Hiring fellowship trained DPMs for PP (associate/partner/etc)

[Feli]

Yes, for hospitals or MSG jobs, they'll tend to prefer fellowship-trained (and most of them don't even understand our fellowships or our hugely variable residency quality). The exception is if the podiatry fellow grad costs/wants significantly more... or if the non-fellowship grad did a significantly better residency (DPM screening applications, which is typically the case). Typically, the DPM(s) already working there at the org job doesn't care the salary of the new hire... they simply want less call and/or they even want new hire pay fairly high - to support their own pay rate.

However, in the real world, the vast majority of DPMs work in private practice after training. This was true, and it is true. Yes, there are more MSG/hospital/ortho DPMs then ever, but there are also just more DPMs practicing then ever - particularly "foot and ankle surgeon" types (grows every year... more grads than DPMs retiring). PP is still the significant majority.

So, the question is: would you be more or less likely to hire a DPM with a fellowship for PP employ (associate, partner) assuming residency and other personality or ties to the area or etc factors were equal? This is ideally asked to PP owners, partners (which we have more than a few of on SDN)... but of course anyone will answer. Try to think in terms of a PP owner/partner view... obviously looking for value of employee, potential longevity of employ, skill set, possible future partner.

Cycling associates is costly in terms of training, patient continuity and reputation, referral doc reputation, and potentially supplying/starting competitor DPM offices, particularly where there are not non-compete laws in place for docs.

...For me personally: I'd be less likely to hire a DPM who did a fellowship (assuming same residency/personality). A few reasons:

• most good residencies give plenty of skill for most/all PP pathology (so they'd have had no need for fellowship, be realistic)
• if they did fellowship, they'll likely want more salary (when they've shown nothing, have no real added value/skill)
• if they did fellowship, decent chance their residency was fairly inadequate (fellowship adds time and opportunity cost onto student loans)
• if they did good residency AND good fellowship, they are 95% chance not a PP type (would be looking to leave from day 1)
• one of the most common reasons to do a pod fellowship is didn't find a MSG/hospital job pgy2/3 (so they'd just keep looking to leave)
• fellowship tilts needle more to "SURGEON," and most PPs simply don't need that "finding" surgery (see that even with 3yr pods, obviously)

Thankfully, I'm unlikely deal with this decision. I'm in an area the size where an associate/partner is unlikely to ever make sense (area only supports about 1.0-1.5 full time DPMs), so I'd only be looking at buyout/transition someday... unlikely hire an employee. It's interesting times right now, though... mix of applications for most jobs between good 3yr trained, crummy 3yr, crummy 3 yr + fellowship, good 3yr + fellowship... maybe even dual fellowship ppl now?

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[Hybrocure]

The type of patients who walk into a private practice do not generally require a fellowship skill set unless you’re doing call.

Symptomatic rearfoot need for surgery is rare for a regular office. And the frequency that it happens is not enough to keep your skills sharp IMO. Sure you can try to sell a fusion for every arthritic boomer there for nails and calluses but you shouldn’t.

I’ve found by and large fellows have that surgeon mentality and in a PP setting not only will they not find an abundance of complicated cases but they will also likely be actively job searching while they work for you.

A friendly podiatrist who has good social skills, is happy to be where they are at and likes lobster work is the ideal PP hire. Essentially you want an NPC as an associate. Having a cocky type A gunner working for you just sounds like a ticking time bomb IMO.



Also, I am that lobster 🦞

 

[Adam Smasher]

If I could, I would hire an associate without residency training.

Hell, I could teach a high school graduate how to do outpatient podiatry.

Sorry, it's not that complicated.

 

[Dermato Fight Club]

If I could, I would hire an associate without residency training.

Hell, I could teach a high school graduate how to do outpatient podiatry.

Sorry, it's not that complicated.

Yup. Seriously go through my schedule daily and think that my MA could handle 90% of this. I feel like we are ridiculously overtrained for what we actually handle

I went to to a good residency and and got good training but don't use 90% of the skills I learned in private practice. Maybe some of that is on me but it can't be all on me. I feel like the demand just isn't there for foot and ankle surgery that we are currently supplying.

 

[Hybrocure]

Yup. Seriously go through my schedule daily and think that my MA could handle 90% of this. I feel like we are ridiculously overtrained for what we actually handle

I went to to a good residency and and got good training but don't use 90% of the skills I learned in private practice. Maybe some of that is on me but it can't be all on me. I feel like the demand just isn't there for foot and ankle surgery that we are currently supplying.

PP in a nutshell:

Nails/calluses
Ingrowns
Ankle sprain
Forefoot fx = cam boot
rare: painful bunion for surgery
Random aches and pains that time heals
PF
Achilles tendinitis

 

[HardRoadPaved]

I feel like we are ridiculously overtrained for what we actually handle

A good third of patients have bad genetics and the rest need to stop thinking sketchers and fit flop make quality "shoe gear"

 

[MicroPod]

Majority of patients are easy but there is that 5-10% that need something more. I have had quite a few patients with complex issues coming in lately. Most recently I had a CRPS, Avascular necrosis of the talus, patient with neglected ankle fracture now healed in bad alignment. Also recently had a suspicion a patient may have Cushings disease that I referred to endocrinology.

I think many kind of doctors would say most of what they do is pretty straight forward, it’s the 5-10% that benefit from our residency training knowledge.

 

[MortonExtension]

If I could, I would hire an associate without residency training.

Hell, I could teach a high school graduate how to do outpatient podiatry.

Sorry, it's not that complicated.

Dispense powerstep inserts and 50% of patients are better

 

[Flip-flop-flerpity]

Dispense powerstep inserts and 50% of patients are better

50% of the time it works everytime

 

[619]

I agree with what everyone has said above. Day to day podiatry stuff is mostly straight forward and easy going. The occasional 5-10% that need something more can easily be referred out for treatment after making the diagnosis. Most folks here will make 100% of the diagnosis that comes into our office but then you don't have to treat everything. I don't want to deal with any pathology that will keep me up at night.

Hiring a fellowship trained doc most times ends up in disaster, job dissatisfaction, resentment and quitting early. The newly minted fellowship trained doc believes cases will just fall at his/her feet from day one. They want to be in OR all day doing so called "big cases" but the reality of PP is not the same. So they get frustrated with their employer when they are in clinic seeing regular stuffs like nails, ingrown, heel pain etc which we folks in PP enjoy. I want to fill up my schedule with regular podiatry pathology. Fellowship training does not prepare you for that. Sad but true.

If you are a PP owner, the only reason a fellowship trained pod is applying to your practice is because he/she has reached the end of the road. He/she has applied to all the hospital jobs or MSG around the entire country (not just your state or county) and did not get anything so they decide to face their faith and apply to your PP.

If in the future I decide to bring on an associate and I have a choice between a fellowship trained doc and a residency trained doc from an average program. My choice is obvious on who to hire.

If I could pick 2 then I will pick

• hey'd want more $$$ when fellowship adds little/nothing​

• LESS likely ... fellowship pod is more likely to try to leave for a different job
  

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[podwho]

Many go into fellowship because the job market sucks so they rather go to big city program paying 80-90k full benefits which is financially the same as a 120k gig, porbably more. Gives them more leverage in the job market and time to network while really not taking a financial loss. I'd argue its probably worth it over a 150k dead end no benefits job. I have found it easy to tell which person did fellowship beacuse they had no other options vs needed it vs wanted it.

 

[MicroPod]

There are fellowships out there that are just through private practice docs that are low pay and have little to no benefits as well.

Fellowships run through academic medical centers are sure to be better, but also taking away cases from residents usually. We had a fellowship that started while I was a first year resident with docs that do mostly limb salvage. Used to be a really good rotation with lots of hands on for the residents, now they just scrub in and watch the fellow operate for the most part (also depends year to year on the fellow and how much they are willing to let the resident do).

 

[Feli]

Many go into fellowship because the job market sucks so they rather go to big city program paying 80-90k full benefits which is financially the same as a 120k gig, porbably more. Gives them more leverage in the job market and time to network while really not taking a financial loss. I'd argue its probably worth it over a 150k dead end no benefits job. I have found it easy to tell which person did fellowship beacuse they had no other options vs needed it vs wanted it.

Yes, the main podiatry fellowship reasons are now definitely that the pgy2/3 couldn't find a job or that they are angling for a job working for the fellowship sponsor group ("audition" year). It's pretty sad to spend a year trying to get a job that's ROI of less than 1:2 ratio. Many current pod fellowship spots are basically just a clerkship of sorts... but instead of trying for a residency, it's for a job with that Weil group, FASMA, AHN, AFLESR, and tons more.

Fellowships for podiatrists started out being to work with elite attendings and get elite skill (albeit never any new or added cert/specialty), but that sure didn't last long. 😐

 

[bloxxeeey]

It's been diluted severely. Aside from a couple of fellowships, its mostly useless and you'd learn more just practicing than a fellowship and hopefully earn more. But again 100k jobs are very real, and sub 100k jobs are also real. So if you want better benefits a fellowship isn't a terrible idea, I think you may come out similarly financially.

 

[podiatryresident]

It's been diluted severely. Aside from a couple of fellowships, its mostly useless and you'd learn more just practicing than a fellowship and hopefully earn more. But again 100k jobs are very real, and sub 100k jobs are also real. So if you want better benefits a fellowship isn't a terrible idea, I think you may come out similarly financially.

how is your current job ? is it good ?

 

[HappyPodiatrist]

I'll throw my 2 cents on this convo. I'm new to the forum so some background. 2 years out from fellowship. I did a good residency and a good fellowship and am now at a hospital teaching residents. When I discuss fellowships with students and residents I let them know that fellowships are really only worth it if you are 1. Trying to get involved in research/industry/lecture circuit, or 2. Really set on surgical hospital type job. Most of my residents end up getting shifted away from fellowship because they don't have an interest in those career paths. Any students reading this I would highly recommend doing a lot of research to find the good fellowships well in advance of applications. The biggest pitfall I see when we interviewed for fellows was 'last-minute' or 'no-reason' applicants. If you do that, you will end up at a fellowship that is just an associate position for a doc making money off you for a year and not learn anything new or unique. You miss out on salary and beginning your career. Fellowship should add something unique to your CV, not a 4th year of residency.

 

[HardRoadPaved]

The biggest pitfall I see when we interviewed for fellows was 'last-minute' or 'no-reason' applicants.

Our schools bank on this in their applicants as well. Would not expect anything less along the road

 

[Feli]

... I let them know that fellowships are really only worth it if you are ... 2. Really set on surgical hospital type job. ...

I think nearly all DPMs want the podiatry hospital jobs for better salary.
Most don't want the on-call and the workload, but they sure don't want to make $150k in PP after $400k school debt either.
(even the lazy-ish ones want VA, IHS, small rural hospital, etc jobs simply due to better income than PP associate)

The issue is, there are only enough of those DPM hospital jobs for about 10-25% of DPMs, depending on area. We are far outshooting the demand.

Many of the people who do podiatry fellowships are trying to avoid "typical podiatry," as you said...
yet they often end up there anyways (PP or supergroup podiatry associate job). It's a numbers game.

 

[GreenHousePub]

I'll throw my 2 cents on this convo. I'm new to the forum so some background. 2 years out from fellowship. I did a good residency and a good fellowship and am now at a hospital teaching residents. When I discuss fellowships with students and residents I let them know that fellowships are really only worth it if you are 1. Trying to get involved in research/industry/lecture circuit, or 2. Really set on surgical hospital type job. Most of my residents end up getting shifted away from fellowship because they don't have an interest in those career paths. Any students reading this I would highly recommend doing a lot of research to find the good fellowships well in advance of applications. The biggest pitfall I see when we interviewed for fellows was 'last-minute' or 'no-reason' applicants. If you do that, you will end up at a fellowship that is just an associate position for a doc making money off you for a year and not learn anything new or unique. You miss out on salary and beginning your career. Fellowship should add something unique to your CV, not a 4th year of residency.

Wow! At a hospital teaching residents??? When does the transformation into a foot and ankle Surgeon truly begin?

 

[podourology]

I do 6 elective cases a month 5 months out, non electives probably double that. Am I just chiropodist? What cases do you do as a ABFAS Foot/RRA Fellowship pod that I a ABFAS Foot/RRA non-fellow pod cant? I don't push surgery. Don't mind warts or calluses. Ingrown nails are cake and matrixectomies are frosting.

Outside of a smaller city of 100k. Good business, good contract, anticipating making 210-230k Year 1- if my volume continues to increase steadily. Not as good as hospital pod, but I only work 45 hours a week total including call 1 week a month with occasional bedside limb salvage consults.

 

[diabeticfootdr]

Fellowships for podiatrists started out being to work with elite attendings and get elite skill (albeit never any new or added cert/specialty), but that sure didn't last long.

If only one of the certifying boards would listen to you and start some type of specialty certificate.

 

[Retrograde_Nail]

If only one of the certifying boards would listen to you and start some type of specialty certificate.

Specialty certificate for what?

It's called podiatry residency programs are overall terrible if you need an extra piece of paper to say you can manage a diabetic foot infection or not when it should be part of everyone's residency experience.

Just like full spectrum foot and ankle surgery should be apart of everyone's residency experience but it clearly is not because we are diluting the residency experience further with more and more fellowship programs taking away cases from residents and giving to a fellow.

We are no longer progressing. We are regressing with this fellowship phenomenon.

 

[AttackNME]

the best thing we can do for our profession right now is offer a non surgical pathway for those who don’t want to or shouldn’t do surgery

 

[Weirdy]

Those who shouldn't do surgery often don't understand or know or want to admit they shouldn't do surgery.

 

[Bored Snorlax]

What was the original rationale behind implementing a mandatory 3-year surgical residency?

 

[Adam Smasher]

What was the original rationale behind implementing a mandatory 3-year surgical residency?

One of the salient criticisms of podiatry after the turn of the millennium is that there was not consistency amongst providers. How could the public entrust podiatrists with the care of inpatients or surgical procedures on bone when everyone's training up to that point was based on a disparate alphabet soup of post-graduate training, and no one really knew what patients were getting when you went to visit a podiatrist. Could be an elite surgeon, could be a lobster.

To answer this criticism, the people in charge decided 100% of graduates should all get the same elite level of surgical training. The PMSR training program was the brainchild of this. Unfortunately, 15 years later, we have discovered that number of years does not equal quality of training. The cost of becoming a DPM in both years and tuition dollars has outpaced the return on investment.

We can't undo this either. If you invent a "nonsurgical" pathway for podiatrists, it hurts the surgeons because we would again face the criticism that podiatry is made up of a "patchwork of disparate providers." Also 3 years of residency may be on a lot of state's legislation as a prerequisite for licensure. So literal acts of congress would be needed. We've painted ourselves in a corner.

 

[GreenHousePub]

Specialty certificate for what?

To spend extra money on yearly dues, of course.

 

[MicroPod]

the best thing we can do for our profession right now is offer a non surgical pathway for those who don’t want to or shouldn’t do surgery

Knowing what I know now, I may have gone this route and just did good old fashioned lobster podiatry. Surgery is only worth it if you are RVU based.

 

[GreenHousePub]

Knowing what I know now, I may have gone this route and just did good old fashioned lobster podiatry. Surgery is only worth it if you are RVU based.

That's what I did. And my income nearly doubled and my headaches completely disappeared.

 

[Bored Snorlax]

One of the salient criticisms of podiatry after the turn of the millennium is that there was not consistency amongst providers. How could the public entrust podiatrists with the care of inpatients or surgical procedures on bone when everyone's training up to that point was based on a disparate alphabet soup of post-graduate training, and no one really knew what patients were getting when you went to visit a podiatrist. Could be an elite surgeon, could be a lobster.

To answer this criticism, the people in charge decided 100% of graduates should all get the same elite level of surgical training. The PMSR training program was the brainchild of this. Unfortunately, 15 years later, we have discovered that number of years does not equal quality of training. The cost of becoming a DPM in both years and tuition dollars has outpaced the return on investment.

We can't undo this either. If you invent a "nonsurgical" pathway for podiatrists, it hurts the surgeons because we would again face the criticism that podiatry is made up of a "patchwork of disparate providers." Also 3 years of residency may be on a lot of state's legislation as a prerequisite for licensure. So literal acts of congress would be needed. We've painted ourselves in a corner.

Thanks for the summary! Here’s what I’m thinking:

A standardized two-year residency followed by a third year of specialization.

The first two years would provide consistent training in medicine and surgery, ensuring a strong foundation, meeting licensure requirements, and maintaining public trust.

The third year would offer focused training in areas like advanced surgery, diabetic foot care, or sports medicine, balancing core consistency with flexibility for diverse career paths. Let me know your thoughts!

 

[Prehealth1011]

I mentioned this before but if fellowship becomes the standard, I would consider AA (anesthesiology assistant) or PA school. Both are 2 years and the former can easily make 200k+ if you’re in a state where they can practice. I’m IM, relatively poorly paid, and that sounds great even to me.

 

[Adam Smasher]

Well if Anesthesia can invent Anesthesiology Assistants, no reason Podiatry can't invent "Podiatry Assistants" to take on a patient load in a clinic. Because I could really use one of those 10x more than a Fellowship Trained Foot and Ankle Surgeon

 

[diabeticfootdr]

To spend extra money on yearly dues, of course.

CAQ Dues are $0 for Diplomates.