Right now, the actual surgical numbers one gets are very similar between a 36 and a 24. The difference is that your first year of a 36 is largely spent on general medicine rotations (IM, ER, anesthesis, general surgery, etc) while a 24 jumps into podiatric surgery much sooner because you have less time. I've seen a lot of docs with only 2 years of training do rearfoot surgery. At this point, you don't have to be certified to do it. However, in my opinion, if medicine continues in the direction that I think it is going, the time will soon come when no rearfoot certification = no rearfoot surgery (which is why they made the new rearfoot board rule in the first place). Just my opinion though. While I don't feel that a PM&S-36 will make me a better surgeon, I do feel that it will make me a more well rounded physician.