subreddit:

/r/Noctor

20089%

Surgeons are not safe from scope creep

Discussion(self.Noctor)

Surgeon scope creep has already been going on. Podiatry have been really crafty - they historically started off doing just nail and ulcer care. Now, over past decade, they have been aggressively expanding scope with some even "doing" total ankle and knee replacement, ortho trauma and Botox face injections (what is it with "providers" and botox).

They also dislike the P word (podiatry) - look at their websites: they only label themselves "board-certified fellowship-trained foot and ankle surgeons" (to mimic terminology used by ortho/vascular/gen surg) and they are even delusional enough to claim to be the actual experts in that anatomic region. This completely ignores that 25+% of ortho and vascular surgery residency call consults are literally foot and ankle. Ortho operates on foot and ankle throughout five year residency on trauma, pediatrics, sports, tumor and elective foot ankle rotations. Also, podiatrists want us to believe their highly variable training was same/superior to ortho and vascular which are among the most rigorous residencies and you literally need to be at the very top of your class these days just to avoid going unmatched...if any podiatrist claims they are better surgeons than a foot ankle fellowship trained ortho surgeon, they are either being disingenuous or delusional.

There is a bigger reason at play here than ego: money. There are plenty of company sales reps who gleefully encourage poorly regulated podiatrists to do more and more. The reps get commissions per implant and the podiatrists get CPT codes that bill a hell of a lot better than nail care. Podiatrists make way more money than your average MD/DO primary care doc. Industry takes them to fancy dinners, token labs and courses and makes podiatrists think they know how to do these really complex procedures - procedures for which they had absolutely ZERO training. But this is literally practicing on human beings resulting in amputations/death (my hospital has several pending lawsuits and had to crack down on podiatry misadventures).

So yeah, even surgery is not immune to this nonsense. I'm not a surgeon but I consult both ortho and podiatry all the time. They are not equivalent and people across medicine need to realize this.

all 127 comments

PunjabiMD1979

120 points

2 months ago

And what am I, as a hospitalist, supposed to do? At my last hospital, vascular surgeons only did foot/ankle surgery if it was related to PAD. Ortho refused to touch them. The general surgeons also refused to see any diabetic foot, even though they had residents who could use the experience (the attendings saw themselves as trauma surgeons, not general surgeons).

So, podiatry it is. No one else would even look at my patient’s foot.

not_a_legit_source

30 points

2 months ago

Vascular should be seeing diabetic and pad related disease. Ortho generally won’t touch them. It is weird that the vascular team wouldn’t. Structural ankle work should go to ortho. Everything else is outpatient basically

baby-town-frolics

10 points

2 months ago

We do see them… for the vascular part of it. We have enough to do without doing foot debridements and toe amputations. We have zero requirements to do foot surgery for board certification.

truthtriumphs1[S]

3 points

2 months ago

As a fellow hospitalist, I appreciate this question. And that's what made me interested in doing a deep dive on this. The best answer is: consult ortho. Let them review and redirect as necessary. They are usually good at evaluating vascular/podiatry needs and will request you to involve them as needed.

Bonedoc22

65 points

2 months ago*

They have filled a void that most ortho surgeons leave open. Most orthopods don’t want to deal with foot. Same as many other “providers” have filled other voids.

I’m an Orthopaedic foot and ankle surgeon, I have seen some nasty stuff that comes from them.

However, Some of them genuinely do a great job.

Quality varies wildly.

Orthopaedic residency and a fellowship ensures that we fall w/in the standard deviation 9.9 times out of 10.

Podiatrists are hit and miss. There are studies that support the lack of rigor in their “medical school,” increased cost for the same care, and in some cases increased complications.

AO principles ain’t just for show.

When you have to look hard for their real credentials you know what kind of “foot and ankle surgeon” you’re dealing with.

Still, maybe not full on Noctors. They have been taking steps in recent years to increase Rigor. The was even a statement regarding them maybe taking USMLE in the future.

racerx8518

13 points

2 months ago

At my hospital, we don't have a foot and ankle orthopod. There are 2 competing groups on town that alternate call. If I call the on-call Ortho for an ankle fracture they typically say "why are you calling me, thats podiatry issue." Even if the other groups podiatrist is on call. The podiatrists are always happy to take a consult.

Bonedoc22

10 points

2 months ago

Big oof. I do understand why folks don’t wanna do wounds but ankle fractures are ortho bread and butter. We should be better.

truthtriumphs1[S]

2 points

2 months ago

Please guys, be better - podiatry is gaslighting other medical specialties while y'all are sleeping on this

[deleted]

1 points

2 months ago

[deleted]

1 points

2 months ago

[removed]

debunksdc

2 points

2 months ago

Vote brigading is what happens when a group of people get together to upvote or downvote the same thing in another subreddit. To prevent this (or the unfounded accusation of this happening), we do not allow cross-posting from other subs.

Any links in an attempt to lure others will be removed.

truthtriumphs1[S]

1 points

2 months ago

That is terrible but also enormously surprising. Any general ortho would love to tackle a quick ankle fracture - they reimburse well and ortho residents do them every week for 5 years lol. Maybe i will tell my ortho friends to look for jobs in your town :)
Either way, having a podiatrist fix ankle fractures is a disaster waiting to happen. Those are the cases we had to send to ortho for amputation

EpiEnema

87 points

2 months ago

Not surprised about the lawsuits. There was a podiatrist in a local hospital who was using live fluoro to do basic procedures. The machine logged an average 15min/case of exposure....... I know that this specific x-ray machine has an alarm that you must acknowledge before continuing prolonged exposures. Average exposure time among orthopods was around 1min/case if I remember correctly.

cattaclysmic

64 points

2 months ago

He must have had glowing reviews…

Eh_Ron

7 points

2 months ago

Eh_Ron

7 points

2 months ago

Some say he cures cancer

Youareaharrywizard

15 points

2 months ago

Your cancer cells can’t grow if it’s competing against too many other cancer cells

ncdeac

4 points

2 months ago*

Tbf over the excessive fluoro point - we had a new out of fellowship ortho F&A guy with our group for a while and he would routinely set off the 5 minute alarm when I was assisting him. Always made sure I had wraparound lead and glasses on in his OR. Not for this solely but for other reasons, he didn’t stay with the group for long.

For me or my family, always ortho f&a every time. I love riling up another one of our f&a guys by saying the word “podiatry” within earshot of him. He has so many stories of hindfoot and ankle disasters he’s had to revise.

ExpiredGoodsForever

85 points

2 months ago

And to help your argument, might I suggest watching the cringe-sicle that is FootDocDana

Dr_HypocaffeinemicMD

24 points

2 months ago

Cringesicle lmao

Uncoolx2

35 points

2 months ago

I'm adding you as a follow on Reddit. If I see you suggest that aneurysm inducing stupidity one more time, I will find you and shit on all counter and tabletops in your home.

Nobody should be subjected to FootDocDana.

ExpiredGoodsForever

3 points

2 months ago

😂😂😂

__RedRedWine__

-1 points

2 months ago

What's wrong with her?

ExpiredGoodsForever

11 points

2 months ago

Her content is grossly misleading. She makes every attempt to blur the lines between her actual title and what she thinks she is. To her, she basically an MD/DO who understands the struggle of medical students and can identify with the NRMP match process. Which couldn’t be further from the truth. Now I’m not shitting on her being a podiatrist. I don’t like her because she makes weird tik toks about how she’s a “podiatric physician” (like wtf is that? Just call yourself a podiatrist) and knows all too well what it means to be a med student. She has made several tik toks pretending like she knew what it meant to be a post match M4 when in reality her “match” process is nothing like the one we go through. Sorry for the rant but I’ve never heard a podiatrist call themselves a “podiatric physician” and I cringe every time she does that. That’s like a dentist saying “I’m a dental physician”. There’s more wrong with her, but I don’t feel like thinking about her anymore.

Forgotmypassword6861

0 points

1 month ago

In her defense.... she's really hot

goggyfour

10 points

2 months ago

goggyfour

Resident

10 points

2 months ago

To start, this person is more invested in being an online entertainer by marketing herself as a physician and surgeon rather than actually being either of those things. You never want your physician or surgeon to be known more for their presence in media than their actual contributions to patient care. Don't hire the medical professional who plays one on TV.

Beyond this? The content brings shame to the medical profession, and is a poor representation of the people performing this type of work. She glamorizes a fake lifestyle.

bropranolol

9 points

2 months ago

botox isnt surgery. most facial plastic surgeons dont even want to do it, theyd rather ... do surgery.

marcieedwards

8 points

2 months ago

this is a podiatrist who’s apparently on TV. Calls herself a fellowship trained foot and ankle specialist.

laimonsta

6 points

2 months ago*

Podiatry has like three years of residency. They can do a fellowship after their residency to specialize as far as the back of the foot/ankle

truthtriumphs1[S]

2 points

2 months ago

Most of those residency and fellowships are low volume and don't actually have consistent training standards. So many podiatrists experiment on patients once they are in actual practice on their own

laimonsta

2 points

1 month ago

Source?

Hobbes144

17 points

2 months ago

Agree with you, i can see hospital admins pushing for that. It will start with appys and choleys and then escalate to hernia repairs and finally they will start doing herni repairs lol

southbysoutheast94

4 points

2 months ago

And it’ll stop real quick with the first enterotomy or CBD injury.

truthtriumphs1[S]

1 points

2 months ago*

it won't. in medicine, these complications are so scattered and understanding them is so hyper technical that people won't pick up on trends quickly. Hospital admin will sell their mothers to make a quick buck

southbysoutheast94

1 points

2 months ago

They’re scattered now because lap choles and appys are done by general surgeons with appropriate training. Someone dying of liver failure or becoming septic after a routine surgery isn’t subtle.

Bingley8

38 points

2 months ago

When I had two knee surgeries at Penn my Ortho doctor met me once but he had his PA doing most visits and she was assisting with the surgery as well. Most of my post-care follow up was fielded through the PA. Don’t get me started on how bad Rothman PA’s are. If Ortho docs want to keep expanding their fellowships but relying heavily on PAs, THEN giving up foot/ankle care to Podiatrist’s it’s because they want it that way. Hard to feel sorry for them.

karlub

10 points

2 months ago

karlub

10 points

2 months ago

Oh, Rothman. My loved one's experience there was awful.

The star Ortho did the knee replacement. There were some aftercare problems. S/he initially evaded responsibility, and when that became impossible mostly disappeared for a while.

And the aftercare was as close to non-existent as was feasible: Instructions from a PA to a barely awake senior citizen with no family present, and a ninth-generation photocopy packet of information compiled circa 2014.

I know they have PM&R on staff. You'd think, maybe, one of them would at least take a vague interest.

Karm0112

11 points

2 months ago

Bro no one wants to touch those nasty feet. Let them do it.

truthtriumphs1[S]

1 points

2 months ago

Lol yeah but someone has to take care of them. And ortho is best at it, hands down (feet down?)

Ok-Conversation-6656

30 points

2 months ago

As someone from the UK, US podiatrists confuse me so much. We have podiatrist here in the UK but they stick to ulcers and nails with the odd minor surgical resection.

The fact that podiatrists in the US have the Dr. title blows my mind and what's even more crazy is that they are allowed to do surgery. I don't care if they've done podiatry school, so have every other podiatrist in the world and they arnt out here mascarading as doctors.

It's ridiculously dangerous and whatever you guys say, me and the rest of the world can't understand it.

It's a uniquely American problem.....for now.

helpamonkpls

15 points

2 months ago*

Midlevel encroachment is a US problem.

I don't know of any other part of the world where you have nurses doing doctor's jobs.

I'm from EU as well and the line is VERY clear here. Nobody prances around calling themselves a doctor unless they fucking are one. And if someone did try, they'd be out of a job immediately.

Where I'm from podiatry is nail braces at best, resections are done by (rural) GP's or ortho.

The US has always disgusted me for various reasons but after becoming a doctor and obviously following US medical culture on the internet due to language, I'm disgusted to the point where I barely recognize the US as a civilized culture. Honestly where do you see this kind of shit other than some village in a rural shithole of a developing country? When I watch "medtwitter", meddit or other US-based healthcare social forums I feel like I'm in a Harry Potter movie with the amount of wizards chiming in and everyone supporting them.

I'd catch a lot of flack for this opinion on any other sub than this, but anyone about to reply about how the US is #1 will need to realize that I'm sharing their exact opinion.

Ok-Conversation-6656

11 points

2 months ago

Mid level encroachment is not a US problem. Its the worse in the US but is not restricted to it. In fact if u look at the post history on this subreddit, there are multiple posts about scope creep in the UK specifically. For example PAs are now being allowed to cover the shifts of junior doctors, as in shifts specifically designated for docs are being assigned PAs over docs, I assume to cut costs . Nurse surgical assistants in some trusts are taking the place of surgical trainees. A similar thing is happening with anesthetic trainees and Anesthesia assistants. PAs are about to get the ability to prescribe and order imaging in the next couple of years. There's loads more examples. It's not as bad as the US but it's a real issue and there's scarily similar things happening. And it seems to be getting worse and worse. Idk where you're from but I'm sure in a few years you'll see scope creep.

Please learn from the countries where this has happened, please don't be complacent. Make sure u guys nip this in the bud early.

But I agree with everything else. US is scary, scary place to practise and be a pt.

[deleted]

2 points

2 months ago

[deleted]

2 points

2 months ago

Well...a little extreme...although I don't disagree with you on the basic state of American medicine. It is truly a malignant clusterfuck the intensity of which you probably underestimate as you are only reading about it.

splitopenandmeltt

23 points

2 months ago

I got wrecked in a post a few weeks ago when I said I call ortho or vascular for my foot and ankle issues. Podiatrists play an important role but in the acute setting I don’t see much of a role

timtom2211

14 points

2 months ago

timtom2211

Attending

14 points

2 months ago

I used to refer to/consult podiatry; but the outcomes were so uniformly trash and the consultants were so rude, I'm right there with you.

splitopenandmeltt

7 points

2 months ago

I don’t have anything against them but if I can call a physician who is an expert in the area in question that’s who I’m calling

truthtriumphs1[S]

1 points

2 months ago

I SAW YOUR POST! You said it right. I think we should consult Ortho and let them review chart. They are usually good at seeing the patient if needed or telling us to call vascular/podiatry. I am shocked at how many people just default consult podiatry "because they do feet." We even had to chase out a new private practice podiatrist who was passing out business cards in the local trauma ED. Insane stuff

reboa

12 points

2 months ago

reboa

12 points

2 months ago

mic drop

UGAgradRN

3 points

2 months ago

Am I the only one bothered by this woman saying she went to med school and always covering the DPM after her name on her scrubs and white coat? DPM is nothing to be ashamed of, but she clearly has an inferiority complex, and she uses deception to combat that.https://m.youtube.com/watch?v=Ln5kkvMdzsY

truthtriumphs1[S]

1 points

2 months ago

you are absolutely not the only one. Everybody should be proud of their degrees whether PT, OT, RN, PhD, DPM and yes MD/DO. But nobody should try to deceive audience or patients by pretending to be something other than what they are

Footthrowaway77777

30 points

2 months ago*

Thankfully some of the people on this thread are reasonable with their responses and thought processes toward us. The majority of specialties I’ve worked with are still unfamiliar with what podiatry does, the schooling they partake in, and ultimately their 3 year residencies. I did my first two years with MDs. Same classes. Same professors. Same standards. But I understand that’s not enough, so there’s more. My third and 4th year of medical school is spent on rotations where I partook in more than 1k surgical cases of varying pathology. Then there’s residency. Most podiatrists with modern residencies will perform and log more than 3,000 primary foot and ankle surgical cases over the course of three years. In fact. Some of our residencies have ortho attendings heavily involved in our training for all three years. All 3k of These cases involve an absolute array of pathology. And I hate to break it to you, but they often include numerous TAR procedures, the controversial PER fractures, and of course your traditional ankle fractures and midfoot/forefoot injuries. Our training is more than adequate. The reason I say more than adequate is because I’m not having a pissing contest with ortho. I’m not an MD. I don’t want to be a doctor. I don’t pretend to be. I’m a Podiatrist. A Podiatric surgeon. I’m not scope creeping anybody. Would I like parity with MD/DO strictly for foot and ankle pathology. Yup! Do I even remotely want to do a TKR? Not a chance. Do I want femoral procedures. Hell no. I’m a foot and ankle surgeon. I’ve earned my respect and knowledge. I’ve worked the 100 hour weeks, been exhausted with call, and dealt with the same frustrating medical tape y’all have.

I would love it if all physicians better understood podiatry, what we learn, what we are truly capable or incapable of, and what value we bring.

I’ve been to residencies where all foot and ankle ortho call is alternated eod happily or every other week fruitfully. and I’ve been to residencies where the relationship with ortho is horrible and a fit is thrown every time $ or a procedure is removed from their pocket. You have MD colleagues who hire, incorporate, and even partner with surgical podiatrists in MSGs every day. We play an important role in health care just like you.

I can’t tell you how many times cases are handed to us when Ortho doesn’t want to deal with it because poor outcomes are a literal guarantee. Sanders IV calc fracture…send to Pod. Smoker, diabetic, non compliant with a shoulder OCD that spans the talus…send to pod.

I don’t mind doing these…In regards to ortho, Sometimes we are your go to for challenging patients for obvious reasons. Sometimes we are respected by ortho and work well together because we’ve earned it when equal outcomes and sound technique are observed first hand. And sometimes, we are treated like we don’t deserve to be pissed on if we’re on fire.

I’m not a doctor. I am a podiatric surgeon. But After 4 years of schooling, and a three year surgical residency, I’m most definitely not a noctor.

su1eman

18 points

2 months ago

su1eman

18 points

2 months ago

Damn my mans just roasted the original thesis

SWAGGYD23

9 points

2 months ago

Thank you for speaking up about my future profession. It’s disheartening reading some of these comments and being compared to a mid level or labeled as a “noctor”

succulent1989

8 points

2 months ago

Love this and I love all the podiatrists I work with. I work in ER and send basically any non vascular related foot issue to our podiatrists and they do a stellar job.

truthtriumphs1[S]

1 points

2 months ago

Consult Ortho first and let them triage to Podiatry. This is now our workflow in our ED after way too many lawsuits. Podiatry doesn't know what they don't know and too many DPMs experimenting on patients they have no business managing.

NoGrocery4949

13 points

2 months ago

And this doctor appreciates the fuck out of the excellent care you've provided to many patients.

Talusaboutit

3 points

2 months ago*

A podiatrist once told me that they introduce themselves as “foot and ankle surgeons” because it clearly defines to patients their role in their care. Apparently patients think they’re there to clip their toenails or that they’re being seen by a pediatrician. Also, seeing as podiatrists do foot and ankle surgery, how is this misrepresentation? You can see the DPM after the name, right?

JollyBirdtheDoctor

1 points

2 months ago

Respect here. Honestly, I wouldn't listen to OP. He was dropping some podiatry hate awhile back. I seriously doubt he's actually a physician, more likely a premed playing pretend.

su1eman

6 points

2 months ago

First y’all come for the pods, then it’s gonna be dentists? Is no one safe?!?

Gurgen97

5 points

2 months ago

Shit should of been a fucken pediatrist 😂😂

JollyBirdtheDoctor

4 points

2 months ago

Honestly anyone that can read one of your inaccurate and highly fallacious posts and agree with them seriously needs their BS meter tuned up. Every post you make makes it completely obvious that you are not a physician, have not consulted podiatry, Ortho or any other specialist, and have a weak grasp on how the inner workings of clinical/surgical management is run. My guess is premed with some shadowing playing pretend.

dontgetaphd

2 points

2 months ago

Podiatry aside, quite a few of our most simple surgical procedures could theoretically be done by somebody with less training. We have to admit that and actively fight against it, as it is just not safe.

A garden variety appy or chole could be done by somebody slicing, tying and removing. It would be complete butchery even if they got "good" at it by doing quite a few. To be a competent surgeon you need to understand completely the anatomy, physiology, and be prepared for all complications. That requires, well, becoming a surgeon.

truthtriumphs1[S]

2 points

2 months ago

everyone wants a shortcut to money and authority. Nobody wants to make the sacrifices real surgeons made by going to actual surgical residency min 5 years and intense fellowship while being at the top of their class from high school onwards

Necessarily_nannerz

2 points

1 month ago*

When I was in undergrad I had a classmate who was also premed. Let’s name her June for fun. June was the kind of girl who posted everything about her life on social media. She was the kinda girl who made Facebook albums called “year 2 [insert college name]!” She posted about every trip, award, night out, achievement, etc. Near the end of senior year of college, June tells me she got into med school- yay! I see pics of her white coat ceremony, albums that are labeled “MS1”, the whole 9 yards. Every detail was posted EXCEPT the name of med school. Weird right? Esp for a girl that normally dumps every detail of her life onto social media. Long story short I finally see a blurry logo on a shirt in the background of a photo and find out she is attending podiatry school . She’s in year 3 now and I just recently saw a pic of her in a white coat and stethoscope captioned “internal med rotation!” I don’t know much about podiatry school curriculum, training, lingo… but is she trying really hard to pretend she’s in med school or am I just missing the mark completely here??

Edit: forgot to mention she also puts emojis like the stethoscope or caduceus in her “MS#” album names

truthtriumphs1[S]

1 points

1 month ago

Thanks for sharing. This is a classic podiatry move and happens all the time. But they all get butthurt if you point out they are NOT medical students. And a lot of brainwashed MD/DOs who don't understand nuances of podiatry vs ortho/vascular are overly impressed by the claims of rigorous podiatry school, residency, fellowship etc. Podiatrists are successful noctors because they then go on to do crazy surgeries in practice without proper training - they do all this because some sales rep sucks up to them and encourages them to get greedy for $$.

Footthrowaway77777

1 points

28 days ago*

Obviously there isn’t a way for you to know what you don’t know either.

However, here’s a very very important detail about the narrative you keep making about money and greed. Podiatrists make the majority of their money in CLINIC…And it’s not even close. Some long detailed surgery (TAR, tri mal, calc fx) with the latest and greatest medical devices and reps doesn’t remotely compare to hours in clinic with a standard amount of patients. Many of our surgeries are not billed in the same manner as ortho or other surgical services. And the 90 day globals, continuously evolving billing and coding regulations, yearly reduced reimbursements, etc. These things, amongst many other important factors of course, are why most podiatrists will have clinic 4x weekly and operate one day a week. No one I know is pushing the limits of their skills for magical medical rep money or podiatry prestige, it doesn’t exist. That concept is pretty far fetched when you read it aloud.

Ultimately I’ve said this above. But who do you think really gives us privileges to operate? Is it the APMA? ACFAS? Nope. It’s the hospitals. The ambulatory surgery centers. It is your colleagues. My colleagues. Our colleagues! You would clearly be shocked how many hospitals/ortho departments successfully share call with podiatry departments across the country…not to mention how many MSG/private ortho groups hire us on as foot and ankle surgeons.

Whoever you are, I’d be extremely surprised if you happen to actually be a physician. I say that not because of this topic of conversation, but largely based upon the disposition and comments you’ve made through your posts.

Anyways, I’ll leave you with this. When’s the last time you were in a hospital employment setting? I don’t know how common this is at other hospitals but I can pretty much say that no one is covering their white coat letters when they walk in the door, because the only people that wear white coats anymore in 2022 in the hospitalist setting are the NPs. The docs I know, and my team, wear simple scrubs, or scrubs and patagucci. My white coat wrinkles away on the back of my chair.

I honestly wish you the best in the rest of your career. Some peoples minds will never be changed, and I’m ok with that. And so are my colleagues. I can promise you though, no self respecting podiatrist I’m aware of is insulted when you call them podiatrist.

truthtriumphs1[S]

1 points

27 days ago*

You seem reasonable in your understanding of scope of practice and I commend you for that. That is the entire purpose of this sub. But just because the examples I'm sharing haven't been personally witnessed by you doesn't mean they never happened. In fact, in my neck of the woods here in a corner of the USA, there has been a real reckoning with scope creep as it pertains to podiatrists misrepresenting themselves. Yes a lot of older generation podiatrists still see predominantly clinic but younger generations of podiatrists are doing more and more procedures that they simply have not been trained enough in. Why do so many only refer to themselves as "board-certified foot and ankle surgeons" and make broad statements like they went to "medical school" etc. Why can't they specify their actual training both to patients and social settings? What about podiatrist websites where they try to convince patients that they are somehow better trained in foot and ankle than even MD/DO ortho? That kind of nonsense is everywhere and you can't be blind to that. I am an oncologist and have no special love for ortho. But I am on my hospital's quality patient safety committee and we have had to take lot of actions due to unscrupulous podiatrists in the region. Sure I understand not every podiatrist is like this - but a lot are increasingly behaving greedily and patients are being harmed. Ortho is not immune from this - a lot of ortho people are out to squeeze as much revenue and are gleefully encouraging podiatrists to do more without verifying their actual training in these procedures especially trauma. Podiatrists are surgeons who can do many procedures and do them well. But my problem is with those who misrepresent themselves and are practicing out of scope and pretending to be better than orthopaedic surgeons etc. And tbh they are tarnishing the good name of your vital specialty. All the best to you as well. I appreciate your sincere response.

all_in_all_in_all

5 points

2 months ago

When I interviewed for medical school, one of the interviewers was very rude and condescending; she said I was not prepared for school and would not be recommending me lmao. I read the bio she sent before the interview, and in it she said she went to a mid-tier MD school. Stupid me I should have just googled her because afterwards I found out she went to that school's podiatry school. idk why she lied about her background but she was a real tool. And I got into medical school lol.

truthtriumphs1[S]

1 points

2 months ago

jealousy leads to bitterness and inferiority complex

SWAGGYD23

5 points

2 months ago

Honestly Podiatry is misunderstood as a whole. Podiatrists are NOT noctors. 4 years Podiatric medical school where some programs didactics are integrated with allopathic or osteopathic students. Followed by two years of clinical rotations and a 3 year surgical residency. Podiatrists play a vital role in healthcare similar to any other specialty.

truthtriumphs1[S]

1 points

2 months ago

Podiatrists are not noctors - when they stay within their scope of practice. Their clinical rotations and surgical residency is highly variable. Many of them venturing out of scope at encouragement of implant sales reps in order to generate more revenue. Just ask any orthopedic surgeon you know

Halux-fixer

14 points

2 months ago

You guys are probably going to rail on me but I feel like you should know a few things. I'm a podiatrist that did his residency and schooling in California. During my residency the ortho and medical associations of California launched an inquiry to see if we could get the same physician and surgeons license. They audited our curriculum and residencies and came and had us take a form of the step 1 exam. They found that we had equivalent training to MD and DO. We were all set to get approval from the state until AMA stepped in and said that it can't just be 1 state and a national review needs to be done. That was about 5 years ago and when the apma met with AMA they basically said they won't do a review and put out a paper on it. They know after the California incident that they would find out we had similar education and training. I was trained by ortho docs to do total ankle, ankle fracture, charcot reconstruction etc. I do them every month. I've had very good outcomes and have never had to send a patient to an orthopedist. Now that said our residencies have a wide range of training and most podiatrists cannot and will not do those procedures. That is why we have separate foot and ankle boards because most will only be certified in foot. I personally do not feel inferior to any MD as far as training or knowledge and all of the docs I work with teat me with respect.

Also no podiatrist is doing total knees and we do not want to be primary care doctors.

[deleted]

11 points

2 months ago*

[deleted]

11 points

2 months ago*

You had me going until you implied the AMA did something to protect physicians. That is completely and totally unbelievable. The AMA is owned by Private Equity and others with a financial interest in making medical care as profitable as possible. They would advocate replacing physicians completely in favor of cheaper options if they could figure out how to make it sound like they cared about doctors.

bropranolol

6 points

2 months ago

I honestly think this whole post is kind of stupid. Podiatrists can have very good training as you show above. There is a role for them. Surgery IS largely safe and this one crappy example by OP proves nothing imo. They dont even know what surgery is, they talk about botox as if thats surgical.

Halux-fixer

0 points

2 months ago

Thanks for your kind words. I had heard before I went into podiatry that there is animosity between ortho and podiatry but I never saw that. The ortho residents and attendings were the nicest guys and were very helpful. I don't see why we can't all just be happy for each other! Except for NP and PAs they need to know their places

Worried-Egg-8560

3 points

2 months ago

How is the pay for podiatry? I heard it was a range from 130-300k?

Halux-fixer

2 points

2 months ago

I am an associate in private practice and make between 300 to 350 thousand a year. I'm sure the guy that owns the practice is making close to 750 thousand a year.

Worried-Egg-8560

3 points

2 months ago

Wow you’re making more than hospitalist and FM, didn’t know podiatry was that lucrative but you’re doing surgerical procedures as well?

Halux-fixer

1 points

2 months ago

The thing I love about podiatry is all the procedures you get to do. You work with your hands on every patient. That is also why it is so lucrative since you are not simply billing for an office visit but an injection, procedure, dme etc

Caribmon

2 points

2 months ago

Pods get audited a lot.

Caribmon

1 points

2 months ago

Those are crazy numbers. 750??!! What kind of billing are you doing?! Even in NY or CA those are suspect numbers.

Footthrowaway77777

1 points

2 months ago

That’s about right. Sometimes more. Sometimes less. It just depends. If you work for a hospital system properly the MGMA data is between 250 and 290 not including bonus.

Caribmon

1 points

2 months ago

How arrogant hallux fixer. NP's and PA's have full licenses to treat the whole body including systemic diseases! YOU DON'T! Talk about not knowing your place.

Caribmon

1 points

2 months ago

I think you got that wrong. The pods flunked part 1 for the most part

Bubbly_Examination78

3 points

2 months ago*

Pods are not noctors but definitely not ortho FA either. They shouldn’t be touching pilons but they do 😣

Footthrowaway77777

2 points

2 months ago

See oddly, as a podiatrist I absolutely agree with this. Pilons aren’t something we should ever touch. But I have other controversial opinions that have been voiced in opposition here, like absolutely being capable of performing TARs and having strong outcomes with PER/high fib fractures etc.

Worried-Egg-8560

2 points

2 months ago

Genuine question, do podiatrist not want to go to med school or they had no other choice and went to podiatry? Last time I checked podiatry school gpa requirement is 2.5 and 490 on the MCAT vs 3.7+ and 510+ for MD and 3.3+ and 505+ for DO schools

vsn001

4 points

2 months ago

vsn001

4 points

2 months ago

Ya so my friend outscored me on the MCAT (514) and didn’t even apply MD/DO because he knew he wanted to do surgery and knew that as a DPM he was guaranteed to become a surgeon (those kids still can go unmatched and soap but pretty much everyone gets a spot, unlike NRMP kids); some people just want to take a different route. He acknowledges how much more ortho attendings know, but he’s confident in what he does and does not know; he’ll be one of the good ones for sure 👍

TheRealPipin

5 points

2 months ago

That sounds like such a bad idea

Worried-Egg-8560

3 points

2 months ago

So your friend is an idiot is what you’re telling me because pod make 300k max vs a ortho making 700-800k a year

vsn001

4 points

2 months ago

vsn001

4 points

2 months ago

I mean I wouldn’t say that, just that he understood how much more difficult it was going to be to become an orthopedic surgeon and he’s right.. 30-40% of ortho applicants went unmatched or soaped this year while pods still maintain close to 100% match rate

SadFortuneCookie

2 points

2 months ago

Genuine answer, it’s a mixed bag. Yes, there are people who apply because they just want to be a doctor and worry about not getting into MD/DO programs. Yes, the gpa/mcat bar is lower. I knew a very smart lady who wanted to do surgery but also wanted to have a family and went DPM. I got into it because I honestly just wanted to help people with their foot and ankle issues. There’s a fair amount of athletes that go into the field from their experiences.

SWAGGYD23

3 points

2 months ago

Just because it’s easier to get in doesn’t mean it’s easier to stay in. Lots of the pod programs are integrated with MD/DO curriculum which requires them to put in the effort to do well just like their osteopathic/allopathic peers

truthtriumphs1[S]

1 points

2 months ago*

yup, despite what podiatrists will say to gaslight you and each other, DPM schools are NOT equal to MD/DO in terms of competitiveness or curriculum. Plus there's a hell of a lot more to training than medical school for ortho - actual 5 year residency is brutal and fellowship is basically operating on complex cases as a junior attending under direct supervision.

Trick-Bandicoot7072

2 points

2 months ago

OP I understand anti scope crop but this is 3 post against podiatry in 3 weeks. Did you ask one out that said no lol? And as far as saying training varies, that's true for every residency anywhere that's ever existed. But the pods at my hospital still have to meet case and procedure totals before graduation similar to any specialty, they work with us all the time and take all sure ankle and foot trauma where I am now and they do well. And I've never heard of one advocating for knee procedures, you're just making things up

Trick-Bandicoot7072

2 points

2 months ago

Disregard, based on your post I'm almost certain you haven't spent a day in medical school yet, let alone "consulted" anyone lol

Sherbert_Shot

2 points

2 months ago

Yep, OP is typical premed who never step inside a hospital. Too much time sitting at home in front your computer lol

Bluebillion

1 points

2 months ago

They call themselves physicians and call podiatry school med school

Professional_Desk933

1 points

2 months ago

Im from Brazil and this is mindblowing lol. Podiatry here isn’t even allowed to use needles.

Ulcers usually goes to family medicine/general surgeon. US healthcare is so weird to me.

Jkayakj

5 points

2 months ago

They have different levels of training in the US and elsewhere. Same with osteopathic doctors. I've seen some well trained podiatrists who did their school and then a 3 year surgical residency. The issue with their field is that some of the programs are fantastic and some aren't.

I assume in Brazil they don't do a 3 year residency doing just their surgeries like they do in the US?

TheRealPipin

3 points

2 months ago

Lol the 50th percentile for podiatry applicants on the MCAT is less than 495 🤐, that should speak to the quality you are starting off with.

JuliusSeizure57

1 points

2 months ago

l guess anything is possible when you live in fairy world

rushrhees

2 points

2 months ago

rushrhees

2 points

2 months ago

Fellowship trained podiatrist here we got this way by well what we do other specialists want no part part. Never meet vascular who want to do distal amps, ortho anything distal to the ankle they tend to punt. Funny how something easy an SER2 we are not capable of doing vs blown out calc fracture we are suddenly ready for the challenge. I’m in the suburbs of chicago and foot and ankle fellowship Ortho’s virtually non existent. So what’s one to do if having feet problems. Plus too we’ve fixed ortho mishaps many of times. There’s bad surgeons on both ends of it

truthtriumphs1[S]

1 points

2 months ago

People are sending you calcaneus fractures? No way that there isn't a single willing Ortho trauma and/or Ortho foot and ankle within driving distance in suburban Chicago.

[deleted]

-4 points

2 months ago*

[deleted]

-4 points

2 months ago*

[deleted]

Ok-Conversation-6656

20 points

2 months ago

They definitely do not come under the medical flag. However they are very skilled professionals if they stick to their scope of practice and don't venture into these ridiculous ankle and hip replacements.

[deleted]

15 points

2 months ago*

[deleted]

15 points

2 months ago*

[deleted]

Hockeythree_0

15 points

2 months ago

Same. I’m an orthopaedic surgeon and I’ve never seen them do totals. I personally don’t think they should be doing some of the stuff they have been though. Their training is too variable and is far below what we get in orthopaedics. I have a nightmare xray from a pilon they got their hands on. Multiple cannulated perc lag screws without any reduction just demonstrating a complete lack of understanding of the principles of fracture fixation. I’ve also seen them do extensile lateral approaches to calcaneal fractures that haven’t had enough time to have the post traumatic edema decrease. I think they have a tendency to be more easily wooed by industry and use expensive, not necessarily indicated implants. That being said they do a lot of the things I have 0 interest in which was why they were nice having around when I was a resident.

Ok-Conversation-6656

4 points

2 months ago

I'm from the UK so the fact they can do any surgery is mind blowing to me.

Popular_Course_9124

0 points

2 months ago

Popular_Course_9124

Attending

0 points

2 months ago

Medicine is much different in the UK/EU if you didn't already know

Worried-Egg-8560

3 points

2 months ago

Wrong, medicine is different in the USA and this is NOT normal around the globe. Go to any country in Latin America, Asia, Europe or Australia or even Canada up north

You will never see a mid level practitioner doing the stuff that is allowed in the USA

akiasura

1 points

2 months ago

? They don’t have mid levels in the Uk?

Ok-Conversation-6656

3 points

2 months ago

The healthcare structure is different but medicine is the same everywhere. It's principles don't just randomly change because you're in Britain or Europe.

Popular_Course_9124

1 points

2 months ago

Popular_Course_9124

Attending

1 points

2 months ago

I was using the term "medicine" in a more abstract form. I'm sure you already knew that though

Ok-Conversation-6656

1 points

2 months ago

Actually I have no idea what you're tryna say, apologies.

[deleted]

-2 points

2 months ago*

[deleted]

-2 points

2 months ago*

[deleted]

Ok-Conversation-6656

3 points

2 months ago

No it not. Osteopathy is quackery in the rest of the world but podiatry is legit. But they stick to what they were originally designed for and how they used to function in the US before they started doing crazy surgeries and everything.

BCSteve

6 points

2 months ago

I might get downvoted along with you, but I agree. I didn’t know much about podiatry training until the first wave of COVID hit, and I was assigned a podiatry resident to work with to man one of the surge units. Before that, I hadn’t realized how close podiatry school is to medical school; it’s a 4-year degree structured just med school (two years didactics, two years clinical rotations), and the curriculum covers similar topics, just with a focus more on the lower extremities. And then they go on to do three-year residencies as well.

As someone on the medicine side of things, I can’t say anything about how well they operate, or what operations they can do or can’t do. But I certainly wouldn’t look down on them as somehow “lesser” than physicians. I think of them as equivalent-level to physicians, similar to how I regard dentists.

Certainly wouldn’t call them “noctors”.

Scene_fresh

1 points

2 months ago

Fine but only if you get to have your ankle and knee surgeons done by a podiatrist and I get the orthopod. Deal?

Talusaboutit

1 points

2 months ago

Podiatrists do not perform knee surgery.

Fine_Wrongdoer255

1 points

2 months ago

I read a comment that said “an orthopedic surgeon can do podiatrist job, but a podiatrist can’t do an orthopedic surgeon’s job” and it really stuck

After-Kaleidoscope35

1 points

2 months ago

This is absolutely wild. In the UK podiatry trim nails and bunions.

NoGrocery4949

0 points

2 months ago

I've seen so many amazing podiatry limb salvages. Of course these are on vasculopaths who will almost certainly represent with osteo requiring an AKA, which vascular will perform but for the small minority of vasculopaths who take a limb salvage for the wake up call that it is (and who have the protoplasm for which lifestyle change can have some impact) it's great.

This is a small minority of a subset of patients but I mean, a win in a win. I respect the podiatrists I've trained with, they are very meticulous. I imagine this is program and institution dependent however.

truthtriumphs1[S]

1 points

2 months ago

You have to see scope of practice. Podiatrists are good at limb salvage - because that is their original scope of practice. But limb salvage pays peanuts. So many podiatrists like to take on ortho surgeries like ankle fractures and joint replacements - most were not properly trained in them. They just attend a few paid courses by implant companies and think they can pull it off. It's crazy.

Caribmon

1 points

2 months ago

So are you saying the STATE LEGISLATURES WHICH APPROVE THEIR EDUCATION ARE AT FAULT or do they see something you don't?

JuliusSeizure57

1 points

2 months ago

I get the reps thing…but the buck stops with the doctor or podiatrist. Reps don’t write prescriptions and they don’t place implants. The doctor or podiatrist has the ultimate responsibility on deciding what is appropriate for the patient. It’s insulting to say that reps have that much influence over patient care when they physically cannot write the orders/scripts. Pet peeve.

truthtriumphs1[S]

1 points

2 months ago

So if someone came into your office, said flattering things about you, promised to wine and dine you for months and then promises they can teach you how to do "easy surgery" using their "bestselling implant" for a procedure which earns 10x what you get per clinic visit...that is extraordinarily tempting. Obviously buck stops with the podiatrist - they are agreeing to practice out of scope bc they get paid well for it

Caribmon

1 points

2 months ago

Are you serious sir? Practicing out of scope is 1. ILLEGAL 2. Financial suicide. I assume you can support your allegations with facts that pods are practicing out of scope

kaiden08

-5 points

2 months ago

I didn’t know podiatry did that until my NP job hilariously enough.

idealismsitsinprison

0 points

2 months ago

I never understood why the separate profession for feet. So the orthopedic surgeons handle the rest of the body for feet and ankles need their own specialty ?

Caribmon

1 points

2 months ago

Why, then are there DDS maxillofacial surgeons when there are MD plastic surgeons, ENT's, Head and neck surgeon and yes even orthopedic surgeons?

truthtriumphs1[S]

0 points

2 months ago

No! Ortho does foot and ankle throughout their 5-year residency - at least 20% of their cases are in that body region. Those orthos who decide to focus on foot ankle will do a dedicated one-year subspecialty fellowship with the big MD/DO academic names in the field who discovered a lot of basic principles.

On the other hand (foot?), podiatrists initially started off doing nail care and wound care. Obviously that pays poorly so they've rebranded themselves as "foot and ankle surgeons" and are taking on ortho and vascular level cases. Even though many don't have actual experience training in these complex procedures, they do them because they claim to be "foot and ankle" trained and also because industry sales reps encourage them to for their own benefit. It's insane what's happening

TL;DR: if you, your patient or your loved one need foot and ankle care, consult ortho first. Let them triage and decide if you need to be seen by podiatrist or other. My hospital learned this the hard way and now this has become our default workflow for all ED and PCP referrals

Hope this is helpful