Ortho Jobs the Best?

[MaxillofacialMN]

This topic is mentioned in the residency thread, but it sounds like people don't want to talk about it there so I thought I'd open an avenue for it here. What are your thoughts? Is landing an ortho job after residency the ultimate goal of pods?

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[jahnke07]

This topic is mentioned in the residency thread, but it sounds like people don't want to talk about it there so I thought I'd open an avenue for it here. What are your thoughts? Is landing an ortho job after residency the ultimate goal of pods?

My ultimate goal is diabetic wound care

 

[Ferocity]

My ultimate goal is winning the lottery or marrying money.

 

[jahnke07]

My ultimate goal is winning the lottery or marrying money.

 

[PADPM]

After speaking with current residents, I don't believe landing an ortho job is the holy grail for all grads.

There are certainly advantages to an ortho job. The most obvious is that these positions often offer almost staggering starting salaries. To some it's also a prestige factor. Many ortho groups are very large entities and there is the possibility that the pod will become a shareholder and benefit from other streams of income generated by othe modalities. These can include ownership in surgical centers, MRI/radiology facilities, physical therapy/rehab, etc.

That's not to say that some pod groups don't also offer similar opportunities, but that's the exception, not the rule.

Many pods who join ortho groups no longer truly practice "podiatry" and to some that's a pro and to some it's a con. I know pods who work for ortho groups who now basically do nothing but surgery, and some who work for ortho groups that do NO surgery, and the surgery is performed by foot and ankle orthopods. The pod acts almost as a built in referral source or triage point for the foot and ankle orthopod to perform surgery.

Working for an orthopod group, it's pretty much a given you will rarely if ever be the boss. But once again, as long as the paycheck is good, many could care less.

Some enjoy the full spectrum of care from treating a badly infected ingrown nail to performing major surgeries. For these people, a more traditional pod practice would be the best choice.

There is no easy answer. It depends on your training, your goals and your needs. Every situation differs and there is no one right or wrong answer.

I know of several DPMs who worked for ortho groups and eventually left when it did not meet their expectations. Two of them told me the same thing......they came to the realization that in each particular case, they felt they would always be the low man on the totem pole and never obtain the full respect of the orthopods in the group.

 

[ManUnderFire]

so, speaking in general terms, is it possible to have full spectrum within an ortho group?

 

[PADPM]

so, speaking in general terms, is it possible to have full spectrum within an ortho group?

I'm sure it's possible, but none I know practice the full scope. As I stated, I know some who treat sprains, strains, fractures and surgical cases. And I know of a very large ortho group who has several foot and ankle orthopods and about 3 DPMs. The DPMs perform NON surgical care, and are even discouraged from giving injections.

 

[ManUnderFire]

I'm sure it's possible, but none I know practice the full scope. As I stated, I know some who treat sprains, strains, fractures and surgical cases. And I know of a very large ortho group who has several foot and ankle orthopods and about 3 DPMs. The DPMs perform NON surgical care, and are even discouraged from giving injections.

Ouch! I suppose the benefit to these type of practices is pay-as in being paid top buck to do scut work that nobody else wants to do?

 

[air bud]

My ultimate goal is winning the lottery or marrying money.

Ferocity, do you ever contribute something useful? Maybe once don't chime in with something like this.


As PADPM said, there are pros and cons to ortho groups as well as other types.

PADPM - Do you believe there will be an overall trend towards either hospital employment / ortho group and away from pod groups / solo practice? This has been a takeaway from many of the programs I have visited. This is obviously a small sample size though.

 

[Ferocity]

Ferocity, do you ever contribute something useful? Maybe once don't chime in with something like this.


As PADPM said, there are pros and cons to ortho groups as well as other types.

PADPM - Do you believe there will be an overall trend towards either hospital employment / ortho group and away from pod groups / solo practice? This has been a takeaway from many of the programs I have visited. This is obviously a small sample size though.

Cry more please.

 

[PADPM]

Ouch! I suppose the benefit to these type of practices is pay-as in being paid top buck to do scut work that nobody else wants to do?

I'm not sure if I would refer to it as "scut" work. This orthopedic group is one of the most successful in the country. They have a system that works for them, and that system includes NON surgical podiatry. I personally would go crazy being thought of so minimally that I was expected to send ALL surgical pathology to the foot/ankle orthopods in the group.

If a patient has a fracture, he is referred to the cast technicians. If the patient has a biomechanical problem amd needs a brace or orthoses, he is sent to the orthotist in the practice. If a patient needs PT, he is referred to the PT dept. If a patient needs surgery, he is sent to the foot/ankle orthopod. In this particular practice, the DPM seems to function as a triage nurse. I'm sure a PA, NP can perform these functions, but the business model of this practice is to have all providers be doctors.

I'm not sure I can respect these DPM's, but they've chosen their path for their own reasons, and it doesn't impact me. On the other hand, they don't get called in for emergencies, the docs in our practice do (one of my partners did an emergency amp today/Sunday), they don't work nights, our doctors do, they never work on weekends, our doctors do. They don't go to the hospital for rounds or consults, our doctors do........so maybe they ARE the smart ones. It's just a way of practice that doesn't interest me..

They basically work 9-5 daily, with no major stress and no major responsibilities, while having the ability to boasts that they are part of a very prestigious group.

 

[ldsrmdude]

so, speaking in general terms, is it possible to have full spectrum within an ortho group?

The director and assistant director at one of the programs I visited were part of an ortho group and both practiced full-scope (well, I think 1 only did forefoot surgery, but that was by choice/training).

As far as ortho group jobs are concerned, if you are thinking that you want an ortho group job, try to pick a residency that has you scrub with ortho F&A attendings frequently. I don't think that things are swinging entirely from pod groups. I think things are going away from solo practices (although I know some that are in solo practice and are making a killing). I think that the majority of podiatrists will be in podiatry groups for quite some time. I know you were asking PADPM, but I figured I would throw in my 2 cents as well.

 

[PADPM]

PADPM - Do you believe there will be an overall trend towards either hospital employment / ortho group and away from pod groups / solo practice? This has been a takeaway from many of the programs I have visited. This is obviously a small sample size though.

Interesting question. I still believe that hospital opportunities are minimal, so I'm not convinced that's a trend that will change soon, though the number of positions are on the rise.

Many who work for hospitals end up not so enamored. Hospitals don't hand out money and your numbers must justify your salary. The "suits" often dictate how you practice and hire/fire office staff. You are an employee, no more or no less. If you don't produce they will replace you with someone who does. Hours can also be long with house coverage, ER coverage, etc.

Orthopedic jobs are presently the hot commodity for the perceived prestige, and generous starting salaries and of course the thought of having a primarily surgical practice.

If everyone trends this way, podiatry as we know it will be a dinosaur. Diabetics still need palliative care. Patients still have huge amounts of non surgical pathology.

HOWEVER, it's a fact that there are only a finite number of orthopedic spots available. And not everyone is cut out to be a surgeon, And that includes those with excellent training. Not everyone has the skills or dexterity to be good at surgery, despite the residency. You can't make chicken salad out,of chicken ****. If you're not skilled, that's tough to change.

In my opinion there are certain skills that can't be learned. My son has always been a very competitive high level soccer player (division 1). When he was pretty young he was scouted by a professional coach (coached in the MLS and Scotland) and he was looking for young talented players to move up the ranks, similar to the way it's done for Manchester United.

He had my son scrimmage with players 2 years older (at that age it's a big deal) and much bigger. After the session, he told me he'd like to take over training my son (I had been training him since I also played Div 1 soccer). He told me that my son had traits you can't teach.........1) speed, 2) balance and 3) tenacity, and that's why he wanted him for training.

Similarly, some graduates of prestigious programs are sadly going to realize they're simply not good surgeons and don't have what it takes.

And of course there is the fact that there are those with poor skills and poor training and those who are at the bottom of the class, etc. I doubt those grads will be working for orthopods.

So for a while the orthopod jobs will be hot, but as slots get filled and become more sparse, the spots will become harder to get and more competitive. After all, not everyone can have a good,looking girlfriend, even though everyone wants one (or two.......).

 

[PADPM]

The director and assistant director at one of the programs I visited were part of an ortho group and both practiced full-scope (well, I think 1 only did forefoot surgery, but that was by choice/training).

As far as ortho group jobs are concerned, if you are thinking that you want an ortho group job, try to pick a residency that has you scrub with ortho F&A attendings frequently. I don't think that things are swinging entirely from pod groups. I think things are going away from solo practices (although I know some that are in solo practice and are making a killing). I think that the majority of podiatrists will be in podiatry groups for quite some time. I know you were asking PADPM, but I figured I would throw in my 2 cents as well.

My interpretation of the question may have differed. When I think of "full scope" I think of everything from mycotic nails to major surgery, and that how I answered. So your director who may have the full scope of surgery available at the orthopod practice, is he practicing the full scope of podiatry??

 

[ldsrmdude]

My interpretation of the question may have differed. When I think of "full scope" I think of everything from mycotic nails to major surgery, and that how I answered. So your director who may have the full scope of surgery available at the orthopod practice, is he practicing the full scope of podiatry??

I don't think our interpretation differed. I did mean that the 2 pods I was talking about do full-scope podiatry, from nails to wounds to reconstructive surgeries. I just brought up the surgery aspect of it because the 1 only does forefoot surgery - in addition to wounds, nails, orthotics, etc.

I would agree that when most students/residents think of working in an ortho group they are usually thinking of a mostly surgical practice.

 

[ManUnderFire]

Interesting question. I still believe that hospital opportunities are minimal, so I'm not convinced that's a trend that will change soon, though the number of positions are on the rise.

Many who work for hospitals end up not so enamored. Hospitals don't hand out money and your numbers must justify your salary. The "suits" often dictate how you practice and hire/fire office staff. You are an employee, no more or no less. If you don't produce they will replace you with someone who does. Hours can also be long with house coverage, ER coverage, etc.

Orthopedic jobs are presently the hot commodity for the perceived prestige, and generous starting salaries and of course the thought of having a primarily surgical practice.

If everyone trends this way, podiatry as we know it will be a dinosaur. Diabetics still need palliative care. Patients still have huge amounts of non surgical pathology.

HOWEVER, it's a fact that there are only a finite number of orthopedic spots available. And not everyone is cut out to be a surgeon, And that includes those with excellent training. Not everyone has the skills or dexterity to be good at surgery, despite the residency. You can't make chicken salad out,of chicken ****. If you're not skilled, that's tough to change.

In my opinion there are certain skills that can't be learned. My son has always been a very competitive high level soccer player (division 1). When he was pretty young he was scouted by a professional coach (coached in the MLS and Scotland) and he was looking for young talented players to move up the ranks, similar to the way it's done for Manchester United.

He had my son scrimmage with players 2 years older (at that age it's a big deal) and much bigger. After the session, he told me he'd like to take over training my son (I had been training him since I also played Div 1 soccer). He told me that my son had traits you can't teach.........1) speed, 2) balance and 3) tenacity, and that's why he wanted him for training.

Similarly, some graduates of prestigious programs are sadly going to realize they're simply not good surgeons and don't have what it takes.

And of course there is the fact that there are those with poor skills and poor training and those who are at the bottom of the class, etc. I doubt those grads will be working for orthopods.

So for a while the orthopod jobs will be hot, but as slots get filled and become more sparse, the spots will become harder to get and more competitive. After all, not everyone can have a good,looking girlfriend, even though everyone wants one (or two.......).

Deviating from the main topic...I absolutely agree that while you can't make a sprinter out of everyone because of individual genetic ceiling's, you can still teach someone to be faster, stronger, jump higher, and even be smarter. What separates a great/excellent player from a good player isn't athleticism; it's their decision making. And even this trait can be taught to some extent. What lacks in soccer (and sport in general) is for mentors to take the time to foster talent (as I alluded to in another thread). But it seems your son is in good hands

But your statement about residents graduating from top programs and still being sub-par baffles me. Who passes them? On what grounds? What do these graduates do when they realize all their surgical training is worth diddly-squat?

 

[air bud]

Deviating from the main topic...I absolutely agree that while you can't make a sprinter out of everyone because of individual genetic ceiling's, you can still teach someone to be faster, stronger, jump higher, and even be smarter. What separates a great/excellent player from a good player isn't athleticism; it's their decision making. And even this trait can be taught to some extent. What lacks in soccer (and sport in general) is for mentors to take the time to foster talent (as I alluded to in another thread). But it seems your son is in good hands

But your statement about residents graduating from top programs and still being sub-par baffles me. Who passes them? On what grounds? What do these graduates do when they realize all their surgical training is worth diddly-squat?

It happens. You can only give somebody the tools to be successful

 

[PADPM]

It happens. You can only give somebody the tools to be successful

Exactly. It doesn't mean these people are dangerous or incompetent. It simply means they may lack the dexterity or other traits.

Yes, decision making is extremely important, but so are the skills to implement those decisions.

 

[PADPM]

. But it seems your son is in good hands

Ha, that was a long time ago. Since that time he played all over the country when he was young playing for the team put together by this trainer coach. He played for several leagues during his "career" and played for a prestigious club team (has produced national/olympic team players) while also playing for his high school team. He then played for a well known Division 1 team and graduated last year. He's pursuing his master's degree in his field, and although he's still playing when possible, his "official" soccer career is done. So that trainer was a LONG time ago, but it led to good places. I miss those days.

 

[ManUnderFire]

Ha, that was a long time ago. Since that time he played all over the country when he was young playing for the team put together by this trainer coach. He played for several leagues during his "career" and played for a prestigious club team (has produced national/olympic team players) while also playing for his high school team. He then played for a well known Division 1 team and graduated last year. He's pursuing his master's degree in his field, and although he's still playing when possible, his "official" soccer career is done. So that trainer was a LONG time ago, but it led to good places. I miss those days.

Means a lot to dad's...I know. Mine sent my bro to play in South America many years ago since their style of play suited his more.

My brother is now an engineer

 

[PADPM]

Means a lot to dad's...I know. Mine sent my bro to play in South America many years ago since their style of play suited his more.

My brother is now an engineer

As a dad it does mean a lot. I was a pretty decent player, and my son had a soccer ball on his feet earlier than the average kid. I had him playing organized soccer when he was 4. He loves the game so it made it easier. I arranged my schedule so I literally missed one game until he was in high school. Even in HS I made most games. College was a different story due to the distance. I wouldn't change a thing, and I enjoyed watching him play all year round, including winter ball.

And similar to your brother, my son is an engineer. His school offered to pay his tuition to come back for his master's and he is also receiving a stipend to be a TA and to do research. So I'm finally off the hook regarding tuition.

BTW, sorry that this is personal and off topic. Just a proud dad.

 

[ManUnderFire]

As a dad it does mean a lot. I was a pretty decent player, and my son had a soccer ball on his feet earlier than the average kid. I had him playing organized soccer when he was 4. He loves the game so it made it easier. I arranged my schedule so I literally missed one game until he was in high school. Even in HS I made most games. College was a different story due to the distance. I wouldn't change a thing, and I enjoyed watching him play all year round, including winter ball.

And similar to your brother, my son is an engineer. His school offered to pay his tuition to come back for his master's and he is also receiving a stipend to be a TA and to do research. So I'm finally off the hook regarding tuition.

BTW, sorry that this is personal and off topic. Just a proud dad.

my dad played junior-national in Mexico; tried to get my bro and I to play soccer for the longest time. I started at 9 while my brother started at 12. Although I had the physical talent, my brother had natural leadership and 'vision'-a real thinker on the pitch. He could've went far if he really wanted to. My dad mourned a long time when my brother decided to call it quits. We still play recreationally, even on the same team which is great, but my memories of having my parents on the sidelines still brings a smile to my face.

Sounds like your son is in a good place now-flying tuition free isn't too shabby either. If I could donate a kidney in place of getting my folks to co-sign a loan, I would do it!

But we digress ...I'm starting to forget what this thread was even about!

My plan is to land a general scope residency and then get a surgical fellowship should I feel the need to apply for an ortho job. Thoughts?

 

[air bud]

my dad played junior-national in Mexico; tried to get my bro and I to play soccer for the longest time. I started at 9 while my brother started at 12. Although I had the physical talent, my brother had natural leadership and 'vision'-a real thinker on the pitch. He could've went far if he really wanted to. My dad mourned a long time when my brother decided to call it quits. We still play recreationally, even on the same team which is great, but my memories of having my parents on the sidelines still brings a smile to my face.

Sounds like your son is in a good place now-flying tuition free isn't too shabby either. If I could donate a kidney in place of getting my folks to co-sign a loan, I would do it!

But we digress ...I'm starting to forget what this thread was even about!

My plan is to land a general scope residency and then get a surgical fellowship should I feel the need to apply for an ortho job. Thoughts?

You are a pre-pod, so I understand why you might make a statement like this. However, your statement makes very little sense. Get to school, hit the books hard, make friends with upper classman, wait as this whole process plays out, then you will look back at this statement and laugh. I have actually looked back at some of my posts and laughed as well. Oh to be young again...

 

[ManUnderFire]

You are a pre-pod, so I understand why you might make a statement like this. However, your statement makes very little sense. Get to school, hit the books hard, make friends with upper classman, wait as this whole process plays out, then you will look back at this statement and laugh. I have actually looked back at some of my posts and laughed as well. Oh to be young again...

hmmm...I suspect that history will repeat itself and that I will look at my posts in 2-3 yrs time and wonder what the heck I was thinking. No sense in 'pretending' I know what I'm talking about just to save face on an anonymous message board; afterall, there is no better place to ask all the silly questions that come to mind without the fear of being patronized, supposedly.

Of course, trends, ideals, and environments change over the years but assumption, lack of information, and tackling problems as they come without the slightest bit of anticipation is how we end up in circumstances we often regret. So I'm open to any/all advice...every little bit helps.

My situation is different than most, being a non-US citizen. I have been told by upperclassmen and adcoms alike that I need to be searching for residencies ASAP since my options are limited. It 'seems' that a fellowship is a viable supplemental option, from what I read on SDN.

 

[air bud]

hmmm...I suspect that history will repeat itself and that I will look at my posts in 2-3 yrs time and wonder what the heck I was thinking. No sense in 'pretending' I know what I'm talking about just to save face on an anonymous message board; afterall, there is no better place to ask all the silly questions that come to mind without the fear of being patronized, supposedly.

Of course, trends, ideals, and environments change over the years but assumption, lack of information, and tackling problems as they come without the slightest bit of anticipation is how we end up in circumstances we often regret. So I'm open to any/all advice...every little bit helps.

My situation is different than most, being a non-US citizen. I have been told by upperclassmen and adcoms alike that I need to be searching for residencies ASAP since my options are limited. It 'seems' that a fellowship is a viable supplemental option, from what I read on SDN.

Sorry, let me be more constructive here. It is good that you know that some of your options will be limited. I honestly know nothing about the troubles non-citizens deal with in regards to residencies. However, this places even more importance on your grades and your performance in school. For the next 2 years, you focus should be on studying for school, not worrying about residency.
What I meant earlier by "let the process play out is this" - You will slowly learn more about podiatry and how residency and the profession work. It takes time to get a better understanding and a lot of it can only be realized first hand. You can only prepare for it so much.
Anyways, back to putting yourself in the best position for residency. If there are 500 residencies out there and you are only eligible for 500 -x residencies, the number one thing you can control is your performance in school. That will trump anything else you can possibly do at this stage.
Fellowships have been discussed on here a lot, there are some good threads. Fellowships in podiatry are not like fellowships in medicine. They are limited in number. They are mostly only available to a select number of residents that come from "above average" programs. OK, maybe it is like medicine...What I mean is that you do not do a "general" podiatry residency like MD's do a internal medicine residency then specialize via fellowship. Again, this will all be more clear when you get to school and start talking to people and dealing with upperclassmen and residents and attendings.

 

[ManUnderFire]

Sorry, let me be more constructive here. It is good that you know that some of your options will be limited. I honestly know nothing about the troubles non-citizens deal with in regards to residencies. However, this places even more importance on your grades and your performance in school. For the next 2 years, you focus should be on studying for school, not worrying about residency.
What I meant earlier by "let the process play out is this" - You will slowly learn more about podiatry and how residency and the profession work. It takes time to get a better understanding and a lot of it can only be realized first hand. You can only prepare for it so much.
Anyways, back to putting yourself in the best position for residency. If there are 500 residencies out there and you are only eligible for 500 -x residencies, the number one thing you can control is your performance in school. That will trump anything else you can possibly do at this stage.
Fellowships have been discussed on here a lot, there are some good threads. Fellowships in podiatry are not like fellowships in medicine. They are limited in number. They are mostly only available to a select number of residents that come from "above average" programs. OK, maybe it is like medicine...What I mean is that you do not do a "general" podiatry residency like MD's do a internal medicine residency then specialize via fellowship. Again, this will all be more clear when you get to school and start talking to people and dealing with upperclassmen and residents and attendings.

My experiences on SDN tell me that too much information is tedious to read and so less people/shorter messages come back to me. So, to be concise, I divulge information as it becomes more pertinent. My need to be prepared often times turns into paranoia . I apologize. But, like I said, every bit of info is much appreciated.

 

[Temperature101]

Interesting question. I still believe that hospital opportunities are minimal, so I'm not convinced that's a trend that will change soon, though the number of positions are on the rise.

Many who work for hospitals end up not so enamored. Hospitals don't hand out money and your numbers must justify your salary. The "suits" often dictate how you practice and hire/fire office staff. You are an employee, no more or no less. If you don't produce they will replace you with someone who does. Hours can also be long with house coverage, ER coverage, etc.

Orthopedic jobs are presently the hot commodity for the perceived prestige, and generous starting salaries and of course the thought of having a primarily surgical practice.

If everyone trends this way, podiatry as we know it will be a dinosaur. Diabetics still need palliative care. Patients still have huge amounts of non surgical pathology.

HOWEVER, it's a fact that there are only a finite number of orthopedic spots available. And not everyone is cut out to be a surgeon, And that includes those with excellent training. Not everyone has the skills or dexterity to be good at surgery, despite the residency. You can't make chicken salad out,of chicken ****. If you're not skilled, that's tough to change.

In my opinion there are certain skills that can't be learned. My son has always been a very competitive high level soccer player (division 1). When he was pretty young he was scouted by a professional coach (coached in the MLS and Scotland) and he was looking for young talented players to move up the ranks, similar to the way it's done for Manchester United.

He had my son scrimmage with players 2 years older (at that age it's a big deal) and much bigger. After the session, he told me he'd like to take over training my son (I had been training him since I also played Div 1 soccer). He told me that my son had traits you can't teach.........1) speed, 2) balance and 3) tenacity, and that's why he wanted him for training.

Similarly, some graduates of prestigious programs are sadly going to realize they're simply not good surgeons and don't have what it takes.

And of course there is the fact that there are those with poor skills and poor training and those who are at the bottom of the class, etc. I doubt those grads will be working for orthopods.

So for a while the orthopod jobs will be hot, but as slots get filled and become more sparse, the spots will become harder to get and more competitive. After all, not everyone can have a good,looking girlfriend, even though everyone wants one (or two.......).

Lol....