Well it is September and many of you are getting ready to start your final year in podiatry trade school or your final year in a non AGME “residency”. In an effort to prepare you for the future, we would like to review the basic rules for success in this so-called profession. These rules cannot be violated. It is the only way you will be successful. Follow the rules and you will likely make a great deal of money so long is no regulatory agencies catch up with you.

Rule number one :

All bunions and hammertoes require immediate surgical correction. It does not matter if they hurt or create any symptomatology. You must treat bunions and hammertoes like a cancer. You must operate on them immediately. Remember to put in your office notes how painful they are and disabling they are so that when the patient sues for malpractice you can call them a liar because you have written in the chart that they are severely painful. After all, you are supposed to be a doctor, why would you lie? You only do what’s best for the patient. The same applies to flat feet, heel spurs, and Achilles problems if you are a residency or fellowship director. 

Number two :

Every Charcot joint requires an external fixator, intramedullary nail, or some extensive surgery. All of them. Forget that these are sick patients. Forget the high risk of limb loss. Remember to tell the patient and their family that without the surgery they may lose their leg. Don’t tell them that with surgery it’s a guarantee that they will lose their leg. Remember to use as many external fixators as you can and  as much hardware as you can. 

Number three :

Always sell as much crap as you can. You have an advantage. The patients trust you. Sell them unproven therapies for toenail fungus. Sell them unproven therapies for neuropathy. Sell them pain creams. Sell them whatever you can. Braces, arch supports, shoes, orthotics. You must sell many things and you will be rewarded with much money. Sell, sell, sell. For details of what to sell, see PM News, AAPPM, IPED, FABI, or go to any APMA meeting. Especially listen to loser ex APMA presidents and the phony MD DPM’s. They are the leaders in snake oil sales you can use.

Number four :

Remember that everyone needs an orthotic. Everyone. First you must give them an over-the-counter arch support to prepare the patient for the ultimate control from an orthotic. Then you sell them an orthotic. You might also sell them some braces. Make certain you know which codes to utilize to obtain maximum reimbursement from any brace which you utilize.

Number five :

Purchase as many wacko physical therapy devices as you can and use them as much as you can. Do not worry about whether or not the machines work. That is not your problem. After all, some patients will have a placebo effect and tell you how great they feel. This will justify in your mind continued use of bullshit machines and bullshit devices and bullshit therapies. If it pays you should do it. Be sure to read PM Magazine every month together with Podiatry Today so that you can keep updated on the latest therapies that you can offer in the office.

Number six :

Always use wound care products when you treat any ulceration or things that you call an ulceration. There is good money to be made in using wound care products. They may not work but the patient will believe you are an advanced scientist utilizing stem cell therapy. However, remember to continue to debride the wound to keep it open so that it does not heal. Otherwise, the wound will heal and your income will stop.

Number seven :

Never tell a patient that their feet hurt because they are a big fat slob. Do not ever do that. There is simply no money in telling patients the truth. Keep injecting them, feeding them medications, and doing useless therapies. You don’t want to make the person feel badly when you tell them that since they weigh 400 pounds and stand on a hard floor all day this is the reason their feet hurt them. Do not ever do that.

Number eight :

Do minimal incision surgeries. According to them you will be able to do 20 surgeries a week. That is because patients will not realize you are actually crunching up their bones. You have to do this first visit. Hit them when they are hot. Don’t let them out of the office without a little bone removed from the front of their foot or the back of their foot. For fast board certification apply with a check to the ABMSP.

Number nine :

Becoming an APMA insider. Once you become an APMA insider you will have access to investing in all of the schemes that the board members and officers are involved in. You will not be left out of anything. Remember, there is a sucker joining the APMA every minute. You will be able to take advantage of the poor bastards who are not making it in practice and are desperate to find someway to add a buck or two to their bottom line. Why work when you could be a consultant. You get to lecture, you get to consult. You get a piece of the action. The best part about this scam is that you don’t need to have a brain or publish anything or have any credibility. You just need to have a smile and be a good bullshit artist. That will take you all the way to the presidency and then some. Sorry, the executive director position is temporarily occupied. Perfect for someone who wants to see nothing, hear nothing, and do nothing.

Number ten :

Become a specialist such as in foot dermatology, pediatrics, infectious disease, biomechanics or medicine. No fellowship training or additional training is required. You just do some extra reading and declare yourself an expert. The next thing you know you will be in tight with all sorts of corporations and lecturing at every APMA meeting. Great way to make a living without cutting toenails.

There you go. You have been given the best advice you’ll ever get. Follow these rules to success. 

Extra bonus:

Become a residency or fellowship director. That way you have free labor that will kiss your ass 24/7. They will go out and find surgeries to do. You just have to act like you know what you’re doing and find intellectual justifications for all the bullshit cases you perform. Make sure you are expert at Medicaid billing. Speaking foreign languages is extremely helpful.

Only do injections with ultrasound guidance. After all we know that whatever you inject stays exactly where you injected it so that accuracy is critical for things such as heel spur injections or neuroma injections.

Take x-rays at every visit. Find some reason to take x-rays. If you have some extra cash do a weight-bearing CT scan on everyone. This is very important to do because it really does change how you treat the patient. Without a weight-bearing CT scan how would you decide whether you would do an Austin bunionectomy or do a uhhhhh Austin bunionectomy

Remember, clip a piece of toenail and send it off to a lab while billing for biopsy of nail unit. Make sure that you do lots of nerve fiber density testing. That is very important to do. Of course what you do with the information is something else. And make sure you biopsy any piece of skin that looks atypical.

After you do a final nail correction make sure that you debride the eschar and get 10 follow up visits.