You’ve been made, all 10 of you

[Boba Foot]

"Good day DOCTOR, please clip my toenails"

Followed by "you didn't clip that corner short enough to make me bleed, cut it shorter foot man" 3 minutes later.

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[heybrother]

But think of the flexibility! YOU can decide if you want to set your Dremel speed to low or high when manicuring those nails. Think of the early retirement too! I mean sure it's early retirement due to onychomycosis induced pulmonary fibrosis but still... think of all the the places you could see and explore with your new oxygen tank! And think of the prestige aspect too! Unlike the salon where they say "yo clip my toenails" instead you will hear "Good day DOCTOR, please clip my toenails".

Back in the day a young podiatrist would create their own nursing home gig. Now the powerful podiatry nursing home racket has their boots on everyone's necks! If you try and cut nails (watch out for the Corn Cop) in this town without their blessing they'll come after you.

 

[podgal2003]

What program?

Considering the responses to my post I’d welcome any candidate to message me for more info.

 

[podgal2003]

Thanks for sharing…That is phenomenal, but unfortunately that isn’t the experience for most of the regular posters on this site - to dismiss the issues this profession has as “negatives” isn’t giving the profession nor its practitioners its due. Given the discrepancy, we would love to know the name of the program as I think it would definitely help podiatry residents who frequent this thread. Please share what program is this?

Considering the response to my post I’d welcome any candidate to contact me for more information.

 

[podgal2003]

This is such an obvious ABPM shill. It takes one minute to google search pod jobs and see that there are about 8 pod hospital/MSG/ortho openings right now. Call each of them and ask the recruiter how many 100s of apps they get for each position. That’s because the rest of the 600 graduating residents will have to settle for garbage 100k private practice jobs.

Saving lives… AAAAAHAHAHA

I’m double boarded and considering letting my ABPM lapse since this latest push. Hardly a shill.

 

[podgal2003]

one toenail trim at a time!

In the OR at 2:00 am with a septic patient. Yes, I’m saving lives. You won’t take that away from me or anyone else doing the same.

 

[podgal2003]

Sometimes I think nothing new will ever be said on this forum and then boom - early retirement and 2 new schools but we'll be fine.

Eternal optimist? Maybe. Not such a bad way to live.

 

[podgal2003]

Majority of pods are not on here. Many of those making good money. So many of them are also gatekeeping the profession. Why hire another pod when you can just start a new residency? Your hospital needs a pod? Just add a 2nd or 3rd residency position. Heck let’s make it 8. Want privileges for tar or complicated rearfoot? Nah that 65yr old assistant associate division chief doesn’t believe in pods doing them to “get along with ortho”. There’s maybe a total of 100 active positions advertised across the country, at any given moment, I know because I checked. Half are mostly nursing home scams. A quarter are msg hospital in the middle of no where usually. Others are private practice showing off their 125-150 competitive salary. Several large podiatry groups sprinkled in between. And there’s 600 new graduates and probably another 250 in their 2nd yr actively looking to get the hell out. Then another 5% of the other 15000 pods who keep an eye out for something better. Which is why suffering for two year’s then starting your practice where you want is the typical recommended model. Or you make your own luck. As long as you know that, come on in! podiatry schools are happy to welcome you and take your money.

No guarantees for any career. DO schools are opening left and right. “Taking money”. Not every grad is successful.

 

[podgal2003]

This is a real person employed by the VA. Podiatry has worked out well enough for them and many of their residents they are aware of.

They have openly said they are not going to renew their APMA membership, but are involved with residency accreditation.

They might not be as in touch with how private practice podiatry is in the majority of this country, but their opinion is not less valid than others on here. Just because their reality and perception of the profession is better than it is for many others does not make them a shill.

There are plenty of residency directors who mean well and are proud how well some of their residents do. I also know of graduates from many these same programs who are struggling…..some even at programs mentioned on here by podiatrists who post under their real name and claim their residents do well.

The job market is really bad all things considered.

If one does not have family money, connections or something else that sets them apart podiatry might not be an ideal career choice if one is not extremely open both geographically and to size of the city they are willing to live in or one is aware of the realities of running and opening a practice. I do not feel the profession adequately represents this. Everyone wants to believe there are good jobs for all at hospitals and multi specialty groups etc, but that is far from true. Things are changing slowly, but the reality is many have a mediocre to poor job for a few years then somehow, someway open their own practice…..it is not easy and is financially and emotionally stressful very often, especially in the early years and not a practice model that lets most leave their work at the office when they walk out the door.

100% agree about not being personally in touch with PP. VA my entire career and doing very well. ZERO PP experience and rely on residents to share what they are finding.

 

[wakaflocka88]

I do not believe they are a shill.

I do believe they are quite a bit out of touch with the current market and discrepancy in training.

Yes I agreee

The number 1 problem I see as a third year resident is that there are barely any jobs... it seems like you either have to move middle of nowhere to get a decent paying job... even associate positions that are paying 100k with no benefits are limited and competitive if in a good location. Majority of jobs posted online are nursing homes.
Regardless of how your training was or finishing top 10% in your class etc... its not like there are hundreds of jobs available that are looking for very well trained surgeons...the problems is there are barely any jobs period.

Send this to all the governing bodies because they claim otherwise.

 

[Shiyuan]

In the OR at 2:00 am with a septic patient. Yes, I’m saving lives. You won’t take that away from me or anyone else doing the same.

Agreed. Feels great getting that final “thank you” from a long-term limb salvage patient ambulating wound-free in their DM shoes (not that i’m looking for a pat in the back in the first place anyway, but very gratifying).

 

[HardRoadPaved]

In the OR at 2:00 am with a septic patient. Yes, I’m saving lives. You won’t take that away from me or anyone else doing the same.

Only thing that's taken away is sleep and being less effective the next day all while getting an EOB for less than a heel pain new visit in the morning.

 

[HardRoadPaved]

Agreed. Feels great getting that final “thank you” from a long-term limb salvage patient ambulating wound-free in their DM shoes (not that i’m looking for a pat in the back in the first place anyway, but very gratifying).

My fav is seeing a healthy athlete from a scheduled ankle fx or achilles repair getting back to sport.

 

[Shiyuan]

My fav is seeing a healthy athlete from a scheduled ankle fx or achilles repair getting back to sport.

Amen brother! Another great feeling.

 

[icebreaker32]

The number 1 problem I see as a third year resident is that there are barely any jobs... it seems like you either have to move middle of nowhere to get a decent paying job... even associate positions that are paying 100k with no benefits are limited and competitive if in a good location. Majority of jobs posted online are nursing homes.
Regardless of how your training was or finishing top 10% in your class etc... its not like there are hundreds of jobs available that are looking for very well trained surgeons...the problems is there are barely any jobs period.

The line you will hear so often is that podiatry is a small profession and very different from other professions and the jobs are mainly word of mouth. Translation.....the job market really does suck, but there are also some jobs out there that are not posted online, but the majority of those are garbage also.

Most I know are doing much better than their first job they had out of residency, but it was only because they started their own practice. Did some get great jobs immediately, sure, but not most. Did some get good jobs a few years later, yes. Much beyond that though and most had already started their own practice.

It is not impossible to get a good job right out of residency, but the problem is you can not count on it happening.

Solo practice might be largely a thing of the past for many specialties outside of very rural areas and could eventually go away in podiatry, but not until the saturated job market goes away. When taking the risk of opening a solo practice is less than that of staying at an underpaid private practice.then it remains a viable alternative despite the difficulties and increased overhead compared to a group practice setting.

 

[PTPuser]

The line you will hear so often is that podiatry is a small profession and very different from other professions and the jobs are mainly word of mouth. Translation.....the job market really does suck, but there are also some jobs out there that are not posted online, but the majority of those are garbage also.

Most I know are doing much better than their first job they had out of residency, but it was only because they started their own practice. Did some get great jobs immediately, sure, but not most. Did some get good jobs a few years later, yes. Much beyond that though and most had already started their own practice.

It is not impossible to get a good job right out of residency, but the problem is you can not count on it happening.

Solo practice might be largely a thing of the past for many specialties outside of very rural areas and could eventually go away in podiatry, but not until the saturated job market goes away. When taking the risk of opening a solo practice is less than that of staying at an underpaid private practice.then it remains a viable alternative despite the difficulties and increased overhead compared to a group practice setting.

Do you feel like it's possible to get loans to open a PP right after residency? Or is it the same situation like trying to go through SBA and showing proof that you've worked for a year or two?

 

[Pronation]

In the OR at 2:00 am with a septic patient. Yes, I’m saving lives. You won’t take that away from me or anyone else doing the same.

If a patient is so floridly septic that they needed go to the OR in middle of the night then they probably just needed a BKA. Just saying...

 

[icebreaker32]

Do you feel like it's possible to get loans to open a PP right after residency? Or is it the same situation like trying to go through SBA and showing proof that you've worked for a year or two?

Surprisingly I know of no one who took an SBA loan or any bank loan for that matter to open their own practice. Not to say it is impossible, but I know nothing about it.

The only podiatrists that I know that financed were buying in as a partner to an existing practice or buying out a retiring podiatrist. A surprising number of podiatry couples bought out a retiring doctor but were very selective, most started their own practice.

Some had family money, some a whole lot of family money and the majority of those still worked a couple years for another podiatrist first, some started their practice immediately.

Some had a parent that was a physician and could share office space and staff the first few years.

Some had spouses with a good job.

Some had no help at all. They had to save and delay a new car and home and some lived at their parents home. Many saved but still had to borrow at least a little money from a parent even if they were not rich. Most did nursing homes and/or home visits to make money. Some worked a day or two in an another's podiatrist office on the side.

Working for another doctor for a couple years sadly makes sense even if not paid what you deserve. Become board certified if possible. When starting your practice you will not usually be that busy surgically the first couple of years unless you take Medicaid (a separate conversation) and may run out of time.

You can still apply for better jobs also while planning to open your own practice as a backup and working for someone else. At some point you need to go all in and give it a try.. It is a risk and it is real easy to be bitter you did not pick a profession with plentiful good jobs with signing bonuses where you could buy a house immediately but that won't help you obviously. Many do well eventually, but go through a lot and have a hard time recommending this profession when the ROI might be better with so much less stress just being a PA.

 

[Boba Foot]

Do you feel like it's possible to get loans to open a PP right after residency?

If you want a loan with crazy high interest from a predatory lender, sure. If you want a fair loan from a reputable bank, no.

 

[GreenHousePub]

Agreed. Feels great getting that final “thank you” from a long-term limb salvage patient ambulating wound-free in their DM shoes (not that i’m looking for a pat in the back in the first place anyway, but very gratifying).

Agreed.

 

[icebreaker32]

If you want a loan with crazy high interest from a predatory lender, sure. If you want a fair loan from a reputable bank, no.

Yah take no crazy high interest loans.

The ongoing cash flow will be more of a concern than an initial loan to buy some equipment.

You can keep costs down on equipment and software in the beginning. If you lease to own lots of nice new things your monthly payment will be very high so beware.

You will need at least one well paid office manager. You will need to pay your lease (your own or sublet). If you start small and sublet there will also be a period where you take another risk and get your own office and add another employee etc. Hopefully at this point you can get a line of credit from a local bank.

You need money to live on. There are less option for podiatrists to moonlight. You will probably be living on the money you make from from moonlighting…….not glamorous and usually home visits, nursing homes, LTACs, wound care centers etc. You will be lucky to cover the office overhead in 3 months and making a monthly profit that would equate to a 6 figure salary (with no benefits) by 12 months. Some do it twice as fast or sometime it take twice as long, and of course some businesses do fail. Podiatry is not a risk free profession. That I why I really recommend someway to moonlight. You can always let if go when you get busy wether that is 3 months or 3 years. You need to make 50,000 to 100,000 doing this on the side. You can probably work only a couple mornings and a couple afternoons the first 6 months in the office and moonlight the rest.

Get board certified by ABFAS and apply for hospital, MSG, ortho, VA jobs etc also. The job market sucks, but is better once you are board certified with at least 2-3 years experience. If you are geographically open it is still not easy, but more often than not you will find a good job within two years. If you don't get a good job or are geographically restricted then your private practice job will either lead to partnership at a fair price (rare) or you give it a go and open your own practice.

 

[diabeticfootdr]

If a patient is so floridly septic that they needed go to the OR in middle of the night then they probably just needed a BKA. Just saying...

Sadly, this is why people don’t post here. Because no matter what good they say, there is always some that will attack them immediately. It’s frankly a poor environment for polite discourse. It made [mention]podgal2003 [/mention]prefer to communicate by PM as not to provoke attacks on their program even.

You have your experiences and others have theirs. There is no need to personally attack colleagues.

And, no, many patients who are septic from a foot infection can achieve limb salvage with a rapid response from a dedicated podiatrist.

 

[Feli]

...And, no, many patients who are septic from a foot infection can achieve limb salvage with a rapid response from a dedicated podiatrist.

This is one of those that the profession and those outside it will go back and forth on until the end of time.
Those whose income depends on limb salvage will say one thing ("totally worth it"), and those looking from the other side will largely say it's futile and a waste of time to be doing 'staged procedures,' nibble amps, wound VACs, TCCs, etc on a foot that will just continue to cause issues and expense on its way to BKA while it drains the pt to keep coming to clinic or wound center instead of just moving on with their life.

The midnight I&Ds, gas gangrene amps, the Charcot recons, etc can work...
...for how long?
...with the permanent support of what expensive DME?
...for how many wound care visits and "wound procedures" post-op?
...for how many more surgeries for future re-ulcers? (then more DME, etc)
...for how many more hospitalizations and PICC lines?

I think that is all that was being suggested.

Everyone knows you need to be quick and aggressive for limb salvage. Everyone knows it can work. Everyone knows the pt will want salvage or a crazy graft attempt even if it's 1% success if the "surgeon" pitches it properly. Many have jobs or practices where the cash register shuts off when BKA becomes the decision. Most also know it's seldom worth it in the long run. Timing to intervention matters. Patient selection matters. It's a personal call... many are just too far gone, and any 'victory' is quickly toasted without the ongoing custom DME support.

 

[diabeticfootdr]

Those whose income depends on limb salvage will say one thing ("totally worth it"), and those looking from the other side will largely say it's futile and a waste of time to be doing 'staged procedures,' nibble amps, wound VACs, TCCs, etc on a foot that will just continue to cause issues and expense on its way to BKA while it drains the pt to keep coming to clinic or wound center instead of just moving on with their life.

When you say “moving on with their life”, it is really moving on with their death. There is a 70% relative 5-year mortality after major limb loss in diabetes. It’s takes more energy to ambulate the higher the amputation. In persons with limited cardiac reserves, that may hasten death and many patients never walk again after a BKA or AKA.

So the consent process needs to account for the patients desires. Also, studies have shown that patients with diabetes fear blindness and amputation more than they do death.

Again, don’t salvage just to salvage. If there is a non-functional foot after salvage, what was the point?

But initially, emergent treatment of the septic patient with a foot infection is about source control and see what we have left to salvage a functional extremity. And this is truly almost unique to podiatry. Many other specialties would just amputate in that instance.

Based on your prior posts, probably stuff you agree with and were just engaging in healthy debate here.

 

[icebreaker32]

You can not fault someone for being aggressive and fast to act. Many will even do a bedside I&D if they delay a more extensive I&D until the next morning.in the OR. For some it easier to just add on and not mess up clinic the next morning. What you feel is best for your patient comes first, but there is a difference depending on the particular hospital if these cases typically go at 2am or wait until 7am. At some hospitals if you say it can wait you might be waiting until noon the next day and they won't let you even get a 7am.....so many variables.

You can drop the WBC count and perhaps save some tissue by acting fast. Yes many of these infections started long before they presented at the ER, but we can not go back in time.

As far as the famous 70% statistic that is a bit of a chicken or the egg conversation with the typical health and comorbiditiies these patients have, but if one will not do all they can to save a functional foot they should let someone with a passion for limb salvage treat these patients if that is an option.

 

[PeaJay]

Again, don’t salvage just to salvage. If there is a non-functional foot after salvage, what was the point?

Couldn’t agree more. I wish this concept prevailed.

I was taught functional salvage and lean toward TMA versus creating lobster claws.

 

[podgal2003]

Sadly, this is why people don’t post here. Because no matter what good they say, there is always some that will attack them immediately. It’s frankly a poor environment for polite discourse. It made [mention]podgal2003 [/mention]prefer to communicate by PM as not to provoke attacks on their program even.

You have your experiences and others have theirs. There is no need to personally attack colleagues.

And, no, many patients who are septic from a foot infection can achieve limb salvage with a rapid response from a dedicated podiatrist.

Employment after graduation is a struggle for every profession - nursing, PA and docs alike. There are great positions and less than great. There are not enough residency programs for MD/DO grads. There needs to be balance in the discussion that this occurs everywhere and is not isolated to DPM. My paycheck doesn’t change according to doing a surgery or not. My decision to salvage vs defer to BKA is based on reality of the situation in front of me and patient desire. I’ve never had to think about how much money I did or didn’t just make or what I’m getting “stuck with” in the future. I’m in the minority here but I am not alone. There is a great future and amazing career in the VA for a young provider. Great salary. Student loan forgiveness. Pension. Retire a millionaire. Antiquated views of working for the VA are just that. Get involved in you state or a national board. Work with a residency program and connect with CPME to become a site reviewer. get on a committee for a certifying board. BECOME A MENTOR. Guide a young practitioner to success and away from what didn’t work for you.

 

[de Ribas]

There are not enough residency programs for MD/DO grads.

What!? In what country is this? There are more than enough residency spots for US grads. Or you count all foreign grads from all over the world?

Employment after graduation is a struggle for every profession - nursing, PA and docs alike

Nurses can find a job literally in every square mile. Last time I checked gaswork site there were 7873 CRNA positions. Basically all start around 200-250k with relocation, sign-on bonuses and lots of vacation/PTO. PAs are hired right out of PA school.

MDs all have competitive offers while still in residency. They don't have associate positions where they will be screwed over by their peers like in podiatry.

Fellowship trained WP grad recently stated in a webinar that 90-120k is a very good offer, 70k is also uncommon for podiatry grads. I have never heard of one MD/DO getting these low numbers for any specialty for a full-time position.

 

[Feli]

...There are not enough residency programs for MD/DO grads....

This is not true at all.

This year, 40,084 MD and DO graduates applied for 37,256 residency positions in the Main Residency Match®, according to the National Resident Matching Program®.

Less than 20k MDs graduated in USA. And less than 8k DO (compared to 6.2k osteopath residency spots)... so roughly 29k overall USA grads.
It's not NRMP's job to accommodate FMGs. If there ever is a residency shortage, it would be due to FMGs that the match was never designed for (although a few USA grads do take foreign residency also) or - less likely - due to DOs graduating way more than their programs can train and counting on MD programs to bail them out. USA MD schools do a great job with graduate : residency spots ratio.

Are you trying to say there are not enough USA residency positions for all MD grads worldwide? That would be accurate.

 

[podwho]

Employment after graduation is a struggle for every profession - nursing, PA and docs alike.

full stop - wrong. Finding a single job vs finding a GOOD job are two different things.

VA gigs seem great, nothing to argue with there. Since the bill passed nearly everyone new is clearing 200k, with great benefits, pension, 120k forgiveness in loans, worklife balance. 28 currently listed. 8 are open to public. 600 total employed. They usualy hire experienced docs. Rare to find a new grad.

also isnt this a dpm forum?

 

[icebreaker32]

She is admittedly a bit out of touch with private practice. 20 years ago things were nowhere like they are as far as the job market for RN, PA, NP, CRNA etc. They were still much better then compared to podiatry, but are so good now the job markets really can not even be compared.

VA is a good option for podiatrists.

Podiatry can work out and be rewarding career.

RN, PA etc Will work out and Will be a good ROI

All professions have pros/cons....one of podiatry's cons is the job market

 

[podgal2003]

 

[podgal2003]

full stop - wrong. Finding a single job vs finding a GOOD job are two different things.

VA gigs seem great, nothing to argue with there. Since the bill passed nearly everyone new is clearing 200k, with great benefits, pension, 120k forgiveness in loans, worklife balance. 28 currently listed. 8 are open to public. 600 total employed. They usualy hire experienced docs. Rare to find a new grad.

also isnt this a dpm forum?

Yes this is a DPM forum. The conversation was about job market prospects. The OAA has a special track for hiring new graduates.

 

[Feli]

View attachment 360473

A phone screenshot is great... you are spreading misinformation by including FMG applicants in the US residency MD/DO match. The GME / CMS has no responsibility - or ability - to provide for foreign grads who may choose to apply. That is a false narrative and misleading statistic to use.

You might as well say there aren't enough resident spots in Arizona for all the immigrants who want them? Cmon.

US podiatry has plenty of duty to provide quality residency spots for grads of schools they approve and fill and fund.

Again, look at the real statistics... huge surplus of USA spots to USA med grads. Always has been.

 

[Feli]

...VA gigs seem great, nothing to argue with there. Since the bill passed nearly everyone new is clearing 200k, with great benefits, pension, 120k forgiveness in loans, worklife balance. 28 currently listed. 8 are open to public. 600 total employed. They usualy hire experienced docs. Rare to find a new grad...

I think this right here is illustrative of the gap from DPM to MD/DO.

Most MDs woundn't look twice at a VA/IHS offer. They are generally seen by MD as low pay, mediocre work, etc. Many they hire would have trouble getting a job elsewhere, failed boards, etc. A few others do it just for the PSLF or something... just a bridge generally. Very few or none - depending on specialty - are residency sponsors as they're not diverse enough and the attendings wouldn't be good enough (VA act as adjunct rotations for local univ hospital residencies only). This is plainly apparent in MD discussions on SDN or anywhere... or just from talking with colleagues. A lot of them view it as a bit of a last resort or more like doing patriotic charity. It is a tiny minority of MD/DO who view govt work as a serious career option or top choice.

Meanwhile, for DPM, many view VA/IHS as good pay, good benefits, lifelong career potential... "dream job." Some VAs are residency sponsors. They were the bailout for the residency shortage overall. The "one person's trash is another's treasure" which is the VA plainly illustrates how far podiatry can still progress in terms of job avenues and residency training metrics.

The VA/IHS jobs are fine for some (MD and DO and DPM) to aspire to. Some good research, teaching, patient outcomes, etc can potentially come from them. It is just a night and day view from MDs to DPMs... and that shows you in bold letters how much our job/training improvement can still progress. Plain and simple.

 

[podwho]

View attachment 360473

93% us medical grads filled in match. of the 2.2k unfilled positions 2.1k were filled. 99.9% of positions were filled. 98% of US grads matched. Foreign grads is a whole different topic.

if you dont match, well theres a long list of careers you can go into with an MD degree. Cant find a single single meanful gig with a dpm degree outside of practicing. Its a risk. It also sucks.

 

[newfeet]

93% us medical grads filled in match. of the 2.2k unfilled positions 2.1k were filled. 99.9% of positions were filled. 98% of US grads matched. Foreign grads is a whole different topic.

if you dont match, well theres a long list of careers you can go into with an MD degree. Cant find a single single meanful gig with a dpm degree outside of practicing. Its a risk. It also sucks.

Were you waiting to drop this knowledge bomb?

 

[de Ribas]

View attachment 360473

This includes FMGs and IMGs. US residencies exist for US grads. Most are MD residencies which are primarily ixist for MD grads. That's why there is fast growth of DO schools because they know that they can push out IMGs and FMGs and they still have plenty of space to go. The fact that new DO schools open every year speaks to abundance of residency positions that these new schools take advantage off.

 

[icebreaker32]

Some US MDs try for more competitive specialties knowing they can pick up something less competitive up if necessary or do what is called a transitional year which takes time off of certain specialties or is even required first and can also make them more competitive if they want to try again for a more competitive specialty.

All US MD graduated can match if they want to and the less desirable ones like psych and family practice are in still high demand as fas as jobs.

 

[CutsWithFury]

Couldn’t agree more. I wish this concept prevailed.

I was taught functional salvage and lean toward TMA versus creating lobster claws.

Podiatry is the biggest offender of creating lobster claws. We are supposed to be specialists but so many DPMs think its ok to leave a foot with toes 4-5 after they just amputated the third toe in a row in three years. C'mon really?

Always create a symmetrical amputation stump. If its the third time the patient is losing a toe then take toes 4-5 or do a TMA.

Always do a gastroc if its indicated.

If you amputate the big toe always perform flexor tenotomies on the lesser toes to prevent that distal tip of the 2nd toe ulcer due to an acquired hammertoe.

Think McFly think

Some podiatrists get it others are just lazy or they are just podiatrists....dumb

 

[CutsWithFury]

Employment after graduation is a struggle for every profession - nursing, PA and docs alike. There are great positions and less than great. There are not enough residency programs for MD/DO grads. There needs to be balance in the discussion that this occurs everywhere and is not isolated to DPM. My paycheck doesn’t change according to doing a surgery or not. My decision to salvage vs defer to BKA is based on reality of the situation in front of me and patient desire. I’ve never had to think about how much money I did or didn’t just make or what I’m getting “stuck with” in the future. I’m in the minority here but I am not alone. There is a great future and amazing career in the VA for a young provider. Great salary. Student loan forgiveness. Pension. Retire a millionaire. Antiquated views of working for the VA are just that. Get involved in you state or a national board. Work with a residency program and connect with CPME to become a site reviewer. get on a committee for a certifying board. BECOME A MENTOR. Guide a young practitioner to success and away from what didn’t work for you.

Woah there. Not all VA hospitals are the same. Some VA hospitals are incredibly disorganized, underfunded, inefficient and ran by admins who simply don't care. Working for a VA you are just an employee and you don't wield a magical stick molding the practice the way you want it to be.

If you want to be an employee with no autonomy and no say with great benefits and below MGMA salary but above private practice salary then VA all the way. Stay there forever. Clock in and clock out. Get your pension on. Super duper.

But do your research and understand what kind of hospital you are getting involved with. Because not all VAs are great places to work.

 

[CutsWithFury]

What!? In what country is this? There are more than enough residency spots for US grads. Or you count all foreign grads from all over the world?



Nurses can find a job literally in every square mile. Last time I checked gaswork site there were 7873 CRNA positions. Basically all start around 200-250k with relocation, sign-on bonuses and lots of vacation/PTO. PAs are hired right out of PA school.

MDs all have competitive offers while still in residency. They don't have associate positions where they will be screwed over by their peers like in podiatry.

Fellowship trained WP grad recently stated in a webinar that 90-120k is a very good offer, 70k is also uncommon for podiatry grads. I have never heard of one MD/DO getting these low numbers for any specialty for a full-time position.

I agree with everything you said her post is fake news paid/funded by the ABPM

 

[podgal2003]

Podiatry is the biggest offender of creating lobster claws. We are supposed to be specialists but so many DPMs think its ok to leave a foot with toes 4-5 after they just amputated the third toe in a row in three years. C'mon really?

Always create a symmetrical amputation stump. If its the third time the patient is losing a toe then take toes 4-5 or do a TMA.

Always do a gastroc if its indicated.

If you amputate the big toe always perform flexor tenotomies on the lesser toes to prevent that distal tip of the 2nd toe ulcer due to an acquired hammertoe.

Think McFly think

Some podiatrists get it others are just lazy or they are just podiatrists....dumb

Or you have a patient that refuses to let you touch anything but the one dead toe. Lobster claws aren’t always a failure of technique by the doc.

 

[CutsWithFury]

Or you have a patient that refuses to let you touch anything but the one dead toe. Lobster claws aren’t always a failure of technique by the doc.

It's called patient education. You explain to them they will be back again with a new ulcer due to abnormal biomechanical forces through an asymmetrical foot stump leading to a new bone infection and another amputation. Most patients get on board.

Like I said these things happen because podiatrists just get lazy or they just don't get it

 

[podgal2003]

I agree with everything you said her post is fake news paid/funded by the ABPM

ABPM doesn’t like me. I don’t agree with their agendas and I’m too opinionated for them. You couldn’t be more wrong. Not everyone graduating from MD/DO gets a residency they want. They end up having to settle for something else. Imagine wanting to do surgery and ending up in psych. No amount of money will lead to a lifelong happy career if your bottlenecked into a field you don’t want. Or wanting anesthesia money and making internal medicine money. PP are getting eaten by hospitals. Many are working for large corporations and not happy. Not every ACGME residency is a “good one” either. ACGME has same challenges CPME does. So much on here is as if only DPMs deal with things that in reality can be said of all similar professions in medicine. Podiatry is a damn good profession to be part of. We have our old timers, millionaires and rising stars.

 

[HardRoadPaved]

It's called patient education

I thought it was called maximizing patient reimbursement.

 

[CutsWithFury]

I thought it was called maximizing patient reimbursement.

Maximizing patient reimbursement is creating lobster claws because you know they will be back. Not for me.

 

[GreenHousePub]

ABPM doesn’t like me. I don’t agree with their agendas and I’m too opinionated for them. You couldn’t be more wrong. Not everyone graduating from MD/DO gets a residency they want. They end up having to settle for something else. Imagine wanting to do surgery and ending up in psych. No amount of money will lead to a lifelong happy career if your bottlenecked into a field you don’t want. Or wanting anesthesia money and making internal medicine money. PP are getting eaten by hospitals. Many are working for large corporations and not happy. Not every ACGME residency is a “good one” either. ACGME has same challenges CPME does. So much on here is as if only DPMs deal with things that in reality can be said of all similar professions in medicine. Podiatry is a damn good profession to be part of. We have our old timers, millionaires and rising stars.

 

[wakaflocka88]

View attachment 360473

We appreciate your insights as a VA attending. But please try to verify information before posting this.

You are also incorrect about job market for other health professions (namely RN and PA/NP). My friend was a travel nurse for the past year and was making $20k+ per month. Her friend was making $40k a month as a travel RN, both in highly desirable large metro cities. I guarantee you no new pod grad will come close to this level
Of job flexibility, location and income. They will, and can, for the foreseeable future, make more than a new pod grad. They can find employment anywhere, even in highly desirable cities. You’re telling me a new grad pod (fellowship or not) wants to work in San Diego and a $250k job is waiting for them? Will not happen.

I was talking to the anesthesiologist during my case today. He does a mix of locums for months at a time because the demand is high right now. Makes a boatload of money and then takes a 6 month vacation. Rinse and repeat.

As said, we can lament all we want about podiatry. There will always be the few good jobs but bottom line: the bad jobs far outnumber the good jobs. How that is still up for debate: I have no clue. The schools, pre pods, current pod students, ABPM seem to refuse to accept it.

In the meantime, I’ll go back to instagram and peruse all these DPM accounts posting their butchered cases.

 

[podgal2003]

View attachment 360486

Oh I love this so much! Thank you!!