Country Club Pod Residencies
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Do you have access to the APMSA residency review? Besides getting answers from residents here that is another good resource.
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In the PMSR/RRA Residency Reviews thread, @FeeltheBern noted that Memorial Hospital of Rhode Island would qualify.
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Unfortunately I don't believe I do. I'm thinking a lot of DVA's are in the country club category
Why would you dedicate 4 years of college and then 4 years of podiatric medical school to then look for a country club residency? The next few years can make or break your career and can impact your income. You're young and this is the time to take advantage of all opportunities. Learn as much as possible, work as hard as possible and then you have the luxury of deciding how you want to practice when it's time.
Taking short cuts now may result in you regretting your decision later. Over the years I've been exposed to many doctors and those who impressed me the most and who had the best work ethic were those who had demanding residencies.
It's your call, but you basically get what you pay for, and I'd recommend you work hard now so you may be able to relax a little in the future.
You've gotten this far, so don't sell yourself short.
Taking short cuts now may result in you regretting your decision later. Over the years I've been exposed to many doctors and those who impressed me the most and who had the best work ethic were those who had demanding residencies.
It's your call, but you basically get what you pay for, and I'd recommend you work hard now so you may be able to relax a little in the future.
You've gotten this far, so don't sell yourself short.
Out of all due respect doctor, Can you not still be rear foot certified at a "country club"? If I work 8hrs per day, and still learn what I need to learn, am I still selling myself short because I didn't work 12 or more hrs? I'm not into academics and research. Will I for sure have a poor work ethic in a "country club" residency? Isn't income determined more so on business rather than what residency you come from? Will I for sure make more money if I can perform triple arthrodesis and ankle transplant procedures like a pro? Generally speaking, Do OR procedures pay more per hour than in office procedures after factoring overhead costs? Could I learn these office procedures in a "country club" residency? Could I still earn an above average living providing only basic care to patients? How young do you think I am by the way? A lot of questions, I know, but they are warranted.
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D
dyk343
...wow
Truth or no? Are there ortho groups who will pay a good salary for DPM's to provide non-surgical care?
Not a whole lot of those going on anywhere (at least in podiatry) 🙂
A better-trained physician with poor business acumen can do worse financially than a less well-trained doctor, for sure. The better-trained physician, however, has a higher income potential ceteris paribus than his counterpart.
I think @ExperiencedDPM gave you solid advice, but you're the one who gets to set your own priorities.
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I'm afraid you've taken my response personally, rather than it's intended purpose as generic advice. I will answer each of your questions based on my experience. I can obviously only provide opinions on my past experience, which I assure you is relatively vast, but may be or may not be of any value to you.
I personally am not aware of any quality residency programs that I would classify as country club. So I'm not confident that you can obtain RRA certification from a country club program, though there will always be exceptions. And obtaining board certification IS a very academic process. Although you may not enjoy research or academics, some of both are necessary to be a competent surgeon. The actual mechanics of surgery is the easy part. You can train a carpenter to perform surgery. The art is in the understanding of why you are performing the surgery, how the surgery will impact the patient, how to handle unforeseen complications intra op and post op, etc.
Yes, I believe that during the education process, working the minimum to get by is selling yourself short. You have your entire career to work any hours you choose, so why not take advantage of the entire residency process. My point was that you can't turn back the clock and shouldn't ever put yourself in the situation where you say "I should have...." My point is simple, work hard now and THEN you have the full opportunity to choose how you want to practice. There may be one small niche or area you find interesting with a little extra effort that stays with you your entire career. Don't tie your own hands this early in your career and possibly regret it later. You can choose later not to use that training, but years down the line you don't want to regret bypassing that training when you had the opportunity.
Surgery isn't the ticket to wealth. Being well rounded is the ticket to success. So you can earn a great living if you never performed a triple arthrodesis or ankle arthroplasty/implant (sorry, they aren't ankle "transplants" as you wrote). But learning how to perform these procedures will certainly never hurt you. Once again, you can choose any path you desire after training.
I don't know you and don't know your work ethic. But anyone who actively is looking for a country club program with a 9-5 schedule in my opinion, isn't exemplifying a strong work ethic.
You don't need a quality residency position to make money. Medicine is a business, and those with a strong business acumen can succeed. That being said, I know many doctors of all specialties that make loads of money and who are horrible doctors. They are businessmen who don't care about patients, but care about money. They treat insurance companies and not patients. They are salesmen who sell anything and everything to a patient regardless of it's worth, as long as it will make them money. So you don't have to do a quality residency to make money, but you already know that fact. And I know very few if any podiatrists who did a very strong residency who didn't also do well in practice due to training and work ethic.
On a side note, our office hired a grad from a country club program. He was hired because he was a relative of a long time employee of the practice. He complained about hours ALL the time. If a patient called and said they were stuck in traffic and would be a few minutes late, he'd make the patient reschedule. If a doctor's office called to ask if they can send a new patient with a problem right over, he'd refuse because it would mean he had to stay an extra 15-30 minutes. He was used to a 9-5 job, but our office doesn't always accommodate that schedule due to unforeseen events. When we didn't renew his contract and hired someone from a very strong program, it was like a breath of fresh air. He never looked at his watch, was a team player and worked hard. As a result he was rewarded financially and fast tracked to partnership.
Again, dollar for dollar, surgery isn't the way to get rich, but having a well rounded training will never hurt you. I want to be as competent performing that triple as I am treating an ingrown nail, but that's ME. You may feel differently. When a primary care doctor calls, I want that doctor to not have to think whether he should send the patient with the ingrown nail, the ulcer, the ankle fracture, the patient with mycotic nails, and so on. I want that doctor to know he can send ANYTHING and I'll be happy to treat it and treat it well.
I have no idea if any country club programs will train you in office procedures since money is made in the office. I know strong programs that don't teach much office stuff, but that should have been learned in school, during office rotations and if the program has a clinic.
You can earn an excellent living doing nothing other than palliative care. But you can back yourself into a corner if you're not well rounded. It's my belief that in the not so near future (it's already happening in many areas), nurse practitioners, especially those with diabetic training, and other ancillary providers will be performing routine palliative care, so you need to be of more value than those providers.
Even the big gun surgeons may be surprised when insurance companies stop paying for elective foot and ankle surgery down the line. So that supports my comment regarding well rounded training for survival of the fittest. We have NO idea if palliative care will be the way of the future for podiatry, or if complicated surgery will be the trend or neither. The money and reimbursements may be for everyday strains, sprains, fractures, infections, injuries, and heel pain. And insurers will track the cost in your office to make that heel pain patient better vs the cost of the guy down the street. That's the new model of medicine. They will be tracking cost and results. So it pays to be proficient in everything to assure your place in the system.
Most ortho practices that hire DPMs are not hiring them for palliative or non surgical care (again there will always be exceptions). Most ortho groups I know are hiring well trained DPMs at a nice salary for surgical care, because it's cheaper than hiring a foot/ankle orthopod. Ortho groups aren't interested in nails being clipped in their offices. I know of a few large ortho groups that have DPMs to treat aches, pains, and similar ailments and use those DPMs to feed surgery to the foot/ankle ortho docs in the group.
I don't know your age and it doesn't matter. I'd provide the same advice if you are 22 or 42.
As per my previous comments, you can find exceptions with every comment I've made. But those are exceptions and my comments are based on the NON exceptions and the norm in my past experience. You must choose your own path basesd on your wants, needs, desires and personality. I can only provide you with my personal opinion based on observations.
Residency training is the time and opportunity to soak it all in and work hard, and private practice is the time to make the choice how you want to practice regarding hours worked, number of patients treated daily and your scope of practice. I just urge you to never put yourself in that position years down the line by saying "I should have..."
No I didn't take it personally. These were all really honest questions I thought you had insight on, which you do. When I said "out of all due respect", I meant it. We research to the extent to find out something, but I'm pretty sure many great docs did no actual formal research to publish. Many residencies have no research to offer.
So after residency, can one not take on additional training??
Some people want a life outside of residency. They can probably still perform the bulk of podiatry after being trained at a 9-5 residency.
My idea of good business is good location, good work ethic, and great interpersonal skills, not selling whatever makes a big dollar.
There must be those with bad work ethic and those with good from country clubs, sure. Complaining about a few extra minutes IS extreme and is something I'd never do. I Also don't see the point in, say, a 4 year residency program or working 6am-10pm and getting little sleep, the latter of which is not beneficial for patient care.
What sets the DPM apart from a nurse practitioner is probably the ability to do surgery. There isn't a program out there, not even a country club, that doesn't offer surgical training. Thus, even a CC trainee is more valuable than a NP, wouldn't you say?
Doesn't every program train DPM's to be able to treat the vast majority of pod issues? If so, then the referring PCP probably doesn't have to worry about too much unless they're asking you to perform out of scope.
From my understanding, the worst case scenario from an educational standpoint is matching into one of the few non-rear foot certified programs, which means I will be ill equipped to handle rear foot and ankle surgical cases. About what percentage of podiatric ailments would you say warrant surgical treatment proximal of the forefoot? If it's a small percentage, then I'd guess that, coming from such a program as aforementioned, I'd still have a pretty good chance of survival. Referring out those few rear foot cases may not make or break me. Just my reasoning.
Thank you for kindly answering those many questions doc. Sorry for there being so many
So after residency, can one not take on additional training??
Some people want a life outside of residency. They can probably still perform the bulk of podiatry after being trained at a 9-5 residency.
My idea of good business is good location, good work ethic, and great interpersonal skills, not selling whatever makes a big dollar.
There must be those with bad work ethic and those with good from country clubs, sure. Complaining about a few extra minutes IS extreme and is something I'd never do. I Also don't see the point in, say, a 4 year residency program or working 6am-10pm and getting little sleep, the latter of which is not beneficial for patient care.
What sets the DPM apart from a nurse practitioner is probably the ability to do surgery. There isn't a program out there, not even a country club, that doesn't offer surgical training. Thus, even a CC trainee is more valuable than a NP, wouldn't you say?
Doesn't every program train DPM's to be able to treat the vast majority of pod issues? If so, then the referring PCP probably doesn't have to worry about too much unless they're asking you to perform out of scope.
From my understanding, the worst case scenario from an educational standpoint is matching into one of the few non-rear foot certified programs, which means I will be ill equipped to handle rear foot and ankle surgical cases. About what percentage of podiatric ailments would you say warrant surgical treatment proximal of the forefoot? If it's a small percentage, then I'd guess that, coming from such a program as aforementioned, I'd still have a pretty good chance of survival. Referring out those few rear foot cases may not make or break me. Just my reasoning.
Thank you for kindly answering those many questions doc. Sorry for there being so many
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Sorry, "implants", not "transplants. And I concur; more job prospects for those coming from stronger programs. Maybe even better salaries. Private practice would probably debunk this rule, however, for then only business matters in regards to income level.
Those residencies that work long hours are usually a reflection of more cases. There are elective cases that are outpatients, there are in patient cases and emergency cases. Emergencies don't make appointments, therefore emergency surgeries are often at inconvenient times. That diabetic with a neglected severe infection with gas gangrene always seems to wait until 11 pm or late on a weekend to enter the ER. And that's a case that needs to get done ASAP.
The best memories of my training (other than an amazingly hot nurse on the 3rd floor) are my days rotating through the ER. The hours were long and tedious but I still remember and use what I learned. I had a fantastic plastic surgery rotation with a fantastic attending who let us do an amazing amount. The knowledge and skills I was taught are also skills I use all these years later. I asked him to call me when I was a resident if he needed a resident, even if I wasn't on call. It meant extra hours but it was worth every minute. When things were quiet at the hospital, I spent time with one particular radiologist who was very nice to the residents. She taught me more during those hours then I ever learned in school the prior 4 years.
As far as private practice, you can make it as simple or complicated as you want. A friend of mine brings home more moemy than I do, but does about 12-15 surgeries a year, but pumps out orthoses all day long. I have a busy surgery schedule, from simple to complex because that's what I chose.
You can spend an entire career and be successful never performing any major RF or ankle cases. You also find what you look for in practice. If you don't perform RF or ankle surgery, you're less likely to recognize a RF or ankle problem that may benefit from surgery. I have a colleague who said he never found the need to perform a Lapidus, and that's because he never has done a Lapidus. I've seen many of his patients who SHOULD have had a Lapidus, but didn't.
Again, you often only see what you look for....
Private practice 'ain't so simple any more. The government is more involved that ever and reimbursements are at an all time low. Most of us are busy, but working harder when we should be working smarter.
The best memories of my training (other than an amazingly hot nurse on the 3rd floor) are my days rotating through the ER. The hours were long and tedious but I still remember and use what I learned. I had a fantastic plastic surgery rotation with a fantastic attending who let us do an amazing amount. The knowledge and skills I was taught are also skills I use all these years later. I asked him to call me when I was a resident if he needed a resident, even if I wasn't on call. It meant extra hours but it was worth every minute. When things were quiet at the hospital, I spent time with one particular radiologist who was very nice to the residents. She taught me more during those hours then I ever learned in school the prior 4 years.
As far as private practice, you can make it as simple or complicated as you want. A friend of mine brings home more moemy than I do, but does about 12-15 surgeries a year, but pumps out orthoses all day long. I have a busy surgery schedule, from simple to complex because that's what I chose.
You can spend an entire career and be successful never performing any major RF or ankle cases. You also find what you look for in practice. If you don't perform RF or ankle surgery, you're less likely to recognize a RF or ankle problem that may benefit from surgery. I have a colleague who said he never found the need to perform a Lapidus, and that's because he never has done a Lapidus. I've seen many of his patients who SHOULD have had a Lapidus, but didn't.
Again, you often only see what you look for....
Private practice 'ain't so simple any more. The government is more involved that ever and reimbursements are at an all time low. Most of us are busy, but working harder when we should be working smarter.
My idea of a country club residency would be one where the ancillary staff does their job. 😉
I'll expect to be on call in whatever residency I'm in.
Yes, hot nurses DO make residency life a bit easier haha!
Yes I would hope lapidus sx is in my training. I know a doc at my school who goes Lapidus crazy!
And I believe that is one of the beauties of podiatry is in the flexibility in which you can provide care. Couldn't you provide palliative care of rear foot and ankle regularly and thus still recognize when sx is needed?
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It's basically a low stress, non academic 9-5 type residency.
You probably haven't hit your clinical years yet.....but this is definitely a face-palm moment.
I second the face-palm
Face-Palm moment? And yeah, I've been in clinic for a year now. Im pretty sure I know that if conservative care is not working or no longer working I need to refer to surgery or do it myself, especially if I am rear foot certified.
Remember, to obtain board certification in foot (there is no forefoot cert) and/or RRA , you not only have to do the appropriate type of residency to allow you to sit for the eligibility/qualification exam, but you also have to submit cases once you're in practice, have those cases accepted and then take and pass the certification exam. It's not a quick or easy process, and when you do enter private practice you'll need to have enough surgical volume to accumulate the required cases.
I see. So if I'm not RRA certified then I'd have to refer someone who I recognize needs rear foot sx.
Not necessarily, but how comfortable are you going to be assessing, managing and operating on these patients if you have minimal experience with it. Every program would be RRA if they could be.
8 hours a day really is very little. You can work significantly more then that without even beginning to touch quality of life or family opportunities. Medicine unfortunately is inefficient - opportunities don't come gift wrapped in little half-hour packages. Cool cases unfortunately come at inopportune times. I recently had the opportunity to see multiple open fracture with extensive soft tissue injuries. Wasn't crazy about the timing, but always grateful for exposure to something I hadn't seen before. Better now under guidance then on my own with people looking at me saying "what do we do?"
8 hours a day really is very little. You can work significantly more then that without even beginning to touch quality of life or family opportunities. Medicine unfortunately is inefficient - opportunities don't come gift wrapped in little half-hour packages. Cool cases unfortunately come at inopportune times. I recently had the opportunity to see multiple open fracture with extensive soft tissue injuries. Wasn't crazy about the timing, but always grateful for exposure to something I hadn't seen before. Better now under guidance then on my own with people looking at me saying "what do we do?"
If you've already been in clinic for a year then you shoultimate definitely know the difference between conservative treatment and palliative care. Palliative care is toenails, calluses, diabetic counseling. Not the same as conservative treatment which can be for anything.
And I want to pose this question to any podiatry students reading this thread. If you're actively looking for an easy breezy country club program, would it bother you later on knowing that you could be getting much better training but elected not to? If it doesn't bother you, then go on ahead. Everyone has different priorities. I know it would bother me.
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This is exactly what I had recommended. Take advantage of any and all training now, because you can't turn back the clock.
You do not need to be RRA certified to perform RRA cases in many institutions. Some facilities require board eligibility, and some require certification within 5-7 years. There are many who are certified in foot surgery who also perform RRA cases, and many who aren't certified at all, and perform RRA cases. This will be dependent on the rules and regs of the hospital. Most facilities simply require a log of cases and proof of past experience prior to authorizing privileges.
Jellybean2020 on a roll! Solid advice - at this stage, mentality should be "go hard, or go home." Sure, go ahead and short-change yourself, but please do not apply this mentality towards your patients. They deserve the best of you and the best of your training and skills.
Well when I think "country club" I'm not really thinking just 8hrs a day. It could b 10 or 12. And again, as I've mentioned, I expect to be on call during residency. Also, what I'm saying is I don't mind referring out when I NEED to. Mind you, the "cool" cases probably aren't going to be that common in most practices. Bottom line, even in a country club, one can probably still obtain the training necessary to successfully and confidently practice the overwhelming majority of podiatry.
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I said "conservative".
Some of us aren't bothered by that. Sorry to burst your bubble. I mean we're all different on what we wanna do jellybean, as you've indicated. Not all of us wanna perform triple arthrodesis and ankle implantations or work up trauma cases. The majority of podiatry patients don't need that anyway. Plenty of successful, fulfilled pods who hardly touch a knife satisfy many, many patients throughout their careers.
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All of you are really getting this screwed up. You say that people who aren't RRA certified can't recognize when someone needs surgery of the rear foot when this can't be the case. Conservative care should be first. If surgery is needed, then do it if you're certified/have enough training and experience or refer if not. Why can't people here understand this simple concept!? Not everyone is GOING to be RRA. Finally, there are residencies that are considered "country club" and yet the residents still become RRA certified.
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I think you're missing the point OP. This thread isn't about RRA certification or whatever. As far as I'm concerned, any residency worth it's salt is already RRA certified. The few that aren't, why would you even want to go there? Nobody is having difficulty understanding the concept of referring out. You're making this discussion into something it's not.
What this thread is about is 'country club' residencies and hours worked (aka your original post). I completely agree with you that not everyone ends up at a program where they do lots of trauma or big procedures. Some people would like to get into a better program but are limited by their grades or by their family situation. Some literally don't care to do that kind of stuff and have successful careers. But I guarantee you none of those successful people went into their 3rd/4th year of podiatry school thinking to themselves "gee I wonder where I could go that won't make me work as hard as the other places". Maybe that's not how you meant it, but it's not a good look. At this stage of your training you shouldn't be afraid of working too hard. That's what this whole discussion boils down to, and is why you're getting the feedback that you're getting.
Hopefully now we're all on the same page.
What this thread is about is 'country club' residencies and hours worked (aka your original post). I completely agree with you that not everyone ends up at a program where they do lots of trauma or big procedures. Some people would like to get into a better program but are limited by their grades or by their family situation. Some literally don't care to do that kind of stuff and have successful careers. But I guarantee you none of those successful people went into their 3rd/4th year of podiatry school thinking to themselves "gee I wonder where I could go that won't make me work as hard as the other places". Maybe that's not how you meant it, but it's not a good look. At this stage of your training you shouldn't be afraid of working too hard. That's what this whole discussion boils down to, and is why you're getting the feedback that you're getting.
Hopefully now we're all on the same page.
Calm down, we all completely understand the entire question and situations described. I certainly never wrote that if you don't have RRA training you won't recognize if someone needs RRA surgery. What I did write is that you often see what you look for in practice. If you don't perform RRA surgery, you're not actively looking for these cases. I know many doctors who spend an entire career never performing OR referring out a patient who needs a triple arthrodesis. I'm sure that in 35-40 years or practice there were a few patients who would need a triple.
I agree 100% with the comments of jellybean. Regardless of what you meant, it was perceived in your original question that you were seeking a program where you wouldn't have to work hard or work long hours. Again, prior to you responding with a knee jerk response, when communicating on this forum, with your family and with patients (or anyone) it doesn't matter what you may have meant, it matters how it was perceived.
I can't tell you how many times I've been guilty of the same thing.
No Dr, you didn't say that one can't recognize when someone needs to be referred to sx because they don't do sx; however, you did say:
"You also find what you look for in practice. If you don't perform RF or ankle surgery, you're less likely to recognize a RF or ankle problem that may benefit from surgery." I'm not sure why this would be; I just don't see how one is less likely to find the underlying pathology in a given area because they don't perform sx of the given area.
Jellybean was speaking of how there's a difference between palliative and conservative care when I lastly only spoke of conservative care of the foot and ankle. What do you agree with from him/her? Some of us just simply want different. I know several more who want the same as I; If I don't want to perform much more than basic foot care and forefoot sx, why would I got to DeKalb, Temple, or Penn Presbyterian? Why not a country club? Maybe Jellybean would regret a country club choice, and perhaps you would doctor; many others and I would not.
As far as what's meant and what's perceived, maybe people, especially professionals, should learn to perceive in a brighter light of what someone's saying. So no, I'm not seeking a country club just to be lazy; I'm seeking one so that I can acquire the training that I actually want.
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Usually people get to residency and THEN decide if they want to stay clinic/forefoot-focused in the future. But hey it's your life and it's true you shouldn't let other people tell you what to prioritize.
Keep in mind that many country club programs barely meet the minimum number of cases required for rearfoot AND forefoot. For first ray surgeries, you only need 60 cases to graduate. That includes everything from hallux valgus, hallux limitus, and amps. If you think about the different types of procedures within each one, 60 is not enough. Good programs will get you 2x the minimum numbers. Great programs will give you 3-4x the minimum. Practice makes perfect and you can't practice if you don't see enough of something during residency.
Also, you only get 1 chance at residency, why not make the most of it? Residency is only 3 years long and for even the most intense programs (in terms of hours/week worked), your 3rd year schedule is way more chill than your 1st and 2nd years. My program is very intense during 1st and 2nd years, but 3rd years don't even take primary call.
Also, you only get 1 chance at residency, why not make the most of it? Residency is only 3 years long and for even the most intense programs (in terms of hours/week worked), your 3rd year schedule is way more chill than your 1st and 2nd years. My program is very intense during 1st and 2nd years, but 3rd years don't even take primary call.
I'm not missing any points or making this into a discussion that it's not; I'm just trying to get clarity on some points that were obviously addressed. Like I told ExperiencedDPM, perhaps you should perceive things people say in a brighter light. I referred to hours worked because I figured more regular hours would correspond to a residency that gives me more of just what I want. Unfortunately, you all perceive in a dimmer light, thinking I just wanna be lazy. Apparently everyone here is more about working hard rather than working towards doing what you want to do. I'm doing the latter.
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If those are not enough cases, then why is that minimum number set as the requirement?
Well if I decide to stay clinic/forefoot focused, would I want to continue through a program that offers so much more? I'd think it would make me miserable if I did. This is why I've decided to not pick a program as such.
The number of required cases may not translate to a person being fully confident in what they can do. A good doctor will continue to evolve with every surgery. Not saying you won't do this but programs that give you more opportunities to do what you want will allow you to perfect your skills faster.
I also agree with those that suggest going to a program that will push you to your limits. For some a "country club" program may be a good fit and for others a 400 hour/week (a bit of exaggeration) program is best. I suggest that you talk to your school admin and get the residency survey. It is very helpful.
I am also figuring out which residency will be a good fit. There are a lot choices and it can be stressful.
Wow, nice job spinning this one. Once again, I'll reiterate that you treat and see what you look for in practice. Even if you have training, but don't use that training, you can easily fall into patterns. One of those patterns is prolonging, delaying or AT TIMES not recognizing that surgical intervention for a rearfoot or ankle problem is in the best interest of the patient.
If you have trouble communicating and no one on this site "perceived" your comments as you intended, don't spin it by saying I or anyone else should "perceive in a brighter light". Just make your point crystal clear and you won't have to worry about the perception of others. Are you going to tell your residency director that he or she didn't perceive your comments correctly so it's THEIR fault? Really? And no, I don't need someone who is still in the earliest stages of training to tell me how I should "perceive" things. I've been there and done that, so you may want to rethink your comments.
You came on here and asked a question, and I answered honestly as did others, but the answers provided weren't necessarily what you wanted to hear.
In future threads I will refrain from answering any of your questions.
Pro tip: Never, ever argue or talk-back with such hostility and choice of words to upperclassmen, residents, and attendings (such as to Experienced DPM). You started this thread with a question about country club residencies and asking about average hours worked (common sense would lead one to think you're looking for an easy way out). Then again and again, you attack the above posters' replies -- time they took out of their schedule to help you, but just above, you tell ExperiencedDPM to perceive things in a brighter light? Keep digging that little hole.
Exactly
Are you serious!? Now you're getting antsy over a few words that were barely harsh. And I didn't even attack anyone; I was attacked! A couple of you acted like you wanted to ridicule me although I was being polite. Sorry for not kissing someone's rear end just because they're a doctor but that's not what I'm here to do. I'm arguing my point and telling it how it is. If you can't handle it, then step out the kitchen and stop responding. Anyone can be lying about who they are by the way. Wakaflocka,you can keep riding the privates all ya want; it's not my style. I can't exactly see a hole I could be digging on SDN, but how about thinking of it this way: is he trying to just get a certain type of training or is he looking for "an easy way out"?
BTW, I mentioned hours to make a comparison to other residencies, and, as I've mentioned, I use the number of hours as a rough indicator of how much I'll get of the training I want. More hours would indicate me getting extra training I don't really care for.
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I see someone's on an ego trip now. I suppose there's no use in being polite anymore. Recognizing when someone needs RRA sx and actually doing it are two different things. No one is going to enjoy being perceived as lazy when that's not the case. Why must assuming the worse be part of your character? You could've asked why I was interested in country clubs first instead of automatically assuming it's to be lazy. The answers I heard sometimes didn't make sense. THAT's why I asked further. Forgive me for continuing to ask questions for you obviously took this as an insult somehow. As far as talking back goes, Im an adult professional student and you're an adult podiatrist. Let's get that straight. Let it be known that I'm not the child and you're not the father *eyes roll*.
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this is how I feel reading this thread. Anyone else?
Right, a set number of cases may give one confidence to start practice while it won't for someone else. However, a set number of cases required for completion of a program is still set. In a country club, I may or may not exceed it, but probably will if I don't feel confident enough to to start practice. I couldn't imagine any of today's pod residency programs letting their residents out without being confident in forefoot sx at least since it's part of our bread and butter. And yes, of course there's always more and more education and perfection of skills throughout practice.
Well I believe a country club is a good fit for the type of training I'm seeking. So I don't take their suggestions; they apparently believe that an intense program should be for everyone. They also don't regard that a country club IS a good fit for some.
So that's who I get it from; ok cool!
Reminder to all to keep things respectful in this thread.
As a graduating 4th yr, I want to give the OP some advice. Never ever mention the words "country club" or "work life balance" to residents or residency directors when you're on your 4th year externship trail (or ESPECIALLY during residency interviews) . They set off all kinds of alarms in people's minds, whether that's fair or not. You may not agree or even fit with the stereotype, but you will have to fight this stigma of laziness. So I would just not mention it. Just say something generic if you're asked what you're looking for. Best of luck going forth. May you get the program that best fits you.
As a graduating 4th yr, I want to give the OP some advice. Never ever mention the words "country club" or "work life balance" to residents or residency directors when you're on your 4th year externship trail (or ESPECIALLY during residency interviews) . They set off all kinds of alarms in people's minds, whether that's fair or not. You may not agree or even fit with the stereotype, but you will have to fight this stigma of laziness. So I would just not mention it. Just say something generic if you're asked what you're looking for. Best of luck going forth. May you get the program that best fits you.
I'm not really sure why you are pretending to know what you're talking about when there are people on this board with more experience than you. You are mistaken about all programs having confident residents in even forefoot. There are some programs who fudge their numbers, programs that have attendings who barely let the residents touch the scalpel. Just because it says a resident did 60 first ray surgeries, does not mean they ACTUALLY did them. Also, there is variety among first rays. You are only required to get 60 TOTAL first rays. As almost a 3rd year at a fairly high volume program, I have done over 70 Austin osteotomies but <10 Lapiduses. The Lapidus is a difficult procedure, and many attendings don't feel comfortable doing it, so they just do an Austin on everyone (no, a lot of them do NOT refer out). If my program got JUST the minimum, who knows if I would have even done 1 Lapidus during residency skin to skin?
Please, have some humility about your inexperience and learn to take advice from others who have been around longer. You will be in a rude awakening once residency starts if you back talk to attendings or senior residents.
You make many excellent points. I work with what I consider excellent residents in a strong program. Some procedures are not that popular among attendings, therefore resident exposure is minimal. Your Austin/Lapidus comments are a perfect example. It also supports my comments that you see what you look for in practice. If you don't look for hyper mobility or don't understand CORA, then everyone gets an Austin. When I perform a Lapidus, you'd think I was performing a miracle surgery. Residents come out of the woodwork because their exposure is limited. Your comments with some surgeons being stingy handing over the scalpel is also excellent. But handing over a scalpel isn't a right, it's a privilege and that comes with trust. My patients are private patients who have come to me via referral, word of mouth, etc. Those patients have put their trust in me, not an unknown resident. So I take that responsibility very seriously. A resident has to earn having the scalpel, it's not automatic. There are some parts of a surgical procedure that are difficult to "undo" if a resident does something wrong. Yes, I love to teach and learn from residents, and many earn my trust and some unfortunately will always watch me do the case. Hopefully, they still learn. A resident really earns my respect when he or she knows I'm doing the entire case, yet still shows up enthusiastically. The other day I performed a case on a major board member at the hospital, who is also chairman of one of the departments. The resident understood why I did the entire case and never complained. That's one way to earn my respect. But it also reinforces the fact that as a resident, exposure to cases and actually performing the case are often not equal.
