Surgery in Podiatry

[babar97]

Hi, everyone and anyone. I was wondering what kind of surgery can a podiatrist do? Are there special dual programs or extended fellowships that podiatrists can achieve to perform more complex surgeries such as vascular surgeries, Neuromas, or anything else? Also, What subspecialty in Podiatry has the highest based salary? This is all more out of curiosity.

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[HardRoadPaved]

Best subspecialty is nerve surgery. 100% compliant patients with no cormorbidies and realistic expectations. Hardly any bad outcomes and case satisfaction is great. You'll train to use a host of amniotic tissue nerve wraps that are guaranteed to fix patient's ailments.

 

[wakaflocka88]

Fellowship training in orthoplastics with emphasis in external fixator assisted triple nerve release with a large rotational muscle flap turn down and cover the deficit with minimum 20 large sheets of EpiFix. Easiest $20k you’ll make in one surgery. Lots of examples on Instagram too for reference.

 

[Pronation]

Hello,

Am regular podiatrist and no fellowship so I only do surgery on toenail.

 

[Shiyuan]

Short n sweet answer:

We do surgery anything below the knee/ankle (anatomical structure depends on state), minus vascular stuff. We can do orthopedic surgery (ankle fractures, bunions, etc.), skin cancer excisions, soft tissue mass excisions, etc.

Hard to say which “subspecialty” pays more.... prob more high powered ortho stuff.

 

[Feeter]

Most podiatrist are trained to perform foot and ankle surgeries these days. I don't think there is data on which sub specialty gets paid more. I do anything from ingrowing nail removal to total ankle replacement. I think the more comprehensive practice you have the higher your earning potential.

 

[Pronation]

I do total toenail replacement also.

How Does it Work? - KeryFlex Nail Restoration System

How Does it Work? Similar to a dentist bonding a tooth, KeryFlex Nail Restoration is a procedure in which a resin material is applied and hardened with a special light, “bonding” the material to the nail to restore or improve the nail appearance. Once bound to the nail, your foot care provider...

keryflex.com

 

[CaptainCool]

I do total toenail replacement also.

How Does it Work? - KeryFlex Nail Restoration System

How Does it Work? Similar to a dentist bonding a tooth, KeryFlex Nail Restoration is a procedure in which a resin material is applied and hardened with a special light, “bonding” the material to the nail to restore or improve the nail appearance. Once bound to the nail, your foot care provider...

keryflex.com

Is that actually worth it? I remember hearing/having a rep back in podiatry school but nothing in the 6 years since

 

[air bud]

Best subspecialty is nerve surgery. 100% compliant patients with no cormorbidies and realistic expectations. Hardly any bad outcomes and case satisfaction is great. You'll train to use a host of amniotic tissue nerve wraps that are guaranteed to fix patient's ailments.

Best and final answer.

 

[Weirdy]

Hi, everyone and anyone. I was wondering what kind of surgery can a podiatrist do? Are there special dual programs or extended fellowships that podiatrists can achieve to perform more complex surgeries such as vascular surgeries, Neuromas, or anything else? Also, What subspecialty in Podiatry has the highest based salary? This is all more out of curiosity.

I highly suggest you shadow a combination of hospital, private practice, and group practice podiatrists before you start school.

Do not pick this profession "just to be a doctor" or "surgeon".

You need to know exactly what you are getting into. We do not need anyone who is disillusioned -doing it just for the title.

 

[heybrother]

I wouldn't fret on what pays well. Focus on satisfaction and what you like. There's adequate money in the mundane/exotic as long as a few criteria are met

(a) It must be done effectively and efficiently with a well managed post-op. Without unbundling, small add on procedures that don't change the overall recovery do increase reimbursement. The simple truth is nothing goes better with a bunion than a few hammertoes.

AND

(b) You must be hospital/MSG/ortho employed
OR
(c) a private practice owner performing the service on someone with higher reimbursing insurance.

I have 4 cases on Monday
(a) a 5th metatarsal head resection. It will take 10-15 minutes, pay $800 and be discharged with sutures out in 11 days.
(b) a cheilectomy. It will take sub-30 minutes. I have a bad insurance contract so it will pay $400ish. It should be double that. I will discharge at 11 days.
(c) a gastrocnemius recession, plantar fascial release, ...f&*&& my life - tarsal tunnel release that bounced around through a bunch of other providers. Let's say an hour. Guestimate $1500K. The patient will follow me the full 90 day global and the rest of my career.
(d) a revision fusion of a lapidus non-union performed by someone else with hardware removal, fusion, and bone grafting. Again, I have a bad contract with the patient's insurance so no matter how I code it - lapidus, single joint fusion, revision of non-union etc - the insurance pays less than $700 + whatever I get for the add on procedures (removal of hardware, possible bone graft harvest). Not kidding, probably less than $1K total for the case. The fusion alone should be double. Good insurance would pay $2K with add-ons. Goal will be in shoes at 6 weeks.

I'm doing it at a surgery center that I have a block at. They always start me a little late, but they turn over the room quickly. I co-own the practice so I'll keep 40% upfront and then anything left over at profit sharing time. Were all the cases done on good insurance the day would possible be $1500 more in collections. I'm dependent on the patient's to pay - if they don't they go to collections and I get even less money. I'm dependent on the insurance company to not pull garbage shenanigans and claim they needed a prior auth. That's a classic United move.

If I owned shares in the surgery center I'd potentially get a cut of profits down the road. I don't. All 4 are private insurance. The surgery center will receive many times over what I will receive for these cases. They routinely get $3K for a single toe amp on private insurance where the surgeon gets $200-300.

Were I hospital employed you could simply multiply all my procedures by their RVU value and your $-conversion value to determine what shows up on next paycheck. It would be substantially larger than I will make as an owner because several of these cases are private insurance but with poor contracts. Its otherwise not fair to compare owner vs hospital because ultimately their pay is coming out of the total compensation the hospital is receiving while I'm obviously leaving the surgery ownership money on the table.

Now - if you thought all the above was going to be worth $10,000 - it isn't unless you charge cash. There used to be a thread stickied at the top of this forum describing the fact that there's money to be made in this profession but its a grind. Two of the above patients need CAM boots. We might make $200 or so on boots except both patients already own them. We'll do a few x-rays to the tune of $25-32. The fusion patient might be a candidate for custom orthotics down the road if she keeps coming back complaining.

Meanwhile, a rep came out pushing amnion to my office. They wanted me to know that a 15mm circle costs like $250 and pays like $800ish from Medicare and can be applied like 10 weeks in a row or something ridiculous.

I'm putting actual numbers down because students go into this with zero idea what our work is worth. There are people who make substantially more money than I do for the same services. My kids eat fine, but I will be sending them to public school. Someone else on here said on average they receive $700 for a surgery. That's often nearly the total reimbursement. If the patient keeps coming back you are seeing them for free. Solid post-operative management is important - hopefully discharging two of the patients above quickly and effectively will open up spots for new paying patients not in a global.

Good luck.

 

[Pronation]

Is that actually worth it? I remember hearing/having a rep back in podiatry school but nothing in the 6 years since

That depends on if you have the training and can handle the immense stress of managing total toenail replacement patients

 

[DYK343]

Hi, everyone and anyone. I was wondering what kind of surgery can a podiatrist do? Are there special dual programs or extended fellowships that podiatrists can achieve to perform more complex surgeries such as vascular surgeries, Neuromas, or anything else? Also, What subspecialty in Podiatry has the highest based salary? This is all more out of curiosity.

Youre getting the responses above because your question has little to no research behind it before asking.

Podiatrists can operate on the foot/ankle. Everything from 5 minute minor surgery to more complex hours long cases. Podiatrists fix bunions, hammertoes, midfoot fusions for arthritis, ankle fusion or replacement. Fracture of the foot and ankle. Ankle arthroscopy. Charcot reconstruction. Etc.

We are not vascular surgeons and beyond excision of a cluster of varicose veins we leave the vascular stuff to vascular surgeons which is a subspecialty of general surgery.

Removal of a neuroma is not a complex surgery at all. Its a 10-15 minute case. But the outcomes typically are bad with anything nerve (IMO).

Most podiatrists do not subspecialize. Its rare. If anything pediatric podiatry would be a subspecialty. The reason we dont subspecialize is we start off subspecialized day #1 only treating the foot/ankle.

 

[DYK343]

I do total toenail replacement also.

How Does it Work? - KeryFlex Nail Restoration System

How Does it Work? Similar to a dentist bonding a tooth, KeryFlex Nail Restoration is a procedure in which a resin material is applied and hardened with a special light, “bonding” the material to the nail to restore or improve the nail appearance. Once bound to the nail, your foot care provider...

keryflex.com

I watched that whole video. 6 minutes 55 seconds of my life ill never get back. Ever.

Repeat every 8 weeks and they need to come in mid way to have the nail debrided at the proximal base as the new nail grows back in.

Youre a saint Pronation. A saint.

 

[wakaflocka88]

I wouldn't fret on what pays well. Focus on satisfaction and what you like. There's adequate money in the mundane/exotic as long as a few criteria are met

(a) It must be done effectively and efficiently with a well managed post-op. Without unbundling, small add on procedures that don't change the overall recovery do increase reimbursement. The simple truth is nothing goes better with a bunion than a few hammertoes.

AND

(b) You must be hospital/MSG/ortho employed
OR
(c) a private practice owner performing the service on someone with higher reimbursing insurance.

I have 4 cases on Monday
(a) a 5th metatarsal head resection. It will take 10-15 minutes, pay $800 and be discharged with sutures out in 11 days.
(b) a cheilectomy. It will take sub-30 minutes. I have a bad insurance contract so it will pay $400ish. It should be double that. I will discharge at 11 days.
(c) a gastrocnemius recession, plantar fascial release, ...f&*&& my life - tarsal tunnel release that bounced around through a bunch of other providers. Let's say an hour. Guestimate $1500K. The patient will follow me the full 90 day global and the rest of my career.
(d) a revision fusion of a lapidus non-union performed by someone else with hardware removal, fusion, and bone grafting. Again, I have a bad contract with the patient's insurance so no matter how I code it - lapidus, single joint fusion, revision of non-union etc - the insurance pays less than $700 + whatever I get for the add on procedures (removal of hardware, possible bone graft harvest). Not kidding, probably less than $1K total for the case. The fusion alone should be double. Good insurance would pay $2K with add-ons. Goal will be in shoes at 6 weeks.

I'm doing it at a surgery center that I have a block at. They always start me a little late, but they turn over the room quickly. I co-own the practice so I'll keep 40% upfront and then anything left over at profit sharing time. Were all the cases done on good insurance the day would possible be $1500 more in collections. I'm dependent on the patient's to pay - if they don't they go to collections and I get even less money. I'm dependent on the insurance company to not pull garbage shenanigans and claim they needed a prior auth. That's a classic United move.

If I owned shares in the surgery center I'd potentially get a cut of profits down the road. I don't. All 4 are private insurance. The surgery center will receive many times over what I will receive for these cases. They routinely get $3K for a single toe amp on private insurance where the surgeon gets $200-300.

Were I hospital employed you could simply multiply all my procedures by their RVU value and your $-conversion value to determine what shows up on next paycheck. It would be substantially larger than I will make as an owner because several of these cases are private insurance but with poor contracts. Its otherwise not fair to compare owner vs hospital because ultimately their pay is coming out of the total compensation the hospital is receiving while I'm obviously leaving the surgery ownership money on the table.

Now - if you thought all the above was going to be worth $10,000 - it isn't unless you charge cash. There used to be a thread stickied at the top of this forum describing the fact that there's money to be made in this profession but its a grind. Two of the above patients need CAM boots. We might make $200 or so on boots except both patients already own them. We'll do a few x-rays to the tune of $25-32. The fusion patient might be a candidate for custom orthotics down the road if she keeps coming back complaining.

Meanwhile, a rep came out pushing amnion to my office. They wanted me to know that a 15mm circle costs like $250 and pays like $800ish from Medicare and can be applied like 10 weeks in a row or something ridiculous.

I'm putting actual numbers down because students go into this with zero idea what our work is worth. There are people who make substantially more money than I do for the same services. My kids eat fine, but I will be sending them to public school. Someone else on here said on average they receive $700 for a surgery. That's often nearly the total reimbursement. If the patient keeps coming back you are seeing them for free. Solid post-operative management is important - hopefully discharging two of the patients above quickly and effectively will open up spots for new paying patients not in a global.

Good luck.

This right here. Thanks for the info. But students will ask how come Dr. X on instagram is living in Miami Beach with a G-Wagon, Lambo and a M5 posting daily pics on IG???

 

[Pronation]

This right here. Thanks for the info. But students will ask how come Dr. X on instagram is living in Miami Beach with a G-Wagon, Lambo and a M5 posting daily pics on IG???

I don’t know how they can afford that on a 110k salary. The podiatrist that I work for says he can barely afford mousse for his mustache with the generous 110k salary he gives me.

 

[heybrother]

This right here. Thanks for the info. But students will ask how come Dr. X on instagram is living in Miami Beach with a G-Wagon, Lambo and a M5 posting daily pics on IG???

He must be one of those nerve surgeons I've heard so much about.

I was actually talking to another podiatrist the other day. I said I wanted to go somewhere hands on for my CME this year. They said they were going a nerve surgery course. I tried to smile but the sound of my teeth grinding ruined it.

 

[GreenHousePub]

I said I wanted to go somewhere for my CME this year.

Why would you want to do that.

 

[heybrother]

Why would you want to do that.

It still momentarily has novelty. That said, I'm done listening to the same Santyl presentation for a free meal. Time with family >>>time with reps.

 

[air bud]

I wouldn't fret on what pays well. Focus on satisfaction and what you like. There's adequate money in the mundane/exotic as long as a few criteria are met

(a) It must be done effectively and efficiently with a well managed post-op. Without unbundling, small add on procedures that don't change the overall recovery do increase reimbursement. The simple truth is nothing goes better with a bunion than a few hammertoes.

AND

(b) You must be hospital/MSG/ortho employed
OR
(c) a private practice owner performing the service on someone with higher reimbursing insurance.

I have 4 cases on Monday
(a) a 5th metatarsal head resection. It will take 10-15 minutes, pay $800 and be discharged with sutures out in 11 days.
(b) a cheilectomy. It will take sub-30 minutes. I have a bad insurance contract so it will pay $400ish. It should be double that. I will discharge at 11 days.
(c) a gastrocnemius recession, plantar fascial release, ...f&*&& my life - tarsal tunnel release that bounced around through a bunch of other providers. Let's say an hour. Guestimate $1500K. The patient will follow me the full 90 day global and the rest of my career.
(d) a revision fusion of a lapidus non-union performed by someone else with hardware removal, fusion, and bone grafting. Again, I have a bad contract with the patient's insurance so no matter how I code it - lapidus, single joint fusion, revision of non-union etc - the insurance pays less than $700 + whatever I get for the add on procedures (removal of hardware, possible bone graft harvest). Not kidding, probably less than $1K total for the case. The fusion alone should be double. Good insurance would pay $2K with add-ons. Goal will be in shoes at 6 weeks.

I'm doing it at a surgery center that I have a block at. They always start me a little late, but they turn over the room quickly. I co-own the practice so I'll keep 40% upfront and then anything left over at profit sharing time. Were all the cases done on good insurance the day would possible be $1500 more in collections. I'm dependent on the patient's to pay - if they don't they go to collections and I get even less money. I'm dependent on the insurance company to not pull garbage shenanigans and claim they needed a prior auth. That's a classic United move.

If I owned shares in the surgery center I'd potentially get a cut of profits down the road. I don't. All 4 are private insurance. The surgery center will receive many times over what I will receive for these cases. They routinely get $3K for a single toe amp on private insurance where the surgeon gets $200-300.

Were I hospital employed you could simply multiply all my procedures by their RVU value and your $-conversion value to determine what shows up on next paycheck. It would be substantially larger than I will make as an owner because several of these cases are private insurance but with poor contracts. Its otherwise not fair to compare owner vs hospital because ultimately their pay is coming out of the total compensation the hospital is receiving while I'm obviously leaving the surgery ownership money on the table.

Now - if you thought all the above was going to be worth $10,000 - it isn't unless you charge cash. There used to be a thread stickied at the top of this forum describing the fact that there's money to be made in this profession but its a grind. Two of the above patients need CAM boots. We might make $200 or so on boots except both patients already own them. We'll do a few x-rays to the tune of $25-32. The fusion patient might be a candidate for custom orthotics down the road if she keeps coming back complaining.

Meanwhile, a rep came out pushing amnion to my office. They wanted me to know that a 15mm circle costs like $250 and pays like $800ish from Medicare and can be applied like 10 weeks in a row or something ridiculous.

I'm putting actual numbers down because students go into this with zero idea what our work is worth. There are people who make substantially more money than I do for the same services. My kids eat fine, but I will be sending them to public school. Someone else on here said on average they receive $700 for a surgery. That's often nearly the total reimbursement. If the patient keeps coming back you are seeing them for free. Solid post-operative management is important - hopefully discharging two of the patients above quickly and effectively will open up spots for new paying patients not in a global.

Good luck.

Lesson? Be a amnio rep.

 

[air bud]

It still momentarily has novelty. That said, I'm done listening to the same Santyl presentation for a free meal. Time with family >>>time with reps.

Oh man, they spent so much money on me during residency. The pork chop at Perry's Steakhouse. But paying for it now when I order a tube of Santyl for the office. Ouch.

 

[GreenHousePub]

Time with family >>>time with reps.

Exactly. I gave up on the free dinners years ago. If they swing by for lunch sure but not in my free time.

 

[air bud]

Exactly. I gave up on the free dinners years ago. If they swing by for lunch sure but not in my free time.

yeah free dinners is for residents. Living very rural, reps stopping by is not a thing. Although I do get annoyed at my hardware reps, they have been used to rural for a long time and don't offer me crap. At least the one guy with amnio stuff is based out of a large city and knows how crap works and we get dinner when he comes to town, but even then I have him bring it to the house. I need to remind the guys who pays their bills.

 

[newfeet]

yeah free dinners is for residents. Living very rural, reps stopping by is not a thing. Although I do get annoyed at my hardware reps, they have been used to rural for a long time and don't offer me crap. At least the one guy with amnio stuff is based out of a large city and knows how crap works and we get dinner when he comes to town, but even then I have him bring it to the house. I need to remind the guys who pays their bills.

Hmm... the dalvance rep in my area does lunch every few months. I've never meet her in person. We talk on Zoom while food is delivery. She never comes north to the rural area.

 

[Pronation]

As a total toenail replacement surgeon, I recognize that I’m a big shot and so I always try to rack up the biggest bill I can when a rep takes me out to dinner.

 

[CutsWithFury]

Unpopular opinion. Doing a fellowship in orthoplastics is by far the most ridiculous unnecessary thing you can do. Most (not all) geographical places would not allow a podiatrist to do a complex procedure of this nature. If they did there would definitely be some pushback you would have to get through without it turning into WW3.

As someone who has worked in a hospital setting see 20-40 patients a day (800-1000 RVUs a month) I’ve seen and done the full gambit of foot and ankle procedures. I also worked in the wound care center as well. I can count on my one hand the number of patients I needed to consider doing a muscle flap on. Maybe 1-2. Which I ended up referring to plastic surgery who said it was unnecessary. Whether or not they were competent in muscle flaps in the lower limb is up to discussion but where I practiced it was a very conservative environment so if I have a plastic surgeon on record saying it wasn’t necessary then it was game over.

Doing nerve surgery as a primary focus of your practice is equally ridiculous. Could you get a lot of patients if you decided to focus on it? Yeah definitely. Whether or not you could competently treat these pathologies without making it worse or dealing with complications are odds I would not like to take on.

Just be a good surgeon treating the most basic prevalent pathology you see and I promise you will be alright.

 

[DYK343]

Rodrigez in chicago does a lot of flaps/orthoplastics. I took his course once. It was interesting but I agree most will not be able to run that type of practice in a viable way.

 

[CutsWithFury]

Rodrigez in chicago does a lot of flaps/orthoplastics. I took his course once. It was interesting but I agree most will not be able to run that type of practice in a viable way.

He is really the exception. He also gets a ton of referrals from other podiatrists in Illinois and throughout the USA. This took many years to create this kind of niche.

If you are tackling wounds very aggressively (bring to OR, grafts, aggressive outpatient care, vascular workup, nutrition workup, endo referral, etc) the need for flap coverage becomes almost unnecessary for what we see as podiatrists which is mostly diabetic/biomechanical and vascular (tibial disease) related.

Flaps are more common place in poly trauma patients where podiatry is not really involved.

 

[air bud]

Unpopular opinion. Doing a fellowship in orthoplastics is by far the most ridiculous unnecessary thing you can do. Most (not all) geographical places would not allow a podiatrist to do a complex procedure of this nature. If they did there would definitely be some pushback you would have to get through without it turning into WW3.

As someone who has worked in a hospital setting see 20-40 patients a day (800-1000 RVUs a month) I’ve seen and done the full gambit of foot and ankle procedures. I also worked in the wound care center as well. I can count on my one hand the number of patients I needed to consider doing a muscle flap on. Maybe 1-2. Which I ended up referring to plastic surgery who said it was unnecessary. Whether or not they were competent in muscle flaps in the lower limb is up to discussion but where I practiced it was a very conservative environment so if I have a plastic surgeon on record saying it wasn’t necessary then it was game over.

Doing nerve surgery as a primary focus of your practice is equally ridiculous. Could you get a lot of patients if you decided to focus on it? Yeah definitely. Whether or not you could competently treat these pathologies without making it worse or dealing with complications are odds I would not like to take on.

Just be a good surgeon treating the most basic prevalent pathology you see and I promise you will be alright.

what is unpopular about this opinion? other than with fellows who do these?

 

[CutsWithFury]

what is unpopular about this opinion? other than with fellows who do these?

There is a very strong female presence who specialize in this. In fact I can't remember the last male fellow who completed one of these fellowships. Since I am criticizing I expect to be cancelled pretty soon.

 

[air bud]

There is a very strong female presence who specialize in this. In fact I can't remember the last male fellow who completed one of these fellowships. Since I am criticizing I expect to be cancelled pretty soon.

yeah I wasn't going to say this part....but you are not wrong.

 

[Pronation]

 

[Redsting]

I wouldn't fret on what pays well. Focus on satisfaction and what you like. There's adequate money in the mundane/exotic as long as a few criteria are met

(a) It must be done effectively and efficiently with a well managed post-op. Without unbundling, small add on procedures that don't change the overall recovery do increase reimbursement. The simple truth is nothing goes better with a bunion than a few hammertoes.

AND

(b) You must be hospital/MSG/ortho employed
OR
(c) a private practice owner performing the service on someone with higher reimbursing insurance.

I have 4 cases on Monday
(a) a 5th metatarsal head resection. It will take 10-15 minutes, pay $800 and be discharged with sutures out in 11 days.
(b) a cheilectomy. It will take sub-30 minutes. I have a bad insurance contract so it will pay $400ish. It should be double that. I will discharge at 11 days.
(c) a gastrocnemius recession, plantar fascial release, ...f&*&& my life - tarsal tunnel release that bounced around through a bunch of other providers. Let's say an hour. Guestimate $1500K. The patient will follow me the full 90 day global and the rest of my career.
(d) a revision fusion of a lapidus non-union performed by someone else with hardware removal, fusion, and bone grafting. Again, I have a bad contract with the patient's insurance so no matter how I code it - lapidus, single joint fusion, revision of non-union etc - the insurance pays less than $700 + whatever I get for the add on procedures (removal of hardware, possible bone graft harvest). Not kidding, probably less than $1K total for the case. The fusion alone should be double. Good insurance would pay $2K with add-ons. Goal will be in shoes at 6 weeks.

Thats not terrible
a- 6.11 wrvu
b- 8.01 wrvu
c- depending on if you get decreasing wrvus for each extra procedure is 17.04 wrvu
d- depending on how you bill is around 9.29

That's a total of 40.45 wrvu x $50 per so that puts you at $2k... Some people get more some less per wrvu.
You're around $3.4k with "bad contracts" plus the potential to buy into the center. Makes me think about going private

 

[wakaflocka88]

There is a very strong female presence who specialize in this. In fact I can't remember the last male fellow who completed one of these fellowships. Since I am criticizing I expect to be cancelled pretty soon.

Question is….is her practice doing exactly what she trained in and market for? That’s what I’m curious about these nerve/orthoplastic/ “complex recon” trained podiatrists. Do they assume the world is going to refer all that stuff only to them??

 

[CutsWithFury]

Question is….is her practice doing exactly what she trained in and market for? That’s what I’m curious about these nerve/orthoplastic/ “complex recon” trained podiatrists. Do they assume the world is going to refer all that stuff only to them??

Definitely not. I was working wound care two half days a week seeing 20-25 patients each half day. Did that for 4.5 years. Maybe needed to consider a flap 1-2 times that’s it. If you know what you are doing and are very aggressive with treatment of the wound and optimizing the systemic or biomechanical factors contributing to it then you will never need to consider a muscle flap.

It’s just bizarre to me. Then these fellows with 1-2 years experience and probably minimal to no cases under their belt as attendings are lecturing at national conferences on this stuff.

Podiatry is very bizarre. We have fellows with 1 year experience lecturing on physician burnout. Non board certified podiatrists lecturing nationally as consultants. Fellows in orthoplastics who will never use their skills again or rarely use their skills lecturing nationally on this stuff. How bizarre (cue that song from the 90s).

 

[air bud]

Question is….is her practice doing exactly what she trained in and market for? That’s what I’m curious about these nerve/orthoplastic/ “complex recon” trained podiatrists. Do they assume the world is going to refer all that stuff only to them??

TikTok tells me this happens so I am going to say yes.

 

[Pronation]

I don’t see why not. For example not many are willing to deal with total toenail replacement, likely due to the complexity involved and so they refer these patients to me. I use my loupes for this procedure.

 

[CutsWithFury]

I don’t see why not. For example not many are willing to deal with total toenail replacement, likely due to the complexity involved and so they refer these patients to me. I use my loupes for this procedure.

That's so Podiometric. When will you present your findings at the next APMA conference sir?

 

[Pronation]

That's so Podiometric. When will you present your findings at the next APMA conference sir?

Hard to say, I’m already booked out for this year for seminars to discuss proper shoe gear, the best socks for diabeetus, and how to properly apply lotion to feet.

 

[CutsWithFury]

Hard to say, I’m already booked out for this year for seminars to discuss proper shoe gear, the best socks for diabeetus, and how to properly apply lotion to feet.

Raking in that consultant monies. I think you are going to give Jeff Lehrman a run for his money.

 

[wakaflocka88]

Definitely not. I was working wound care two half days a week seeing 20-25 patients each half day. Did that for 4.5 years. Maybe needed to consider a flap 1-2 times that’s it. If you know what you are doing and are very aggressive with treatment of the wound and optimizing the systemic or biomechanical factors contributing to it then you will never need to consider a muscle flap.

It’s just bizarre to me. Then these fellows with 1-2 years experience and probably minimal to no cases under their belt as attendings are lecturing at national conferences on this stuff.

Podiatry is very bizarre. We have fellows with 1 year experience lecturing on physician burnout. Non board certified podiatrists lecturing nationally as consultants. Fellows in orthoplastics who will never use their skills again or rarely use their skills lecturing nationally on this stuff. How bizarre (cue that song from the 90s).

Saw on IG a recent “pre-fellows” course. Are there any current fellows on here SDN that wanna give more insight??

 

[air bud]

Saw on IG a recent “pre-fellows” course. Are there any current fellows on here SDN that wanna give more insight??

Oooh that gives me an idea. Let's create a pre fellow position. After a student doesn't get a residency they will do their preceptorship and free labor. Then residency. Then when they don't get their fellowship, we will provide them with further advanced training (free labor) as they wait another year to reapply for fellowship(free labor). How is this worse than these 2 year fellowships? Ok who wants in?

 

[Pronation]

Oooh that gives me an idea. Let's create a pre fellow position. After a student doesn't get a residency they will do their preceptorship and free labor. Then residency. Then when they don't get their fellowship, we will provide them with further advanced training (free labor) as they wait another year to reapply for fellowship(free labor). How is this worse than these 2 year fellowships? Ok who wants in?

This sounds too good to be true. What’s the catch!?

 

[air bud]

This sounds too good to be true. What’s the catch!?

No catch. And now with this they will finally be equal to Ortho.

 

[Agent9]

Saw on IG a recent “pre-fellows” course. Are there any current fellows on here SDN that wanna give more insight??

Not a fellow but I would imagine they are a bit busy to be on here reading boards full of disgruntled people mocking and condemning them for their decision to pursue further training. Everyone on here is entitled to their own opinions and much of the advice that regular posters provide here is highly beneficial and appreciated, but the constant belittling of the fellowship process grows old and seems to just be fueled by misinformation and insecurity.

 

[Pronation]

Not a fellow but I would imagine they are a bit busy to be on here reading boards full of disgruntled people mocking and condemning them for their decision to pursue further training. Everyone on here is entitled to their own opinions and much of the advice that regular posters provide here is highly beneficial and appreciated, but the constant belittling of the fellowship process grows old and seems to just be fueled by misinformation and insecurity.

So which fellowship did you do?

 

[CutsWithFury]

Not a fellow but I would imagine they are a bit busy to be on here reading boards full of disgruntled people mocking and condemning them for their decision to pursue further training. Everyone on here is entitled to their own opinions and much of the advice that regular posters provide here is highly beneficial and appreciated, but the constant belittling of the fellowship process grows old and seems to just be fueled by misinformation and insecurity.

Fake news. It’s the other way around. Lots of experienced podiatrists on here getting sick and tired of fellowship trained DPMs acting like a three year trained DPM can’t operate or do a TAR.

Most fellowship trained docs are overcompensating 99.9% of the time. Buying into the lies that ACFAS feeds them that the AOFAS respects them for doing fellowship.

Have a brain and do a good residency and you can go far. Trust me. I’ve come in contact with numerous fellowship trained DPMs and majority of them are arrogant AF.

 

[Pronation]

Overcompensating for being under compensated

 

[icebreaker32]

Fake news. It’s the other way around. Lots of experienced podiatrists on here getting sick and tired of fellowship trained DPMs acting like a three year trained DPM can’t operate or do a TAR.

Most fellowship trained docs are overcompensating 99.9% of the time. Buying into the lies that ACFAS feeds them that the AOFAS respects them for doing fellowship.

Have a brain and do a good residency and you can go far. Trust me. I’ve come in contact with numerous fellowship trained DPMs and majority of them are arrogant AF.

There has always been an subset of our profession with many in it that think they are foot and ankle surgeons and everyone else is just a podiatrist. This subset was once board certified podiatrists that did a surgical residency 1 year in length and before that it was probably someone that did a surgical preceptorship and obtained privileges at a rural hospitaL.

Individual motivations for completing a fellowship obviously vary. The main questions is does the market reward the additional year of training financially or in some other meaningful way?

 

[Pronation]

There has always been an subset of our profession with many in it that think they are foot and ankle surgeons and everyone else is just a podiatrist. This subset was once board certified podiatrists that did a surgical residency 1 year in length and before that it was probably someone that did a surgical preceptorship and obtained privileges at a rural hospitaL.

Individual motivations for completing a fellowship obviously vary. The main questions is does the market reward the additional year of training financially or in some other meaningful way?

From an educational standpoint: that’s debatable.

From a financial standpoint: much better chances of landing a hospital/MSG/ortho gig fresh out of training compared to a resident. However, all of these groups will pick a non freelaborship trained pod with 2+ years experience and board certified over the freelaborship trained pod with zero experience.