2 yr residency vs. 3 yr residency

[Clovers]

Hi Everyone,

Would everyone suggest to do a 3 yr residency over 2 yr? Would I be placed at a disadavantage if I were to do a 2 yr residency? Is it easier to get a job with a 3 yr residency?

Also, can anyone tell me how is residency life like? Is it very busy like didactic years? Will I have a life? I'd like to get marry and have a kid during residency. I dont know if that is possible.

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[Dr_Feelgood]

you have more opportunities w/ a 3 year residency. I have heard, but do not know if it is true, that you will not be board certified in RF surgeries if you do not go to a PM&S 36. That is might make the difference getting in w/ an orthopedic group. The more qualifications you have, the better. Some 3 year programs also allow you to do external work, perhaps do a fellowship in external fixation or work w/ vascular surgeons.

I can't tell you how residency is but I know that many of the CPMS grads are married w/ kids.

 

[Clovers]

you have more opportunities w/ a 3 year residency. I have heard, but do not know if it is true, that you will not be board certified in RF surgeries if you do not go to a PM&S 36. That is might make the difference getting in w/ an orthopedic group. The more qualifications you have, the better. Some 3 year programs also allow you to do external work, perhaps do a fellowship in external fixation or work w/ vascular surgeons.

I can't tell you how residency is but I know that many of the CPMS grads are married w/ kids.

If I want to specialize in wound care then a 2 yr residency is enough? Any thoughts?

 

[dpmgrad]

Hi Everyone,

Would everyone suggest to do a 3 yr residency over 2 yr? Would I be placed at a disadavantage if I were to do a 2 yr residency? Is it easier to get a job with a 3 yr residency?

Also, can anyone tell me how is residency life like? Is it very busy like didactic years? Will I have a life? I'd like to get marry and have a kid during residency. I dont know if that is possible.

In general, I would recommend someone to get the best and the most amount training that they can get. Hence, if you have the opportunity to do a 3 year residency program, I would go for it. Remember, after doing a 3 year residency program, you can choose to only focus on forefoot surgery and not do any rearfoot surgery in your practice. The 3 year residency would also open more opportunities for you.

However, with all of that being said, you need to sit down and decide what you want to do. If you know for sure that you only want to do forefoot surgery and not do any rearfoot surgery, a 2 year residency program may be the best way to go because you get a one year head start in earning money.

As for balancing family life and residency program, you would need to sit down and choose programs that will allow you to be able to balance your family life with the residency program. There are many 3 year residency programs that will allow you to do so. For example, in my PM&S-36 residency program, many of the current and former residents are married and did just fine in residency program. You are right in that some of the residency programs are very intensive and it would make it hard to balance family life with residency training. So, if you do your homework, I am sure that there are programs out there that fit what you want. There are plenty of residency program that offer excellent training besides the few famous / top ranked programs. Good luck.

 

[Dr_Feelgood]

Possibly. That is definitely not my area of specialty. Would you like to be able to do surgical procedures as the next step in wound care? The reason I ask is it is always good to be able to do a ray resection or a trans-met if a diabetic ulcer is not healing or appears gangrenous. I'm not sure if you know what either of those things are but they are limb salvage surgeries. You maybe able to do a ray resection but you might not have enough experience to do a trans-met. If this is something you have a major interest in, it can be done. One PM&S 24 that comes to my mind is at U of Texas Health Science Center. They are the group that came up w/ the UT ulcer classification; they do a ton w/ diabetic feet and wound care. They also offer a PM&S 36, if you choose that route. If you'd like more info on the program check out the CRIP section on www.aacpm or www.diabeticfoot.org.

 

[dpmgrad]

If I want to specialize in wound care then a 2 yr residency is enough? Any thoughts?

There are several 3 year residency programs where you are exposed to a great deal of wound care. The decision between 2 yr vs 3 yr residency training will depend on what you want to do surgically. For example, if you want to decrease the occurence of forefoot ulcers in a diabetic foot, you may elect to do a gastrocnemius recession or TAL in order to decrease amount of forefoot pressure. If you did a 2 yr surgical residency training, you will not be qualify to do the gastrocnemius recession. In another situation where you have a deficit in the heel area after debridement of heel decubitus, you may want to do a reverse sural artery flap to cover the heel deficit. Again, if you did a 2 year surgical residency program, you will not be able to do that. Remember, wound care is more than just treating the wound itself. You need to look at the etiology of the wound and some of these wounds may require some surgical correct the etiology in order for it to heal. If you are only interested in local wound care and would rather leave the more complicated surgical intervention of the etiology of the wound to someone else, then a 2 year surgical residency training may be all you need. By the way, some of the more complicated limb salvage surgeries may require skills acquired from a 3 year surgical residency training program.

 

[krabmas]

DPMGRAD - are you sure that you need a 3 year program to do a TAL? I agree with the 3 year thing and the rearfoot procedures but I thought that was more related to boney work.

How can my professors to TALs when they obviously did not have 3 year residencies. and they are in NY (don't ask, don't tell).

but anyway - how does this work?

one more question for DPMGRAD - do you know if sitting for the rearfoot boards is based on doing a 3 year program or just getting the numbers. For instance what if you did a PM&S 24 but got the numbers of a PM&S36 could you then sit for the rearfoot boards?


Now to the OP- as DPMGRAD said it is not just about treating the ulcer but also the biomechanical causes of the ulcer.

The people that are leaders in the field on wound care and wound care research have DPM's with fellowships in wound care and some have PhDs. These are not people that would have settled for a 2 year residency if offered a 3 year.

If you want to be the best or attempt to be the best at something it is always advised to get the best training possible.

yes it is always possible to find ways around the straight path but do you want to compete for a wound care fellowship with PM&S 36s when you only have a PM&S24. The first question will probably be - "why didn't you do a 36?"

About kids - I am female so I think better to answer the question about kids. It is easy for guys to have kids at any point in the career or podiatric student or resident. For the female it might require bed rest.... and then child care and breast feeding.

I plan to do a 3 year residency and get pregnant in my 3rd year.

 

[dpmgrad]

DPMGRAD - are you sure that you need a 3 year program to do a TAL? I agree with the 3 year thing and the rearfoot procedures but I thought that was more related to boney work.

How can my professors to TALs when they obviously did not have 3 year residencies. and they are in NY (don't ask, don't tell).

but anyway - how does this work?

one more question for DPMGRAD - do you know if sitting for the rearfoot boards is based on doing a 3 year program or just getting the numbers. For instance what if you did a PM&S 24 but got the numbers of a PM&S36 could you then sit for the rearfoot boards?


Now to the OP- as DPMGRAD said it is not just about treating the ulcer but also the biomechanical causes of the ulcer.

The people that are leaders in the field on wound care and wound care research have DPM's with fellowships in wound care and some have PhDs. These are not people that would have settled for a 2 year residency if offered a 3 year.

If you want to be the best or attempt to be the best at something it is always advised to get the best training possible.

yes it is always possible to find ways around the straight path but do you want to compete for a wound care fellowship with PM&S 36s when you only have a PM&S24. The first question will probably be - "why didn't you do a 36?"

About kids - I am female so I think better to answer the question about kids. It is easy for guys to have kids at any point in the career or podiatric student or resident. For the female it might require bed rest.... and then child care and breast feeding.

I plan to do a 3 year residency and get pregnant in my 3rd year.

As for performing a TAL, it is considered a reconstructive rearfoot procedure by most hospital's priviledges. A lot of it depends on your professor's credentials and the priviedges that they got. Remember, many of the older podiatric surgeons possesses the older ABPS board certification - Foot and Ankle Surgery. These Podiatric Surgeons can perform both forefoot and rearfoot procedures, no matter how many years of residency training they received. Of course, some of these podiatric surgeons may choose to be grandfathered into the new Foot Surgery and Reconstructive Rearfoot Surgery boards if they can pass the respective exams. Most of the newer podiatric surgeons possess the newer ABPS board certification - Foot Surgery and Reconstructive Rearfoot Surgery. Up until last year, residency grads who completed two years of residency training (PSR-12/PSR-12 - back to back PSR-12 programs or RPR/PSR-12) could sit for the Rearfoot boards if they had attained enough cases to sit for the rearfoot boards. Hence, you do have some of the older PSR-12 grads being boarded in both Foot Surgery and Reconstructive Rearfoot Surgery. Therefore, you probably know of some attendings with only a PSR-12 training doing rearfoot stuff. By the way, the older PSR-24 (two year programs) programs are considered to be equivalent to the three year PSR-24+ or PM&S-36 programs. Hence, PSR-24 grads would sit for both Foot Surgery and Reconstructive Rearfoot Surgery boards. Lastly, it is possible that some hospitals may grant limited reconstructive rearfoot procedures priviledges to podiatric surgeons who are boarded in Foot Surgery only if they can demonstrate competency to their credentialling committee. It can get very complicated.

In my previous posting, I was referring the 2 yr surgical residency program to PM&S-24 and the 3 yr surgical residency program to PM&S-36 or PSR-24+. By the time the original poster applies for residency training, there will be no more two years PSR-24 programs existing.

To answer your second question, as of this year, only candidates completing a PSR-24 (two years), PSR-24+ (three or more years), and PM&S-36 program will be allowed to sit for the ABPS Reconstructive Rearfoot Surgery Board exam. This is explicitly stated in the ABPS 110 Document. Hence, no matter how many rearfoot cases that you do in the PM&S-24 program, one will not be able to sit for the Reconstructive Rearfoot Surgery Board exam.

I hope that this helps.

 

[krabmas]

As for performing a TAL, it is considered a reconstructive rearfoot procedure by most hospital's priviledges. A lot of it depends on your professor's credentials and the priviedges that they got. Remember, many of the older podiatric surgeons possesses the older ABPS board certification - Foot and Ankle Surgery. These Podiatric Surgeons can perform both forefoot and rearfoot procedures, no matter how many years of residency training they received. Of course, some of these podiatric surgeons may choose to be grandfathered into the new Foot Surgery and Reconstructive Rearfoot Surgery boards if they can pass the respective exams. Most of the newer podiatric surgeons possess the newer ABPS board certification - Foot Surgery and Reconstructive Rearfoot Surgery. Up until last year, residency grads who completed two years of residency training (PSR-12/PSR-12 - back to back PSR-12 programs or RPR/PSR-12) could sit for the Rearfoot boards if they had attained enough cases to sit for the rearfoot boards. Hence, you do have some of the older PSR-12 grads being boarded in both Foot Surgery and Reconstructive Rearfoot Surgery. Therefore, you probably know of some attendings with only a PSR-12 training doing rearfoot stuff. By the way, the older PSR-24 (two year programs) programs are considered to be equivalent to the three year PSR-24+ or PM&S-36 programs. Hence, PSR-24 grads would sit for both Foot Surgery and Reconstructive Rearfoot Surgery boards. Lastly, it is possible that some hospitals may grant limited reconstructive rearfoot procedures priviledges to podiatric surgeons who are boarded in Foot Surgery only if they can demonstrate competency to their credentialling committee. It can get very complicated.

In my previous posting, I was referring the 2 yr surgical residency program to PM&S-24 and the 3 yr surgical residency program to PM&S-36 or PSR-24+. By the time the original poster applies for residency training, there will be no more two years PSR-24 programs existing.

To answer your second question, as of this year, only candidates completing a PSR-24 (two years), PSR-24+ (three or more years), and PM&S-36 program will be allowed to sit for the ABPS Reconstructive Rearfoot Surgery Board exam. This is explicitly stated in the ABPS 110 Document. Hence, no matter how many rearfoot cases that you do in the PM&S-24 program, one will not be able to sit for the Reconstructive Rearfoot Surgery Board exam.

I hope that this helps.

Thank you. this does help.

this is a warning to you all. Residency directors will lie to get you to their program.

I had a PM&S 24 director tell me that their hospital has enough cases in 2 years to fill the 3 year requirements so you could still sit for the rearfoot boards. Not true apparently. Beware and look up info for yourself.

 

[efs]

There is a difference between Board Certification and credentialling (or priveledging).

The residency determines elegibility for Board Certification. That is, PM&S-24 grads will only be elligible to sit for Forefoot Boards, while the PM&S-36 are elligible to sit for that and RRA Boards. Board Qualification and Board certification really don't have that much to do with being able to do procedures. It may help with getting credentialled (to be allowed to do them in a particular hospital).

There are plenty of people out there who have the training, ability and are credentialled to do surgeries but don't have all the Board Qualifications to go with it. It's a tougher way to go though.

Having a PM&S-36 doesn't mean I can just go out and do reverse sural flaps either. From my training, I don't have much exposure to vascular procedures, and have not done one of these (or seen one done).

I would rather have the papers saying I am allowed to do more, and then stay within my comfort zone instead of having the training and need to fight to get permission to do what I know I am capable of.

 

[dpmgrad]

There is a difference between Board Certification and credentialling (or priveledging).

The residency determines elegibility for Board Certification. That is, PM&S-24 grads will only be elligible to sit for Forefoot Boards, while the PM&S-36 are elligible to sit for that and RRA Boards. Board Qualification and Board certification really don't have that much to do with being able to do procedures. It may help with getting credentialled (to be allowed to do them in a particular hospital).

There are plenty of people out there who have the training, ability and are credentialled to do surgeries but don't have all the Board Qualifications to go with it. It's a tougher way to go though.

Having a PM&S-36 doesn't mean I can just go out and do reverse sural flaps either. From my training, I don't have much exposure to vascular procedures, and have not done one of these (or seen one done).

I would rather have the papers saying I am allowed to do more, and then stay within my comfort zone instead of having the training and need to fight to get permission to do what I know I am capable of.

You are right in that just because one is Rearfoot boarded, it does not mean that one would go out doing procedures that they have very little experience in. A good example of this would be clubfoot reconstruction in kids. Many 3 year residency program do not expose their residents to clubfoot reconstruction. As I said in my previous posting, if you are able to demonstrate some competency in doing a procedure, you may get the priviledge to do the procedure, even though that person may not possess the appropriate board certifcation for that procedure. I agree with you that credentially / priviledges and board certification are two different things.

 

[dpmgrad]

Thank you. this does help.

this is a warning to you all. Residency directors will lie to get you to their program.

I had a PM&S 24 director tell me that their hospital has enough cases in 2 years to fill the 3 year requirements so you could still sit for the rearfoot boards. Not true apparently. Beware and look up info for yourself.

For those who want to look up the exact requirement to sit for the ABPS Foot Surgery and the ABPS Reconstructive Rearfoot Surgery Board exams, you can view the ABPS 110 document at this link:

http://www.abps.org/exams.asp?p=4_1