What's the difference between "accredited fellowships" and other fellowships?

[Robin-jay]

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If I earn a fellowship, is it more void if its not accredited?

I don't want to do a fellowship that isn't accredited by CPME and then realize its not "official".

List of Accredited Fellowships – Council on Podiatric Medical Education

www.cpme.org

 

[Adam Smasher]

As a fellowship director, I find that accrediting bodies are overly concerned with i-dotting and t-crossing, and I prefer not to involve them in micromanaging my ability to help fellows attain their training goals.

Ultimately, on the job market, none of them are official.

 

[air bud]

Interestingly, you do see people talking about doing non-ACGME approved fellowships on real doctor boards..... MD's they're just like us!

 

[eyeeye_captain]

Interestingly, you do see people talking about doing non-ACGME approved fellowships on real doctor boards..... MD's they're just like us!

Funnily enough, the vast majority of eye fellowships are non-ACGME (*cough* so fellows can bill as an attending *cough*). So yeah, I’m sort of unofficial.

Our board recently killed an initiative to give at least my subspecialty the equivalent of a CAQ, most likely because the generalists who want to dabble in my game didn’t want to be labeled as inferior for reimbursement and/or medicolegal purposes.

We do at least have AUPO which certifies the actually reputable ones, but yeah, there’s some sketchy ones out there, especially in cosmetics and refractive surgery.

 

[Bored Snorlax]

As a fellowship director, I find that accrediting bodies are overly concerned with i-dotting and t-crossing, and I prefer not to involve them in micromanaging my ability to help fellows attain their training goals.

Ultimately, on the job market, none of them are official.

I’d like to formally request a shellary raise for the Adam Smasher AO Fellowship. These gas prices have me clawing for survival.

 

[Feli]

Real question: you're way in debt, getting older. Why do a low paid additional residency year that adds nothing (still a podiatrist)???

These aren't MD/DO fellowships that make you into a sub-specialist.

 

[Boba Foot]

Why do a low paid additional residency year that adds nothing (still a podiatrist)???

Some people really want to be able to wear loupes and call themselves a fellowship trained nerve microsurgeon.

 

[Adam Smasher]

Know what's better than being able to call yourself "fellowship trained?" Calling yourself a Fellowship Director.

 

[air bud]

Know what's better than being able to call yourself "fellowship trained?" Calling yourself a Fellowship Director.

My ultimate goal is to call myself a thought leader on LinkedIn

 

[Bluecollarmed]

I always tell residents that it won’t hurt and good ones are definitely a net positive but if it means a good job won’t work out timing-wise then it’s probably not worth it. There aren’t many jobs requiring fellowship and the vast majority of jobs out there won’t use most of what you did at the good fellowships anyways. Definitely a personal preference if you did a good residency. Funny enough the people who did good residencies are also the ones getting the good fellowships so there’s that.

 

[Feli]

...vast majority of jobs out there won’t use most of what you did at the good fellowships anyways.

...Funny enough the people who did good residencies are also the ones getting the good fellowships so there’s that.

^^100% ... paradox of podiatry fellowships:
The DPMs who will get one of the very few fellowships actually worth doing usually don't need a fellowship at all (had top flight residency, high surg volume, good training already).

Also, pretty funny that most DPM fellowships are run by pods who didn't do a fellowship themself. How does that work?

I don't get it.
95% of podiatry grads should pass on fellowship. You won't get that year, money, or real world exp back...

• So few quality fellowships.
• The fact that they add nothing (still a podiatrist),
• and now, the fact that even most of the best ACFAS fellowships watered down over the last decade (took 1/yr... now 2/yr or even more with same/similar attending group and similar case volume). It's one thing if you are doing all of Dr. X and maybe Dr. Y and Dr. Z's cases... but a $50k or $60k year with compounded loan interest just to do a third, half, etc of the cases? Hmm.

...as sad as it sounds, many of the podiatry fellowships are just used as a vehicle to buy more time to job search and even to maybe work with that fellowship group afterwards (usually MSG, big pod group, supergroup sponsored ones). It's like doing the first associate year for $50k to "stay on staff" there... wild, but happens pretty often. Simpin ain't easy.

 

[AdrenalineJockie]

Met a "fellowship trained" pod couple of weeks ago who said she completed her fellowship at a big trauma facility and did so many cases. Young doc, 3 years out of fellowship, said she completely stopped doing surgeries because she realized she was losing money from clinic, and not getting much from surgeries. So what was the point of losing that 1 year completing fellowship 🤡

Just putting it out there

 

[heybrother]

Met a "fellowship trained" pod couple of weeks ago who said she completed her fellowship at a big trauma facility and did so many cases. Young doc, 3 years out of fellowship, said she completely stopped doing surgeries because she realized she was losing money from clinic, and not getting much from surgeries. So what was the point of losing that 1 year completing fellowship 🤡

Just putting it out there

If you want to do elective surgery you really have to master and control the billing process. A surgery performed without collecting the full surgical fee/deductible etc is going to be a free surgery. Payment plans seem like a solution, but are fantasies - the second the patient is close to being discharged they will stop paying. Patients also love to set up payment plans that won't pay off a surgery for a time period that's just not viable for your practice. I've had people ask to make $20 payments on $1000 balances. People have talked about this before, but the truth is that if you are doing 1-2 surgeries 3-4 times a month you really should be doing all of those surgeries on one day and covering your clinic on the rest of those days. I personally don't enjoy running from surgery to a clinic and depending your facility it may not be doable, but its very easy to give up a large part/all of a day to perform a $200 toe amp or a sub-$400 metatarsal head resection. If a higher reimbursing insurance ie. good BCBS plans isn't a solid part of your insurance cohort you are really just doing surgery as a courtesy. The other day I did a TON of procedures - but all Medicare. The facility is going to do well, but one good BCBS case would have been worth more money. Medicare surgery is also highly dependent on picking up a CAM boot to make the reimbursement more tolerable.

My clinic went hard this past year on no surgery without full fee schedule down. It was fascinating to me how many people cancelled their surgeries when they were asked to put payment forward. I do find a measure of enjoyment in performing surgery, but the reimbursement has become so low that the only thing worse than what we are owed for our surgeries is how much patients actually pay for them.

The battle is that patients still need to believe you are a surgeon and that you can see their problem through to conclusion.

All of this though is just a symptom of our overall broken system. We've all had to become physicians and surgeons and coders and debt collectors. I've told this story before, but a big deal hand surgeon in my town left their fancy hospital position to try and start their own thing. Out of business in 2 years. Its hard squeezing dollars out of rocks out there.

Sob story on my part - I rode my office manager on collecting from people and then boom - she let through a surgery because the patient said their secondary insurance (husbands insurance would pay) even though my OM knew the patient still had large deductibles on both. Boom. $1200 owed. Made 1 $70 payment. Its more than a month past the last payment and still nothing.

Another patient owed money on their first surgery and wanted a second. We told them no 2nd surgery without paying off the first. They paid off the first and then didn't pay the second. Payment plan payments stopped the second they approached discharge.

You look at these patients. You talk to them. You think you know them. You think they are good people - that they appreciate your service and skill, that they appreciate what you do for them. How you've improved their life. But very often - the second that relationship involves a $500 debt you've just become a rich doctor. Your OM calls them and says - hey, we just wanted to let you know you owe $500 dollars. Oh sure, let me call you back tomorrow. And then they never do.

The viability of surgery is a reflection of your process and your patients insurance. It is simultaneously I suspect for most podiatrists the part of their practice where they could would like to increase their collections and also the most perilous part from a reimbursement/collections perspective.

 

[Hybrocure]

Some people really want to be able to wear loupes and call themselves a fellowship trained nerve microsurgeon.

Loupes in podiatry are so bizarre. The only time I’ve ever seen an attending wear them was for an MTPJ thing on the east coast too.

Like why.

 

[Hybrocure]

Met a "fellowship trained" pod couple of weeks ago who said she completed her fellowship at a big trauma facility and did so many cases. Young doc, 3 years out of fellowship, said she completely stopped doing surgeries because she realized she was losing money from clinic, and not getting much from surgeries. So what was the point of losing that 1 year completing fellowship 🤡

Just putting it out there

It’s true. I was super into surgery in PP after graduation and when I saw the reimbursement for the effort it’s just so not worth it. If it even gets paid. Sometimes it takes months. Then a surgery that took a sizeable time block (even if the case itself takes 15 minutes let’s be honest it’s still 2 hours out of your day in PP) really only ends up with 50-200 dollars or so in your pocket when it’s all said and done after taxes, insurance, associate cut, etc.

 

[Stormblest]

Loupes in podiatry are so bizarre. The only time I’ve ever seen an attending wear them was for an MTPJ thing on the east coast too.

Like why.

I had an attending wear them anytime he did any type of nerve surgery (tarsal tunnel, neuroma, PNS implant). I bought some to wear with him because I quickly realized he would never let me do anything on those cases and I was with him for like 4 months straight pretty much. My take on them is they help you see the anatomy better but they make everything else harder and more awkward.

 

[Hybrocure]

I had an attending wear them anytime he did any type of nerve surgery (tarsal tunnel, neuroma, PNS implant). I bought some to wear with him because I quickly realized he would never let me do anything on those cases and I was with him for like 4 months straight pretty much. My take on them is they help you see the anatomy better but they make everything else harder and more awkward.

Wearing them for a neuroma is hilarious because that’s one of the nerve surgeries that literally stares you right in the face

 

[Robin-jay]

What are the actual responsibilities of a fellow vs that of a resident? Do they lead the residents in academics or surgeries... if residents exists around the area?

Do fellows have academics? I'm not sure I really understand the role.

 

[HalluxSlicer]

What are the actual responsibilities of a fellow vs that of a resident? Do they lead the residents in academics or surgeries... if residents exists around the area?

Do fellows have academics? I'm not sure I really understand the role.

From what I have gathered if there are residencies attached to the fellowship program than you lead academics, residents present to you (then you present to an attending lol), act pretty much like a chief resident aka PGY-4 doing the same things other residents are doing but not low level stuff, and do hopefully skin to skin. I know non CPME and/or hospital based fellowships can't sponsor non-American DPMs so they're severely limited on where they could do fellowships which kinda sucks (they should've done Caribbean or not do done DPM)... All in all, you're a glorified PA who can't bill despite being Board qual (ABFAS) or cert (ABPM) who can't even use those cases for your ABFAS case logs (im sure certain programs are exceptions)

 

[Feli]

What are the actual responsibilities of a fellow vs that of a resident? Do they lead the residents in academics or surgeries... if residents exists around the area?

Do fellows have academics? I'm not sure I really understand the role.

It's the wild west, man. There are no rules.

Most fellowships are same as a resident or associate (PGY-4, as mentioned): help the fellowship director make more money (by helping see more patients, expedite notes/reports, pub research, cover more locations, etc). It may involve academics if a residency is affiliated or if it's just an academic fellowship.

There are no guidelines, though... no req case volume, diversity, etc. Podiatry can barely keep tabs on its residencies; you can bet they don't check up much on fellowships. The ACFAS ones are a better bet to be fairly solid only due to better training of the attendings, but it's no slam dunk. Some of the Cpme fellowships aren't even run by a director who is ABFAS cert... so that tells you all you need to know about the "accredited" status. Just like podiatry residencies, podiatry fellowships are ALLLLLL over the board as to amount of cases, academics, etc. One might be 45 TAA + 50 flat foot recons while one is basically wounds and toe amps and nails and "practice management." Podiatry fellowships are even more varied than residencies are as they are a much newer thing.

There are a few podiatry fellowships which might get you appreciable exposure to cases you didn't see in residency and more awesome attendings (depending where you did residency), but many podiatry fellowships are just basically a cheap associate for the fellowship group/director. That is what's in it for fellowship group/director: low paid PA. None of them will give you any additional specialty cert.... podiatrist with same boards nonetheless. There is no guarantee that the fellowship director will help advocate or connect you with better jobs (may not even make a single post on IG!). All one can do is just visit and research as best you can, talk to director extensively, hope for some luck also... the people who take a fellowship without visiting and researching it a lot (basically just take director at their word) are nuts.

 

[diabeticfootdr]

There are real differences b/w unaccredited and accredited fellowships, but probably not in the recognition of the fellowship afterwards.

The differences are that CPME-accredited are more stable because they can draw down GME funding from CMS, probably higher salary. Unaccredited fellowships are self-funded by the hospital or the group. Also CPME-accreditation requires that the fellowship follow certain standards in the protection of the fellow/trainee, such as a contract, PTO, sick time, no non-competes, standardized evaluations, and a grievance policy. They also require a formal curriculum.