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Don't forget the "Denial" factor. You may be right, Dr. Schneider, that the realization of their plight has rendered students speechless. At the same time, however, I strongly suspect that most students are in denial concerning the grim fate that faces all of them as a distinct possibility, and which awaits a very significant percentage of them as an inevitability--no matter how hard they work, no matter how much business and practice management they study and implement, no matter how much butt they kiss--and they'll have to kiss a lot of butt over the next few years!
This condition of denial that afflicts students today is essentially the same as the denial we see in our patients with
chronic degenerative diseases such as diabetes or arteriosclerosis, and in our patients addicted to substances
such as nicotine. It is a terrible problem, resulting in an incredible amount of misery and destruction in our
Just as is the case with chronic degenerative disease patients, there are individuals who facilitate and reinforce the
condition of denial in students today. Students are routinely being told how wonderful everything really is and
how "bright" their "futures" are going to be.
Prospective students are being fed propaganda sponsored by our schools and professional associations that is, to
be charitable, inaccurate and highly suspect. Pre-professional students are routinely lured into applying and
matriculating to our schools by literature that touts ridiculously short work weeks, no pagers or call, practices
that are a mixture of palliative care, medicine, orthopedics/biomechanics, and surgery, high personal income
levels, and a high level of respect and acceptance by the medical community and the public.
It is only AFTER they are financially committed that they discover that there is NO widespread respect for
podiatry in the medical community--our profession continues to be viewed by the overwhelming majority of MDs
and DOs as a mere "hand maiden" profession to medicine, and not as an integral part of medicine. A tremendous
number of MDs and DOs are genuinely surprised--and often shocked and dismayed--to find that we can
prescribe medications beyond simple topicals, NSAIDs and some antibiotics, and that podiatrists can do
surgery--many still believe that all we can do is trim toenails and pare corns and calluses.
A big percentage of our students, by the way, WILL only be qualified to trim toenails, pare corns and calluses,
and provide a few other minor and menial services, thanks to the turf-grabbing going on in this profession right
now--once they get residency training "standardized", RPRs will disappear altogether and PPMRs will eliminate
surgery and begin turning out the over-priced, overly- debt-burdened, over-trained pedicurists they have always
been intended to produce.
It is only after they are in too deep to realistically back out again that students learn that there are few jobs out
here for them--and that only a very few of those that exist are available to those with the non-surgical training that
is supposedly so valuable. Only when it is too late do they learn that the jobs that exist generally pay about what
a high school drop-out in a "blue collar" job earns, but with even LESS future than the high school drop-out can
count upon.
Only when it is too late do they learn that certain elitist minority elements of their so-called "colleagues" out here
in the Real World have conspired to deny them the full training they are paying such outrageous tuitions sums for,
to deny them access to meaningful board certification, to deny them access to
meaningful hospital privileges, to
deny them access to participation on insurance provider panels--often to deny them even the ability to come to
the state of their choice and provide needed high-quality care to patients, subjecting them to harassment and an
There are people at the schools who are telling students everything is just
peachy-keen, and dismissing anyone
who has been adversely affected by all of these negatives as being just a few "losers", "whiners", "poor students",
"poor managers", etc. The truth is, several thousand podiatrists across the nation are affected by these negatives,
with damage ranging from severe loss of practice satisfaction and income to bankruptcy and lifetime financial
ruin--and the range is rapidly shifting to put more and more into the "lifetime financial ruin" category each and
every year.
The lies, half-truths, misrepresentations, and all the other examples of deceit serve only to support the hunger of
certain institutions for tuition dollars, of others for numbers to increase political clout. Unless students wake up,
snap out of it, get angry, and take action TODAY, a large percentage of them will be destroyed--not MAY be,
but WILL be!
The people who are foisting off all of this "touchie feelie" feel-good crap directly and/or indirectly benefit from the
destruction it produces. The people who tirelessly point out all of the negatives that afflict this profession--the
inequities, the injustices, the discrimination, the back-biting, the back-stabbing, and
the lies--do not benefit from
doing so. It does not put money in our pockets--tuition, dues, or otherwise. It does not make our own practices
more prosperous or secure.
Everyone who has spoken out against the negatives in podiatry and attempted to warn students and prospective
students of the very real dangers that lay ahead, has done so for one reason only: they recognize that to bring
innocent young men and women into this situation, to burden them heavily with huge student loan debts, only to
consign many of them to lives of frustration, disappointment, despair, and inescapable financial ruin, is
irresponsible and unethical. Those who benefit from a constant influx of "new blood" cannot be counted upon to be open, honest, and forthright concerning the negative realities facing newcomers to this profession. Those who were themselves once part of that "new blood", and who struggle daily with the destructive effects of these negative realities, can be.
There are ways to address these negatives, of course. There are solutions that can enhance the survival potential
of all podiatrists. Those solutions, however, will not be forthcoming from the APMA, the ABPS, the
ABPOPPM, or any of their affiliate organizations--the solutions do not advantage them or the minority elitists
Instead, look to forums such as this one for the necessary solutions. The Compendium currently being developed
by Dr. Willner is one example. As another, I am attempting to address problems and propose solutions in this
It's time to show some interest, Dear Readers--and some guts. Do any of you out there want the help being
offered? Do you want to hear about the problems that are going to face you--problems the "insiders" benefit from
and thus deny exist--and effective solutions to those problems? Do you want to see information on how to get the
training that is critical to your survival
information about how to start up your own practices--which is what most of you are going to have to do? About
how to analyze the health and profitability of your practices, get patients in the door and keep them coming back
to you, manage scheduling, select and work with professional advisors (attorney, accountant, etc.), select and
manage employees, market your practice, and all the myriad other information that is critical to surviving and
prospering--information your schools are not providing?
If students, residents, and new/recent graduates are not interested, not reading this forum, not listening to and
internalizing the information being provided, then there's no hope for them, and no reason for anyone to bother
trying to act on their behalf. Lame excuses about having classes and being busy studying just don't cut it--learning
the material being presented here on this forum, internalizing it, and acting upon it, is just as important as what
they are getting in classes and clinical rotations.
After all, if they don't deal with what we are telling them, many of them are doomed to inevitable, unavoidable
failure, frustration and misery, and lifetime financial ruin. Then nothing they learn in school or residency will mean
a thing.
What do you think, Dr. Schneider? Is anyone out there right now, reading this forum? Are they listening to what
we say, and giving the information we present serious thought? Or are they just blindly staggering through school
and residency like so many lemmings headed for the cliff and that inevitable, fatal plunge?
I'm beginning to wonder....
John L. Trench III, DPM |