So You Want to Be a Podiatrist

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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.

 

What is Podiatry?

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, ingrown 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, or 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 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.

 

Misconceptions about Podiatry

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 article to clear up any confusion.

 

How to Become a Podiatrist

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 a male-dominated field, with close to 60% of matriculants being men. However, the gap has been narrowing as more and more women enter the field.

 

Subspecialties within Podiatry

After podiatry residency, you can subspecialize further with podiatry fellowship, which is usually 1 year in duration.

Sports Medicine

Sports medicine podiatrists deal with athletes and their associated injuries. They receive the highest compensation, 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/Preservation

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 Foot and Ankle

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

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

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.

 

What You’ll Love About Podiatry

There’s a lot to love about podiatry.

It’s a low acuity field with a 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.

 

What You Won’t Love About Podiatry

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 a 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 article.

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.

 

Should You Become a Podiatrist?

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 the premed route 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.

If you found this article interesting, check out the rest of the So You Want to Be series, where 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 might also enjoy my other piece – So You Want to Be an Orthopedic Surgeon – or my article on being a physician assistant.

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