Do you notice a signifcant difference in quality of the residents coming out from different residency programs?

[bloxxeeey]

I'm deciding on ranking my programs and I know a few programs where they are surgery heavy and the residents can do the surgery well and I think those may be the programs I rank high but there is another program I enjoyed that does very little surgery and very little hands on surgery but he residents in 3rd year are very knowledgeable and confident in their skills. Do you notice a huge difference in quality between programs who have heavy surgery and programs who have heavy academics?

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[heybrother]

Clinic and "academics" is the locker room. Everyone is confident in the locker room. The OR is the bedroom. I rest my case.

Any 3rd year resident can BS a student. In general, even though some are stupid, most 3rd years project confidence because if you aren't confident its all going to fall apart very quickly. Patients in general will not tolerate an unconfident doctor. That's a very quick way to get someone to seek a second opinion. Jokingly, every 1st year at my residency botched their first pre-op and got sent home with instructions to do it until it was natural.

The OR is the great revealer. When you are an attending you have to do the whole case skin to skin.

If they aren't doing surgery. What are they doing? What pathology are they seeing. Surgical volume doesn't necessarily mean good medicine, but lack of surgery can suggest all sorts of problems. Poor referrals. A focus on work instead of actual training. Just because there's lots of work doesn't mean a resident should be doing it. Perhaps attendings don't want to pull the trigger on cases.

Aim for heavier cases. You can decide afterwards if they were good cases, done right, should have been done, etc.

 

[dtrack22]

Do you notice a huge difference in quality between programs who have heavy surgery and programs who have heavy academics?

I would avoid heavy academics unless you have a strong desire to publish, do multiple fellowships so that you can publish more, and possibly set yourself up for the handful of academic center type jobs that exist in podiatry. I had a classmate who was successful in doing just that.

98% of us will never work in that setting so I personally would choose clinic and surgical volume over a robust academic schedule if you do in fact have to choose between the two.

I noticed a difference in clinical and surgical skills between big name programs that had less patient care and more academics compared those which prioritized the patient care aspect. But it wasn’t huge because the academic focused programs were still getting enough cases. Not to mention after a few years in practice it’s basically all evened out.

 

[DYK343]

My residency was way more surgical oriented than clinic.
Middle of the line academics.

For the most part, clinic is pretty straight forward IMO as long as you pay attention along the way.

Doing a big case on your own and knowing how to get yourself out of trouble when it hits the fan is a skill that isnt learned from a journal article or your 25th wound you debrided that day in wound care clinic.

 

[JewOnThis]

If I had to do it all over again, I would have picked a program with connections. Connections is how you survive in podiatry. It’s all about who you know and not what you know.

 

[Utvolsdpm]

I’ve been thinking the same thing. The line from Step Brothers is actually very true:
Dr. Robert Doback: He quit college his junior year and said he wanted to join the family business.

Nancy Huff: But you’re a medical doctor…

Dr. Robert Doback: I told him that. He just said, ‘It’s all about who you know.”

 

[wakaflocka88]

I echo a lot of the OGs above. JewOnThis makes a solid point about connections. Too many residents I know thought their training alone was sufficient to land a dream job. Nope. I mean....how many fellows y’all know of that are cranking out the same amount of TARs they were trained to do? One of the most beneficial part of my training was having our own clinic our last year. Being able to work up patients from start to finish and follow their progress has been a priceless experience now that I’m in the real world. Get the best training you can, minus the BS. From the volume, you will hopefully see what you like, don’t like, what’s ethical and what is shady.

 

[Pronation]

If I had to do it all over again, I would have picked a program with connections. Connections is how you survive in podiatry. It’s all about who you know and not what you know.

Connections. Cant emphasize this enough. You NEED a director/attending these days that can help you get your foot in the door at a good hospital/practice. Otherwise, it doesn't matter how many damn TARs you did in residency, you'll be at one of these garbage $100k private practice associate jobs. Coincidentally, the directors/attendings that have these connections are generally at good programs as well. However, not all good programs have these connections.

 

[dtrack22]

You NEED a director/attending these days that can help you get your foot in the door at a good hospital/practice. Otherwise, it doesn't matter how many damn TARs you did in residency, you'll be at one of these garbage $100k private practice associate jobs.

I think this is something that is good to look out for, but there is still a lot of dumb luck involved with those types of jobs.

let’s say your director is best friends with 10 podiatrists in big multispecialty groups/health networks. And there are 3 of you that graduate from the program every year. The chance of the being 3 openings between all these groups every year is incredibly slim.

I mean you could take the entire Kaiser system and find plenty of years where they don’t hire a new podiatrist. That’s dozens of hospitals and clinics covering 8 states and DC. It’s the largest managed care organization in the country and there isn’t an opening for a new DPM (let alone 3) every year.

There are zero programs in the country who have placed a majority of their residents in non-podiatry group jobs over the last 10 years. That being said connections are helpful, I would just rank it below the actual training aspect in terms of importance. Because ultimately the most well connected director still has relatively little ability to get you the job you want in the area you want to live.

 

[Feli]

You need a high surgical volume. That is why there are numbers requirements for competence. Those are minimums. Even if you are a "fast learner" in training or have "good hands," you still need to produce logs after graduation to get privileges. That is particularly important if you end up in a bad scope state with MDs limiting you or a saturated metro where other DPMs will try to limit your privileges.

More important reasoning for good competence is your own integrity and your patients' outcomes. The more you see, the more struggles you will see... and overcome. "If you're not having complications, you aren't doing surgery." I can do even a simple Austin 20 times and have at least 10 different experiences... crazy OA of the met head cartilage that I didn't expect, tag the intermet artery (I do them wet) and have to tie it off, find unexpected gout tophi, crack the wing due to osteoporotic and have to go to bail out fixation, lateral release struggle, need to add Akin or Weil for best correction, etc. You need to be a machine, and you will be if you've seen 1000+ procedure in residency and got involved with many of those. Remember that you can do low/mid volume and read/video to compensate for it - esp the procedures you don't see much of. However, you can also do high volume and read/video to prep also. Do the latter.

The bottom line is that you want so many you can do them in your sleep. As was said, everyone talks a big game. Everyone boasts their xrays or skills. Follow up is the enemy of good surgery, though.... a lot of stuff looks good on the table and then crashes and burns later. Intra-op complications also happen... a lot. It is one thing to watch a senior resident or attending struggle while you retract, but your own mishaps and complications are what will define you. Not everyone is rock solid when the training wheels come off. Be solid. My program was one of the first 3yr ones in the country, and two of my senior attendings who were program alumni said that even back when it was a 2yr program in their day, they were sick of cutting by that 2nd residency year... but they kept doing it. Today, they are both residency directors at their own programs and docs I'd trust to operate on me or my family's F&A without question. You always want too much rather than too little. Do you want a pilot with 500 hours of flight or 2000?

...so, can a good DPM student do well at almost any residency program? Yeah. Will they be better and more proficient at a variety of procedures if they do a good program with high volume? Yeah.
You will do what you like, but it is a bit short-sighted to pick a "fun group" or certain city or etc over a program with clearly better volume+training. It is your skill set for the next 30+ years. GL

 

[GreenHousePub]

Do you notice a huge difference in quality between programs who have heavy surgery and programs who have heavy academics?

Stop by your local associate mill and you'll see graduates from top tier residencies to bottom list people all working the same job.

 

[air bud]

Connections are great and all. But dumb luck and putting yourself out there is important too. My first set up with a MSG was based on connections. My second setup with a MSg/Hospital was dumb luck. My current set up with ortho was putting myself out there and selling myself.


To expand. Go for the surgical volume. Make sure academics is as least done. Connections are gravy. Don't rely on anyone else, you are your own best salesperson.