How does quality of residency training impact employment?

[deleted1003403]

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[GreenHousePub]

No one cares. It doesn't matter. Good business training is the best type of training you can get in residency, as well as good networking. An ortho group job is not a holy grail of jobs. I wouldn't take one if I was looking. Neither is being "hospital based."

This gets posted a lot.

 

[deleted1003403]

No one cares. It doesn't matter. Good business training is the best type of training you can get in residency, as well as good networking. An ortho group job is not a holy grail of jobs. I wouldn't take one if I was looking. Neither is being "hospital based."

This gets posted a lot.

Thanks for the response.

 

[G0dFather]

No one cares.

It doesn't matter.

Good business training is the best type of training you can get in residency, as well as good networking.

An ortho group job is not a holy grail of jobs. I wouldn't take one if I was looking.


Neither is being "hospital based."

This gets posted a lot.

WOW!.... These five sentences are POD LIFE ! totally agree , couldn't have said it better and more concise

 

[CutsWithFury]

No one cares. It doesn't matter. Good business training is the best type of training you can get in residency, as well as good networking. An ortho group job is not a holy grail of jobs. I wouldn't take one if I was looking. Neither is being "hospital based."

This gets posted a lot.

Are you in practice?

 

[deleted585480]

Are you in practice?

Do you disagree with him

 

[CutsWithFury]

Do you disagree with him

Jobs with ortho and hospital are 9/10 superior situations than the classic DPM associate job. The poster would know that if they actually were working and not typing from a computer in their resident room or from their apartment at school.

The only people who would disagree are “successful” private practice OWNERS

Majority (not all) of the usual suspects/ talking heads on the ACFAS lecture circuit are employed by hospitals and ortho groups.

 

[G0dFather]

Jobs with ortho and hospital are 9/10 superior situations than the classic DPM associate job. The poster would know that if they actually were working and not typing from a computer in their resident room or from their apartment at school.

The only people who would disagree are “successful” private practice OWNERS

Majority (not all) of the usual suspects/ talking heads on the ACFAS lecture circuit are employed by hospitals and ortho groups.

Yes i agree with this... what he makes is the caveat that comes with what was said above, being employed by a hospital or ortho group is way more beneficial and STABLE than working as an associate for a pod office/group .. there is no debate or comparison

 

[DYK343]

Ortho/Multispecialty/Hospital are probably the best positions

Owning your own practice I have no experience in but I know it can be lucrative

Podiatry associate "with option to buy in" I have no experience in but no thanks. Hard pass.

 

[GreenHousePub]

Are you in practice?

Yes, for a hospital.

 

[theconzumer]

I've heard some great offers from the "lesser respected" programs from some residents in great areas to live like DC metro etc for high 100ks to low 200k. Most of the NYC programs and North Jersey programs I know graduates state that is about the ball park offers they got. I've heard higher offers from other programs in different states but these are some solid offers.

 

[CutsWithFury]

Yes, for a hospital.

Then what’s your problem?

 

[dtrack22]

So.. better residency = better chance at getting the ortho group job everyone wants?

It certainly can. But there is plenty of "luck" and timing involved that I personally wouldn't stress about it if I was an "average" student. One of the docs we worked with in residency was a partner in an ortho group and he did a VA program that did not necessarily offer great training. An ortho group in an area he wanted to be in just happened to be open to hiring a podiatrist to do their foot and ankle. Dumb luck.

Personally, i feel like sure i want to be exposed to as much as possible in residency so i can be the best doctor/surgeon possible. Obviously, only time we really get to learn how to be surgeons. But how many people are coming out of these top residency programs and doing all these complicated surgeries?

That should be your goal. Be realistic with where you clerk. Whether it is fair or not, as other posters who know who I am can attest, my former program would not rank you in the top 2,3,4 (which is about the furthest we ever fell on our rank list) being middle of the road in terms of class rank. There are plenty of programs that offer good to great training that do not care about academics (or can't afford to be picky). Check out the residency reviews, reach out to posters here, most importantly speak with current 4th years or previous ones from your own school. You'll find that there are "big name" programs that are generally disliked once students actually clerk, and then there are places few people have heard about that offer a lot of hands on experience, autonomy, case variety, etc.

In terms of people who graduate from these "top programs" doing "complex surgeries" in practice, the number is certainly lower than many of them would like. But my argument would be, there is no reason you cannot build a practice to where you do complex reconstructions semi regularly. So get the best training you can while in residency because you may just stumble into a position where you have the opportunity to see that kind of pathology. Worst thing that happens is you do something in residency that you don't end up seeing in practice. No harm in that.

 

[GreenHousePub]

Then what’s your problem?

Nothing, just my point being residency/gpa/class rank etc doesn't matter. I got the job through a couple guys I met during school. Besides, other specialties know/care nothing about what our residencies are anyway.

I know plenty of people who went to good programs as well as "fellowship" trained podiatrists working the same associate jobs as everyone else.

Our profession is mainly a business one, and surgical as an aside. Learn business practices and networking.

 

[CutsWithFury]

Nothing, just my point being residency/gpa/class rank etc doesn't matter. I got the job through a couple guys I met during school. Besides, other specialties know/care nothing about what our residencies are anyway.

I know plenty of people who went to good programs as well as "fellowship" trained podiatrists working the same associate jobs as everyone else.

Our profession is mainly a business one, and surgical as an aside. Learn business practices and networking.

Exactly. Ortho/MSG/Hospital jobs can be dumb luck. I have seen some hospital gigs specifically looking for “fellowship” trained DPMs. I’ve seen some fellowship trained DPMs just work for a private practice podiatry practices. I know for a fact that fellows in some of the more respected” fellowships have recruiters that send them job postings not published to the masses.

 

[ExperiencedDPM]

Jobs with ortho and hospital are 9/10 superior situations than the classic DPM associate job. The poster would know that if they actually were working and not typing from a computer in their resident room or from their apartment at school.

The only people who would disagree are “successful” private practice OWNERS

Majority (not all) of the usual suspects/ talking heads on the ACFAS lecture circuit are employed by hospitals and ortho groups.

Ha, I know many of these people personally and the reason they aren’t in private practice is because they couldn’t/didn’t make it on their own.

 

[G0dFather]

Ha, I know many of these people personally and the reason they aren’t in private practice is because they couldn’t/didn’t make it on their own.

Probably because they couldn't come to terms finding out that everything but surgery pays in podiatry and not every person with a pedal deformity is so inclined to go under the knife for an elective surgery LOL ... many let ego limit their income potential aside from those that just couldnt run a business

 

[CutsWithFury]

Ha, I know many of these people personally and the reason they aren’t in private practice is because they couldn’t/didn’t make it on their own.

Couldn’t make it on their own lying to patients that they need steroid injections and custom orthotics for their heel pain?

Couldn’t make it on their own because the private practice owner’s wife wouldn’t give them their productivity numbers and they got short changed?

Couldn’t make it on their own because the private practice owner convinced the patient that they needed surgery. A surgery that they couldn’t do themselves so they make you, the associate, do it. Freeing them from all liability...

Couldn’t make it on their own because the private practice owner pushes toenail biopsies, debridement under anesthesia, or forces you to use hardware that they are part owner in?

These are all classic private practice scenarios that occur today.

It has nothing to do about not making it on your own. It has everything to do with not wanting to be associated with a crooked profession and practicing podiatry the way it should be practiced.

 

[air bud]

Couldn’t make it on their own lying to patients that they need steroid injections and custom orthotics for their heel pain?

Couldn’t make it on their own because the private practice owner’s wife wouldn’t give them their productivity numbers and they got short changed?

Couldn’t make it on their own because the private practice owner convinced the patient that they needed surgery. A surgery that they couldn’t do themselves so they make you, the associate, do it. Freeing them from all liability...

Couldn’t make it on their own because the private practice owner pushes toenail biopsies, debridement under anesthesia, or forces you to use hardware that they are part owner in?

These are all classic private practice scenarios that occur today.

It has nothing to do about not making it on your own. It has everything to do with not wanting to be associated with a crooked profession and practicing podiatry the way it should be practiced.

This.

There is nothing I like more than to be a tell a patient they don't need custom orthotics, that they can relieve their problems with 30 bucks spent on some powersteps and replace every 1-2 years.

 

[heybrother]

Here's my different take on your training and future - your greatest danger is that you will be taught a bunch of podiatry hokum that does not work and that will serve your patients poorly. You'll then be doomed to a life of telling people its fine as you stare at your bad outcome and ultimately blame the patient or the dressing or just how tricky the whole thing was to begin with. Gotta spend time in clinic to see your wins and your fails and you have to be willing to call your fails what they are when you see them. My joke about 4th year is that its a year of people putting up X-rays that look like crap saying "what do you think" and the only thing most of them want to hear is "that's great".

Sort of trying to stay vague.. 2 years ago I went to ACFAS and saw that event where they head to head 2 attendings over someone else's crappy X-rays and the inevitable complication and crap show that results. The starting and worsening disaster (and unfortunately even the "heroes" plans) is what I think we produce way too much of.

 

[ldsrmdude]

This.

There is nothing I like more than to be a tell a patient they don't need custom orthotics, that they can relieve their problems with 30 bucks spent on some powersteps and replace every 1-2 years.

Sort of related anecdote. About a year into practice, I had a patient on my schedule for "custom orthotics." When they got there they told me they needed a new set of custom orthotics and their old orthotics refinished. Apparently they hadn't been wearing their custom orthotics because they were worn out and it had been about 6 months since they had worn them. They said they weren't having any problems, no pain, but had been told by their previous podiatrist that they would have to wear custom orthotics all the time for the rest of their lives. I asked why he thought he needed the orthotics now if his feet weren't hurting and he was having no problems without the orthotics. His only answer was that he had been told in the past he would always need them. I felt bad for him because he had been saving up for the past 6 months until he could afford the orthotics, all the time just convinced his feet were only minutes away from falling apart and causing severe pain. I think I even felt bad enough that I didn't charge him an office visit and gave him his copay back. He followed up with me about another problem like a year later, still super happy he didn't need orthotics and still having no problems without them.

 

[DYK343]

I went to a quality residency and got a good job.
My friends (and co-residents) went to a quality residency and got a good job.

It does matter IMO. Not required but it certainly helps. I 100% brought up my surgical logs and case numbers to show what I am trained to do during my interview. I suspect that helped me get the job I have today.

 

[JAJE]

Anecdote-
I was a far below average student academically (you could say bottom of the barrel and I wouldn't disagree) but I was above average socially. I communicate well, I'm a team player, I recognize others hard work, and I work hard myself. I landed a good, but relatively unknown residency. My numbers were done in a year. I scrubbed everything from bunions to ilizarov frames to IM nails and TAR. I truly went above and beyond in residency with my approach to learning (learning surgery, clinical knowledge, billing, etc). I passed ABFAS boards confidently. I didn't feel the need to pursue fellowship for additional training or as a "resume booster". I interviewed with an orthopedic practice, a hospital and successful private practice groups. I got the job I wanted (the one in the best location with the best pay and the most potential).

So, to answer your question. If you get an average residency what happens? You work your tail off. You go to every single case knowing every step of the surgery, you never just "show up". You never slack off in clinic. You actively look for something new to learn from every patient. You go to skills courses and augment any skills which are lacking at your residency. You go above and beyond so that your attendings trust you enough to hand you the knife early on. When the time comes to find a job, you look really hard. You cold call with confidence the places where you want to work. You know exactly what value you will bring to the table and you sell them on that. The best jobs are often "right time right place", and theres more to that than just chance. I can tell you how I was the only one on the list for the ortho job and on the short list for the hospital and private practice jobs.

There's a great book called Skill by Christopher Ahmed. He's a renowned orthopedist who trained at a residency that was in the bottom 10% as far as surgical numbers go. However, his approach to his training put him on a path to become a highly sought after surgeon with a CV that any doctor would envy. Read it, and wherever you go, squeeze every bit you can out of residency and don't be passive about your job hunt.

At the end of the day your employer will want to know that you are confident, capable, sociable, ethical, reliable and ready. That will be far more important than the name of the institution on your residency diploma.

 

[air bud]

Anecdote-
I was a far below average student academically (you could say bottom of the barrel and I wouldn't disagree) but I was above average socially. I communicate well, I'm a team player, I recognize others hard work, and I work hard myself. I landed a good, but relatively unknown residency. My numbers were done in a year. I scrubbed everything from bunions to ilizarov frames to IM nails and TAR. I truly went above and beyond in residency with my approach to learning (learning surgery, clinical knowledge, billing, etc). I passed ABFAS boards confidently. I didn't feel the need to pursue fellowship for additional training or as a "resume booster". I interviewed with an orthopedic practice, a hospital and successful private practice groups. I got the job I wanted (the one in the best location with the best pay and the most potential).

So, to answer your question. If you get an average residency what happens? You work your tail off. You go to every single case knowing every step of the surgery, you never just "show up". You never slack off in clinic. You actively look for something new to learn from every patient. You go to skills courses and augment any skills which are lacking at your residency. You go above and beyond so that your attendings trust you enough to hand you the knife early on. When the time comes to find a job, you look really hard. You cold call with confidence the places where you want to work. You know exactly what value you will bring to the table and you sell them on that. The best jobs are often "right time right place", and theres more to that than just chance. I can tell you how I was the only one on the list for the ortho job and on the short list for the hospital and private practice jobs.

There's a great book called Skill by Christopher Ahmed. He's a renowned orthopedist who trained at a residency that was in the bottom 10% as far as surgical numbers go. However, his approach to his training put him on a path to become a highly sought after surgeon with a CV that any doctor would envy. Read it, and wherever you go, squeeze every bit you can out of residency and don't be passive about your job hunt.

At the end of the day your employer will want to know that you are confident, capable, sociable, ethical, reliable and ready. That will be far more important than the name of the institution on your residency diploma.

Awesome story. Also last sentence is the truth.

 

[ExperiencedDPM]

Couldn’t make it on their own lying to patients that they need steroid injections and custom orthotics for their heel pain?

Couldn’t make it on their own because the private practice owner’s wife wouldn’t give them their productivity numbers and they got short changed?

Couldn’t make it on their own because the private practice owner convinced the patient that they needed surgery. A surgery that they couldn’t do themselves so they make you, the associate, do it. Freeing them from all liability...

Couldn’t make it on their own because the private practice owner pushes toenail biopsies, debridement under anesthesia, or forces you to use hardware that they are part owner in?

These are all classic private practice scenarios that occur today.

It has nothing to do about not making it on your own. It has everything to do with not wanting to be associated with a crooked profession and practicing podiatry the way it should be practiced.

I think you over-reacted and misunderstood my comment. I agree with your associate scenario above.

I’ve been at this a long time and know the players, the thieves, the shakers and movers and the wannabes.

My comment was NOT about an associate getting screwed. It’s about a lot of docs out there who I personally know who had their OWN practice and failed miserably. And now they are the self proclaimed bigshots and experts.

These doctors are my reference.

On a side note, my partners often busted my stones at partner meetings since I was the lowest “producer” in the practice regarding custom orthoses. The vast majority of my patients obtained relief with a quality OTC device.

The resolution? I told them to all F themselves and walked out of the meeting. They were so busy worrying what we could sell next and how we can make more money, rather than any concern about how we can provide higher quality care.

 

[dtrack22]

The vast majority of my patients obtained relief with a quality OTC device.

And the literature says this should be the case. Which is why more and more commercial plans have total exclusions on L3000...

Lots of podiatrists and chiropractors ruining it for the rest of us