Honestly, as much as I dislike the whole "fellowship" only BS this was a decent post.
I wasn't going to comment, partly because I wanted Retro to have a chance to respond, partly because I thought the post was self-evidently refutable, and partly because these are old topics and we're really running out of stuff to talk about here. But I could use the exercise so here I go...
Yes, diabetes is increasing. From the CDC:
Yes, there will be more foot complications of diabetes that will need to be prevented/treated by experts.
We really are overplaying the Diabetes card, so much so that I often wonder if other doctors know what we have to offer non-diabetics.
By FAR, the single most common complication of diabetes is thickened toenails. I agree that nail debridement is an important part of patient's hygiene, and I might even agree that nail debridement should be performed by a professional. Now should this professional absolutely be required to complete a doctorate and a 3-year surgical residency? No way.
Then you have people like Allen Jacobs writing into PM News that the nailcare appts really should not be about the nail care, we need to be performing thorough neuromuscular and circulatory exams to really screen for underlying problems. I just don't understand how much actionable information you gain from doing all that. Maybe there's some gait disturbance, maybe that translates to a few more PT scripts and a few less falls. Otherwise, if a neuropathic patient has no Achilles reflex, does that change your treatment algorithm? If a patient has asymptomatic PAD, does it confer a benefit to make the vascular referral just because? And at the end of the visit, we reappoint them for 9 weeks not because they need to be re-screened but because they need their toenails clipped.
I personally enjoy wound care, I know many of us on here don't, and most pods in my community definitely don't. I agree it's important, but the increasing incidence of wounds is not driving professional demand. And like almost all other DPMs not employed in a university setting, I'm not touching Charcot with a 10 foot pole.
I am skeptical of all the epidemiological studies involving podiatry and diabetes. They're taking a 30,000 foot view without thinking critically about mechanisms of action/behavior. Yes patients who are conscientious about going to their podiatrist will have better outcomes, because they are conscientious in other dimensions of their health. This is called selection bias. I know this is not what the literature reports, I know I'm just an idiot PP attending doing what he's told, but you can't ask me to ignore the evidence before my own eyes.
That's your opinion. Most DPMs I know (including self-admittedly the SDN attendings) are doing just fine.
This has been argued here. Most podiatrists make it eventually, after spending a few years of eating
. It's the mandatory
-eating phase we need to curtail.
Even once you "make it," most of us have zero mobility. You have to settle in less-than-desireable situations because there aren't any realistic options without uprooting your whole life. Jarrod Shapiro came on here and wrote about how he had to relocate 3x to different states to land where he landed. Kudos to him that he's enjoying his success, but this shouldn't be a normal feature of the podiatrist's career. It was either the toenail thread or the lobster thread (or maybe they're all lobster threads) where I talked about how I do things not because I choose to but because I don't have any choice.
Hospital jobs are more desirable?
Why do you suppose that is? Hint: see my
-eating remarks above.
I've addressed this before. I'm not looking for a podiatrist to do a job and rack up RVUs. I'm looking for someone who is expected to be a professor, teach residents, do research, and publish. That is not someone who just finishes residency. Although I help all our residents find jobs and I receive inquiries for new grads to fill jobs more than 1x per week.
I find this reasonable, academic medical positions are not so much about patient care as they are about producing paper. This dovetails with my diabetes remarks. Get a cloistered academic gig writing papers about the importance of diabetic foot care to minimize the amount of diabetic foot care you need to actually do.
Can other providers do what we do? Yep. Do they want to? Nope. Do they do as good of a job? Debatable.
🦞
Then get out there and be a better example of what today's podiatrist does and make a better name for what we do. Stop being offended when someone doesn't know what you do. Use it as an opportunity to educate them.
Another thing I've written about and we've discussed is the baggage that comes with being a podiatrist, everyone's preconceived notions about us. I have too many other battles to fight, not taking on this one. Not interested in changing hearts and minds or getting involved with leadership comittees. If drafted, I will not run; if nominated, I will not accept; if elected, I will not serve.
100% true. Podiatrists do eat their young. It must stop. We wrote about it
here.
ABFAS is not responsible for the eating our young culture.
I used to be friendly with someone who was a professor of Islamic Studies. She told me an anecdote about how the ambassador from Saudi Arabia to the U.S. was once asked about Saudi Arabia's poor record for women's rights. He responded to the effect of, "In Saudi Arabia, we have our problems with mistreatment of women, but in the U.S. you have your problems with mistreatment of women too, so mistreatment of women is a problem for all of us."
