Orthopedic Residency Interview

[RPC2011]

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My question pertains to the interview process. I have received an invite for consideration and an interview for particiaption within a orthopedic residency. I was wondering if anyone on here had experience with a residency or the interview process?

 

[engmedpt]

Why are you doing a residency instead of just applying to ortho jobs?

Is it a competitve clinic or will you just be getting an accelerated bunch of letters after your name that you would get normally practicing and most likely being more competent with time?

Are you positive that will get good clinical instruction and the "perks" the residency promises or is there the possibility that you're going to get hired as a full time worker accepting a 30k salary to your employers benefit only?

Some things to think about....

 

[engmedpt]

I see residencies going in one of two directions:

A model that is much more structured and mandatory to reflect the medicine model in order to get professionals more trained experience before screening for injuries outside of their scope of practice which would hopefully raise the respect and renown of the degree which has a. long way to go or

Two: It becomes a model employers will use to go ahead and acquire cheap labor without hiring the individual and then passing them off for new residents every year just like the abusive pharmacy residency. This would require oversaturation

 

[Sheldon]

Here's my take: if you have the opportunity to do a residency, do a residency. There are really two types: 1) In-house programs. Some may already be doing what ENGMEDPT described in "Direction Two" above my post. 2) Hybrid program - on-line coursework mixed with week-long and/or weekend intensives. Then, you travel for your 1:1 mentored hours or your residency instructor/s travel to you. Ideal for the resident who likes/loves where he or she is geographically and does not want to move for a year and lose a good job.

I've seen PTs with OCS that haven't done a residency and those that have. While recent research (albeit small and extremely limited in what exactly was measured - Rodgehero in JOSPT) does not support residency-trained clinicians as far as outcomes versus others, I beg to differ and I've seen this in 6 clinics already. Mentors are out there, but a good mentor willing to actually take time outside of his or her schedule is a difficult find.

Other thoughts: 1) It's not about the letters. It's what it took to get those letters, to actually earn those letters. Any credential doesn't make the clinician; it is truly about the process, THE JOURNEY.
2) Don't expect a pay-raise after completion of residency and board-certification. Again, don't do it for the money. Do it because you want to learn from clinicians that were in your shoes before, who've made mistakes, and who've learned from those mistakes. Do it because you want to deliver top care to your patients.
3) I'm not aware of any residency (in-house program) that pays 30K. If such is the case, then know you are truly cheap labor.
4) How much TIME do you have to practice to become a better clinician without having done a residency or, at the very having been mentored very well? Practicing the same way you did for the 1st year after graduating for the next 9 years is not experience, it's re-living the same 1st year of practice for 10 years (cant' remember who said that but someone at a conference did recently). Seen "Groundhog Day?"

The OP and anyone else is free to PM with any questions.

 

[engmedpt]

I'm not aware of any residency (in-house program) that pays 30K. If such is the case, then know you are truly cheap labor.

All the ones Ive seen are this bad. It is employer abuse of a model that will not benefit the student UNLESS the intrinsic knowledge and instruction of the program gives the reward for being a better clinician. This is where the problem is:

a good mentor willing to actually take time outside of his or her schedule is a difficult find.

How is a grad supposed to find this? He/she can't. It's a gamble. That's why I'm frustrated about this residency model currently which students are already turned off by from their debts.

Thank you for your long reply. I've tried discussing this before.

While recent research (albeit small and extremely limited in what exactly was measured - Rodgehero in JOSPT) does not support residency-trained clinicians as far as outcomes versus others, I beg to differ and I've seen this in 6 clinics already

Can you please expand on this? The lack of evidence for the benfits is disconcerting and it seems the only thing to pull from is direct, observed product from clinicians such as yourself. What specifically in your six clinics have you noticed? Thought process? People skills? Better time and stress management? Problem solving?

Also, are you familiar with when the residency model was first started? Was it in the same year as the DPT?

 

[Sheldon]

All the ones Ive seen are this bad. It is employer abuse of a model that will not benefit the student UNLESS the intrinsic knowledge and instruction of the program gives the reward for being a better clinician. This is where the problem is:



How is a grad supposed to find this? He/she can't. It's a gamble. That's why I'm frustrated about this residency model currently which students are already turned off by from their debts.

Thank you for your long reply. I've tried discussing this before.



Can you please expand on this? The lack of evidence for the benfits is disconcerting and it seems the only thing to pull from is direct, observed product from clinicians such as yourself. What specifically in your six clinics have you noticed? Thought process? People skills? Better time and stress management? Problem solving?

Also, are you familiar with when the residency model was first started? Was it in the same year as the DPT?

In regards to resident salaries, a quick search of approved ortho residencies shows salaries from 75-85% of non-resident salaried and licensed PTs. If anyone accepts a residency for 30K a year, that's on them. They've got taken. Do you have a link available that shows this? Or a program in mind?

In regards to mentorship, it is a gamble. Anyone looking for a mentor has to do research, network on social media, attend conferences, be active and likable. Do those things and you are more likely to reap the benefits. Some hybrid residences set you up with the resident instructor that is OCS; others allow you to find one outside of the program.

IMO, some benefits are difficult, if not impossible to measure. That's one problem with the recent study (as well as sample size and many other limitations). During the course of my residency, I worked in a variety of clinics around the country. In these clinics, other residents from other programs were there too. Other clinicians, new grads and established worked in these places too. I've worked with OCS clinicians that did not complete a residency. In ALL the clinics, the residents-in-training or residency-trained clinicians were sought out for their expertise, given challenging patients, and in general (and completely subjective on my end) approached patient care with a different perspective. I observed a lot and had a great opportunity to compare/contrast my residency training with that of others.

The intrinsic benefits outweigh the extrinsic, IMO. I became a better clinician quicker with the tutelage of my residency instructor. And I'd quantify "better" as being more apt to get to the end-result quicker (inductive AND deductive reasoning, prioritizing), way better clinical skills, differential dx skills, and interaction with other healthcare professionals.

I've no complaints about my residency whatsoever. Again, anyone can PM me with any questions.

 

[engmedpt]

Do you have a link available that shows this? Or a program in mind?

Won't publicly state the clinic. However I have a few individuals in mind....at least 2 I know for sure where their salary was that. This is what gave me such an incredible distaste and has influenced my opinion on the subject. The pharmD residency is about 40k and has been cited by multiple pharmD students Ive talked to, some in the forum on this cite. I simply assumed the abuse was prevalent in all residencies, perhaps a little mistakenly. That being said, buyer beware, and be cautious.

The intrinsic benefits outweigh the extrinsic, IMO. I became a better clinician quicker with the tutelage of my residency instructor. And I'd quantify "better" as being more apt to get to the end-result quicker (inductive AND deductive reasoning, prioritizing), way better clinical skills, differential dx skills, and interaction with other healthcare professionals.

^This is something to consider.

 

[RPC2011]

When choosing a residency I made it a point to look for further education in my clinical reasoning skills within a structured environment. Not all residencies are just within your basic orthopedic clinic. I have particularly looking at APTA residency that are within an actual teaching hospital or within a DPT program itself where they are willing to foster an environment for learning to occur, but at the same time allow for independence with clinical decision making. I am willing to give up an extra 12+months if in the end I come out a better clinician then when I started. As of today I have received yet another invite for an interview and I am truly excited about the opportunity to see if each one of these places is the correct fit.

I do agree doing a residency could seem as a waste of 12+months of an increase in pay, but then again I didn't get into the field solely to cash a pay check every week. From my research as well its hard for me to believe that a residency would be paying someone with a doctoral level degree 30k a year. When it comes to the OCS, yes it allows an easier path to earning this specialty, but the letters don't make the PT, it comes back the their clinical reasoning and being able to determine the best treatment options for every patient.

I want to be able to explain why I am doing something with the utmost confidence, and at the same time back it up with current evidence. A huge percentage of the way we treat patients is based on our intuition and how similar patients presented in the past. If a residency can help me with anything I've listed above then by all means I see it as a positive. But I do understand if someone is tired of school and is ready to pay off all the loan debt they've gathered (trust me I have a ton) I can not judge for wanting to begin working immediately. Seven years of school is a lot.

 

[engmedpt]

Best of luck to you then!

 

[Miguel Mendieta]

I am preparing right now for this interview!
I am so nervous, but I am sure i will pass! Also I'd like to thanks all of members of this forum and stuff. I am using a lot of info from it. Also, maybe it will be useful for you, when you are trying to apply for orthopedic residency program. So, I am using this books for preparation for my interview:
The International Medical Graduate's Guide to Us Medicine and Residency Training
Write Your Way to a Residency Match
101 Tips to Getting the Residency You Want: A Guide for Medical Students
The Residency Interview; How to make the best possible impression
US Residency Programs: Guide to Application

Suggest some other good books, if you have!
Good luck for all applicants!

 

[AlanWattsBlues]

For the interested, here is a link to the study that compares fellows vs. residency-trained vs. plain old schlubs.

http://www.jospt.org/doi/abs/10.2519/jospt.2015.5255

It seems like folks who have been through a residency speak highly of having gone through a residency, but I have to wonder how much cognitive dissonance plays a role in this. Also, there's a great deal of self-selection going on here...folks who want to get into a residency, are accepted into a residency and complete it are likely not your average PT--which is why the results from the JOSPT article above are so difficult for me to reconcile.

I'd like to be an OCS within a couple years of practicing (< 6 months to graduation now). I've thought I'll just get a job, work with a lot of patients, carry around the book Orthopedic Physical Therapy Secrets, work my way through the Ortho section's Current Concepts study course and flip through JOSPT on a regular basis. Then take the test after a year or so and see what happens. If that "works" with a pass on the test, I wonder if I'll come out the other side and speak highly of the benefits of taking the autodidact route? I wonder if my outcomes with patients will be any different?

To be clear, I don't mean any disrespect to residency trained folks or their decisions.

FWIW.

EDIT: I realize this is off topic from the OPs original question. It was more just a personal reflection. Apologies for the tangent.

 

[btjack22]

For the interested, here is a link to the study that compares fellows vs. residency-trained vs. plain old schlubs.

http://www.jospt.org/doi/abs/10.2519/jospt.2015.5255

It seems like folks who have been through a residency speak highly of having gone through a residency, but I have to wonder how much cognitive dissonance plays a role in this. Also, there's a great deal of self-selection going on here...folks who want to get into a residency, are accepted into a residency and complete it are likely not your average PT--which is why the results from the JOSPT article above are so difficult for me to reconcile.

I'd like to be an OCS within a couple years of practicing (< 6 months to graduation now). I've thought I'll just get a job, work with a lot of patients, carry around the book Orthopedic Physical Therapy Secrets, work my way through the Ortho section's Current Concepts study course and flip through JOSPT on a regular basis. Then take the test after a year or so and see what happens. If that "works" with a pass on the test, I wonder if I'll come out the other side and speak highly of the benefits of taking the autodidact route? I wonder if my outcomes with patients will be any different?

To be clear, I don't mean any disrespect to residency trained folks or their decisions.

FWIW.

EDIT: I realize this is off topic from the OPs original question. It was more just a personal reflection. Apologies for the tangent.

Hi Alan,

I've thought about this route and would like to hear how that worked out for you!

 

[Smash Atoms]

Soooo some thoughts....

I have seen some pretty not great resident trained PTs and FAAOMPTS (still sighting the SIJ or talking axial torsion, yikes!), and some non-OCS non resident trained, non fellowship PTs who excel (and are teaching courses for nationally recognized providers). Ive also seen some brilliant fellows and former residents. Just like everything in the clinical world - it depends

Some benefits - for younger students/clinicians, the residencies seem pretty good at streamlining how to objectively perform an exam, improve clinical reasoning, and expand on differential diagnosis skills. Exposure to multiple clinicans in certain residencies can be a big benefit, and some offer some pretty cool and unique experiences like spending time with surgeons, ER trauma teams, or major sports teams.

Draw backs: Where I am yet to see a resident that excels (sans having an existing strength training background) - is actually understanding how to progress patients. I see a lot of residents (and FAAOMPT PTs) keeping patients on the table waaay too long, or doing nifty "PT" "core stability" exercises (like weight shifts with neutral pelvis, etc...)... which more or less ignores basic fundamental principles of loading tissues and progressive overload: IE diminishing returns and shortened results... There is also a frequent over medicalization or excessive emphasis on pathoanatomic diagnosis from many residents I have met, which at the end of the day really doesnt matter a whole hell of a lot (in most instances).

I am also just an n=1, so take the above for what it is. I am currently self studying for OCS and taking CEU courses that align with my beliefs and interests (as well as with companies who favor keeping up with evidence), and in lieu of directed 1:1 for an hour a week (or whatever the residency allows), I regularly speak to people within a pretty robust network I have developed to get multiple (sometimes conflicting and sometimes overlapping - another issues with residencies and fellowships) responses to various questions or clinical issues.

 

[PTAide2DPT]

Why are you doing a residency instead of just applying to ortho jobs?

Ditto. I've done some brief reading on residency programs and for the life of me, I can't see the appeal. Add an additional stressful year of school after 7 years of education and make less money than your peers. Where do I sign???!!!

They seem to advertise these residencies with this aura of prestige and those who participate earn clout on their resumes. But I haven't found any that guarantee a salary increase. Now if it was similar to an apprenticeship where you're offered a position with great pay and benefits, I'd be interested.

 

[RPC2011]

Ditto. I've done some brief reading on residency programs and for the life of me, I can't see the appeal. Add an additional stressful year of school after 7 years of education and make less money than your peers. Where do I sign???!!!

They seem to advertise these residencies with this aura of prestige and those who participate earn clout on their resumes. But I haven't found any that guarantee a salary increase. Now if it was similar to an apprenticeship where you're offered a position with great pay and benefits, I'd be interested.

It's very interesting returning to this forum and seeing a post I made over 7 years ago still garnering responses. I will say looking back completing a residency was 100% the right choice and went directly in line to what my professional goals were at the time. I have no reservation that it had a profound affect on my professional and clinical development as a new-grad clinician as I reflect back those several years ago. It gave me the capability to position myself in a role within a health system that fosters education and development. Am I biased towards post-professional education, i.e residency and fellowship, absolutely! But it's because of how much I've seen those who decide to pursue residency evolve into expert clinicians and future leaders of the profession.

You are correct post-professional education is not for everyone. But as is when searching for your first job as a new graduate there a pros and cons to all settings. Pay for residents has absolutely improve compared to 5 years ago. Residents should expect to make at a minimum 80% of what a starting clinician makes, but this also comes with health benefits, 401k, reimbursement for travel/lodging, conference registrations, exam application fees, etc (based on programs researched). When all this is taken into account and compared to a flat yearly rate, it can come close to what some starting therapist may make in their first job. Once I completed residency, I 100% leveraged this when negotiating my salary and it did have an effect on what I was making 1 yr out of residency compared to my counterparts.

Again, I'm not writing this for or against residency as I have many colleagues who did not go through residency and are excellent clinicians. I can only speak from my one perspective and experience. I would be happy to speak to anyone on these forums about post-professional education and the pros/cons associated with them.

Best,

Ryan

 

[oldmanDPT69420]

Why do a residency when insurances don’t care and reimburse your units you bill the exact same as a new grad?

 

[PTAide2DPT]

I wish we could hear from those who are willing to admit that their residency was a waste of time and money. We've heard from those who've completed a residency and defend the decision. However, I'm sure there are many experiencing buyer's remorse and feel that all of the skills they learned could have easily been self-taught and discovered working as a staff employee, while not earning 75¢ on the dollar.

Maybe it's my own cynicism but you can't convince me that residencies are in the best interest of the residents when there is such a huge pay-gap. 4-7+ years of higher education is MORE THAN ENOUGH time to establish yourself as a worthy clinician. I respect those magnanimous residents who believe that it's not about the money and are willing to take a pay cut in the belief that it'll make them a better PT. But I feel that you're doing yourselves and the profession a disservice by having your income set so low during a residency. My student loans haven't placed me in a position to ignore my rightful compensation.

I would love to hear those who now realize they bought the lemon that is PT residencies so others aren't taken advantage of in the future.