Harvard/Boston area residencies

[JEWmongous]

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Hey all,

I was curious if anyone externed at Beth Israel Deaconess or Cambridge
Health Alliance in Boston. If so, could you comment on the programs? My pod mentor said the residencies are not the most famous in the US but the outside rotations and opportunities are amazing.

I know Mass General has a PM & S residency, but oddly enough noexternship.

I'm looking to maybe relocate there after pod school/residency so that's the reason for interest.

 

[Feli]

I think Cambridge is pretty much regarded as the best of the Boston programs.
BI is also solid, and I've heard their focus is diabetic stuff. Yale is also regarded as quite solid.
I think one or two students from my class might have gone there, but I can't remember. I will post or PM you more info if I get it. Those rotations are gonna be EXPENSIVE unless you have friend/family housing available.

The northeast programs at big, academic university hospitals are HUGE on comprehensive medical management of inpatients, particularly diabetics, from everything I've seen and heard. This is either a big plus or a big waste of time depending on how you look at things. My views are mostly the latter: rotate the basic IM, ER, ID, etc... but at the end of the day, you are going to be a foot surgeon, not the patient's internal med doc.

Personally, I've also realized that many (not all) northeast US docs, and people in general, just turn me off. I was warned of this by multiple midwest and southern docs, but now I'm seeing it firsthand. The arrogant ivory tower attitude is not necessary, and I certainly don't think it helps patient care, doc-to-doc communication, etc. If you are from New England and accustomed to it, you may not mind it?.

 

[SportPOD]

Cambridge - emphasis in on surgeries (forefoot, rearfoot and trauma). Program is well known in the area, but isn't as high powered as it was 5 years ago.

BI Deaconess - consistently a top performer as a program for exposure to diabetic care. If you know you want to get in and take care of diabetic patients, you will be the diabetic go to person in the community when you graduate from this program. Affiliated with Joslin Diabetes Center which is world renowned for diabetic care.

Mass General (MGH) - very academic program, only take one resident per year. They have good exposure to surgery, but not as high of numbers as Cambridge. MGH is one of the main hospitals that teaches residents who graduated from the Harvard Medical School.

All of the above programs have affiliations with Harvard Medical School, so when you graduate you get a little seal that states you graduated from Harvard Medical School if you care about things like that. As Feli has stated in the above post, Boston attitudes can be a little different. Cambridge has a much lighter atmosphere, whereas MGH and BI can be very structured and rigorous (say like the Podiatry Institute). You'll get great training and great research papers, but it depends on what you want to do afterwards. You will be able to find academic positions after these residencies due to the network that has been in place from prior graduates. Boston is a VERY expensive place to live and a pain in the butt to travel around due to the amount of traffic/weather. But Boston is also a nice city to live in and a very young population lives there. There's a lot of culture and history here.

Just a side note, Boston Medical Center has a program, but it is a PM&S 24 (two year program). Don't know much about it, but the program director used to be at BI Deaconess over 10 years ago and split up from there and started a podiatry/diabetes care center at BMC. Not sure of it's numbers and I don't know if it will be transitioning into a PM&S 36.

 

[215512]

Cambridge - emphasis in on surgeries (forefoot, rearfoot and trauma). Program is well known in the area, but isn't as high powered as it was 5 years ago.

BI Deaconess - consistently a top performer as a program for exposure to diabetic care. If you know you want to get in and take care of diabetic patients, you will be the diabetic go to person in the community when you graduate from this program. Affiliated with Joslin Diabetes Center which is world renowned for diabetic care.

Mass General (MGH) - very academic program, only take one resident per year. They have good exposure to surgery, but not as high of numbers as Cambridge. MGH is one of the main hospitals that teaches residents who graduated from the Harvard Medical School.

All of the above programs have affiliations with Harvard Medical School, so when you graduate you get a little seal that states you graduated from Harvard Medical School if you care about things like that. As Feli has stated in the above post, Boston attitudes can be a little different. Cambridge has a much lighter atmosphere, whereas MGH and BI can be very structured and rigorous (say like the Podiatry Institute). You'll get great training and great research papers, but it depends on what you want to do afterwards. You will be able to find academic positions after these residencies due to the network that has been in place from prior graduates. Boston is a VERY expensive place to live and a pain in the butt to travel around due to the amount of traffic/weather. But Boston is also a nice city to live in and a very young population lives there. There's a lot of culture and history here.

Just a side note, Boston Medical Center has a program, but it is a PM&S 24 (two year program). Don't know much about it, but the program director used to be at BI Deaconess over 10 years ago and split up from there and started a podiatry/diabetes care center at BMC. Not sure of it's numbers and I don't know if it will be transitioning into a PM&S 36.

How can they give you a seal that says you graduated from harvard medical school when you didnt? Maybe I'm missing something but that doesnt make sense if im not

 

[JEWmongous]

How can they give you a seal that says you graduated from harvard medical school when you didnt? Maybe I'm missing something but that doesnt make sense if im not

I think it means on your PM & S - 36 certificate granted from Cambridge/Beth Israel/Mass Gen, it will have a Harvard seal attached. This is because all 3 programs are Harvard-affiliated teaching hospitals.

I may be wrong but that seems logical

 

[JEWmongous]

Cambridge - emphasis in on surgeries (forefoot, rearfoot and trauma). Program is well known in the area, but isn't as high powered as it was 5 years ago.

BI Deaconess - consistently a top performer as a program for exposure to diabetic care. If you know you want to get in and take care of diabetic patients, you will be the diabetic go to person in the community when you graduate from this program. Affiliated with Joslin Diabetes Center which is world renowned for diabetic care.

Mass General (MGH) - very academic program, only take one resident per year. They have good exposure to surgery, but not as high of numbers as Cambridge. MGH is one of the main hospitals that teaches residents who graduated from the Harvard Medical School.

All of the above programs have affiliations with Harvard Medical School, so when you graduate you get a little seal that states you graduated from Harvard Medical School if you care about things like that. As Feli has stated in the above post, Boston attitudes can be a little different. Cambridge has a much lighter atmosphere, whereas MGH and BI can be very structured and rigorous (say like the Podiatry Institute). You'll get great training and great research papers, but it depends on what you want to do afterwards. You will be able to find academic positions after these residencies due to the network that has been in place from prior graduates. Boston is a VERY expensive place to live and a pain in the butt to travel around due to the amount of traffic/weather. But Boston is also a nice city to live in and a very young population lives there. There's a lot of culture and history here.

Just a side note, Boston Medical Center has a program, but it is a PM&S 24 (two year program). Don't know much about it, but the program director used to be at BI Deaconess over 10 years ago and split up from there and started a podiatry/diabetes care center at BMC. Not sure of it's numbers and I don't know if it will be transitioning into a PM&S 36.

SportPOD and Feli, Thanks for the info!

I know residency is very far away but I was curious to these programs due to the recommendation of my pod mentor. He has a friend who went to either Cambridge/Beth Israel residency and had a great experience. My pod mentor is huge on diabetes and focuses the majority of his practice in this area. Even with the strict scope of NY, he does really well and has excellent rapport with vascular surgeons, endocrinologists, etc. Only about 35 and chief of podiatry in one of the local hospitals along with being president of our county podiatric medical society. Been to private offices, wound care center, and OR with him - amazing experience overall.

About Beth Israel and diabetes, are you talking about doing related surgeries as well (ie charcot reconstruction)? With my shadowing, I've seen a lot of debriding, applications of various antibiotics, apligraf, etc.

 

[SportPOD]

About Beth Israel and diabetes, are you talking about doing related surgeries as well (ie charcot reconstruction)? With my shadowing, I've seen a lot of debriding, applications of various antibiotics, apligraf, etc.

Yes, you will be doing charcot reconstructions involving frames. At BI and Joslin, podiatry is regarded as the authority in limb salvage and works closely with vascular in managing the lower extremity. Wound care is also part of the care of the patient.

 

[SportPOD]

I think it means on your PM & S - 36 certificate granted from Cambridge/Beth Israel/Mass Gen, it will have a Harvard seal attached. This is because all 3 programs are Harvard-affiliated teaching hospitals.

I may be wrong but that seems logical

Exactly. All three of these hospitals are some of the teaching hospitals for Harvard Medical school, since the medical school doesn't have an actual hospital.

 

[Foot Doc]

All of the above programs have affiliations with Harvard Medical School, so when you graduate you get a little seal that states you graduated from Harvard Medical School if you care about things like that.

yeah but keep in mind it is just a seal and won't make or break you to someone in the know

 

[Feli]

yeah but keep in mind it is just a seal and won't make or break you to someone in the know

👍 Bottom line right there^^

The certificates hanging on your wall or the papers you've published don't mean jack when you are at the scrub sink outside the OR. At that point, the only thing that really matters to the patient, the support staff, the residents, etc is your level of competence.

I've seen some fantastic foot surgeons on my travels this year, and I watch videos of others. IMO, to be adequate, you need to do a lot of surgery and know anatomy. To be good, add in a confident personality and some experienced teachers during residency who can show you veteran technique tricks and diagnostic pearls that you can take away. If you want to be great, add in a LOT of personal hard work and preparation (reading the night before, practicing on cadavers, studying the anat/path over and over, etc). To be amazing, you need all that stuff mentioned... plus a natural gift of great hands.

Interesting thread that's somewhat related:
http://forums.studentdoctor.net/showthread.php?t=266313
The Ivy league, and similar, teaching hospitals see a ton of off-the-wall crazy cases and will try cutting edge treatments, but sometimes, they're actually a bit deficient in common cases and overall numbers. Things can also tend to get lost in the shuffle at huge teaching hospitals, and with the many huge egos at most highly academic hospitals, podiatry can struggle to find its place. You will see.

...A pretty smart faculty DPM at Barry told me back when I was a new clinical student that there are basically 2 types of good programs:
1) High academics/research, mediocre numbers: They will say that less academic programs are "underpublished" or "poor technique."
2) High numbers, low/mediocre academics/research: They will simply say the lower numbers programs "can't cut their way out of a paper bag."
(unfortunately, there are also some programs that don't have very good numbers or academics... avoid those at all costs)

Which one do you want? Well, I say that you can always read books/journals at any pod school but can't learn how to treat patients if the clinics are slow. The same goes for residencies IMO... you want high case volume and good numbers. You can always decide to read more or publish if you go to a high numbers program. There is nothing stopping you; if you make it a priority, you will make time. However, you simply cannot find patients to do surgery on if your program doesn't give you enough hands on, and all the research or journal club in the world won't make up for that. JMO...

 

[Foot Doc]

thats right, Seth, VOLUME, VOLUME, VOLUME!!! You can't learn surgery from reading about it......most high volume programs allow you to do as much research as you want to do (which is hard because of the time you spend in surgery).

 

[JEWmongous]

Not sure if this will improve/improved the Mass programs to a great extent. However, the scope of practice for pods was increased like 1-2 years ago due to succesful lobbying in the state. Pods are now allowed to do ankle surgery and I believe soft tissue work of the lower leg. This may help in a sense as you can now have pods teaching you ankle surgery in the OR (in addition to ortho surgeons).

Curious of your thoughts - especially of those who rotated at the 3 PM and S - 36 Boston residencies

 

[Peter59]

most high volume programs

So which hospitals/unis in nation have high volume/case/surgery programs?
Especially in Cali, Mass, NY or MI

 

[Feli]

So which hospitals/unis in nation have high volume/case/surgery programs?
Especially in Cali, Mass, NY or MI

There are a lot of high volume programs. Case diversity and the attendings teaching you also matter, though.

Trauma, elective, diabetic, revisional, etc surgery all have different dissection/handling concerns and different patient expectations. Some people will say that if you can fix a high energy calc fracture or met fracture, then a triple or a bunion should be easy. Other people will say that an ankle or lisfranc fracture just has to have a functional foot again in order to be a "good result," but a bunion or flatfoot has to end up nearly perfect. I honestly don't know who is right.

You have to think about what want... and what you see yourself doing after residency.

 

[jonwill]

Trauma, elective, diabetic, revisional, etc surgery all have different dissection/handling concerns and different patient expectations. Some people will say that if you can fix a high energy calc fracture or met fracture, then a triple or a bunion should be easy. Other people will say that an ankle or lisfranc fracture just has to have a functional foot again in order to be a "good result," but a bunion or flatfoot has to end up nearly perfect. I honestly don't know who is right.

I think you should just do a bunch of all of those cases!!!

 

[jonwill]

thats right, Seth, VOLUME, VOLUME, VOLUME!!! You can't learn surgery from reading about it......most high volume programs allow you to do as much research as you want to do (which is hard because of the time you spend in surgery).

👍

 

[JEWmongous]

There are a lot of high volume programs. Case diversity and the attendings teaching you also matter, though.

Trauma, elective, diabetic, revisional, etc surgery all have different dissection/handling concerns and different patient expectations. Some people will say that if you can fix a high energy calc fracture or met fracture, then a triple or a bunion should be easy. Other people will say that an ankle or lisfranc fracture just has to have a functional foot again in order to be a "good result," but a bunion or flatfoot has to end up nearly perfect. I honestly don't know who is right.

You have to think about what want... and what you see yourself doing after residency.

Hey Feli, if you don't mind me asking, what philly program are you externing at now? (Penn Presby, Temple, etc). You can PM if you want.

 

[Feli]

Hey Feli, if you don't mind me asking, what philly program are you externing at now? (Penn Presby, Temple, etc). You can PM if you want.

I did 3wks at Penn Presby... finished last Friday.

It's a good program if you're the type of student who likes comprehensive medical management of inpatients; they often admit their own patients under podiatry and just consult medicine (it's the opposite most other places). They do some cutting edge surgery and have some attendings who like to try new stuff (implants, ex-fix, biologics, etc). The main drawing points are some famous attendings and fact that it's affiliated with an Ivy League medical school. The pod service there is under the umbrella of general surgery, and that's a lil unique (most other programs are on their own or under ortho dept). For that reasoning, Presby gets relatively little ortho trauma but great gen surg rotations (plastics, vascular, peds hand surgery, etc).

I was planning on visiting a couple other Philly programs, but the city just didn't impress me at all. I think Temple, Frankfurt, Drexel, Crozer, etc are also solid ones if you like the Philadelphia area. Again, it's all a matter of what you want, though.

 

[JEWmongous]

I did 3wks at Penn Presby... finished last Friday.

It's a good program if you're the type of student who likes comprehensive medical management of inpatients; they often admit their own patients under podiatry and just consult medicine (it's the opposite most other places). They do some cutting edge surgery and have some attendings who like to try new stuff (implants, ex-fix, biologics, etc). The main drawing points are some famous attendings and fact that it's affiliated with an Ivy League medical school. The pod service there is under the umbrella of general surgery, and that's a lil unique (most other programs are on their own or under ortho dept). For that reasoning, Presby gets relatively little ortho trauma but great gen surg rotations (plastics, vascular, peds hand surgery, etc).

I was planning on visiting a couple other Philly programs, but the city just didn't impress me at all. I think Temple, Frankfurt, Drexel, Crozer, etc are also solid ones if you like the Philadelphia area. Again, it's all a matter of what you want, though.

Did that count as one of your externships or was it during vacation time? Also, about patients, what is it like at most places (consult vs pod manages themselves)?

Thanks