Should All Podiatrists Be Primarily Surgeons?

[DexterMorganSK]

I wanted to know your opinions after reading the following article by Dr. JARROD SHAPIRO

https://www.podiatrym.com/pdf/2019/3/Shapiro319web.pdf

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[Podstar]

I agree with some points and disagree with others. We do have a recruitment problem, but I don’t think it’s because podiatry advertises the surgical side so hard. It’s because we treat feet, which is probably the least desirable area of the body to treat for the majority of people wanting to go into medicine and podiatry is still seen as a backup/second rate to MD/DO. I can’t speak on his suggestions for surgical and clinical podiatrists and the practice style he suggests because I am still in school and do not have the experiences to make a truly educated opinion. Personally, I probably wouldn’t work in this type of practice because I am currently interested in a variety of pathology and could not see myself doing just surgery or just clinic alone. I personally like the idea of 1 surgery day, 1 wound clinic day, and 3 regular clinic days.

 

[J29622]

I don't think people should be forced into doing anything they don't want to do. That being said, I don't really know of anyone who wants to do strictly chiropody. Surgery is a major selling point for applicants, and it was certainly the case for me as well. Maybe not everyone wants to be in the OR all day every day, but literally everyone I've asked is interested in at least doing *some* surgery.

I would have done a DO were podiatry like it is in the UK and strictly orthotics and nail care with the occasional callus or two. It was because podiatry is a sure bet for a surgical specialty, and a pretty attractive one at that, that I was interested in it.

Lack of applicants is a combination of wariness of an early commitment to a single body part, perceived stigma against the field, the stigma associated with working on feet and a lack of awareness that we even exist as an option. Two of those are largely due to misconceptions and wrong assumptions about the profession, which IMO is where the focus should be in attracting more people. Making it more known that podiatrists are qualified surgeons and do more than cut toenails would in all likelihood be beneficial for recruitment.

 

[air bud]

No

 

[air bud]

I don't think people should be forced into doing anything they don't want to do. That being said, I don't really know of anyone who wants to do strictly chiropody. Surgery is a major selling point for applicants, and it was certainly the case for me as well. Maybe not everyone wants to be in the OR all day every day, but literally everyone I've asked is interested in at least doing *some* surgery.

I would have done a DO were podiatry like it is in the UK and strictly orthotics and nail care with the occasional callus or two. It was because podiatry is a sure bet for a surgical specialty, and a pretty attractive one at that, that I was interested in it.

Lack of applicants is a combination of wariness of an early commitment to a single body part, perceived stigma against the field, the stigma associated with working on feet and a lack of awareness that we even exist as an option. Two of those are largely due to misconceptions and wrong assumptions about the profession, which IMO is where the focus should be in attracting more people. Making it more known that podiatrists are qualified surgeons and do more than cut toenails would in all likelihood be beneficial for recruitment.

Great post. Yeah, I didn't want to risk being forced to go PCP, so they guarantee of surgery was huge

 

[Weirdy]

Like everyone else has mentioned.
Article's argument is very level-headed.

Cannot advertise without mentioning surgery. Ability to do these procedures on top of bread and butter stuff makes this profession unique, inferiority complex/ image issues regardless.
Not everyone coming in wants to do 100% surgery, myself included. Not realistic to expect that when you get out and the article mentions that.


When you train, train balls to the walls- surgery included.
When you get out and practice, do what you like, what brings you the most money/fulfillment.

 

[heybrother]

My experience reading this forum for years is that we are drawing way more people who are excited about the thought of having a "backdoor" way into surgery than losing people because they won't have the option to be mostly clinical. If students are doing any shadowing at all what I strongly suspect they are finding is that most podiatrists are very minimally surgical. The clinical option is really the majority of people's work-week. We don't need to advertise it because its already what people see. The guy I shadowed did 1 Austin during the time period I was shadowing him (but keep in mind his white coat says surgeon on it). Of my many misconceptions, thankfully, I did not enter this profession thinking I'd be in the OR day after day.

I'm personally pretty distrusting of the Podiatry Present/Podiatry Management type guys who think they are going to "fix" the profession. There are people within these groups, program directors and what not, who are working to water down the residency requirements which are already pathetically weak. Can't have residents to be your b*tch labor if you can't meet the minimal requirements to graduate them. CPME is a joke, trust me, I've been through an evaluation. They are like a teacher's union propping up a dead body at the head of a classroom.

Most programs I visited 4th year were significantly greater than 50% clinic. The programs we review on this website that get praised for their surgical volume are in my opinion the exception. We do have a recruitment problem, but its a because there's a crapshow going on in this profession at every level. That said - nothing accentuates it better than the toenail fixation. Our many problems (terrible schools, terrible admission requirements, poor residency training, residency crisis/shortage, public/medical profession perception) are bad, but students don't find out about those till later or if they dig and explore.

We cut toenails. Its disgusting. Is there really anyone who shadowed for the first time and thought - this is what I really want to do? I hope this is the majority of the profession? Hell no. As an aside, most of it isn't needed. We've a got a stupid bureaucracy in the Q system and everyone still qualifies. Anyway, I'm certain there are students who saw dremmeling (barf) on day 1 and thought - no, no, no, no no.

 

[DexterMorganSK]

Another way to get more students interested in this field would be to advertise the average salary of pods after residency (the true salaries..if one such exists).
Not the ones listed on bls or like sites...because to a pre-med going through 7 years of school only to make 100-120K is very downing, esp once we consider the 200-300K debt.

Advertising the surgical aspect of this field won't do much.

 

[Weirdy]

Another way to get more students interested in this field would be to advertise the average salary of pods after residency (the true salaries..if one such exists).
Not the ones listed on bls or like sites...because to a pre-med going through 7 years of school only to make 100-120K is very downing, esp once we consider the 200-300K debt.

Advertising the surgical aspect of this field won't do much.

Double edged sword.
You should be fairly compensated for your skill set.

But with everything else out there, there will be individuals who go in only wanting the title and the salary without putting in the work, or go in thinking they were entitled to all of the above and come out upset real world work experiences of being a doctor are not what they expected.

You can send me emails of what your latest marketing and advertising firms suggest or how there's been a 6% increase in applications and sit around in a circle to pat our own backs.

But this does not guarantee quality doctors in the future.

Not directing this at you. Just pointing out the sheer delusion and wasteful funding I've seen on the recruitment side.

 

[DexterMorganSK]

Wanted to post this here...the APMA findings based on their student recruitment market research (published Jan 2019):

https://www.apma.org/files/MarketResearchPresentation.pdf

 

[Weirdy]

Wanted to post this here...the APMA findings based on their student recruitment market research (published Jan 2019):

https://www.apma.org/files/MarketResearchPresentation.pdf

Fair enough. I did not give them enough credit for their methodology.

Very interesting findings and is very accurate compared to what I've seen going out and talking to students.

 

[GypsyHummus]

I actually think the 100% can be a surgeon thing is a big deal. I met many on the interview trail pointed it as a major selling point. I think personally, pushing for surgery might save the profession in the long run with PAs and NPs running rampant. A PA can do injections, trim nails, wounds,etc, but only a MD/DO/DPM can do a flatfoot reconstruction. This is something PRimary care docs are gonna have to deal with in the upcoming years.

I think the main issue is threefold:

Lack of exposure: premeds all know what an MD does, and DO schools have been very good at spreading the physician title for DOs. Nobody knows what a Pod is or what they do at the college level. Most people find out about it when they aren’t getting into MD/DO school, if at all. More pods going to premed seminars on college campuses would do good, or YouTube videos.

Debt to income ratio: this was my reason for not going. it costs way too much to go to DPM school to make 130-150k\year. Granted, some pods will make more, but that there is NOT a standard across the Pod spectrum for salary leaves people hesitant. A family med doc can make 220k his first year out. Pod schools cost as much as most md/do schools. The school I would have gone to total cost of attendance was around 300k.

Ew feet. People just can’t get over it, though dentistry seems to have the same response with tons of competition.

I think the residency issue also plays a part in it. I’m not even talking about lack of spots, I’m talking about even having one. Dentists can do “surgical” procedures and only need to go to school for 4 years. Granted, most dentists aren’t considered “physicians” but they have much more competition. Does it really take 3 year residency to learn to do a hammertoe or bunion procedure? Or ingrown nail?

 

[DexterMorganSK]

Does it really take 3 year residency to learn to do a hammertoe or bunion procedure? Or ingrown nail?

yeah, cauz bunions and hammertoes are all we learn for 3 years right...

 

[AttackNME]

yeah, cauz bunions and hammertoes are all we learn for 3 years right...

Our medical and surgical training should start to reflect the demand, and I agree with Shapiro's article. He didnt talk about this but I think our future should start separating training programs to recognize clinical and limited surgical podiatrists versus podiatrists with advanced training. To force every resident to complete 3 years of training dilutes the experience for those that have the hunger and skillset for more complex cases.

There are residents interested in forefoot or clinical podiatry who can benefit from scrubbing complex cases, however their requirement for those cases should be decreased so those more interested in that stuff could do more. In the future should we have 2 year and 4 year programs? Or make guidelines on what constitutes a fellowship more strict, maybe even make it 2 years of fellowship. Ortho does 5 years and then another year of fellowship so we have potential to extend our training to improve the quality of newgrads. I have no idea what is best, but I know that a 3 year residency for all residents isn't addressing the diversity of need.

As an attending who works with residents, I know that we cab train a resident to do clinical, bread and butter forefoot surgery, and pus cases, but for complex recon, usually we start trusting a third year to do most of it towards the end of their residency. Imagine a program where the 2 year clinical podiatrists don't do those complex cases, that means those cases will get funnelled to the 4 year surgical podiatry residents, their numbers of rearfoot and trauma will dramatically increase.

I think there will also be less dropout students from pod school knowing there is a a clinical podiatry option, where you aren't forced to feel bad about not having an interest in doing trauma/recon.

 

[Apprentice of St. Luke]

I hope you don't mind a pre-professional student chiming in for this one comment, but since Dr. Shapiro asks, "How many potential applicants to podiatry schools are we missing because they don't want to be primarily surgeons?", I will respond by saying that it is not the lack of non-surgical residencies which is dissuading me; it is your limited license.

As a pre-medical student, I actually gave some thought to joining your profession years ago - since then, I have developed other medical interests. Nevertheless, it appears that y'all are the leaders of preventing lower extremity amputations in diabetic patients, which I appreciate. I hope the California Physicians and Surgeons Task Force finds a way to make things work so that future graduates receive the unlimited physicians and surgeons certificate, even if it means having to add a fifth year to the DPM program, and that this task force is not merely a publicity stunt to gain parity for reimbursement purposes. Maybe even develop a program in order to grandfather in current podiatric physicians which is recognized in all U.S. jurisdictions so that you don't have to take the whole four years of an MD/DO degree. I have been awaiting curiously any future developments in this task force almost since it was announced in 2011 that there was going to be one established by agreement of the California Medical Association, the California Podiatric Medical Association, and the California Orthopedic Association.

 

[GypsyHummus]

Limited license kinda goes with the territory.

I do think Podiatrists are making headway into parity. It’s at a very slow pace, but I could see in my lifetime Podiatrists being recognized as “physicians” at least equivalent to DO as DO is to MD. More pods are getting gigs at MSG and Hospitals, and younger MDs and DOs know about other health professions.

DPM schools linked with DO schools goes a long way in earning the respect of DO physicians. I have personally talked to a DO student who didn’t know about DPM until they were sitting in class together.

I think if DPM schools were smart, they should all link with MD/DO. I doubt we will see MD residencies in Podiatry, but hey, the DOs did it.

I hope you don't mind a pre-professional student chiming in for this one comment, but since Dr. Shapiro asks, "How many potential applicants to podiatry schools are we missing because they don't want to be primarily surgeons?", I will respond by saying that it is not the lack of non-surgical residencies which is dissuading me; it is your limited license.

As a pre-medical student, I actually gave some thought to joining your profession years ago - since then, I have developed other medical interests. Nevertheless, it appears that y'all are the leaders of preventing lower extremity amputations in diabetic patients, which I appreciate. I hope the California Physicians and Surgeons Task Force finds a way to make things work so that future graduates receive the unlimited physicians and surgeons certificate, even if it means having to add a fifth year to the DPM program, and that this task force is not merely a publicity stunt to gain parity for reimbursement purposes. Maybe even develop a program in order to grandfather in current podiatric physicians which is recognized in all U.S. jurisdictions so that you don't have to take the whole four years of an MD/DO degree. I have been awaiting curiously any future developments in this task force almost since it was announced in 2011 that there was going to be one established by agreement of the California Medical Association, the California Podiatric Medical Association, and the California Orthopedic Association.

 

[call1800doctorb]

I hope you don't mind a pre-professional student chiming in for this one comment, but since Dr. Shapiro asks, "How many potential applicants to podiatry schools are we missing because they don't want to be primarily surgeons?", I will respond by saying that it is not the lack of non-surgical residencies which is dissuading me; it is your limited license.

As a pre-medical student, I actually gave some thought to joining your profession years ago - since then, I have developed other medical interests. Nevertheless, it appears that y'all are the leaders of preventing lower extremity amputations in diabetic patients, which I appreciate. I hope the California Physicians and Surgeons Task Force finds a way to make things work so that future graduates receive the unlimited physicians and surgeons certificate, even if it means having to add a fifth year to the DPM program, and that this task force is not merely a publicity stunt to gain parity for reimbursement purposes. Maybe even develop a program in order to grandfather in current podiatric physicians which is recognized in all U.S. jurisdictions so that you don't have to take the whole four years of an MD/DO degree. I have been awaiting curiously any future developments in this task force almost since it was announced in 2011 that there was going to be one established by agreement of the California Medical Association, the California Podiatric Medical Association, and the California Orthopedic Association.

This is the newest information I could find about Podiatry students taking USMLE Getting Podiatric Physicians Access To USMLE Testing This article says there is going to be a national task force.

 

[Podstar]

Personally, I’m glad I don’t have to take the USMLE.

 

[Fresh10]

Personally, I’m glad I don’t have to take the USMLE.

No kidding.

One of the perks of podiatric medical school is to take an easier standardized test. Standardized tests based on percentile scores are on my "I don't care much for" list.