Are Podiatry Fellowships Necessary?
- Thread starter CutsWithFury
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Thats an interesting study. My smoothbrain couldn't handle the calculus though
D
deleted1061086
This study compares a survey from 4 select fellowship programs with the ACFAS 2018 compensation and benefits survey. That survey had an n of 362 - twenty of which were part time, and 25 were paid hourly (8% of n). 251 of the 346 (69%) of respondents were between ages 36-65, meaning most were likely completing training before fellowships became somewhat commonplace, as they are becoming now. 25 of the ACFAS respondents spent 4+ years in residency, meaning they attending one of the few 4-year podiatry residency programs, OR they completed 3 years and a fellowship. 94 of ACFAS respondents reported 2 years or less of residency, meaning they almost certainly trained prior to the current fellowship surge - fellowship was likely never an option for many of these survey respondents because they were not widely available as they are now. 190 respondents reported they had been in practice for 11 years or more (again, they started practice before fellowships were popular). In the ACFAS survey, 68 reported completing a surgical fellowship and the average pre bonus salary was 240,000. 276 reported they had not completed a surgical fellowship, and their average pre bonus salary was 226,000. In other words, comparing these two groups (the 4 selected fellowship programs vs. the ACFAS 2018 compensation and benefits survey), probably doesn't show us much - if anything at all. The two groups are not comparable. There is almost certainly crossover between the two groups (people who responded to both surveys).
I don't mean to take down this poster/research - those trained at that program have advanced our profession, but I don't think the poster has any real/valuable data as the data are presented above. I think they recently published in ACFAS, and maybe more data are available in the actual paper.
As fellowships become more common, the difference in starting income between those who complete fellowships and those who don't will become less and less. There are only so many podiatry/foot and ankle jobs available, and the vast majority of surgical foot and ankle practice positions go to orthopedic foot and ankle surgeons - this is not changing anytime soon. Most "fellowship-trained" individuals are targeting coveted hospital and orthopedic group jobs. As others have said and we all know, there are only so many of those positions open a year, and its much less than the number of podiatrists graduating residency, fellows finishing fellowship, and orthopedic foot and ankle surgeons finishing fellowship. If you count ACFAS fellowships, CPME fellowships, and fellowships that are not "recognized" by any recognizing body, such as those posted on PM news or podiatry exchange, there are probably close to 100 podiatry fellowship slots and increasing. I did not do the math, this is an educated guess. So as those increase, I would expect the difference in "fellowship trained" income and residency trained income to become less over time.
Some fellows do have a better chance at higher-paying and coveted jobs. A lot of that has to do with connections. Sure an extra year of training is helpful, but I would take a graduate from a very good residency over a graduate from a bad residency + average fellowship ten out of ten times. I used to think more training was always a good thing. Now that anyone can start a "fellowship" and there is a large supply of fellowship slots (meaning less qualified candidates), in some cases more training = more dangerous.
I don't mean to take down this poster/research - those trained at that program have advanced our profession, but I don't think the poster has any real/valuable data as the data are presented above. I think they recently published in ACFAS, and maybe more data are available in the actual paper.
As fellowships become more common, the difference in starting income between those who complete fellowships and those who don't will become less and less. There are only so many podiatry/foot and ankle jobs available, and the vast majority of surgical foot and ankle practice positions go to orthopedic foot and ankle surgeons - this is not changing anytime soon. Most "fellowship-trained" individuals are targeting coveted hospital and orthopedic group jobs. As others have said and we all know, there are only so many of those positions open a year, and its much less than the number of podiatrists graduating residency, fellows finishing fellowship, and orthopedic foot and ankle surgeons finishing fellowship. If you count ACFAS fellowships, CPME fellowships, and fellowships that are not "recognized" by any recognizing body, such as those posted on PM news or podiatry exchange, there are probably close to 100 podiatry fellowship slots and increasing. I did not do the math, this is an educated guess. So as those increase, I would expect the difference in "fellowship trained" income and residency trained income to become less over time.
Some fellows do have a better chance at higher-paying and coveted jobs. A lot of that has to do with connections. Sure an extra year of training is helpful, but I would take a graduate from a very good residency over a graduate from a bad residency + average fellowship ten out of ten times. I used to think more training was always a good thing. Now that anyone can start a "fellowship" and there is a large supply of fellowship slots (meaning less qualified candidates), in some cases more training = more dangerous.
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you shouldn’t apologize. A bad poster/paper/study is a bad poster/paper/study. This one is bad. Its obvious they set out to prove their hypothesis correct with this “study,” a hypothesis which justifies their own decisions/existence. The selection bias noted by Bill should be enough to write off the study. Of course if you make your math and analysis complicated enough, it looks like real “science,” even though it doesn’t give us any valuable information nor does it allow for any meaningful conclusions.
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I think we should do a study on what percentage of DPM "Fellows" are working at large ortho groups and hospitals systems vs private practice.
10 years ago I would say 100% of DPM fellows would be in ortho groups or hospitals. But now there are so many garbage fellowship programs with more being produced each year that you are seeing the majority of fellows having no where else to go other than private groups. They are cutting toenails and making a 75-100K base salary like the rest of the first year associates...
So what exactly is our profession accomplishing with all these fellowship programs with more and more being produced each year? It certainly is not parity with AOFAS IMHO.
10 years ago I would say 100% of DPM fellows would be in ortho groups or hospitals. But now there are so many garbage fellowship programs with more being produced each year that you are seeing the majority of fellows having no where else to go other than private groups. They are cutting toenails and making a 75-100K base salary like the rest of the first year associates...
So what exactly is our profession accomplishing with all these fellowship programs with more and more being produced each year? It certainly is not parity with AOFAS IMHO.
D
deleted1061086
It seems it is easier to eat your young if you give them a fellowship certificate after dinner. There are excellent fellowship programs, but do your research first.
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Does that Bako 1 month fellowship count? Are expert dermatopathologypodiatric fellows coming out of that one??
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It’s up there with the - “I spent one week in Russia” fellowship
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Or....
I did my “fellowship” at Harboview Medical Center in Seattle with Sig Hansen....for 1 month
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I did that (was forced to)...
As soon as I told Bakotic I was doing a hospital job he stopped talking me for the entire two weeks because I was useless to him now. I obviously would send everything to my hospital pathology lab.
Still have never done a biopsy in clinic yet...
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I just did my first biopsy in clinic the other day. Maybe you should see more patients.
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No, but you’re an expert on hookers and blow. I’ve heard you can tell which region of Colombia the coke came from based on appearance alone after you spend a month with Brad
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Show the man some respect guys - he paid for that room I hate at DMU.
After the fact edit - patient called (not for me) to say they'd never have had their nail sent off if they knew it would cost $500. There's ridiculous money in some of this blind testing stuff. Another lab (ASP?) came by my office the other day desperate to buy us breakfast and lunch and let us know we should send them nail clippings or whatever pathology we have. I don't think I ever sent off a single nail in residency... I'm now a willing contributor to the podiatry garbage medicine system. Oh how I have fallen.
After the fact edit - patient called (not for me) to say they'd never have had their nail sent off if they knew it would cost $500. There's ridiculous money in some of this blind testing stuff. Another lab (ASP?) came by my office the other day desperate to buy us breakfast and lunch and let us know we should send them nail clippings or whatever pathology we have. I don't think I ever sent off a single nail in residency... I'm now a willing contributor to the podiatry garbage medicine system. Oh how I have fallen.
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I laughed out loud considering one month of RVUs for me is your entire yearly production...maybe more
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Was that by choice? Or was it because your older TFP mustache DPM private practice owner tells you to?
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Only thing I've been told to do is more surgery.
I've done fewer than 10 submits. A patient presents to me for onychomycosis (wanting treatment) - they are unlikely to have a nail clipping sent. There usually needs to be some sort of trigger - the patient says I don't want to do an oral medicine without proving its fungus, or I'm a 20-30 something successful woman and I just have to know what is going on, what I can do, etc. And you aren't wrong about working with someone who sends a lot off.
I think these things are a intercept of our good intent. We wonder - should I know its fungus before I prescribe and someone gets in between that with an expensive test. Till the other day I had no idea of the cost. Before I knew the cost though - once I started to offer it to people, I found it creeping into my shpiel more. Here's another option - and what I'm not telling you, because I didn't know, is its a financial pillaging.
I've done fewer than 10 submits. A patient presents to me for onychomycosis (wanting treatment) - they are unlikely to have a nail clipping sent. There usually needs to be some sort of trigger - the patient says I don't want to do an oral medicine without proving its fungus, or I'm a 20-30 something successful woman and I just have to know what is going on, what I can do, etc. And you aren't wrong about working with someone who sends a lot off.
I think these things are a intercept of our good intent. We wonder - should I know its fungus before I prescribe and someone gets in between that with an expensive test. Till the other day I had no idea of the cost. Before I knew the cost though - once I started to offer it to people, I found it creeping into my shpiel more. Here's another option - and what I'm not telling you, because I didn't know, is its a financial pillaging.
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Study Asserts Higher Costs And Longer Hospital Stays When DPMs Perform Ankle Arthroplasty And Ankle Arthrodesis Procedures
A controversial study maintains that when podiatrists perform ankle arthroplasties and ankle arthrodeses, patients experience longer hospitalization and higher costs in comparison to when the surgeries are performed by orthopedic surgeons.www.podiatrytoday.com
Lower Complication Rate Following Ankle Fracture Fixation by Orthopaedic Surgeons Versus Podiatrists. - PubMed - NCBI
Two completely poorly written and biased studies which sole purpose is to make DPMs look bad. Anybody in healthcare could look/dissect the methods/ data and can conclude that these are low power studies with a lot of flaws. But it didn't stop JBJS and FAI from pushing it through to achieve its purpose which is to make DPMs look bad in the public eye.
There were a few letters to the editor published by JBJS, including mine, that pointed out the flaws in the study and inherent bias. See link below.
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I would have felt better if APMA disseminated this response to all podiatrists.
It is important to know that there are individuals actually fighting back against the AOFAS agenda.
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