You are starting a residency...

[deleted1149159]

We are as strong as our weakest link.

It makes sense pragmatically.

It makes zero sense in terms of optics/how others will view us.

I find that the further out you get in practice, the less you care about how others view you, or the profession. If we take care of our own, the rest will follow. Something has to give. No one outside of Podiatry or Academics has any clue what our training entails. It's up to us to educate them.

"Yeah, I didn't really want to be a surgeon, so I did a one year program with a lot of medicine rotations, so you're well taken care of". That's all that needs to happen.

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[diabeticfootdr]

I find that the further out you get in practice, the less you care about how others view you, or the profession. If we take care of our own, the rest will follow. Something has to give. No one outside of Podiatry or Academics has any clue what our training entails. It's up to us to educate them.

"Yeah, I didn't really want to be a surgeon, so I did a one year program with a lot of medicine rotations, so you're well taken care of". That's all that needs to happen.

This is not an issue about how any particular patient may view your care or the profession of podiatry.

It is an issue about how governments, hospitals, payers, universities, etc view podiatry as a profession.

A standardized 3-year residency assures a minimum quality of training. Yes there will alway be exceptional programs and doctors ... and we all applaud that. But the minimum standard is what we will be judge on as a profession. This higher minimum standard is responsible for expansion of scope of practice in many states. It is responsible for surgical and H&P privileges.

The 3-year residency is good for the profession and it is here to stay.

 

[diabeticfootdr]

I assure you, it does not. Your comment is precisely one of the main issues I have.

Of course the three year residencies are here to stay. I didn't say anywhere they shouldn't be. But there is a place for one year programs. Not everyone who enters any kind of medically based schooling should be a surgeon. And right now, podiatry is the only profession that necessitates it. And shouldn't.

Do you honestly feel that every podiatry graduate should be a surgeon? And if they shouldn't, why bother training them to be? Especially since most of what we do on a daily basis is office based.

A podiatrist is a podiatrist. We are physicians and surgeons of the foot and ankle. That is the profession. Every podiatrist will have the same minimum training.

(Family Practice residents learn how to do deliveries, although most of them won't in practice)

After your training, you can choose what focus your practice will take, based on interest or maybe limited by personal abilities.

There are some podiatrists who are totally non-surgical. There are some that are mostly surgical. A majority of them are in a wide bell in the middle.

 

[ExperiencedDPM]

I'm curious folks. Do you consider Dermatologists, surgeons?

Another question. Would you let a non-board certified general surgeon take out your child's appendix or fix your hernia? Especially if they've been out for over a decade?

Hmmm. Going to play devil’s advocate again. Your comment about the general surgeon seems a little contradictory to your own past comments.

You have stated you are certified in foot surgery BUT have done rearfoot cases, etc, though you have backed off those cases.

So you make a comment about a general surgeon who is out 10 years not performing surgery on your child, but you have performed rearfoot cases and you don’t hold certification in RRA??

My point is basically is that certification is just one factor and not always indicative of a surgeon’s skills. I’d much rather have an accomplished non certified surgeon than an incompetent certified surgeon. And we ALL know that scenario exists.

 

[AttackNME]

It makes sense pragmatically.

It makes zero sense in terms of optics/how others will view us.

If you care what others think of us, it should matter how our training could be optimized pragmatically

A standardized 3-year residency assures a minimum quality of training.

Addition of a 1 year program will only improve the quality of the 3-year training regimen

A podiatrist is a podiatrist.

How confusing is it to say that some 3-year trained podiatrists could end up doing non surgical work?

 

[deleted1149159]

Let's get back on topic. More ideas on how to make a residency great, please. Thanks!

 

[air bud]

We need to think of residencies like a football team. The head coach is often more a CEO. They have a lot of other responsibilities. A good residency director doesn't necessarily need to be a stud surgeon. They need relationships within the community, hospital etc in order to drive better off service rotations. They need to be able to teach, educate and coach residents and those take people skills. You can have a super academic person be your Academics director, just like you would have a defensive coordinator. Guy/girl who does total ankles? Cool that's your QB coach. Guy/girl that is a TFP....uh the punting coach....

 

[diabeticfootdr]

I guess as a show of hands... how many of you had rotations with rheumatology or PM&R?

Both should be mandatory.

We advocated for mandatory wound care and pain management rotations in the latest revision of CPME 320. Especially given the opioid crisis. Those were not adopted.

We also advocated for mandatory 1 month of vascular surgery. The Council approved 2 weeks effective next year.

 

[wakaflocka88]

Both should be mandatory.

We advocated for mandatory wound care and pain management rotations in the latest revision of CPME 320. Especially given the opioid crisis. Those were not adopted.

We also advocated for mandatory 1 month of vascular surgery. The Council approved 2 weeks effective next year.

The PM&R is tricky. I’m fortunate that I had numerous attendings that were very conscientious about post op pain management and I have adopted these into my practice. I wish more grads would stop following the mantra of “I was told to do it this way, so that’s why I only prescribe 90 tablets of oxy 5 for any big recon procedure”. I only do Norco 5, regional blocks pre and post op, IV toradol, and good ole ibuprofen. I’ve only done 5 oxy 5 prescriptions in the 3 years I’ve been out. The biggest thing is one must set the expectation for the patient to differentiate between true surgical pain and then the neuropathic component. It’s a simple pain/inflammatory response curve that many other specialities follow and discuss with patients.

 

[Feli]

Another question.

The CPME guidelines require 5 months of rotations in a variety of medical subspecialties. Looking at some programs I know of, they far exceed that number. Some do double that. Is that good or bad?

Almost invariably bad...
24mo pod /12mo other should be max. At the end of the day, they're going to be a F&A specialist. Surgical and procedure specialties like ortho, trauma, vasc, ER etc are somewhat useful if they're busy... ID or Endo can be useful only since they see a lot of pod patients... still none are as useful as more good F&A surgery.

The ER, IM, etc are frankly the job of the schools... some pod schools do well, some do terrible on that (those are mainly the schools that have to send out core students due to not enough local rotations for pod or other med rotations). The same goes for DPM residencies... in bona fide teaching hospitals and with many residencies and fellowships, research of all specialties, teaching services, much academics of M&M and grand rounds, then ID or ER or Vascular or even FP or whatever can be highly useful if you're rounding daily with residents and fellows and teaching attendings. Small community hospital or VA, which most DPM programs are sponsored by? Likely to be basically junk with minimal attending pearls and minimal pathology in off-service unless you really luck out and find a non-teaching attending who is a rare rock star.

A lot of good programs have their DPM residents assigned off-service show up some days but are also happy to pull them off radiology or family med or pathology for a half day if F&A cases need to be covered. Those are the programs you want to emulate (tons of F&A cases, off service exists yet takes absolutely a lower priority). They key is to ASK the residents if they are seeing a lot, doing a lot on off service... remove/replace bad rotations as fast as possible... get them on F&A more (take fewer residents if volume isn't there). That is the main difference between a lot of good pod programs and joke ones (bad off-service, dinky little non-teaching hospital, and mainly not enough F&A cases or good attendings relative to resident spots).

 

[air bud]

I guess as a show of hands... how many of you had rotations with rheumatology or PM&R?

My first month of residency was Path/anesthesia. I bet I put 6 hours in tops in Path. Went, checked in then drive 30 mins back to place and laid by the pool. Killer tan. And in good shape. Met my future wife that month. That wouldn't have happened if I was toiling away at a teaching hospital.....

My off service rotations were a complete joke. I was at a small community hospital where there were no other residents so nobody was used to teaching. I killed all that I am stuff in school, but I will disagree with Feli a little bit about that. Even though I killed it in school not actually putting it into place in real life certainly has made me weak in terms of some medicine stuff. Fortunately every place I have been I have been able to get out of any type of admitting my own patience and having to manage medicine. I know just enough to be dangerous....

But once there was other off service rotations in there was surgery for you to scrub it was nice being able to tack on extra cases

 

[heybrother]

The funny thing is that the pod residencies that suck at F&A surgery exp are also usually the same ones that suck for off service opportunities.

I always felt like there were a lot of ways for programs to fail, but they all ultimately came back to "squandering resident time".

 

[Feli]

exactly. pain management rotation is useless. podiatrists who make these decisions don't even know what they are talking about

I found Vasc, ID, and plastics to be fairly useful. ER was great for how to do conflict mitigation with drunks.
Rheum and Endo and FP were trivia but not a total waste. None were anywhere near as good as more F&A cases and F&A academics.

All other months and half-months I did (rad, path, trauma, gen surg, anesth, psych, ortho, etc etc) were basically rounding or sitting and learning maybe one or two things I may actually use one day. OR involvement ranged from tiny to none. It was fun to meet other non-pod residents to compare notes on nursing talent of various units and find new ways to enjoy the local nightlife, but I learned little med knowledge from them nor they from me. I reinforced a few meds for boards on anesthesia, but it was nothing I couldn't do with a couple hours of study. I absolutely would have been much better off doing more months of pod surg or in pod offices, but thankfully, my program had tons of those anyways.

And yes, I did all of these rotations in a real teaching hospital (or others within the system) with residency programs in those specialties, residents and/or fellows on all services. The vast majory of DPM residencies are NOT doing that. The off-pod months are even more wasteful. Many are VAs with just podiatry or places with podiatry program and FP residency and nothing else which don't even have the capability to do a real vascular, ortho, ER month... or sometimes even true FP, gen surg, ID, etc teaching rotation. The "requirements" are a formality if it's simply being faked with sending DPM residents to go to the office of some PP cardiologist who hasn't ever lectured or been part of a fellowship and calling that "vascular."

...The reason for the "integrated medical rotations" big push by all of the older pods and APMA/CPME is because they want visibility for podiatry, increase respect and awareness, be able to say DPMs are highly trained, etc. I'm sure the new term is Vision 2050? There is also the elephant in the room issue that they often don't have enough F&A cases and want to have some residents hidden off-service so they aren't triple scrubbing or sitting reading or bored to death all day in the resident room (but they want many residents to get much GME funding!). It reminds me of the USMLE nonsense... sending student/resident sacrificial lambs to do things they never did and wouldn't know where to start... "for the good of the profession."

Back in reality, no doc knows it all. There is a reason plastics, ortho, ENT, neurosurg, and many other residency tracks are now direct match... they want to get done sooner and get more cases for residents within their specialty, crush board exams. All of the historic best podiatry programs were also surgery factories... none of them made their name on non-podiatry offerings (although some have good away rotations in addition to massive F&A cases now also). Any students coming across this should pay very little attention to the amount of off-service and how great the pod residency program may tout its pedi ortho, plastics, etc month; as was said, the non-pod months are skipped or truncated to cover all the F&A surgery or just used as vaca/library time at many good DPM residency programs anyways. It should be viewed as a requirement that should be learned from as possible, but overall, it is not as productive as F&A time with good attendings. DPMs aren't going to be intubating and starting central lines or doing tibial plateaus or running a code anytime soon.

 

[CutsWithFury]

I found Vasc, ID, and plastics to be fairly useful. ER was great for how to do conflict mitigation with drunks.
Rheum and Endo and FP were trivia but not a total waste. None were anywhere near as good as more F&A cases and F&A academics.

All other months and half-months I did (rad, path, trauma, gen surg, anesth, psych, ortho, etc etc) were basically rounding or sitting and learning maybe one or two things I may actually use one day. OR involvement ranged from tiny to none. It was fun to meet other non-pod residents to compare notes on nursing talent of various units and find new ways to enjoy the local nightlife, but I learned little med knowledge from them nor they from me. I reinforced a few meds for boards on anesthesia, but it was nothing I couldn't do with a couple hours of study. I absolutely would have been much better off doing more months of pod surg or in pod offices, but thankfully, my program had tons of those anyways.

And yes, I did all of these rotations in a real teaching hospital (or others within the system) with residency programs in those specialties, residents and/or fellows on all services. The vast majory of DPM residencies are NOT doing that. The off-pod months are even more wasteful. Many are VAs with just podiatry or places with podiatry program and FP residency and nothing else which don't even have the capability to do a real vascular, ortho, ER month... or sometimes even true FP, gen surg, ID, etc teaching rotation. The "requirements" are a formality if it's simply being faked with sending DPM residents to go to the office of some PP cardiologist who hasn't ever lectured or been part of a fellowship and calling that "vascular."

...The reason for the "integrated medical rotations" big push by all of the older pods and APMA/CPME is because they want visibility for podiatry, increase respect and awareness, be able to say DPMs are highly trained, etc. There is also the issue that they often don't have enough F&A cases and want to have some residents off-service so they aren't triple scrubbing or sitting reading or bored to death all day in the resident room (but they want many residents to get much GME funding!). It reminds me of the USMLE nonsense... sending student/resident sacrificial lambs to do things they never did and wouldn't know where to start... "for the good of the profession."

Back in reality, no doc knows it all. There is a reason plastics, ortho, ENT, neurosurg, and many other residency tracks are now direct match... they want to get done sooner and get more cases for residents within their specialty, crush board exams. All of the historic best podiatry programs were also surgery factories... none of them made their name on non-podiatry offerings (although some have good ones now also). Any students coming across this should pay very little attention to the amount of off-service and how great the pod residency program may tout its pedi ortho, plastics, etc month; as was said, the non-pod months are skipped or truncated to cover all the F&A surgery or just used as vaca/library time at many good DPM residency programs anyways. It should be viewed as a requirement that should be learned from as possible, but overall, it is not as productive as F&A time with good attendings. DPMs aren't going to be intubating and starting central lines or doing tibial plateaus or running a code anytime soon.

Only off service rotations podiatrists need are vascular surgery, ortho, plastics, medicine.

Rheumatology is not needed. It is just subspecialty of medicine
Infectious disease is not needed. It is just subspecialty of medicine
Endocrinology is not needed. It is just subspecialty of medicine

I think 2 weeks of neurology would be helpful to hash out EMG interpretation, tarsal tunnel and managing neuropathic pain

Pain management, physiatry, general surgery are not needed at all. These are completely useless to podiatry.

If podiatry residencies focused their off service rotations in robust vascular surgery, ortho, plastics and medicine rotations we would graduate more well rounded podiatrists who could actually function in the real world a lot better than what we are graduating right now.

 

[Feli]

Only off service rotations podiatrists need are vascular surgery, ortho, plastics, medicine...

100% ...

The ID and Endo can be considered if there are fellowship programs or great attendings in the pod residency hospital system.

I think plastics is even a bit questionable if the local surgeons are just cosmetic and/or dont teach. I was fortunate to have a local legend who was a former program director and did much recon plastics, but that's rare in most areas.

 

[AttackNME]

I think most pod programs have residents spend nearly 12 months on off-service rotations. I think it is bad. It just shows that programs do not have much going on to keep all 6-18 residents busy on service. I talked about it elsewhere. I do not think we need more than 6 months on off-service rotations as residents.

If you look up the CPME 320 section 6.4 it says the following:

"The residency program shall provide rotations that enable the resident to achieve the competencies identified by the Council and any additional competencies identified by the residency program. These rotations shall include: medical imaging; pathology; behavioral sciences; internal medicine and/or family practice; medical subspecialties; infectious disease; general surgery; surgical subspecialties; anesthesiology; emergency medicine; podiatric surgery; and podiatric medicine. The residency curriculum shall provide the resident patient management experiences in both inpatient and outpatient settings."

I don't see any specific requirements about duration or length of each rotation. I can see how its easy for previous program directors to interpret each as a 1 month duration and feel like they're doing whats required. I wonder what is the minimum requirement for these rotations? Better yet, why not clarify/rewrite/update these rules?

I looked up what it takes to become a member of the council of CPME and looks like you can only be voted in?

CHAPTER 3. MEMBERSHIP Section 1. Number The Council shall consist of eleven members, including the officers, all of whom are elected by the Council.

If this is true, is that fair? How can the CPME have council members that represent the diversity of the podiatry community if they're choosing who gets in? They serve 3 year terms and say that calls for candidates are advertised on APMA News. TBH I usually throw away APMA News when I get it but might want to pay attention to these announcements.

 

[AttackNME]

These are the required rotations, and looks like d, e, and f need to combine 3 full-time months.

a. Medical imaging
b. Pathology
c. Behavioral sciences
d. Infectious disease
e. Internal medicine and/or family practice
f. Medical subspecialties. Rotations that satisfy the medical subspecialty requirement include at least two of the following: dermatology, endocrinology, neurology, pain management, physical medicine and rehabilitation, rheumatology, wound care, burn unit, intensive/critical care unit, pediatrics, and geriatrics.
g. General surgery
h. Surgical subspecialties: Training resources that satisfy the surgical subspecialty requirement must include at least one of the following: orthopedic, plastic, or vascular surgery.
i. Anesthesiology
j. Emergency medicine. Training resources may include emergency department, urgent care center, and trauma service.

So if a, b, c, g, i, rotations can be 1 week, that is 5 weeks, plus the 3 required months. 1 month in ER, 1 month in ortho, that gives us basically 6 months of off-service rotations while respecting the good ones, and following the rules. Is this setup possible?

 

[bloxxeeey]

Podiatry residency should be 2 years, third year should be an option!

I’ll offer you 3 years with an added year of fellowship before a 70k private practice job

 

[DPM TRUTH]

Can someone younger explain what the heck "board vitals" and "board wizards" actually is? How is this OK? Conflict of interest?

I was an oral examiner @ the O'Hara Hyatt and part of the abps test for about a decade. Am I allowed to start a "website" and give all the new residents the "way" to pass the exam also?

You guys should be ASHAMED this is what the podiatry boards have become. And yes Weirdy, after 35 years in the profession I have the RIGHT to call out the "young gurus" on here making "know it all comments". Weirdy, after you practice for 35 years you can call out the young "know it alls also". We know who EVERYONE is on here..."we" might play stupid but we trained YOU! As division chief for 25 years, I don't put up with smarties/know it alls. I call them out a mile away. My wife and I spent 20 years defending them in court, getting them out of pretzels!

So abfas gurus, how do I make a website to to sell "how to pass the test" for 700 bucks also? What a great gig! I have decades of exams/oral questions. Heck, why didn't my generation think of this scam sooner!?!? .

So let me get this straight. The profession extorts board registration fees, board "prep" fees, and board "review" fees to become boarded by abfas these days....THOUSANDS!
Wow, just wow! How long do the "powers ro be" think the residents are gonna put up with this? How long do the "powers to be" think my generation is gonna allow the residents to be treated like this?

Wonder why the gurus don't wanna change things. They can extort thousands from the new residents to pass the exam....sick! But keep patting yourselves on the back. Ortho is watching this whole embarrassment!

Ortho talking points...you pass the abfas exam by paying thousands.....not studying. Think about that for a second. Sounds good, doesn't it. But they are the "legit board" right? Keep up the good work abfas crowd, your doing a great job of making the ABPM seem more legit everyday!!!

 

[air bud]

Can someone younger explain what the heck "board vitals" and "board wizards" actually is? How is this OK? Conflict of interest?

I was an oral examiner @ the O'Hara Hyatt and part of the abps test for about a decade. Am I allowed to start a "website" and give all the new residents the "way" to pass the exam also?

You guys should be ASHAMED this is what the podiatry boards have become. And yes Weirdy, after 35 years in the profession I have the RIGHT to call out the "young gurus" on here making "know it all comments". Weirdy, after you practice for 35 years you can call out the young "know it alls also". We know who EVERYONE is on here..."we" might play stupid but we trained YOU! As division chief for 25 years, I don't put up with smarties/know it alls. I call them out a mile away. My wife and I spent 20 years defending them in court, getting them out of pretzels!

So abfas gurus, how do I make a website to to sell "how to pass the test" for 700 bucks also? What a great gig! I have decades of exams/oral questions. Heck, why didn't my generation think of this scam sooner!?!? .

So let me get this straight. The profession extorts board registration fees, board "prep" fees, and board "review" fees to become boarded by abfas these days....THOUSANDS!
Wow, just wow! How long do the "powers ro be" think the residents are gonna put up with this? How long do the "powers to be" think my generation is gonna allow the residents to be treated like this?

Wonder why the gurus don't wanna change things. They can extort thousands from the new residents to pass the exam....sick! But keep patting yourselves on the back. Ortho is watching this whole embarrassment!

Ortho talking points...you pass the abfas exam by paying thousands.....not studying. Think about that for a second. Sounds good, doesn't it. But they are the "legit board" right? Keep up the good work abfas crowd, your doing a great job of making the ABPM seem more legit everyday!!!

did you just wake up from a nap? this is not what we are discussing here...

 

[air bud]

100% ...

The ID and Endo can be considered if there are fellowship programs or great attendings in the pod residency hospital system.

I think plastics is even a bit questionable if the local surgeons are just cosmetic and/or dont teach. I was fortunate to have a local legend who was a former program director and did much recon plastics, but that's rare in most areas.

WTF are you guys talking about with Endo? That was a rotation?

 

[Feli]

If you look up the CPME 320 section 6.4 it says the following:

"The residency program shall provide rotations that enable the resident to achieve the competencies identified by the Council and any additional competencies identified by the residency program. These rotations shall include: medical imaging; pathology; behavioral sciences; internal medicine and/or family practice; medical subspecialties; infectious disease; general surgery; surgical subspecialties; anesthesiology; emergency medicine; podiatric surgery; and podiatric medicine. The residency curriculum shall provide the resident patient management experiences in both inpatient and outpatient settings."

I don't see any specific requirements about duration or length of each rotation. I can see how its easy for previous program directors to interpret each as a 1 month duration and feel like they're doing whats required. I wonder what is the minimum requirement for these rotations? Better yet, why not clarify/rewrite/update these rules?

I looked up what it takes to become a member of the council of CPME and looks like you can only be voted in?

CHAPTER 3. MEMBERSHIP Section 1. Number The Council shall consist of eleven members, including the officers, all of whom are elected by the Council.

If this is true, is that fair? How can the CPME have council members that represent the diversity of the podiatry community if they're choosing who gets in? They serve 3 year terms and say that calls for candidates are advertised on APMA News. TBH I usually throw away APMA News when I get it but might want to pay attention to these announcements.

I believe it is (or at least was) two weeks each.

This is where it's awesome to have a director who stands up for the residents and gets regular feedback...
We truncated psych, path, Rad, anesth, etc to 2 weeks. We weren't getting any meaningful Ortho involvement or OR time with thier teaching service, so he basically scrapped that month, put us with an Ortho Onco guy who had trained fellows, published a ton, and let us participate (we could still do gen ortho if it were a slow day for podiatry cases).

It's all about finding the best local teaching attendings/services... but many of those are swamped with their own residency/fellowship. Still, this is why podiatry needs to get into big academics hospitals and have FTE academic program director (good rotations/academic/research/visibility)... but they also still need tons of ASC and outside PP attendings and cases for volume of F&A cases and clinics. Only a tiiiny pct of our training programs have even half those elements.

 

[air bud]

I believe it is (or at least was) two weeks each.

This is where it's awesome to have a director who stands up for the residents and gets regular feedback...
We truncated psych, path, Rad, anesth, etc to 2 weeks. We weren't getting any meaningful Ortho involvement or OR time with thier teaching service, so he basically scrapped that month, put us with an Ortho Onco guy who had trained fellows, published a ton, and let us participate (we could still do gen ortho if it were a slow day for podiatry cases).

It's all about finding the best local teaching attendings/services... but many of those are swamped with their own residency/fellowship. Still, this is why podiatry needs to get into big academics hospitals and have FTE academic program director (good rotations/academic/research/visibility)... but they also still need tons of ASC and outside PP attendings and cases for volume of cases and clinics. Only a tiiiny pct of our training programs have even half those elements.

This goes back to the idea that the director doesn't need to be big time surgeon guy. They need to be a people person

 

[Feli]

This goes back to the idea that the director doesn't need to be big time surgeon guy. They need to be a people person

I think a lot of ways can work... our late directors were both very pro-resident, both good surgeons but not amazing or best of the program. They both kept the volume up, the boards passed, the program quality good/great... graduated dozens of competent alumni.

 

[deleted1149159]

Thank you all for the great feedback, everyone! And Happy Thanksgiving!

What's interesting to me, is that back in my day, when I did my one year PPMR (Primary Podiatric Medicine Residency), I was only off service for 6 months. The rest of the time I was in the OR. And back then, I did more Podiatry cases in those six months than some of my colleagues who did a one year surgical program.

Now it seems that programs are inflating the off service time for no good reason, really.

 

[air bud]

Thank you all for the great feedback, everyone! And Happy Thanksgiving!

What's interesting to me, is that back in my day, when I did my one year PPMR (Primary Podiatric Medicine Residency), I was only off service for 6 months. The rest of the time I was in the OR. And back then, I did more Podiatry cases in those six months than some of my colleagues who did a one year surgical program.

Now it seems that programs are inflating the off service time for no good reason, really.

Oh there is a good reason...they don't have enough cases to be a real residency.

 

[deleted1149159]

Oh there is a good reason...they don't have enough cases to be a real residency.

I really wonder about that. When you apply to create a residency, there is a very specific way to tell the CPME about your case load. Now certainly, things change, which is also something the CPME is made aware of via the residency annual report.

Again, I'm genuinely curious, how do programs get away with this kind of thing? The numbers are there in black and white.

 

[deleted1149159]

Just as a complete aside, if you can somehow get your Behavioral Health rotation done in a VA, it's VERY interesting stuff. I learned A TON over my month rotation there. Didn't really help me in my career but it was intense.

 

[air bud]

Just as a complete aside, if you can somehow get your Behavioral Health rotation done in a VA, it's VERY interesting stuff. I learned A TON over my month rotation there. Didn't really help me in my career but it was intense.

They may have seen some things in Vietnam, but @DYK343 saw some stuff in the residency shortage of 2014

 

[DPM TRUTH]

Happy Thanksgiving to you also Dr. Ron.

To answer Dr. Ron's question - Again, I'm genuinely curious, how do programs get away with this kind of thing? The numbers are there in black and white?

$$$. Plain and simple. The "gurus" thought it was a good idea to convert all the ppmrs/psrs/pm&s to 3 year programs about 15 years ago. I think they gave them all a couple years to "comply". The point is there were (and in my opinion still) only a handful of TRUE PM&S-36s.

That didn't matter to the leadership gurus. They knew (and still know now) that most programs don't even come close to what they are advertising. CPME always acts "suprised" by this. Just talk to some 3rd year residents sometime, they will let you know how bad it is.

So instead of fixing the REAL PROBLEMS in our DPM world, leadership argues about what board we should use. PRIORITIES!!! Who cares our programs are failing. Nothing to see there leadership says.

So CPME stop wasting your time taking positions on boards. CPME, a lot of those students advocating for the ABPM sx certificate feel like they were scammed 250k into podiatry by YOU in the 1st place. It starts at the schools promising "foot and ankle surgery". The least you can do is let them choose the board they feel fits their training. It's the least you can do for promising something that doesn't exist.

 

[PeaJay]

All other months and half-months I did (rad, path, trauma, gen surg, anesth, psych, ortho, etc etc) were basically rounding or sitting and learning maybe one or two things I may actually use one day. OR involvement ranged from tiny to none

I think this is the difference between my experience and the norm. My off service time was still OR time (averaged 3 days a week in the OR on off service). Most of the clinic time was procedure based. If there is going to be long drawn out off service rotations they need to be procedural.

 

[call1800doctorb]

exactly. pain management rotation is useless. podiatrists who make these decisions don't even know what they are talking about

These guys are disconnected from reality and do not even have a background in medicine to know which off service rotations are useful. They picked 3 year residency out of a hat because it’s the same length as the minimum MD residency length. Of course MDs did not notice or care. We’re still just podiatrists. Then they pulled off service rotation requirements out of their ass. The people who make the decisions don’t even seem to know what the off service rotations do. Just looks good on paper.

Funny thing is, the people who set the requirements for 3 year residencies today did not have a 3 year residency themselves. The older generation is always holding the younger generation to standards they themselves were not held to.

 

[DPM TRUTH]

Funny thing is, the people who set the requirements for 3 year residencies today did not have a 3 year residency themselves. - Yes!

Don't forget that a lot of these people also got grandfathered into the abps/abfas and never completed the process fairly like the rest of us.

 

[deleted1149159]

These guys are disconnected from reality and do not even have a background in medicine to know which off service rotations are useful. They picked 3 year residency out of a hat because it’s the same length as the minimum MD residency length. Of course MDs did not notice or care. We’re still just podiatrists. Then they pulled off service rotation requirements out of their ass. The people who make the decisions don’t even seem to know what the off service rotations do. Just looks good on paper.

Funny thing is, the people who set the requirements for 3 year residencies today did not have a 3 year residency themselves. The older generation is always holding the younger generation to standards they themselves were not held to.

I wanna say they used the medical internships as a model for what off service rotations they require. And then pulled a bunch of non-podiatric surgical specialties out of a hat. That's what it seems like to me, at least.

 

[PeaJay]

After actually sitting down and re-reading this thread, there are some interesting points that should be taken.

We have regular posters that for the most part came from surgery heavy programs. They advocate volume at all costs and want higher levels of education/quality in our profession. Programs that have even moderate volume are bashed. When it comes to a weakness in the high volume programs (off service rotations) everyone tries to brush it off and say that "they didn't learn anything" and thus the requirement should be abolished. Has it ever occurred to some of the posters that maybe their programs were not perfect? Maybe they went to programs that made them weak in certain aspects and are afraid to admit it?

Some programs need to increase volume or elevate attending quality, but others need to develop quality off service rotations. There is much to be learned on QUALITY off service rotations.

 

[air bud]

After actually sitting down and re-reading this thread, there are some interesting points that should be taken.

We have regular posters that for the most part came from surgery heavy programs. They advocate volume at all costs and want higher levels of education/quality in our profession. Programs that have even moderate volume are bashed. When it comes to a weakness in the high volume programs (off service rotations) everyone tries to brush it off and say that "they didn't learn anything" and thus the requirement should be abolished. Has it ever occurred to some of the posters that maybe their programs were not perfect? Maybe they went to programs that made them weak in certain aspects and are afraid to admit it?

Some programs need to increase volume or elevate attending quality, but others need to develop quality off service rotations. There is much to be learned on QUALITY off service rotations.

I have stated often how terrible my off service was and how my medicine knowledge suffered. No other residents in my hospital. You only spend 1st year there, otherwise no inpatient works years 2 and 3. Also, I think you are significant outlier in terms of the strength of your off service rotations.

 

[CutsWithFury]

After actually sitting down and re-reading this thread, there are some interesting points that should be taken.

We have regular posters that for the most part came from surgery heavy programs. They advocate volume at all costs and want higher levels of education/quality in our profession. Programs that have even moderate volume are bashed. When it comes to a weakness in the high volume programs (off service rotations) everyone tries to brush it off and say that "they didn't learn anything" and thus the requirement should be abolished. Has it ever occurred to some of the posters that maybe their programs were not perfect? Maybe they went to programs that made them weak in certain aspects and are afraid to admit it?

Some programs need to increase volume or elevate attending quality, but others need to develop quality off service rotations. There is much to be learned on QUALITY off service rotations.

I've been through a ton of off service rotations which were at level 1 trauma centers. All robust. I'm telling your podiatrists needs heavy duty exposure to medicine, ortho, vascular surgery and plastics to be the most well rounded podiatrists they can be. Everything else is pointless.

 

[deleted1149159]

After actually sitting down and re-reading this thread, there are some interesting points that should be taken.

We have regular posters that for the most part came from surgery heavy programs. They advocate volume at all costs and want higher levels of education/quality in our profession. Programs that have even moderate volume are bashed. When it comes to a weakness in the high volume programs (off service rotations) everyone tries to brush it off and say that "they didn't learn anything" and thus the requirement should be abolished. Has it ever occurred to some of the posters that maybe their programs were not perfect? Maybe they went to programs that made them weak in certain aspects and are afraid to admit it?

Some programs need to increase volume or elevate attending quality, but others need to develop quality off service rotations. There is much to be learned on QUALITY off service rotations.

This reminds me of the conversations I had with Rob Mendicino way back when. He admitted that his residents were deficient in the forefoot procedures that were the bread and butter in favor of the more reconstructive intensive rear foot cases. My personal view is good forefoot surgery is more difficult than many of the "big" cases. It was explained to me in residency by an attending I had a lot of respect for this way.

You don't want to screw up that profession female's bunion. You want to make sure she does well at all costs. That diabetic train wreck Charcot recon...well...you get the idea.

 

[CutsWithFury]

This reminds me of the conversations I had with Rob Mendicino way back when. He admitted that his residents were deficient in the forefoot procedures that were the bread and butter in favor of the more reconstructive intensive rear foot cases. My personal view is good forefoot surgery is more difficult than many of the "big" cases. It was explained to me in residency by an attending I had a lot of respect for this way.

You don't want to screw up that profession female's bunion. You want to make sure she does well at all costs. That diabetic train wreck Charcot recon...well...you get the idea.

Every case has its own headaches.

Coming out of residency all we did was TARS, complex recon, ankle work, foot and ankle trauma, bread and butter MSK. No wounds. No charcot. No ex fix.

As I have been in practice I tend to favor the trainwrecks and the wounds because there is always plenty of patients to fix. The TARs, complex recon, ankle work, foot and ankle trauma...now you cross paths with foot and ankle ortho for that. In some markets it is contentious. Lots of potential for bad mouthing and getting sued because the patient saw foot and ankle ortho and told them you are a podiatrist who should not be operating in the ankle, etc.

Do I still do MSK? Yes I do but I've been transitioning more so to wounds and charcot since I started my new job. I can because I am in a bigger hospital system where we have other podiatrists employed who have zero interests in wounds and charcot.

I probably would want to do all MSK cases if I had MORE FAITH in the profession that it would protect me. But I don't. Especially when the profession sat on their hands when AOFAS published ortho vs podiatry articles for TAR and ankle fractures that were clearly biased. When they said nothing it proved to me that the DPMs we all admire (who are employed in ortho groups) would NEVER bite that hand that feeds them.

They would rather have their career over the podiatry profession. For me that changed everything. Nobody cares about podiatry the profession. Everyone has their own agenda to milk this profession for all its worth. We just so happen to be podiatrists. We are not in this together. This thing of "ours" more like this "thing of mine". Those are the cold hard facts.

 

[deleted1149159]

Every case has its own headaches.

Coming out of residency all we did was TARS, complex recon, ankle work, foot and ankle trauma, bread and butter MSK. No wounds. No charcot. No ex fix.

As I have been in practice I tend to favor the trainwrecks and the wounds because there is always plenty of patients to fix. The TARs, complex recon, ankle work, foot and ankle trauma...now you cross paths with foot and ankle ortho for that. In some markets it is contentious. Lots of potential for bad mouthing and getting sued because the patient saw foot and ankle ortho and told them you are a podiatrist who should not be operating in the ankle, etc.

Do I still do MSK? Yes I do but I've been transitioning more so to wounds and charcot since I started my new job. I can because I am in a bigger hospital system where we have other podiatrists employed who have zero interests in wounds and charcot.

I probably would want to do all MSK cases if I had MORE FAITH in the profession that it would protect me. But I don't. Especially when the profession sat on their hands when AOFAS published ortho vs podiatry articles for TAR and ankle fractures that were clearly biased. When they said nothing it proved to me that the DPMs we all admire (who are employed in ortho groups) would NEVER bite that hand that feeds them.

They would rather have their career over the podiatry profession. For me that changed everything. Nobody cares about podiatry the profession. Everyone has their own agenda to milk this profession for all its worth. We just so happen to be podiatrists. Those are the cold hard facts.

I think I've mentioned this before, but why are people so concerned about what others do?

Do your own work. Make your own career and reputation. There will be roadblocks. Overcome them.

 

[CutsWithFury]

I think I've mentioned this before, but why are people so concerned about what others do?

Do your own work. Make your own career and reputation. There will be roadblocks. Overcome them.

I don't even know what you are referring to. This is too general of a statement.

 

[Feli]

After actually sitting down and re-reading this thread, there are some interesting points that should be taken.

We have regular posters that for the most part came from surgery heavy programs....
...When it comes to a weakness in the high volume programs (off service rotations) everyone tries to brush it off and say that "they didn't learn anything" and thus the requirement should be abolished. Has it ever occurred to some of the posters that maybe their programs were not perfect? ...
...There is much to be learned on QUALITY off service rotations.

All fine points. It is good that you had good exp off service.

As I said, I absolutely did have neat away rotations and pathologies in a trauma teaching center also. When I say "OR involvement tiny to zero," I was cutting a vascular surgeon's sutures while they did fistula or fem pop for hours... watching ortho do revision TKA... doing a suture or two at the end of a cleft palate... retracting for colon CA resection or GSW chest. Very cool stuff, but also very minimum utility to what I do today.

And sure, part depends on when you do the rotations. Doing a hallux amp while on Vasc or some ER sutures is fun early first year but a snooze-fest as a senior.

In the end, it's the era of specialization. The away rotations are fine and required, but I feel they should be done early on and not exaggerated any more than required to graduate or beyond the high level teaching capabilities of the facility/system (which is very low at many pod sponsor hospitals). That max time on own specialty and sub specialties is how ortho, neurosurg, plastics, ent, optho, etc etc trainings trend... and how we should also.

Bottom line: no podiatrist can tell me they learned more doing fractions of cases or shadowing another specialty versus a month with 5 ankle fx, a calc fx, a lisfranc fx, met fx, 10 Lapidus, 3 flatfoot, 2 cavus, 10 Austin, 15 Weil, 25 hammertoes, 2 ankle scopes, a few diab recon/amp, some Myerson and journals reading, etc. Whether most are first or 2nd assist, that's all highly useful. Especially in second and third year, all DPM residents need max time with skilled attendings of their own specialty. If they are bored or have already seen a ton, they matched well... unconscious competence

 

[deleted1149159]

I don't even know what you are referring to. This is too general of a statement.

It referred to your statement about how we don't look out for one another, and how Ortho will get you sued because they think you shouldn't do ankle.

If you are within your state licensure, and do good work that you can back up with training and documentation, who cares about what Ortho says or does, or if your colleagues have your back?

 

[CutsWithFury]

It referred to your statement about how we don't look out for one another, and how Ortho will get you sued because they think you shouldn't do ankle.

If you are within your state licensure, and do good work that you can back up with training and documentation, who cares about what Ortho says or does, or if your colleagues have your back?

Doing good work is not enough in some states. All it takes is one person to discredit you before the patient gets a lawyer who knows a grandfathered DPM on his payroll that will give a different opinion on the case to at least bring it to court with hopes of getting a settlement. It happens.

 

[deleted1149159]

Doing good work is not enough in some states. All it takes is one person to discredit you before the patient gets a lawyer who knows a grandfathered DPM on his payroll that will give a different opinion on the case to at least bring it to court with hopes of getting a settlement. It happens.

Sure it happens. So? Again, if you do good work, have the credentials and documentation to back you up, you need not worry. Let your malpractice carrier work it out. You can be sued for anything. A different opinion isn't the only thing needed to get a case to court or force a settlement. Most of the time it's the doctor being sued being negligent about something that forces that hand. Back in the day, when Ross Taubman was still in the APMA, we talked about this a lot. Sure it's stressful to have a potential case against you. Follow the rules we all know about documentation and also be careful about patient selection, and you have nothing to worry about. IF you didn't screw something up.

I worked in Philly for a couple of years. Plenty of DPMs there make a career out of burying their own. Attempts at "discrediting" me were common. Especially by one Ortho group in particular. And that followed me when I crossed the bridge. And still does. Again, do good work, and document properly, often and as if your life depended on it. Which it does.

 

[DYK343]

I've been through a ton of off service rotations which were at level 1 trauma centers. All robust. I'm telling your podiatrists needs heavy duty exposure to medicine, ortho, vascular surgery and plastics to be the most well rounded podiatrists they can be. Everything else is pointless.

Agree 100% but I would add in infectious disease.

ID is something we do all the time as DPMs. My experience on that rotation was one of the better rotations I had. I learned a ton.

My last job I was practicing in an area where outpatient ID was impossible and I had to manage my own PICCs, etc. Is that actually hard? No its not. But having a rotation to solidify the knowledge was invaluable. I put in some PICCs too which I dont think a lot of people do. It helps when discussing with a patient what is going to happen.

I wouldnt cut ID

 

[newfeet]

Agree 100% but I would add in infectious disease.

ID is something we do all the time as DPMs. My experience on that rotation was one of the better rotations I had. I learned a ton.

My last job I was practicing in an area where outpatient ID was impossible and I had to manage my own PICCs, etc. Is that actually hard? No its not. But having a rotation to solidify the knowledge was invaluable. I put in some PICCs too which I dont think a lot of people do. It helps when discussing with a patient what is going to happen.

I wouldnt cut ID

Yes ID was good.

 

[Weirdy]

Make sure your surgery heavy rotations don't already have an ortho resident, hired PA, and medical student scrubbed in.

Otherwise you are only asking your 1st year podiatry residents to be glorified floor nurses.

 

[deleted1149159]

Make sure your surgery heavy rotations don't already have an ortho resident, hired PA, and medical student scrubbed in.

Otherwise you are only asking your 1st year podiatry residents to be glorified floor nurses.

Funny enough, when I had my Vascular Rotation, the group had a PA and a Fellow, and they both let me do EVERYTHING. On the floors and in the OR. The Fellow was super nice, and was very glad to have the load off of him while I was there. I was AMAZING. The residents after me had similar experiences with that group on their rotations. And it continued even after I returned to the area to practice and was an Admin in the residency.

 

[Feli]

This thread had some twists and turns, but a lot of good ideas overall for what to look for and aim for in residency programs. It could be a sticky... in pod students forum or this forum?

...One of the most common PMs I get is definitely what to look for and how to choose on limited clerkship.

Hint to students: if any program ever brags that its off-service aka non-pod months are their "biggest strength," that's a backup at best.