Forum Members ABFAS/ABPM

[newpodgrad]

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Hey guys

While looking for jobs , I inquired with a few local hospitals about how to go about getting privileges.

Several of them sent me info and I wanted to highlight a board concern.

Not sure how to really take it, but here’s a excerpt from one of the docs re: board status.

“Board Certification Requirement means certification from one of the following boards: the American Board of Medical Specialties, the American Osteopathic Association, the American Board of Foot and Ankle Surgery, or those Boards which may be approved by the Executive Committee to satisfy this Requirement”

As a disclaimer, I’m not a HUGE surgery pod. I enjoyed it , and did it in residency because, well, that’s what we had to do. And I’m fine with my forefoot procedures. I believe I’ve done well with them at my current level. I don’t care to do TARS, scopes mid foot fusions etc. I have no problem referring them out. I took the ABFAS qualifying tests etc, because again, it’s encouraged in residency and passed them.

Looking at this doc, it almost seems like this board required if you wanted to be on staff. The little statement at the end regarding “or those boards” seems like it might open the door for ABPM with some petitioning or something.

What do you guys make of this? I have heard from others that ABPM will get involved with issues regarding privileges etc. Is there more to this picture than meets the eye?

Thanks in advance for everyone’s take

 

[deleted664048]

You don't need a fellowship to do a TAR or SMO. Stop pushing this narrative. There are high powered programs that offer these experiences and residents can get competent at it.

Fellowship training is overrated

As as a student never seen one. As a resident foot and ankle orthos would do like 2 SMO per year and 5 TAR per year. Podiatrist did zero. Maybe a handful of programs offer that. I have friends all over who went to any different programs and none of them were doing enough quality TAR to be able to do that after residency. Not sure if you learn in fellowship, or just take course and help other doc who does it regularly and learn that way.

 

[Pronation]

Not pushing any narrative, fellowship is dumb. But not a lot of programs do TAR or SMO. Certainly not enough to make board training exams focus so heavily on it. Never even saw one being done when I was a student on rotations.

Sorry to hear about your subpar externship rotations. I saw TARs at most of the places I rotated at, did them in residency, and do them in practice. Executing a proper lapidus with a 2nd crossover toe with plantar plate pathology is more technically challenging anyway. This is why I think separating pods who just do “forefoot surgery” is a joke.

 

[Pronation]

As as a student never seen one. As a resident foot and ankle orthos would do like 2 SMO per year and 5 TAR per year. Podiatrist did zero. Maybe a handful of programs offer that. I have friends all over who went to any different programs and none of them were doing enough quality TAR to be able to do that after residency. Not sure if you learn in fellowship, or just take course and help other doc who does it regularly and learn that way.

With all due respect, it seems based on your posts that you went to a mediocre residency program. Like generally hangs out with like, and most of us were sufficiently exposed to TARs in my circle of degenerates.

But also here we are begging and clawing at hospital employed positions where pus is the main focus so that we can be paid like doctors.

 

[Boba Foot]

With all due respect, it seems based on your posts that you went to a mediocre residency program. Like generally hangs out with like, and most of us were sufficiently exposed to TARs in my circle of degenerates.

But also here we are begging and clawing at hospital employed positions where pus is the main focus so that we can be paid like doctors.

Some of us have no interest in doing TARs, bruh.

 

[Pronation]

Some of us have no interest in doing TARs, bruh.

I wasn’t implying that. I’m just saying that those of us that went to high quality residency programs were exposed to it sufficiently to do them. I have friends that have the training to do them but choose not to (reimbursement vs stress compared to simple/other procedures)

 

[Weirdy]

Sorry to hear about your subpar externship rotations. I saw TARs at most of the places I rotated at, did them in residency, and do them in practice. Executing a proper lapidus with a 2nd crossover toe with plantar plate pathology is more technically challenging anyway. This is why I think separating pods who just do “forefoot surgery” is a joke.

Agree with technical aspects on forefoot surgery being somewhat more challenging than TAR as a current resident exposed to both (although minimal with TAR).

Smaller bones, smaller joints, smaller space, more swelling, more mobile joints = more time dedicated to getting it right.

And patient comes back and will always say "Why is my toe so swollen and big??"

 

[deleted664048]

I wasn’t implying that. I’m just saying that those of us that went to high quality residency programs were exposed to it sufficiently to do them. I have friends that have the training to do them but choose not to (reimbursement vs stress compared to simple/other procedures)

There are a handful of high quality residency programs in podiatry. Unless you do not care about location, getting one that you describe is pretty hard in majority of the states, not because of the competition but because they just do not exist in many places. Many states do not even allow podiatrist to do TAR. Also they do not last very long, if you have to replace something in 10 years, thats not very good IMO. If you do one for a 65 y/o, do you want to have a major surgery on a 75y/o? Honestly, all research I have read did not convince me. If I ever need TAR for myself I will get a fusion with a rocker shoes. TAR, is not a total hip or knee. But again just my opinion.

 

[dtrack22]

There are a handful of high quality residency programs in podiatry. Unless you do not care about location, getting one that you describe is pretty hard in majority of the states, not because of the competition but because they just do not exist in many places.

Going left to right on the map, states with residency programs where you can get “high quality training” that would allow you to do TARs if you so choose…anyone can feel free to add a state I may have missed…

WA, OR, CA, CO, TX, MN, IA, WI, IN, MI, OH, PA, FL, VA, NJ, CT, MA

Many of those states have multiple programs that would be considered “high quality.” Those states cover every region of the country. It might not be a majority of states, but do we even have residency programs in a majority of states? I mean a lot of the mountain west and the “south” don’t even have programs. The only externship I did without TAR or complex ankle recon was a VA core type rotation through the school. Location restrictions can limit your opportunity to get good training but there are multiple high quality programs in every region of the country.

 

[deleted664048]

Going left to right on the map, states with residency programs where you can get “high quality training” that would allow you to do TARs if you so choose…anyone can feel free to add a state I may have missed…

WA, OR, CA, CO, TX, MN, IA, WI, IN, MI, OH, PA, FL, VA, NJ, CT, MA

Many of those states have multiple programs that would be considered “high quality.” Those states cover every region of the country. It might not be a majority of states, but do we even have residency programs in a majority of states? I mean a lot of the mountain west and the “south” don’t even have programs. The only externship I did without TAR or complex ankle recon was a VA core type rotation through the school. Location restrictions can limit your opportunity to get good training but there are multiple high quality programs in every region of the country.

Podiatry graduates 500-600 students every year. Not even 10% of people go to these "high quality programs", even the once who go might not get a job that gives them opportunity to do that.
Out of 100 students in my class, probably 10, at most 15 went to these programs. Most people even having opportunity decided to stay close to their home and not spend 3 years in the middle of nowhere.
Congratulation you can do TAR!
Thanks for bragging how amazing you are.
The point of the discussion was that ABFAS tests heavily on TAR while less than 10% of podiatrist ever do that and majority residencies do not even offer that as an opportunity. But you decided to talk about yourself and brag about how much TAR you do. Good for you.

 

[Pronation]

Podiatry graduates 500-600 students every year. Not even 10% of people go to these "high quality programs", even the once who go might not get a job that gives them opportunity to do that.
Out of 100 students in my class, probably 10, at most 15 went to these programs. Most people even having opportunity decided to stay close to their home and not spend 3 years in the middle of nowhere.
Congratulation you can do TAR!
Thanks for bragging how amazing you are.
The point of the discussion was that ABFAS tests heavily on TAR while less than 10% of podiatrist ever do that and majority residencies do not even offer that as an opportunity. But you decided to talk about yourself and brag about how much TAR you do. Good for you.

Reading comprehension is critical here. The point of the discussion was that you don't need to do a fellowship to do this stuff if you went to a good program. Are you offended because you were a bottom tier student and went to a bottom tier residency?

 

[deleted664048]

Reading comprehension is critical here. The point of the discussion was that you don't need to do a fellowship to do this stuff if you went to a good program. Are you offended because you were a bottom tier student and went to a bottom tier residency?

Dude, I was top 10 of my class and I was accepted to every externship I applied to and I did not like any of them. As I mentioned before, none of the programs I did were doing anything interesting or advanced. They all weren't great in my opinion.
My program did not accept anyone with GPA below 3.3, and most of my co-residents were top of the class as well. And yes, we did no TAR, and all our RRA numbers were with ortho. I did only few calc fractures per year, so did other co-residents. All my friends in the area had the same experience.
Reading comprehension exactly, the thread is about ABFAS/ABPM and not about fellowships.

 

[newfeet]

Dude, I was top 10 of my class and I was accepted to every externship I applied to and I did not like any of them. As I mentioned before, none of the programs I did were doing anything interesting or advanced. They all weren't great in my opinion.
My program did not accept anyone with GPA below 3.3, and most of my co-residents were top of the class as well. And yes, we did no TAR, and all our RRA numbers were with ortho. I did only few calc fractures per year, so did other co-residents. All my friends in the area had the same experience.
Reading comprehension exactly, the thread is about ABFAS/ABPM and not about fellowships.

Is TAR something everyone wants to do? I didn’t have any desire for it so I didn’t look for programs where it was a thing.

It’s weird that this became about TAR instead of the ABPM declaring WAR.

 

[dtrack22]

Out of 100 students in my class, probably 10, at most 15 went to these programs.

The schools that take 100+ students generally have a high % of poor quality students. DMU would have lower board pass rates and worse residency placement if they took 100+ students.

Most people even having opportunity decided to stay close to their home and not spend 3 years in the middle of nowhere.

Seattle WA is the middle of nowhere? Denver? Dallas/Fort Worth? Miami or Tampa suburbs? The Bay Area?

Congratulation you can do TAR!
Thanks for bragging how amazing you are.

But you decided to talk about yourself and brag about how much TAR you do. Good for you.

I’d like you to go back and quote any post I made about “how much TAR” I do, or how amazing I am for doing TAR.

I’m pretty sure the last post I made about TAR was months ago and was in regards to referring them to ortho because I don’t have the volume in a rural setting to do them regularly…

 

[deleted664048]

Is TAR something everyone wants to do? I didn’t have any desire for it so I didn’t look for programs where it was a thing.

It’s weird that this became about TAR instead of the ABPM declaring WAR.

neither did I... spending 6+ hours in OR, no thank you and all the complications.

But apparently you are low tier podiatrist if you don't do them 🤣🤣🤣

Our othos did a handful and they all came back with horrible complications and I haven't seen positive results. They probably were not super good at it, but they were foot and ankle fellowship trained orthopedic surgeons with 20+ years of experience. Maybe a podiatrist after 3 year residency can give them a lesson.

It's became a bragging game and "let's put someone down game". 😉

Reminded me about all those toxic attendings I met as a student that I never want to see again in my life.

 

[deleted664048]

The schools that take 100+ students generally have a high % of poor quality students. DMU would have lower board pass rates and worse residency placement if they took 100+ students.


Seattle WA is the middle of nowhere? Denver? Dallas/Fort Worth? Miami or Tampa suburbs? The Bay Area?





I’d like you to go back and quote any post I made about “how much TAR” I do, or how amazing I am for doing TAR.

I’m pretty sure the last post I made about TAR was months ago and was in regards to referring them to ortho because I don’t have the volume in a rural setting to do them regularly…

Chicago, Temple and NY have all 100+ students. It's half of all country podiatry school class.

If you live in Chicago, Philly, NYC, LA, you probably do not want to go to a random state. At least majority of people I encountered, including myself wanted to stay local. And taking to account 600 students, there are not so many of these "top programs" and many of them are in the middle of nowhere. I know, because I visited friends in PA and in NY, and I do not think 3 years there would be amazing. But it is personal preference.

In my podiatry school most people were local and people who were not local, had no issue going across the country for residency. But let's be honest, if. you want to find a job in a specific area, you better do residency in that area.

The point is that podiatry residencies are very different across the board, you can have super surgical programs which extensive reconstruction training and some VA program where most days residents cut nails to 60 patients and that is it.

Even "top programs" in the are that had valedictorians, weren't great. They would have amazing academics, and pretty much it. They would triple scrub ankle scope, and ankle fracture, and watch attending do everything.

Also fellowships do not even consider you if you did not go to the "top program", so people who already have good training usually go get fellowship to get resume bust and land a better job. Ortho groups like having podiatrists who are fellowship trained, even if it means nothing.

 

[deleted285117]

I make the same face to patients asking about getting a TAR like the ones I do asking about the “new bunion surgery” (lapiplasty)

 

[newfeet]

neither did I... spending 6+ hours in OR, no thank you and all the complications.

But apparently you are low tier podiatrist if you don't do them 🤣🤣🤣

Our othos did a handful and they all came back with horrible complications and I haven't seen positive results. They probably were not super good at it, but they were foot and ankle fellowship trained orthopedic surgeons with 20+ years of experience. Maybe a podiatrist after 3 year residency can give them a lesson.

It's became a bragging game and "let's put someone down game". 😉

Reminded me about all those toxic attendings I met as a student that I never want to see again in my life.

I’m ok being a low tier podiatrist. It is what it is.

 

[de Ribas]

neither did I... spending 6+ hours in OR, no thank you and all the complications.

But apparently you are low tier podiatrist if you don't do them 🤣🤣🤣

Our othos did a handful and they all came back with horrible complications and I haven't seen positive results. They probably were not super good at it, but they were foot and ankle fellowship trained orthopedic surgeons with 20+ years of experience. Maybe a podiatrist after 3 year residency can give them a lesson.

It's became a bragging game and "let's put someone down game". 😉

Reminded me about all those toxic attendings I met as a student that I never want to see again in my life.

Not bragging, but my residency program does great amount of RRA including TARs. They take 1-1.5hrs to do. Haven't seen TAR longer than 2 hrs.

 

[de Ribas]

Even "top programs" in the are that had valedictorians, weren't great. They would have amazing academics, and pretty much it. They would triple scrub ankle scope, and ankle fracture, and watch attending do everything.

True

 

[dtrack22]

At least majority of people I encountered, including myself wanted to stay local. And taking to account 600 students, there are not so many of these "top programs" and many of them are in the middle of nowhere. I know, because I visited friends in PA and in NY, and I do not think 3 years there would be amazing. But it is personal preference.

Imagine an MD/DO student saying any of this. “Yeah I matched Derm but decided to do family medicine because I didn’t want to leave NYC.”

If you are talking about living somewhere permanently, I get it. Job search geography limitations make sense. I had them. But for temporary education and training?

But let's be honest, if. you want to find a job in a specific area, you better do residency in that area.

This is objectively false. If you want to get a job in a certain area you should still get the best training you can and then you should have some ties to the area and then you need to get lucky that there is an opening the same year you finish residency. Location of training is meaningless outside of some inbred residency programs and Kaiser.

 

[Boba Foot]

Reading comprehension is critical here. The point of the discussion was that you don't need to do a fellowship to do this stuff if you went to a good program.

Actually, Reading Rainbow, the topic began because I was referring to prevalence of TAR and ankle osteotomies on ABFAS, just as Iaris said. Somewhere along the line, CutsWithFury saw the word "fellowship" and got triggered, but the discussion was never about fellowship.

Majority of threads on here always devolve into a group of people doing pissing matches over how great their residency was compared to the other 80%. But whatever, still a good amount of good info mixed into these threads when you skim through the BS.

 

[PeaJay]

I understand not everyone will be doing advanced reconstruction, but that doesn’t negate the fact that you need to know how to work it up.

All of the stems when I took the exam stated to the affect “ patient refuses replacement”. Osteotomies just correct varus/valgus. Not rocket science.

Moral of the story is…just because you don’t like something or were not trained on something doesn’t mean you do not need to understand it.

 

[deleted664048]

Imagine an MD/DO student saying any of this. “Yeah I matched Derm but decided to do family medicine because I didn’t want to leave NYC.”

If you are talking about living somewhere permanently, I get it. Job search geography limitations make sense. I had them. But for temporary education and training?

My friend got into 4 MD schools and none of them were in the area, so she went to Podiatry school to be close to her family. We are talking 35 MCAT (old standard) and 3.9 GPA. She got her number one choice residency in the area as well, and had a job offer in her PGY2.

4 years of school, 3 years of residency and fellowship is 7-8 years of your life, best years of your life, when you are in your 20th. Obviously someone who has an ambition to to be a neurosurgeon would not consider an area, but if your goal is to see 20-30 patient in clinic and do occasional bunion/hammertoe why would you go to a place you do not want to be at. Not everyone has an ambition to do surgeries all day and be on trauma call. And most podiatrists do not do crazy surgeries on a daily basis. More often than not I meet podiatrists who were all into surgery in their early days and now realized they rather spend time with family and just enjoy plantar fasciitis and ankle sprains in clinic.

 

[deleted664048]

This is objectively false. If you want to get a job in a certain area you should still get the best training you can and then you should have some ties to the area and then you need to get lucky that there is an opening the same year you finish residency. Location of training is meaningless outside of some inbred residency programs and Kaiser.

So when you ask how to find a job everyone says "word of mouth", but then you say it's not true that location maters. Obviously in residency most attending know someone who is looking for an associate/new hire to the practice. Decent attendings help residents in finding jobs and no one wants to hire a person from the street that applied online. How would you expect to get into let's say Texas market if you did your residency in Colorado? Apply to jobs on PM News? Indeed?
Most podiatrists get PP jobs, and those are definitely word of mouth. If you want some hospital job, even then it helps to know someone, and the likelihood is higher if you know more people from the area where you are applying.

 

[air bud]

So when you ask how to find a job everyone says "word of mouth", but then you say it's not true that location maters. Obviously in residency most attending know someone who is looking for an associate/new hire to the practice. Decent attendings help residents in finding jobs and no one wants to hire a person from the street that applied online. How would you expect to get into let's say Texas market if you did your residency in Colorado? Apply to jobs on PM News? Indeed?
Most podiatrists get PP jobs, and those are definitely word of mouth. If you want some hospital job, even then it helps to know someone, and the likelihood is higher if you know more people from the area where you are applying.

I will summarize what a lot of people on here are going to say. Between this post and multiple posts you have made recently, either you make stuff happen and don't make excuses or the opposite happens. And you get what you put into it.

 

[deleted664048]

I will summarize what a lot of people on here are going to say. Between this post and multiple posts you have made recently, either you make stuff happen and don't make excuses or the opposite happens. And you get what you put into it.

You are stating the obvious. If you dedicate your life to podiatry, work 80 h/week in school/residency/fellowship and get a high demanding job, obviously you can be successful unless you are an idiot. But it is in any field.

The difference is that you can be a mediocre PA and still make more than mediocre podiatrist with less debt and less schooling.

There are also many people who tried their best, went to the best residencies and end up in the same jobs that someone who went to FFA only program making same 100K salary.

 

[wakaflocka88]

You are stating the obvious. If you dedicate your life to podiatry, work 80 h/week in school/residency/fellowship and get a high demanding job, obviously you can be successful unless you are an idiot. But it is in any field.

The difference is that you can be a mediocre PA and still make more than mediocre podiatrist with less debt and less schooling.

There are also many people who tried their best, went to the best residencies and end up in the same jobs that someone who went to FFA only program making same 100K salary.

Actually I work average 36-40 hours a week, hover around 60-70 percentile of MGMA with salary+RVU bonus. I can be busier if I like but I’m happy with my current load. Paid very well already at the wRVU I’m generating. Most of my classmates that finished at the top including my co residents are all doing very well too and probably average a little more than me, around 45 hours a week as they do take some call

 

[DexterMorganSK]

A reminder that personal attacks are against the TOS. Please be respectful!

 

[de Ribas]

My friend got into 4 MD schools and none of them were in the area, so she went to Podiatry school to be close to her family. We are talking 35 MCAT (old standard) and 3.9 GPA. She got her number one choice residency in the area as well, and had a job offer in her PGY2.

What a poor decision. 😢 Even if that is true.

 

[newfeet]

What a poor decision. 😢 Even if that is true.

For reals.

 

[air bud]

You are stating the obvious. If you dedicate your life to podiatry, work 80 h/week in school/residency/fellowship and get a high demanding job, obviously you can be successful unless you are an idiot. But it is in any field.

The difference is that you can be a mediocre PA and still make more than mediocre podiatrist with less debt and less schooling.

There are also many people who tried their best, went to the best residencies and end up in the same jobs that someone who went to FFA only program making same 100K salary.

Well yes you just described podiatry and its problems perfectly.

 

[AttackNME]

Well yes you just described podiatry and its problems perfectly.

I mean people who sign up to be a podiatrist should know they’re putting their eggs in 1 basket. This is a specialty profession where you go all in, and if you want out, you won’t have much alternatives. Similar with dentistry no?

 

[dtrack22]

How would you expect to get into let's say Texas market if you did your residency in Colorado?

Oh, I don’t know, let’s go with: I’d use my cell phone.

You think that might work?

 

[CutsWithFury]

Actually, Reading Rainbow, the topic began because I was referring to prevalence of TAR and ankle osteotomies on ABFAS, just as Iaris said. Somewhere along the line, CutsWithFury saw the word "fellowship" and got triggered, but the discussion was never about fellowship.

Majority of threads on here always devolve into a group of people doing pissing matches over how great their residency was compared to the other 80%. But whatever, still a good amount of good info mixed into these threads when you skim through the BS.

Not triggered just stating facts. It was insinuated you need fellowship to do TAR and SMO. You don’t need a fellowship to perform complex elective foot and ankle recon or fix trauma. Get a good residency and you will go far and be able to do as much as you want.

 

[air bud]

Not triggered just stating facts. It was insinuated you need fellowship to do TAR and SMO. You don’t need a fellowship to perform complex elective foot and ankle recon or fix trauma. Get a good residency and you will go far and be able to do as much as you want.

Well we have already established that is not possible for 50% of the population if you want to stay close to home to home for ....checks math...4% of your life....in order to vastly improve your chances of success in your chosen profession for....checks math....50% of your life.

 

[Weirdy]

Reading comprehension is critical here. The point of the discussion was that you don't need to do a fellowship to do this stuff if you went to a good program. Are you offended because you were a bottom tier student and went to a bottom tier residency?

Dude, I was top 10 of my class and I was accepted to every externship I applied to and I did not like any of them. As I mentioned before, none of the programs I did were doing anything interesting or advanced. They all weren't great in my opinion.
My program did not accept anyone with GPA below 3.3, and most of my co-residents were top of the class as well. And yes, we did no TAR, and all our RRA numbers were with ortho. I did only few calc fractures per year, so did other co-residents. All my friends in the area had the same experience.
Reading comprehension exactly, the thread is about ABFAS/ABPM and not about fellowships.

Cool it guys. Its the internet. You two might actually have a lot more in common meeting in person.

 

[air bud]

Cool it guys. Its the internet. You two might actually have a lot more in common meeting in person.

Yeah can bond over hatred of this profession.

 

[air bud]

 

[air bud]

 

[ExperiencedDPM]

Not bragging, but my residency program does great amount of RRA including TARs. They take 1-1.5hrs to do. Haven't seen TAR longer than 2 hrs.

I was just asked to review a Lapiplasty case and the provider took 2 hours and 43 minutes on the case. And there were no notable patient or equipment/hardware complications intra operatively. Brutal.

 

[Pronation]

I was just asked to review a Lapiplasty case and the provider took 2 hours and 43 minutes on the case. And there were no notable patient or equipment/hardware complications intra operatively. Brutal.

Oof. I hope this person has been in practice less than one year.

 

[Utvolsdpm]

I was just asked to review a Lapiplasty case and the provider took 2 hours and 43 minutes on the case. And there were no notable patient or equipment/hardware complications intra operatively. Brutal.

Is that bad? Haha. I remember an attending during residency taking 4 hours for a bunion. I forget if it was an Austin or lapidus. The OR staff was asking about putting in a catheter mid case and anesthesia was pissed.

 

[Sweatshirt]

Is that bad? Haha. I remember an attending during residency taking 4 hours for a bunion. I forget if it was an Austin or lapidus. The OR staff was asking about putting in a catheter mid case and anesthesia was pissed.

Dear god that is insane. Austin should take 30-60 minutes max depending on skill level, experience, and OR staff. Lapidus should take anywhere from 60-90 minutes (maybe 120 minutes if you are fresh out of residency with limited OR help)

 

[heybrother]

Dear god that is insane. Austin should take 30-60 minutes max depending on skill level, experience, and OR staff. Lapidus should take anywhere from 60-90 minutes (maybe 120 minutes if you are fresh out of residency with limited OR help)

My big thing is - people should see a drop in their tourniquet times across some version of their 1st-2nd year. Not saying I don't sometimes have weird cases but my forefoot fusion times are down dramatically from where I started.

 

[Feli]

Dear god that is insane. Austin should take 30-60 minutes max depending on skill level, experience, and OR staff. Lapidus should take anywhere from 60-90 minutes (maybe 120 minutes if you are fresh out of residency with limited OR help)

It totally depends on the case for me. If it's a straightforward case with bone solid like hickory, first temp fix is good position, tech is one step ahead or you have a resident, etc... yeah 60min Lapidus - or even significantly less.

I just take as long as it takes to get it done well. That is usually 45-60min for my Lapidus +10min for each Weil. Estimates with "under-promise and over-deliver" are key. I board them for 90mins + 15min each Weil to allow for hiccups. I always look like a rock star since the other DPMs here or who have been here range from very slow to molasses slow. I could probably shave 10% off my times, but I don't typically inflate a tourniquet except for sometimes the ~20min part of resecting and fixing MCJ (no cuff for the beginning dissect + lateral release McBride, cuff down for closure). The saving a few mins is not worth the post-op pain or hematomas I'd probably get not just dissecting and cauterizing major bleeders. I do 95% of Austins and MPJ1 fusions or digit, Achilles, forefoot, etc work without cuff inflate at all for same reasoning.

I have definitely had some Lapidus go to 90mins or even more if it's revision with HWR or graft, the joint pieces just take awhile to get out, my fixation blows through osteoporotic bone (most common delay), I take a few tries to get the position right (2nd most), I have to go to bailout fixation method, etc. Even in normal BMI ppl, you have to always expect soft/osteoporotic bone in age 50+ with today's couch potato lifestyle and diet. Those are the ones where the "system" jig crap will crash and burn if the surgeon doesn't have the chops and the plan to use other methods. Technique over technology. 👍

If anything, I'd say my average op times have gone up a bit since training... just because it's now smaller community hospitals without residents to retract and assist well or with techs who don't really know the screw sets well. My first couple jobs were operating at hospitals that did a lot of foot/ankle and I was with good or at least decent pod residents. A lot depends on the setting, but the result is paramount to speed. And hey, turnover times or late starts will kill even a fast surgeon, haha.

 

[Feli]

I understand not everyone will be doing advanced reconstruction, but that doesn’t negate the fact that you need to know how to work it up.

All of the stems when I took the exam stated to the affect “ patient refuses replacement”. Osteotomies just correct varus/valgus. Not rocket science.

Moral of the story is…just because you don’t like something or were not trained on something doesn’t mean you do not need to understand it.

This is the bottom line. ^^

All of the answers are in McGlamry, journals, etc. Every DPM has access to those.

Making easy "boards" that everyone passes is not the answer. Education is the answer.

If we want all residencies to be "surgical" (foregone conclusion at this point), then people can pass an exam on it. Even if they just want to do Austins and ganglions or be a wound wizard, they still need to know a varus calc fx need ORIF refer and a valgus one in a 70yo smoker can be casted safely. They need to know a fibula bone tumor benign vs malignant when they see one... Charcot vs cellulitis... what peds deformities can be casted vs imminent surgery, fair elective surgery pt versus poor one, how to handle a post-procedure infection, etc etc etc.

You see what you know. And everyone knows how to read.

 

[air bud]

This is the bottom line. ^^

All of the answers are in McGlamry, journals, etc. Every DPM has access to those.

Making easy "boards" that everyone passes is not the answer. Education is the answer.

If we want all residencies to be "surgical" (foregone conclusion at this point), then people can pass an exam on it. Even if they just want to do Austins and ganglions or be a wound wizard, they still need to know a varus calc fx need ORIF refer and a valgus one in a 70yo smoker can be casted safely. They need to know a fibula bone tumor benign vs malignant when they see one... Charcot vs cellulitis... what peds deformities can be casted vs imminent surgery, fair elective surgery pt versus poor one, how to handle a post-procedure infection, etc etc etc.

You see what you know. And everyone knows how to read.

Gonna have to disagree with you on bone tumors there champ. I hate them and refuse to learn anything about them. I don't care how many mnemonics you come up with. I will die on this hill.

But overall good take.

 

[HardRoadPaved]

I hate them and refuse to learn anything about them.

I died on this hill. Since entering practice I thought I'd never in hell see a tumor and waste of time, etc. I was dead wrong. I've had everything from PVNS to enchondromas to mxyoid lesions under toenails. Last week I had a second opinion subungual melanoma where the dpm didnt do the biopsy correctly and it was missed since it was taken too distal. I punted that so fast after getting the biopsy correctly but I am glad I knew how to work it up. (So did the PCP who referred the case to me).

I think in school you start with cellular level stuff like histology. If you hated that then good luck in pathology. Then if you hated that then damn no way you get it in the third year with tumors in podiatric medicine/radiology. If only we could cherry pick what came into our office. Until then gotta be prepared!

 

[CutsWithFury]

I died on this hill. Since entering practice I thought I'd never in hell see a tumor and waste of time, etc. I was dead wrong. I've had everything from PVNS to enchondromas to mxyoid lesions under toenails. Last week I had a second opinion subungual melanoma where the dpm didnt do the biopsy correctly and it was missed since it was taken too distal. I punted that so fast after getting the biopsy correctly but I am glad I knew how to work it up. (So did the PCP who referred the case to me).

I think in school you start with cellular level stuff like histology. If you hated that then good luck in pathology. Then if you hated that then damn no way you get it in the third year with tumors in podiatric medicine/radiology. If only we could cherry pick what came into our office. Until then gotta be prepared!

Brad Bakotic is smiling somewhere

 

[PeaJay]

I died on this hill. Since entering practice I thought I'd never in hell see a tumor and waste of time, etc. I was dead wrong. I've had everything from PVNS to enchondromas to mxyoid lesions under toenails. Last week I had a second opinion subungual melanoma where the dpm didnt do the biopsy correctly and it was missed since it was taken too distal. I punted that so fast after getting the biopsy correctly but I am glad I knew how to work it up. (So did the PCP who referred the case to me).

I think in school you start with cellular level stuff like histology. If you hated that then good luck in pathology. Then if you hated that then damn no way you get it in the third year with tumors in podiatric medicine/radiology. If only we could cherry pick what came into our office. Until then gotta be prepared!

I am right there with you.

I am in no way am I looking to deal with tumors, but being rural I see tumors/cancer more frequently than I would ever want. I do appropriate testing or biopsy and ship out. This circles back to my original comment. You need to know how to work it up.