Thoughts on Fellowship given job market

[Shiyuan]

Yah those 3D prints for bunions are hilarious.

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[MoostashPod]

I had a co-resident that did a two-week "Podiatric Dermatopathology Mini-Fellowship Program". He thought that was a good idea.

 

[ExperiencedDPM]

I had a co-resident that did a two-week "Podiatric Dermatopathology Mini-Fellowship Program". He thought that was a good idea.

I’ve seen this ridiculous BS on so many CVs. Two weeks with Bako and they have the balls to actually use the word fellowship.

If someone listed that he spent 2 weeks rotating thru Bako, that’s no problem. The minute I see that person use the word “fellowship” for those two weeks looking through a microscope and eating donuts, is the instant that CV gets tossed in the trash, right on top of the one that stated that he was a MASTER surgeon for HyProCure.

 

[Feli]

I’ve seen this ridiculous BS on so many CVs. Two weeks with Bako and they have the balls to actually use the word fellowship.

If someone listed that he spent 2 weeks rotating thru Bako, that’s no problem. The minute I see that person use the word “fellowship” for those two weeks looking through a microscope and eating donuts, is the instant that CV gets tossed in the trash, right on top of the one that stated that he was a MASTER surgeon for HyProCure.

Yeah, but who is dumber:

People who do a mini-fellowship or rep workshops and try to put that on CV...
...or people who do a junk 1yr fellowship and get underpaid + student loan interest that whole time?

I think they're just banking on a facility or MSG going fast through apps and seeing 'fellowship.' Lol.
People really sorely underestimate how much of the gatekeeping and CV sorting is done by DPMs - for all types of DPM jobs.

 

[Adam Smasher]

I'll admit I did the Bako mini-fellowship, and I still have it on my CV. Yes it's just a line of padding at this point. It really was an interesting rotation, however. I didn't have many chances in residency to study histology of skin. I still look at my photomicrographs when they come back if I do an interesting biopsy.

In hindsight was it that marketable of a thing? Not really. It came up during one interview, maybe my enthusiasm impressed the guy interviewing me, maybe not.

 

[newfeet]

I'll admit I did the Bako mini-fellowship, and I still have it on my CV. Yes it's just a line of padding at this point. It really was an interesting rotation, however. I didn't have many chances in residency to study histology of skin. I still look at my photomicrographs when they come back if I do an interesting biopsy.

In hindsight was it that marketable of a thing? Not really. It came up during one interview, maybe my enthusiasm impressed the guy interviewing me, maybe not.

I did it too. It was a good two weeks.

 

[Shiyuan]

I did it too. It was a good two weeks.

Same. I tried to make the best of it. Picked the pathologist’s brains as much as I could.

 

[Feli]

I'll admit I did the Bako mini-fellowship, and I still have it on my CV...

You don't have a CV anymore. You are PP owner. 🤠
Your 'CV' is only for hospital apps every few years. 🙂
All we get to worry about is the insurances cutting rates or competition increasing. 😐

Leave the updating CV and browsing jobs daily for the associates looking to move up or the hospital DPMs looking to get a better gig. 🤑

 

[Susitna]

You don't have a CV anymore. You are PP owner. 🤠
Your 'CV' is only for hospital apps every few years. 🙂
All we get to worry about is the insurances cutting rates or competition increasing. 😐

Leave the updating CV and browsing jobs daily for the associates looking to move up or the hospital DPMs looking to get a better gig. 🤑

Flip side of the coin - Keep your CV updated so when opportunities arise you can deliver. Research, papers, grant applications, lecture invites, advisory boards - all require a CV - an updated one. And yes, you can do all of this with a private practice background. And yes, you can make more $$. It's kind of like investing - diversify your income sources.

 

[Adam Smasher]

Do drunken boasts at the pub count as lecture engagements?

 

[Susitna]

You have to start somewhere.

 

[619]

You have to start somewhere.

True if you are a high school graduate with no experience but going to school/training for 11 years and starting salary at $75k - $100k with $300k or more student loan debt is not "starting somewhere". That is starting deep in a hole. That is starting in a trash can (lit on fire).

A high school graduate with zero debt has a brighter future.

 

[Susitna]

True if you are a high school graduate with no experience but going to school/training for 11 years and starting salary at $75k - $100k with $300k or more student loan debt is not "starting somewhere". That is starting deep in a hole. That is starting in a trash can (lit on fire).

A high school graduate with zero debt has a brighter future.

We were discussing the drunk pub lecture series.

 

[HardRoadPaved]

A high school graduate with zero debt has a brighter future.

UPS driver pay and benefits deal in US to be worth $170,000 a year, firm says

The shipping giant warns of lower profits after it agreed a deal to avert a US drivers' strike.

www.bbc.com

Yep no education needed...

 

[newfeet]

UPS driver pay and benefits deal in US to be worth $170,000 a year, firm says

The shipping giant warns of lower profits after it agreed a deal to avert a US drivers' strike.

www.bbc.com

Yep no education needed...

I couldn't do it. The money is good though. They deserve every penny.

 

[JustAPedicurist]

True if you are a high school graduate with no experience but going to school/training for 11 years and starting salary at $75k - $100k with $300k or more student loan debt is not "starting somewhere". That is starting deep in a hole. That is starting in a trash can (lit on fire).

A high school graduate with zero debt has a brighter future.

Podiatry is one of the biggest scams in America, by far

 

[wakaflocka88]

3 anesthesiologists today all tried to push their own kids to go into nursing school. Blew their mind when I told them about the podiatry job market prospect.

 

[DogSnoot]

If I could go back in time, I’d never pick podiatry. By far the most horrendous and detrimental financial decision of my life. Literally, the job market is obsolete dumpster on fire.

 

[PTPuser]

3 anesthesiologists today all tried to push their own kids to go into nursing school. Blew their mind when I told them about the podiatry job market prospect.

No one in general believes that a doctor in America can't find appropriate job. Tried telling my family that I might have to leave in order to put food on the table or go back to my trade job and you can just see the sorrow in their faces.

 

[FutureDPM323]

The job market is absolute trash to the point where you might as well just take whatever job you can get in an area you wanna live in and then try to find other career options…unless of course you manage to snag a decent job.

I made this thread thinking a fellowship would do something for me but the more I look for jobs and talk with friends and read on here the more i think my plan will be to finish residency. Snag the best job I can get in the area I want to live in and then see my exit plan out of this profession before it gets worse.

 

[air bud]

The job market is absolute trash to the point where you might as well just take whatever job you can get in an area you wanna live in and then try to find other career options…unless of course you manage to snag a decent job.

I made this thread thinking a fellowship would do something for me but the more I look for jobs and talk with friends and read on here the more i think my plan will be to finish residency. Snag the best job I can get in the area I want to live in and then see my exit plan out of this profession before it gets worse.

Solid plan. It sucks chasing jobs in crappy locations. Source trust me bro.

 

[bloxxeeey]

True if you are a high school graduate with no experience but going to school/training for 11 years and starting salary at $75k - $100k with $300k or more student loan debt is not "starting somewhere". That is starting deep in a hole. That is starting in a trash can (lit on fire).

A high school graduate with zero debt has a brighter future.

Yeah if I could go back,

The job market is absolute trash to the point where you might as well just take whatever job you can get in an area you wanna live in and then try to find other career options…unless of course you manage to snag a decent job.

I made this thread thinking a fellowship would do something for me but the more I look for jobs and talk with friends and read on here the more i think my plan will be to finish residency. Snag the best job I can get in the area I want to live in and then see my exit plan out of this profession before it gets worse.

oh it is, the tuition nowadays is insane, KSUCPM cost is 95k a year for the class of 2024, that’s 380k over 4 years. You’re never going to make enough as an associate to pay that off then start your own practice, I mean you will in 30 years but you’ll be near retirement then. What blows my mind is I have attendings who started 10 years ago who took jobs paying 80k and guess what, we still make 80k despite every other specialty going up in income

 

[Shiyuan]

Yeah if I could go back,

oh it is, the tuition nowadays is insane, KSUCPM cost is 95k a year for the class of 2024, that’s 380k over 4 years. You’re never going to make enough as an associate to pay that off then start your own practice, I mean you will in 30 years but you’ll be near retirement then. What blows my mind is I have attendings who started 10 years ago who took jobs paying 80k and guess what, we still make 80k despite every other specialty going up in income

95k a year?!? WTF. Education they provide ain’t worth near that much. When I graduated in 2015 my total debt was 220k taking out the minimal amount of loans as possible (I had a 5k per year scholarship... not much).

 

[FutureDPM323]

Solid plan. It sucks chasing jobs in crappy locations. Source trust me bro.

Yea I can’t live in a crappy location even if i magically find a good job. I’m already away from my family and friends in residency and i hate it. Can’t imagine being away from them and in a crappy location for the sake of this profession. Especially when the job market is so unstable.

Yeah if I could go back,

oh it is, the tuition nowadays is insane, KSUCPM cost is 95k a year for the class of 2024, that’s 380k over 4 years. You’re never going to make enough as an associate to pay that off then start your own practice, I mean you will in 30 years but you’ll be near retirement then. What blows my mind is I have attendings who started 10 years ago who took jobs paying 80k and guess what, we still make 80k despite every other specialty going up in income

I feel like I was scammed but at the end of the day I’m an adult and this was my decision but still a small part of me feels that way 🙃

 

[JustAPedicurist]

95k a year?!? WTF. Education they provide ain’t worth near that much. When I graduated in 2015 my total debt was 220k taking out the minimal amount of loans as possible (I had a 5k per year scholarship... not much).

probably including living expenses. which has gone up over time as well.

 

[Feli]

The job market is absolute trash to the point where you might as well just take whatever job you can get in an area you wanna live in and then try to find other career options…unless of course you manage to snag a decent job...

Yeah, your "fellowship" should just be working a year or two at a PP and learning the ropes... billing, supplies, marketing.
Get a decent place to learn (busy, successful/skilled doc, NO NON-COMPETE if you intend to stay there).
Save like a mofo, soak up what you can, think about ideas.
After that, break off on your own, keep 50 or 60% of your collections, not some stupid 35% deal.

The other path of trying to get a hospital job or grinding in PP job for ABFAS (and then trying to get hospital job) can work too, but you are almost certainly NOT going to get your choice of locations if you land the hospital gig. When if you do find one, it has its own set of problems (namely call and ortho/admin politics)... not the least of which will be more and more DPM grads/alums chasing the same number of those jobs and undercutting one another. The create-your-own-job for MSG/ortho/hospital was much more viable 20 or 10 years ago than it is now. A lot of those spots are now occupied and basically only networked into when a surgical DPM leaves/retires (retirement's rare as few surgical are DPMs retire age). The supply of 'surgical DPM' has gone exponential and gets more and more oversupplied every year now.

 

[FutureDPM323]

This is from a thread 13 years ago on this forum…

“took a position in a podiatry practice where I made $80K + 40% of collections above $200K and made roughly $105K year #1”

Literally looks and sounds like a post from here today except now a days you get 30% of collections above $300-$400k instead

 

[Weirdy]

I don’t understand why SDN “attendings” are so against Fellowships. Fellowships give you an opportunity to do research, write papers, work with leading docs, develop mentors, give lectures, become a better surgeon, be an expert in something. You’re going to have a 30 year career and the trajectory of that career could be significantly enhanced with a 1 year fellowship opportunity.

@Susitna

 

[Weirdy]

Fellowship in podiatry does nothing.
Grahm Hamilton didn't do one.
Stan Kalish.
George gumann.
Tom Chang.
Rob Mendocino.
Camasta.
Half of them didn't even do 3yr training.
On the other hand, tons of DPMs who can't even pass Abfas foot did do fellowships. Anyone can do one.
In podiatry, fellowships add nothing... no new cert, no official subspecialties, no specific skill the DPM couldn't get in just a good residency. None. It is simply a voluntary 4th year of residency (in podiatry). It is commonly used as a make-up attempt for deficiency of the residency or pathetic look-at-me attempt for a glimmer of hope at finding a decent job, which is another big problem in DPM land - yet not MD (where fellowship does change specialty and job options and board cert 100% of the time).
For podiatrists, it is MUCH better to just do a good high surgical volume residency at one of the relatively few solid ones. After that, fellowship is a personal choice.

@Feli

 

[Weirdy]

hanks Feli, you paint a broad stroke and not all fellowships are a waste of time for the reasons I stated above. These fellowships are relatively new. What I said about opportunities is true. Give it a few years.
I agree that 3 years of top notch training is sufficient but, as in the past, there aren’t enough of them to go around.

@Susitna

 

[JustAPedicurist]

I think @Weirdy is malfunctioning

 

[Weirdy]

Yes. I will start a sports medicine fellowship. Focusing on:
-subungual hematoma
-orthotics
-adjusting the settings on your Shockwave unit
-athlete's foot, which counts because it has "athlete" in it
Program outcomes:
-being able to call yourself Fellowship Trained Foot and Ankle Surgeon
-...

@Adam Smasher

 

[Weirdy]

I think @Weirdy is malfunctioning

I have deleted comments that are off topic in the Jobs thread and reposted them to the relevant thread.

If you would rather I delete all off topic content arbitrarily - I am more than happy to do that as well so I can spend more time with my kid who is crawling all over me right now while their parent plays "sDn MoDeRaToR" on a Sunday morning for grown adult foot and ankle surgeons.

 

[eyeeye_captain]

I did 2 years of fellowship (come at me bros!)

From an MD perspective, there are multiple reasons to do a surgical fellowship.

EDIT for clarification: why MDs do a surgical fellowship

Uncomfortable surgically - can be because your residency program didn't prepare you or just a personal thing
Trying to get into academics - not my speed, but you do you
You like the subspecialty - this means you actually have a niche that you want to be in as opposed to general practice
Marketability - potentially makes you more attractive to new jobs , which can also help in regionality/saturated markets
Job - looking to get hired at that spot
Money - you can potentially make more dough if you specialize, not always though as doing anything pediatric means you're taking a pay cut

To me, the first 2 reasons aren't great, but not the end of the world. I have no idea if your current fellowship setup does anything to address the following 4, and if not, then yeah, it's not exactly a winning proposition.

Those 2 years of fellowship gave me a subspecialty that generally isn't touched by any of the rest of my field (nobody does surgical retina if they aren't trained in it). I like the job, I'm marketable, and have already covered my opportunity cost. That's what fellowships should do - lift you up. If they can't do that, meh.

 

[podwho]

There is no doubt fellowship has its benefits for the right candidates. It inherently makes a better doctor.

The core question is why 3 years of “surgical” podiatry training is not enough and does it lead to better jobs and salaries. We know why it’s now standard in ortho, total body to limb specialty. Pods go from foot -> foot. Incredible! Ofcourse there’s areas of specialty but at what cost? Ortho commands the highest reimbursements and salaries in medicine. Pods are scraping the floor.

Regardless with 600 grads and maybe 100 fellowships most don’t do one and the ones that did know exactly why they did it. It just screws everyone over when jobs want a fellowship trained but truth is half of them did it because they got crap training to begin with and they get rewarded.

Idk about you guys but I didn’t get into medicine to be poor and struggling to save for retirement or a house

 

[Pronation]

That's what fellowships should do - lift you up. If they can't do that, meh.

Bingo. In your world, if you do a fellowship, you are all but guaranteed to be doing the things you did in fellowship after completion. In podiatry, it’s a total crapshoot that you will do any of the advanced training that you did in fellowship because our profession is horribly saturated. Not only that, it’s a total crapshoot that your income would be any higher after fellowship, because… podiatry.

 

[Adam Smasher]

I have deleted comments that are off topic in the Jobs thread and reposted them to the relevant thread.

If you would rather I delete all off topic content arbitrarily - I am more than happy to do that as well so I can spend more time with my kid who is crawling all over me right now while their parent plays "sDn MoDeRaToR" on a Sunday morning for grown adult foot and ankle surgeons.

I firmly believe that people reach a point of "peak maturity" in their lives after which time they digress into unruly children. We will only get worse.

From an MD perspective, there are multiple reasons to do a surgical fellowship:

Uncomfortable surgically - can be because your residency program didn't prepare you or just a personal thing
Trying to get into academics - not my speed, but you do you
You like the subspecialty - this means you actually have a niche that you want to be in as opposed to general practice
Marketability - potentially makes you more attractive to new jobs , which can also help in regionality/saturated markets
Job - looking to get hired at that spot
Money - you can potentially make more dough if you specialize, not always though as doing anything pediatric means you're taking a pay cut

1. True once upon a time. I think the original podiatry fellowships of the early 00s were more remedial than training for advanced stuff
2. True I guess
3. False. Podiatric subspecialties don't really exist. There is no highly evolved intricate tissue analogous to the retina in the foot. I don't know of any "subspecialty" case that say, @Feli couldn't tackle. Hell, there's not much I'd be uncomfortable with and I learned a dangerous amount from watching videos and cadaver courses
4/5. Potentially True but no slam dunk
6. Variably true. Remember ANYTHING can be a fellowship, most of them are not accredited, so who knows what you're really learning. See my troll post above about directing a sports medicine fellowship.

A lot of the fellowship push is ego-driven. Too many pods have an inferiority complex about being lumped in with the numerous simpletons in our field. So we self-inflict all sorts of misery with fellowship, board certifications, CAQs just to appear a little bit better than the next doc in the crowd. We see this in nursing too with all the postnomial credentials and the Ph.D.s who are suing to be called "dr."

The core question is why 3 years of “surgical” podiatry training is not enough and does it lead to better jobs and salaries.

ding ding ding

 

[eyeeye_captain]

@Adam Smasher Think there’s a small misunderstanding. I was giving reasons for why an MD does fellowship. I don’t know the market for DPMs, but it sounds like fellowship has diminishing returns.

On a side note, I think I saw in a (now locked) thread that you guys graduate ~565 residents a year? Everyone needs glasses, gets cataracts, has diabetes, has macular degeneration. We have supply. How many residents do we graduate yearly? 465. Food for thought.

 

[Weirdy]

I did 2 years of fellowship (come at me bros!)

From an MD perspective, there are multiple reasons to do a surgical fellowship:

Uncomfortable surgically - can be because your residency program didn't prepare you or just a personal thing
Trying to get into academics - not my speed, but you do you
You like the subspecialty - this means you actually have a niche that you want to be in as opposed to general practice
Marketability - potentially makes you more attractive to new jobs , which can also help in regionality/saturated markets
Job - looking to get hired at that spot
Money - you can potentially make more dough if you specialize, not always though as doing anything pediatric means you're taking a pay cut

To me, the first 2 reasons aren't great, but not the end of the world. I have no idea if your current fellowship setup does anything to address the following 4, and if not, then yeah, it's not exactly a winning proposition.

Those 2 years of fellowship gave me a subspecialty that generally isn't touched by any of the rest of my field (nobody does surgical retina if they aren't trained in it). I like the job, I'm marketable, and have already covered my opportunity cost. That's what fellowships should do - lift you up. If they can't do that, meh.

DPM fellowships are not equivalent to MD fellowships.

 

[air bud]

I did 2 years of fellowship (come at me bros!)

From an MD perspective, there are multiple reasons to do a surgical fellowship.

EDIT for clarification: why MDs do a surgical fellowship

Uncomfortable surgically - can be because your residency program didn't prepare you or just a personal thing
Trying to get into academics - not my speed, but you do you
You like the subspecialty - this means you actually have a niche that you want to be in as opposed to general practice
Marketability - potentially makes you more attractive to new jobs , which can also help in regionality/saturated markets
Job - looking to get hired at that spot
Money - you can potentially make more dough if you specialize, not always though as doing anything pediatric means you're taking a pay cut

To me, the first 2 reasons aren't great, but not the end of the world. I have no idea if your current fellowship setup does anything to address the following 4, and if not, then yeah, it's not exactly a winning proposition.

Those 2 years of fellowship gave me a subspecialty that generally isn't touched by any of the rest of my field (nobody does surgical retina if they aren't trained in it). I like the job, I'm marketable, and have already covered my opportunity cost. That's what fellowships should do - lift you up. If they can't do that, meh.

You are out of your element Donny

 

[eyeeye_captain]

You are out of your element Donny

 

[JustAPedicurist]

@Adam Smasher Think there’s a small misunderstanding. I was giving reasons for why an MD does fellowship. I don’t know the market for DPMs, but it sounds like fellowship has diminishing returns.

On a side note, I think I saw in a (now locked) thread that you guys graduate ~565 residents a year? Everyone needs glasses, gets cataracts, has diabetes, has macular degeneration. We have supply. How many residents do we graduate yearly? 465. Food for thought.

But we cut toenails…. It’s very needed! Much needed

 

[bloxxeeey]

Really, anyone can have a fellowship in anything. There isn’t a system to track what you do and there aren’t many practices at all doing consistent complicated cases on a regular basis like ortho does. The training is inconsistent in residency where there’s a governing body that closely monitors things, fellowship doesn’t have that level of monitoring, there’s no way it’s consistent or high quality training. It’s a great way to get a cheap associate though!

 

[diabeticfootdr]

Some fellowships are extremely valuable. Some are just valuable. A small number would be detrimental.

For all the ROI folks in the crowd, if a fellowship leads to a better paying job (even if you think it’s just perception and there is no educational value), isn’t that better ROI?

You don’t have to be a hater all the time.

PS. Full acknowledgment that CPME has totally abdicated their responsibility to govern fellowships and it harms residency training and the profession.

 

[Susitna]

being lumped in with the numerous simpletons in our field.

Adam Smasher, in half a sentence you hit the nail on the head. The top and bottom of our profession are light years apart....no wonder people want to do fellowships to further differentiate themselves. And I don’t think it’s an inferiority complex - quite the opposite.
Adam Smith’s “invisible hand” in full display.

 

[Retrograde_Nail]

Some fellowships are extremely valuable. Some are just valuable. A small number would be detrimental.

For all the ROI folks in the crowd, if a fellowship leads to a better paying job (even if you think it’s just perception and there is no educational value), isn’t that better ROI?

You don’t have to be a hater all the time.

PS. Full acknowledgment that CPME has totally abdicated their responsibility to govern fellowships and it harms residency training and the profession.

A lot of fellowship trained docs are not getting those coveted hospital jobs or ortho jobs anymore. It was nice to be distinguished initially but now with the over saturation of graduating fellows the value of fellowship training has been watered down. Hospitals are looking for experience and board certification. This has been my experience working in two different hospital systems and being hospital employed my entire career. But I know my opinion means nothing.

 

[icebreaker32]

For all the ROI folks in the crowd, if a fellowship leads to a better paying job (even if you think it’s just perception and there is no educational value), isn’t that better ROI?

No it is not a better ROI. That was my point it is a worse ROI.

Many organizational jobs that could previously be had with 7 years of training (from the right applicant) now might require 8 due to fellowships. 8 years is a worse ROI than 7 for the same job.

As far as the 7 year trained podiatrist goes their ROI now just got worse also. They now have an even lower chance of getting an organizational job and an even higher chance of a 100K associate job.

The only one that has a better ROI is the individual fellow that got a better job than they would have otherwise. Even if they get the better job though the overall ROI of the profession is now lower for the reasons mentioned above.

I am not saying we should not have a few fellowships, but too many do hurt the ROI.

The saturation already present though hurts the ROI even more for the profession than 7 versus 8 of training.

 

[bloxxeeey]

Imagine other specialities had a fellowship in their own specialty.
Example: emergency medicine fellowship in working up chronic diseases (something they should know how to do in residency)

Family medicine fellowship in working up hypertension (something they should know how to do in residency)

Podiatry fellowship in ???? (Something they should know how to do in residency)

 

[diabeticfootdr]

No it is not a better ROI. That was my point it is a worse ROI.

Many organizational jobs that could previously be had with 7 years of training (from the right applicant) now might require 8 due to fellowships. 8 years is a worse ROI than 7 for the same job.

As far as the 7 year trained podiatrist goes their ROI now just got worse also. They now have an even lower chance of getting an organizational job and an even higher chance of a 100K associate job.

The only one that has a better ROI is the individual fellow that got a better job than they would have otherwise. Even if they get the better job though the overall ROI of the profession is now lower for the reasons mentioned above.

I am not saying we should not have a few fellowships, but too many do hurt the ROI.

The saturation already present though hurts the ROI even more for the profession than 7 versus 8 of training.

I think there are too many fellowships too.

About 90 in our estimates (CPME and unaccredited - ACFAS and no recognition).

Unaccredited fellowships harm the profession and may place the fellow at risk of being exploited.

But the problem is the only one who can fix that is CPME, and via their actions (and inactions), they have shown it’s not a priority.

 

[Adam Smasher]

Family medicine fellowship in working up hypertension (something they should know how to do in residency)

They'd call it "The Advanced Angiotension Reconstruction Fellowship" and be based in Youngstown, OH