HCDM 7 | Podiatry Career

 

Many people see a podiatry career as inferior to other medical specializations, but that is not actually the case. As for podiatrist Ernest Isaacson, it’s time to change this perspective, especially now that the training for this field is evolving for the better. In this second part of his interview with Richard Marn, MD, he provides a more comprehensive description of what podiatry really is, explaining the processes involved in his practice and how they treat other diseases beyond simple warts and ingrown toenails. He also shares how he sees the field of podiatry in the next years, sharing his thoughts on the possible innovations that it could undergo in the future.

Listen to the podcast here:

Episode 014: Podiatry – Beyond Simple Warts And Ingrown Toenails With Ernest Isaacson

Nothing is 100% perfect, but I like it. I would tell any medical student, whatever you’re going into, if you’re going into podiatry, dentistry, medicine, or whatever it is, any field that you’re going to do, don’t go into medicine unless you love it. You have to love medicine. You have to have a calling for it because it’s hard. You’re going to do four years of school, you can do at least three years of residency, no matter what you do, and possibly a lot more. You’re going to do research, take tests, take board exams, and then you’re going to come out, you’re going to work hard and have to either work for a big group, or you’re going to have to do all this business of medicine and all this stuff that’s a drag. If you love what you do, you walk into the room, sit down with a patient, interact with them, and they walk out feeling better. If that makes your day, you can imagine doing that, then you should go into medicine.

That was a little snippet of my guest interview with Dr. Ernest Isaacson, a podiatrist. This episode is part two of his interview. Part one can be found in episode number thirteen. In that episode, we talked about other careers to pursue, but eventually why and how he chose podiatry as his career call. Also, I give a little bit more background information about Dr. Isaacson if you’re interested in that. In this episode, we’re going to talk more about what his career is like, what is his day-to-day, what he enjoys, and what he doesn’t enjoy. You’re going to get a lot of gems in this and have a good time. It’s fun to talk with Ernie. He’s light-hearted and easy to talk to. Let’s dive into it.

Now you’re at your practice to your two locations, one is in the Bronx and one is in Manhattan. What’s your day like?

It depends, I have three different locations and they’re in diverse populations but I could tell you what I would expect to see and what I expect to do. There’s a lot of production but I do a lot of diverse things. I do anything from treating sports medicine, especially in Manhattan. I run so I treat a lot of runners. I help to optimize them. I deal with their injuries, and I get them to try to figure out what shoes they’re wearing if I can get orthotics which are custom inserts for their shoes. I’m dealing with fractures, injuries, and all sorts of other things.

I do a lot of aches and pains, sprains and strains, skin and nail infections. You may not like to hear this but we do routine care for people who have nails that are thick and disgusting that they can’t cut them themselves and they come to me for that service because they have a condition that will put them at risk if they would cut their own nails like diabetes. Diabetics can get into real trouble from cutting their nails. They cut the nail, slip, don’t realize it, get infected, and they can lose a toe, leg, or worse. These stories happen all the time. Diabetes is a big part of the practice. Diabetics, over time, can lose their sensation or can develop poor circulation.

If that happens, they can get openings on their skin called ulcers. They’re like open sores on the bottom of the foot. If those get infected and they get into the bone, then that bone needs to get cut out and that’s what amputations are. That’s why 70% of non-traumatic amputations worldwide are performed on diabetics. The numbers are staggering. They’ve stabilized somewhat but most of the amputations worldwide are performed on diabetic. Most of it is from stupid things. The most common event at least for diabetic foot ulcer is a tight shoe. If I can have them in the office every three months, cut their calluses and their nails, get them into the right shoe and make sure that they’re comfortable, then we can prevent all sorts of mishaps and it’s easy to stuff.

Even simple things like having the type of shoe is what you’re doing. You’re educating patients on how to choose footwear.

It’s not a lot of what we do in medicine is common sense. When they go to the internist and they say, “Eat right and don’t smoke,” your mom told you that. You don’t need a guy with an MD to tell you that. These patients come every few months and we try to prevent problems from happening. When they happen, I try to minimize it. As a podiatrist, I am much more likely to spend a lot of time on diabetic limb salvage than other specialists.

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What do you mean by limb salvage? Does that mean you’re trying to save the leg?

Other practitioners might say, “You’ve lost three toes. Let’s amputate below the knee because eventually, you’re going to lose that leg.” That may be true. For me, I’ll say, “You lost three toes, now you have an infection and two toes. I’m going to try to salvage as much as the limb as possible.” The more limb and leg that they have, the less energy they use them in walking. It’s been shown that if you have a more proximal amputation, you amputate further up the leg, they use more energy than walking. You can get a prosthetic leg and there are ways to walk and things like that but having more leg uses less energy.

Their survival rate over five years is about 40%. There are other factors that go into that too. There are comorbid conditions because these patients are generally sick by this point but there are multiple reasons for it. People don’t always live long. One of the reasons is because they’ve lost a leg. Psychologically, we want to leave this world with the body parts we came in with. I will generally do what I can to salvage the leg as much as possible.

Can you tell us a situation where you were very successful in salvaging a leg if it’s a little green?

I was on-call for a hospital in Manhattan and I got a call from the residents. They said, “This guy’s got a bad infection and starting to track up the leg. Can we do something about it?” The medicine team is deciding what to do. The residents called me back and they’re saying that this is too far gone and they’re going to call the vascular team or the surgery team, and they’re going to do a below the knee amputation. I said, “He already lost the leg.” They’re saying it’s already gone. Why don’t we go in and try to salvage it? Let’s try to save. We have nothing to lose at that point.

You’ve got to call for a consult on this like, “We need your help,” then you get another call later on saying, “Forget it, don’t worry about it.” You’re like, “Let me try and do something.”

I said like, “It’s already gone. What do we have to lose? Let’s go in there and see what we can do.” Not to get too gory, it was a bad infection. We cut from the bottom of the third toe. We took him to the operating room, took the third toe off, and then cut the foot sliced from the third toe going all the way up to the ankle. I sliced the whole foot down to the bone and opened it up. It was mounds of pus. It was one of the worst infections that I’d seen. We washed it out. We ended up doing another surgery on him while he was there and then I ended up working with the wound.

He had a wound on the top of his foot. That took six months to close but it closed and he kept his leg. Years later, the leg ended up breaking down. He had at least a good ten years of walking around. Every time he would see me, he would give me a big hug. That doesn’t happen every day. We have our failures and stuff like that, especially diabetics do end up breaking down. We have a lot of successes too. You’ve got to be willing to work with the patients and willing to go in. Go in on a Sunday, open it up, and do what needs to be done. I have other cases. I had a patient who came in with a flat foot and she had pain with every step. I did a procedure where you can rebuild an arch. It was an extensive reconstruction of her foot.

HCDM 7 | Podiatry Career

Podiatry Career: You’ve got to be willing to work with the patients and willing to go in.

 

Her foot is quite flat from ankle to toe.

The arches are flat. The arches in on the ground.

You did surgery to reshape her foot on the bottom.

We did a series of procedures all in one sitting but that’s 3 or 4 hours or something. It was a long procedure. We did it and once she recovered, she ended up one of the top girls on the track team. This is why medicine is the greatest thing that you can go into. Every doctor has that story of a patient whose life changed. Unfortunately, every doctor has a story of the one you missed. At some point, if you practice long enough, you make the very best decision that you can with the information that you have at hand and then you live with that decision.

Sometimes, that decision ends up being wrong but you made an informed decision at that time. It was a good decision to make. Just because the outcome is bad, it doesn’t mean the decision was bad. Anything in life except the stakes is infinitely higher in medicine or I imagined for an airplane pilot or the engineering of the nuclear power plant. You try to make an informed and right decision but every doctor has those cases where when you look at it, you have somebody that you could do something on or you recognize something that nobody else knew. I had a patient that came to me and she had terrible pain in her foot.

She had been to the emergency room a month before. She was seen by a team of doctors and they all said that she sprained her ankle, “It’s going to be okay and it’s not a problem.” When I looked at it, her foot looked purple to me and it was a little bit cold. I said, “This doesn’t look right.” I got on the phone with a vascular surgeon that I knew and I said, “This woman is about to lose her foot because she’s got a blockage somewhere and there’s not any blood getting down to her foot.” She ended up going to the vascular surgeon and the next day, they opened it up. We were able to salvage most of her foot. She had been seen a month before. Somebody had seen it and looked at it and said, “This is an ankle sprain, no problem.” She works at one of the hospitals that I do surgery at. Every time I go into the hospital, I see her. She gives me a big hug and a kiss.

Thank God for the second opinion.

As I said, every doctor has a story. The doctors who missed it have their story of the one you look at it. I’m sure if I were to call them up and say, “What were you guys thinking?” they would look back and go like, “You’re right. We missed it.” Doctors are human.

Be good at your field and what you do, and the rest will come along. Click To Tweet

You’re talking about your Manhattan practice. Are your other practices similar even though they’re in different locations in terms of what you do and how you take care of people?

Manhattan has more sports medicine and younger, healthier patients. A good amount of surgery and a lot of the surgery that I do is bunions, which is a big swelling on the big toe joint. A lot of other reconstructive surgeries like that. I have an office in Suffolk County where that population tends to be a little bit older, a lot of diabetics, and a lot of the problems that go along with the diabetics. A lot of the wounds and the other things that go along with the diabetics. My Bronx office is in a working-class neighborhood.

It has a large minority population and a large Central Asian population. There are a lot of people from Bangladesh and Pakistan. They tend to have high rates of diabetes so we have a lot of diabetic foot issues. Every office gets generalized aches and pains, sprains and strains, and little skin and nail infections. It’s a diverse population. I could be seeing newborns or little kids with walking issues. I could be seeing old ladies with long nails that you see in your grandma, and then everything in between. It’s all good. You’ll never know what’s going to come in.

What’s your favorite part of the day, Ernie?

I like what I do. This is a good field. I happen to like the surgery. I enjoy being in the operating room. I enjoy seeing the before and after, your patient’s reactions when they see what we can accomplish and have done, even if it’s a little procedure. It’s something that changes people’s lives in a positive way. It’s a whole lot of fun. You’re going to fix, cut, and secure.

What is your least favorite part of what you do?

Any doctor will tell you like, “The paperwork is a drag, writing charts,” and things like that. You don’t want to get in the soapbox as a business of medicine but dealing with insurance companies is a drag. There’s a third-party payer system that we have in this country where I do have to be submitted to somebody else who decides how much I should get for that service. It’s a drag for patients, me as a doctor, for other doctors, and the economy. I don’t want to get started with my opinion on all that, but it’s a drag. Thankfully, I don’t have to go through a lot but the worst part of it is there’s a medical-legal part to medicine.

There’s a legal aspect to it. Patients, if they don’t like something that a doctor does, they have the ability to initiate litigation. They are able to sue their doctors and that is not fun. That part of medicine, for me, is the worst. Unfortunately, I’ve been through it and it’s a harrowing experience. I don’t recommend it to anybody. There are ways to try to avoid it but if you’re busy and working long enough, there’s a chance you’re going to be involved in some litigation at some point in your career. Thankfully, it doesn’t happen often.

HCDM 7 | Podiatry Career

Podiatry Career: If you practice long enough, you make the very best decision that you can with the information that you have at hand, and then you live with that decision.

 

Are there any misconceptions about the public that they have about your career?

What I treat is a unique field. It’s different than medicine. There may be a lot of misconceptions. Anybody who’s seen Seinfeld has their own opinion of it. You’re not a real doctor. That’s not so far off.

Technically, you are a doctor.

I am a doctor but I’m a doctor of podiatric medicine. I’m not an MD and not a medical doctor. There are a few things with that. One is that people don’t know what podiatrists do. Some people think that all we do is ingrown toenails and warts. When in reality, we do much more than that. Part of that is the perception. As we talked about before, we were talking about the residencies that there was varying training for many years. The podiatrist didn’t receive any real medical or surgical training. That fed into public perception but there is a certain perception.

I have a good foundation of medicine. I’m good at what I do. What I’ve learned is that you have to sell yourself by being good at what you do. Be good at your field and what you do and then the rest will come along. The doctors and the patients that know me can send me things, anything on the foot and ankle. In every field, you only have a certain amount of knowledge. It’s okay to consult other specialists and other doctors within your own field who may be better at handling things. The perception of podiatry is it’s a lesser field and things like that. You have to sell the field. That’s a drag.

I’m proud of what I do. I’m proud to say that I am a podiatrist. The other thing is once you enter podiatry school, you’re committed to podiatry. You’re committed to working with the foot and ankle. If you don’t like cutting old lady’s toenails, doing ingrown toenails, warts and all the other stuff, then you’re stuck. Think about that. If somebody is considering a career in podiatry, go and shadow a podiatrist. Be in the office and you can shadow me. I have students shadow me on a regular basis. Most of them ended up moving forward and going to the field. They have a great time in the office and they’re happy with it. I have ones that are now attendings that are working and ones that are residents.

I’m proud to say that I influenced them in some positive way. I tried to talk them out of it but they didn’t listen to me. I generally try to encourage them to go into the field, but I would say you look into it. You’re committed to it at that point. If you talk to a young college student and they say, “I want to go into medicine.” “What do you want to do?” “I want to be a neurosurgeon.” You’re not going to be a neurosurgeon. If somebody comes to me when they’re a sophomore in college and says, “I’m going to be a neurosurgeon.” It’s cool to say you’re going to be a neurosurgeon. Do you realize that you’re going to be doing seven years of the most intense, grueling, miserable residency that you could possibly imagine?

That’s after medical school. That’s a short end of the training.

Go into medicine because you love it. Be ready to adapt to the changes and work hard. Click To Tweet

That’s a minimum of seven years of the most intense, mind-numbing residency. You’re going to be physically demanding and you have to know everything. Once you get out, you’re going to be working like a diggity dog and doing ten-hour procedures routinely. Do you love it? If you love it then you should do it and if that’s something you can handle. When there’s a sophomore or junior in college and they say, “I’m going to be a neurosurgeon.” I’m always looking a little askew. If they come to me and they say, “I want to be a pediatrician.”

You’re going to be podiatrician, that’s realistic. In medicine, you have the liberty and the luxury of choosing your field. You’re able to go through four years of medical school, do different rotations, talk to different doctors, and hopefully, get into the procedure of your choice. You may not get into dermatology or anesthesia because only smart people get into that. You have time to change the road you’re on. If you’re getting into podiatry, you’re committed to foot and ankle and being a podiatrist.

You look in the mirror and say, “I’m a podiatrist.” Tell all your friends and family that you’re a podiatrist. I can do that, I love what I do, I’m proud of it, and I’m proud of the work that I do. Sometimes the stuff that I do is a drag and some of the work can be a drag. For the most part, nothing is 100% perfect, but I like it, I would tell any medical student, “If you’re going into podiatry, dentistry, medicine, or any field that you’re going to do, don’t go into medicine unless you love it.” You have to love medicine and have to have a calling for it because it’s hard.

You’re going to do four years of school, at least three years of residency no matter what you do, and possibly a lot more. You’re going to do research, take tests, take board exams. You’re going to come out and work hard. You’re going to have to either work for a big group or do all this business of medicine and all this stuff that’s a drag. If you love what you do, when you walk into the room, you sit down with a patient, interact with them, and they walk out feeling better. If that makes your day and you can imagine doing that, then you should go into medicine. If you’re smart enough to get into medical school and hardworking, then you could get an MBA, law degree, or work for Google and do well. Medicine is hard but it’s worth it if it’s a labor of love.

In your field in podiatry, do you foresee any changes in the profession in the next few years?

The profession is getting better because the training is much better. The residents of graduate now are much better trained. It’s more uniform training. One big thing that they’ve been talking about in podiatry for years is something called parity, meaning making podiatry more on an equal footing with other medical specialties. Right now, podiatry is a different field. They want to bump up to the training a little bit so that podiatrists can get something more akin to a medical degree than a Doctor in Podiatric Medicine.

I don’t know if that’s going to happen or if it’s going to have any practical effect on the day-to-day life of a podiatrist. The changes in podiatry are the changes in medicine. Who knows how the business of medicine is going to change? It’s changed over the past twenty years or so. There’s more managed care. People are more conscious of the costs of medicine, spending, budgets, and things like that. That’s going to change. That business of medicine is certainly going to evolve. Unless things change dramatically, we get some single-payer system, which I don’t think would be a bad thing, but that’s another conversation. Medicine is always going to be a comfortable living.

As a doctor, we deserve to be compensated for the amount of work that we do and the responsibility that we take. If your foot is in my hands and letting me alter the shape of your foot permanently, there’s a certain level of compensation that’s deserved for that. I don’t know what it is and I don’t know if other people should necessarily determine what that is but there is a level of compensation that is deserved. When people tell you that medicine is going to change, and it’s not going to be a fee for service system or it’s going to be single-payer, nobody knows. Almost nobody would have predicted that we are where we are now, in the middle of a pandemic with a celebrity real estate mogul for a president. Life is surreal and you’ll never know what’s going to happen. We don’t know what’s going to happen with medicine. Go into medicine because you love it. Be ready to adapt to the changes and work hard. Treat first and make money second, and you’ll do well.

HCDM 7 | Podiatry Career

Podiatry Career: Some people think that all podiatrists do are ingrown toenails and warts. But in reality, they do much more than that.

 

Ernie, are there any resources that you can recommend to students to learn more about podiatry?

The American Podiatric Medical Association is the main umbrella organization like the AMA. The American Medical Association of Podiatry is a good place to start. The AACPM, which is American Association of Colleges of Podiatric Medicine is also the umbrella organization of colleges. They have links to residency and things like that. They also have links there. There’s a shadowing program through the ACPM. I’m on that program, and there are others. You can find a podiatrist if you wanted to mentor or shadow somebody. I would highly recommend talking to somebody in any field of medicine and talking to doctors. It makes sense to do it.

Go to the office and go into the worst parts of medicine. Don’t start in the operating room. If you’re thinking of being a surgeon, don’t spend your first day in the operating room. Whenever students come to shadow me and they want to go into the operating room with me, I have that as the last thing that they’ll love to do. Watching me in the office for at least a few days before they can go into the operating room. Once you go into the operating room, that’s it. You’re hooked. There’s nothing sexier than the act of walking into a room in green scrubs with your hands dripping wet.

Where can people learn more about you, Ernie?

DoctorIsaacson.com is my website. That’s the best place to start. You can see my two offices. My third office is not on there yet but we’re working on that

The third office is the one in Suffolk County in Long Island. Do you have other social media?

I have an Instagram, @Doctor.Funguy. I am @DrIsaacson on Twitter. There’s also a Facebook page. I haven’t been active on social media. We haven’t been posting anything. I’m not doing a bunch of COVID updates. Nobody needs to see any. We’ve got enough COVID out there. You can’t go on any website now that’s in COVID. I spared people the misery of seeing that on my website other than basic information.

Ernie, you also have a bunch of educational videos online as well.

Treat first and make money second, and you’ll do well. Click To Tweet

I do. They’re on my website and it’s about different varying foot conditions. I will tell you that the cool thing about these videos is that people come to see me despite having watched those videos.

Where do they find your videos?

It’s on the website and on YouTube. We have full bunion surgery.

There’s another resource for people if they want to know a little bit more about what you’re doing in podiatry. Ernie, it’s been great having you on this show. A lot of fun and laughs. I appreciate you participating in this.

It’s my pleasure. I hope it was informative for your audience. If anybody wants to get in touch with me, use any of those platforms to get in touch with me. Don’t PM me, DM me, or any of that. Shooting me an email through my website is the best way to get ahold of me or call the office. If anybody is in the New York area, if you want to come and shadow me, we have students coming in all the time. I’m more than happy to have somebody come in.

Thanks a lot.

That was Dr. Ernie Isaacson, a podiatrist here in New York City. I hope you got a lot out of that. If you want to get ahold of Dr. Isaacson, you can access him through his website and email him, or check out his Instagram, YouTube, and Twitter accounts. If you like what you’re reading, please put a review out there for this show or even subscribe. That will help bring attention to this show and make this resource more available and more recognizable to other people who may be interested in this. Thanks again for reading. I appreciate it. I hope you will come to visit us again. Thank you.

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About Dr. Ernest Isaacson

Ernest L. Isaacson, DPM PC, is an exceptionally well-qualified and experienced board-certified podiatrist providing services for men, women, and children of all ages living and working in the Murray Hill neighborhood of Manhattan in New York City.

Dr. Isaacson is a graduate of the Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science in North Chicago, Illinois, earning a Doctor of Podiatric Medicine. He completed two years of further training in general surgery, internal medicine, orthopedic surgery, plastic surgery, vascular surgery, and podiatric medicine as part of a comprehensive medical education before beginning his podiatric surgical residency.

Dr. Isaacson is an active researcher and author of several notable scientific papers. He is a diplomate of the American Board of Podiatric Surgery and a fellow of the American College of Foot and Ankle Surgeons and the American Society of Podiatric Surgeons. Dr. Isaacson is also a member of the New York State Podiatric Medical Association and the American Diabetes Association.

Dr. Isaacson welcomes new patients to his practice, where his priority is to both treat and enlighten his patients in a comfortable atmosphere.

Dr. Isaacson provides gentle, personalized care when diagnosing and treating foot conditions and injuries.

One of his many skills is his expertise in sports injuries affecting the feet and ankles, such as Achilles tendonitis, shin splints, sprains, and strains. He also excels in treating a wide variety of foot problems, including heel pain, toenail fungus, bunions, neuromas, and plantar warts, and has exceptional surgical skills.

When he’s not dedicating himself to the health of his patients’ feet and ankles, Dr. Isaacson enjoys running, reading, and above all else, spending time with his family.