Podiatrists eat their young?

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subtleoverlord

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I've been lurking around the forums and googling all sorts of pre-health related topics for a while now and more than once I've come across the phrase "podiatrists eat their young." What does this mean? How is a relatively newcomer into the field supposed to deal with this? Is this a relatively new phenomenon or something everybody goes through at least once?

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This kind of thing happens in all fields of medicine, and probably all professions. The older established docs don't want the competition to decrease their patient load and will often bad mouth the locality to possible interlopers. You will also see this happen when an older doc hires a young recent residency grad for low pay with pie in the sky promises that never quite come true. In fact there are some pods that are well known for chewing up young docs then spitting them out. Again this is not limited to podiatry. It just stands out more in a relatively small profession. Don't worry about it just get the best training you can, keep your eyes and ears open and you will do fine.
 
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I've been lurking around the forums and googling all sorts of pre-health related topics for a while now and more than once I've come across the phrase "podiatrists eat their young." What does this mean? How is a relatively newcomer into the field supposed to deal with this? Is this a relatively new phenomenon or something everybody goes through at least once?

I think this is one of those situations where if you allow yourself to be taken advantage of, there are those that will taken advantage of you. There are podiatrists out there that will try. Having recently gone through the process of finding a job, some of these guys were absolutely comical. But if you get good training, you will have lots of options and you won't have to "settle" for some ridiculous contract.

Educate yourself on what a proper contract should consist of, understand how to negotiate, and you will be fine. And in the end, there is a fair amount of trust involved. If you don't trust them, don't sign.
 
Excuse me, I just burped after eating and digesting a few "young".

Podiatrists eating their young is one of the oldest urban legends in existence! There are probably dozens of supposed origins of this legend from docs offering low contracts, to docs not allowing young docs on staff on hospitals due to the threat of competition to docs being grandfathered into certifying organizations, etc., etc.

However, this certainly is not unique to podiatry.

As a matter of fact, I believe there is no better time for young DPM's than the present time. Since the training is presently at it's highest level ever, many "older" docs need these young docs to bring their practices into the 21st century and to keep up with the times.

Young docs are not a threat, they are an excellent opportunity for older practices to move forward and offer their patients a broader spectrum of care.
 
Thanks everybody. I was getting worried, and I realize that this phenomenon, while something to keep in mind, may have been blown out of proportion. If there ever comes a time when I'm finished with residency and looking for a job I'll remember this.
 
I agree with everything posted above. There are people in all professions that will try to take advantage of their colleagues. I find that our profession has many more good than bad and most seem to help each other out. The bad eggs stand out and the stories about them seem to spread faster than those about the good eggs.

BTW age has nothing to do with the equation. Some young try to eat the old. (We are tough and require tenderizing) An example is where a residency director who did a one or two year residency in the 1980s, is board certified, performs complex cases on a regular bases trains a PM&S-36. When this resident graduates he/she changes the hospital rules to require a 3 year residency. I have seen this time and time again. Most of the newbies are fine but some of the young have issues as well.
 
I agree with everything posted above. There are people in all professions that will try to take advantage of their colleagues. I find that our profession has many more good than bad and most seem to help each other out. The bad eggs stand out and the stories about them seem to spread faster than those about the good eggs.

BTW age has nothing to do with the equation. Some young try to eat the old. (We are tough and require tenderizing) An example is where a residency director who did a one or two year residency in the 1980s, is board certified, performs complex cases on a regular bases trains a PM&S-36. When this resident graduates he/she changes the hospital rules to require a 3 year residency. I have seen this time and time again. Most of the newbies are fine but some of the young have issues as well.

You bring up an excellent point that I omitted. I have also witnessed the "young" eating the old, or better yet turning their back on many that bent over backwards for them.

I've been in hospital locker rooms and have heard some young DPMs fresh out of training, criticizing and making fun of many of the quality attendings that spent years training these same docs. These young DPMs made fun of everything from their clothes to their "old" training to their loss of hair to their bad breath. It was classless and disrespectful, but it's something I've heard in hospital locker rooms, in elevators, at conventions, seminars, etc.

As I've stated many times on this site, many of the leaders in our profession never had the opportunities the younger docs have now, yet created the open doors and path for today's DPMs, with hard work and perseverance, and I'm not always sure this is acknowledged or appreciated by some of today's graduates.

These are the docs that eat the old.
 
I've been in hospital locker rooms and have heard some young DPMs fresh out of training, criticizing and making fun of many of the quality attendings that spent years training these same docs. These young DPMs made fun of everything from their clothes to their "old" training to their loss of hair to their bad breath.

You're kidding!!!??? Completely unacceptable...
 
You're kidding!!!??? Completely unacceptable...

I wish I was kidding. And that wasn't even the beginning of what I've heard. What I've probably heard most over the years, and what bothers me the most, is when I hear one of these young docs telling someone that it was a good thing they scrubbed in on a case when they were a resident because if he/she wasn't in the case the attending would have "no idea" what to do, etc., etc.

Although I've seen that happen on rare occassions, I can assure you that is the exception and not the rule, and the attendings I've heard these young docs talk about were better surgeons than they will ever be in their wildest dreams.

And in case you're wondering, I did walk over and defend the docs being "slammed" and let the young docs know how classless they were acting.
 
It's fun grilling them...although I never had one for dinner.
 
I wish I was kidding. And that wasn't even the beginning of what I've heard. What I've probably heard most over the years, and what bothers me the most, is when I hear one of these young docs telling someone that it was a good thing they scrubbed in on a case when they were a resident because if he/she wasn't in the case the attending would have "no idea" what to do, etc., etc.

Although I've seen that happen on rare occassions, I can assure you that is the exception and not the rule, and the attendings I've heard these young docs talk about were better surgeons than they will ever be in their wildest dreams.

And in case you're wondering, I did walk over and defend the docs being "slammed" and let the young docs know how classless they were acting.

Unfortunately, I was in this position more than once as a resident where I was asked to come into a case, because an attending knew I was available or asked for me to be there due to my expertise. Some of these attendings had no earthly business booking those cases, but knew they had a resident that was more skilled/trained than they were to lean on. Forefoot surgeons booking very complex rearfoot cases which they had never seen before and the ilk. Sad, but true.

I wouldn't dare badmouth anyone as we are a small community of practitioners and our profession has VERY open ears.

You never know who you may run into and become friendly with and the last thing you want is to have bad blood. Even when you meet a new colleague you really have to be careful what you say and how you react to them. Your strongest ally may have ties to your most hated adversary. Prudence is always the order of the day.
 
More on topic, as a prospective employee or partner in a practice you have to ask yourself why this practice needs you.

The #1 mistake an older practitioner makes when thinking about hiring a new doctor is that the only reason they want to do this is to take a break. They're burnt out and don't think of the economic impact of another doctor in the office, either in the short or the long term, and once they have this doctor with them, they are not prepared to deal with the intricacies of the relationship. Now they are stuck and eventually the relationship dissolves and they've now "eaten their young".

There are very specific economic situations where hiring an associate or developing a partnership is necessary for the economic longevity of the practice and most of the time, this is NOT taken into account. In the end the result is bad for all parties involved.
 
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Unfortunately, I was in this position more than once as a resident where I was asked to come into a case, because an attending knew I was available or asked for me to be there due to my expertise. Some of these attendings had no earthly business booking those cases, but knew they had a resident that was more skilled/trained than they were to lean on. Forefoot surgeons booking very complex rearfoot cases which they had never seen before and the ilk. Sad, but true.

I wouldn't dare badmouth anyone as we are a small community of practitioners and our profession has VERY open ears.

You never know who you may run into and become friendly with and the last thing you want is to have bad blood. Even when you meet a new colleague you really have to be careful what you say and how you react to them. Your strongest ally may have ties to your most hated adversary. Prudence is always the order of the day.


Of course we all know this does happen, but we also know this is the exception and not the rule. However, with all due respect to your residency director and chief of service, this is really their fault/responsibility.

The doctor(s) who "needed" you in their case(s), who were really only competent to perform forefoot procedures, yet were booking compelx rearfoot procedures should simply NEVER have been granted those privileges!!!

That's not your fault as a resident, but is the responsibility of the chief of the department. He/she has a responsibility to police his/her department, not just for the sake of the residents, but for the safety of the public. If a surgeon isn't skilled enough to perform a given procedure or group of procedures, he/she should not be granted privileges for those procedures.

It's really quite simple and a preventable problem.

No resident should ever be scrubbiing in on a case with an attending who can not perform the case without the resident, with the exception of the simple fact that the attending simply needs another set of hands due to the complexity of the case, not for lack of skill or knowledge.
 
Of course we all know this does happen, but we also know this is the exception and not the rule. However, with all due respect to your residency director and chief of service, this is really their fault/responsibility.

The doctor(s) who "needed" you in their case(s), who were really only competent to perform forefoot procedures, yet were booking compelx rearfoot procedures should simply NEVER have been granted those privileges!!!

That's not your fault as a resident, but is the responsibility of the chief of the department. He/she has a responsibility to police his/her department, not just for the sake of the residents, but for the safety of the public. If a surgeon isn't skilled enough to perform a given procedure or group of procedures, he/she should not be granted privileges for those procedures.

It's really quite simple and a preventable problem.

No resident should ever be scrubbiing in on a case with an attending who can not perform the case without the resident, with the exception of the simple fact that the attending simply needs another set of hands due to the complexity of the case, not for lack of skill or knowledge.

I agree with you 100%, but this happens more than you know.

As far as you're estimation of practitioners making rules for themselves beyond their capabilities, where I did my residency many doctors were part owners of the surgery centers where they did their work. They MADE the rules, so they were free to do whatever they wanted. I had attendings scrub out for a huge number of reasons as well. Did it make me nervous? Of course! Did I learn a lot regardless? Absolutely!!

This spills in my community as doctors who didn't have nearly the training that some of us younger doctors had/have, but since they've been around longer, are the ones on the boards of the hospitals making policy. We had a doctor here locally on one of those borders set into policy that you had to have 3 years of training to get privileges at this facility as a podiatrist. He was grandfathered in and guess what? He didn't even have a residency, because back in his day, there were hardly any residencies to be had. Although I applaud his generation for what they did and how much they helped the profession, there is something a little fishy when these policies are created. It really makes you wonder what the true motive is.
 
I agree with you 100%, but this happens more than you know.

As far as you're estimation of practitioners making rules for themselves beyond their capabilities, where I did my residency many doctors were part owners of the surgery centers where they did their work. They MADE the rules, so they were free to do whatever they wanted. I had attendings scrub out for a huge number of reasons as well. Did it make me nervous? Of course! Did I learn a lot regardless? Absolutely!!

This spills in my community as doctors who didn't have nearly the training that some of us younger doctors had/have, but since they've been around longer, are the ones on the boards of the hospitals making policy. We had a doctor here locally on one of those borders set into policy that you had to have 3 years of training to get privileges at this facility as a podiatrist. He was grandfathered in and guess what? He didn't even have a residency, because back in his day, there were hardly any residencies to be had. Although I applaud his generation for what they did and how much they helped the profession, there is something a little fishy when these policies are created. It really makes you wonder what the true motive is.


After being in this profession for over 20 years, and having served as a residency director and also having been very active with the ABPS, ACFAS and APMA, I can assure you that I am well aware of how often "this happens".

But as often as it may happen, I can also once again state that it's the exception and not the rule. I am NOT questioning the quality of your skills or the quality of your training, but obviously, from what you have told me, I've got to question the integrity of some of those involved with your training.

There is NEVER a reason for a doctor to schedule a case that is beyond his/her skills or to credential himself/herself or colleagues for procedures that they are not capable of performing, simply because they "call the shots". That's unethical, a double standard and a danger to the community. And having an attending "scrub out" is beyond my comprehension, unless the attending had some medical condition or illness warranting that action.

Once again, I am not in any way, shape or form blaming you for the actions of these doctors. However, in my opinion it is unethical and if any doctor at the hospital where I am on staff was involved with that type of activity, I can assure you he/she would be brought before the proper committee to explain his/her actions.

I applaud any doctor who had minimal training and opened doors and now runs a 36 month program or has high standards for the doctors on staff. But that is all erased if that doctor has two sets of rules and actually places his/her patients at danger. There's a huge difference between "grandfathering" and self-serving.
 
I too have been involved in training residents for over 8 years now and have had much experience dealing with residents in our program and in other programs.

Through many discussions with many residents, it seems that each residency that I've come across has at least one attending whose "integrity" can come under scrutiny.

I was just pointing out one way that some podiatrists find a way to "eat their young" without ever employing them.

Also, I am an attending at a major medical school, and just about every residency in the allopathic world has residents that tell similar stories.

No its not the rule, but it seems that the "exception" is everywhere, which negates the term "exception". This is far too common in my travels and experience.

My training was supreme imho. 2000 procedures in 2 years was far and away more than the CPME minimum and the quality of my attendings was also superior imho. It still doesn't take away those hair raising experiences, but truthfully, those experiences also taught me a great deal. Integrity was certainly suspect, BUT I learned so much from these experiences that I used the situations to better myself, rather than dwell on the negative.
 
And having an attending "scrub out" is beyond my comprehension, unless the attending had some medical condition or illness warranting that action.

How about so the resident can learn what it will be like when they do not have an attending to retract for them? Or so the resident can learn what it is like to struggle?

There comes a time at the end of the 3 years when the attending will not be standing at the resident's side. It is nice to know what that is like with the attending at least in the corner or down the hall in an office, but available.

I had it both ways in residency. I needed both. There is a progression of the 1st year to a 3rd year resident. If the attending cannot realize that at my program those attendings typically got 1st year resident assists even for complex rearfoot cases since it was too painful for the resident otherwise.

Have you seen Boston Medical? This is a reality show based out of the main hospitals in Boston. One episode showed the cardiac sx resident, not a fellow, doing a heart valve replacement. The attending scrubbed in to check on the resident's work, critiqued him, then scrubbed out. The valve repair was not finished nor was the heart close to being closed prior to the surgeon scrubbing out. This is how general surgery programs and other MD type residencies run. The attendings realize the need to cut the cord and let the residents sink or swim.

In fact, if you look at competencies for gen surg residencies they are not just counting cases that they have to DO. They also have a number of cases that they have to teach the junior residents to do. This is how medicine has progressed. They recognize the need for residents to be trained to do procedures, but also to learn to teach the next generation.

Since everyone seems so hyped up on Vision 2015 and parity, we could learn a lot from their system.
 
Krabmas, I understand but don't agree with your point of view. And in Kidsfeet's case, I believe he was intimating that the doctors scrubbing out was not a positive thing.

My patients come to me for my expertise. Although I like to teach and trust the residents, I feel it is a breach in confidence to MY patient to walk out of the room until the case is complete.

If a hospital has a clinic, that's a slightly different story, since the resident is in essence the treating doctor from day one, with an attending overseeing the case.

There is a local well known orthopedic surgeon who got in trouble for doing exactly what you described. However, he was actually also running a few ORs at the same time. His fellow would open the hip, he would walk in and pop in the impplant and leave the room and move to the next room where a 5th year resident had the knee opened, etc and he would pop in the implant and so on.

In my opinion, it has nothing to do with the competency of the senior resident, etc. It's simply a matter of the confidence I feel a patient placed in me and I believe my patient would expect me to be in the room until the case is completed.
 
... There is a progression of the 1st year to a 3rd year resident. If the attending cannot realize that at my program those attendings typically got 1st year resident assists even for complex rearfoot cases since it was too painful for the resident otherwise...

...This is how general surgery programs and other MD type residencies run. The attendings realize the need to cut the cord and let the residents sink or swim...
As another resident at a large teaching hospital, I would tend to agree here. In general surgery, as long as there's a fellow or a senior (3rd-5th year depending on procedure complexity), the attendings usually don't even scrub in for routine procedures. If they do scrub, they are basically sitting on the stool with arms folded and chatting with the OR staff - yet available in case the resident/fellow gets "stuck" and needs a pointer. The resident has seen the attending do the procedure, the attending has observed the resident do it, and it's time for the senior to teach his junior residents. The attending might take a mental break, round on a few inpatients, grab a coffee, etc before his next case.

Yes, the attending definitely needs to be there for the key components of the procedure (fracture fixation, anastamosis of vessels, inserting total knee components, patching of hernia, etc... but it's not uncommon for the attendings to run 2+ ORs in order to be more efficient and save turnover time, esp if they have a chief or fellow in one of the rooms.

For pod, I think it's a bit irresponsible for attendings to leave the OR before the joint capsule is closed. However, as long as they discussed the gameplan at the scrub sink, oversaw the key aspects of the procedure, are working with residents they know to be competent based on same or highly similar procedures, and will be available in the doctors lounge or by pager afterwards, then I see nothing wrong with letting residents close, splint, etc. I've had attendings jokingly ask "do I even need to scrub in today?" when it's a slower surgery schedule day and they walk into the room and see a 2nd or 3rd year resident present for stuff like hammertoes, bunions, TMA, etc. Especially for inpatient I&Ds, Apligrafs, toe amps, etc... there's really no way to make the patient "worse" and there's reason not to let a [competent] resident struggle - so long as the attending takes a look and voices approval before the bandages go on.
 
Feli,

As usual I agree with your estimation.

I would like to add though, that if you're in large teaching institution, many of the the attendings are engaged by the hospital system or medical school and they technically don't have "private" patients.

I can't imagine that someone bringing private patients to these facilities are so open to not be as involved with these cases as I believe they should be. Competency of residents not withstanding.
 
As another resident at a large teaching hospital, I would tend to agree here. In general surgery, as long as there's a fellow or a senior (3rd-5th year depending on procedure complexity), the attendings usually don't even scrub in for routine procedures. If they do scrub, they are basically sitting on the stool with arms folded and chatting with the OR staff - yet available in case the resident/fellow gets "stuck" and needs a pointer. The resident has seen the attending do the procedure, the attending has observed the resident do it, and it's time for the senior to teach his junior residents. The attending might take a mental break, round on a few inpatients, grab a coffee, etc before his next case.

Yes, the attending definitely needs to be there for the key components of the procedure (fracture fixation, anastamosis of vessels, inserting total knee components, patching of hernia, etc... but it's not uncommon for the attendings to run 2+ ORs in order to be more efficient and save turnover time, esp if they have a chief or fellow in one of the rooms.

For pod, I think it's a bit irresponsible for attendings to leave the OR before the joint capsule is closed. However, as long as they discussed the gameplan at the scrub sink, oversaw the key aspects of the procedure, are working with residents they know to be competent based on same or highly similar procedures, and will be available in the doctors lounge or by pager afterwards, then I see nothing wrong with letting residents close, splint, etc. I've had attendings jokingly ask "do I even need to scrub in today?" when it's a slower surgery schedule day and they walk into the room and see a 2nd or 3rd year resident present for stuff like hammertoes, bunions, TMA, etc. Especially for inpatient I&Ds, Apligrafs, toe amps, etc... there's really no way to make the patient "worse" and there's reason not to let a [competent] resident struggle - so long as the attending takes a look and voices approval before the bandages go on.


Feli,

Once again, this has nothing to do with the competency of the residents or the confidence I have in the residents. In my opinion, it's simply the responsibility I have to my patient to be present. The patient's safety is my responsibility and I'm captain of the ship.

The patient did not come to my office to be treated by you or any other resident. The patient came to my office to be treated by me. Yes, the consent form states that the procedure will be performed by me or whoever I designate, yada, yada, yada, but I have a private practice and my patients come for my expertise and reputation, not for the resident that happens to be scrubbing that day.

Yes, of course I allow the resident to perform parts of the procedure in conjunction with the skill level and attitude of the resident. But I NEVER leave the room. I don't need to take a "mental break", go to the lounge to get a cup of coffee or mingle with the other docs, etc. I have dedicated my time to my patient, no matter how long the case takes. If I get bored, I shouldn't have booked the case. If I decide to allow an amazing resident to perform a case skin to skin, that's also great, but I will be in the room 100% of the time.

I believe it's my moral obiligation, and once again has nothing to do with resident competency. When you are in practice, there are a lot of things you can do that are "OK", but then there are things you will do simply because you feel it's the "right thing" to do. And I believe that staying in the OR with my patient is the right thing.

And if you really want to look at this from another perspective, forget about academic/hospital based practices regarding general surgical practices. Let's talk about private podiatric practices for a minute.

I am consulted on a regular basis to defend podiatric malpractice cases, and in these cases, everyone involved gets "cold feet" and looks to point fingers at everyone else named in the case. It can get very ugly. When depositions are taken, they often depose everyone that every looked at the patient, including scrub nurses, circulating nurses, residents, anesthesia personell, etc.

If and when it comes up in deposition that an attending of a private practice patient was down the hall, performing rounds, getting a cup of coffee, etc., and NOT in attendance until the completion of a case, there will be ramifications. Because everyone in that room will have a different account of when the attending left the room. Someone will say after the skin incision, someone will say during the osteotomy, someone will say prior to fixation, someone will say during closure, etc., etc. Regardless of whether or not that anything to do with the outcome, it certainly will not look good in court and it will always be tough to answer "why" you felt the need to leave the OR. There is no correct answer.

So, even if you don't follow my philosophical belief that it's simply the "right thing" to do, since your patient expects you to be there, then at least think of the medical-legal ramifications when you are an attending.

But most importantly, is there REALLY a valid reason to leave the OR?
 
As an aside, I never understood how an attending can hand over the knife the first time they meet a resident.

In my OR, you have to earn the privilege to cut on my patients. First you have to show me you can suture (which is the most important part of any procedure imho). Once I see that you can suture well, then you better be able to retract and know where my knife will be before I do. How can you cut if you don't know where you need to retract? This comes down to Spatial Awareness. This is a step wise approach to teaching. The bottom line for me is that these are my private patients. A resident screws things up (which happens all the time), I'm on the hook. If I screw up, at least I can take responsibility for the error and work my way out of it. It is difficult, as an attending, to reverse a mistake you didn't make.

Maybe that's why some of the residents don't like to work in my OR. I actually force them to learn something before they get to "do" anything. Many of them just want to cut, and not be involved any other way. That's a good way to become a Surgical Monkey rather than a skilled, thoughtful Podiatric Surgeon.
 
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