Podiatry...
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| Important Note:
I am not a prophet of doom and gloom and not the podiatric antichrist. Things have gone comparatively well for me. It's just that I know somewhere there is a young person trying to make a sound decision between allied health professions. If disposing of, and or clarifying, the podiatric rhetoric and propaganda can save just one person from the misery I have suffered over the last decade, then my hardship will have served a purpose. Since I first applied to podiatry school many years ago, the podiatry profession has relied heavily on propaganda so deceptive that it would make Slobodan Milosevic laugh in disbelief. This has been a perpetual thorn in my side (foot), and if you have made it to this site, you owe it to yourself to carefully read and research this profession independent of our professional rhetoric. What follows are, in my opinion, Podiatry's Biggest Lies. Certainly, you can find practicing podiatrists who will dismiss them, but I urge you to talk to many young practitioners to find out what it will be like for you. Don't listen to the complacent old guard. Those podiatrists plundered health care over the last 3 decades and don't really have to be concerned with the future because they have capitalized so incredibly on the past. I speak with a lot of young podiatrists. It was hard for me and it is hard for them. There is still money to be made in podiatry, but not enough for everyone. And it won't necessarily be an insurance company that denies you your fair share. Many times it will be your own "colleague." |
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| Big Lie Number 1 | |||
| There is a demand for Podiatrists. |
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| This is simply not true and I will explain at length. First, there is a classic propaganda clip at the AACPM website (under "Is there a need or demand for podiatrists") which describes how the increased injuries of the older and athletic people are going to increase the demand for podiatrists. Secondly, they note that manpower studies in the health professions indicate the "need" to increase practicing podiatrists by the year 2000. Does this sound familiar to anyone? You can almost recite it off the top of your head. I think they forgot to tell two very important parties involved in this equation. Patients, and their health insurers. Most of the schools have a similar propaganda clip on their sites. Something about the increase in injuries creating a need for foot care. This is classic podiatry propaganda, and one of the issues that has irritated me since my first day. The passages above would have you believe that because the number of injuries and the number of old people are going to increase, so too will the need for podiatrists. Horse hockey, I say!! I agree that demand goes hand in hand with supply, but NOT the supply of injuries, the supply of money to PAY for the treatment of those injuries. And the supply of money to provide medical care for feet has been declining steadily - therefore, so has the demand for podiatrists. Medicare cuts to reimbursements happen regularly, and the other health care companies follow suit. Someone should have shared this rhetoric with the health care companies, because they certainly are not preparing to pay for the great onslaught of podiatric care. Managed care and other types of health care industry changes often LIMIT the number of podiatrists on their plans. If we are so in demand, how come there are not an unlimited number of podiatrists allowed on insurance plans? The first letter you receive stating that "XYZ Health Plan currently has enough podiatric providers in its plan" will quickly disabuse you of the notion that you are in demand. Podiatry schools have consistently graduated hundreds (over 600) of podiatrists per year to replace the tens of doctors who have died and retired. Where do all the leftovers end up? They are crawling on top of each other to make a living. In demand? When you can throw a rock in any urban or suburban area and hit five podiatry offices, I don't think we are in demand. I think we like to convince ourselves we are in demand. Sure, if you really want to be in demand, you can exile yourself and your practice to some bayou in the deep South where you are the only podiatrist within a hundred miles, but according to the propaganda above you shouldn't have to do this. How much will you end up sacrificing for your profession? |
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| Big Lie Number 2 | |||
| Podiatry is an integral part of the health care system. |
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| This is also simply not true and you should indulge me once again. An integral part of the health care system would mean "a necessary part." Our professional societies would have you believe that we are an integral part but we are not. We are OPPORTUNISTS. Dentists are an integral part of health care because a General Practitioner is not going to fill somebody's tooth, a Neurologist is not going to remove cataracts, and an Orthopedic surgeon is not going to restore vascular flow to a lower leg. But, one or several practitioners out there can do "your" job. The GP can treat the infections, the Vascular Surgeon can do the amputations and wound care, the Orthopedist will treat the fractures. You are not really necessary. You may think you do it better, but you are just being defensive. For sure, there are areas in the USA where no podiatrists practice, and these other doctors fill in the gaps quite well. If you decide on podiatry, understand one thing. You will always be struggling for medical legitimacy and for good reason. Medicine would do fairly well without you. The practitioners that you speak with who dismiss this are probably megalomaniacs who have enjoyed, too much, the ego boost of being a "doctor." In the end, you have to realize that it is JUST podiatry. |
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| Big Lie Number 3 | |||
| The average salary for a podiatrist is [ fill in inflated amount here] . |
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| PLEASE NOTE: There are many practitioners, ethical and unethical, making a crazy amount of money in podiatry. Fortunately and unfortunately, they are the exceptions. This is an astounding lie though often repeated. Podiatry recruiters have long used faulty surveys to illustrate the income of a podiatrist. One of these surveys was done by the APMA in 1996 and supposedly demonstrated that podiatrists in their first two years make an average net income of $44,662 (you can find this table at the AACPM website). They also "determined" that the overall "average" net income according to the survey was $108,077. These figures are complete bunk, and I challenge the APMA or the AACPM to show me differently. Do you think the young podiatrists out there only making $30,000 a year in some Medicaid clinic are going to return your survey? Just how many people in the 0-5 year range were included in this survey? I want a hundred people in their first five years of practice to send me email and tell me truthfully how much you are making. Don't feel bad about it. Just tell me anonymously. I talk with a lot of you. I know many of you aren't making as much as the office manager! Four years of school, residency, countless loans and you get a job grossing $35K, and you are one of the lucky ones. Maybe that doesn't bother you. Maybe your spouse works and can ease the hardship. But is that still worth it? All of the medical-legal nonsense, the paperwork, the money you send to professional dues, societies and boards. For what? The ever decreasing possibility that someday down the line you might make $110,000 a year? More propaganda, a little closer to the truth, maybe, at the College Board website, cites a study done by the AACPM in 1993 that showed the average net income of podiatrists overall was $110,287 and the average net income of those in their first two years was $35,578. This gives you an indication of how figures lie, and liars figure. In 1993, the AACPM decided that the net income for pods with 1-2 years of experience was $35,578 and the APMA found in 1996 that the average income was $44,662. I assure you youngsters, the starting salaries for new practitioners have only gone down. Way down! Even areas and practices in the Midwest and the South that used to pay well, now pay thousands less than a couple of years ago. I am not going to go into to all of the financially horrible situations you can get yourself into working for someone else in those early years. It will suffice to say that what you have heard about "Podiatry eating its young" is very true and you should be on guard for it all the time. The people I knew in school and know in the field can be divided into two lopsided categories. Those who got lucky, and those who got burned. Almost all young docs have a horror story of how they were an associate for some guy who took complete advantage of them. Learn from these. You will have to pay your dues, but you shouldn't have to lose your dignity in the process. Well, you say, you are smarter. You know the only way to make money in podiatry is to own your own practice. You are right but still not in luck. Suppose you get out, find the practice you want, negotiate, and buy the practice. Or you open cold. Will you be able to get on the plans as a new doc, or did the other guys in your area beat you to the punch? Just think for a minute about the spiraling debt you can get into in podiatry with no promise of breaking even. Probably over $100,000 in educational loan added to a similar amount of practice loan, and still you are not guaranteed that you will have even one patient. You face the competition of the "colleagues" in your area and the limitations of your insurance plans, and every year insurance companies cut into your earnings again, and again. The old guys are complaining because they are making $250,000 when they used to make $300,000 or more, but what if that $50,000 was all you were going to make this year and it is not there? Do you youngsters in school, or thinking about school, even understand how ludicrous our health care system is for a practitioner?? Each year, sometimes more than once a year, Medicare and associated medical plans do some voodoo and decide how much your procedures and services are worth. Then they come back and cut the reimbursements. So that this year, you can get paid $500 for a surgery, but next year they may decide you should only get $400. This is like walking into a food store and telling them that you paid $10 for a ham the last time, but they are only getting $7 this year. Would they stand for that?!?!?! Podiatry accepts it and sucks it up because they are getting something at least. "Don't rock the boat or they'll cut you out completely," the undercurrent warns. This is the system in which you WILL be working, get used to it. Understand it. It is only going to be worse for you despite your optimism. Once Medicare has realized that you will take $250 for a procedure, they sure aren't going to suddenly decide to give you $500 next year. And the worst part is, if you quit being a provider under protest, some "colleague" will be right there to take your place and you are out that many patients. Another thing that you need to know about that will infringe on your ability to make the living that you may have fallaciously heard is comfortable is that you are going into a field of specialists. The specialist is the lowest on the list for reimbursements. Most gatekeeping primary care practitioners try to avoid sending patients to specialists because they lose money. The things that podiatrists used to do to provide services and generate income are slowly being taken away. Some programs don't let you take x-rays, draw labwork, or do physical therapy in your office. Other health insurance programs have gotten into financial trouble, gone bankrupt, or closed completely leaving claims unpaid or settled for pennies on the dollar. Anyone whoever tells you that you will make just as much as a general practitioner (something I saw on another website) is simply deluded. It's possible, but not the rule especially in your early years. Think of it this way. All things being equal, those GPs bill for anything and everything and get paid for it. All office visits, hospital visits, checking BP, labwork, etc. You don't. You are a specialist, and you are a podiatrist to boot, which puts you under the microscope. If you get the referred patient, and you treat them you're happy to get the 80% or whatever the plan pays, but it pales in comparison to all the things the GP can bill that you can't. He is not relegated to 60 day time periods, he will not get his office visit codes downgraded, and he is not as likely to be audited. For more on the topic of income, please see the essay Why It's Called "Gross" Income. |
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| Big Lie Number 4 | |||
| Podiatry allows for a more flexible lifestyle than other medical professions. |
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| This is another one of those selling points left over from tens of years ago. The AACPM website describes how the podiatry practice lends itself to flexible hours, and is better for those who want a balanced lifestyle. Let me tell you, every person I know in podiatry these days works very hard. The rich ones and the poor ones. They go to the office early and they get home late. Some spend lots of time driving between satellite offices, surgery centers, nursing homes, or house calls. None of them would say their schedule is flexible, and none of them would say they have it easier than the other medical doctor down the street. In the glory days of podiatry, maybe there were guys who sat in their offices 40 hours a week and made a great living. That isn't the situation today. You will work hard for the little money you make, and much of your work will be undervalued by your patients who don't want to pay, and by the insurance companies who don't want to pay. Medicine is a volume driven business these days and it is in your financial interest to see as many people as you can this year, because they are only going to pay you less to see them next year. Aside from the clinical time, there is voluminous paperwork, notes to referring docs, charting, practice building time, financial concerns - it really is not even a 50 hour job. The successful ones will be immersed in it 24 hours a day. After all, someone has to be on call for your office. I know many who are exhausted with it. If they had it to do again, I know many who would gladly take on the "inflexibilities" of another kind of doctor. In reality, to dispute this lie, I offer that other doctors actually have it more flexible now because it is easier for them to establish larger group practices and support more office help than the already strapped podiatrists. Just remember, if you are an MD or DO you have a much more marketable degree. You don't "have" to take a crazy job with lots of call. There are so many more opportunities for regular medical doctors over podiatrists. You could do anything from a desk job at an insurance company to working in the ER. If you ever look at the want ads for medical doctors you will see that there are plenty of opportunities which would be more flexible than any podiatry job. As a second job, or a part time job, podiatry can be flexible, but at that point your expectations are not the same as those trying to run a complete practice on their own. |
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So far, so nearly indisputable.
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