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A General Misconception Concerning Residency Training

jonwill

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I have seen enough pre-pod and pod student postings to suspect that there may be a lack of understanding concerning the "New" residency training.

There really isn't anything new about it except the names. These are new models but 3 year residencies have been around for at least a decade. There was simply no residency model for it. When the profession first deemed a three year residency necessary, there was no residency model for it (there were only one and two year models at the time) so programs would get around the problem by having a one year residency that led directly into another two year program. For example, program "A" would designate themselves a PSR-12/PSR-24 which meant that a 24-month Podiatric Surgical Residency directly followed a 12-month one and they would usually specify that one led directly to the other. At the time, there also existed various 1-year models and a two year model which people would do as well.

When enough programs started doing the "piggy-back three year residency" and the powers that be decided that it was time to standardize podiatric medical training, they moved to the PM&S-24 and 36 models. The only thing that really changed was the name, along with the fact that one year residencies were no longer an option.

So while yes, these are new residency models, multi-year surgical training has been around for a while.

This post may benefit pre-pods or pod students that are new to the profession.
 

JEWmongous

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Hello,
I was just curious if there were some pod graduates who would ONLY complete a 1 year residency before the standardization (in recent years)?

From what I am understanding with the recent standardization, you are now required to have at least 2 years of training in pod med AND surgery. Before this, one could complete a 1 year residency and be fine to practice (depending on state laws). People who wanted more training could do a 2, 3, or even 4 year residency. Furthermore, in the past, one could complete a non-surgical based residency if they wanted (such as the orthopedic POR residency). And I've understood that there are some practicing pods out there who did not complete a residency at all. Please correct me if I'm wrong!

So with these changes, all of the new pods graduating will have surgery training and at least 2 years of residency (can get board cert in forefoot). The 3 year progams allow pods to get board certified in fore, rearfoot, and ankle. Are the 3 or 4 four year programs going to be called PM and S 36 while keeping the program 4 years in lenght?

Anywho, It seems much different from some older generation of pods who did not complete a residency or only had one year (and may or may not included surgery). In the long run, hypothetically of course, as the older pods with no/1 year/minimal or non-surgical residencies will retire they will be replaced by podiatrists with 2 or 3 years of training in both pod med and surgery. It should help standardize the abilities of practicing podiatrists. Right now, it appears there is a disparity in training (especially surgical) between the newer graduates and those of some older generations. As I heard, there used to be more people graduating than residency positions available in the past. So not everyone was able to receive residency training. But now there are more spots available than graduating students.

Seems like this could have a pretty big impact on the field itself in some years time. It definitely makes things more simple as the former residencies were called "Alphabet Soup" on these forums once. Such as POR, PPMR, RPR, etc. Please let me know your opinion and comments on this. Thanks and take care!
 

krabmas

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"I was just curious if there were some pod graduates who would ONLY complete a 1 year residency before the standardization (in recent years)? "

There are pods out there that did this even in recent years but they are the ones that either took what they could get, knew they did not want to do surgery, or thought they would do the one year and flow into 1 or 2 more years of surgical residency but could not hack it (pun not intended).

"From what I am understanding with the recent standardization, you are now required to have at least 2 years of training in pod med AND surgery. Before this, one could complete a 1 year residency and be fine to practice (depending on state laws). People who wanted more training could do a 2, 3, or even 4 year residency. Furthermore, in the past, one could complete a non-surgical based residency if they wanted (such as the orthopedic POR residency). And I've understood that there are some practicing pods out there who did not complete a residency at all. Please correct me if I'm wrong!"

This is all true as far as I know.

"So with these changes, all of the new pods graduating will have surgery training and at least 2 years of residency (can get board cert in forefoot). The 3 year progams allow pods to get board certified in fore, rearfoot, and ankle. Are the 3 or 4 four year programs going to be called PM and S 36 while keeping the program 4 years in lenght?"

According to the Council of Podiatric Medical Education (CPME) website the CPME 320 document states "The curriculum of a PM&S-24 must be completed within 36 months, and the curriculum of a PM&S-36 must be completed within 48 months."

So the 4 year program is within the time frame of a PM&S 36.



"Anywho, It seems much different from some older generation of pods who did not complete a residency or only had one year (and may or may not included surgery). In the long run, hypothetically of course, as the older pods with no/1 year/minimal or non-surgical residencies will retire they will be replaced by podiatrists with 2 or 3 years of training in both pod med and surgery. It should help standardize the abilities of practicing podiatrists. Right now, it appears there is a disparity in training (especially surgical) between the newer graduates and those of some older generations. As I heard, there used to be more people graduating than residency positions available in the past. So not everyone was able to receive residency training. But now there are more spots available than graduating students."

2007 will be the last year for at least 2-3 years that the number of graduates is less than the number of programs. With the closing of programs and the increase in students accepted the APMA and CPME must watch very closely so the past does not repeat itself.
 
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Dr_Feelgood

"From what I am understanding with the recent standardization, you are now required to have at least 2 years of training in pod med AND surgery. Before this, one could complete a 1 year residency and be fine to practice (depending on state laws). People who wanted more training could do a 2, 3, or even 4 year residency. Furthermore, in the past, one could complete a non-surgical based residency if they wanted (such as the orthopedic POR residency). And I've understood that there are some practicing pods out there who did not complete a residency at all. Please correct me if I'm wrong!"

This is all true as far as I know.

This is very true, we actually work with a pod that never did a residency at DMU. You can see how restrictive his practice can be and why it is important to get as much training as possible even if you don't think you will use it.

That being said he still makes a good living. Advance surgery does not always mean big bucks. Simple procedures such as nail avulsions are where the real money is at. Low complications and high return.
 

cool_vkb

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This is very true, we actually work with a pod that never did a residency at DMU. You can see how restrictive his practice can be and why it is important to get as much training as possible even if you don't think you will use it.

That being said he still makes a good living. Advance surgery does not always mean big bucks. Simple procedures such as nail avulsions are where the real money is at. Low complications and high return.

Hey just curious, i was going thru Wisconsin Scope of practice and i saw that they dont require a post graduate to get a License and Similarly in IL, they need only 1 yr Post graduate residency to get Unlimited License. It never mentions what kind of procedures they are eligible to do had they completed 1 yr residency or wht they can do if they have done 3yr residency.

Then which governing body decides what kind of restrictions are to be imposed on physicians who have done 1yr residency or 2yr or 3yrs. or these are restritctions self imposed by the physicians themselves realising that they dont have sufficient knowledge!
 
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Dr_Feelgood

Hey just curious, i was going thru Wisconsin Scope of practice and i saw that they dont require a post graduate to get a License and Similarly in IL, they need only 1 yr Post graduate residency to get Unlimited License. It never mentions what kind of procedures they are eligible to do had they completed 1 yr residency or wht they can do if they have done 3yr residency.

Then which governing body decides what kind of restrictions are to be imposed on physicians who have done 1yr residency or 2yr or 3yrs. or these are restritctions self imposed by the physicians themselves realising that they dont have sufficient knowledge!

It may not be mentioned in the state licensing board but you will not be certified by the national organizations (generally ACFAS but there are other surgical boards). Without board certification good luck getting a surgical center or hospital to grant you privledges.
 

krabmas

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This is very true, we actually work with a pod that never did a residency at DMU. You can see how restrictive his practice can be and why it is important to get as much training as possible even if you don't think you will use it.

That being said he still makes a good living. Advance surgery does not always mean big bucks. Simple procedures such as nail avulsions are where the real money is at. Low complications and high return.

I usually agree with you feelgood, but I have to call you out on this one. While typically nail avulsions go well and people do fine... I have seen pictures and lectures of the nail avulsion gone wrong - OM leading to amoutation of digits or more.

So even though it is usually a low risk procedure, the doc must still be careful and the patient must be compliant. The distal phalanx is less than 1cm deep to the nail bed and perforation of the nail bed can easily lead to OM.
 

Podman

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I usually agree with you feelgood, but I have to call you out on this one. While typically nail avulsions go well and people do fine... I have seen pictures and lectures of the nail avulsion gone wrong - OM leading to amoutation of digits or more.

So even though it is usually a low risk procedure, the doc must still be careful and the patient must be compliant. The distal phalanx is less than 1cm deep to the nail bed and perforation of the nail bed can easily lead to OM.

We had a case like that at the clinic about a month ago, it was a 62 y/o lady who had a nail procedure done on her hallux by a family practicioner about 18 months ago, and unfortunately it wasn't done properly so when she presented, there was a nice yellow purulent - did the bone probing and then we took AP x-rays, only to see that her entire distal phalanx was eaten up.
 
D

Dr_Feelgood

I usually agree with you feelgood, but I have to call you out on this one. While typically nail avulsions go well and people do fine... I have seen pictures and lectures of the nail avulsion gone wrong - OM leading to amoutation of digits or more.

So even though it is usually a low risk procedure, the doc must still be careful and the patient must be compliant. The distal phalanx is less than 1cm deep to the nail bed and perforation of the nail bed can easily lead to OM.

Come on Sam which has a higher complication rate, a nail avulsion or pick your surgical procedure (flatfoot correction, bunions, ect). Yes, it can go very wrong but I was playing the odds. I have seen some bad things also, we had a poor older lady that had a total avulsion b/c of onycho and lost her toe b/c the FP doctor asked like the procedure was a joke. I stating the fact as a comparison to most of the big procedures that a lot students think they need to build a practice doing.
 

krabmas

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Come on Sam which has a higher complication rate, a nail avulsion or pick your surgical procedure (flatfoot correction, bunions, ect). Yes, it can go very wrong but I was playing the odds. I have seen some bad things also, we had a poor older lady that had a total avulsion b/c of onycho and lost her toe b/c the FP doctor asked like the procedure was a joke. I stating the fact as a comparison to most of the big procedures that a lot students think they need to build a practice doing.

I guess compared to the outcomes of calcaneal fractures especially sanders IV you would be right. :smuggrin: :cool: :D
 
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