Office Based residencies

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jedimaster

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Hi! A podiatrist came to speak to our school yesterday and he mentioned an idea about having residency programs based out of offices instead of hospitals to help with the residency shortage. He mentioned how a lot of community hospitals are closing due to financial issues. For example during a month radiology rotation he stated that you could go to a radiologists office and work there for the month, and gain the same exposure to various pathologies as in a hospital. I am curious as to what you think of this idea?
 
Hi! A podiatrist came to speak to our school yesterday and he mentioned an idea about having residency programs based out of offices instead of hospitals to help with the residency shortage. He mentioned how a lot of community hospitals are closing due to financial issues. For example during a month radiology rotation he stated that you could go to a radiologists office and work there for the month, and gain the same exposure to various pathologies as in a hospital. I am curious as to what you think of this idea?

Medicare will not fund an office based type residency. Running a residency is an expensive affair and would require a private doc with very deep pockets to do this.

Also the CPME requires some type of hospital affiliation now to approve a residency. Also, the CPME guidelines require a very limited amount of office time vs. rotations in various medical specialties. I would wonder how a private doc could not only set those up, but make sure the residents get the required amount of patient contacts per rotation.

I guess it is somewhat possible, but would take A LOT of time, money and dedication from one private doc.
 
Although on the surface it may seem like a good idea, this would be taking a giant step backwards for our profession.

Years ago there were preceptorships that allowed graduates to gain exposure by working with practicing DPM's. There were also residencies that were based out of surgical centers and the resident had "outside" rotations to satisfy certain requirements such as emergency medicine, radiology, etc.

However, one (yes only one) of the reasons that podiatric residencies should be hospital based is to maintain parity with the allopathic and osteopathic community. Our profession has evolved over the years from no residencies and no hospital privileges to 3 and 4 year residency programs and full foot & ankle privileges with great respect from the MD/DO community.

MD's/DO's don't offer "office based" residency programs, nor should we. It would be a huge mistake and giant step backwards, and when grads of these programs apply for hospital privileges it will be mass confusion and destroy any "parity" that we have attempted to create over the past decades.

In my opinion, it is a very feeble attempt at a fix and is not an acceptable answer. Part of the educational process is to learn the hospital system, hospital protocol, interaction of the hospital departments, staff, etc. For most young docs, they will eventually be providing some level of service in a hospital setting, whether it be consults, surgical care, ER care, etc., and they need to be familiar with the in's and out's of a hospital environment and hospital protocol, and that must be learned via hands on experience, hospital rotations, etc. That can not be learned in an "office based" residency.
 
Although on the surface it may seem like a good idea, this would be taking a giant step backwards for our profession.

I agree 1000%
 
Although on the surface it may seem like a good idea, this would be taking a giant step backwards for our profession.

Years ago there were preceptorships that allowed graduates to gain exposure by working with practicing DPM's. There were also residencies that were based out of surgical centers and the resident had "outside" rotations to satisfy certain requirements such as emergency medicine, radiology, etc.

However, one (yes only one) of the reasons that podiatric residencies should be hospital based is to maintain parity with the allopathic and osteopathic community. Our profession has evolved over the years from no residencies and no hospital privileges to 3 and 4 year residency programs and full foot & ankle privileges with great respect from the MD/DO community.

MD's/DO's don't offer "office based" residency programs, nor should we. It would be a huge mistake and giant step backwards, and when grads of these programs apply for hospital privileges it will be mass confusion and destroy any "parity" that we have attempted to create over the past decades.

In my opinion, it is a very feeble attempt at a fix and is not an acceptable answer. Part of the educational process is to learn the hospital system, hospital protocol, interaction of the hospital departments, staff, etc. For most young docs, they will eventually be providing some level of service in a hospital setting, whether it be consults, surgical care, ER care, etc., and they need to be familiar with the in's and out's of a hospital environment and hospital protocol, and that must be learned via hands on experience, hospital rotations, etc. That can not be learned in an "office based" residency.

I agree that pod residency should be hospital based and the idea of office based residencies are nothing more than preceptorships of the past, but...

I just wanted to mention that Family Practice (where I did residency anyway) was "based" out of the hospital but the 1st year was an intern year with all the specialty and medicine rotations required, then in the 2nd and 3rd years they are clinic based except for some hospital call for admissions. I their clinic, they are working up the patient, deciding treatment, and following the patient. Their is an attending when needed, but not every patient is presented to the attending like in podiatry.

If something similar to this could be set up for podiatry it might not be so bad.
 
I agree that pod residency should be hospital based and the idea of office based residencies are nothing more than preceptorships of the past, but...

I just wanted to mention that Family Practice (where I did residency anyway) was "based" out of the hospital but the 1st year was an intern year with all the specialty and medicine rotations required, then in the 2nd and 3rd years they are clinic based except for some hospital call for admissions. I their clinic, they are working up the patient, deciding treatment, and following the patient. Their is an attending when needed, but not every patient is presented to the attending like in podiatry.

If something similar to this could be set up for podiatry it might not be so bad.


Krabmas,

This is true, but in essence has always been the "model" for many family practice residencies. However, podiatry has made tremendous strides to move away from this model.

Additionally, as you also may acknowledge, the vast majority of family practitioners no longer admit to the hospital, and utilize hospitalists for their patients requiring "in-patient" services. Therefore they spend little if any time in the hospital. Family docs now rarely if ever admit to the hospital unless they are in a very rural area (yes I know there are always exceptions, but I'm referring to the majority), family docs don't get called to the ER, family docs don't perform surgical procedures at the hospital and family docs usually don't receive consultations.

It's for all those reasons that I believe it's imperative that podiatric residency training remain hospital based.
 
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