Country Club Pod Residencies

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arez10 said:
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.
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I'm not pretending anything. I'm just giving my thoughts. And some things that I'm told just aren't making sense. If anyone can successfully refute the rear foot argument then please do. And I did say "I can't imagine a program would let their residents go without being confident in forefoot sx at least", never did I say that "programs don't". Right, I'm aware of the variety of first Rays, and I have heard about residents not actually performing the logged surgeries. At a program with a larger minimum, residents can fudge their numbers as well. My point was that different doctors need different amounts of procedures to be confident. And just because a program sets a minimum doesn't mean that I can't do more, right?

I don't know who would "talk back" to attendings outside of SDN. You really think I'd still be in school and liked by attendings here if I did that to them? I do what I have to do in school and will do so in residency as well, including biting my tongue. (Mind you, there are many attendings, residents, and upperclassmen in my experience who actually know how to approach people in a tactful manner in which case tongue biting won't be necessary.). But this is online *chuckles*. For all I know, none of you are even college graduates. So yes, I WILL speak my mind here and acknowledge that I am an equal adult who deserves likewise respect.
 
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jellybean2020 said:
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.
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No I'd never do that. I know what to say and what not to say. I would never "talk back" to attending or residents because I understand that, in the professional world, not all adults deserve the same respect apparently, albeit it's a shame. I know to even admit fault when there really wasn't fault on my behalf so that perhaps the attending will write a letter of recommendation for me. It's a tough world and I've faced it successfully many times obviously. However, this is online, and the worst consequence for my actions here would be my account being cancelled. Thus, I speak my mind. It was a bit disconcerting how a few of you approached me about this. Maybe you did so because you took my desire to apply for CC residencies in the wrong sense. If you give tactfulness, you're more likely to get it in return. Nevertheless, thank you for the advice.
 
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DedosdelosPies said:
And just because a program sets a minimum doesn't mean that I can't do more, right?
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Individual programs don't set the minimum.... and programs who barely meet their numbers do so because they don't have the volume. So no, you probably can't do more.

Not everyone is meant to be a surgeon. We need heavy volume C&C (that's chip and clip) providers out there as well. Bare minimum effort in residency would be hard to overcome when you get out. Surgery, to be efficient, requires a lot of time with the scalpel (At least that is how I feel/felt). Putting in the bare minimum would likely withhold your career as a hot shot surgeon. Just wait until you get into the OR and start running into complications. An inexperienced surgeon may not know what to do. There have been many times when I have thought to myself "What would I have done if Dr X was not here standing next to me"? These complications are things you run into with high volume programs. Learning to properly deal with a complication is one of the most valuable parts of training under experienced provider(s).

And yes, Lapidus are hard. I have done "a lot" of them (2-3 a week for ~2 years) and still struggle getting them flush with a good IM angle at times.
 
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DedosdelosPies said:
But this is online *chuckles*. For all I know, none of you are even college graduates. So yes, I WILL speak my mind here and acknowledge that I am an equal adult who deserves likewise respect.
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SDN's in a weird zone between real life & internet. Yes it's an online forum, but because you're interacting with people who are your seniors & juniors, you can't quite treat it like you're on Reddit per say. Just remember you may know a lot less of what you're talking about at this stage of your training than others who have been through it. You may feel like you're an 'equal adult' on here, but I can already tell you that some of the statements you've made about the way residencies work make it pretty obvious you're still a student. (ie. that you don't fully understand everything you're talking about). I don't mean any offense; just pointing out some things you're not seeing.
 
In any case, I think we can all agree this thread (for better or worse) has served its purpose. It's time to drop it and move on to new productive discourse.
 
Probably because that poster is an attending who is posting in a student sub forum. And nothing that person has posted has been incorrect or off base.

Who exactly are you? Your very 1st post and personal attacks are what you have to offer? Its easy to be an intenet tough guy, but please troll elsewhere.
 
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Ladies and gentlemen, I have been part of this forum for many years. You want to hear a neat little history lesson?

Once upon a time the podiatry forums had a bunch of other attendings and residents who posted. A couple might have even been forum mods. You wanna know why they slowly left and now the forums here are so quiet and dead? Because of tough guys (mostly students) who, emboldened by the anonymity of the Internet, insulted and drove them off for "daring to come off so high and mighty" on an Internet forum.

You get what you wish for folks. You want a dead forum with premeds and students bumping question threads with no authoritative replies? Keep doing what you're doing. After all we're all equal on here right?
 
Gonna recommend this thread be closed.
 
Excellent points and assumptions have abounded in this thread. As others have said, please keep the discussion respectful.

To comment on the actual (at one point actually interesting) discussion, "Country Club" certainly has a negative connotation when discussing residency programs. Every student has their ideal program and some ideals look very different than others. The same applies to ideal schools or ideal jobs.

As far as internet tough guys, they're everywhere. I would argue that the reasons that there aren't more attendings and residents isn't as simple as them not liking the forum atmosphere. The only moderators that were attendings at the time they were made moderators aren't absent because of this, their accounts were banned. Attendings and residents are busy and have better things to do. Now, attendings don't want to come to an internet forum and offer their advice, only to be met with disdain and disgust, I absolutely agree. All of the forums on SDN have a lot of pre-professional students, some students, a few residents, and very few attendings. It's not just this forum. I'm sure some of it has to do with the internet culture, but it's not as easy as A+B=C.

In other words, discussion is good if it stays respectful. Take or leave the advice you get on here, because SDN can be a great help. It's up to you
 
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Bananaboatsunshine said:
Everything about this post, from the user name to the reply, reeks of arrogance and an over-inflated ego
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Reeks of arrogance and an over inflated ego. Yes, that describes me perfectly, you're very astute.

So now let's dissect my comments:

-I work with excellent residents-------don't see anything arrogant there. So let's move on..
- Some procedures are not popular among attendings, therefore resident exposure is minimal-----don't see anything arrogant there.
-I made comments on why some don't perform procedures because they may not understand the pathology----is that arrogant or reality?
-when I perform a Lapidus it's as if I was performing a miracle surgery and residents come out of the woodwork. I didn't imply it was due to my amazing skills. My point was they often don't get to see many Lapidus procedures.......arrogant? Doesn't seem to be, but hey, I've been wrong before.
-exposure to hands on is sometimes limited because attemdings don't always hand over the blade. Is that also arrogant?
- I don't automatically hand over the blade because patients came to me. Is it arrogant to understand that if given the choice most patients would prefer the attending and not a resident to perform a surgery?
-Is it really arrogant to have a resident earn my trust prior to handing over the blade?
-is it arrogant to state that some residents don't have the skills to give me the confidence to hand over the blade?
-is it arrogant to write that I love to teach AND learn from the residents?
-is it arrogant that I didn't hand over the blade to a resident when performing surgery on an exec at the hospital?

If you answered yes to those questions than our definition of arrogant certainly differs. It's interesting that every post addressed the issues that were originally asked, even if the answers weren't all in agreement, yet your post did nothing but attack me. Something a little fishy there.

I attempted to answer the questions based on my experience. Not sure how the name experienceddpm is arrogant or reeks of an ego. It just signifies that I'm not new in practice. If arrogance was my intention my name would have been amazingdpm, studdpm, supertalenteddpm........
 
jellybean2020 said:
After all we're all equal on here right?
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feel the Bern

jellybean2020 said:
You wanna know why they slowly left and now the forums here are so quiet and dead? Because of tough guys (mostly students) who, emboldened by the anonymity of the Internet, insulted and drove them off for "daring to come off so high and mighty" on an Internet forum.
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Not quite. As ldsrmdude noted, the banhammer was dropped...thankfully.
 
I'm applying to podiatry school for the upcoming cycle, and I must say this thread was a bit overwhelming lol.
 
To the O.P.
I've read a few of these posts, not all. I think I may understand and agree with at least some of where you are coming from. The podiatry profession can consume your life. A well known podiatrist, Alan Jacobs, spoke about this at the 2015 ACFAS conference in Phoenix, AZ. I shared similar feelings even before hearing this talk. There is a popular consensus that you need to learn all you can, and give all you have, to be the best podiatrist that you can be. I understand this, and am so dedicated that I have personally written a 2500 page personal podiatry treatment guide with notes from nearly every lecture I've heard since the second year of pod school. Its on my cell phone, and I can instantly view specific notes on a huge variety of podiatry conditions, on demand. If you see me at a continuing education conference, I am often the only guy in my part of the room who has their laptop out, taking meticulous notes, often trying to hear the lecture over the chatter of nearby attendees. I graduated in the top 1/3 of my class, had above average mcat scores, and have been very dedicated to my profession. I do flatfoot reconstruction cases, lapidus cases, etc. But guess what? I searched for a "country club" program too. I went to a residency that is considered below average, and matched there by choice. But I also spent time outside of the program getting surgical experience that I needed, and I did what I had to do to get what I needed, outside the norm of the program. While my co-residents were chilling at home, I was in the morgue dissecting. The program didn't require 70 hours per week, in fact you could get away with 30 hours per week or less. But I put in about 50 hours per week. As a dedicated adult I didn't need my residency program to motivate me to learn my craft. Nobody could stop me from getting in with plastics, vascular, and more. I showed initiative and got my hands dirty. But if there was a third, fourth, or fifth derma graft night lecture given, while the other residents were there to make a good impression, I knew I had already heard the lecture twice and stayed home with my wife. The reason is that I value my wife, and refuse to allow podiatry to consume my life. My residency program was located at a waterfront hospital in a sunny southern town with an NFL team, a great walkable hip neighborhood, and provided an excellent lifestyle. I did podiatry school at the sunniest, most beautiful campus offered. I'm going to do everything I can to enjoy the ride. Does this mean that I am incompetent, or should have my license pulled, etc.? No, I believe that you can be competent and not do a 70 hour per week residency, not go to every podiatry evening lecture offered, etc. In fact, let me give you some examples. I have worked with a podiatrist who went to a high caliber residency and thought so highly of it that he put "orthopedic surgery" as the specialty on the hospital credentials application (it had to be changed to "podiatry"). This podiatrist recently performed a forefoot slam on a patient who was a noncompliant smoker who arguably didn't need the multiple procedures in the first place. Just because somebody has a foot deformity, you don't need to correct the deformities just because you can. This patient isn't healing, isn't following instructions, etc. This same podiatrist was recently joking with the nurses about an overweight patient, making fun of the patient right outside the patient's room. Mean spirited. What makes you a good podiatrist is often common sense adherence to basics that you can pick up in most residency programs, and that you picked up in pod school, and a responsible approach to your profession. One of the first of these basics is not taking on cases that you aren't qualified to do. I applaud podiatry students who aren't above being a podiatrist, who admit they went to podiatry school, not medical school, and who are happy to do main street bread and butter podiatry work. It seems that everyone wants to be doing complex rear foot cases, but the truth is most of us aren't going to be doing this stuff on a daily basis. Last time I checked the most common condition treated by podiatrists is onychomycosis. I do surgery weekly, but I'm just as happy trimming callouses and warts, because I am, after all, a podiatrist. All of this said, I never used the words "balanced life" our "country club" out loud. I just kept it to myself. To the O.P. - Run YOUR race, be yourself, enjoy the ride.
 
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jellybean2020 said:
SDN's in a weird zone between real life & internet. Yes it's an online forum, but because you're interacting with people who are your seniors & juniors, you can't quite treat it like you're on Reddit per say. Just remember you may know a lot less of what you're talking about at this stage of your training than others who have been through it. You may feel like you're an 'equal adult' on here, but I can already tell you that some of the statements you've made about the way residencies work make it pretty obvious you're still a student. (ie. that you don't fully understand everything you're talking about). I don't mean any offense; just pointing out some things you're not seeing.
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I wasn't THAT harsh, geesh. I believe I made some sound assertions. Different people take different amounts of experience to get comfortable with a said procedure, no? You can graduate from a country club and still land a great practice and cover the vast majority of what a podiatric patient needs, right? Please point out where I was wrong about residencies. And I'm not saying that I'm not wrong about those points, but I'm just not successfully refuted. Finally, I don't believe that education, degrees, income, or even age makes someone superior and more deserving of respect.
 
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Creflo said:
To the O.P.
I've read a few of these posts, not all. I think I may understand and agree with at least some of where you are coming from. The podiatry profession can consume your life. A well known podiatrist, Alan Jacobs, spoke about this at the 2015 ACFAS conference in Phoenix, AZ. I shared similar feelings even before hearing this talk. There is a popular consensus that you need to learn all you can, and give all you have, to be the best podiatrist that you can be. I understand this, and am so dedicated that I have personally written a 2500 page personal podiatry treatment guide with notes from nearly every lecture I've heard since the second year of pod school. Its on my cell phone, and I can instantly view specific notes on a huge variety of podiatry conditions, on demand. If you see me at a continuing education conference, I am often the only guy in my part of the room who has their laptop out, taking meticulous notes, often trying to hear the lecture over the chatter of nearby attendees. I graduated in the top 1/3 of my class, had above average mcat scores, and have been very dedicated to my profession. I do flatfoot reconstruction cases, lapidus cases, etc. But guess what? I searched for a "country club" program too. I went to a residency that is considered below average, and matched there by choice. But I also spent time outside of the program getting surgical experience that I needed, and I did what I had to do to get what I needed, outside the norm of the program. While my co-residents were chilling at home, I was in the morgue dissecting. The program didn't require 70 hours per week, in fact you could get away with 30 hours per week or less. But I put in about 50 hours per week. As a dedicated adult I didn't need my residency program to motivate me to learn my craft. Nobody could stop me from getting in with plastics, vascular, and more. I showed initiative and got my hands dirty. But if there was a third, fourth, or fifth derma graft night lecture given, while the other residents were there to make a good impression, I knew I had already heard the lecture twice and stayed home with my wife. The reason is that I value my wife, and refuse to allow podiatry to consume my life. My residency program was located at a waterfront hospital in a sunny southern town with an NFL team, a great walkable hip neighborhood, and provided an excellent lifestyle. I did podiatry school at the sunniest, most beautiful campus offered. I'm going to do everything I can to enjoy the ride. Does this mean that I am incompetent, or should have my license pulled, etc.? No, I believe that you can be competent and not do a 70 hour per week residency, not go to every podiatry evening lecture offered, etc. In fact, let me give you some examples. I have worked with a podiatrist who went to a high caliber residency and thought so highly of it that he put "orthopedic surgery" as the specialty on the hospital credentials application (it had to be changed to "podiatry"). This podiatrist recently performed a forefoot slam on a patient who was a noncompliant smoker who arguably didn't need the multiple procedures in the first place. Just because somebody has a foot deformity, you don't need to correct the deformities just because you can. This patient isn't healing, isn't following instructions, etc. This same podiatrist was recently joking with the nurses about an overweight patient, making fun of the patient right outside the patient's room. Mean spirited. What makes you a good podiatrist is often common sense adherence to basics that you can pick up in most residency programs, and that you picked up in pod school, and a responsible approach to your profession. One of the first of these basics is not taking on cases that you aren't qualified to do. I applaud podiatry students who aren't above being a podiatrist, who admit they went to podiatry school, not medical school, and who are happy to do main street bread and butter podiatry work. It seems that everyone wants to be doing complex rear foot cases, but the truth is most of us aren't going to be doing this stuff on a daily basis. Last time I checked the most common condition treated by podiatrists is onychomycosis. I do surgery weekly, but I'm just as happy trimming callouses and warts, because I am, after all, a podiatrist. All of this said, I never used the words "balanced life" our "country club" out loud. I just kept it to myself. To the O.P. - Run YOUR race, be yourself, enjoy the ride.
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I agree, I agree. Country clubs are for a particular personality, intense programs are for another. Being in a country club doesn't spell laziness. This is a main point I was trying to make. And you can cover the vast majority of podiatric care coming from a CC. BTW, one would have to keep the term 'country club' to him/herself because others may take it the wrong way. As I said, I know what to say and what not.
 
jellybean2020 said:
Probably because that poster is an attending who is posting in a student sub forum. And nothing that person has posted has been incorrect or off base.

Who exactly are you? Your very 1st post and personal attacks are what you have to offer? Its easy to be an intenet tough guy, but please troll elsewhere.
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I'm not trying to be an Internet tough guy, but I also DO NOT back down or suck up as long as there are no consequences to it I cannot control, such as the case when I'm actually around residents and attendings. I say what's on my mind. I tell it how it is. Again, if ya can't take it, don't respond anymore.
 
dyk343 said:
Individual programs don't set the minimum.... and programs who barely meet their numbers do so because they don't have the volume. So no, you probably can't do more.

Not everyone is meant to be a surgeon. We need heavy volume C&C (that's chip and clip) providers out there as well. Bare minimum effort in residency would be hard to overcome when you get out. Surgery, to be efficient, requires a lot of time with the scalpel (At least that is how I feel/felt). Putting in the bare minimum would likely withhold your career as a hot shot surgeon. Just wait until you get into the OR and start running into complications. An inexperienced surgeon may not know what to do. There have been many times when I have thought to myself "What would I have done if Dr X was not here standing next to me"? These complications are things you run into with high volume programs. Learning to properly deal with a complication is one of the most valuable parts of training under experienced provider(s).

And yes, Lapidus are hard. I have done "a lot" of them (2-3 a week for ~2 years) and still struggle getting them flush with a good IM angle at times.
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You are correct, pertaining to those who actually want to become hot shot surgeons. If someone doesn't want to be such, a CC residency would probably be sufficient for them. At least that's my theory.
 
What year in schooling are you?


You will learn more about what you want in your 4th year and the kind of program you want.
 
DrGonz said:
What year in schooling are you?


You will learn more about what you want in your 4th year and the kind of program you want.
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I think you are right. I am starting my 4th year and I feel like during the next year I am going to find out about what type of program will be right for me.
 
DrGonz said:
What year in schooling are you?


You will learn more about what you want in your 4th year and the kind of program you want.
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Starting fourth year. The intense programs will probably have snappy attendings who will only piss me off rather than help me learn. Sleep deprivation never helped learning or patient care either I bet. I have a laid back personality. I don't care for rear foot and ankle surgery. This is why I'm asking "why would I try an intense program?".
 
DedosdelosPies said:
Starting fourth year. The intense programs will probably have snappy attendings who will only piss me off rather than help me learn. Sleep deprivation never helped learning or patient care either I bet. I have a laid back personality. I don't care for rear foot and ankle surgery. This is why I'm asking "why would I try an intense program?".
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I have been with a few "intense" program attendings and I have really enjoyed being with them. It seems to me that the attendings that are more educated and experienced are a bit more relaxed in the OR and are more willing to teach. Of course, you have to know your stuff when they ask you questions.
 
Most people here have given genuine good advice… I'll go against the sentiment a bit

I myself went through a "country club" program not out of first choice per se but I'm glad everything worked out the way it did. I consider myself well trained but I did put in a lot of extra time in that I wasn't even held responsible for. Much like creflo above, I stayed behind with other dedicated people and worked on cadavers (our limbs were basically left over BKA's for the month - the pathology PA personally sets these aside for us out of his own time which started out through sheer diplomacy). I traveled across town to cover trauma cases with orthopedic residents when I didn't have to. Did a case one time in the middle of a snow storm while everybody else was enjoying the day off and watching football. Covered clinic both ortho and podiatry, majority of it wasn't even mandatory. Those are just examples. Did it help me at all with what I'm doing now? Eh, About 50-50…

In the end, I landed a pretty sweet gig. My salary review is coming up and I'm looking at a big raise.. I've had a very productive start. I don't even do a lot of surgeries but when I do perform surgeries I do all kinds of stuff, even Lapidus....surgery isn't rocket science but there are certain ingredients that will make u successful. You need good hands, you need to make the correct decision, you need to do your homework, and you need to know your limit.

And there is money to be made with onychomycosis. There is a senior colleague in our group who does the least amount of surgeries and clips the most nails…..people make snide remarks about on a daily basis yet he makes way more than all of us. Ive seen his RVU’s. He brings in even more than some of the orthopedic surgeons in our group.

Knowing yourself is the key. Nobody knows you more than yourself. Good luck.
 
streetsweeper said:
Most people here have given genuine good advice… I'll go against the sentiment a bit

I myself went through a "country club" program not out of first choice per se but I'm glad everything worked out the way it did. I consider myself well trained but I did put in a lot of extra time in that I wasn't even held responsible for. Much like creflo above, I stayed behind with other dedicated people and worked on cadavers (our limbs were basically left over BKA's for the month - the pathology PA personally sets these aside for us out of his own time which started out through sheer diplomacy). I traveled across town to cover trauma cases with orthopedic residents when I didn't have to. Did a case one time in the middle of a snow storm while everybody else was enjoying the day off and watching football. Covered clinic both ortho and podiatry, majority of it wasn't even mandatory. Those are just examples. Did it help me at all with what I'm doing now? Eh, About 50-50…

In the end, I landed a pretty sweet gig. My salary review is coming up and I'm looking at a big raise.. I've had a very productive start. I don't even do a lot of surgeries but when I do perform surgeries I do all kinds of stuff, even Lapidus....surgery isn't rocket science but there are certain ingredients that will make u successful. You need good hands, you need to make the correct decision, you need to do your homework, and you need to know your limit.

And there is money to be made with onychomycosis. There is a senior colleague in our group who does the least amount of surgeries and clips the most nails…..people make snide remarks about on a daily basis yet he makes way more than all of us. Ive seen his RVU’s. He brings in even more than some of the orthopedic surgeons in our group.

Knowing yourself is the key. Nobody knows you more than yourself. Good luck.
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You basically confirm my thoughts. Although you did a country club program (which wasn't your first choice), you also took the initiative to stay longer, cover trauma at another facility, etc. That initiative is a recipe for success.

You are also correct that surgery isn't necessarily the ticket to wealth. You can make money clipping and chipping for several reasons. Number one, palliative patients don't get better, they keep returning every 9-12 weeks for care. Number two is that they are simple patients who don't require a lot of time, so you can realistically see 6-8 palliative care patients an hour. Number 3 is that most EHR systems will allow you to basically repeat the prior palliative care note or it takes minimal time to update vascular exams, neuro exams, PMH, PSH, and it is much less time consuming regarding the computer than having to create a note from scratch when treating a new patient or complicated patient.

Although I certainly perform palliative care and don't mind it, I would not want to have a strictly palliative practice despite the earning potential. I personally would be very frustrated and find it unrewarding that I spent 4 years in college, 4 years obtaining my DPM, finishing a residency, obtained ABFAS certification all to be a glorified nail technician. Again, I don't mind performing palliative care, it's just not what I want to do all day after the education I received.

For those who are performing palliative care all day, they will either be glad or sad in the near future. Medicine IS changing and it depends on how it plays out. Scenario number one has the government saving money and having nurse practitioners and others performing these palliative services. The DPM will be more of a surgical specialty. The other model is the opposite. It wants the most bang for the buck. It will have orthopods performing all musculoskeletal procedures, including the foot and ankle so it's one stop shopping, since the DPM can only work on the foot and ankle.

In that model, DPMs will perform palliative care, aches, sprains, etc., but not much surgery. In addition, the government will likely decrease payments for elective surgery and the majority of podiatric cases are elective.

Payment will be based on outcomes. So if it takes me 6 visits to resolve a patient's heel pain, at a cost of $2,000, and it takes you 4 visits at a cost of $900, you win. It's no longer going to be the more you do, the more you bill, the more you make. It will all be bases on efficiency and outcomes.

Therefore, the more well rounded you are, the more prepared you'll be when changes happen. And they ARE going to happen.
 
We need TFPs (just not the ones doing in office bunions under local without fixation), and to those of you who desire nothing more than that...I salute you

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Yes, until the young have to make a career
 
I've heard a few of the Detroit programs are pretty laid back (Not DMC), and teach you how to bill and code (translation: how to make $), so this sounds like a decent choice for the OP. Avoid "high power" programs like Inova, UPMC, DeKalb, Swedish, Kaiser, etc. Would almost be better to take a look at the "high powered residencies" thread, and just avoid all the programs that are in bold, because while the training is generally great, the hours are generally atrocious.

Yes, you certainly should learn a lot from a high numbers guy like Jack Shuberth, but that doesn't mean that everyone would want to work with him. That's just an example, I'm not criticizing him in particular, but every big program has their stern or "high-powered" attending, so you can substitute many different names for his and get the point.

I don't understand ragging on the guy for not wanting a miserable residency. There are a lot of decent programs that aren't 9-5, but are 7-3 (cases normally start @ 0730). You do elective outpatient cases all morning, and then you go home. This is actually more common than you think, especially during one's 3rd year. A few of my buddies admitted to this, but most won't because they equate long hours with good training, which is not necessarily the case. Now a lesser program might limit your capabilities and potentially the practice opportunities down the line, but if it's something he/she is not interested in, then why hate life for 3 years.

And also let's be honest, in many areas (yes mine), ortho is the first thought for surgery and trauma, and we get sent bunions and fungus. This is very geography dependent, but speaking from experience, ortho is very dominant in some areas. They have actually narrowed the Podiatric scope of practice at one hospital to exclude TAR and soft tissue leg surgery (e.g. Gastroc recession). So while my great training helped me land my job, I don't use it on a regular basis (private practice in a region dominated by multi-specialty groups). It's nice to have, and I've gotten to do a handful of cool recon cases, but for the most part it's regular podiatry that literally anyone from any program across the country could do. I am not a special and unique snowflake, and you don't have to be to effectively work MOST (not all) Podiatry jobs.
 
Pronation said:
Proper bunion fixation is crucial.

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If my post op patient's X-rays looked like that I'd be changing my underwear. Yes, the hallux is straighter and the bump is gone, but displacing the met head that much is just waiting for an AVN. And if you believe the NEW bony prominence that's created at the medial aspect of the metatarsal shaft isn't going to cause discomfort, then I've got some land I'd like to sell you. Look closely at the post op 8 week X-ray vs the pre op film. The head is already showing deceased density.

I would personally be embarrassed to post those films.
 
streetsweeper said:
Most people here have given genuine good advice… I'll go against the sentiment a bit

I myself went through a "country club" program not out of first choice per se but I'm glad everything worked out the way it did. I consider myself well trained but I did put in a lot of extra time in that I wasn't even held responsible for. Much like creflo above, I stayed behind with other dedicated people and worked on cadavers (our limbs were basically left over BKA's for the month - the pathology PA personally sets these aside for us out of his own time which started out through sheer diplomacy). I traveled across town to cover trauma cases with orthopedic residents when I didn't have to. Did a case one time in the middle of a snow storm while everybody else was enjoying the day off and watching football. Covered clinic both ortho and podiatry, majority of it wasn't even mandatory. Those are just examples. Did it help me at all with what I'm doing now? Eh, About 50-50…

In the end, I landed a pretty sweet gig. My salary review is coming up and I'm looking at a big raise.. I've had a very productive start. I don't even do a lot of surgeries but when I do perform surgeries I do all kinds of stuff, even Lapidus....surgery isn't rocket science but there are certain ingredients that will make u successful. You need good hands, you need to make the correct decision, you need to do your homework, and you need to know your limit.

And there is money to be made with onychomycosis. There is a senior colleague in our group who does the least amount of surgeries and clips the most nails…..people make snide remarks about on a daily basis yet he makes way more than all of us. Ive seen his RVU’s. He brings in even more than some of the orthopedic surgeons in our group.

Knowing yourself is the key. Nobody knows you more than yourself. Good luck.
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You're absolutely right about knowing yourself. And knowing what you want is extremely important too if you ask me.
 
g squared 23 said:
I've heard a few of the Detroit programs are pretty laid back (Not DMC), and teach you how to bill and code (translation: how to make $), so this sounds like a decent choice for the OP. Avoid "high power" programs like Inova, UPMC, DeKalb, Swedish, Kaiser, etc. Would almost be better to take a look at the "high powered residencies" thread, and just avoid all the programs that are in bold, because while the training is generally great, the hours are generally atrocious.

Yes, you certainly should learn a lot from a high numbers guy like Jack Shuberth, but that doesn't mean that everyone would want to work with him. That's just an example, I'm not criticizing him in particular, but every big program has their stern or "high-powered" attending, so you can substitute many different names for his and get the point.

I don't understand ragging on the guy for not wanting a miserable residency. There are a lot of decent programs that aren't 9-5, but are 7-3 (cases normally start @ 0730). You do elective outpatient cases all morning, and then you go home. This is actually more common than you think, especially during one's 3rd year. A few of my buddies admitted to this, but most won't because they equate long hours with good training, which is not necessarily the case. Now a lesser program might limit your capabilities and potentially the practice opportunities down the line, but if it's something he/she is not interested in, then why hate life for 3 years.

And also let's be honest, in many areas (yes mine), ortho is the first thought for surgery and trauma, and we get sent bunions and fungus. This is very geography dependent, but speaking from experience, ortho is very dominant in some areas. They have actually narrowed the Podiatric scope of practice at one hospital to exclude TAR and soft tissue leg surgery (e.g. Gastroc recession). So while my great training helped me land my job, I don't use it on a regular basis (private practice in a region dominated by multi-specialty groups). It's nice to have, and I've gotten to do a handful of cool recon cases, but for the most part it's regular podiatry that literally anyone from any program across the country could do. I am not a special and unique snowflake, and you don't have to be to effectively work MOST (not all) Podiatry jobs.
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I'm glad someone gets it!!!!:soexcited::clap:
 
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