F&A Surgery Fellowship

[darazon]

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I'm interested in learning more about what benefits a fellowship in F&A surgery would do for me, if any?

Are you more likely to get picked up by a surgical group, have an increase in pay vs non-fellowship, or just have a competitive edge over someone who does not have a fellowship.

Is it competitive to get selected for a fellowship?

 

[PADPM]

Fellowships are not accepted (in my opinion) in the anticipation of an increased salary. They are usually sought out for specific additional training in a "specialty" such as reconstructive surgery, sports medicine, diabetic limb salvage, etc.

Having additional training is always an advantage for you and your future patients, but is never a "guarantee" of future additional earnings. Obviously a fellowship can also be an advantage in the job market IF a group or hiring doctor is seeking someone with your specific training and skills.

And yes, I believe it's usually relatively competitive for most fellowships, since not that many approved fellowships presently exist.

However, I appreciate the fact that you are attempting to plan for your future, but given the fact that you aren't graduating for 2 more years, and still have to worry about graduating, obtaining a quality residency program, AND completing that program, etc., it may be a little pre-mature for you to be concerned about a fellowship at this point in your training.

Healthcare is changing, you don't know what your wants and needs will be in 5 years and you don't know what fellowships will be available at that time. So relax a little, concentrate on your studies to assure yourself the best opportunity at obtaining a great residency and then start thinking about fellowships.

 

[347932]

Fellowships are not accepted (in my opinion) in the anticipation of an increased salary. They are usually sought out for specific additional training in a "specialty" such as reconstructive surgery, sports medicine, diabetic limb salvage, etc.

Having additional training is always an advantage for you and your future patients, but is never a "guarantee" of future additional earnings. Obviously a fellowship can also be an advantage in the job market IF a group or hiring doctor is seeking someone with your specific training and skills.

And yes, I believe it's usually relatively competitive for most fellowships, since not that many approved fellowships presently exist.

However, I appreciate the fact that you are attempting to plan for your future, but given the fact that you aren't graduating for 2 more years, and still have to worry about graduating, obtaining a quality residency program, AND completing that program, etc., it may be a little pre-mature for you to be concerned about a fellowship at this point in your training.

Healthcare is changing, you don't know what your wants and needs will be in 5 years and you don't know what fellowships will be available at that time. So relax a little, concentrate on your studies to assure yourself the best opportunity at obtaining a great residency and then start thinking about fellowships.

Excellent advice and insight.

 

[Feli]

I agree with the above... wait to see what residency you get before thinking about fellowships.

Fellowships might be of advantage if you are going for academic positions or want to work in ortho settings and didn't do a residency that gave you a lot of RF/trauma cases. The main advantage to fellowships is usually research pubs (for the academic jobs) and beefing up your case logs (for ortho or academic jobs). It's generally considered for most MD surgeon specialties that fellowship makes you a better surgeon, but DPMs do way way higher % of cases which are relevant to our eventual subspecialty during residency than say... a vasc surgeon, hand ortho, transplant surgeon, pedi ortho, etc that might only spend 10% of their residency time dedicated to their future specialty (whereas most pod surg residencies are at least 50+% pod surgery months).

If your logs are good and you feel confident doing the sort of cases you want coming out of residency, then you can probably just get into practice. Even if you did 10 fellowships and had done tons of every surgery in our scope, you still have to eventually learn the realities of office dynamics, billing/coding, prac mgmt decisions, politics, etc. From a purely financial standpoint, fellowships are almost always a losing proposition, but I suppose that depends on what kind of offers can elicit out of residency versus what type of fellowship quality you can find and the political connections it might make for you.

GL, but I agree 100% with just trying to get a good residency and then go from there...

 

[jonwill]

I've had some friends do F&A fellowships for various reasons. It's similar to those few residencies out there that are four years instead of three years in that I don't think it's ever a BAD idea. More training is never a bad thing. But in the end, how does a F&A fellowship benefit you? It depends on what type of residency you did. If your residency was lacking in certain areas and you wanted more training, then it would help you. Or maybe it would give you some added confidence. I bet it would open up more doors into the orthopedic world as well.

 

[krabmas]

I agree with the above, it is never a bad idea to get more training/education, it is not a garuntee for a increase money making.

John Steinberg Would not be where he is with out his fellowship at UTHSC
same with Armstrong and Lee C. Rogers w/out his fellowship at CLEAR. Which is just re-inforcing the idea that fellowships help in academic careers.

If, when time to decide, you want to do a fellowship don't let anyone talk you out of it for financial reasons. It is almost impossible for you to go back and do a fellowship later if you decide down the road that you regret not doing one. You will most likely not look back and say, "I wasted a year" if you do a fellowship.

This advice is from a current fellow and I will be continuing on to one more fellowship before beginning my career.

 

[347932]

What is the status for CPME approval for fellowships now?

 

[krabmas]

Are you heading towards an academic career? I know you came out of the INOVA program so I am unsure why you would need two more years of fellowship training if you weren't going into academics or research, etc. Just curious and just asking. Thanks!

If it works out yes, but not necessarily. I don't need the fellowships it is a want. I could have gotten a job right out of residency and done just fine but maybe not what I want to do.

My second fellowship is at the Rubin Institute for Advanced Orthopedics in Baltimore with Drs. Herzenberg, Standard and Conway in limb lengthening and deformity correction. Since they wrote the book with Dr. Paley and give the course each year the only way to learn what they do is work with them. Some residencies rotate through for a few months but Inova does not.

 

[347932]

With the advanced training you have gained via these two seperate fellowship programs what are you hoping to accomplish professionally (if you don't get into academics)?

Is there really a job out there that would solely utilize the training you are gaining? Don't you worry that some of this training might go to waste in the long run?

Training never goes to waste really. Any opportunity to advance your skill set can only help you long term. One thing to realize is that you are not going to be as busy surgical right out of residency, as you were when you were a resident. You are probably technically speaking the best you will ever be the day you leave your residency.

 

[darazon]

Thanks for the replies.

Is there any benefit in going to a CPME approved fellowship? What about the ACFAS fellowships?

 

[krabmas]

Thanks for the replies.

Is there any benefit in going to a CPME approved fellowship? What about the ACFAS fellowships?

CPME requires specific rotations of their approved fellowships. The point of a fellowship is to get specialized training, not re-do a residency year. I would stay away from CPME approved fellowships unless you find one that benefits what you are looking for.

The ACFAS fellowships are not accredited just approved. Read the list of requirements; it is mostly just making sure there is an educaitonal aspect to the fellowship and you are not a slave or cheap labor to the podiatrist that hired you.

 

[347932]

The ACFAS fellowships are not accredited just approved. Read the list of requirements; it is mostly just making sure there is an educaitonal aspect to the fellowship and you are not a slave or cheap labor to the podiatrist that hired you.

Approved by whom? Is there a committee much like the CPME within ACFAS that does this?

Avoiding being "a slave or cheap labor" is precisely why the CPME should be involved imho.

 

[PodunkUDPM]

Approved by whom? Is there a committee much like the CPME within ACFAS that does this?

Avoiding being "a slave or cheap labor" is precisely why the CPME should be involved imho.

I am curious about this as well. Also, is there a list of fellowships available anywhere?

 

[347932]

http://www.apma.org/Members/Education/CPMEAccreditation/Fellowships.aspx

 

[PodunkUDPM]

http://www.apma.org/Members/Education/CPMEAccreditation/Fellowships.aspx

Thanks. So does it really matter if it is a CPME vs ACFAS fellowship if they both are labeled "advanced foot and ankle reconstructive surgery" let's say?

 

[347932]

Thanks. So does it really matter if it is a CPME vs ACFAS fellowship if they both are labeled "advanced foot and ankle reconstructive surgery" let's say?

If it matters to you to do a "CPME approved" fellowship then yes it does matter. I'm not sure what the advantages are to doing a "CPME approved" vs. "ACFAS approved" fellowship in the long run at this point. Anyone else have any input?

 

[Feli]

This is a good question, a good thread, and we are getting some good info on the topic. 👍

I stated my thoughts on fellowships after podiatry residency, but I thought of a great example from the "dark side" also:
There's a F&A ortho in the city who is a relative of a resident (non-pod) at my training hospital right now. The guy did lots of F&A elective and trauma in his 5yr general orthopedics residency at a quality program in a major metro trauma center. He then did Sig Hansen's 1yr ortho F&A fellowship. He then did Paley's 1yr F&A fellowship. He has amazing training and dozens of publications (I honestly don't think you could get any better for F&A surg education in the *ortho* post-grad model unless maybe you then did a year with Myerson??? FTW? lol).

What's the point of all this? The point is that after my 3yrs of training, I feel I'm capable of doing anything he can do. Seriously. We both know the anatomy, the surgical instruments, and the literature, standards of care, etc. Am I cocky... ask anyone who has worked with me, but remember that confidence and preparation are important parts of good surgery. I was gonna add jonwill to this discussion of anecdotal examples since his residency surgical logs put a lot of fellowship ortho F&As (or fellowship DPMs) to sleep, and his will logs probably be higher than mine (esp for major RRA and trauma)... but he can obviously speak for himself.

Would this fellowship (x2) ortho doc have the edge on me (and jon, and others) out for academic hospital jobs? Of course, but because he's an ortho and I'm a pod... as well as just the fellowship and pubs. Do you know who else would edge me out for the academic jobs? Podiatrists like Krabmas with Inova + Rush + Paley on her CV, and so would William DeCarbo, so would James Cottom (akin to the ortho above, I don't think you could get much/any better *DPM* model postgrad training than Cottom), and tons of others would have my CV terribly, terribly outmached also.

With that in mind, why in the world aren't I planning on a fellowship then? Well, let's answer (or at least think about) that question:
Would the well trained F&A ortho or the fellowship pods mentioned really have more to offer their patients than I will have for mine? Assuming I keep doing collegial and industry workshops, going to CMEs, reading the lit and texts, etc, then I honestly think they won't have any more to offer *for patients* (disclaimer: I'm decidely off the total implant bandwagon, and I think Taylor Spatial frames are for very, very select patients due to complexity of pt education/complaince). I would even say it's plausible the fellowship trained ppl might actually have slightly less to offer for their patients if they consistently devote a significant % of their career time to non-patient care stuff like publishing (often a firm req for the ivory tower jobs) and/or travelling all over the place to take the helm at CME lectures. Now comes the part of the the show where I may get lambasted for being "shortsighted," "arrogant," or even "off my rocker"... but keep in mind that the ultimate proof in *clinical* medicine, imo, is simply patient outcomes and individual doc satisfaction with their life/career quality.

...just a little food for thought. Like I said, for the readership of SDN (aka mostly students), I'd always recommend just do a good 3yr residency program and then everyone has to carve their own path based on their needs/wants. It's absolutely great that fellowships are out there in podiatry just like any other med specialty.

 

[Feli]

http://www.apma.org/Members/Education/CPMEAccreditation/Fellowships.aspx

Great link^...

Also related: http://www.acfas.org/Students/Content.aspx?id=1975

If it matters to you to do a "CPME approved" fellowship then yes it does matter. I'm not sure what the advantages are to doing a "CPME approved" vs. "ACFAS approved" fellowship in the long run at this point. Anyone else have any input?

My views on your question (CMPE approved, ACFAS approved, AOFAS approved, non-accredited, etc fellowships) fall largely in line with krabmas comments in this thread:
http://forums.studentdoctor.net/showthread.php?t=766856&highlight=cpme+acfas

 

[PodunkUDPM]

Great link^...

Also related: http://www.acfas.org/Students/Content.aspx?id=1975
My views on your question (CMPE approved, ACFAS approved, AOFAS approved, non-accredited, etc fellowships) fall largely in line with krabmas comments in this thread:
http://forums.studentdoctor.net/showthread.php?t=766856&highlight=cpme+acfas

awesome! thanks for the link to that thread

 

[densmore22]

From my understanding of CPME vs ACFAS fellowships, in ACFAS approved fellowships, the fellow can book their own surgeries, perform said surgeries on their own (without a senior attending) and run their own clinic. The fellowship portion pertains to advanced training in said fellowship (diabetic recon, trauma, complex RF/Ankle recon, etc). You're not solely (necessarily) spending all of your waking surgical time doing surgery on what your fellowship is in. You have your own clinic and are doing your own surgery. Plus with ACFAS fellowships, you can count the cases towards board certification. With CPME, the above, again, how I understand it, is not true. You're focus is to learn under the attending and only function in the capacity of what the fellowship is in.

Why do I think the ACFAS model is better, well, you're still getting fellowship training, but you're also still progressing towards the ultimate goal of board certification and becoming a competent and thorough Podiatrist. You are still doing bunions, hammertoes, STJ fusions, whatever, but then you may have your 1 or 2 or whatever days dedicated with your attending in surgery and clinic seeing those pts and doing the surgery/assisting. It seems to be a better model for what I want when I do my fellowship.

That's my opinion.

 

[347932]

From my understanding of CPME vs ACFAS fellowships, in ACFAS approved fellowships, the fellow can book their own surgeries, perform said surgeries on their own (without a senior attending) and run their own clinic. The fellowship portion pertains to advanced training in said fellowship (diabetic recon, trauma, complex RF/Ankle recon, etc). You're not solely (necessarily) spending all of your waking surgical time doing surgery on what your fellowship is in. You have your own clinic and are doing your own surgery. Plus with ACFAS fellowships, you can count the cases towards board certification. With CPME, the above, again, how I understand it, is not true. You're focus is to learn under the attending and only function in the capacity of what the fellowship is in.

Why do I think the ACFAS model is better, well, you're still getting fellowship training, but you're also still progressing towards the ultimate goal of board certification and becoming a competent and thorough Podiatrist. You are still doing bunions, hammertoes, STJ fusions, whatever, but then you may have your 1 or 2 or whatever days dedicated with your attending in surgery and clinic seeing those pts and doing the surgery/assisting. It seems to be a better model for what I want when I do my fellowship.

That's my opinion.

There are countless ways that this can be abused imho. Be very careful with this.

 

[Feli]

There are countless ways that this can be abused imho. Be very careful with this.

Yes. It's great that we have the, but unfortunately, podiatry fellowships (and post-grad training overall) represent a rapidly evolving process. There have been - and will continue to be - major growing pains whenever you advance by leaps and bounds.

Can anybody (besides maybe PADPM) tell me the available residency types for pod school grads 20 years ago? 10 years ago? Do we all know it's changing again summer 2012 (I honestly can't even remember off the top of my head what my residency cert will say... I think it'll be PMR with RRA?). The point is that whenevery you have rapid transition, it won't be 100% smooth... maybe that's why US govt seems to move so grindingly slow?

An attending I really like will casually say that fellowship in podiatry - with few exceptions - amout to basically just an under paid associate + research generator for the attendings. He will say that private practice groups keep oversight on junior associates (and even partners) for years anyways, so just go out into practice unless you feel uneasy about some F&A surgeries after residency (fwiw, he did a 1yr... then applied for a 2nd year to learn more RRA). He will admit that fellowships are also for those who really want more pubs than you could do in residency and possibly a future academic medicine career. I largely agree, but it's a tradeoff for both parties with the fellow getting the short end of the stick imho:

Pros:
-fellow gets CV/ego padding, pubs, surg volume, meager salary, teaching exp
-the fellowship director/attendings get pubs with (typically) little effort - often including industry $ponsored research, cheap associate (err, fellow!) to do consults/clinic/first assist, teaching/exp, and prestige/ego boost

Cons:
-fellow has to work hard, req research, and low pay year with no guarantee of higher income after
-fellowship director/attendings have to do a bit of admin work, have to fix whatever mistakes the fellow makes (these are surely a cake walk compared to teaching residents)

 

[Feli]

It is interesting to me that there will always be many views on pod fellowships. In specialties off of int med (GI, cardio, inf dz, etc) or gen surg (vasc surg, transplant, pedi surg, etc), of course you have to do a fellowship. It's absolutely required for board certification in that specialty. For pod surg, a fellowship is much more of just a personal choice; there are no (recognized) subspecialty boards. Then again, for ortho, F&A fellowship leads to no additional recognized board, but gen ortho residents do nowhere near the F&A case volume that a pod surg resident does.

(Am Board of Med Specialties: http://abms.org/Who_We_Help/Physicians/specialties.aspx )

It'd be very interesting to see if there are fellowships available to MD grads who direct match into a residency which - like podiatry - is basically limited to one anatomic region (ENT, OB, opthalmo, urology, or OMFS come to mind?). How many fellowships are out there for those specialties? What % of their residency grads do a fellowship? Why? Just food for thought.