I entered this site while surfing through the term, Podiatry, just curious as to what has been written on the subject of late. I have taken time and read several of the posts here. The points and arguments presented are not much different than they have been over the last 10-15 years. I have some thoughts and wanted to share an opinion, similar in some respects, different in others.

I am a podiatrist, one who departed clinical practice 3 years ago. I completed a PSR-24, practiced privately, semi-successfully, attained board certification by ABPS and was later employed by a hospital as part of an orthopedic practice. (I actually had floated my resume to a recruiter and that was the only position he has ever come across since.) A total of 9 years practicing, not a bad gig really. I decided I had had enough when the hospital, losing money as managed care pervaded the market and combined with inexperience managing a group practice, could no longer sustain and retain us. Having no desire to re-enter private practice, fairly spoiled with such perks as; a 7% “yearly good boy bonus”, 7 % 401K additions yearly, 4 weeks vacation, and 2 weeks and $3,500 to spend on CME. This was in addition to, standard health care benefits, disability insurance, life insurance and malpractice coverage. Additionally, I was chair of physician recruiting and served as a member of the governing board of our medical group. In essence, I was one of the 3% or so podiatrists who got to see how it is be integrated and treated as an equal medical professional.

I learned a great deal as part of a system; medically, politically and personally. I was treated with the same respect as my M.D. colleagues, something I definitely could not say in private practice. I knew my limitations and did not attempt to go beyond, yet I was able to practice well, granted privileges consistent with my training and using my abilities to the fullest.

When our group was essentially dissolved piece by piece, I accepted a year’s severance and half my CME, as negotiated in good faith with the hospital. As it pertains, when recruiting physicians, I was both impressed and envious for Podiatry at what I could offer a perspective M.D. or D.O. candidate. I was also envious for Podiatry at the competition I faced negotiating against competing groups/hospitals for an allopathic or osteopathic applicant’s services. Sign on bonuses of 10-20K, significant CME allotments, moving expenses, 4 weeks vacation minimum, six-figure salaries, even special arrangements for loans for housing. The number of recruiters who would call me daily trying to place physicians was endless. There truly is no comparison on that level with podiatry. I can’t even talk about what it takes to arrive at a level playing field, because in this game, podiatry doesn’t even have a field. Unfortunately, insufficiently prepared, and taking responsibility for it, I never really knew such details when I decided to enter Podiatry. All I recall were the schools painting a very rosy picture. Only after residency did I realize and experience how much life was different with a D.P.M.

And so, after careful consideration, I was well aware my chances of entering a practice situation I had experienced were negligible. As a recruiter I did see salaries and perks plunging in all specialties, but at least as an M.D./D.O one can at least be recruited. Also, I did not like what I saw in clinical medicine and in the ranks of podiatry. Managed care reducing reimbursements, terrible infighting with the APMA and ACFAS (a randomly trained conservative guard vs. a more progressive, though still non-uniform aggressive guard). Lower insurance reimbursements than for M.D. and D.O. counterparts, strong opposition and competition from foot and ankle orthopedists. An increasingly poorer student selection pool, inconsistent training with half the profession surgically trained (and to wide varying degrees) and the other half happy to just call themselves doctor; and no support of either by the other.

During my time off I realized I was fairly burned out and explored other options available. Granted, I was in a position to do such, having no wife, children or debts.

And so what have I learned? What is the market like outside of podiatry? Is the degree worth anything? My experience has been mixed.

I learned my medical training (and yes, it was medical training in a real hospital with real rotations, despite the ignorance and misinformed attitudes of a few, young, God complexed, allopathic students) is on par with most of my M.D. counterparts, especially orthopedists. That said, I didn’t realize the depth and breath of my schooling until I became a resident, my medical and surgical acumen solidified when in a group practice and aligned with orthopedics. In many ways podiatry is more advanced in training, in many ways, it is unfinished. Summed-up, I never felt like I needed to prove anything and more importantly, was medically inferior in any way. Does it make a difference I completed a well-rounded PSR-24 with full hands-on rotations? Probably.

As far as the market outside of podiatry, success has come, but it is not easy by any means. There are virtually no arenas that recognize the D.P.M. degree, let alone know what it entails. Step back a minute too and realize, solely as a podiatrist, you are not equipped with even basic interviewing skills for the world outside of clinical medicine. A learning process.

The direction I chose was two fold at first. I learned how to interview and began meeting with larger pharmaceutical companies for positions in sales. I received the same message with each company, “decent candidate, no sales experience.” So, with determination, I obtained experience as an outside sales consultant for a medical placement agency, giving my resume credibility in the field. Additionally, I taught a few university courses in biology, anatomy and nutrition. (Mind you, I maneuvered into the university position because the interviewer was an interim chair for science and had only a month to find someone to replace a retired instructor. The chair knew only that I was a “doctor” and I admit I used and continue to use the word “podiatry” as little as possible in my resume, well aware of the unfamiliarity and futility of attempting to explain.) This is not to say I am not qualified to teach science courses, quite the opposite, but it is to reinforce that my D.P.M degree had little to do with securing the position. In essence, persistence and the right place, right time.

Subsequently, I entered the field of pharmaceutical / medical sales. Did my degree help? I can say, with honesty, no. Go on to any pharmaceutical or medical device web site and apply. You will notice when checking off level of education, the graduate degree choices are: Pharm-D, Ph.D., or M.D./ D.O. So as a podiatrist. one can’t really fill out the online application beyond using a bachelor’s degree.

I have been able to move up the ladder in the last 2 years. First in a temporary position and most recently contracted as a clinical sales consultant. I have enjoyed most of the benefits I had as a hospital employed podiatrist with much less stress and certainly less time put in. I also still teach a course here and there. My income last year was ¾ of what it was contracted to the hospital as a podiatrist, I’ll take it. I can say too, I am much happier in this life, not having to worry if my profession will be around in 5 to10 years or face prejudices so often seen in the medical and non-medical community. The leaders and members of the profession itself perpetrating and perpetuating universal ignorance with the mantra, “a podiatrist is a podiatrist.” We all know nothing could be farther from the truth, an absence of advanced and consistent training resulting in the “if you don’t know any better, you don’t know any better.”

For myself, there are no doubt, some frustrations in the “new world.” Avenues such as working as a clinical liaison in the pharmaceutical industry, while a great position in my eyes as one who enjoys teaching, are thus far unavailable to me. All such positions I have encountered require a Pharm-D, M.D. or D.O degree. I understand and accept it, but it doesn’t mean I have given up or in any way believe I am unqualified.

Even such jobs as clinical educator usually have a pre-requisite of an R.N.; DPM will not make the grade. I accept, that, although my background, schooling and experience make me equipped, perception is reality and a computer-scanned resume detects no R.N. in mine. In fact, the brief time I have been teaching on the college level gives me a better chance at such positions.

What about teaching in an allopathic or osteopathic medical school? Probably not an option, though I have yet to probe the possibilities. I do have a friend, a podiatrist, who also departed practice and is teaching cadaver anatomy in an allopathic medical school. Bear in mind, he had initially entered a Ph.D. program in anatomy and while choosing not to complete the program, had enough academic credit, support and experience to secure the position.

The reality is, sad as it may be; a degree in podiatry holds very little meaning or weight outside of podiatry. However, if you are determined enough and have a modicum of intelligence, you can parlay your experience and knowledge into other areas outside the shrinking box called podiatry.

Please understand, I believe a well-trained, (defining well-trained by today’s standards as 3 years in a versatile surgical residency program) foot and ankle surgeon, is incredibly valuable and needed in all medical practices. I prefer the term "foot and ankle surgeon" to Podiatry when discussing such advanced training, the way a maxillofacial surgeon is further advanced than a dentist. In Podiatry, however, it is a free for all with in-office O.R. suites, hungry hospital O.R.’s and profit driven surgi-centers making anyone a “surgeon.” Is there room for the “primary care” Podiatrist? Truly, no, it is work that a Podiatric assistant could easily do under the guidance of a foot and ankle surgeon, much as a P.A. works under a physician.

The problem in all of this is, in this medical climate: A 3-year trained foot and ankle surgeon has about as much real time value as an ice vendor in Alaska. In essence, what I am saying is: With the time and effort needed to put in, if you really enjoy foot and ankle pathology, until or if things change equality wise, you may be better off obtaining an M.D. or D.O. and apply for a high powered Podiatric residency.

Of course, that’s just my opinion.