Specialize in Foot and Ankle??

[doclm]

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Hello,

I am going to be starting a Podiatry program this fall and looking forward to doing a three year foot/ankle surgery residency after graduating with a DPM.

I was wondering how many of you are planning on specializing in the foot and ankle? I sure that majorty of Surgery will specialize in Hip/Knee and Spine.

Thank you for your input.

 

[sscooterguy]

Hello,

I am going to be starting a Podiatry program this fall and looking forward to doing a three year foot/ankle surgery residency after graduating with a DPM.

I was wondering how many of you are planning on specializing in the foot and ankle? I sure that majorty of Surgery will specialize in Hip/Knee and Spine.

Thank you for your input.

A lot of Orthopods specialize in foot and ankle. I think it also depends on the region you are in as to how much Orthopods do and how much Podiatrists do. I was talkin to a chief at my ortho program in the midwest, and he said the podiatrists in this region only do forefoot stuff. In other parts of the midwest though, the rotating podiatry students told me they do everything from the knee down. If this is indeed true, the answer to your question may vary on the region.

sscooterguy

 

[doclm]

A lot of Orthopods specialize in foot and ankle. I think it also depends on the region you are in as to how much Orthopods do and how much Podiatrists do. I was talkin to a chief at my ortho program in the midwest, and he said the podiatrists in this region only do forefoot stuff. In other parts of the midwest though, the rotating podiatry students told me they do everything from the knee down. If this is indeed true, the answer to your question may vary on the region.

sscooterguy

I believe that it is different from state to state. Some states only allow forefoot, some states only allow anything below the ankle, while others allow everything including soft tissue up to the hip (FL). I am looking for MN, where I believe the entire foot and ankle is game for Podiatric Surgery. However, I believe that AAPMA are lobbying for standardization of scope of practice for Podiatrists nationwide. This would include ankle, rear foot, fore foot and partial foot amputations.

What region are you from??

I believe that an Orthopaedic specialist would have to go through a specialized fellowship to do foot and ankle surgery. Why would they go through this much training to specialize in the foot and ankle, while they could do hand, hip, or spine specialization instead?

Thanks

 

[sscooterguy]

I believe that it is different from state to state. Some states only allow forefoot, some states only allow anything below the ankle, while others allow everything including soft tissue up to the hip (FL). I am looking for MN, where I believe the entire foot and ankle is game for Podiatric Surgery. However, I believe that AAPMA are lobbying for standardization of scope of practice for Podiatrists nationwide. This would include ankle, rear foot, fore foot and partial foot amputations.

What region are you from??

I believe that an Orthopaedic specialist would have to go through a specialized fellowship to do foot and ankle surgery. Why would they go through this much training to specialize in the foot and ankle, while they could do hand, hip, or spine specialization instead?

I'm in the southern Midwest area. Many people do get fellowships specializing in foot and ankle, and I believe all fellowships are 1 year long. The consensus seems to be that if you want to join a practice in a decent sized city, you most likely need to specialize. Why you ask would they go thru this much training "just" to do foot and ankle you ask? Well, they do it because they like it, thats why. Plus, even though you specialize in a certain area, that does not mean that you have do ONLY the specialized area. In smaller practices, and especially in smaller cities, you may be the foot specialist, but also do other general stuff too. Also, especially in smaller cities and the further you get away from cities in general, there are a lot of general ortho guys that do almost everything, even without a fellowship.
I'd be interested to know how much podiatrists do in other areas/regions if anyone knows.

sscooterguy

 

[SOUNDMAN]

Podiatrists doing knee stuff is scary.

 

[IlizaRob]

Podiatrists doing knee stuff is scary.

I dont think there are any podiatrists doing "knee stuff". Although today's trained podiatrist has 2-3 yrs of surgical residency training, not much of it has to do with the knee. So I agree, it would be scary. They are trained however to deal with osseous and soft tissue conditions up to the knee. I think sscooterguy was refering to how much foot and ankle stuff they do per region as opposed to a foot and ankle orthopod. He can clarify. Here in Iowa, at least at one of the residency hospitals, pods handle all the foot and ankle surgery. Im not sure how many foot and ankle fellowship trained orthos there are in the area though.

 

[dawg44]

I plan on doing a foot and ankle fellowship. First because I enjoy it. Second because it is a very good niche with a potentially very big referral base in most areas with the paucity of fellowship trained foot and ankle guys. Most MDs and DOs will refer to their own when the get the chance to, granted if the guy does a good job. I still plan on doing general when I get out but I will build a foot and ankle practice as I go and as I get busy.

 

[doclm]

I plan on doing a foot and ankle fellowship. First because I enjoy it. Second because it is a very good niche with a potentially very big referral base in most areas with the paucity of fellowship trained foot and ankle guys. Most MDs and DOs will refer to their own when the get the chance to, granted if the guy does a good job. I still plan on doing general when I get out but I will build a foot and ankle practice as I go and as I get busy.

"Most MDs and DOs will refer to their own when they get the chance to"

I think it is great that you want to build a foot and ankle practice, as that is my plans as well. There are many people out there that will need foot and ankle surgeries and care. However, why would most MD's/DO's PREFER to refer a patient to someone who is less trained than a DPM? I understand that it is great that MD's/DO's will do the foot and ankle, but Podiatrists (DPM's) go through 4 years of medical school and 2-3yr intensive residencies just to do this. By all standards, DPM's (the ones with PM&S-24,PM&S-36 residencies) are way more trained and experienced to do the foot and ankle. The number of patient surgeries done by foot docs in these 2-3 years far surpases what a 1 year fellowship can offer. Also, DPMs are really good at using non invasive procedures to help peoples feet when surgery is not likely warranted. In addition, DPMs are also specialist in helping patients rehab their foot/ankle after surgery.

Please do not get offended by this, however it would alarm me if MD's/DO's would prefer to have "their own" do this rather than someone who has dedicated their life to the foot and ankle. "I am not saying that you are not doing this yourself." Its like favoring the referral of a patient with an eye problem to a neurosurgery doctor with a 1 year ophthalmology fellowship, versus an ophthalmologist.

Anyway, good luck 👍

I like to see more MD's/DO's that understand the importance the foot and ankle has on peoples lives. You will do well helping people with their foot/ankle as well other orthopaedic parts of the human body.

 

[dawg44]

"Most MDs and DOs will refer to their own when they get the chance to"

I think it is great that you want to build a foot and ankle practice, as that is my plans as well. There are many people out there that will need foot and ankle surgeries and care. However, why would most MD's/DO's PREFER to refer a patient to someone who is less trained than a DPM? I understand that it is great that MD's/DO's will do the foot and ankle, but Podiatrists (DPM's) go through 4 years of medical school and 2-3yr intensive residencies just to do this. By all standards, DPM's (the ones with PM&S-24,PM&S-36 residencies) are way more trained and experienced to do the foot and ankle. The number of patient surgeries done by foot docs in these 2-3 years far surpases what a 1 year fellowship can offer. Also, DPMs are really good at using non invasive procedures to help peoples feet when surgery is not likely warranted. In addition, DPMs are also specialist in helping patients rehab their foot/ankle after surgery.

Please do not get offended by this, however it would alarm me if MD's/DO's would prefer to have "their own" do this rather than someone who has dedicated their life to the foot and ankle. "I am not saying that you are not doing this yourself." Its like favoring the referral of a patient with an eye problem to a neurosurgery doctor with a 1 year ophthalmology fellowship, versus an ophthalmologist.

Anyway, good luck 👍

I like to see more MD's/DO's that understand the importance the foot and ankle has on peoples lives. You will do well helping people with their foot/ankle as well other orthopaedic parts of the human body.

I'm not offended this is a good thread.
As far as MDs/DOs prefering to refer to their own. That just how it is. We all sat in the same classes together for 4 years and dealt with each other during intership and residency so we have a feeling what the training is about. Most MDs and DOs have no idea what is involved with podiatry school, because we aren't there. The debate over who is better trained could go on forever and most orthopods don't just do foot and ankle for 1 year during their fellowship. They do it for 4 years of residency as well, in trauma, peds, sports- foot and ankle is a component of all of those. So that means 4 years of medical school, 1 year intership, 4 years of residency and 1 year fellowship.

 

[IlizaRob]

I'm not offended this is a good thread.
As far as MDs/DOs prefering to refer to their own. That just how it is. We all sat in the same classes together for 4 years and dealt with each other during intership and residency so we have a feeling what the training is about. Most MDs and DOs have no idea what is involved with podiatry school, because we aren't there. The debate over who is better trained could go on forever and most orthopods don't just do foot and ankle for 1 year during their fellowship. They do it for 4 years of residency as well, in trauma, peds, sports- foot and ankle is a component of all of those. So that means 4 years of medical school, 1 year intership, 4 years of residency and 1 year fellowship.

If a family practice doc had to choose between a foot and ankle surgeon DPM or MD, I would not be surprised if he chose the MD (for reasons stated above). But I think this would only occur if the FP had an equally good relationship with both docs or if he didn’t know either. That probably doesn’t happen too often. It all boils down to the relationship the FP has with the DPM or MD. He'll refer to the one he is most comfortable with. If he has been referring to a DPM for many years and has been satisfied with his work, I don’t think a new orthopod recently moved into the area would change that. The same goes for vice versa.

 

[jonwill]

Dr. Michael Pinzur, MD,(Loyola) published an article in the July 2003 edition of Foot and Ankle International. The study focused on the general (ie not foot and ankle fellows) training of orthopods in the foot and ankle. I would encourage anyone interested to look it up.

 

[diabeticfootdr]

A lot of orthopedic foot and ankle fellowship go went unfilled last year. Including some with famous MD Foot/Ankle orthos and a few have taken DPMs to fill slots.

LCR

 

[Blade Plate]

Hello,

I am going to be starting a Podiatry program this fall and looking forward to doing a three year foot/ankle surgery residency after graduating with a DPM.

I was wondering how many of you are planning on specializing in the foot and ankle? I sure that majorty of Surgery will specialize in Hip/Knee and Spine.

Thank you for your input.

I finished my orthopedic surgery residency last year and can tell you that your assumption is correct. Of all the orthopedic residents that I have known over the years only one went into foot and ankle. The extent of my training in foot and ankle consisted of covering an orthopod trained in foot and ankle and a podiatrist both were excellent surgeons. I have extensive experience in lower extremity trauma from the community setting to Level 1 trauma center setting. Soon I will start my first job when my fellowship is completed. The current situation at the hospital where I will work is the ER will call the orthopedist first with foot and ankle problems, if the orthopedist declines the ER will call the podiatrist. I plan on taking on everything down to ankle joint and selectively problems distal to the ankle joint such as Lisfrancs fx-d/ls, Jones fxs, Achilles tendon ruptures, ect. Plenty of stuff distal to the ankle joint I would not be interested such as a crushed foot, traumatic amputations, degloving injuries as well as any reconstructive foot and ankle cases. I feel that most general orthopedist do not receive enough training in reconstructive foot and ankle unless they do a fellowship. Hope this helps. Congrats on your acceptance. Study hard and do well in your classes/boards/rotation evaluations and your career will be what you want.

 

[endodoc]

A lot of orthopedic foot and ankle fellowship go went unfilled last year. Including some with famous MD Foot/Ankle orthos and a few have taken DPMs to fill slots.

LCR

Can you name any famous places who filled with DPM's? Not that I don't believe you, but most state that you must be a MD and completed a Othro residency (GME) prior to applying. I beleive DPM and MD's residency req. is not the same, so to sit for the board, this would make life very tough on the DPM doc.

 

[Blade Plate]

Can you name any famous places who filled with DPM's? Not that I don't believe you, but most state that you must be a MD and completed a Othro residency (GME) prior to applying. I beleive DPM and MD's residency req. is not the same, so to sit for the board, this would make life very tough on the DPM doc.

It probably happens. A good comparison would be with hand fellowships. Many hand fellowships go unfilled and fill with FMG, plastic surgeons, and general surgeons. If I was a fellowship coordinator that had an unfilled spot, I would rather have a fellow rather than go fellowless.

 

[IlizaRob]

I finished my orthopedic surgery residency last year and can tell you that your assumption is correct. Of all the orthopedic residents that I have known over the years only one went into foot and ankle. The extent of my training in foot and ankle consisted of covering an orthopod trained in foot and ankle and a podiatrist both were excellent surgeons. I have extensive experience in lower extremity trauma from the community setting to Level 1 trauma center setting. Soon I will start my first job when my fellowship is completed. The current situation at the hospital where I will work is the ER will call the orthopedist first with foot and ankle problems, if the orthopedist declines the ER will call the podiatrist. I plan on taking on everything down to ankle joint and selectively problems distal to the ankle joint such as Lisfrancs fx-d/ls, Jones fxs, Achilles tendon ruptures, ect. Plenty of stuff distal to the ankle joint I would not be interested such as a crushed foot, traumatic amputations, degloving injuries as well as any reconstructive foot and ankle cases. I feel that most general orthopedist do not receive enough training in reconstructive foot and ankle unless they do a fellowship. Hope this helps. Congrats on your acceptance. Study hard and do well in your classes/boards/rotation evaluations and your career will be what you want.

Blade Plate, Im curious to know where you did your residency? Also, what are you doing your fellowship in? Its good that you had the opportunity to work with both ortho and podiatry in your training. I think that pods and ortho can can be more beneficial to the patient when they work together. This is becoming easier and more common as the podiatric surgical residencies are becoming standardized across the board.

 

[DOctorJay]

It probably happens. A good comparison would be with hand fellowships. Many hand fellowships go unfilled and fill with FMG, plastic surgeons, and general surgeons. If I was a fellowship coordinator that had an unfilled spot, I would rather have a fellow rather than go fellowless.

This is actually a poor comparison. Everyone viable for the hand fellowships are trained as physicians first, not the case if podiatrists are able to get into foot & ankle orthopedic fellowships.

I'm not saying pods shouldn't get the spots, just pointing out that there is a difference here.

-J

 

[diabeticfootdr]

Can you name any famous places who filled with DPM's? Not that I don't believe you, but most state that you must be a MD and completed a Othro residency (GME) prior to applying. I beleive DPM and MD's residency req. is not the same, so to sit for the board, this would make life very tough on the DPM doc.

Exactly the question I asked when I heard this. How can DPMs get a GME spot? I think these fellowships must be "industry supported", so that they're not reliant on CMS/GME money or oversight.

Brad Lamm, DPM did Dror Paley's fellowship in Baltimore. A senior at UPMC DPM residency is doing an ortho F&A fellowship next year, I forget which one.

Here's a listing of some AOFAS fellowship unfilled.
http://www.aofas.org/displaycommon.cfm?an=1&subarticlenbr=133

Some famous foot and ankle fellowships. Surprising the pay is so low. It's in the $40,000's. I make much more than that as a resident.

LCR

 

[dawg44]

Thats what most fellowships pay in any field, around 40,000. You can always make more moonlighting as well if your call isn't bad.