Podiatry Attending/SDN Moderator - AMA

[ldsrmdude]

Hello everybody! I wanted to create an AMA thread partially as a means to introduce myself to everybody. Even though I’ve been on SDN for more than 12 years, and I’ve been a moderator for more than half of that time, recently I’ve been more absent from the pre-podiatry forums than I want and I feel like I don’t know as many of you as I wish.
Anyways, to introduce myself, I’ve been in practice for about 4 years. I started off in private practice, worked there for about 2 years before a local hospital system bought the practice I worked for, and I’ve been hospital-employed for almost 2 years. I practice in a relatively rural area of the Southeast. My practice is a pretty balanced mix of everything foot and ankle. I do some diabetic foot care, some sports medicine, wound care, occasional trauma, bunions, etc. I live close enough to a few big centers where I can refer patients out if I don’t feel comfortable handling their case. This happens once or twice a year.
I went to school in Arizona at AZPod, and I did my residency at one of the programs in Michigan. I feel like my residency prepared me well for practice.
Fire away!

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[Stronguess]

What were some of your expectations in the field and how well did they match up with your reality? Thanks!

 

[ldsrmdude]

What were some of your expectations in the field and how well did they match up with your reality? Thanks!

I shadowed a few podiatrists before applying and talked to them about the profession so I feel like I had a decent idea of what the field involved. The podiatrists I shadowed we’re private practice and did a lot of routine care and didn’t take hospital inpatient call. One thing I didn’t realize or expect is the amount of inpatient work some podiatrists do. I bought into the line about podiatry being a 9-5 profession and having a great work/life balance. For some it is, but my job is fairly time intensive. I cover 2 hospitals for inpatient call. If I have patients at both hospitals, I usually leave my house around 5:00 AM and I’m home around 6:00 PM. If I don’t have patients at either hospital (rare, but happens), then I leave home around 6:30 AM and I’m home just after 5:00 PM. I’m currently taking call every weekend (generally just rounding), so I probably work 60 hours most weeks. So that’s what I didn’t expect with the profession. I’m happy with my job and optimistic about the field. There are quite a few pessimists in podiatry, but I see no reason to be pessimistic, just realistic.

 

[I Drink Riesling]

Thank you so much for doing this AMA! Would you do podiatry all over again, or choose something else?

 

[GypsyHummus]

Thanks for doing this.

Do you as a pod feel the squeeze that PCP md/DOs are facing with PA/NPs being pumped out?

Do you think Pods will face an over saturation problem like Pharm or ODs? Are there too many pods graduating now?

Do you feel Podiatrists in the hospital system are fairly compensated like MD/DOs in the hospital system?

Do you find licensing to be fair? I have read many accounts of podiatrists being upset with the ABFAS.

Do you think Podiatry is a specialty that people can practice into their 60s or early 70s?

Along with the last question, if for some reason a Podiatrist loses the ability to work with fine motor skills (bloodborne pathology, tremor, physical disability, etc.) do you think it is still possible to make a living in the profession?

Knowing what you know about debt and income, what is your debt level threshold if you were going to go into Podiatry school again? 200K? 300K? I've personally met someone who was 450K in student loan debt with Pod school.

 

[de Ribas]

Thank you for doing this and being here on SDN.

1. Are you working towards any board certification? Do you feel your current job provides you with required numbers and procedures to get certified?

2. When you do inpatient work or weekend call, do you see patients you have seen before (your own patients) or these patients are that came to ER or patients that are there for other reasons but also need to be cared by podiatrist?

Thank you

 

[ldsrmdude]

Thank you so much for doing this AMA! Would you do podiatry all over again, or choose something else?

You’re welcome. And yes, I would do podiatry again if I had to choose. It’s not a perfect profession by any means, but I’m happy with where I am in life. Even when I was in private practice and pretty much hated my job, I still would have chosen podiatry. With that said, it’s not for everyone and I think I could have been happy doing any number of jobs. Certainly some days I wish I made more money or worked less, but overall I’m happy.

 

[ldsrmdude]

Thanks for doing this.

Do you as a pod feel the squeeze that PCP md/DOs are facing with PA/NPs being pumped out?

Do you think Pods will face an over saturation problem like Pharm or ODs? Are there too many pods graduating now?

Do you feel Podiatrists in the hospital system are fairly compensated like MD/DOs in the hospital system?

Do you find licensing to be fair? I have read many accounts of podiatrists being upset with the ABFAS.

Do you think Podiatry is a specialty that people can practice into their 60s or early 70s?

Along with the last question, if for some reason a Podiatrist loses the ability to work with fine motor skills (bloodborne pathology, tremor, physical disability, etc.) do you think it is still possible to make a living in the profession?

Knowing what you know about debt and income, what is your debt level threshold if you were going to go into Podiatry school again? 200K? 300K? I've personally met someone who was 450K in student loan debt with Pod school.

You’re welcome.

I haven’t noticed any pressure from PAs/NPs.

As far as over-saturation, I’m sure there will come a time when there’s over-saturation. There probably is in some areas. In my rural setting, there are several nearby counties without any podiatrists, so I’m definitely not in an over-saturated area. I don’t think there are too many pods graduating now, but there aren’t enough quality jobs to go around. Some will end up either needing to create a good position, spend some time in a lousy job, or go out on their own.

I feel that I am fairly compensated being hospital-employed. If I see more patients or bill more surgeries than my partners, I make more money. We’re all on the same pay format, and that seems about as fair as it can be.

I’ve never had any issues with licensing or ABFAS.

There are pods that practice into their 60’s or 70’s, sure. I plan to practice until 60’s, will plan to take less call, maybe less surgery, and hopefully more teaching. You could find other ways to make money as a podiatrist I suppose. Sticking to just routine care or in-office procedures would be possible. Or maybe consulting, speaking, or advising. Or you could use the degree to go in to another field (law, research, etc). All possibilities.

As far debt, pod school costs too much. It’s probably not going to get any better though. I’d say 200,000 - 300,000 is manageable to pay off as a podiatrist. But student debt is a huge problem as a country. And I’d say the best answer is really to get into as little debt as possible.

 

[ldsrmdude]

Thank you for doing this and being here on SDN.

1. Are you working towards any board certification? Do you feel your current job provides you with required numbers and procedures to get certified?

2. When you do inpatient work or weekend call, do you see patients you have seen before (your own patients) or these patients are that came to ER or patients that are there for other reasons but also need to be cared by podiatrist?

Thank you

You’re welcome.

1. Yes, I have enough cases to be board-certified through ABFAS. I could have sat for foot boards after just a year or two in practice but decided to wait and go for both foot and rearfoot/ankle at the same time so I’ll submit cases this winter. It wasn’t the number of cases that held me back, just needed more diversity.

2. When I’m on call (which is currently 24/7/365), I see my own patients as well as patients I’ve never seen before. I typically see them after they’ve been admitted, but occasionally get consulted from the ED. It’s pretty easy for me to do that right now since my main clinic is attached to one of the hospitals I cover. But I’d say it’s 50/50 whether I’ve previously treated a patient when I get consulted on them. I’ve got plenty of “long-term” patients that always seem to be having problems.

 

[Stronguess]

Are podiatrists being employed in hospitals becoming more common? And would this only be achievable in rural hospitals around the nation?

Also, what would you say is the major difference in your (disliked) private practice experience compared to your current hospital based experience? Is there an issue of job security while being employed in a hospital?

Though it’s practically impossible to predict the future of medicine, but where do you see the state of podiatry in a decade or so?

What would you like aspiring podiatrists to know now before they go out in the real world, especially for those who are already married?

Thanks once again for spreading the knowledge mate!

 

[UnDecided92]

I am planning on going to podiatry school next year and I will be mostly focused on getting a very solid residency. What do you think are the most important factors in choosing a residency especially a very strong residency? Is it the director's reputation or the location? My main interests are in limb salvage and reconstruction. Thanks!

 

[ldsrmdude]

Are podiatrists being employed in hospitals becoming more common? And would this only be achievable in rural hospitals around the nation?

Also, what would you say is the major difference in your (disliked) private practice experience compared to your current hospital based experience? Is there an issue of job security while being employed in a hospital?

Though it’s practically impossible to predict the future of medicine, but where do you see the state of podiatry in a decade or so?

What would you like aspiring podiatrists to know now before they go out in the real world, especially for those who are already married?

Thanks once again for spreading the knowledge mate!

Hospitals employing podiatrists is becoming more common from what I’ve seen. When I was in school or even residency, the big thing many students or residents wanted was to get a job with an ortho group, but it seems that more and more are looking for hospital employment. I don’t know that this is a rural thing, I think we’ll see it at many hospitals.

For me, the big differences have been in pay and benefits. The job itself has stayed pretty much the same. When I sat down with the hospital to discuss my contract, we went over the work I had done in private practice and discussed how I would have been paid as a hospital employee for doing the same amount of work. I would have made almost double what I actually made that year. Plus all all of the benefits that I didn’t get in private practice.
I feel pretty secure in my employment right now, but I suppose unless you’re the boss, there’s always risk of losing your job. My contract has a clause there that I can quit without cause or the hospital can fire me without cause with a certain amount of notice (I think 4-6 months). I think that’s enough time to secure another job if I needed to.

I would assume podiatry in 10 years will keep slowly moving forward in terms of respect. Hopefully there will continue to be a push to put out good literature because that’s one area we are really not that great at.

I think anybody, but especially those with families, should do their research on the profession before going into it. Look at different practice options, and understand that a great job is not guaranteed. Because podiatry is a relatively small field, there will always be limited options for jobs. If you’re set on a specific location or practice setting, be realistic and understand that not everyone will be making tons of money doing big surgeries. As a profession, we still do a lot of diabetic foot care, wound debridements, abscess drainage, amputations, etc. It’s a great profession if you understand and accept what it is and what it isn’t. Not every job pays well and has great benefits, not every job is 8-5, and not every podiatrist is a great surgeon. Take the good with the bad, come in with both eyes open, and I think it’s a pretty good profession to be in.

 

[zapproximator1]

I've seen a ton of variation in podiatrist salaries, from very low 100s to high 400+. What would you expect median total salary range to be for an good, experienced podiatrist at a hospital, group practice, solo practice, etc? Thank you so much!

 

[ldsrmdude]

I am planning on going to podiatry school next year and I will be mostly focused on getting a very solid residency. What do you think are the most important factors in choosing a residency especially a very strong residency? Is it the director's reputation or the location? My main interests are in limb salvage and reconstruction. Thanks!

I think that my best advice would be to take it one step at a time. Focus on doing great your first semester, then first year, then second year, choose good rotations and clerkships for 3rd and 4th years, and then start focusing on residency. Be open to your interests changing as you get more experience and exposure, but always try to do your best with the task you have at hand.
As far as choosing a residency, I feel about the same way I do for picking a school. I think “fitting in” and having a good “gut feeling” about a program is important. No program is perfect but there are a lot of programs that will train you well. Personally, I don’t think location should be high on the list when it comes to choosing a residency. For 3 years, you should be able to deal with just about any location if it means you get good training. A directors reputation probably helps mostly when it comes time to get a job. My residency director wasn’t a big name guy with a big reputation. But he was a great surgeon and taught well and was dedicated to our program. I’d rather have that then a director who is gone half of the time lecturing at conferences or would rather work with fellows than residents.
When it comes to choosing a residency, have an idea about what you want to be doing after graduation. Do you want to be in an ortho group doing reconstruction and trauma, would you rather be in private practice doing bunions and hammertoes, or do you want to be involved heavily with research? Look at where graduates of the program have ended up and what kind of jobs they have. If a program has a lot of graduates doing big recon cases and leading other residency programs and that is what interests you as a career, look into that program. Almost all the graduates of my program ended up in community group practices. Probably not the place for you if you want to be the next ex-fix whiz or Charcot king. I hope my rambling thoughts make sense.

 

[Stronguess]

Would you consider, for now, hospital based employment opportunities to be “invisible” meaning they’re there but only if you ask/look for them? If you don’t mind can you explain how you or how others you know have gotten into hospital based employments?

Sorry if it feels like I’m hogging up the thread, thanks again mate!

 

[UnDecided92]

I think that my best advice would be to take it one step at a time. Focus on doing great your first semester, then first year, then second year, choose good rotations and clerkships for 3rd and 4th years, and then start focusing on residency. Be open to your interests changing as you get more experience and exposure, but always try to do your best with the task you have at hand.
As far as choosing a residency, I feel about the same way I do for picking a school. I think “fitting in” and having a good “gut feeling” about a program is important. No program is perfect but there are a lot of programs that will train you well. Personally, I don’t think location should be high on the list when it comes to choosing a residency. For 3 years, you should be able to deal with just about any location if it means you get good training. A directors reputation probably helps mostly when it comes time to get a job. My residency director wasn’t a big name guy with a big reputation. But he was a great surgeon and taught well and was dedicated to our program. I’d rather have that then a director who is gone half of the time lecturing at conferences or would rather work with fellows than residents.
When it comes to choosing a residency, have an idea about what you want to be doing after graduation. Do you want to be in an ortho group doing reconstruction and trauma, would you rather be in private practice doing bunions and hammertoes, or do you want to be involved heavily with research? Look at where graduates of the program have ended up and what kind of jobs they have. If a program has a lot of graduates doing big recon cases and leading other residency programs and that is what interests you as a career, look into that program. Almost all the graduates of my program ended up in community group practices. Probably not the place for you if you want to be the next ex-fix whiz or Charcot king. I hope my rambling thoughts make sense.

Perfect advice thank you so much!

 

[ldsrmdude]

I've seen a ton of variation in podiatrist salaries, from very low 100s to high 400+. What would you expect median total salary range to be for an good, experienced podiatrist at a hospital, group practice, solo practice, etc? Thank you so much!

That’s a good question. The reason there is so much variation in any survey you read is because there is a lot of variation in the salaries themselves. The MGMA data, which is not really for private practice, has the median for a surgical podiatrist somewhere in the mid-200s for total compensation. I’d say that’s probably accurate from what I’ve seen. Private practice is trickier. As a new graduate in private practice, I would say you’ll be seeing salary offers from 70-120k plus some sort of a bonus. Probably total salary plus bonus in most private practices just starting out would be low to mid 100k. After a few years, if you’re still an associate I’d anticipate around 200k total salary plus bonus. As a partner, it’s usually “eat what you kill” plus split expenses and whatever ancillary income there is from a surgery center or something like that. That’s probably where the higher salaries are at, either as an owner of a private practice with associates working for you and making money for you or as a partner in a group that brings in ancillary income. It’s certainly possible to make that much as a solo practitioner, but you’d probably be really busy.

 

[ldsrmdude]

Would you consider, for now, hospital based employment opportunities to be “invisible” meaning they’re there but only if you ask/look for them? If you don’t mind can you explain how you or how others you know have gotten into hospital based employments?

Sorry if it feels like I’m hogging up the thread, thanks again mate!

In a lot of examples, the hospital jobs either aren’t advertised or when they are, they get hundreds of applications. Sometimes the position doesn’t even exist until you create it.

Like I mentioned above, I worked in private practice for 2 years, and then a local hospital system bought the practice I worked for. So I didn’t really go after a hospital job, it just came to me. Like I mentioned, if a hospital job is advertised, there are usually a lot of applicants, so it can be tough to stand out, especially if you are a new graduate. I know some who have had success by contacting hospitals directly and talking to them about hiring a podiatrist if they don’t already. Sometimes that can lead to a new job being created that never gets advertised and you can fill that spot. Finding a good job usually involves a bit of work and a lot of luck.

And don’t worry about asking questions, that’s what this thread is for.

 

[Dochopeful13]

That’s a good question. The reason there is so much variation in any survey you read is because there is a lot of variation in the salaries themselves. The MGMA data, which is not really for private practice, has the median for a surgical podiatrist somewhere in the mid-200s for total compensation. I’d say that’s probably accurate from what I’ve seen. Private practice is trickier. As a new graduate in private practice, I would say you’ll be seeing salary offers from 70-120k plus some sort of a bonus. Probably total salary plus bonus in most private practices just starting out would be low to mid 100k. After a few years, if you’re still an associate I’d anticipate around 200k total salary plus bonus. As a partner, it’s usually “eat what you kill” plus split expenses and whatever ancillary income there is from a surgery center or something like that. That’s probably where the higher salaries are at, either as an owner of a private practice with associates working for you and making money for you or as a partner in a group that brings in ancillary income. It’s certainly possible to make that much as a solo practitioner, but you’d probably be really busy.

Thanks for the great info. It seems that just the starting salaries are a bit low but they quickly jump up over 200 k a few years in.

 

[ldsrmdude]

Thanks for the great info. It seems that just the starting salaries are a bit low but they quickly jump up over 200 k a few years in.

Well, hopefully, but unfortunately I wouldn't say that's guaranteed. There are unfortunately jobs where that won't happen.

 

[Weirdy]

1. Are you satisfied with the variety of cases in your current work place?
2. Did you come out wanting to specialize in something specific and ended up liking something else?
3. Are you financially stable (relatively in your own view) enough to raise a family + have some left over to put into savings/ invest?
4. How did you decide to tackle your debt if you don't mind us asking? Did this strategy change after your 1st, 2nd, 3rd job as you settled into the groove of things?
5. What do you value that keeps you going? Is it family? That odd meaningful patient interaction? A combination of different things?

 

[ldsrmdude]

1. Are you satisfied with the variety of cases in your current work place?
2. Did you come out wanting to specialize in something specific and ended up liking something else?
3. Are you financially stable (relatively in your own view) enough to raise a family + have some left over to put into savings/ invest?
4. How did you decide to tackle your debt if you don't mind us asking? Did this strategy change after your 1st, 2nd, 3rd job as you settled into the groove of things?
5. What do you value that keeps you going? Is it family? That odd meaningful patient interaction? A combination of different things?

Sorry it’s taken me so long to reply.

1. Yes, I’m pretty happy with the cases I see. In my small group, I get referrals from my partners for cases they don’t feel comfortable doing. If I don’t feel comfortable doing it, I can refer it out to a larger facility. I wish I did more trauma, but I will hopefully start seeing a little more at my new office.
2. When I started school I thought I might like sports medicine more than I actually do. Now, I handle a little bit of everything (and a lot of diabetic foot stuff) and that’s just fine with me.
3. Yes, with my hospital-employed position. I would have answered no when I still worked in private practice.
4. I’ve taken a longer-term view of debt and decided to take more time to pay it back. I’m making way more progress on it now than I have previously but I am not paying it off as fast as others I know.
5. There are a lot of things. I sort of feel like medicine in general is a bit of a calling, as cliche as that sounds. I find it fairly easy to stay dedicated when I feel like I’m making a difference. I enjoy working with people and I get along with most people pretty well. I like helping people and that makes me stay motivated.
I’m a family guy, and spend most of the time I’m not at work with my family. That’s how I keep centered on the really important things because I think I would be a huge workaholic otherwise.

 

[ldsrmdude]

I went ahead and added this AMA thread to the list of AMA threads that is stickied at the top of this forum, but please feel free to keep asking questions! If you have a question you would rather ask privately, feel free to PM me as well.

 

[podiatryfootinmouth]

Incoming student to TUSPM Class of 2023 here. I was wondering if you could give some insight on working in the hospital system as a podiatric surgeon. Surgery, specifically limb salvage or other reconstructive procedures are my interest, and I was wondering the advantages/disadvantages to staying in the hospital system for my future career in podiatry.

 

[ldsrmdude]

Incoming student to TUSPM Class of 2023 here. I was wondering if you could give some insight on working in the hospital system as a podiatric surgeon. Surgery, specifically limb salvage or other reconstructive procedures are my interest, and I was wondering the advantages/disadvantages to staying in the hospital system for my future career in podiatry.

There are pro’s and con’s to working in a hospital system as a podiatrist. Pay and benefits are better than you’d likely find in private practice as an employee. There is often a built-in source of referrals with other hospital-employed physicians, ie family practice, ED, pediatrics, etc. On the other hand, you generally have less control. If they want you to work in a certain clinic, that’s where you work. If they want you to see 40 patients a day, that’s how many they will try to schedule. Now, hospitals usually want to keep their physicians happy, so I’m my experience they don’t dictate everything, they try to work with you, but in the end, they are in charge to a certain degree. If they don’t want you doing limb salvage, you may not be doing much limb salvage. My hospital doesn’t really get involved in that and if I want to focus more on surgery, they would let me. If I want to see trauma, they’ll work with me. It depends on the hospital. My group was the first set of podiatrists our hospital had hired so they pretty much just let us dictate how we practice, but over time I can tell they’re trying to dictate more and more where we practice and our schedule. Basically, it depends. My hospital system has been good to work with, but I’m sure there are others that want to dictate what type of practice you have. When you are looking for a job, see if they already employ podiatrists and see how they’re treated. If you’re the first, ask a lot of questions about what they anticipate your practice looking like and what sort of control you’ll have in regards to what the practice looks like. I feel like some hospital administrators need to justify their jobs, so they try to dictate how physicians practice. Stay away from those types.