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How many hours does a typical podiatric resident work each week?

Discussion in 'Podiatric Residents & Physicians' started by supposedly, Mar 12, 2008.

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  1. supposedly

    supposedly

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    Hello,

    I have seen stories about podiatric residents working hours ranging from "brutal" to "country club"... I am just wondering, what is the typical work week like for a resident? How many hours on the high end? Low end?
  2. HenryH

    HenryH

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    To add to your question -- are any of the "country club" residencies also the ones that happen to be known as "very good" residencies, or is this kind of distinction reserved only for the "brutal" residencies?
  3. JEWmongous

    JEWmongous Member

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    Do you really think you are going to get excellent training when working a light on hours, cushy residency? I really don't think it is possible these days (I may be wrong you never know). After-residency one may want a 40 hour a week job, but I would definitely not go for a particular residency that was this "chill", especially for PGY 1. Working 80 hours a week (or more sometimes) may sound ridiculous, but it is supposed to be a learning experience and others were/are in the same boat as you.
  4. PharmD/DPM

    PharmD/DPM PGY-2

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    To what I know, none of the "brutal" residencies are easy on the hours, which are a lot of your high powered residencies. Sorry guys! Depending exactly on the program, you'll work anywhere from 60-100 hrs a week. I know that sounds bad, but that's how it is. At interviews last Dec. at Penn-Presby one of the 1st years told me to enjoy myself as much as I can before July, because once July hits, you will be worked like a dog!!! And that's fine, because I expect it, it won't be so bad then. Plus, I externed there, that's where you guys should get the best idea of programs, see for yourself.
  5. Feli

    Feli ACFAS Member

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    Whether you have to spend a ton of time doing surgery, research + reading, or both, the high power programs usually have you there sun up to sundown. There are high power programs where you will do 2k procedures and others where you will do ~500 and publish 10 papers/posters. Either way, you will learn a lot and should have no problem with surgical board exams. Hours totally vary due to the program and amount of self-directed reading after you leave the hospital.

    On the other end of the spectrum, there are the "family friendly" 8a-4p M-F residencies also (maybe 7a-7p M-Sa in first year).
  6. jonwill

    jonwill SDN Senior Moderator Moderator Emeritus

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    My program has very high surgical volume and is a pretty busy program overall. But hours generally depend on things like rotations, call schedule, surgical schedule, etc. There are days when we only have 8-10 cases and there are days that we have 25-30 cases scheduled. Sometimes we have huge inpatient loads while other times, it isn't that bad. At most programs, as a first year, you are going to take more call than the others and that factors in as well. And some months are spent on off rotations which can be quite nice or brutal depending on the rotation.

    I'd say (ballpark) I've worked anywhere from 50 to 90 hours a week while on podiatry. Some weeks have been insane while other weeks, I've been home for dinner nearly every night. And as I progress through the second and third year, my schedule will get better and better which means more time for reading and research.
  7. HenryH

    HenryH

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    Is it possible to get one of those $100k+ pod. jobs coming straight out of a residency with "lite" hours? Is it essentially a given that residents graduating from the high-powered, long-hours programs will have no problems getting these jobs?

    I understand the importance of developing surgical prowess, but if I'm going to bust my butt for 70-90 hours every week, I would want the peace of mind of knowing that I'll be making at least $100k when I graduate...
  8. supposedly

    supposedly

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    Thank you for the informative and helpful replies!
  9. PharmD/DPM

    PharmD/DPM PGY-2

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    Nothing's a sure thing, but being at a high-powered program, putting in tons of hrs and being deligent on job prospects will land you a $100k+ job out of residency. You must do all that I mentioned to make it happen.
  10. Feli

    Feli ACFAS Member

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    It is generally assumed that matching and graduating from a prestigous residency is reserved for docs who are smart, can work hard, and will be familiar with a variety of procedures and literature. That, along with recommendation from renowned attendings those residents trained under, will open some doors for their alumni, particularly in the academic hospitals. You will find that many students willing to work hard, compete for, and train in top residencies are as much concerned with doing interesting cases and teaching down the line as they are with simply income.

    On the other hand, some very high grossing practices looking to bring in a new DPM don't really need, and might not break the bank for, elite skills. No matter where you did your training, they might only offer you 30-60k base plus 33% of what you can bill for since they are more concerned with your ability to see a lot of patients and attract new patients to the practice. There was a nice cover story in Podiatry Management a year ago that headlined "Surgery is Fun, but Fungus Pays the Bills." Well, guess what? A grad of a PMS-24 can probably clip nails, debride small diabetic wounds, cast orthotics, do nail procedures, give heel injects, and fill out a SuperBill form just as well as a PMS-36-er who did an ortho fellowship in Europe.

    It sounds like the financial aspects of podiatry are important to you. When you start pod school, you could look into joining the student Practice Management Club if it is active and has good leadership. Those chapters are sponsored by Am Acad of Pod Prac Mgmt (aappm.org) and are generally pretty well endowed.
  11. HenryH

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    Feli, thanks for your insight; you bring up some other points of consideration.

    Are the vast majority of podiatry practices mostly just interested in hiring another "c&c" podiatrist? In other words, is there really much of a point to enduring a PM&S-36 unless you just enjoy learning surgery? It just seems that, if you're not actually going to implement many (or any) of your advanced surgical skills or improve income, what's the point in spending the extra year learning them?

    Also, you're not the first person who has remarked about surgery not being as lucrative of a service as the more standard podiatric treatments involving nails, orthotics, etc. Why is this? Almost every other specialty of medicine rakes in "the big bucks" doing surgery, so why isn't it as financially viable for podiatrists?
  12. jonwill

    jonwill SDN Senior Moderator Moderator Emeritus

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    What? With the way the profession is heading, I honestly think it will be the other way around. I think there will be very limited opportunities for the basic trained podiatrist. As all podiatrists are now surgically trained (granted some better than others), that is how podiatrists are now being utilized. It has truly evolved into a surgical sub-specialty where you can and do use all of your surgical training. I guess I don't understand your statement. We don't learn complex surgical procedures to not use them in practice! Of course you are going to utilize most or all of your training. Why else would you get it?

    As for surgery being "more lucrative", I'm not sure about that. It generally does pay very well. I think the point is that "procedure-based" medicine is more lucrative. That does not just include surgery but many things that can be done in an office such as injections and avulsions.

    As with all surgical specialties (general, vascular, ortho), there is a surgical/clinical balance that must be utilized to maximize your earning potential.
  13. Feli

    Feli ACFAS Member

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    More and better training always correlates with higher average income. That is because you will have more job options (and can pick the best of them), but it's probably also just because most people who will go get a tough and long residency will also work more hours when they go out into practice (again, on average). "Top" residencies also typically provide good external rotations and research support; those factors will facilitate their grads obtaining fellowships or teaching and leadership jobs after residency.

    Surgery does make money. The problem is getting enough cases, and centralizing them. If you are driving to a hospital to do 2 cases. Driving to a remote surgery center to do 1 case the next day, taking call at a hospital in the 'burbs to do an ER call late at night, etc, then it really isn't a big money maker in per hour terms. Think of how many office patients you could've seen in that timespan. This is where group practices come in, and it's also where being in a metro area helps most surgeons' income greatly.

    As for jobs after residency, yes, there are certainly groups looking for an associate that will take low salary and do the C&C work that the senior partners don't want to do. As you can imagine, situations like that is where the pod "doom and gloom" stories and websites stem from. Well, if you have good training, you can probably laugh at those job offers and move on to others, but for some residency grads, it might be the only options they have (at least in the area they want).

    Even if you get that high level surgical training, there will be always be offers that try to pay you a lot less than you are worth. Groups of older pods or ortho might want to hire you to do most/all of their group's F&A surgery since you are efficient. However, presby made a great point awhile ago that you will probably become unhappy very fast if you are a hired surgical gun being paid $120k salary yet you are earning the practice two or even five times that money.

    Basically, think of it this way. The current senior pod students who just matched with highly regarded PMS-36s this year are probably not thinking "SHOW ME THE MONEY." It's far more likely they're saying to themselves "nice, I get to learn from the renowned Dr. so-and-so" or "wow, I get to be a resident at one of the few programs in the country that will teach me advanced endoscopy and ankle arthroplasty."

    IMO, that is the beauty of podiatry. It can be a family friendly 8a-5p career with basic, typically non-urgent, pathology if you want it to be that way. It can also be a surgical subspecialty that exposes you to complex, urgent, and even some emergent cases if you go out and acquire that training. You get good variety. In the end, you don't have to use everything you are trained for (and few DPMs do), but you can't (well, probably shouldn't) ever do things you weren't exposed to and taught in training. It will never hurt you to learn more.
  14. HenryH

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    jonwill, the reason I mentioned that it might not make sense to get the full 3 years of surgical training is because of the fact that, according to what I've been told, most podiatrists looking for associates are only interested in hiring someone to do primary care. I guess it would be a better idea to start your own practice and get on staff at hospitals, etc...
  15. krabmas

    krabmas Senior Member Moderator Emeritus

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    Just realize that what ever you decide to do in life from Check-out person at K-mart to Neurosurgeon your boss and patients will all expect you to work hard and give it your all.

    If you choose to do something because it is more lucrative and get less training because of it it is very difficult to go back and get the training that you missed.

    I recommend working as hard as you can in school, get the best residency you can, continue to give it your all, and then decide what pat of your training you want to use. Because then it is your choice.
  16. SportPOD

    SportPOD Arizona Sports Pod Lifetime Donor

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    That's a very narrow minded and very non-progressive thinking way to hire a podiatrist who has three years of training. If you sit in my shoes as a practice owner, if I hire a three year surgically trained podiatrist now, I will allow my practice to have much greater treatment options for the patients. I am surgically trained in forefoot, but that hasn't stopped the referrals coming for rearfoot issues. If I have that rearfoot trained individual in my office, I will benefit from that fact that the patient will be able to receive care in my office and my new associate will get to do what they trained to do.
  17. jonwill

    jonwill SDN Senior Moderator Moderator Emeritus

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    Again, I'm not sure who you've been talking with but in my opinion, they couldn't be more wrong. Remember, the majority of pods now do a 3 year surgical residency.

    Maybe some old-school pods are only interested in hiring an associate for primary care. But the majority of intelligent podiatrists are looking to hire people who can expand their practice and make more $$$ for the practice. As SportPOD mentioned, this is a very narrow-minded approach and VERY POOR business sense.

    Would they rather the better-trained pod open up a practice across the street and put them out of business??:laugh:

    In all honestly, you are getting some very bad and inacurate info.
  18. HenryH

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    jonwill, I'm glad to hear I'm being misled. I guess that part of it is, in my city, the podiatrists don't seem to get the "respect" that the orthopaedic surgeons do. For example, at the bigshot sports medicine center here (Hughston Clinic), there isn't a single podiatrist on staff. I also can't find information regarding whether any of the other private or public hospitals here have any on staff.

    Then again, this fella practices in a few cities about 45 minutes away, and he seems to be a pretty high-profile dude (the Lotufo guy):

    http://www.realpagessites.com/ankleandfootcenter/page6.html

    Also, I think part of the problem is that there isn't ONE PM&S-36 trained podiatrist here in my city, so they're all kind of regarded as mid-level toenail clippers. I guess I could shoot for being the first podiatrist to undergo a PM&S-36 residency and practice here...
  19. jonwill

    jonwill SDN Senior Moderator Moderator Emeritus

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    That is not too suprising as three year residencies really haven't been around very long. The residency standard 10 years ago was 1-2 years with very few 3 year residencies out there. I am suprised though because if you're referring to the state of Georgia, they have a good scope of practice and there are a lot of well-trained pods doing good things down there and some very good residency programs (Dekalb-Tucker is one of the top). Dr. George Vito in Macon does some great stuff and is a leader in our profession.

    As for doing a 3-year residency, by the time you came through, I don't think you would have much of a choice but to do one. Again, that is the way the profession is moving.

    Interesting the Dr. Lotufo doesn't talk about his schooling or training on the website.
  20. SportPOD

    SportPOD Arizona Sports Pod Lifetime Donor

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    Yeah, I find that concerning also, jonwill.

    But as you have said, jonwill, Georgia is one of the more liberal states as far as scope of practice for a podiatrist.

    I would talk to the people at the Hughston clinic and pick their brains about why they don't have a foot and ankle guy there (pod or ortho). See if they have a need and let them know that you'll be there in 7 years. Maybe they'll pay for your tuition :D.
  21. HenryH

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    Yeah, I thought that was unusual -- but then again, since he's certified in Rearfoot, doesn't that mean he did a three-year residency?

    If it was my website, I'd be beaming about it: "As one of the only podiatric physicians in the LaGrange-Newnan area to have completed an extensive three-year surgical residency, Dr. HenryH is widely regarded in the medical community for..." :D
  22. HenryH

    HenryH

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    For real?! I never thought to ask if practices ever offered tuition relief deals...please tell me you're not joking! :thumbup::D
  23. SportPOD

    SportPOD Arizona Sports Pod Lifetime Donor

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    Actually, I am joking, but you don't know until you ask. So, who knows, if they have a huge need for a foot and ankle guy they might want to help pay down your loans if you come back and practice with them.
  24. HenryH

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    It's too bad that you're joking, but now that you mention it, is it possible/common to work out a "preliminary" deal with a practice after one's acceptance to podiatric medical school has been confirmed? I would love to get accepted this summer and then have a job lined up just a week later...
  25. SportPOD

    SportPOD Arizona Sports Pod Lifetime Donor

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    I don't know how common it is. But it never hurts to ask to find out. The key is that you have to come back and work for them. Sometimes this can be hard after you've been away from the area for a while or you get a great job offer from the residency that you completed.
  26. NatCh

    NatCh Senior Moment

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    ...aaaand there goes your relationship with the other DPM's in town! j/k.

    Consider that since the 3-year Residency is a relatively new thing, some of the most accomplished Podiatrists in the country graduated before this era and have fewer than 3 years of Residency. Not every 2-year trained DPM is a "mid-level toenail clipper." Actually one of the best rearfoot guys I've worked with had only one year of Residency. The number of years spent in training doesn't necessarily equate to skill, dexterity, or judgement. Nonetheless, get the most you training you can.

    Edit: out of curiosity, those of you in 3-year programs currently, did most of your Attendings graduate from a 3-year program themselves? I've been wondering. I suppose eventually all Attendings who provide the training to 3-year Residents will have come from 3-year programs themselves. Is that the case yet?

    If said practice happens to be owned by your moms or pops maybe. Otherwise, first things first: graduate from podiatry school.

    Nat
  27. NatCh

    NatCh Senior Moment

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    When people say that surgery doesn't make as much money as other things, what they mean has to do with the amount of time involved and how much you end up making per time spent. Basic foot surgeries might make you $800-$2000 in surgeon's fees, something like that.

    If you spent two hours in the O.R., plus 2 hours driving to and from the O.R., plus a few (non-billable) hours doing follow-up visits, then you made less money per hour than say doing ingrown nail procedures ($500/15 min.) or orthotics ($400/10 min.) in the same amount of time for example.

    If you happen to have five bunionectomies lined up for one morning, then hallelujah!
  28. Feli

    Feli ACFAS Member

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    Amen.

    I know it was a joke, but if I were a practicing pod and a pre-pod came to me saying he was gonna do a bigshot 3yr surg residency and come back to practice in my town, I'd probably have to try not to laugh as I wished him good luck on pt1 boards (and making it that far). :D
  29. HenryH

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    I thought that it was a *fairly* common practice with DO/MD docs, anesthetists, etc.?
  30. jonwill

    jonwill SDN Senior Moderator Moderator Emeritus

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    No, it doesn't actually. When they came up with the new requirements for board certification, all of the old guys were grandfathered in.

    NatCh is correct in that just because you did or didn't do a 3 year residency in the past doesn't make you a premiere surgeon. One of the best surgeons I know did a one year because he came out in the mid-1970's. It all depends on whether you treat your career as a progressive one or a stagnant one.
  31. SportPOD

    SportPOD Arizona Sports Pod Lifetime Donor

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    Exactly, and this is where all the "doom and gloom" posts originate from those who aren't progressive. You could come from a three year program now, but if you don't keep up with the new stuff, you'll be in the same boat as the podiatrist who graduated 10 years ago and never kept up with the times.
  32. Feli

    Feli ACFAS Member

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    :thumbup::thumbup:
  33. NatCh

    NatCh Senior Moment

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    As a Resident about to finish, yes, but as a pre-med ??? Doubtful.

    A pre-med is still at least six years away from being able to work. As an employer:
    • I do not know if I will need another doctor to join my group in six years.
    • I do not know how well the pre-med will do in Residency.
    • I do not know how well the pre-med will do in med school.
    • I do not know if the pre-med will graduate from med school.
    • I do not know if the pre-med will even finish undergrad.
    Nat
  34. JEWmongous

    JEWmongous Member

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    Keep Dreaming man. Unless its your mom or dad as NatCh said. You honestly think a doc is going to give you an offer right after getting accepted to pod med school? They have no idea how you will do in pod school, let alone on rotations and residency.
  35. HenryH

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    I wouldn't be so sure about that...
  36. JEWmongous

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  37. supposedly

    supposedly

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  38. MaseratiGT

    MaseratiGT Legilimens!

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    I didn't know the sasquatch went to Hogwarts...in the middle of the jungle...:scared:
  39. efs

    efs SDN Advisor SDN Advisor

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    out of curiosity, those of you in 3-year programs currently, did most of your Attendings graduate from a 3-year program themselves? I've been wondering. I suppose eventually all Attendings who provide the training to 3-year Residents will have come from 3-year programs themselves. Is that the case yet?


    When my attending graduated 3-year residencies did not exist. I did have one attending who recently graduated from a PSR24. In fact for the majority back in the days, residencies did not exist. The fact that my attendings had residencies at that time made them stand out.

    I would expect that eventually most of the residencies will have attendings that had 3 year residencies, but that will likely take another 10-15 years. The 3 year residnecies have not been around that long.
  40. Feli

    Feli ACFAS Member

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    This is true, but fellowships and preceptorships both in the US and abroad have been around awhile. A lot of older DPMs who are primary attendings for a residency program also did 1+1 or 2+1 type of training. While they are rare, there are pods who graduated 20 or even 30+yrs ago and have done 3yrs or more of surgical training via fellowships or preceptorships.

    I think the big thing is just what jon hit on already: keeping up with current techniques and standard of care. The way I see it, an active residency attending, even if he did only officially did a 1yr residency that was the standard training when he graduated 30yrs ago, has actually been training almost his entire time at the residency (assuming he stays active). Journal clubs, conferences, research, grand rounds, M&M, etc with the residents and other attendings is learning, and it forces you to stay current with other docs. Regardless of residency, it's mostly the docs who get away from the academic setting, away from other docs, and go off to their own island that get behind the current standards of care.

    I think that an active attending or director at an academically oriented program, even if he only had 1 or 2yr residency training, is probably more up on podiatry's advances than his classmate who did a 3yr residency but then just went off to his own little world in private practice to see patients, do most CMEs online, and crack a text/journal only when absolutely necessary.
  41. MossPoh

    MossPoh Textures intrigue me

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    I'm not saying this from a podiatry standpoint, but from a management/boss standpoint. That is unwise on every level. It is cliché but the saying goes that one should only hire "Bs and higher", you can always make a B an A level, but the Cs and Ds will only max out at the B. (Weird I know) To continue that, you want the A level guys/gals because they will hire the B levels and make more As. I know it is stupid and confusing, but it is true. You want to hire the best, most talented staff you can find and train them the best you can. The benefits far outweigh the disadvantages.
  42. Some work 80hrs a week nonstop b/c too few residents while on call every other day seemingly and some work 30hrs a week and sit around in the pod room for an additional 30hrs which seems kind of wasteful.

    I mean, why would any program make their residents sit in a dirty room when there is absolutely nothing going on????

    Also stay away from the ones that are almost pure scut work, I've seen residents happy to cast or hold a retractor or I'm sure some somewhere are even happy to scrub in!

    Honestly, spending many hours in a pod residency might seem like a good idea at first, but then you MUST look at exactly how those hours are spent.

    regardless of high powered program or not, if they are spent doing knees hips and orthopod work, maybe ask yourself what that has to do with you and podiatry and learning to do a good bunion sx! If they are spent in a pod room in some dark corner of a hospital, ask.... is sitting around telling jokes a good way to manage residency time. If they are spent scrubbing in and actually doing procedures (not being some scut work nurses aid) or in clinic actually treating the patients (not just doing what the attending tells you to do as a treatment) then maybe you are OK.

    The TWO rules of #2's regarding Brutal Residencies

    Then ask yourself, are these "brutal" residencies brutal in a good or a bad way. I like to use the rule of 2's to figure that one out.

    [1st rule of 2's] If you are treated like a b@tch and an idiot, and everyone is walking around acting like they are king carp on t. island does that make anyone a better doctor and surgeon???? If it does, then they may all really be real #2's lol.

    [2nd rule of 2's] Is it brutal because of the volume of relevant cases where you have to know your #2's and get to do the #2's mostly by yourself?

    Remember to follow the rule of 2's and ask yourself why is it that this program is so brutal.... You might be surprised to find a #2!
  43. krabmas

    krabmas Senior Member Moderator Emeritus

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    Wiskers
    If you spend a few months on orthopedic surgery and a few months on general surgery you learn techniques that podiatrists do not use. You can pick up techniques good and bad from all your rotations. Also, the general surgeons and orthopedic surgeons teach differently than the podiatric surgeons.

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