Defaulted student loan bankruptcy

Anger is an understatement. Furious, aggrieved, full of hatred, taken advantage of, lied to, etc. You're welcome to add any expletive, printable or other-wise. If it is perceived that I make light of my experiences in a podiatry Internet hate site, let me dispel that now. These people, possibly recently graduated podiatrists, students and some residents, are our brothers and sisters. Their suffering is, or should be, ours. They represent our future, which according to them is nil.

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It is too easy to dismiss this rage. Certainly many leaders among the colleges and APMA have. They have virtually ignored this situation as well as its potential implications. This is tragic on a number of levels. First, these people were supposed to be part of our future. Second, they are suffering. Lastly, Internet negativity has an impact upon college enrollment and on the profession itself. The Anti-Defamation League and Southern Christian Law Center have not underestimated hate sites. Neither should our leadership. Free speech is certainly an entitlement, but there is also an obligation to present the profession's side of the story.

Unfortunately, these hate sites do present some truth. I would guess that many who read Podiatry Management are already quite successful; after all, you read this magazine. This demonstrates a willingness and ability to increase your knowledge and range of practice. You might ask, "How many DPM's are in dire straights?" I don't know. The sites are anonymous, so posters might just be the same people reposting chronically. A more objective source is the high incidence of podiatry student loan defaults. This tells us that all is not well.

Internet Hate Sites

My first view on visiting one of these Internet sites was shock and dismay. The complaints are directed against established podiatrists, the APMA, but mostly, and with the most vitriol, against the podiatry colleges.

I started to look at one site almost every day, succumbing to my own personal curiosity (I salve my embarrassment by trying to convince myself that I might be helping these people). I created a website at my own expense for unhappy podiatrists to drag themselves up by their boot straps.

My efforts were usually met with a stream of anger and hatred. The malcontents were anonymous, but I used my own name on my posts. Therefore, I presented a tempting target. I am retired and but had been a successful podiatrist. That separated me in a gulf, a world apart from those posters. That brings me to their chief complaints.

"It costs far too much in terms of time and money to become a podiatrist. Even while you do, the training is spotty, inconsistent and on some occasions, incompetent. Podiatry schools tend to advertise our profession as a part of organized medicine," which these writers feel that we clearly are not and never will be.

"Negative amortization forces recent graduates and residents to face an ever increasing debt-load, post-college and residency, and doom them to a life of indentured servitude to government. These loans can never be forgiven or excused. They ride you like an addiction, into your tomb."

"The opportunities in podiatry are the most limited of any and all professions. We sit in one spot. Either you make it or not in that spot. The DPM degree is virtually useless in the open market, except in one category. Nobody knows what it is; so it is not recognized as having any value outside of our single venue."

"There is great competition for foot care in the open market and we are being usurped in almost every venue by competitors who are part of the real medical establishment and have the power and ability to shake the tree of patients over to their side of the orchard."

"Insurances regard us as unnecessary and prone to overcharging. Like our orthopedic colleagues, they'd just as soon see us gone."

The one area I didn't see a diatribe in was in the case of hospital privileges, where apparently our battles have been successful. But the Internet anger would just gloss over that, suggesting that: "We don't have any patients to take to the hospital anyway. So what difference does that make?"

There is a huge penance to pay if you fail as a podiatrist. Your spouse may leave you, taking your kids, because (she) never really expected to have to work after all of your school and residency training. She is sure that you are hiding money. Your life will be a Dante's inferno of bill collectors, increasing debt-load, depression, anger and resentment.

For the survivors of this debt-load who have failed at podiatry, these same voices torment them into a cascade of personal failure, worthlessness and destitution. They are forced to confront the most painful of realizations, that "They made the worst mistake of their lives by becoming podiatrists." To them, it is an "unfixable error."

Podiatric Physicians?

If I were asked what the worst characterization of disgruntled DPM's is, I would reply that they don't consider themselves podiatric physicians. Instead, they regard themselves as totally unnecessary mechanical automatons, whose only purpose in life is to trim calluses and nails and be hounded by bill collectors. Being a doctor has no validity to them. This is how they see it.

Throughout the history of podiatry, we have always been shadowed by about 10-20% who never practice; or do so in a highly limited, unproductive fashion. Before the Internet these people were shunted aside into their own private circle of failure, known only to their parents and immediate family. Many, like disgraced, defrocked priests, slid silently into other professions, not calling themselves doctors and certainly not doing doctors' work. It was feasible then. It cost only a fraction of time and money to become a podiatrist. If it took 12,000 dollars (even in 1977) to become a podiatrist, eventually you could pay the loan back. Back then, podiatry colleges charged a very small tuition. Those students were under no illusions that they were part of the medical establishment.

Everything changed when the Government started the real college loan guarantee programs. They were designed to provide upward mobility to the masses. A few years ago Congress was enraged by doctors not paying off their college loans and driving expensive cars. They even eliminated bankruptcy as an option for defaulted loans.

It was easier for DPM's like me. I had a tough start, but was able to pay my loans back far more quickly, because it cost me only a fraction of what it costs now.

Podiatric Colleges

Podiatry colleges get the most heat from Internet posters, who feel lied to, taken advantage of and ruined by the laissez faire attitude of podiatry colleges to their plight. They also feel betrayed by the APMA. Established podiatrists fare little better, as recent graduates are seen as unlucky beasts of burden, to be taken advantage of, cursed and worked to the grindstone with little benefits, little money, no time off and no respect.

In Search of Respect

Looking at the constant flow of tragic and angry words pass by me on my dimly lit monitor at 1:00 AM in the morning had its effect. I resolved to try to help. My efforts were not met with enthusiasm or appreciation. I was unprepared for the diatribe of hate and anger turned against me, for my nerve in thinking that I could help. I was excoriated as everything from a financial opportunist, a shyster salesperson, an unwelcome interloper and even a fraud. If I was looking for respect from these posters, it was damn sure not to come.

I developed a website which I thought contained some financial tools and practice management pearls. Ironically, Podiatry Management magazine contains many of the tools that these people need to survive and prosper. I never encountered a single reference to PM throughout my 6-month visit to the hate site.

How can podiatrists succeed in today's healthcare environment? Consider these ideas:

1. There is an epidemic of obesity and diabetes sweeping through the U.S. Are you doing routine blood sugars and cholesterol screenings in your office? If you discover a new diabetic or one out of control, your referral to a local medical doctor will enrich your chances of getting into their "referral loop" from which you may have been excluded in the past. Also, this will grant you the ability to add more detail to your E/M coding, which will bump it up to a higher level.

2. How often do you see draining, foulsmelling lesions between toes during your routine foot care? If I were your patient and had such a lesion, I would expect this to be treated properly, which includes a culture and sensitivity, with the possible or likely treatment with antibiotics. This would enrich your coding sequences.