The above underlined statement baffles me. You're telling me a level 1 trauma center/ university hospital doesn't get surgical volume? .............I don't know what to say to that......
How can you definitively make that statement??? Have you ever been apart of a university based program and then transferred to a community hospital that has a bunch of satellite surgery centers? It's really the only way you could make such a statement. Even then you would be wrong. UPMC, University of Cincy, University hospital (UMDNJ), Carilion Clinic (VA Tech) are programs that fit that mold of level 1 trauma center/university hospital setting. I'm sure there are several more.
The key is how you define surgical volume. Sure, volume at a level 1 trauma is high (high energy trauma and limb salvage) but after about 6 months of first year you can keep the limb salvage hallux amps and I&D; I'd rather do elective cases and recon. But again; it's how you are defining volume, that's what you say.
I'm not sure of anyone who has transferred from 2 drastically different programs; I'm sure they are out there but they are so few and far between that its hard to rule out anyone from having an opinion that hasn't. You named 4 programs; congrats. I'd even add one for you, Temple has a 4 year program at a level 1 trauma center. If you want to convince yourself, compare your 3rd year numbers to a resident from a higher volume program; the proof is in the pudding. And then compare how many times you doubled or tripled scrub compared to others. (I use "you" generically, not you specifically).
When $hit hits the fan, patients are going to the major hospital in the area. They are going to level 1 trauma center. They are going to the university hospital. If decide to go to a smaller community hospital they will just get transferred to the level 1 trauma center. I hate to break it to you but large hospitals have podiatry clinics too. The podiatry residency programs within these kind of hospital systems are getting in house consults. Podiatry residency programs within these hospital settings are getting paged to see the trauma/diabetic limb salvage case in the ED. The podiatry clinics are filled with post-ops, new pts who were referred from the ED, walk-ins. Surgical cases are generated from these busy clinics. I don't need to travel to get my volume. My hospital is a machine, churning out trauma and diabetic limb salvage cases every day. Which is what you should be expecting. Need more elective cases? Add some private docs to the program. Something my program has addressed
Yup; high energy trauma and high complexity cases go to level 1 trauma centers. Again, all you seem to talk about is trauma and limb salvage. Trauma represents such a small percentage of this profession and the vast majority of residency graduates will not be doing pilon fractures, calc fractures, etc. after residency. How many residents from your program are practicing the type of environment you are hyping?
We work with two ortho foot and ankle trained docs here who are purely elective/clinic based.
Wow. 2 elective based doctors? That's awesome. But it is all relative to the number of residents. If your program only takes 1 a year, then that's probably fine. If your program has 18 residents like UPMC, then you are going to need all those hallux amps to keep residents happy because 2 elective docs won't cut it.
We get a lot of trauma from podiatry residency program solely. There is a foot and ankle call here at my hospital and we own it. We get even more when we rotate on ortho trauma for 30 weeks between 2nd and 3rd year of residency. The ortho traumatologists love us which is not bad company to have.
Yeah the "complexity" of the bunion and hammertoe deformity really drives me wild. How will I ever get good at bunion and hammertoe correction if I don't do 1000 of them in residency? It keeps me up at night.Scopes/Brostrom/Flatfoot recon...yeah you got me there. Those obviously takes reps.
Again, that's great you get so much trauma training; its just not realistic for life after residency for 98-99% of graduates. I'm not knocking it but I know the ortho docs love having you there; many hands make light work but I bet they give the blade to the ortho resident before the podiatry resident most if not all the time...until its time to close
The comment about bunions and hammertoes show your ignorance and clearly you are a first year resident somewhere; and somewhere you don't get to do a lot. Elective cases are a completely different animal from trauma- the bunion patient doesn't want an ugly scar or a wound healing problem/numbness but the trauma patient will be happy that they didn't lose their leg, they will care less about the scar 90% of the time. No one needs to do 1000 bunions during residency (maybe some people do) but the same is said for those hallux amps/tma/"limb salvage" cases you are touting at your program.
why can't I use my brain and knowledge of basic surgical principles to do some of the elective cases I may not be getting exposed to in residency?
You absolutely can. I'd rather expand my fundamental skills to do a SMO or TAR than to teach myself a lapidus or cotton. What's more likely for your first case out of residency, an open pilon fracture or a bunion on a 50 year old lady?
The programs who actually deal with the least post-ops are the ones who you are arguing provide the greatest volume of training...the community hospitals that have like 50 surgical centers associated with them. How can the residents actually have time to see all those post-ops if they are spending a lifetime in a car traveling to do all those surgeries?
I'm not arguing for the community hospital model. I'm simply saying the more places you go, the more volume/diversity of cases you will be exposed too. There are lots of programs that are part of a decent size hospital that cover surgery centers and other decent size hospitals. It's not just covering 50 community hospitals or whatever although it can be.
I think you missed my point and took my post as a personal attack which it wasn't meant to be. I'm not knocking programs at a level 1 trauma center; I'm just saying that to tell people that amazing medicine rotations are better than surgical volume/diversity is not the best advice to give. You don't have to be at a level 1 trauma center to obtain great training on par with ortho. Every model has it shortcomings but feeding people this idea that doing crazy trauma and limb salvage all day everyday is not realistic for the vast majority of residents. Tissue handling and acceptable patient outcomes are vastly different for trauma and elective patients and since elective cases are much less forgiving, I'd personally like more exposure to that than another hallux amp or pilon fracture.
I thought that's what hospitalists were for?
