purulent goodness, courtesy of Pseudomonas. I can't believe I forgot about Pseudomonas eye guy.

(And did he go to the ER even after that? Noooo, of course not. He just taped his eyelid back shut because he figured it would "take care of itself." 🙄)

(And most ophtho programs make you do a prelim or a transitional year, so you can't escape disgusting feet and necrotic genitals.)

Basically, the point is - no matter how disgusting the other health professions seem, it's not like being a doctor is necessarily any less digusting. Each medical specialty has its own brand of nauseating patient conditions.

 

[dpmPOD]

After about 5 years, his practice did come around and he makes roughly $100,000 a year now.

Compare that to an ortho surgeon that makes $250,000 min. fresh out of residency.

Your friend is definitely doing something wrong:

Here are some newly released statistics for income of Podiatrists from the 2007 APMA Podiatric Practice Survey:

1. A dramatic increase in the gross incomes of practice owners was found for 2006. The median gross income in 2006 was $400,000, compared to an estimated $275,000 in 2004.
2. A much higher percentage of members reported gross incomes over $500,000 in 2006 (37%) than in 2004 (20%) and 2001 (14%).
3. Net income in 2006 increased substantially from 2004. The median net income in 2006 was $150,000, compared to an estimated $137,500 in 2004.
4. Net income in 2006 was higher for members with high volumes of total patient visits and for members with board certification from the American Board of Podiatric Surgery (ABPS).
__________________
Source: The American Podiatric Medical Association

 

[DeadCactus]

Why not podiatry? Why not dentistry? Why not pharmacology?

Because I don't want to.

 

[TheBigGREEN]

<-- doesn't like feet

whaaat?? i love feet.

 

[FreshPodStudent]

Podiatrists found a niche. There are a LOT of foot problems and someone capitalized on that. Do podiatrists do anything the medical profession can't or isn't doing: No. In my opinion, podiatry just allows FP's to handle other things. I once went to a podiatrist and made the mistake of telling my PCP this.......he basically told me that if I ever have problems with my feet again, he'd fix it that day.

Few emergency dept. would call in a podiatrist. I have heard of a couple pretty well-known podiatrists who were able to get on an ED's call schedule. It is rare. An ED doc would probably call down the FP resident to handle it - not worth the ED doc's time.

Take it for what its worth but here is the advise from the 1 podiatrist I know well. He told me NOT to go to podiatry school. He regretted not getting better grades in undergrad and doing the med school route. He said that opening a podiatry practice that makes a profit is incredibly difficult (even in Houston where he was located). He graduated #1 from his class (I think it was the NY pod school - not positive), did an internship in surgery, and still had trouble finding a niche. His wife was a pod also and together they opened a practice. They were having so much trouble that he went to law school at night (and graduated UH law) so that if the practice continued to fail, he could feed his family. After about 5 years, his practice did come around and he makes roughly $100,000 a year now.

Compare that to an ortho surgeon that makes $250,000 min. fresh out of residency.

I shadowed 5 podiatrists in the Houston area - each one netting over 300K. That's odd he was #1 and couldn't find a better job, he could've easily started with an ortho group anywhere if he did a decent residency. Maybe what happened is that he went into a lot of debt opening up his own practice, and it took a few years for it to break for him? That's not uncommon, which is why most pods shy away from that approach now, unless they are just taking over Dad's

 

[NAVYLABTECH08]

You need to do some research here. These are completely different career paths. A podiatrist is a foot specialist. An ortho surgeon is a surgical specialist of everything but the head. If I needed surgery on my foot, I'd call an ortho surgeon. If I get an ingrown toe-nail, I'll call a podiatrist.

Actually, you need to do your research. For starters, podiatry physicians are not just the foot, but the entire lower leg. Second, a orthropedic surgeon can't touch a podiatrist. A pod learns lower leg from day one. A orthro guy learns all systems, decides to do bones, maybe fellow in foot and ankle. That sounds like a lot of schooling while the pod guy is surgically doing! third, compare the salary of a podiatrist and a orthropedic surgeon. They are NOT that far off in relationships to the excess baggage a bone surgeon carries around. Fourth, who do you think a hospital would rather bring in to do a lower leg surgery, orthro surgeon fellow or pod. My monesy goes on the pod guy who may actully bring money into the hospital! Before you debase another doctor, remember that all of us (MO or DO, or pod) will be specialized physicians. No matter if you specialize in psychology, gas, peds, or the many surgical specialities. The main flaw with the pod approach is that you have already chosen your specialty on day 1 of pod med school. MD/DO gives you time to fish out your path!

 

[bcat85]

Honey, I saved a man's life today when I fixed his toenails.


Eh, I'll pass. Besides, I'm not sure what I want to specialize in yet. That would be like going to gynecology school right off the bat.

Yeah... I think podiatry is interesting don't get me wrong... but it is sort of limited in its scope. You can do prettyyyyy muchh anything with an M.D.

I do know a guy going to podiatry school though and he loves it.

 

[RoyBasch]

Do realize that you wont be just working on your local magazine foot models. I think after a few old men and 2 instances of athletes foot, you'll throw in the towel.

If you think medicine is that much more glamorous, I've got a phrase for you to kick around in your head (put together what it entails)

"disimpacting a bowel"



-Roy

Edit: For the record, I seriously considered podiatry, but other medical specialties seemed more interesting to me than the scope of the lower extremity. The general consensus is that for those seeking "lifestyle" (and I think that's a lot of people on SDN) but still want to be a doctor, Pod might be a far better choice (9-5 is more of a norm for DPMs and not the exception like it is for MD/DOs.) For those who say they are not "real" doctors they make pretty real bank. Those who are simply concerned with being a "real" doctor might want to get their priorities straight before embarking on the 10+ year journey it takes to become an attending physician.

 

[zephryus14]

Podiatry definitely isn't for everyone. Not everyone can handle working with feet all day. Personally, I'd much rather work with feet than scope butts or giving pelvic exams all day.
Some of the above posts do reflect the ignorance of the medical field toward podiatry. Many medical professionals don't know that we go to podiatry school (many of us take classes with MDs) for 4 years, our residencies are either 2 or 3 years (A vast majority are 3 years). Our residencies are SURGICALLY based. We focus solely on surgery of the foot AND ankle and depending on the state soft tissue higher than that. Honestly, would you rather have your ankle fracture fixed by someone who spent 3 years working on them or someone who completed a 1 year fellowship? The advantage that we get toward the foot and ankle comes with our early commitment to our field of study. All of our classes follow the allopathic tract except we don't have classes in behavioral science, embryology and genetics. We focus on the foot and ankle, with additional classes and anatomy labs on more detailed focus of the pelvis down.
If you're confused or have any questions regarding what podiatry students learn in school, what our residencies are like or more let me know. I'd be more than happy to tell you.

 

[Chocolate Bear]

Glad to see that some legitimate knowledge is being dropped on people about podiatry. Like many other aspects in life, ignorance is not only bliss, but is the reason many feuds exist. This is especially true amongst the various providers of healthcare.

I thought I'd also chime in on the Podiatry/GP/Ingrown toenail/Scope of practice issue.

Thanks to the curvature of my first toenails, I've had both sides of both first toes surgically treated, and one of the toes was done twice. The first time was by an overzealous GP. He assured me that he was qualified and that I would NOT need a referral--he would "take care of it." After insufficient local anesthetic, he began a 20 minute ordeal of cutting and literally YANKING AS HARD AS HE COULD on my half-anesthetized toe. He then failed to fully remove the "root" of the nail, thus rendering the "do not grow back" chemical treatment useless.

Enter a regrown, ingrown toenail. I immediately went to a podiatrist, though I was skeptical about anyone trying this procedure again. It took him 10 minutes to fully numb my toe and remove the problem without any pain, pressure, or other sensation. I went back to him for the other toe, as well, and haven't had a problem in 10 years.

Years after all of that, I asked my GP (when I was shadowing him) if he ever did that procedure, to which he responded, "After about three of them, I realized that GPs don't get proper training in that area, and I refer all of my patients to a local podiatrist."

Brilliant.

 

[JaggerPlate]

Heh ... I learned a lot of stuff in reading this thread. Cool.

 

[TexasPhysician]

Your friend is definitely doing something wrong:

Here are some newly released statistics for income of Podiatrists from the 2007 APMA Podiatric Practice Survey:

1. A dramatic increase in the gross incomes of practice owners was found for 2006. The median gross income in 2006 was $400,000, compared to an estimated $275,000 in 2004.
2. A much higher percentage of members reported gross incomes over $500,000 in 2006 (37%) than in 2004 (20%) and 2001 (14%).
3. Net income in 2006 increased substantially from 2004. The median net income in 2006 was $150,000, compared to an estimated $137,500 in 2004.
4. Net income in 2006 was higher for members with high volumes of total patient visits and for members with board certification from the American Board of Podiatric Surgery (ABPS).
__________________
Source: The American Podiatric Medical Association

Almost 40% of owners had a gross income of $500,000, but 50% of owners had a net of $150,000? Either these numbers are highly skewed or pods need to work on economics. That is $350,000/year of overhead. What are you spending over twice your income on yearly? Do toenail clippers cost that much? (kidding). Still, I'm not seeing how you use that much money in an average pod practice/year.

I have heard that pods make decent money once they establish their niche. It isn't easy, and the general public doesn't always know they exist. My parents both have advanced degrees, and neither knew what a podiatrist was until I explained it. It is an up and coming field, but one that is here to stay IMO.

 

[TexasPhysician]

Podiatry definitely isn't for everyone. Not everyone can handle working with feet all day. Personally, I'd much rather work with feet than scope butts or giving pelvic exams all day.
Some of the above posts do reflect the ignorance of the medical field toward podiatry. Many medical professionals don't know that we go to podiatry school (many of us take classes with MDs) for 4 years, our residencies are either 2 or 3 years (A vast majority are 3 years). Our residencies are SURGICALLY based. We focus solely on surgery of the foot AND ankle and depending on the state soft tissue higher than that. Honestly, would you rather have your ankle fracture fixed by someone who spent 3 years working on them or someone who completed a 1 year fellowship? The advantage that we get toward the foot and ankle comes with our early commitment to our field of study. All of our classes follow the allopathic tract except we don't have classes in behavioral science, embryology and genetics. We focus on the foot and ankle, with additional classes and anatomy labs on more detailed focus of the pelvis down.
If you're confused or have any questions regarding what podiatry students learn in school, what our residencies are like or more let me know. I'd be more than happy to tell you.

Serious question here: I've worked in multiple hospitals now, and I've never seen a podiatrist do surgery on someone's foot/ankle, etc.(haven't even heard of it happening). Do yall have hospital privileges? What percentage of pods have privileges? I've seen plenty of ortho residents handle foot/ankle surgery even without this 1 year fellowship. I have seen plenty of outpatient pods practices here in TX, but 0 surgery. What percentage of your practice is invasive surgery?

 

[Pinkertinkle]

Cuz the higher up on the body the better. Cept teeth.

 

[DPMstudent]

serious question here: I've worked in multiple hospitals now, and i've never seen a podiatrist do surgery on someone's foot/ankle, etc.(haven't even heard of it happening). Do yall have hospital privileges? What percentage of pods have privileges? I've seen plenty of ortho residents handle foot/ankle surgery even without this 1 year fellowship. I have seen plenty of outpatient pods practices here in tx, but 0 surgery. What percentage of your practice is invasive surgery?

l-o-l

 

[Leejwwc]

I'm not planning to be an orthopedic surgeon, but I know a bit about this so I'll try to answer.

The main difference between podiatry and orthopedic surgery is that orthopedic surgeons are physicians (holders of an MD or DO) who have a very wide scope of practice with regards to treating and operating on the musculoskeletal system. Orthopedic surgery is one of several medical specialties and requires that you attend a allopathic or osteopathic medical school.

Podiatry is a separate health profession with a more limited scope of practice on the foot and ankle. Podiatrists earn a DPM degree after four years of podiatry school. They can treat and operate on the foot and ankle, with slightly different rules as to the extent of their precise scope of practice in different states.

Unlike orthopedic surgeons, podiatrists are not physicians and therefore have restrictions on doing certain things that orthopedic surgeons do not have. For example, in some hospitals, podiatrists are not allowed to perform a preoperative history and physical or may have to have a physician (usually the anesthesiologist) check/sign-off on their pre-op H and P. In contrast, an orthopedic surgeon can perform his/her own pre-op H and P. I may be wrong about this, but I am pretty sure podiatrists can only prescribe medications related to the treatment of a foot or ankle disorder but can't prescribe a medication to treat something else (say, writing a prescription for an allergy medication for a friend who suffers from allergies). An orthopedic surgeon can prescribe any medication, whether it is Fosamax for a patient's osteoporosis, Nasonex for a friend with allergies or Paxil for his wife's anxiety disorder.



Podiatry is very legitimate. They perform surgeries that alleviate problems for a lot of people, many of whom have diabetes and other serious diseases. I won't pass judgment on chiropractors, but I think it is safe to say that physicians hold podiatrists in higher regard that they do chiropractors.

Regarding comparisons, I think the optometry vs. ophthalmology comparison is pretty accurate. Optometrists are also non-physicians with a more limited scope of practice than ophthalmologists. The tension between these two professions is intense, with optometrists engaging in heavy lobbying efforts to increase their scope of practice and ophthalmologists lobbying to prevent them from doing so. The optometrists have been much savvier than the opthalmologists in this regard and have even managed to win themselves the right to perform ~200 scalpel procedures in the state of Oklahoma. Personally, I don't think that's such a good idea as it might result in serious harm to patients, and ophthalmologists agree.

Some orthopedic surgeons do a fellowship in foot and ankle surgery after their residency, so you can see how similar tensions would exist between them and podiatrists over scope of practice. Predictably, podiatrists lobby to expand their scope of practice while orthopedic surgeons oppose such expansions.

I'm not really interested in podiatry but was just perusing this thread and happened to see your response. That is some great information and insight, thanks for taking the time to share 🙂.

 

[dpmPOD]

Serious question here: I've worked in multiple hospitals now, and I've never seen a podiatrist do surgery on someone's foot/ankle, etc.(haven't even heard of it happening). Do yall have hospital privileges? What percentage of pods have privileges? I've seen plenty of ortho residents handle foot/ankle surgery even without this 1 year fellowship. I have seen plenty of outpatient pods practices here in TX, but 0 surgery. What percentage of your practice is invasive surgery?

http://forums.studentdoctor.net/showthread.php?t=563572&highlight=resident

 

[TMP-SMX]

Fixed. (Seriously, some ophthalmologists get super-pissed if you don't spell it with the H.)

If you're one of the few who can cut into a cornea without getting freaked out, and don't mind practicing almost exclusively outpatient medicine - congratulations. 🙂

I have to say for the record, though, that rotating through ocular oncology was fascinating, but kind of disgusting. The highlight was when one guy was having some infections after his enucleation - and lifted up his eyepatch to reveal a hollow in his face where his eye should be. The hollow was oozing and weeping pus and some weird fibrinous exudate.

Oh, no wait! The ophtho ER was worse! The guy who banged his eyeball up, didn't bother to take out his contact lens because it "hurt" to open the eyelid - so he just smushed some tissue on it, and then taped his eyelid shut. The next day, he opened his eyelid to reveal an eyeball full of green purulent goodness, courtesy of Pseudomonas. I can't believe I forgot about Pseudomonas eye guy.

(And did he go to the ER even after that? Noooo, of course not. He just taped his eyelid back shut because he figured it would "take care of itself." 🙄)

(And most ophtho programs make you do a prelim or a transitional year, so you can't escape disgusting feet and necrotic genitals.)

Basically, the point is - no matter how disgusting the other health professions seem, it's not like being a doctor is necessarily any less digusting. Each medical specialty has its own brand of nauseating patient conditions.

Mmm... Pseudomonas. Uh yeah. The eye can get pretty disgusting. A little Gonorrhea or Chlamydia? Come on. The more purulent the better.

 

[mterp45]

If I was a podiatrist I would only treat women with nice feet and everyone else would be out of luck. No diabetic foot for me. I would probably go bankrupt.

Ok… I’m just kidding. Rain, sleet or shine, medicine is medicine is medicine which is medicine. Podiatry is definitely a good field to go into nowadays, especially with the baby boomer generation.