Podiatry as a career

I suppose it is time that I write this. To those considering entering podiatry as a career, all I can tell you is what I would tell myself if I had it to do over again: DON’T DO IT!

It is true that some of my classmates were able to make podiatry work as a career. A couple of them are employed at a major university, teaching podiatry to medical students who want to enter family practice. Some classmates were able to join established practices. A few made it starting cold. If you have connections who can help you into a good position, then podiatry might make a good career. Otherwise it is a huge gamble, and you should understand that you can easily lose the bet, even if you are smart, hard working, and personable. The most impressive young podiatrist that I ever met failed in private practice in an urban area.

You will hear the adage, “If you’re a good doc, you’ll do fine.” This is at best misleading. You are far more likely to “do fine” if you are willing and able to talk patients into undergoing unnecessary surgical procedures and other unnecessary care. Perhaps half the surgical procedures I witnessed during my senior year and during my residency were, in my opinion, undertaken because the podiatrist talked the patient into them, not because they were medically necessary. Those pods that did unnecessary surgery indeed did well financially, and that was the reason. Welcome to the reality of podiatry that no one wants to talk about. I was never willing to do that to patients, which is one of the reasons I am no longer in practice. I don’t mean to imply that all pods do this. Some podiatrists are ethical, practice excellent podiatry, and after many years are able to establish a highly successful practice. Just don’t assume that they are the norm.

Once you have finished your residency, if you scout around for a place to practice, you will hear the same story from almost all podiatrists. “No, we’ve got way too many pods around here, but I hear that (some distant place) is still pretty open.” Then you drive to the distant place, where you can talk to the local pods, and hear exactly the same story. Then you drive to distant states, and hear the same story. Eventually it will dawn on you – either all these pods are lying, trying to protect their turfs, or your services are really not needed. Don’t believe me? Try it yourself! If you are in podiatry school, or are considering entering the profession, go out and actually ask pods in the area where you want to practice about practice conditions. Ask for specifics: “How long will it take me to get established? How much can I realistically expect to earn? Did you earn that much?” When a podiatrist talks to you, you should bear in mind that there are some mistakes in life that are so large that they can be very hard to admit – such as choosing the wrong career.

If you start a practice cold, be prepared to learn what cold really means, and familiarize yourself with bankruptcy laws. (Isn’t that why you wanted a medical career?) Hey, maybe you’ll make it, it’s possible.

Nursing home patients were once regarded as a necessary evil for paying the bills until a podiatrist established a practice. Those days ended long ago. Best of luck finding a nursing home that needs the services of a new podiatrist. If you find one, make sure they don’t require that you pay an illegal kickback. And remember that your employment depends on the nursing director, so when she changes jobs...

You may be able to find a position treating indigent patients as a volunteer or for a small salary. I helped some people who genuinely needed help, and I think my compensation almost covered my coffee bill.

The best podiatrists are genuine experts in foot care and foot surgery, and are far more competent than their MD competition. The problem is that for decades the schools have continued to selfishly serve their own interests by cranking out an outrageous number of graduates, well in excess of any public need. If you need foot surgery, see a good podiatrist. If you need a career, look elsewhere.

I thought podiatry would be an unglamorous but safe and lucrative career. I now think of it as an unglamorous, expensive, ethically perilous hobby. I’m privileged to have been able to learn all I learned, and I met some great people along the way, but entering podiatry was the worst mistake I ever made.