Considering Podiatry - Pro and Con List - Is It Reasonable and Realistic?

[azumaril]

I am considering podiatry and am trying to do my research before choosing a lifelong career. I am planning to forego applying to MD/DO next cycle to apply DPM. I am having second thoughts given the SDN podiatry forum and the amount of posts discussing if podiatry has a reasonable ROI. I made this pro/con list to see if podiatry would still be a good fit for me. Any additional insight would be appreciated.

Advantages:

1. Choosing Specialty vs. Step Score Choosing For Me - I worked with an orthopedic foot & ankle surgeon for 4 years in clinic and shadowing surgery. I know I like foot and ankle pathology as well as the surgical and clinical aspects of medicine. It doesn’t make sense for me to gamble with the possibility of not matching into ortho as an MD; risking being unfulfilled in my future career when I can go into podiatry and I know I am doing what I love.
2. Specialization - I worked closely with physicians in an Orthopedic department at an academic hospital. I became familiar with the process of residency - residency schedules, responsibilities, and lifestyle. Many residents knew what they wanted to specialize in by PGY2 but had to rotate with specialities they weren’t excited about. This was just one factor contributing to burn out during most rotations. Furthermore, they lost a lot of opportunities surgically by spending significant time in other rotations that were not related to their fellowship/chosen specialty.
3. Lifestyle - Podiatrists, on average, work anywhere from 35-46 hours/weeks from what I could find with a google search. MD/DO counterparts work between 40-60hrs/week but ~25% will work 61-80 hrs/week.
4. Residency Match Rate - Regardless of the two new schools opening, it appears that podiatry match rate into residency is still much higher than that of DO/MD schools.
5. Cost of School - MD/DO school 40-63,000 per year on average with most of the MD schools I was looking to apply to near 50-60,000/ year. Podiatry school is 35-45,000/year and offers merit based scholarships (MD/DO rarely, if ever, does).

Disadvantages:

1. Poor Job Market - From viewing these forums I see that there is a problem currently with saturation. A lot of new graduates are unable to find jobs. Am I willing to live absolutely anywhere? Probably not. I want a family and I want my children to have access to opportunity. Am I okay with not living in NYC, LA, etc? Yes. Alternatively, am I okay with living in the middle of nowhere with a population <2,000? No.
2. Significantly Lower Pay for Surgical Speciality - Red flag to me that salaries are hidden and extremely variable. There seems to be a legitimate possibility of <100,000/yr or no job at all. I know podiatry will not make me rich - I am interested in podiatry because I love the field. Nevertheless, I sadly cannot choose a job that doesn’t pay me enough to make ends meet.
3. Lack of Public Awareness - I think podiatry as a field is very misunderstood by the general public. It appears that the public does view podiatrists as toenail specialists instead of specialized foot and ankle physicians. This affects the patient base for podiatry and the volume of certain cases podiatrists are treating. I like the mix of clinic, surgery, and small procedures. I like post-op follow ups and seeing people’s quality of life improve with medicine. How much of my job will that actually be? Is there a large chance I never see any of that, even if I am surgically trained?

** I have shadowed only one podiatrist who had their own private practice - I fell in love with podiatry through this shadowing experience. After viewing this forum and doing research, I realize this is probably not the reality for many podiatrists. I have not been able to shadow younger podiatrists outside of occasionally working with them when consulted in the ED. Many of my points came through research on this forum and other Internet forums. Please correct me if I am mistaken on any of the above**

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[deleted1093615]

Do what I did and call some offices in an area where you wouldn’t mind living. Most people are happy to answer questions.
in my experience most podiatrists said it was pretty tough to make a buck.
when I told them the current price of the DPM degrees they agreed it’s questionable if it’s worth it. I’ve heard debt to obtain the degree shouldn’t be more than 1-2 times your starting annual salary. With the current tuition prices and low salaries It’s likely to be at least that.
maybe you’ll have a different experience

 

[icebreaker32]

Can you keep debt low? Savings, family help, spouse with good job?

Podiatrists can do well regardless of class rank, but the upper 25 percent that also have a good personality and good work ethic fair much better on average.

It is good you are fairly open geographically.
I think you would do fine.

Make sure you have considered foreign medical school and PA etc in addition to MD/DO. If you do this and find podiatry still appeals to you most, then it is a wise choice for you. You know the pros/cons. Ignore forums like this while in school as much as possible. While there is a lot of truth on here as far as the cons, it does you no good once you have made your decision. It rarely makes sense to change careers for podiatry outside of maybe your first year as far as ROI.

 

[diabeticfootdr]

Can you keep debt low? Savings, family help, spouse with good job?

Podiatrists can do well regardless of class rank, but the upper 25 percent that also have a good personality and good work ethic fair much better on average.

It is good you are fairly open geographically.
I think you would do fine.

These are very good points.

I made this pro/con list to see if podiatry would still be a good fit for me. Any additional insight would be appreciated.

That's actually a pretty thorough, well-researched list. I think you'll do well in any career if this is how you approach problems.

** I have shadowed only one podiatrist who had their own private practice - I fell in love with podiatry through this shadowing experience. After viewing this forum and doing research, I realize this is probably not the reality for many podiatrists. I have not been able to shadow younger podiatrists outside of occasionally working with them when consulted in the ED. Many of my points came through research on this forum and other Internet forums. Please correct me if I am mistaken on any of the above**

Definitely shadow some more. Find a hospital-based podiatrist for contrast with private practice. If you send me a DM and tell me where you are I can probably hook you up with someone.

Also, VA is hard to shadow.

And we always let people shadow here at UT, which has lots of pod students and a busy residency program.

 

[deleted1138023]

I would do something else personally. These 7 years are way longer than you think.

 

[Feli]

...4. Residency Match Rate - Regardless of the two new schools opening, it appears that podiatry match rate into residency is still much higher than that of DO/MD schools...

This is not accurate info.

The MD/DO match rates (US grads) is basically 100% for those who pass the USMLE steps (also nearly 100%).
It gets more dicey for FMGs, but US residencies were never designed to accommodate them.

For podiatry, you need to be VERY much concerned with securing a high quality residency training program. There is a night and day difference between learning major reconstructions, trauma care, passing ABFAS board exams, etc... versus just learning the basic diabetic wound/amp stuff and skin/toenail cares and struggling with surgical board exams. The surgical board pass rates attest to that year after year.

MD and DO residencies are not all exactly the same in terms of quality/volume/diversity either... but they're quite a bit more standardized than podiatry, which has changed residency type/reqs many times over the years. Podiatry programs have MUCH larger variance and many newer programs, so, even if there is not a bona fide residency shortage upcoming, not all DPMs who match or scramble into a spot will get good training. Basically, if you match one ENT program or Ortho program or another as a MD, you will learn the basic and complex procedures and be well very prepared to pass the logical ABMS member surgical boards (95% or much higher rate)... not such in podiatry.

Nobody should go to any professional school type not planning to do the best they can, but it's potentially very detrimental in podiatry to fail student boards and/or match or scramble a poor quality residency program. It happens to 100+ podiatry students every year already even in years with a small or large residency spot surplus: fail student boards, low quality residency, or both. Residency shortages have happened in the past multiple times, and it looks dicey at best with two new schools. Even in a best case scenario where new residencies spring up and existing ones add spots and water down, those top training programs will become scarcer and tougher to match with the new schools. Tuition is obviously not getting any cheaper.

Podiatry can be a very good choice, but the working hard in school and match is serious concern. Not all residencies are good. Basically, consider it a bit like Caribb med school... easy to get into, but reasonably hard to succeed. You had better finish top half or better... or you do risk huge tuition debt with no match, poor match, scramble, etc. The job market is another issue... probably beyond scope for a pre-pod. If you undertake it, getting the best training you can secure is essential.

 

[Adam Smasher]

The financial side has been stated frequently on here and I won't disagree.

As a pod who operates sort of often (10-15 cases/month), I would caution you to not fall for what I've called the podiatry bait and switch. In my opinion, the surgical aspect of podiatry is oversold to pre-health students. I'm not saying you'll never have a busy surgical practice, but there's an excellent chance it won't work out that way. Certainly, you can work hard to rise above the rest, but no one goes into podiatry school not thinking this.

 

[heybrother]

I like that you went into this trying to be systematic, but I think a lot of your summaries still have intrinsic flaws built into them.

I've posted excessively elsewhere about a variety of issues (podiatrists eating their young, reduced reimbursement from health insurance, decreasing Medicare reimbursement in the future, oversaturation, the reality of the profession vs the marketing, being a "surgeon"). Those are real issues.

Here's my big thing for you. I appreciate that you shadowed a podiatrist. I may be putting words in your mouth but I can't help but feel that you think/believe that:

(a) foot and ankle orthopedics is cool (you shadowed, they did good stuff)
(b) podiatry only does foot and ankle (the person you met seemed to have a good practice)
(c) there's so much uncertainty about getting to be a foot and ankle ortho ie. step scores, medical school, competition
(d) why bother doing all that extra stuff like hand, knee, hip, etc
(e) therefore I can avoid uncertainty, "skip the line" and pursue podiatry and get exactly what I want.

This is a path to disappointment. Before I knew how terrible the financials of podiatry are (I own, I see the numbers) I used to tell people - don't go into podiatry believing it is something it isn't. Historic pre-pods questions regularly used to be: I want to be entirely hospital based just seeing inpatients on the floor, or I want to be entirely surgical and operate every single day, or I'm going to manage other problems and use podiatry as a path to medicine/surgery so I'll be just like an MD dosing insulin. Most of those are just not realistic. They show a lack of understanding of what the profession is for the vast majority of people.

Is it possible you will be the podiatrist who somehow has a practice resembling a F&A ortho... it can happen, but its uncommon.

In fact podiatry has just as many or more uncertainties - the biggest of all being - will your training be worth a damn.

If you are deadset on a MSK foot and ankle practice - swing for orthopedic surgery. Historically, if you match into orthopedics - you will have no issues matching to foot and ankle.

 

[diabeticfootdr]

There is a night and day difference between learning major reconstructions, trauma care, passing ABFAS board exams, etc... versus just learning the basic diabetic wound/amp stuff and skin/toenail cares and struggling with surgical board exams. The surgical board pass rates attest to that year after year.

"Basic diabetic wound/amp stuff"?

None of this is basic. People with diabetic wounds and infections have the highest complication rate in podiatry, in a sick population with many medical co-morbidities, and a high recurrence rate.

Perhaps one of the issues with the profession (and one of the board's) is that limb salvage is viewed as "basic", where a podiatrist's care really saves limb and/or life vs fixing a bunion with a couple screws, which is also valuable, but pales in comparison to the risk and medical knowledge you need to do a competent job.

 

[Feli]

"Basic diabetic wound/amp stuff"?

None of this is basic. People with diabetic wounds and infections have the highest complication rate in podiatry, in a sick population with many medical co-morbidities, and a high recurrence rate.

Perhaps one of the issues with the profession (and one of the board's) is that limb salvage is viewed as "basic", where a podiatrist's care really saves limb and/or life vs fixing a bunion with a couple screws, which is also valuable, but pales in comparison to the risk and medical knowledge you need to do a competent job.

It's all important work... I agree...
But it's no small miracle that foot wound I&Ds and amps and nail/derm issues are the work most MD surgeons dodge like the plague and refer out to podiatry. This is common knowledge.

No podiatry residency has a shortage of abscess I&D cases, toe amps, wound clinic, ingrowns, etc... that stuff is abundant anywhere for reasoning above (MDs almost universally don't want that work). Diabetic fractures and recon may or may not be common, but they are easy refers to get. Many of the DPM residencies do have a fairly finite amount of true fracture ORIFs (esp non-diabetic fx), major recon (planus, cavus, non-diabetic fusions, etc), and some have a shortage of even basic elective (HAV, lesser ray/digit, tendon, etc).

Any high quality residency will have the whole spectrum of cases. There is a reason that most of the wound/amp stuff is designated to 1st year residents at most high quality programs (elective and trauma work gets earmarked more for the mid and senior residents). That is what students need to be aware of: not all residencies are equal. Not every DPM who makes it through school and gets any old residency will have the skill and cert and refer base to be doing triples, rheumatoid recon, ankle and Lisfranc fx, etc. One must seek out that competency. All residency-trained DPMs will be able to slap on a "biologic" in office or go to the OR for a re-infected partial hallux amp... yes. I would assume the OP is interested in F&A recon from reading their post and shadow exp.

wound/amp = low skill, low pt expectations
trauma = high skill, low pt expectations
recon/elective = high skill, high pt expectations

 

[Pronation]

It's all important work... I agree...
But it's no small miracle that foot wound I&Ds and amps and nail/derm issues are the work most MD surgeons dodge like the plague and refer out to podiatry. This is common knowledge.

No podiatry residency has a shortage of abscess I&D cases, toe amps, wound clinic, ingrowns, etc... that stuff is abundant anywhere for reasoning above (MDs almost universally don't want that work). Diabetic fractures and recon may or may not be common, but they are easy refers to get. Many of the DPM residencies do have a fairly finite amount of true fracture ORIFs (esp non-diabetic fx), major recon (planus, cavus, non-diabetic fusions, etc), and some have a shortage of even basic elective (HAV, lesser ray/digit, tendon, etc).

Any high quality residency will have the whole spectrum of cases. There is a reason that most of the wound/amp stuff is designated to 1st year residents at most high quality programs (elective and trauma work gets earmarked more for the mid and senior residents). That is what students need to be aware of: not all residencies are equal. Not every DPM who makes it through school and gets any old residency will have the skill and cert and refer base to be doing triples, rheumatoid recon, ankle and Lisfranc fx, etc. One must seek out that competency. All residency-trained DPMs will be able to slap on a "biologic" in office or go to the OR for a re-infected partial hallux amp... yes. I would assume the OP is interested in F&A recon from reading their post and shadow exp.

wound/amp = low skill, low pt expectations
trauma = high skill, low pt expectations
recon/elective = high skill, high pt expectations

Bingo. Thanks for the reality check. Agree 100%. The diabetic limb salvage stuff is very low skill and is exactly why residents that actually went to a good program were taught this in their first year before they were trusted to do things that require more skill. Of course some folks went to subpar programs where they were only exposed to diabetic limb salvage, so they don’t have a comparison of cases that require greater skills. Unfortunately there are a lot of residency programs like this.

 

[wakaflocka88]

Consider this OP. During my 3 years of training, there were weeks when I had 20+ operative ankle fractures. Weeks where we had 20+ inpatients with life threatening severe limb infections requiring multiple staged surgeries. The volume of our program exceeds the average and minimum required to graduate. My current job: minimal to zero limb salvage inpatient stuff, at most 1-2 ankle fractures per week. Bulk of my clinic is “bread butter podiatry.” Point is: what you shadowed and experienced and what I was trained in usually does not equate to your final experience once you’re out on your own. This specifically applies to podiatry. Now if you were F&A ortho trained, whole different story. You can operate 4 days a week if you please and not see a single ingrown nail in your career. Vast difference in terms of what you can expect to do in your career

 

[de Ribas]

I am considering podiatry and am trying to do my research before choosing a lifelong career. I am planning to forego applying to MD/DO next cycle to apply DPM. I am having second thoughts given the SDN podiatry forum and the amount of posts discussing if podiatry has a reasonable ROI. I made this pro/con list to see if podiatry would still be a good fit for me. Any additional insight would be appreciated.

Advantages:

1. Choosing Specialty vs. Step Score Choosing For Me - I worked with an orthopedic foot & ankle surgeon for 4 years in clinic and shadowing surgery. I know I like foot and ankle pathology as well as the surgical and clinical aspects of medicine. It doesn’t make sense for me to gamble with the possibility of not matching into ortho as an MD; risking being unfulfilled in my future career when I can go into podiatry and I know I am doing what I love.
2. Specialization - I worked closely with physicians in an Orthopedic department at an academic hospital. I became familiar with the process of residency - residency schedules, responsibilities, and lifestyle. Many residents knew what they wanted to specialize in by PGY2 but had to rotate with specialities they weren’t excited about. This was just one factor contributing to burn out during most rotations. Furthermore, they lost a lot of opportunities surgically by spending significant time in other rotations that were not related to their fellowship/chosen specialty.
3. Lifestyle - Podiatrists, on average, work anywhere from 35-46 hours/weeks from what I could find with a google search. MD/DO counterparts work between 40-60hrs/week but ~25% will work 61-80 hrs/week.
4. Residency Match Rate - Regardless of the two new schools opening, it appears that podiatry match rate into residency is still much higher than that of DO/MD schools.
5. Cost of School - MD/DO school 40-63,000 per year on average with most of the MD schools I was looking to apply to near 50-60,000/ year. Podiatry school is 35-45,000/year and offers merit based scholarships (MD/DO rarely, if ever, does).

Disadvantages:

1. Poor Job Market - From viewing these forums I see that there is a problem currently with saturation. A lot of new graduates are unable to find jobs. Am I willing to live absolutely anywhere? Probably not. I want a family and I want my children to have access to opportunity. Am I okay with not living in NYC, LA, etc? Yes. Alternatively, am I okay with living in the middle of nowhere with a population <2,000? No.
2. Significantly Lower Pay for Surgical Speciality - Red flag to me that salaries are hidden and extremely variable. There seems to be a legitimate possibility of <100,000/yr or no job at all. I know podiatry will not make me rich - I am interested in podiatry because I love the field. Nevertheless, I sadly cannot choose a job that doesn’t pay me enough to make ends meet.
3. Lack of Public Awareness - I think podiatry as a field is very misunderstood by the general public. It appears that the public does view podiatrists as toenail specialists instead of specialized foot and ankle physicians. This affects the patient base for podiatry and the volume of certain cases podiatrists are treating. I like the mix of clinic, surgery, and small procedures. I like post-op follow ups and seeing people’s quality of life improve with medicine. How much of my job will that actually be? Is there a large chance I never see any of that, even if I am surgically trained?

** I have shadowed only one podiatrist who had their own private practice - I fell in love with podiatry through this shadowing experience. After viewing this forum and doing research, I realize this is probably not the reality for many podiatrists. I have not been able to shadow younger podiatrists outside of occasionally working with them when consulted in the ED. Many of my points came through research on this forum and other Internet forums. Please correct me if I am mistaken on any of the above**

To become successfull in podiatry, it is an uphill battle for many years. Better spend 6 more months, hire personal tutor, take a course or do whatever you can and retake that MCAT and go to MD/DO school. Try 2 times, try 3 but get in and you will be much better.

 

[diabeticfootdr]

No podiatry residency has a shortage of abscess I&D cases, toe amps, wound clinic, ingrowns, etc... that stuff is abundant anywhere for reasoning above (MDs almost universally don't want that work). Diabetic fractures and recon may or may not be common, but they are easy refers to get. Many of the DPM residencies do have a fairly finite amount of true fracture ORIFs (esp non-diabetic fx), major recon (planus, cavus, non-diabetic fusions, etc), and some have a shortage of even basic elective (HAV, lesser ray/digit, tendon, etc).

Agree with that.

 

[PTPuser]

If my loans could be erased, I'd leave yesterday.

 

[diabeticfootdr]

The diabetic limb salvage stuff is very low skill and is exactly why residents that actually went to a good program were taught this in their first year before they were trusted to do things that require more skill.

I see all the diabetic disasters that come from others, MD and DPMs (and also from the patient’s own delays). Low skill leads to disasters.

Yes, there are probably low expectations. But low skill it is not - to salvage these limbs.

Yesterday we filleted out an entire foot to flap a Chopart’s amputation with an ankle/stj fusion.

We’re on standby with leeches and HBOT.

Many people would’ve recommended BKA here. But this is a patient with recent bypass and a contralateral BKA.

Images redacted.

 

[air bud]

"Basic diabetic wound/amp stuff"?

None of this is basic. People with diabetic wounds and infections have the highest complication rate in podiatry, in a sick population with many medical co-morbidities, and a high recurrence rate.

Perhaps one of the issues with the profession (and one of the board's) is that limb salvage is viewed as "basic", where a podiatrist's care really saves limb and/or life vs fixing a bunion with a couple screws, which is also valuable, but pales in comparison to the risk and medical knowledge you need to do a competent job.

Nothing basic about limbs salvage pods bank account

 

[air bud]

Consider this OP. During my 3 years of training, there were weeks when I had 20+ operative ankle fractures. Weeks where we had 20+ inpatients with life threatening severe limb infections requiring multiple staged surgeries. The volume of our program exceeds the average and minimum required to graduate. My current job: minimal to zero limb salvage inpatient stuff, at most 1-2 ankle fractures per week. Bulk of my clinic is “bread butter podiatry.” Point is: what you shadowed and experienced and what I was trained in usually does not equate to your final experience once you’re out on your own. This specifically applies to podiatry. Now if you were F&A ortho trained, whole different story. You can operate 4 days a week if you please and not see a single ingrown nail in your career. Vast difference in terms of what you can expect to do in your career

Waka, also point out you have a great job, Benny's, location you want, security etc.
OP life and experiences change you. It takes time to get this perspective. That is why so many of attendings like Waka are like cool I did that in residency, I have a good gig now and don't do these stuff I trained to do but so what, quality of life and paycheck. Other specialties the sky can be the limit. In Podiatry, sometimes/most often you have to settle. And nothing wrong with that. And it's not always settling, it's realizing what you have is better than most and also a changing of priorities.

Anecdotal story. Friend who is fellowship trained (top 3) and great guy with successful solo practice doing good work in an awesome location close to family....worried that group practice is being bought by only hospital system in town. All ER/wound/PCP referrals going to them. Worried now he has to move. Fortunately he will be in high demand due to training, connections and personality, but still possible major life change due to circumstances completely out of his control.

 

[icebreaker32]

Anecdotal story. Friend who is fellowship trained (top 3) and great guy with successful solo practice doing good work in an awesome location close to family....worried that group practice is being bought by only hospital system in town. All ER/wound/PCP referrals going to them. Worried now he has to move. Fortunately he will be in high demand due to training, connections and personality, but still possible major life change due to circumstances completely out of his control.

This is something seldom mentioned but true. Most hospital jobs are good jobs, but in some areas they verge on a monopoly with podiatry being included.

With enough marketing and creative income streams one might be able to weather the storm in one of these markets if in private practice and established or maybe not.

Not a nationwide concern as healthcare markets are still currently vary a lot from one area to another, but there are not enough organizational jobs for podiatry. There is a trend towards more organizational jobs. The more podiatry monopolies that are created by hospital systems the harder it is for private practice to survive in these markets.

In a monopolized market with 6 hospital employed podiatrists and a coupe PAs the same market without the monopoly might have a dozen in private practice. Not a big deal if podiatry was not saturated, but it is saturated.

In podiatry you have to find or create a good job if you can and then you hope it does not go away.

You can not blame these residents for doing a fellowship if they feel it gives them an edge for an organizational job.

 

[Shiyuan]

I know i’ve said this many times... but look into FQHC’s! Malpractice + good bennys, decent pay, etc...

Some are hidden gems. One I looked into has a single pod who got paid 297k last year. (I know this because FQHC salaries are public knowledge... 990 forms)

 

[deleted1138023]

really impressive. stuff Dr. Rogers. Are those your size 6 gloves? Kidding. great work though!

 

[deleted1138023]

I know i’ve said this many times... but look into FQHC’s! Malpractice + good bennys, decent pay, etc...

Some are hidden gems. One I looked into has a single pod who got paid 297k last year. (I know this because FQHC salaries are public knowledge... 990 forms)

where's the best place to look for these?

 

[Shiyuan]

where's the best place to look for these?

Google haha! Every state should have an FQHC listing/association, may be a good place to start. Note that FQHCs can also have another name/designation - PCMHs (Patient Centered Medical Home).

 

[wakaflocka88]

Waka, also point out you have a great job, Benny's, location you want, security etc.
OP life and experiences change you. It takes time to get this perspective. That is why so many of attendings like Waka are like cool I did that in residency, I have a good gig now and don't do these stuff I trained to do but so what, quality of life and paycheck. Other specialties the sky can be the limit. In Podiatry, sometimes/most often you have to settle. And nothing wrong with that. And it's not always settling, it's realizing what you have is better than most and also a changing of priorities.

Anecdotal story. Friend who is fellowship trained (top 3) and great guy with successful solo practice doing good work in an awesome location close to family....worried that group practice is being bought by only hospital system in town. All ER/wound/PCP referrals going to them. Worried now he has to move. Fortunately he will be in high demand due to training, connections and personality, but still possible major life change due to circumstances completely out of his control.

AirBud is correct here and the above is true. I fell for the bait as a pre-pod that AACPM was promoting us to be “surgeons first, toe nail cutters second.” I’m speaking from the other side obviously but when I was a student, this wealth of information on this forum did not exist. We are just trying to provide our perspective as relatively young attendings that have seen and experienced things you are not told about in school. As a PGY-2, I really thought I wanted a job that mirrored the volume I was seeing and doing but that’s not attainable or feasible for >90% of new PGY-3 grads. Just doesn’t exist for podiatry despite what AACPM claims.

 

[icebreaker32]

I know i’ve said this many times... but look into FQHC’s! Malpractice + good bennys, decent pay, etc...

Some are hidden gems. One I looked into has a single pod who got paid 297k last year. (I know this because FQHC salaries are public knowledge... 990 forms

Not a bad job in many ways. You often do not surgery. Of course if we talk about overall jobs, it is not that many.

You can not be sued and have federal tort coverage, but it is not a federal job. Benefits for employees are required to be a FQHC.

Essentially FQHC are mini non profit primary care clinics. Podiatry is included as an eligible specialty, probably due to diabetes.

Essentially through donations and government funding you are making the clinic private insurance amounts from a poor insurance mix. Each patient visit counts as far as credit for the facility

I know an OBGYN that worked only a couple days a weeks at one and made almost 300K and no liability insurance needed of course. You should see some of the salaries of some of the directors. It will make you realize there is money to be made in non profit organizations.

As far as pay 300K is high for podiatry, but certainly making 160K is not uncommon and making less than 120K is uncommon. If you do well as a podiatrist, it will likely be because you are very busy.

The down sides.

Administration might be really bad. They can get rid of your specialty, replace you or lose their status and shutdown or shutdown a particular location if they have several. Once you do this work for awhile if the job ends, going back to private practice, especially if you do not do any surgery, might be a difficult transition.

 

[footdoctor22]

I am considering podiatry and am trying to do my research before choosing a lifelong career. I am planning to forego applying to MD/DO next cycle to apply DPM. I am having second thoughts given the SDN podiatry forum and the amount of posts discussing if podiatry has a reasonable ROI. I made this pro/con list to see if podiatry would still be a good fit for me. Any additional insight would be appreciated.

Advantages:

1. Choosing Specialty vs. Step Score Choosing For Me - I worked with an orthopedic foot & ankle surgeon for 4 years in clinic and shadowing surgery. I know I like foot and ankle pathology as well as the surgical and clinical aspects of medicine. It doesn’t make sense for me to gamble with the possibility of not matching into ortho as an MD; risking being unfulfilled in my future career when I can go into podiatry and I know I am doing what I love.
2. Specialization - I worked closely with physicians in an Orthopedic department at an academic hospital. I became familiar with the process of residency - residency schedules, responsibilities, and lifestyle. Many residents knew what they wanted to specialize in by PGY2 but had to rotate with specialities they weren’t excited about. This was just one factor contributing to burn out during most rotations. Furthermore, they lost a lot of opportunities surgically by spending significant time in other rotations that were not related to their fellowship/chosen specialty.
3. Lifestyle - Podiatrists, on average, work anywhere from 35-46 hours/weeks from what I could find with a google search. MD/DO counterparts work between 40-60hrs/week but ~25% will work 61-80 hrs/week.
4. Residency Match Rate - Regardless of the two new schools opening, it appears that podiatry match rate into residency is still much higher than that of DO/MD schools.
5. Cost of School - MD/DO school 40-63,000 per year on average with most of the MD schools I was looking to apply to near 50-60,000/ year. Podiatry school is 35-45,000/year and offers merit based scholarships (MD/DO rarely, if ever, does).

Disadvantages:

1. Poor Job Market - From viewing these forums I see that there is a problem currently with saturation. A lot of new graduates are unable to find jobs. Am I willing to live absolutely anywhere? Probably not. I want a family and I want my children to have access to opportunity. Am I okay with not living in NYC, LA, etc? Yes. Alternatively, am I okay with living in the middle of nowhere with a population <2,000? No.
2. Significantly Lower Pay for Surgical Speciality - Red flag to me that salaries are hidden and extremely variable. There seems to be a legitimate possibility of <100,000/yr or no job at all. I know podiatry will not make me rich - I am interested in podiatry because I love the field. Nevertheless, I sadly cannot choose a job that doesn’t pay me enough to make ends meet.
3. Lack of Public Awareness - I think podiatry as a field is very misunderstood by the general public. It appears that the public does view podiatrists as toenail specialists instead of specialized foot and ankle physicians. This affects the patient base for podiatry and the volume of certain cases podiatrists are treating. I like the mix of clinic, surgery, and small procedures. I like post-op follow ups and seeing people’s quality of life improve with medicine. How much of my job will that actually be? Is there a large chance I never see any of that, even if I am surgically trained?

** I have shadowed only one podiatrist who had their own private practice - I fell in love with podiatry through this shadowing experience. After viewing this forum and doing research, I realize this is probably not the reality for many podiatrists. I have not been able to shadow younger podiatrists outside of occasionally working with them when consulted in the ED. Many of my points came through research on this forum and other Internet forums. Please correct me if I am mistaken on any of the above**

I did podiatry school at Temple, and I highly recommend pursuing MD orthopedic. Don't worry about the risk, if your heart is really in it, it will happen. Podiatry, on the other hand, is not worth all the risks and looking back, I wish I would have done Caribbean med school or DO instead. Don't make the mistake that I made!

 

[Prehealth1011]

Go MD (preferably) or DO if you want orthopedics

I have friends who were gung-ho about Ortho and then ended up doing EM (easier to match as DO). Now they’re signing contracts that makes me wonder if a long residency is even worth it

Point is they changed their mind. Can’t do that in Podiatry. You’ll be locked into a 7 year investment. If those cons bother you I would definitely not do podiatry. It’s been the same cons list for years

 

[DexterMorganSK]

I am considering podiatry and am trying to do my research before choosing a lifelong career. I am planning to forego applying to MD/DO next cycle to apply DPM. I am having second thoughts given the SDN podiatry forum and the amount of posts discussing if podiatry has a reasonable ROI. I made this pro/con list to see if podiatry would still be a good fit for me. Any additional insight would be appreciated.

Advantages:

1. Choosing Specialty vs. Step Score Choosing For Me - I worked with an orthopedic foot & ankle surgeon for 4 years in clinic and shadowing surgery. I know I like foot and ankle pathology as well as the surgical and clinical aspects of medicine. It doesn’t make sense for me to gamble with the possibility of not matching into ortho as an MD; risking being unfulfilled in my future career when I can go into podiatry and I know I am doing what I love.
2. Specialization - I worked closely with physicians in an Orthopedic department at an academic hospital. I became familiar with the process of residency - residency schedules, responsibilities, and lifestyle. Many residents knew what they wanted to specialize in by PGY2 but had to rotate with specialities they weren’t excited about. This was just one factor contributing to burn out during most rotations. Furthermore, they lost a lot of opportunities surgically by spending significant time in other rotations that were not related to their fellowship/chosen specialty.
3. Lifestyle - Podiatrists, on average, work anywhere from 35-46 hours/weeks from what I could find with a google search. MD/DO counterparts work between 40-60hrs/week but ~25% will work 61-80 hrs/week.
4. Residency Match Rate - Regardless of the two new schools opening, it appears that podiatry match rate into residency is still much higher than that of DO/MD schools.
5. Cost of School - MD/DO school 40-63,000 per year on average with most of the MD schools I was looking to apply to near 50-60,000/ year. Podiatry school is 35-45,000/year and offers merit based scholarships (MD/DO rarely, if ever, does).

Disadvantages:

1. Poor Job Market - From viewing these forums I see that there is a problem currently with saturation. A lot of new graduates are unable to find jobs. Am I willing to live absolutely anywhere? Probably not. I want a family and I want my children to have access to opportunity. Am I okay with not living in NYC, LA, etc? Yes. Alternatively, am I okay with living in the middle of nowhere with a population <2,000? No.
2. Significantly Lower Pay for Surgical Speciality - Red flag to me that salaries are hidden and extremely variable. There seems to be a legitimate possibility of <100,000/yr or no job at all. I know podiatry will not make me rich - I am interested in podiatry because I love the field. Nevertheless, I sadly cannot choose a job that doesn’t pay me enough to make ends meet.
3. Lack of Public Awareness - I think podiatry as a field is very misunderstood by the general public. It appears that the public does view podiatrists as toenail specialists instead of specialized foot and ankle physicians. This affects the patient base for podiatry and the volume of certain cases podiatrists are treating. I like the mix of clinic, surgery, and small procedures. I like post-op follow ups and seeing people’s quality of life improve with medicine. How much of my job will that actually be? Is there a large chance I never see any of that, even if I am surgically trained?

** I have shadowed only one podiatrist who had their own private practice - I fell in love with podiatry through this shadowing experience. After viewing this forum and doing research, I realize this is probably not the reality for many podiatrists. I have not been able to shadow younger podiatrists outside of occasionally working with them when consulted in the ED. Many of my points came through research on this forum and other Internet forums. Please correct me if I am mistaken on any of the above**

Could you tell us about your GPAs and MCAT score?

 

[azumaril]

Could you tell us about your GPAs and MCAT score?

I have a 3.78 cGPA, 3.5 sGPA, and 512 MCAT.

I planned to apply to MD/DO and am currently in my first gap year getting my application ready. I have not applied to any medical programs in the past; upcoming cycle will be my first. I stumbled upon podiatry at the start of my gap year and it made me reconsider if I should apply MD/DO at all.

I had worked in the ER during my undergrad - occasionally working with podiatrists. They consistently told me they didn't go to "medical school" and only learned F&A. At the time I ruled out podiatry altogether because I wanted a well rounded understanding of medicine. After graduating, I had an ingrown toenail and went to private pod for treatment. I asked about their education, lifestyle, etc. This cleared my initial misconceptions about podiatry and the schooling. Following this second impression, I felt like podiatry offered all of the things I seek from medicine. I definitely need more shadowing experience and this forum has been really insightful.

I tried to be concise in my original post so I may have miscommunicated a couple of points.

I liked that orthopedic surgery offered:

1. treatment options (surgical and nonsurgical) which, for the most part, had good outcomes and could drastically improve a patients quality of life
2. continuity of care (you get to know your patients well and establish patient provider trust).

I'm not hell bent on ortho because I only want to do MSK. Ortho has been the only specialty I have shadowed (given MD/DO route) where you get to know your patients well and can provide reliable treatment options, not just for management but substantial quality of life improvements. For reference, I have shadowed ED, family med, rheumatology, pain management, sports medicine, orthopedic (spine, F&A, total knee/hip), OB/GYN, cardiology, infectious disease. Although I enjoyed learning about all of these specialties, my most gratifying moments in medicine over the past 5 years have been when a patient comes in post-op and is excited to tell me all about their return to their hobbies, playing with grandchildren, or simply completing their activities of daily living without pain. I am not sure if I would be happy in a field where those two above aspects don't coincide. If another specialty offered those things I would also consider it.

Thank you to everyone who has replied. I really appreciate everyones feedback and found this to be very educational.

 

[iridocyclitiss]

I have a 3.78 cGPA, 3.5 sGPA, and 512 MCAT.

I planned to apply to MD/DO and am currently in my first gap year getting my application ready. I have not applied to any medical programs in the past; upcoming cycle will be my first. I stumbled upon podiatry at the start of my gap year and it made me reconsider if I should apply MD/DO at all.

I had worked in the ER during my undergrad - occasionally working with podiatrists. They consistently told me they didn't go to "medical school" and only learned F&A. At the time I ruled out podiatry altogether because I wanted a well rounded understanding of medicine. After graduating, I had an ingrown toenail and went to private pod for treatment. I asked about their education, lifestyle, etc. This cleared my initial misconceptions about podiatry and the schooling. Following this second impression, I felt like podiatry offered all of the things I seek from medicine. I definitely need more shadowing experience and this forum has been really insightful.

I tried to be concise in my original post so I may have miscommunicated a couple of points.

I liked that orthopedic surgery offered:

1. treatment options (surgical and nonsurgical) which, for the most part, had good outcomes and could drastically improve a patients quality of life
2. continuity of care (you get to know your patients well and establish patient provider trust).

I'm not hell bent on ortho because I only want to do MSK. Ortho has been the only specialty I have shadowed (given MD/DO route) where you get to know your patients well and can provide reliable treatment options, not just for management but substantial quality of life improvements. For reference, I have shadowed ED, family med, rheumatology, pain management, sports medicine, orthopedic (spine, F&A, total knee/hip), OB/GYN, cardiology, infectious disease. Although I enjoyed learning about all of these specialties, my most gratifying moments in medicine over the past 5 years have been when a patient comes in post-op and is excited to tell me all about their return to their hobbies, playing with grandchildren, or simply completing their activities of daily living without pain. I am not sure if I would be happy in a field where those two above aspects don't coincide. If another specialty offered those things I would also consider it.

great gpa and great mcat. Apply MD DO!
PM and R is a great field and what you are describing too. Look into that. Do ortho but then do a fellowship in foot and ankle. Do anything but podiatry.

 

[diabeticfootdr]

Although I enjoyed learning about all of these specialties, my most gratifying moments in medicine over the past 5 years have been when a patient comes in post-op and is excited to tell me all about their return to their hobbies, playing with grandchildren, or simply completing their activities of daily living without pain. I am not sure if I would be happy in a field where those two above aspects don't coincide. If another specialty offered those things I would also consider it.

Love your passion! You’ll make a great podiatrist and one day you might lead the profession!

 

[DexterMorganSK]

I definitely need more shadowing experience and this forum has been really insightful.

Your answer to pursuing this field or not is right there. Shadowing more DPMs is the only way. Read what we have here on SDN but don't make a decision based on it; make a decision based on what YOU experience in the real world. That said, the MD/DO field will offer you other options in case you decide to hate the foot and ankle one day. Good luck!

 

[Weirdy]

What Dexter said.

You need to thoroughly shadow.
When you enter podiatry, you are locked in from day one. The opportunities are not the same as MD/DO and there are nuances.
Shadow thoroughly.

 

[icebreaker32]

Podiatry is a risk that things will work out exactly like you have planned in you mind right now. It might.....you are a good applicant, but you have to accept the great residencies and great jobs, especially great jobs in in great locations are not a sure thing....even for a great applicant. The career path you have in mind for podiatry is like going to dental school and wanting to guarantee you will be an orthodontist....you can not guarantee it.

Demand is not great enough for all podiatrists to have great jobs and there is not great training for all as far as residencies.

MDs/DOs are and will be in crazy demand. Good jobs everywhere and very often with signing bonus, relocation and loan repayment assistance very often.

The choice is obviously yours.

 

[Pronation]

I think you've accurately made all of the arguments for and against choosing podiatry.

The things to consider:

- A majority of pods are in private practice (this is supported by searching pod jobs - most are private practice, with about a dozen organizational jobs (hospital etc) available throughout the entire country)

- Look at the salaries for private practice ads and you'll see that they average around $100k... consider 7 years of training and ~300k in loans.

- Salaries for hospital jobs are all $200k+, if hospital employed then can expect to clear 300+ after production bonus. (supported by MGMA data). Do note that at any given time there are about a dozen advertised hospital jobs, and a good portion of these are in rural areas.

The above topics are on the subject of ROI risk. If you go the MD/DO route, it is almost guaranteed that you will make a minimum of 200k at your first job and less likely that you will need to take your first job in a rural area.

If you are interested in doing foot & ankle surgery, just understand that a majority of pods do a few surgeries in a 1-2 week interval (especially in private practice).

In my job search history, I experienced that most hospital employed positions were primarily seeking a podiatrist to do diabetic limb salvage (amputations, managing inpatient diabetic foot wounds/infection). While some hospitals also said that other foot & ankle pathology would trickle into my clinic (pain, injuries, fractures, some hospitals flat out said not to expect anything outside of diabetic limb salvage.

 

[PTPuser]

If you are interested in doing foot & ankle surgery, just understand that a majority of pods do a few surgeries in a 1-2 week interval (especially in private practice).

OP, THIS! Literally this. Won't be doing sexy surgery like they sell this profession out to be unless you're one of the lucky few. And you literally can't go into this profession thinking you're going to be an exception cause that's just gonna set you up for chest pain later in life.

 

[voxveritatisetlucis]

Go MD/DO

 

[heybrother]

You can and should shadow. The problem with shadowing is its very superficial. No one tells you a lot of surgery was basically free. No one tells you - oh, I don't have a 401k or health insurance I'm financially struggling. I find myself thinking of "The Price is Right". You sit their and you shadow the clinic but no one says "now what do you think today was worth". My concern for future grads is that negative payor trends in the future will make reimbursement even worse down the road. The debt is already substantially worse than it was when I graduated in 2016.

Here's what I really want though. I want to hear what happened to you in 7 years. Cya then. Bump this thread.

 

[PTPuser]

You can and should shadow. The problem with shadowing is its very superficial. No one tells you a lot of surgery was basically free. No one tells you - oh, I don't have a 401k or health insurance I'm financially struggling. I find myself thinking of "The Price is Right". You sit their and you shadow the clinic but no one says "now what do you think today was worth". My concern for future grads is that negative payor trends in the future will make reimbursement even worse down the road. The debt is already substantially worse than it was when I graduated in 2016.

Here's what I really want though. I want to hear what happened to you in 7 years. Cya then. Bump this thread.

OP, THIS TOO!!! heybrother, feli, pronation, dtrack and cutwithfury(R.I.P) has not been wrong about any of this. Please think hard. I'm seeing all these train-wrecks unfold before my eyes and it's concerning.

 

[deleted959484]

OP, I was in a very similarly place as you heading into the application cycle of 2020. I ended up dual applying to pod and MD to see how things would work out. Ended up going to MD route despite very generous scholarship offers and getting into all the pod schools… I’m almost done with preclinical and I am sooo happy I went MD route for all the reasons stated above. I’m not gunning for ortho, but even as a pretty average student I can easily go into FM or PM&R and then sports med which will fill the procedural/msk appeal of podiatry, you can obviously go into anything which is the best reason to go MD/DO because you never know what might catch your interest! Dual apply, make an informed choice, and don’t close any doors

 

[diabeticfootdr]

We’re on standby with leeches and HBOT.

Update:

Post-op day #2 flap started to show signs of venous congestion.

Decided to use medicinal leeches (Hirudo medicinalis).

Applied 2 leeches (based on area) for ~30 minutes and repeat every 12 hours.

Levofloxacin 750 mg/daily prophylaxis for Aeromonas hydrophilia (normal flora in the gut of the leech).

 

[Feli]

OP, THIS! Literally this. Won't be doing sexy surgery like they sell this profession out to be unless you're one of the lucky few. And you literally can't go into this profession thinking you're going to be an exception cause that's just gonna set you up for chest pain later in life.

Yeah, very good point.. I was one of the ones who got my top choice residency, basically knew before match, happy with it then, feel well trained now, etc. I also could've shadowed more as a pre-pod (I did many hours, but my hometown DPMs both did just forefoot/toes), so I truly didn't know until I was in pod school that DPMs do fractures, ankles, major recon, etc. I do a good amount of that stuff today (again, minority of DPMs), could be ok without it (probably would have better hours), but I do see many students/residents unhappy with how much real ortho/RRA type surgery most attendings do after residency or how hard it is to find those refers in PP (esp ones with decent insurances!!!).

 

[Pronation]

Update:

Post-op day #2 flap started to show signs of venous congestion.

Decided to use medicinal leeches (Hirudo medicinalis).

Applied 2 leeches (based on area) for ~30 minutes and repeat every 12 hours.

Levofloxacin 750 mg/daily prophylaxis for Aeromonas hydrophilia (normal flora in the gut of the leech).

HOT TAKE: what a colossal waste of resources and taxpayer money. I would happily join an expert panel to recommend denying cases like this from being reimbursed. For every biased journal article that argues the financial and/or clinical viability of this, there are as many high quality/power articles that demonstrate the opposite.

Just out of curiosity, did you give the patient any kind of insight into the probability of failure? If so, what was your opinion the probability of failure?

 

[iridocyclitiss]

great gpa and great mcat. Apply MD DO!
PM and R is a great field and what you are describing too. Look into that. Do ortho but then do a fellowship in foot and ankle. Do anything but podiatry.

Just to piggyback off of my original thought for your sake and others who will eventually read this thread, I wanted to point out a big reason why I said do anything but pod. A lot of these more seasoned docs on here are not paying what we are paying for school. I got pretty lucky and have about 100k in the hole finishing as the 4th year. Had free rent for all four years of school, and applied for every scholarship. Classmates of mine even with the loan stop are in 200-300k. The ROI is pretty hard to determine. The job market is difficult to assess. Some of your teachers at pod school haven't seen patients since Moses saw the burning bush, so you aren't learning relevant material. You are accepting the same amount of loans with a chance of making anywhere from 80k-200k. Not to mention insurance, most PPs don't cover your family. White coat investor says if your income to debt ratio is greater than 3 or 4 to 1 (ex 100k income to 300k in debt) the investment is risky and to reassess the investment.

I recommend MD/DO because it's more stable. There is a stable job market, opportunity everywhere, a stable income, debt relief, and good insurance. You can get lucky and get a great job in podiatry, but just recognize you're picking the harder path with more unknowns. Also your income to debt ratio is much more manageable with a better salary even if you end up being primary care.

 

[wakaflocka88]

HOT TAKE: what a colossal waste of resources and taxpayer money. I would happily join an expert panel to recommend denying cases like this from being reimbursed. For every biased journal article that argues the financial and/or clinical viability of this, there are as many high quality/power articles that demonstrate the opposite.

Just out of curiosity, did you give the patient any kind of insight into the probability of failure? If so, what was your opinion the probability of failure?

I know limb salvage was hotly debated as “low skill” but this is a little overkill. Framing, leech therapy, prophylactic abx due to usage of leech. I’ve only used leech therapy once in training purely out of my curiosity and by the time it got approved the huge wound was already over 50% granulated in just from a wound vac and Santyl over it. Daz it. Can’t recall I ever used anything else besides Dakin (works FANTASTIC), betadine, xeroform and wound vac and of course, aggressive source control.

 

[DexterMorganSK]

OP, you have enough info here to make a decision. Good luck. Closing!