Orthopedic Surgery and Podiatric Surgery

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AlleghenyPOD

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How many of you podiatry students or pod residents interested in specializing in podiatric surgery? Is common to see podiatrists working with orthopedic specialists? Your views etc.

Talk.😎
 
I think we're all interested in being Podiatric Surgeons. It's very common to see Pods working w/ Ortho's.
 
uh ho, now he's gonna say how DO's and MD's look down upon DPM's...as well that surgery is very limited in pod medicine...and that we should have became orthopods instead! 🙄
 
Haha was that a Freudian slip, brahski? :laugh:
Actually, I was just interested on the pod's point of view, thats all.

Hahaha, see you around brahski.
 
Haha was that a Freudian slip, brahski? :laugh:
Actually, I was just interested on the pod's point of view, thats all.

Hahaha, see you around brahski.

Concerning podiatric surgery, all pods are now trained in surgery. All podiatry grads must do a surgical residency and the minimum you can do is 2 years. The majority of students chose to do three years (the difference being that a 2 year residency qualifies you to sit for forefoot surgical boards whereas a 3 year will allow you to sit for forefoot, rearfoot, ankle). Now, whether or not your practice consists of much surgery or not is up to you but you will at least get the training. But if you're planning on working for a multipspecialty or ortho group, you're most likely going to be doing a fair amount of surgery.

I already partially answered your other question. Pods and orthos do work together a lot. Every year, at least one of our residents is hired by an ortho group and there are many offers. On SDN, it seems that there is often the misconception that pod and ortho are at each others throats. I'm sure it is a possibility at some hospitals across the country (as is the case with various specialties) but for the most part, we work well together. You will often find that podiatic surgery is in the ortho dept at hospitals. With the advance in podiatric training, pods are well utilized. You'll be hard pressed to find any general orthopod that will touch the foot. And even with F&A ortho, from my experience, they generally only do the rearfoot trauma stuff. There are always exceptions but I'm sure most would agree that in the medical community, when it comes to foot and ankle surgery, pods are the experts. Not to mention those poor orthopods have enough to worry about!
 
How many of you podiatry students or pod residents interested in specializing in ...
I say it all the time, but podiatry is already a specialty.

Like almost any pod student you'll meet, want to be a comprehensive F&A specialist. No, not everyone will use all of their training, but you want to be able to experience it all so you have a base of knowledge for nearly any podiatry related complaint. Also, having comprehensive pod training also lets you then decide if and how to sub-specialize. Some residency programs are certainly known more for one thing or another (trauma surgery, diabetic limb salvage, pediatric surgery, elective surgery, sports med, etc etc etc).

Basically, one prof I respect broke podiatry down into 4 main branches like this:

1) Bone and joint - This is the classic podiatric bone fracture repairs or deformity correction surgery... bunions, hammertoes, midfoot, STJ, ankles, etc. It also encompasses the arthritis and joint sepsis arena. This is stuff pods might choose to team with radiologists, rheumatologists, orthopedists (esp F&A or pediatric), etc on.

2) Soft tissue - This is essentially the "sports medicine" branch of tendons, bursa, fascia, ligaments and the sprains, strains, etc which plague them. These complaints involve using a lot of the biomechanics knowledge that pod education prides itself on.

3) Derm - This is your skin and nail pathology such as infection, lesions, disorders, etc. This is huge and difficult since a lot of skin diseases present differently or late in their course when they show up in the foot. For these cases, pods might work with infectious disease docs, pathologists, oncologists, etc.

4) Vascular - This is the wound healing, peripheral arterial disease, diabetes, limb salvage, etc stuff. This is the part of the pod specialty where you team up with vascular and plastic surgeons quite a bit... as well as infectious disease.

Of course, you also work with the patient's PCP on almost any of those, but most pod cases fall into one or a combo of those categories.

There are other categories of pod specialization like pod pediatrics, pod radiology, pod path, F&A orthoses, etc which some DPMs become very well known for, but most of the pathologies they see will still fall into one of those 4 main cats.
 
Thanks Feli and Jonwill. 👍
 
uh ho, now he's gonna say how DO's and MD's look down upon DPM's...as well that surgery is very limited in pod medicine...and that we should have became orthopods instead! 🙄
I'd say GL on being at the tip top of a med school class and scoring the 90+ percentile on USLME. There might be just a couple other MD and DO students who are thinking of ortho also 😉

Pod is one of medicine's best specialties and a relly well kept secret IMO. You will see this firsthand once you start, and you will especially notice once you get into rotating through different specialties as a clinical student and resident. Every specialty has its ups and downs, but the well trained and hardworking DPMs have about the best and most interesting life I could ever imagine in medicine. Seriously.

As was said, pod and ortho certainly aren't a dog eat dog competition. Their scope overlaps, but there's no reason not to work as a team and do what's best for the patient. With all of the treatment options, journals, and advancing techniques out today, nobody knows it all. It's a team approach where you want to utilize each specialist's strengths.
 
Thanks Feli and Jonwill. 👍

Great forum question and great answers... any current practitioners or attendings want to comment? It would be nice to hear about how relevant this question is to their practice.
 
Great forum question and great answers... any current practitioners or attendings want to comment? It would be nice to hear about how relevant this question is to their practice.

In my Podiatry group practice, my group have a great working relationship with Orthopedics at my hospital. We get referrals from all of the Orthopedic groups at my hospital. Due to great relationship with Orthopedics, the residents at my hospital also benefit from this relationship.
 
Great forum question and great answers... any current practitioners or attendings want to comment? It would be nice to hear about how relevant this question is to their practice.

Where I live we have six (soon to be seven) podiatrists and four F&A orthopods in a city of 75,000, and competition is very fierce. I wish I could say we all have a nifty relationship but when there's only so much pie to go around people are not exactly holding hands singing Kumbaya. Three of the F&A Orthopods are in a practice that is notorious for trying to put other groups out of business (literally). One of them even went on a local tv news show to say that "podiatrists have only one or two years of training after college."

Add to that four separate businesses that specialize in custom orthotics (not even counting the Physical Therapy clinics that also do so) and the hospital's nurse-run Foot Care Clinic, and you can see that we need to pull on the jockstraps and put in the mouth guards.

The only Ortho referral I've ever gotten was from a non-F&A orthopod from a rural town two hours from here for a patient with a bunion. Even that Orthopod does his own bunion surgeries occasionally, but somehow he found me.

Nat

Edit: Before someone misinterprets what I wrote as being gloom & doom specifically for podiatry, note that this level of competition exists here for all other specialties except for a few subspecialties that have only one or two docs in town (Vascular Surgery, Intensive Neonatology, Infectious Diseases, Allergy).
 
^ You forget neurosurgery, cardiothoracic surgery, dermatology, gastroenterology, proctology, gynecology, nephrology, endocrinology, neurology, rheumatology, and hematology. Well, in my view that is.

Interesting perspective on competition...😉
 
^ You forget neurosurgery, cardiothoracic surgery, dermatology, gastroenterology, proctology, gynecology, nephrology, endocrinology, neurology, rheumatology, and hematology. Well, in my view that is.

Interesting perspective on competition...😉

I was referring specifically to my city. We have numerous neurosurgeons, dermatologists, gastroenterologists, OB/GYNs, rheumatologists, and endocrinologists, and therefore they face stiff competition.

I've never actually met someone who called himself a proctologist. Does that term still exist?
 
I was looking around at various sites and found these two soutnern doctors. If you read their bios, they say 2 year residency, yet they also say foot and ankle board certified. I don't get it. Some of you guys were saying you have to do a 3 year residency to do rear foot/ankle. Just wondering...

Nice website, though...
http://www.texasfootdoctor.org/staff.php
 
I was looking around at various sites and found these two soutnern doctors. If you read their bios, they say 2 year residency, yet they also say foot and ankle board certified. I don't get it. Some of you guys were saying you have to do a 3 year residency to do rear foot/ankle. Just wondering...

Nice website, though...
http://www.texasfootdoctor.org/staff.php

Most of the 3 year residencies are recently institutionalized; podiatrists say 10+ years ago didn't have to go through a 3 year residency. As an example, one podiatrist that I shadowed went to OCPM back in the late 1980s and went through a 2 year residency---and practices only general podiatry; basic wound care, diabetic care etc---and stays away from the surgical aspect.

Natch: Yea competition is everywhere, thanks for the personal info, btw.
 
I was referring specifically to my city. We have numerous neurosurgeons, dermatologists, gastroenterologists, OB/GYNs, rheumatologists, and endocrinologists, and therefore they face stiff competition.

I've never actually met someone who called himself a proctologist. Does that term still exist?

The term proctologist is an outdated term, physicians that specialize in diseases and disorders of the rectum, anus, colon, and pelvic floor are now called colorectal surgeons. Its a subspecialized field, colorectal surgery, and many MDs need to be certified by the ABCR (American Board of Colon and Rectal Surgery) while DOs need to be certified by the AOBP (American Osteopathic Board of Proctology) after finishing the 4 year General Surgery residency.
 
I was looking around at various sites and found these two soutnern doctors. If you read their bios, they say 2 year residency, yet they also say foot and ankle board certified. I don't get it. Some of you guys were saying you have to do a 3 year residency to do rear foot/ankle. Just wondering...

Nice website, though...
http://www.texasfootdoctor.org/staff.php

Some of the older podiatrists (graduated before around 2000ish) did not have an option of completing a 3 year residency. The 3 year residency is fairly new only being around since about 2000 (please correct the date if you know it).

Many of the programs that are listed as 2 years really took 3 years to complete though due to having to complete a year of primary podiatric medicine and/or orthopedics first (PMR or POR). The surgical residencies were then called PSR - podiatric surgical residency. Most PSRs required successful completion of a POR or PMR and some were set up as pyramids.

There are also podiatrist that have been in practice for so long that they may not have completed a residency at all or only 1 or 2 years and are rearfoot and ankle coard certified because they have been grandfathered in.

Now it is required to complete a 3 year PM&S residency to be able to sit for the rearfoot and ankle boards.

There is one other thing that I would like to explain...

Being board certified does not all the sudden give you the ability or power to do any surgery within the foot and ankle that you would like. There are surgeons in podiatry and other specialties that are not board certified (maybe board qualified, maybe not) that do surgery all the time. It depends on the hospital by-laws and surgy centers that you wish to work in for what is required to practice surgery. As a high profile example Dr. Rey (plastic surgeon on Dr. 90210) is not board certified and does surgery on people all the time. He is board qualified though.

What ever it is that you become certified, just make sure that when you actually practice you only do things that you are confident doing. It is OK to try new things but ask for help when needed.
 
Some of the older podiatrists (graduated before around 2000ish) did not have an option of completing a 3 year residency. The 3 year residency is fairly new only being around since about 2000 (please correct the date if you know it).

Many of the programs that are listed as 2 years really took 3 years to complete though due to having to complete a year of primary podiatric medicine and/or orthopedics first (PMR or POR). The surgical residencies were then called PSR - podiatric surgical residency. Most PSRs required successful completion of a POR or PMR and some were set up as pyramids.

There are also podiatrist that have been in practice for so long that they may not have completed a residency at all or only 1 or 2 years and are rearfoot and ankle coard certified because they have been grandfathered in.

Now it is required to complete a 3 year PM&S residency to be able to sit for the rearfoot and ankle boards.

There is one other thing that I would like to explain...

Being board certified does not all the sudden give you the ability or power to do any surgery within the foot and ankle that you would like. There are surgeons in podiatry and other specialties that are not board certified (maybe board qualified, maybe not) that do surgery all the time. It depends on the hospital by-laws and surgy centers that you wish to work in for what is required to practice surgery. As a high profile example Dr. Rey (plastic surgeon on Dr. 90210) is not board certified and does surgery on people all the time. He is board qualified though.

What ever it is that you become certified, just make sure that when you actually practice you only do things that you are confident doing. It is OK to try new things but ask for help when needed.

Absolutely great advice, IMO.
 
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