Current state of podiatry fellowships...

[air bud]

Attached is the new list of approved and awaiting approval ACFAS fellowships. My personal opinion is that fellowships are only necessary for a very very very small percentage of residents that will open very unique career opportunities. More and more hospital/MSG jobs are being opened and even more are being filled - and it basically doesn't matter at this point if you have a fellowship or not to them. Ortho jobs are essentially non-existent as more and more well trained foot and ankle surgery is being done by them and you are not of value to them ie you can't take call and they need somebody who can split call. There is a big difference to them of 4:1 and 5:1. Another year of 300k loans at 6.8% (you better refinance ASAP). So 200k salary, 18k 401k contribution on your end, another 18k on their end, 7.5k HSA contibution on your end lost and another 20k of interest added.

For what?

Check out the new fellowship in Salt Lake City. Maybe they just did a poor job in detailing per the ACFAS website, but they offer

• "This program will augment the abilities of an already skilled surgeon and give them confidence to perform foot and rear foot advanced reconstructive surgery efficiently and effectively."

It says ankle in the program name.....

All these people are realizing they can hire fellow (see associate) at 60k a year, have them see their post-ops and see all new medicaid (oh wow you can count those towards boards if you are the surgeon of record).

The ACFAS fellowship is becoming a joke. There is no exclusivity to it. It is being watered down.

If you are not going to become a heavy hitter on the ACFAS/ABFAS/Lecture/Consultant circuit (this assumes you are an alpha male), then this is going to add minimally to your job outlook other than any in-network associations you may develop (I know many fellows who banked on this only to come away empty-handed). So yes, you may have advanced your training - but if I am applying for hospital job with 3+ years of experience and already ABFAS certified and you are a new grad with fellowship and ABFAS qualified - I am getting the job 9/10 over you.

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[air bud]

Lets not forget the cannibalization of residency programs that is occurring. I would bet that the vast majority of attendings associated with fellowship programs are also associated with residency programs. There is invariably friction between the fellow and the residents. Fellow does more=residents do less. So you are sacrificing 3-4 3rd year residents training per year for 1 fellow, which then has trickle down effects.

 

[air bud]

Last year there was a real bad trend of DPMs posting positions for fellowships on PM news that were not accredited by ACFAS. ACFAS refused to do anything about it. Right there that hurts the ACFAS fellowships.

Pearls for choosing fellowships:
- No affiliation with residency programs
- Director publishes research and lectures...considered a leader of our profession (if you have never heard of the guy/gal don't do the fellowship)
- Only do a fellowship to pick up a NEW skill (total ankle replacement, muscle flaps recon, complex ex-fix/charcot

- Do a fellowship if you are going to see/own patients. Do not do a fellowship to see the director's post-ops when he/she sees new patients. Clinical eval and understanding WHY you need to do surgery is best thing you can get out of this. FOLLOW UP of your surgical patients is the best thing you can get out of this. Being a robot and pumping out surgeries builds confidence but how you do know what you are doing actually works if you don't follow up with patient?

Getting a new hospital DPM position will only waste your fellowship training. It will take awhile for the hospital to warm up to the idea of your huge reconstructions. They may not be ready for that. You really need to have the support from the orthopedic department to pull that off. If they say no then you are screwed.

If you are fellowship trained and you want to go hospital I recommend getting your role within the hospital clearly defined in your contract. What surgical procedures can you do? What procedures can't you do? Leaving things vague or allowing vague language to be entered into the contract makes it harder for your lawyer to break it down if you were to file a lawsuit against the hospital in future for blocking you from doing cases you are trained to do or legally allowed to do based on the state scope.

I agree. I think fellowship can better prepare your for private practice. There at least if you can get them in the door, they are yours. In a hospital or group you have to worry about them being weeded out before ever seeing you.

 

[feet2017]

Thanks for posting prospectives from working pods. As a current resident it's been an internal struggle to decide whether to do one or not. Some of my attendings tell me to do it because it is just one year and it adds to your CV, so it is essentially a marketing tool. At the same time I think to myself when you are doing a fellowship in podiatry you are still just a podiatrist with the same exact scope, so what's the point. Where as in other medical specialities there is an actually reason for doing fellowship, for example you go from an internist to a nephrologist.

From what you all are saying a fellowship isn't much of a marketing tool for getting that extra edge in the job search.

 

[air bud]

Thanks for posting prospectives from working pods. As a current resident it's been an internal struggle to decide whether to do one or not. Some of my attendings tell me to do it because it is just one year and it adds to your CV, so it is essentially a marketing tool. At the same time I think to myself when you are doing a fellowship in podiatry you are still just a podiatrist with the same exact scope, so what's the point. Where as in other medical specialities there is an actually reason for doing fellowship, for example you go from an internist to a nephrologist.

From what you all are saying a fellowship isn't much of a marketing tool for getting that extra edge in the job search.

I looked at fellowships, obviously I didn't get one (I would have had one but I hadn't taken part 3 boards yet and they couldn't risk accepting me a month before I took part 3....turns out best thing that could have happened). I can count on 1 hand how many cases in 1.5 years that I may have tackled that I didn't because residency didn't give me as much exposure as I wanted to feel comfortable doing. Again, I know numerous people who have done fellowships and will be the first to say that it did nothing monumental for their job search. If you think you are getting inadequate training in residency, or don't feel like you are prepared for the real world - RELAX - you are fine, its normal - the real world is scary. If you KNOW you didn't get good training, then maybe try and do a fellowship (unless part of the select few mentioned below...).

Another thing to consider: its a good old boys club. There are only a few fellowships that are truly unique that provide extraordinary training. Guess what - if you THINK you might want to apply to one of those - ITS TOO LATE you have no chance of getting it. The people who get Hyer, Brigido, Cottom etc are told to do those fellowships by their directors because they have a personal relationship with them (and they are studs - on and off paper - they get it because they deserve it). Its like in college football - if you want to be the quarterback at USC - you go to De La Salle high school. You don't end up being the QB at USC by going to middle of nowhere in Kansas high school. Then there is the 2nd and 3rd tier fellowships. Unfortunately there is now going to be 4th and 5th....is that worth it if you ended up with 1000+ cases, 50 ankle fractures, 20 ankle fusions/TARS, 50 RF fusions, 100 lapidus....NO.

If you think you are going to become a consultant for stryker, Arthrex etc - wrong again - you have to go to one of the powerhouse programs.

If you think you are going to have anything handed to you because you are fellowship trained - wrong again (most likely).

 

[air bud]

At the same time I think to myself when you are doing a fellowship in podiatry you are still just a podiatrist with the same exact scope, so what's the point. Where as in other medical specialities there is an actually reason for doing fellowship, for example you go from an internist to a nephrologist.
/QUOTE]

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[pacpod]

I agree with a lot of these statements as someone who is doing a fellowship. Many that apply to me - research under a published/known attending(s), picking up new skills, owning the patients, specialized desire in my career, etc.

If you want to do a fellowship you need to be able to voice concrete reasons why. It is a year missed out on attending work/salary/boards numbers if you aren’t surgeon of record. I’m not knocking it as I’m doing one but a word of caution - know why you want to do one. As with anything in life, weigh your options.

 

[ExperiencedDPM]

I think one of the advantages of a fellowship is that it is almost expected in the MD world. If you are looking for a job with a MSG or Ortho group, many of these MDs have never heard of many of the hospitals that have Podiatric residency programs. In my experience, and when talking to orthopedic surgeons, they are often impressed with “name recognition”. For example, many DPMs don’t believe the Podiatric residency programs at Yale or Harvard are the cream of the crop. But to an MD group in Iowa, all they see is that this DPM did his/her residency at Harvard, Yale, etc. These MDs don’t know whether it’s a top program or midlevel, etc.

Similarly, most MDs do a fellowship. I don’t know of any specialist who graduated in the past 15 years who hasn’t done a fellowship. In Ortho, it’s often hand, joint replacement, spine, etc. So to the MD community it’s almost standard. I’m on Credentialing committees at a few facilities and I see the applications. All these docs have fellowships.

So in my opinion, having a fellowship makes you more mainstream to these MDs since it’s really the norm for them.

This isn’t to say I believe the training is better or it’s mandatory. I’m saying you have to see it in the perspective of the potential employer.

Ironic about thr comment regarding Hyer’s fellowship. I was at a seminar and there was a doc there who was asking the most *****ic questions and was a true buffoon. Ends up this doc did Hyer’s fellowship. If you lined up 100 people, including 20 who were homeless and downtrodden, I would have picked them over this doc.

He talked like an a-hole, he acted like an a-hole, he looked and dressed like a slob and his questions were all *****ic and all his questions were based on fraudulent billing and unnecessary surgery.

I’m “assuming” this guy is the rare exception and not the rule. I can’t even imagine how he was picked after any interview process.

 

[air bud]

I think one of the advantages of a fellowship is that it is almost expected in the MD world. If you are looking for a job with a MSG or Ortho group, many of these MDs have never heard of many of the hospitals that have Podiatric residency programs. In my experience, and when talking to orthopedic surgeons, they are often impressed with “name recognition”. For example, many DPMs don’t believe the Podiatric residency programs at Yale or Harvard are the cream of the crop. But to an MD group in Iowa, all they see is that this DPM did his/her residency at Harvard, Yale, etc. These MDs don’t know whether it’s a top program or midlevel, etc.

Similarly, most MDs do a fellowship. I don’t know of any specialist who graduated in the past 15 years who hasn’t done a fellowship. In Ortho, it’s often hand, joint replacement, spine, etc. So to the MD community it’s almost standard. I’m on Credentialing committees at a few facilities and I see the applications. All these docs have fellowships.

So in my opinion, having a fellowship makes you more mainstream to these MDs since it’s really the norm for them.

This isn’t to say I believe the training is better or it’s mandatory. I’m saying you have to see it in the perspective of the potential employer.

Ironic about thr comment regarding Hyer’s fellowship. I was at a seminar and there was a doc there who was asking the most *****ic questions and was a true buffoon. Ends up this doc did Hyer’s fellowship. If you lined up 100 people, including 20 who were homeless and downtrodden, I would have picked them over this doc.

He talked like an a-hole, he acted like an a-hole, he looked and dressed like a slob and his questions were all *****ic and all his questions were based on fraudulent billing and unnecessary surgery.

I’m “assuming” this guy is the rare exception and not the rule. I can’t even imagine how he was picked after any interview process.

Yeah, we get it. That's how a lot of us rationalize doing a fellowship when first starting to look into them. Then we get to the real world and realize it STILL doesn't matter if you are fellowship trained, because you are still just a podiatrist. And again, there is only more and more F&A ortho coming out now taking those positions in ortho groups that pods used to fill for a few good years

As far as your comments about the fellow, I am sure it was not one of my friends. He is a great guy, polite, respectful. But as a general rule its a short walk between that program's teaching and your good buddy Weil's program's teaching....

 

[ExperiencedDPM]

Yeah, we get it. That's how a lot of us rationalize doing a fellowship when first starting to look into them. Then we get to the real world and realize it STILL doesn't matter if you are fellowship trained, because you are still just a podiatrist. And again, there is only more and more F&A ortho coming out now taking those positions in ortho groups that pods used to fill for a few good years

As far as your comments about the fellow, I am sure it was not one of my friends. He is a great guy, polite, respectful. But as a general rule its a short walk between that program's teaching and your good buddy Weil's program's teaching....

Please......don’t get me started on the entire FABI tbing. He’s “discovered” these secret modifiers as if no one knew they existed. Now for a hefty fee, you can learn how to attempt to abuse the system with these modifiers.

Pitiful.

And I’m sure the guy I met who did the fellowship with Hyer isn’t the friend you mentioned. I can’t imagine the guy I met actually has any friends.

 

[diabeticfootdr]

Fellowships can be valuable for certain people. I used mine as a year to do research and publish. I was given opportunities I wouldn’t have otherwise received. Afterwards, the fellowship (and fruits of my labors, papers, books, lectures) all helped me get the job I wanted.

Reasons to do a fellowship:
1. If you’re interested in academics and want a sabbatical year to write and publish
2. To do research
3. To spend time with a mentor
4. To make yourself a more attractive hire (sometimes)

Reasons not to do a fellowship:
1. To learn how to do surgery (a 3 year PMS residency should be plenty)
2. Can’t find a job
3. Scared to practice without a safety net

Also, ACFAS has no real authority to accredit fellowships. Only CPME can do that, but they haven’t made it a priority yet. Most DPM fellowships are unaccredited, but that doesn’t mean they are without value. I’d mostly consider who the fellowship director is and who the sponsoring institution is.


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[OlderGeorgiaPreMed]

Since I am still pre-podiatry (have an interview with Kent State in February) I apologize up front if this is a "dumb" question or anything (I simply don't know).

In the opinion of the people on this board, do you think fellowship training would be better (for lack of a better word, I guess) if it led to some sort of extra, useful, qualification and scope? For example, suppose there was a fellowship that dealt specifically with lower-extremity vascular surgery, and allowed the graduate to obtain board certification in podiatric vascular surgery. Do you think this would be more useful than the current style of most podiatric fellowships? Now, I'm not saying that this "fellowship-trained, board-certified, podiatric vascular surgeon" would have enough patient load to ONLY be a podiatric vascular surgeon, but I'm just using this as an example (and there may already be people who do this - again, I'm still a pre-pod). I'm also not saying this would be accepted with open-arms by the MD/DO vascular surgery community either.

This thought just came to mind because that is essentially what fellowships are for on the MD/DO front. They don't always change the MD/DOs title either. For example, an ER Physician who undertakes an EMS Fellowship is still an ER Physician after finishing. They just have more experience with pre-hospital care, and managing EMS providers in the field (supposedly, at least). Here, also, the fellowship isn't required to be an EMS Medical Director either, so, I guess, the person there has to decide if that fellowship is worth it for them or not. But either way, this still adds information to what they learned in residency. In other words, they don't go from a three year Emergency Medicine Residency into a one-year Emergency Medicine Fellowship where they just get "more experience" doing the exact same things they did in residency (which seems to be a complaint about many podiatric fellowships).

If this is the case, do you think the podiatric professional bodies (CPME, APMA, etc.) need to do more to encourage the formation of these types of fellowships?

Thanks for your answers, and I apologize, again, if this seems dumb (or if its a horse that has been beaten far past death already).

 

[jehjr]

How far do you take subspecialization before you decide that it’s absurd? Yes, if fellowship bestowed some otherwise unobtainable skill set it would be more desireable, and vascular surgery is a fine example of a new skill. That said, the vascular surgery kitchen arguably has too many cooks as it is, none of whom have the anatomic limitations that we do.

It’s good to try and better yourself, but you also need to realize what you signed up for and own it. If you want to do a fellowship, ask yourself why. Then consider whether the fellowship will actually get you there.

 

[OlderGeorgiaPreMed]

How far do you take subspecialization before you decide that it’s absurd? Yes, if fellowship bestowed some otherwise unobtainable skill set it would be more desireable, and vascular surgery is a fine example of a new skill. That said, the vascular surgery kitchen arguably has too many cooks as it is, none of whom have the anatomic limitations that we do.

It’s good to try and better yourself, but you also need to realize what you signed up for and own it. If you want to do a fellowship, ask yourself why. Then consider whether the fellowship will actually get you there.

The vascular example, as I say, was just one that I pulled out of the air, but I completely understand, and recognize, your point about it.

Personally, I think medicine in general could get to the point where some subspecialize themselves out of existence (if that makes sense). I know, for instance, of a family physician who wants to practice only "preventative medicine" to the extent that she refuses to see any patients with chronic conditions as well as any patients with acute conditions either. All she really sees people for are basically "wellness checks", and she refers them out for everything else (or outright drops them from the practice if they develop a chronic condition). If she didn't have another source of income as well (she is a medical director for a clinic also), I don't think her model would be financially realistic. That is probably a very extreme example, but I think you know what I mean over all.

Thanks for your reply and insight!

 

[ExperiencedDPM]

The vascular example, as I say, was just one that I pulled out of the air, but I completely understand, and recognize, your point about it.

Personally, I think medicine in general could get to the point where some subspecialize themselves out of existence (if that makes sense). I know, for instance, of a family physician who wants to practice only "preventative medicine" to the extent that she refuses to see any patients with chronic conditions as well as any patients with acute conditions either. All she really sees people for are basically "wellness checks", and she refers them out for everything else (or outright drops them from the practice if they develop a chronic condition). If she didn't have another source of income as well (she is a medical director for a clinic also), I don't think her model would be financially realistic. That is probably a very extreme example, but I think you know what I mean over all.

Thanks for your reply and insight!

That’s why they say that with all the evolving specialties, the GPs know less and less about more and more and the subspecialist knows more and more about less and less.

 

[hematosis]

I visited the top 5 ACFAS fellowships and I wasn't impressed with any of them (most of them are just looking for free labor) so i went and did one in europe. I operated everyday. In the end, I did about 1000 cases. I got really good at total ankles, pilons, frames, etc

I do 0 pilons now and 0 TARs. They go to ortho. I don't plan on doing these anytime soon--even if given the chance. So for me, it was a waste of 1 year salary ( about 250k ish).

oh and what really annoys me is when i see these guys writing "FELLOWSHIP TRAINED PODIATRIST." That just makes our profession look stupid. How many ortho's are writing that on their linkedin profile?

 

[OlderGeorgiaPreMed]

oh and what really annoys me is when i see these guys writing "FELLOWSHIP TRAINED PODIATRIST." That just makes our profession look stupid. How many ortho's are writing that on their linkedin profile?

I guess this depends on the part of the country or the size of the area because around where I live there are quite a few MDs/DOs, orthos and otherwise, who advertise themselves as "Fellowship Trained" (a local "shoulder specialist" ortho advertises as "fellowship trained", or at least used to the last time I saw any of his material). I'm even aware of a couple of cardiologists who do this, or at least did, and you have to fellowship to be a cardiologist. I've also seen some bios for PAs state "Residency Trained" (I guess since PAs don't have to undergo residency) and there are quite a lot of DVMs who advertise as "Residency Trained" (again, residency is not required for DVMs, and DVMs are often paid very low during these residencies). My point here being this phenomenon is not limited to just podiatrists.

My perspective on this from the outside looking in is that, at least in my area, these people do this because they think it makes the public think higher of them (and thus more likely to visit their practice versus the guy across town who doesn't use this fancy sounding wording). Also, at least on group practice websites, handout, etc., the decision to list this might be one made by the practice manager or marketing firm. For example, a friend of mine and his wife are both MDs, and both completed fellowships. She is a pediatrician who completed a fellowship in ambulatory pediatrics after residency (which she did so she could more easily stay in the same area as him while he was still finishing up his residency). She now works for a pediatrics practice outside of Atlanta, and her bio makes mention of the fact that she is "fellowship trained". This wasn't her decision to emphasize this, though. The decision came from the marketing people for the practice. They said emphasizing extra training like this has been shown to have an influence on bringing in more patients. Now, of course, a LinkedIn profile is a different ballgame, but my point is at least some of these people might do this because they have been told it will help with marketing. It may look dumb to people in the know, but a less informed public sees it as an extra accomplishment which, in many people's minds, equals more competency whether this is the case or not.

Again, just my two-cents worth looking in from the outside.

 

[OlderGeorgiaPreMed]

That said, the vascular surgery kitchen arguably has too many cooks as it is, none of whom have the anatomic limitations that we do.

I actually heard from an MD after you wrote this (and I wrote my post above) who said that some vascular surgeons are already afraid that their field is becoming oversaturated. At least according to this guy, some of what vascular surgeons used to do is now being done by other surgeons and/or allied fields like Surgical Assistant in certain cases. I'm not familiar with specifics, but I thought this was interesting, and relevant, given your response above.

 

[mimelim]

I actually heard from an MD after you wrote this (and I wrote my post above) who said that some vascular surgeons are already afraid that their field is becoming oversaturated. At least according to this guy, some of what vascular surgeons used to do is now being done by other surgeons and/or allied fields like Surgical Assistant in certain cases. I'm not familiar with specifics, but I thought this was interesting, and relevant, given your response above.

I'll just say this simply and bluntly so the message is unambiguous. "This guy" that you refer to knows nothing about the current state of vascular surgery or the economics behind the field. Vascular surgery is one of the least saturated specialties in the US. There are approximately 6-8 jobs per graduate on the market right now. Every RRC meeting and APDVS meeting is about how do we increase our trainee numbers by 30-40% over the next 20 years to meet the increasing vascular disease burden.

Beyond that and more directly, name one procedure being performed by other surgeons or allied health practitioners that is new. I live in the vascular world. I can certainly see complaints about IR, IC or IN, but other surgeons or surgical assists (that can't bill independently)? I'm sorry, but this person is clearly just rabble rousing and/or making **** up.

 

[ExperiencedDPM]

I actually heard from an MD after you wrote this (and I wrote my post above) who said that some vascular surgeons are already afraid that their field is becoming oversaturated. At least according to this guy, some of what vascular surgeons used to do is now being done by other surgeons and/or allied fields like Surgical Assistant in certain cases. I'm not familiar with specifics, but I thought this was interesting, and relevant, given your response above.

Sorry, don’t agree at all. I work with vascular surgeons almost daily. I’m at a university hospital with vascular fellows. There are no other surgeons doing what they do, and certainly no ancillary providers. There is some crossover with interventional cardiology and interventional radiology. But the vascular are in the trenches and work some crazy hours. Not to mention the length of time of some of their cases.

In our hospital the general surgeons and orthopedic surgeons rarely perform amps and vascular is so busy they are happy to send us every amp we are allowed to perform by law. If my scope allowed me to perform BK amps, vascular would send them to me. The vascular at our hospital certainly are busy enough to not seem to worry about any dilution of their cases or of any saturation.

The vascular docs I know work long hours and work hard, and with the exception of one douchebag, they are the most pleasant specialty I deal with daily.

No DPM is going to specialize in “vascular”. To perform vascular surgery you must be able and ready to expect complications above and beyond the local area of the foot and ankle.

 

[mimelim]

Sorry, don’t agree at all. I work with vascular surgeons almost daily. I’m at a university hospital with vascular fellows. There are no other surgeons doing what they do, and certainly no ancillary providers. There is some crossover with interventional cardiology and interventional radiology. But the vascular are in the trenches and work some crazy hours. Not to mention the length of time of some of their cases.

In our hospital the general surgeons and orthopedic surgeons rarely perform amps and vascular is so busy they are happy to send us every amp we are allowed to perform by law. If my scope allowed me to perform BK amps, vascular would send them to me. The vascular at our hospital certainly are busy enough to not seem to worry about any dilution of their cases or of any saturation.

The vascular docs I know work long hours and work hard, and with the exception of one douchebag, they are the most pleasant specialty I deal with daily.

No DPM is going to specialize in “vascular”. To perform vascular surgery you must be able and ready to expect complications above and beyond the local area of the foot and ankle.

When you can do BKAs or even AKAs give me a call, you can have every single last one of them. I actually enjoy doing them, especially with junior residents, at least from an operative standpoint, but I have no need for them to be on my schedule.

 

[ExperiencedDPM]

When you can do BKAs or even AKAs give me a call, you can have every single last one of them. I actually enjoy doing them, especially with junior residents, at least from an operative standpoint, but I have no need for them to be on my schedule.

That’s exactly how the vascular surgeons feel where I work. That’s why I wrote that if my scope allowed BK amps, they would send them all day long.

 

[OlderGeorgiaPreMed]

Sorry, don’t agree at all. I work with vascular surgeons almost daily. I’m at a university hospital with vascular fellows. There are no other surgeons doing what they do, and certainly no ancillary providers. There is some crossover with interventional cardiology and interventional radiology. But the vascular are in the trenches and work some crazy hours. Not to mention the length of time of some of their cases.

In our hospital the general surgeons and orthopedic surgeons rarely perform amps and vascular is so busy they are happy to send us every amp we are allowed to perform by law. If my scope allowed me to perform BK amps, vascular would send them to me. The vascular at our hospital certainly are busy enough to not seem to worry about any dilution of their cases or of any saturation.

The vascular docs I know work long hours and work hard, and with the exception of one douchebag, they are the most pleasant specialty I deal with daily.

No DPM is going to specialize in “vascular”. To perform vascular surgery you must be able and ready to expect complications above and beyond the local area of the foot and ankle.

Like I say, my information came from an MD practicing in the Chattanooga, TN area based on discussions he has had with vascular surgeons in this area apparently. I, personally, have no axe to grind in the matter one way or another. And, again, my mention to vascular surgery in my question above was just an out of the blue example (in other words, I didn't pick vascular because I thought there was some need there for podiatrists to fill missing slots). As it turns out it was a bad choice of example, but then I bet anything I picked here would have had people coming out of the wood work to defend that field. My initial question was basically this: "what would need to happen for podiatry fellowships to be more worth it for podiatrists".

Most certainly not trying to step on anyone's toes at all here.

 

[OlderGeorgiaPreMed]

I'll just say this simply and bluntly so the message is unambiguous. "This guy" that you refer to knows nothing about the current state of vascular surgery or the economics behind the field. Vascular surgery is one of the least saturated specialties in the US. There are approximately 6-8 jobs per graduate on the market right now. Every RRC meeting and APDVS meeting is about how do we increase our trainee numbers by 30-40% over the next 20 years to meet the increasing vascular disease burden.

Beyond that and more directly, name one procedure being performed by other surgeons or allied health practitioners that is new. I live in the vascular world. I can certainly see complaints about IR, IC or IN, but other surgeons or surgical assists (that can't bill independently)? I'm sorry, but this person is clearly just rabble rousing and/or making **** up.

You would definitely know more about it than me. This MD practices in the Chattanooga TN area, and this was apparently based on discussions with vascular surgeons in that area (at least that's what I got from his comment). It is possible he was just trying to "rabble rouse", but that most certainly wasn't my intention.

I have encountered some physicians, quite a few on boards like this it appears too if you read the posts enough, who downplay other specialties, and it is possible that this person was doing the same (but he came across as sincere, and maybe he was just repeating what he had heard too I don't know).

Other markets must have the same feeling as well though based on a comment above, that I was responding to actually, that said "the vascular surgery kitchen already has too many cooks as it is". This appears, then, that at least someone else thinks the field isn't facing a shortage, but, again, as a vascular surgeon yourself you'd know better than others.

Anyway, I can assure you I wasn't trying to step on anyone's toes here at all.

As I said above, I am still a pre-med/pre-pod, and, again, my intent wasn't to upset anyone at all.

 

[OlderGeorgiaPreMed]

Oldergeorgiapremed is pre -pod. While he/she may be older and have some experience in the medical field, he/she is still a prepod and has no idea what he/she is talking about in regards to professional podiatry. Thus the reason for separate forums based on experience...so let's listen to the vascular surgeon who was kind enough to jump in. And disregard the prepod.

Sorry for getting involved. I meant no harm at all. I was only curious about what would make fellowships more worthwhile for those who were considering them since if I do get into school I will have to make a decision like that one day myself.

I also want to point out that I NEVER claimed I had any knowledge of professional podiatry. I actually made that claim myself from the beginning, and AGAIN I mentioned vascular only as an example (and a terribly bad one it turned out because people apparently misunderstood what my whole question was about).

I won't make the mistake of trying to get advice from those who have more experience in the field on this board again.

Sorry I ruffled so many feathers.

 

[Weirdy]

Like I say, my information came from an MD practicing in the Chattanooga, TN area based on discussions he has had with vascular surgeons in this area apparently. I, personally, have no axe to grind in the matter one way or another. And, again, my mention to vascular surgery in my question above was just an out of the blue example (in other words, I didn't pick vascular because I thought there was some need there for podiatrists to fill missing slots). As it turns out it was a bad choice of example, but then I bet anything I picked here would have had people coming out of the wood work to defend that field. My initial question was basically this: "what would need to happen for podiatry fellowships to be more worth it for podiatrists".

Most certainly not trying to step on anyone's toes at all here.

You would definitely know more about it than me. This MD practices in the Chattanooga TN area, and this was apparently based on discussions with vascular surgeons in that area (at least that's what I got from his comment). It is possible he was just trying to "rabble rouse", but that most certainly wasn't my intention.

I have encountered some physicians, quite a few on boards like this it appears too if you read the posts enough, who downplay other specialties, and it is possible that this person was doing the same (but he came across as sincere, and maybe he was just repeating what he had heard too I don't know).

Other markets must have the same feeling as well though based on a comment above, that I was responding to actually, that said "the vascular surgery kitchen already has too many cooks as it is". This appears, then, that at least someone else thinks the field isn't facing a shortage, but, again, as a vascular surgeon yourself you'd know better than others.

Anyway, I can assure you I wasn't trying to step on anyone's toes here at all.

As I said above, I am still a pre-med/pre-pod, and, again, my intent wasn't to upset anyone at all.

Sorry for getting involved. I meant no harm at all. I was only curious about what would make fellowships more worthwhile for those who were considering them since if I do get into school I will have to make a decision like that one day myself.

I also want to point out that I NEVER claimed I had any knowledge of professional podiatry. I actually made that claim myself from the beginning, and AGAIN I mentioned vascular only as an example (and a terribly bad one it turned out because people apparently misunderstood what my whole question was about).

I won't make the mistake of trying to get advice from those who have more experience in the field on this board again.

Sorry I ruffled so many feathers.

Listen more. Speak less.

Nothing against you.

 

[bunNfxr]

Oh please. There is nothing wrong with starting a discussion as to whether or not our fellowships have adequate direction and are useful for anything but bragging rights. I believe that was what OGP was getting at. "listen more and speak less." How about don't be condescending!! The fellowship question will affect whether these guys pursue this profession, so its good that they know full well what lies ahead and it should be fine if they try and engage. And we should answer these questions so that these prospective students do know what they are talking about. Is it good to leave the prepods in a soup of their own ignorance, asking each other questions about fellowships?

 

[air bud]

Oh please. There is nothing wrong with starting a discussion as to whether or not our fellowships have adequate direction and are useful for anything but bragging rights. I believe that was what OGP was getting at. "listen more and speak less." How about don't be condescending!! The fellowship question will affect whether these guys pursue this profession, so its good that they know full well what lies ahead and it should be fine if they try and engage. And we should answer these questions so that these prospective students do know what they are talking about. Is it good to leave the prepods in a soup of their own ignorance, asking each other questions about fellowships?

You bring up some good points. Where I felt this go downhill was when a random vascular specialist found this thread and commented on it. By no means am I saying SDN is the main marketing arm of podiatry. But any type of inorance/misinformation coming from pods only goes to perpetuate stereotypes. If this was all pods and a closed forum, I might have felt different

 

[OlderGeorgiaPreMed]

Oh please. There is nothing wrong with starting a discussion as to whether or not our fellowships have adequate direction and are useful for anything but bragging rights. I believe that was what OGP was getting at. "listen more and speak less." How about don't be condescending!! The fellowship question will affect whether these guys pursue this profession, so its good that they know full well what lies ahead and it should be fine if they try and engage. And we should answer these questions so that these prospective students do know what they are talking about. Is it good to leave the prepods in a soup of their own ignorance, asking each other questions about fellowships?

Thank you so much!

Finally someone who seems to understand that I was NOT (1) trying to claim I had any knowledge of "professional podiatry" [that's actually why I asked what I asked as mentioned in my first post], (2) start any sort of flame war over a specialty [I simply made a poor choice - rookie mistake(?) - of specialty training to use as an example], and (3) that the REASON I asked this on here [where practicing podiatrists are supposedly at] was because what I was getting from "listen[ing] more [and] speak[ing] less" was confusing [and, apparently at least with regards to the state of vascular surgeon saturation inaccurate]!

How, as you mention, are any of us that are really considering podiatry as a career suppose to know we are making a good decision if all we speak with are other pre-podiatry people (and, nope, I am NOT someone who decided to apply to podiatry school as a "last resort" - which seems to be a belief among some people about us pre-pods sadly - I actually think this field would be a good fit for me - and, for what it's worth - I have a 3.9 overall GPA, a 3.86 science GPA, and a 507 MCAT). As you say, how in the heck is the profession supposed to attract applicants if we are met with responses like "disregard the pre-pod"?

To be completely honest, the whole exchange was really discouraging, but it really makes me feel a lot better to know that not every podiatrist is "bitter party of one".

Thank you for that!

 

[air bud]

The Bitter party has a very large reservation. Still waiting for all the guests to show up.

And if those stats are good enough for MD (I don't know new MCAT ) then do that because you don't know enough about podiatry

 

[de Ribas]

507 MCAT is higher than DO average and good enough for most MD schools with that GPA

does he know more about MD/DO as pre-med?

 

[GypsyHummus]

Bitterness is not unique to podiatry. Many people regret going into medicine MD/DO/POD when they find it is not all hot nurses and everyone fawning all over you and your medical knowledge. There are content pods out there, it just takes awhile to find them.

As a side note, The happiest docs Ive seen are ENT, Ortho (MD) and Dentists. If I had your stats, I would do everything in my power to get into an MD or DDS school.

Thank you so much!

Finally someone who seems to understand that I was NOT (1) trying to claim I had any knowledge of "professional podiatry" [that's actually why I asked what I asked as mentioned in my first post], (2) start any sort of flame war over a specialty [I simply made a poor choice - rookie mistake(?) - of specialty training to use as an example], and (3) that the REASON I asked this on here [where practicing podiatrists are supposedly at] was because what I was getting from "listen[ing] more [and] speak[ing] less" was confusing [and, apparently at least with regards to the state of vascular surgeon saturation inaccurate]!

How, as you mention, are any of us that are really considering podiatry as a career suppose to know we are making a good decision if all we speak with are other pre-podiatry people (and, nope, I am NOT someone who decided to apply to podiatry school as a "last resort" - which seems to be a belief among some people about us pre-pods sadly - I actually think this field would be a good fit for me - and, for what it's worth - I have a 3.9 overall GPA, a 3.86 science GPA, and a 507 MCAT). As you say, how in the heck is the profession supposed to attract applicants if we are met with responses like "disregard the pre-pod"?

To be completely honest, the whole exchange was really discouraging, but it really makes me feel a lot better to know that not every podiatrist is "bitter party of one".

Thank you for that!

 

[ldsrmdude]

Let's try to get this thread back on topic. Which if I recall correctly was the state of fellowships in podiatry.

 

[AudiLova619]

Bitterness is not unique to podiatry. Many people regret going into medicine MD/DO/POD when they find it is not all hot nurses and everyone fawning all over you and your medical knowledge. There are content pods out there, it just takes awhile to find them.

As a side note, The happiest docs Ive seen are ENT, Ortho (MD) and Dentists. If I had your stats, I would do everything in my power to get into an MD or DDS school.

I rarely saw a happy dentist in NY. Saturation/debt kills.

 

[ExperiencedDPM]

Dentists are the happiest? Hmmm, is that why the suicide rate of dentists is one of the highest of all professions? Guess your definition of happy and mine must differ.

 

[med2345]

507 MCAT is higher than DO average and good enough for most MD schools with that GPA

does he know more about MD/DO as pre-med?

Pasha, you absolutely kill me when you mention MD/DO when someone has competitive stats. Do you really think someone with those stats don't know about MD/DO?

Some people choose POD because they don't want the risk of or repulsed (me) by the thought of ever having to do IM, FM, Peds, psych, or any of the "lower scoring" residencies after 4 years of medical school. They enjoy what Pod has to offer and you know what you will be doing no matter what after Pod school. You can't say that with allopathic/osteopathic medicine. With MD/DO if you don't score well on your STEP you will be stuck doing one of these. Especially DO, and that's when you could be unhappy with the rest of your career, doing something you don't enjoy. He probably sees himself doing pod which is completely understandable, than doing something the MD/DO route for medicine.

Sorry, now let's get back on subject.

 

[de Ribas]

Pasha, you absolutely kill me when you mention MD/DO when someone has competitive stats. Do you really think someone with those stats don't know about MD/DO?

Some people choose POD because they don't want the risk of or repulsed (me) by the thought of ever having to do IM, FM, Peds, psych, or any of the "lower scoring" residencies after 4 years of medical school. They enjoy what Pod has to offer and you know what you will be doing no matter what after Pod school. You can't say that with allopathic/osteopathic medicine. With MD/DO if you don't score well on your STEP you will be stuck doing one of these. Especially DO, and that's when you could be unhappy with the rest of your career, doing something you don't enjoy. He probably sees himself doing pod which is completely understandable, than doing something the MD/DO route for medicine.

Sorry, now let's get back on subject.

you completely misunderstood my point. completely.

 

[med2345]

you completely misunderstood my point. completely.

On that post maybe I did but it was a reoccurring theme I see everytime someone has decent stats or in DO or MD territory. It was just now i decided to say something.

Regardless, if he is bright enough to get those stats i think he knows his motivation to do medicine. Not sure what your point was but i think he knows what he’s doing.

 

[de Ribas]

Not sure what your point was but i think he knows what he’s doing.

If you are not sure, first, please try understand the point and then reply.

 

[med2345]

If you are not sure, first, please try understand the point and then reply.

Okay..?
I didn’t know completely understanding someone’s statement was a pre-requisite to reply. Excuse my ignorance.

For the sake of nonsensical posts, you could’ve easily just stated your point instead of claiming I don’t understand it when you’re clearly assuming he is under informed about MD/DO. And again i stated that from what I’ve also seen before.

 

[air bud]

I visited the top 5 ACFAS fellowships and I wasn't impressed with any of them (most of them are just looking for free labor) so i went and did one in europe. I operated everyday. In the end, I did about 1000 cases. I got really good at total ankles, pilons, frames, etc

I do 0 pilons now and 0 TARs. They go to ortho. I don't plan on doing these anytime soon--even if given the chance. So for me, it was a waste of 1 year salary ( about 250k ish).

oh and what really annoys me is when i see these guys writing "FELLOWSHIP TRAINED PODIATRIST." That just makes our profession look stupid. How many ortho's are writing that on their linkedin profile?

Getting back on track....this is an incredibly interesting perspective. Can you fill us in on how you found this fellowship? I likely won't do and TAR or Pilon in my new position even though I am credentialed for them. I will likely still obtain TAR training from Integra/Wright. I am going to be in a small town in a state without a lot of pods. Essentially no pods are doing TAR. I am at too much risk if something goes wrong and need to refer out for complications. It is not worth it to me. Granted, ortho can go take a weekend course then start popping in them tomorrow with no reservations and no concerns if it goes bad, but that is reality. Same thing with Pilons.

 

[hematosis]

I was at a AOFAS meeting a few years ago and a couple of the European guys I follow were presenting there. I made small talk with them and invited myself to visit them during the tail end of my last year in residency. Prior to this opportunity I was debating on doing one of the ACFAS fellowships in Ohio. Anyways, we clicked and worked on a paper together. Later, I asked to come for 3 months and train with them. The first three months I worked for free, used all my savings. After that they sponsored me for the remaining 9 months.

The group I work with now has another ortho guy who is soon to be retiring and he does the TAR and Pilons. He's been doing it for the past 10 years and gets about 30-35% complication rate with TAR. I am happy with my current pace and lifestyle. I just don't want to deal with these complications and the post op management. I can pump out 4-5 cases in the morning and have clinic in the afternoon. I easily bill the 2nd highest in our group of 7. I make a great salary. There are plenty other challenging and satisfying procedures in our field that I actually enjoy doing so I do those instead.

 

[GypsyHummus]

Thank you for your insight.

Do you perform any surgeries related to the ankle, or are most of your surgical cases rear foot and forefoot?

What would you say are your most common surgical procedures? How long do these usually take? The pod I shadowed said she got punted all the reconstructive foot stuff, and she would just be happier with hammertoes and the occasional bunion.

I was at a AOFAS meeting a few years ago and a couple of the European guys I follow were presenting there. I made small talk with them and invited myself to visit them during the tail end of my last year in residency. Prior to this opportunity I was debating on doing one of the ACFAS fellowships in Ohio. Anyways, we clicked and worked on a paper together. Later, I asked to come for 3 months and train with them. The first three months I worked for free, used all my savings. After that they sponsored me for the remaining 9 months.

The group I work with now has another ortho guy who is soon to be retiring and he does the TAR and Pilons. He's been doing it for the past 10 years and gets about 30-35% complication rate with TAR. I am happy with my current pace and lifestyle. I just don't want to deal with these complications and the post op management. I can pump out 4-5 cases in the morning and have clinic in the afternoon. I easily bill the 2nd highest in our group of 7. I make a great salary. There are plenty other challenging and satisfying procedures in our field that I actually enjoy doing so I do those instead.

 

[air bud]

@hematosis so would you do this fellowship again?

 

[hematosis]

Our residency faculty encouraged us and I was convinced that after a fellowship I'd be treated fairly by my MD colleagues and perhaps equal to a f/a orthopod. Obviously i'm better trained but i mean it in terms of respect, etc. Well its not like that at all. You could do a 4 year fellowship but unless you can sit for the USMLE and score a 245+, you're just a lowly Podiatrist to them. So knowing what I know now...absolutely not. All the fellowship did for me was push back my Tesla purchase for a year.

 

[MyAnklesAreBroken]

All the fellowship did for me was push back my Tesla purchase for a year.

Lol

 

[feet2017]

not to bump an old thread, but what happened to the fellowship review thread??? Wasn't it sticked before?

 

[ldsrmdude]

The person who started the thread deleted the first post and that deletes the entire thread. So that thread doesn't exist anymore. Feel free to start another fellowship review thread, and it could be stickied if needed.

 

[Agent9]

Bump. For those of you that have recently been involved in the fellowship search/interview process, what are the fellowships that allow a fellow to use cases for board numbers? I was unable to find this information on the forum or ACFAS. Thanks in advance.

 

[CutsWithFury]

Bump. For those of you that have recently been involved in the fellowship search/interview process, what are the fellowships that allow a fellow to use cases for board numbers? I was unable to find this information on the forum or ACFAS. Thanks in advance.

If it’s documented that you are the primary surgeon and you did the entire work up leading up to surgery and did the complete follow up you can log it. All notes need to be documented and signed by you and not your fellowship director. Very few fellowships offer this experience.

You can’t log your fellowship directors patients surgeries.


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