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We're pretty jaded about the career outlook for podiatry here, probably more than we should be. But every other resource at students' disposal paints an unrealistically rosy picture of the podiatry career outlook. In this thread, we raised the question, under what circumstances is there a rational basis for a student to drop out mid-way through school?
TLDR: the answer is more than likely you shouldn't drop out. So I don't want any of our leaders in the way-too-many alphabet soup podiatry orgs to come after me for being self-loathing, though there most certainly are loathsome parts of the process. Let's begin.
1. The Podiatrist Wage Curve
With the cost of higher education being what it is, you 100% have the right to ask what kind of return you're getting on your investment of time and tuition. Perhaps the most important determinant of the return on education is your salary. Unfortunately, the answer to the question "how much money do podiatrists earn?" has proven nebulous. Many of our university-employed leaders have the wherewithal to rigorously investigate this question, but, to my knowledge, no efforts are taking place. So we rely on the next best thing, survey data and SDN's treasure trove of anecdotes.
What is true in podiatry as in other healthcare fields as well as just about anyone's career is that what you are earning in your second year in practice will most likely be different from your 10th year in practice which will most likely be different from your 25th year in practice. You rise, then plateau, then scale down. That's the wage curve.
While on SDN we have a very high representation of hospital-employed DPMs, I think it's fair to assume podiatry will remain a private practice dominated career for most, at least 75% if not 90%. Because I'm in PP, that's the wage curve I'll discuss here; someone else can discuss the hospital-employed wage curve. Plus this is pretty common knowledge:
Student Years (4): accumulate debt
Residency (3): debt compounds, make a little money
Early years/Underemployment (X): make a bit more money, hopefully service your debt
"Cruising Altitude:" making plenty of money, financial path more or less set
We talk a lot about getting the best grades you can to get the best residency you can. But the fact is that 90% of students will not graduate in the top 10% of their class and by the end of your P2 year, your GPA is basically set in stone. In your early years, you need to be strategic about where you conduct your job search and who you work for. In my case, I found a well-run office in a community I could tolerate with an older doc on the cusp of retirement (i.e. motivated seller) so they offered me partnership pretty quick. The years to follow where highly frictional, however, and it wasn't until 4 years in that I really felt like I'd hit my cruising altitude.
This is why it's so hard to figure out the podiatry wage curve and ROI. You'll eventually make it to the top, you eventually make $200-300k or more, but no one knows how many years you have to spend as an underemployed associate to get there. No one knows how many times you switch jobs or move to different states. If you buy into a group, there's no telling how much of your wealth you need to sink into your job. If you hang your shingle, it's difficult to know how long before your business becomes profitable. (But see #4 below).
Bottom line: to the P2 with doubts, if you have the right grindset, choose where you work carefully, minimize the underemployment years, increase ROI, and still reap rewards in podiatry.
2. Sunk Cost and Time Period Zero
So you've spent a couple of years in podiatry school and you've witnessed first hand that it's kind of scammy. But you've also sunk $150k worth of tuition into it, may as well go the distance, right?
Not for that reason. That money is sunk. No matter what you do, you'll never get it back.
However, what you DO have is two years worth of podiatry school credit, which may not be worth much, but it's something. Consider the following thought exercise:
Suppose as you are near the end of your undergraduate pre-health studies, you are wrongfully imprisoned and accumulate $150k in legal fees to get yourself exonerated over the next two years. However, also suppose a DPM program is willing to give you advanced standing, so for only $150k more and 5 more years (2 school, 3 residency), you can move along your wage curve. The consensus on SDN is that $300k debt and 7 years offers a poor ROI, but, given that you've already put in the first 2 years, $150k more and 5 more years isn't so bad. (The first $150k doesn't count, it doesn't matter if it's legal fees or tuition paid, it's already sunk.)
That's the quirk of time period zero. That's why we can in the same breath dissuade a pre-health student from going down this path but encourage a P2 to keep going, because there's simply not as much left to go. Every day is a new time period zero, every day you progress, you are closer to seeing the return on your investment.
3. The Alternatives
So you've made your choice to drop out of podiatry school. What are you going to do next? Are you going to apply to DO or PA school? If yes, how many years will it take you to get accepted? Your podiatry school credits will count for nothing, and you will always have the stigma of someone who wasn't even smart enough to get through a DPM program. [ @heybrother Meme of a podiatry school dropout with a scarlet letter P on their chest] Sorry, that's what they think of us, accept it and own it. If it takes a few years to get through the application cycle, that's not so very different from the underemployment years I described in section 1. Maybe the NP/CRNA route? You have to put in some underemployment years working as a RN.
None of these are necessarily bad career moves, not necessarily good moves either. You move yourself back to the bottom of a new wage curve, hopefully it curves higher for you.
4. Self Appraisal
I have a hypothesis that no one enters podiatry school without having some "red flags." Sorry if I sound like I'm victim blaming, but you have to look yourself in the mirror, and it's no one else's fault if you don't like what you see. Unlike the job market, you actually have some control over what you see there. Plus the more honest you are with your self-appraisal, the better job you can do of controlling your career trajectory.
I've experienced more than a little success in my practice. Not much secret to it. I practice in a town few would desire to live, doing work no one wants to do for populations no one wants to treat. I have to work a little harder for every dollar, but that forced me to figure out how to be efficient at what I do and accomplish more with less. I'm at a point where I worry less about money and more about ways to curate my practice to be more in line with my goals. Until I hit that point, I've got to hustle. And that might not be what you want.
And that's what you've got to figure out, are you willing to adapt to challenges? Are you willing to go the extra mile for your patients? You can still coast, but then that entitles you to a smaller slice of the pie.
5. Should you quit?
Midway through podiatry school, there's still so much undetermined. A lot is up to chance. I think, on balance, sticking it out and finding satisfaction with the state of your life will be better for most peoples situations than dropping out. But it's all a gamble. As Kenny Rogers said:
Every gambler knows
That the secret to survivin'
Is knowin' what to throw away
And knowin' what to keep
'Cause every hand's a winner
And every hand's a loser
And the best that you can hope for is to die
In your sleep
TLDR: the answer is more than likely you shouldn't drop out. So I don't want any of our leaders in the way-too-many alphabet soup podiatry orgs to come after me for being self-loathing, though there most certainly are loathsome parts of the process. Let's begin.
1. The Podiatrist Wage Curve
With the cost of higher education being what it is, you 100% have the right to ask what kind of return you're getting on your investment of time and tuition. Perhaps the most important determinant of the return on education is your salary. Unfortunately, the answer to the question "how much money do podiatrists earn?" has proven nebulous. Many of our university-employed leaders have the wherewithal to rigorously investigate this question, but, to my knowledge, no efforts are taking place. So we rely on the next best thing, survey data and SDN's treasure trove of anecdotes.
What is true in podiatry as in other healthcare fields as well as just about anyone's career is that what you are earning in your second year in practice will most likely be different from your 10th year in practice which will most likely be different from your 25th year in practice. You rise, then plateau, then scale down. That's the wage curve.
While on SDN we have a very high representation of hospital-employed DPMs, I think it's fair to assume podiatry will remain a private practice dominated career for most, at least 75% if not 90%. Because I'm in PP, that's the wage curve I'll discuss here; someone else can discuss the hospital-employed wage curve. Plus this is pretty common knowledge:
Student Years (4): accumulate debt
Residency (3): debt compounds, make a little money
Early years/Underemployment (X): make a bit more money, hopefully service your debt
"Cruising Altitude:" making plenty of money, financial path more or less set
We talk a lot about getting the best grades you can to get the best residency you can. But the fact is that 90% of students will not graduate in the top 10% of their class and by the end of your P2 year, your GPA is basically set in stone. In your early years, you need to be strategic about where you conduct your job search and who you work for. In my case, I found a well-run office in a community I could tolerate with an older doc on the cusp of retirement (i.e. motivated seller) so they offered me partnership pretty quick. The years to follow where highly frictional, however, and it wasn't until 4 years in that I really felt like I'd hit my cruising altitude.
This is why it's so hard to figure out the podiatry wage curve and ROI. You'll eventually make it to the top, you eventually make $200-300k or more, but no one knows how many years you have to spend as an underemployed associate to get there. No one knows how many times you switch jobs or move to different states. If you buy into a group, there's no telling how much of your wealth you need to sink into your job. If you hang your shingle, it's difficult to know how long before your business becomes profitable. (But see #4 below).
Bottom line: to the P2 with doubts, if you have the right grindset, choose where you work carefully, minimize the underemployment years, increase ROI, and still reap rewards in podiatry.
2. Sunk Cost and Time Period Zero
So you've spent a couple of years in podiatry school and you've witnessed first hand that it's kind of scammy. But you've also sunk $150k worth of tuition into it, may as well go the distance, right?
Not for that reason. That money is sunk. No matter what you do, you'll never get it back.
However, what you DO have is two years worth of podiatry school credit, which may not be worth much, but it's something. Consider the following thought exercise:
Suppose as you are near the end of your undergraduate pre-health studies, you are wrongfully imprisoned and accumulate $150k in legal fees to get yourself exonerated over the next two years. However, also suppose a DPM program is willing to give you advanced standing, so for only $150k more and 5 more years (2 school, 3 residency), you can move along your wage curve. The consensus on SDN is that $300k debt and 7 years offers a poor ROI, but, given that you've already put in the first 2 years, $150k more and 5 more years isn't so bad. (The first $150k doesn't count, it doesn't matter if it's legal fees or tuition paid, it's already sunk.)
That's the quirk of time period zero. That's why we can in the same breath dissuade a pre-health student from going down this path but encourage a P2 to keep going, because there's simply not as much left to go. Every day is a new time period zero, every day you progress, you are closer to seeing the return on your investment.
3. The Alternatives
So you've made your choice to drop out of podiatry school. What are you going to do next? Are you going to apply to DO or PA school? If yes, how many years will it take you to get accepted? Your podiatry school credits will count for nothing, and you will always have the stigma of someone who wasn't even smart enough to get through a DPM program. [ @heybrother Meme of a podiatry school dropout with a scarlet letter P on their chest] Sorry, that's what they think of us, accept it and own it. If it takes a few years to get through the application cycle, that's not so very different from the underemployment years I described in section 1. Maybe the NP/CRNA route? You have to put in some underemployment years working as a RN.
None of these are necessarily bad career moves, not necessarily good moves either. You move yourself back to the bottom of a new wage curve, hopefully it curves higher for you.
4. Self Appraisal
I have a hypothesis that no one enters podiatry school without having some "red flags." Sorry if I sound like I'm victim blaming, but you have to look yourself in the mirror, and it's no one else's fault if you don't like what you see. Unlike the job market, you actually have some control over what you see there. Plus the more honest you are with your self-appraisal, the better job you can do of controlling your career trajectory.
I've experienced more than a little success in my practice. Not much secret to it. I practice in a town few would desire to live, doing work no one wants to do for populations no one wants to treat. I have to work a little harder for every dollar, but that forced me to figure out how to be efficient at what I do and accomplish more with less. I'm at a point where I worry less about money and more about ways to curate my practice to be more in line with my goals. Until I hit that point, I've got to hustle. And that might not be what you want.
And that's what you've got to figure out, are you willing to adapt to challenges? Are you willing to go the extra mile for your patients? You can still coast, but then that entitles you to a smaller slice of the pie.
5. Should you quit?
Midway through podiatry school, there's still so much undetermined. A lot is up to chance. I think, on balance, sticking it out and finding satisfaction with the state of your life will be better for most peoples situations than dropping out. But it's all a gamble. As Kenny Rogers said:
Every gambler knows
That the secret to survivin'
Is knowin' what to throw away
And knowin' what to keep
'Cause every hand's a winner
And every hand's a loser
And the best that you can hope for is to die
In your sleep
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