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Picture 9I was perusing the online content at the Podiatry Today website and came upon this poll, whose results I found extremely disturbing.  As of 9pm EDT, 07/13/10 (and my vote), greater than half of those who responded say that they would not have gone into podiatric medicine if they had a chance for a 'do over.'

 

I don't know about you, but i found this a particularly disturbing and disheartening statitistic.  Certainly, in any group, there is always the potential for the few disgruntled souls within the larger group who are unhappy with their current position, but I always imagined this that in our profession this would be a smaller number ---a grouping far left  of the bell curve--but it seems that there are more  among us that i had anticipated that are unhappy with their career choice.

 

Why do you suppose that is? 

 

What is it about their current situation that makes these individuals regret the decision to pursue this career path?


Was there a time that these people were happy with their choice---and if so why, now, have they become so disaffected?

 

This genuinely makes me sad.  How unfortunate to have to live your life wishing for something else--that you were someone else --that seems to be the quintessential wasted life. 

 

While it is certainly difficult, it is important for us to critically evaluate these issues to attempt to determine if there are specific triggers or other cause-and-effect scenarios that can lead us from a place of general contentment to a feeling of disenfranchisement in our lives.

 

More than that, as our profession continues to grown and develop, it is vital that we serve as good ambassadors for our field in order to inspire the next great generation of podiatric surgeons --we must be able to do so with excitement and enthusiasm about our selected professional path.  The advances we have made thus far are directly a consequence of the tireless work of numerous leaders who's passion and zeal for our profession have outlasted the nay-sayers, and it is important that the next generation of profession leaders take this as their example and lead with enthusiasm and hope for the bright future that can be ours.

 

Hemingway once said: "The older you get, the harder it is to have heros, but the more necessary it becomes," and we are a profession seemingly living by that motto.  Despite our growth and the numerous advances that have been made, we are still in need of heros --perhaps now more than ever.  Can you be that leader?  Can you bring that enthusiasm and hope to your patients and your community?

 

Or would you prefer a "do over"?

 

If you had it do over again with you still be a podiatrist?
YES
66%
(21 votes)
NO
34%
(11 votes)
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  • Having worked in the current climate of the last 10 years of rapidly falling reimbursement amounts on the so-called & ever-changing fee schedules, that is, here in the civilian sector.  My previous work environment had no trappings of insurance verifications, requests for authorizations, claims, denials, appeals, corrected claims, unduly denials, ridiculous delays before payments are made (2 weeks to 8 months).  Despite endless study, reading, researching, downloading documents, lots of training, pod med business seminars, AND literally working closely IN PERSON with the plethora of entities involved in chasing the income for work (i.e, med-surg services) --that I had ALREADY performed, mind you!-- I can honestly say that I never fully got acclimated to this "fee-for-service" hostile environment.  As many of you know, I went from 2 residencies, one civilian and one residency, with a year in between the two--of being activated & deployed; and, then onto a posting where I had the freedom to practice as best seen fit---and full well within all of the published podiatric practice guidelines (and I am all about EBM/S); but, there were virtually NO non-medical, barely literate, under-educated, and poorly qualified people [read: clerks & jerks of the health insurance industry] looking over my shoulder, tying my hands, and drowning me avalanches of paperwork, either digital or killed trees!!  So, after a very rewarding time in service working at MTFs(^), the shark infested waters of "private practice" is something of which I am most glad to be able to have finally washed my hands clean thereof.  

        My only regret is that, in the first place, my spine gave out, thereby disqualifying me for continued military service, which is a real shame because I was on the cusp of being promoted to a Lieutenant Colonel (aka: O-5 pay grade), which would have gotten me assigned to a much larger, if not major military Medical Center, wherein I would have been part of a team of Podiatrists, gotten to work with Pod Med-Surg Residents--thus returning to my first love as an educator and mentor; then, 7 years later, or right about now, I would be getting promoted to a full bird Colonel (aka: O-6 pay grade) - which was forever my ultimate goal in life; because, having started out in 1982 as a Private E-1, I was sure that a Colonel, only 1 step from becoming a General, was akin to being next to the right hand of God!  However, it was not to be, I do nevertheless live vicariously through a classmate and study group friend, whom I recruited into the Podiatry Cadre of the Medical Service Corps of the ever-luvvin' U.S. Army; and, she is going ALL the way to full bird; and, one day, she will be Chief and Lead Consultant of Podiatry, answering or reporting only to the AMEDD saints & gods, and of course -like any of us- to our patients.  

         In any event, after recovering from spine surgeries, and then hitting the ground running, as it were, into private practice (this was following a medical discharge and partially full military retirement after a total of a glorious 27 years career, capped off by nearly 10 years as a chief podiatrist at the premiere force training base of the U.S. Army); I eventually found myself running through quicksand, getting caught in a massive thicket of 'wait-a-minute vines,' and getting bogged down in mind, body, and soul-crushing stresses of the vaunted private practice of an honorable profession, as such, being termed as Podiatry, as a Podiatrist whom found himself hating it, all of it, finding NO joy, zero satisfaction, and lousy pay, no benefits, no way to save for retirement, no banks willing to lend for a proper practice setup into one's own solo venture, and groups of this & that variety all too willing to devour 60% or even higher percentages (I've seen 80%, and it's supposedly 'standard!@#$%&*??!!) of what I produced, and of course other old-timer podiatrists cunningly ready to 'eat their young!' And, also, the unsuspected practice manager AND claims contractor - who commit the fraud, defraud you [me], and embezzle 6 to 7 figures from the one multi-specialty group that I was with for 4 years--causing all of us to go broke at one point  And, all of it hidden so well, that the investigation has been going on for 3 years already; with all of that lost [stolen] income, I could've paid off my foreclosed house, I wouldn't be driving an old vehicle, nor would I be in chapter 7.  So, phuk u very much to the fractured, layered, bankrupt, scamming, stress that kills system that is the american sick-care system. 

    The BLUF(#)  ==  I would NOW change my answer to a resounding "NO!"  And, not only NO, but HELL no!!  I would definitely do something else in the sciences and/or medicine. 

     

    Medicare for ALL!

    WWG

         The reimbursements process is all too convoluted, a moving target, confusing & confounding, un-necessarily steeped in layers of bureacracy (e.g., digital, paper, agencies, firms, contractors, call centers; and, it is frought with pitfalls; and, there are fraudsters, embezzlers, and sociopaths around every corner; plus, every dollar you actually do get paid has an invisible string attached to it (that can be yanked away from you at any moment);

  • a)  we are the true experts regarding the foot and ankle...not the orthopods.

    b)  we are the true experts when it comes to sports medicine of the lower extremity.

    c)  we are the true experts in lower extremity diabetic and venous leg ulcer management.

     

    Well this depends on the state one is practicing in. For example look at NYS. 

     

    Let's again look at the wording:  "proximal to the level ending at the distal tibial tuberosity"

    Did anyone even study or analyze the above words in quotes?

    (woundcare of foot ulcers just because the word contiguous is present, this may actually be a restrictive effect by "clearly defining" what cannot be done which may have been in the grey area of the law previous to Feb 2014. 

    This I believe means after Feb 2014 the skin and soft tissue at the talus level will be out of scope for most podiatrists in NYS because of the grey area of the ankle law being clearly defined as out of scope and not to be treated by the podiatrist without ankle privileges in NYS. So how can podiatrists without ankle privileges even be licensed to treat venous leg ulcer management or even get reimbursed for taking ankle x-rays after Feb 2014. Yes I believe great changes are in store for most podiatrists. As far as rearfoot surgical privileges go, if a skin incision is required at the medial maleollar level, if this is clearly defined as the ankle and no longer a grey area of the law is it advisable to call in an orthopedist to perform the skin and soft tissue dissection so the podiatrist can perform the osseous surgery. If there is an osteochondral fracture and the advanced procedure of ankle arthroplasty is required, how about calling in an orthopedist to assis the podiatrist in all soft tissue dissection? Bottom line is the skin around the talus might be out of scope after Feb 2014, but the osseous work on the talus is what I believe to be in scope. 

    We might be the experts of treating the foot now what is to be considered the foot but lets see what stops becoming part of the grey area of the law after Feb 2014.

    Will podiatrists in NYS be able to perform posterior tibial nerve blocks. Well if the posterior tibial nerve is at the level of the medial malleolus this may be difficult so try to give the injection slightly distal. Forget about ankle x-rays which are really currently questionable because the foot is defined in the law. But the moment the ankle gets defined, forget about ankle x-rays. 

     

    Could letters be written to the Gov of NYS to try to repeal this law as soon as possible and to propose a new law defining podiatrists as podiatric physicians, defining the foot as all structures attatched to the ankle, and allowing a certain number of years successful practice of podiatry in another state as meeting the criteria for license in lieu of residency training as in other states such as Maryland, Florida, etc... so that the unmatched who have experience in practice can have that opportunity to get licensed in other states later on in their careers. 

     

    There is always the option to practice in another state such as New Jersey, etc... 

    Why can't the majority of podiatrists that will be restricted work to attempt to repeal this law as soon as possible. Then we can say that soft tissue privileges were offerred for every currenly licensed podiatrist so they should be offered again. 

    Finally ankle osseous surgery can be performed only by those who are qualified to do so provided the ankle is not defined in the law and the foot is defined as all soft tissue structures attatched to the foot. 

     

    personal opinions and questions of 

    Dan class 84

     

  • I would just like to say I am proud of Dan Chaskin, DPM (class of 84).
    There are days I love my profession and days I hate it. But, I can honestly say, I am glad I met (virtually at least) Dan Chaskin, DPM
  • a)  we are the true experts regarding the foot and ankle...not the orthopods.

    b)  we are the true experts when it comes to sports medicine of the lower extremity.

    c)  we are the true experts in lower extremity diabetic and venous leg ulcer management.

     

    I guess different professions each may perhaps think they are the experts.

     

    Regarding the word "true" would a legal court of law in NYS beginning 2013 disagree with the above?

    My guess is that because of this new ankle law that people do not want to repeal has so many negative aspects regarding most podiatrists but the most significant is that a physician can be an expert witness against a podiatrist and that podiatrists cannot call themselves a physician. Which is more highly credentialed in a juror's eyes being a physician or a non physician. Also if the expert witness physician is in the eyes of a juror a specialist becuase of that NYS ankle law taking effect Feb 2014. That clause is in such legislation? Why would any podiatrist ever support any ankle legislation containing such a clause that might possibly lead to higher malpractice premiums? Yes one's lack of "credentials in the mind of a juror might possibly lead to higher malpractice rates".

     

    If we were experts in NYS we would have first asked NYS legislature to define all podiatrists as podiatric physicians. Yet we are not. If a lawsuit occurs against a podiatrist regarding a foot problem a NYS licensed physician will Feb 2014 be legally able to give "expert testimony against podiatrists" yet not visa versa. I can see it now a plaintiff attorney saying "Ladies and gentlemen of the jury this expert witness in NYS is a physician and this witness is a podiatrist someone who is not a physician." Plaintiff attorneys used to say he is not board certified. Now after Feb 2014 what is to stop them from saying this podiatrist defendant is not even a physician but my expert witness here is a physician giving expert testimony"

    In the minds of a juror what strikes more of a chord, " not even board certified or not even a physician" ?

    Is it possible that a plaintiff attorney may successfuly resort as a legal strategy to bringing up after Feg 2014 that a podiatrist is not a physician and the a plaintiff expert witness is if that witness is an MD or DO?

    How many podiatrists actually wanted the above situation to pass where a physician could give testimony against the podiatrist in NYS beginning Feb 2014? Why is such a situation being even thought of as any type of positive situation for most podiatrists in NYS?

     

    Regarding the above A, B, C I do agree there are many good podiatrists out there but whenever the word true is used my mind then thinks of a court of law and what is true according to NYS law.  By the way I am proud to be a podiatrist because podiatrists help many with foot pain.

    Now to make a living as a podiatrist well if someone had 2 jobs perhaps one job could possibly support the podiatry profession in this type of an economy. And it's just not some podiatrists that are not doing as well but doctors in health fields unrelated to podiatry might not be doing well.

    But after reading Alan's post me personally I think of all the people I helped and would probably make the same decision again to be a podiatrist. I am however hoping this NYS ankle law gets repealed as soon as possible because of all the problems I believe it will cause most podiatrists.

     

    Dan

     

  • It was the best choice for me as a runner, biker, hiker, and short-lived career as a triathlete.  Could've gone to a D.O. school in Maine, but:  My Podiatrist made the case for me: he was home in time for dinner, and had all the time he wanted to spend on weekends with his 6 kids.  No overnight & wknd call.  No brain, no heart surgery.  Does better than GPs, and spends very little time in the O.R.  *  Well, I took a lot of call in the military as the solo Pod in the down-under outback of a very active trng post in west central Louisiana where troop pop'n would fluctuate in the 10's of 1000's (can't give exact, need to know- and u don't!).  But did have fun coaching soccer & asst coaching B-ball & swimming for our son.  Living amongst the military community was like having a 2nd family, and my son always had more piles of B'day presents than back home!  When wife was ill, hot meals would appear on our doorstep.  *  Had the freedom to practice w/ best interests of patients at heart; also learned that there are indications, and then there are indications:  when to do surgery - for the right pt at the right time, that they had the mental game & all, & when to wait a bit.  No turf wars; ortho had me helping doing ankles & scopes. Got surg courses & cert's paid for. Went to residency as a Cpt, already had 17 yrs since PEBD in USAR - not too shabby.  *  EVERYTHING HAPPENS FOR A REASON.  THE MAKER SENDS US WHERE WE ARE NEEDED.  Next stop: the V.A. - in the service of the veterans.  Luv what I do, and wouldn't change it for all the gold-pressed latinum in the alpha quadrant.

  • Quote:

    I did do this over again in a way....this is my second career, journalism having been my first.

    Sure, there are things that I would change if I had a trusty magic wand:
    Lower student loans
    More flexibility to move from state to state
    Better public education about what we do (that's OUR fault though and we need to get busy educating people)

    On Monday I walked into a classroom to meet the first year students at WesternU and everyone of them was excited to be there. They chose podiatry. Podiatry did not choose them. That is different than it was 30 years ago. We have to accept that the poll results reflect conditions of a time in history when things were not especially fair for all who were graduating, with great grades even. I can understand some hard feelings. We were not told that we had to be entrepreneurs as well as podiatrists to make it. I think many people thought that success was a "given" and it was not.

    Hard feelings are to be expected.


    Interestingly,  in the survey on the top of this page, nearly 41% of respondents related that they would not go into Podiatry again --which still seems like a lot of providers, even among those who have had the hard feelings that Kathy is describing above. 

     

    I wonder how this compares with members of other professional groups?  How many attorney's or bankers  wish they were doing something else....

     

  • I did do this over again in a way....this is my second career, journalism having been my first.

    Sure, there are things that I would change if I had a trusty magic wand:
    Lower student loans
    More flexibility to move from state to state
    Better public education about what we do (that's OUR fault though and we need to get busy educating people)

    On Monday I walked into a classroom to meet the first year students at WesternU and everyone of them was excited to be there. They chose podiatry. Podiatry did not choose them. That is different than it was 30 years ago. We have to accept that the poll results reflect conditions of a time in history when things were not especially fair for all who were graduating, with great grades even. I can understand some hard feelings. We were not told that we had to be entrepreneurs as well as podiatrists to make it. I think many people thought that success was a "given" and it was not.

    Hard feelings are to be expected.

  • The question I want to ask is, what about other MDs?

    I know several doctors (mostly in family medicine, primary care) who told me rather openly that they "hate" their jobs and how little they make in relations to their experience and training. I've also known a few OBs who decided to take an early retirement because their malpractice rates are too high.

    Isn't this just a case of "the grass is greener on the next door" thing? 

  • well, i have been out of touch lately but given the recent news and issues that surround what we are and how we do things I feel the need to input regarding this issue:

     

    a)  we are the true experts regarding the foot and ankle...not the orthopods.

    b)  we are the true experts when it comes to sports medicine of the lower extremity.

    c)  we are the true experts in lower extremity diabetic and venous leg ulcer management.

     

    .....Get the point of this post?

     

    I don't need to list every single thing that we are experts at.  I agree with Dr. Klein:  stop worrying about Dr. X down the street, cause trust me, things are usually worse on the inside than on the outside as presented.

     

    Eric

  • I agree. I also believe this malaise is affecting all doctors, not just podiatrists. Many of my MD friends lament going into medicine and will NOT encourage their children to do it. This IS disturbing because if supposedly more people will have insurance and will need doctors we need young people to become doctors, not to be discouraged about going into the profession. Are we all going to be treated by nurse practitioners?

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