Rejuvenating Your Perspective By Relocating

As with any career path, redundancy and burnout are inevitable. When this occurs, whether the effect is temporary or longstanding, one begins to entertain thoughts of pursuing a completely new profession or obtaining additional training and education. Relocating to a different geographic location or transferring jobs may also be considerations.

Before making any abrupt decisions, consider your options carefully. You have already sacrificed a lot, including countless hours of studying, many days of labor and spending thousands of dollars on tuition.

Sometimes the simple act of relocation is rejuvenating. If your lifestyle affords the flexibility to work in different geographic location, whether as a long-term permanent relocation or a short-term mission trip or volunteer experience, taking the time to work in a different location with a different patient population may significantly break up the monotony of the day-to-day routine in the office. Additionally, it may be essential for your well-being and improve your satisfaction with the profession. A few different phenomena occur when you branch out into a different geographic area. For example, as a result of climate, population and environmental difference, the incidence of foot and ankle pathologies may differ significantly. For example, in tropical areas, you may encounter more patients with marine animal injuries such as shark bites and jellyfish and sea urchin stings.  

Recently, a family practice physician referred a patient to me with an atypical presentation of scaling, redness and itchiness on his foot. He had been previously treated for tinea pedis with no resolution of symptoms. When I was a podiatry student, one of my professors would frequently advise that not everything is a horse and sometimes you should look for zebras.

After examining radiographs, obtaining bloodwork and taking a thorough history, I discovered that the patient lived on a farm. He had a variety of pets and different animals. The previous weekend, he spent the day fishing barefoot on a sandbar and sustained small puncture wounds on his feet from stepping on sharp shells and sea urchin spines. I determined that the cause of his foot lesion was cutaneous larva migrans. After the shock of knowing small worms were invading his foot, the patient regained his composure, adhered to the treatment regimen as prescribed and had full resolution of his symptoms within the week.

The rarity of this condition sparked interest throughout the medical facility. Even the pharmacist gave me a call to inquire about what I was treating because of the infrequent prescriptions of the medication. He ended up having to place a special order for it because the pharmacy did not have any in stock.

I am fortunate to have learned from one of the most renowned podiatric dermatologists in the world. Although I never physically saw a case of cutaneous larva migrans while in school in Philadelphia or during residency in the Midwest, I was immediately able to identify the condition. A week later, I called a local colleague to repair tendon lacerations from a shark bite.  

By contrast, in cold climate regions, thermal injuries such as frostbite and frostnip are much more common whereas sunburn-related injuries are more common in the South. In areas near the ocean, surfing injuries are common whereas ski injuries may be more common in mountainous areas. In addition, systemic diseases such as diabetes may have a higher prevalence in certain regions as well. For example, in 2011, scientists from the Centers for Disease Control and Prevention identified a “diabetes belt,” comprised of 644 counties in 15 states, located mostly in the southern United States.¹ Certain congenital defects are also more prominent in certain populations. If you develop an interest in treating a particular deformity or disease, it may be worth seeking job opportunities in locations where that condition is most prevalent.

Relocating to a different region is not easy and requires preparation, such as reviewing old class notes, textbooks and scholarly articles relevant to your new practice environment. As podiatrists continue to achieve parity with other physicians, we expect to be the lower extremity specialists. Having a thorough understanding of all aspects pertaining to the foot and ankle including dermatology, vascular, neurologic and musculoskeletal is paramount. Although the scope of practice for podiatric physicians in most states includes the foot and ankle, patients can have many different etiologies and one way to diversify and decrease profession fatigue is to consider a change in one’s practice environment.

Dr. Ryans is in private practice in St. Louis.

Reference

1. Centers for Disease Control and Prevention. CDC identifies diabetes belt. Available at https://www.cdc.gov/diabetes/pdfs/data/diabetesbelt.pdf .