So you want to become a podiatrist. You like feet, maybe a little bit too much, but hey
I'm not one to judge. Let's debunk the public perceptions myths, and give it to you straight.
This is the reality of podiatry. Dr. Jubbal, MedSchoolInsiders.com.
Welcome to our next installment in So You Want to Be. In this series, we highlight a
specific specialty or profession within medicine, such as podiatry, and help you decide if it’s
a good fit for you. You can find the other videos on our So You Want to Be playlist.
And make sure you’re subscribed if you want to vote for future videos.
Podiatry is the field specializing in the foot and ankle, and related structures of
the leg, both in medical and surgical management. They use principles from sports medicine,
biomechanics, wound healing, and various surgical techniques to treat anything from discomfort
and pain to discoloration or odor. Some common conditions podiatrists manage
include plantar fasciitis, which is inflammation of the connective tissue on the sole of the
foot, in-grown toenails, achilles tendonitis, structural deformities such as crossover toes,
nerve or vascular damage, ankle sprains, ulcers, infections such as athlete's foot, fractures,
and bunions. Many patients requiring podiatry care have
comorbidities, meaning other chronic medical conditions, such as diabetes. Because of compromised
blood circulation in the foot and resulting nerve damage, diabetics are particularly prone
to foot issues, such as neuropathic ulcers from losing protective sensation. On the other
hand, some of your patients may be healthy athletes, and you'll be tasked with treating
their ankle fractures or other acute injuries with bracing, casting, orthotics, or surgery.
The conditions you treat within podiatry will be both acute and chronic in nature, sometimes
for the same injury. For example, an acute ankle sprain, meaning soon after it occured,
is primarily focused on dealing with the immediate inflammatory process. If the patient continues
to have chronic ankle issues and repeated sprains, say one year later, the management
plan changes. If they have scar tissue and structural changes, for instance, surgical
intervention may be warranted. Podiatrists will assess neurovascular, dermatological,
and musculoskeletal components in making treatment decisions. While most presentations are non-urgent,
urgent and emergent management may be necessary for open fractures, degloving injuries, compartment
syndrome, and some infections. Podiatry is a misunderstood field, and as
I joked about at the beginning of this video, many think podiatrists have foot fetishes.
Maybe some do, but they probably aren't getting their kicks through podiatry, as they're working
with diseased feet with ulcers, fungus, calluses, and interesting smells.
Some believe podiatrists only cut toenails and give pedicures. While it's true that clinical
care may involve trimming toenails and calluses for patients who are at elevated infection
or bleeding risk, they do much more than that. Podiatrists run the whole gamut, from trimming
toenails to surgical procedures. And last, many people confuse podiatry with
pediatrics. We have a So You Want to Be a Pediatrician episode to clear up any confusion.
Podiatrists earn their DPM, standing for Doctor of Podiatric Medicine, after attending podiatry
school, which is 4 years, just like medical school. You'll cover some similar foundational
training that MD and DO students cover in the first two years, but focus more heavily
on podiatry in years three and four. In the U.S., there are 9 podiatry schools,
with roughly 1,000 students applying each year, and approximately 60% gaining admission.
If you thought that applying to podiatry school would spare you from the MCAT, think again.
Do note, however, that podiatry school admissions are substantially less competitive than either
allopathic or osteopathic medical schools. In 2020, the average matriculant scored a
494.6 on the MCAT, which is around the 35th percentile, with a 3.4 overall GPA, more specifically
a 3.2 science GPA and 3.5 non-science GPA. In comparison, allopathic medical school averages
were 511.5 on the MCAT, which is an 88th percentile, and an overall GPA of 3.73.
After podiatry school, most states require a 3 year residency covering medical and surgical
training, although the duration does vary by state. And just like with MD or DO residency,
podiatrists have various general and more specialized rotations.
As a first year resident in your postgraduate year 1, or PGY-1, you'll spend anywhere from
2 to 6 months on podiatry, and the rest of the year on core rotations, including anesthesiology,
orthopedics, and emergency medicine. As a PGY-2 and 3, you'll focus exclusively
on podiatry, both in the inpatient and outpatient settings, gaining additional autonomy as your
training progresses. Podiatry is more male dominated, with close
to 60% of matriculants being men. However, the gap has been narrowing as more and more
women enter the field. After podiatry residency, you can subspecialize
further with podiatry fellowship, which are usually each 1 year in duration.
Sports medicine podiatrists deal with athletes and their associated injuries. It’s the
highest compensated, as it includes a high volume of quick procedures. Conservative management
is also common, including taping, padding, dressing, splinting, and casting. It includes
a strong biomechanics component and incorporation of physical therapy modalities and rehabilitation
techniques. Limb salvage and preservation podiatrists
work primarily with diabetic or vascularly compromised patients. You'll be preventing
or conducting lower extremity amputations, and therefore there is a heavier operative
component to this fellowship. The lifestyle may be more unpredictable, however, as you
may need to take call. Reconstructive podiatrists are the most heavily
surgical, dealing with complex reconstructions such as in addressing Charcot foot. Compared
to other podiatry subspecialties, complication rates are higher and compensation is lower,
as cases take longer on average. Public health podiatrists place an emphasis
on quality care and preventive medicine. This subspecialization is best suited for those
who want to think bigger picture about healthcare policy, clinical care, and making a wider
impact on quality of care. Wound care podiatrists focus on complex wounds,
managing infections, and limiting complications. It's highly interdisciplinary, incorporating
elements from infectious disease, dermatology, vascular surgery, and plastic surgery.
There are other fellowships too, including trauma, pediatrics, and orthopedics.
There's a lot to love about podiatry. It's a low acuity field with great work-life
balance, with podiatrists working generally 30 to 60 hours per week, depending on practice
type and setting. You aren't dealing with life or death situations, and outcomes are
generally favorable. It's less taxing when your patients aren't dying on you, but note
that depending on your clinical focus, some of your patients may have substantial complexity
or comorbidities. Depending on your interests, there is some
flexibility in your clinical practice. For example, you could be more or less surgical
depending on your preference, or subspecialize with one of the various fellowship offerings.
One of the other benefits of already being comparatively narrow in scope compared to
something like medical school is that you already know your specialty from day one.
That means you won't face the stress or uncertainty with choosing a specialty, or having to work
extra hard to match into a particularly competitive specialty.
Podiatry isn't for everyone. First, and most obviously, you'll need to be ok with forever
working on the foot and ankle for the rest of your career. Unlike medical school, where
you can choose highly varied specialties, the level of differentiation within podiatry
is comparatively limited. You won't get the same social recognition,
status, or compensation as going the physician route, despite spending 4 years in podiatry
school and 3 years in residency. The average podiatrist makes $148,000 per year, which
is substantially less than the average physician, yet podiatry school is roughly the same cost
as medical school – approximately $40,000 per year. With four years of medical school
and 3 years of internal medicine residency, you would make an average of $248,000. And
yes, we know your cousin's toad's sister's twin makes a million dollars per year as a
podiatrist, but we're speaking to the U.S. averages here. After all, you could say the
same about high earning outliers in just about any specialty or field of medicine.
There's debate between orthopedic surgeons and podiatrists. Given the 5+ years of surgically
focused training orthopedic surgeons receive in addition to specialized foot and ankle
fellowship, my orthopedic surgeon colleagues believe they are better suited for surgical
management of the lower extremity, and believe podiatrists are better suited for non-surgical
management. However, podiatrists do receive a mix of medical and surgical training focused
on the foot and ankle in their 3 year residency, and most podiatrists would argue they are
plenty qualified. I cover this more in my So You Want to Be an Orthopedic Surgeon video.
This leads us to the next point, which is an ego battle. If you need the ego boost that
comes with being a physician, podiatry may leave you unfulfilled. On one hand, some podiatrists
want recognition for their hard work, and want to be considered physicians and surgeons.
As one podiatry student writes, they have "the same education, training, and expertise
as MDs and DOs, yet lack the same recognition". On the other hand, many MDs and DOs find the
obfuscation of the term "physician" or "surgeon" to be unnecessary and believe it simply further
confuses patients. They raise the question, what's wrong with saying you're a podiatrist
that went to podiatry school, versus a podiatric physician that went to podiatric medical school.
How can you decide if podiatry is a good fit for you? If you want to build longitudinal
relationships with patients, work with feet, and want to improve quality of life without
the pressure of life or death decisions, podiatry may be a good fit.
If you are comfortable focusing on the foot, but are not sure how medical or surgical you
want to be, podiatry offers that flexibility. If you want to work in healthcare but aren't
thrilled about how cutthroat and competitive premed can be, podiatry offers a more attainable
alternative. If you like the idea of working within a smaller
community, podiatry has you covered, with only approximately 15,000 active podiatrists
in the U.S. Thanks to The Podiatry Journey for helping
me with the creation of this video. Link to their channel in the description.
If you enjoyed this video, check out my video on So You Want to Be an Orthopedic Surgeon,
or my episode on being a physician assistant. Much love, and I'll see you guys there.