Fellowships

[GrandHustle01]

What would be the top foot and ankle fellowships in the country? And I mean podiatry specificly.

---

Members don't see this ad.

 

[PADPM]

What would be the top foot and ankle fellowships in the country? And I mean podiatry specificly.

It depends on the type of fellowship you are seeking. There are surgical fellowships, some stronger in trauma, some stronger in reconstructive surgery, sports medicine fellowships, some strong in practice management, and many others. So I'm not sure there is a strongest, it depends on your interest. For example, Chris Hyer has an incredible program in Ohio. I believe Justin Fleming recently started a fellowship in Philadelphia which is heavy in trauma, there is an excellent sports medicine/surgery fellowship with Amol Saxena in Palo Alto, Califormia.

So it's dependent on your goals.

 

[Feli]

It depends on your reason for doing a fellowship...

Are you doing it because you didn't get enough cases or don't feel comfortable with certain types of cases based on your residency?

Are you doing it to network in an area in hopes of getting a better job after (maybe a job with the fellowship training group/institution)?

Are you doing it for personal enrichment and to advance what you will have to offer patients during your career?

Are you doing it to learn practice management and office/billing?

Are you doing it to say you trained with so-and-so and gain publications to gun for an academic job like residency director / conf speaker?

Are you doing it because you started your job hunt too late or too passively during your residency, didn't like your job options, and you just need to buy time?

...it all depends. There's a lot to consider. Many of those listed above are poor reasons for doing a fellowship, and some are great reasons, but people pick fellowships for all kinds of personal and other reasoning.

 

[GrandHustle01]

I'm thinking more surgical. Like rear foot, ankle, flatfoot. I heard Mendicinos program in Houston, hoffbauer in Pittsburgh and DiDomenico in Youngstown were the big programs. What do you guys think?

 

[PADPM]

I'm thinking more surgical. Like rear foot, ankle, flatfoot. I heard Mendicinos program in Houston, hoffbauer in Pittsburgh and DiDomenico in Youngstown were the big programs. What do you guys think?

I don't think that there are any bad fellowships. However, I also heard the fellowship with Hyer is excellent.

As a student, a fellowship is a long way down the road, and it's very feasible there will be changes and additional programs. At this point, concentrating on obtaining a high quality residency should be your priority.

 

[feet2017]

I am just a pre-pod so this might be incorrect but there are also ortho f/a fellowships that pods can get into. I don't think there are many and I do not know the quality of ortho f/a fellowships compared to podiatry fellowships. But I just wanted to throw it out there so you were aware of them.

Also I don't know about GrandHustle01 but I was just looking into them so I could prepare myself for acceptance into the fellowships if I do decide to do them. I know there are not many and so I am going to assume they are competitive. I wanted to know earlier so I could prepare myself to be an competitive applicant whether or not I decide to do a fellowship. I figure it is better to be prepared to have that option rather to not be prepared and not even have the choice of obtaining a fellowship.

Please feel free to correct anything I have said because as I have stated my knowledge is only from the research I have done.

I am sure you have probably seen this list, but just in case you have not.

http://www.acfas.org/Students/content.aspx?id=493

 

[PADPM]

The program I've mentioned with Dr. Hyer also trains orthopedic surgeons. I believe they usually have one pod position and 2 ortho positions.

 

[feet2017]

The program I've mentioned with Dr. Hyer also trains orthopedic surgeons. I believe they usually have one pod position and 2 ortho positions.

That is correct, it is an aofas approved f/a ortho fellowship.

 

[hematosis]

Interesting. Never thought i would see a program that is both acfas approved and aofas approved. There is also a very good sports med fellowship with Jim Losito. its not on the list but its solid. plus you get to attend every heat game

 

[air bud]

Pretty simple solution here. Make yourself a great candidate for the "top" residency program. Then worry about it. The reality is many people from the "top" programs are the ones doing the "top" residencies

 

[GrandHustle01]

I appreciate the feedback on Dr. Hyers program, but how about some of the other guys.

 

[ldsrmdude]

Interesting. Never thought i would see a program that is both acfas approved and aofas approved. There is also a very good sports med fellowship with Jim Losito. its not on the list but its solid. plus you get to attend every heat game

Here's the program you mentioned on the list of CPME-approved fellowships.
http://www.cpme.org/fellowships/content.cfm?ItemNumber=2441

I've looked at the fellowships listed on both the ACFAS and CPME pages. As someone who might consider a fellowship, it's sort of like trying to research residencies except there is less information and less word-of-mouth out there about most of them. Hyer publishes a lot, as do DiDomenico, Saxena, and a few others and some of them are well-known on the lecture circuit, but I still think it's tough to find out much about the quality of the programs.

 

[nndtodd]

I wanted to post a response regarding fellowships. I just completed a fellowship so I am a bit biased on the topic. I spent the last year at Palo Alto Medical Foundation (Dr. Rush director). It was by far the best professional decision I have ever made. The year was extremely rigorous; the fellow works with 7 doc's and usually operates everyday including most weekends. The fellow has a great deal of responsibility and is expected to perform a great deal on his own. What makes the fellowship special is not all the trauma/reconstructive cases but high-powered attending’s that truly want to see the fellow learn and succeed. Feel free to contact me regarding fellowships. I truly feel fellowships are important for our profession.

 

[PADPM]

I appreciate the feedback on Dr. Hyers program, but how about some of the other guys.

Once again, I don't believe that there are realistically any bad fellowships at the present time. It depends on exactly what you want and how you will fit the program.

I appreciate that you have set goals for yourself and would like to prepare ahead. But since you haven't even graduated, have not yet obtained a residency and have not yet started a residency, I would concentrate on your studies, then concentrate on obtaining the best residency possible and THEN put your efforts into being the best resident you can be to allow yourself to be competitive with any fellowships that exist when you are ready to apply.

Once again, I appreciate that you are looking forward to the future and setting goals, but I think it may be a tad early, since a lot may change over the next several years.

 

[PADPM]

I wanted to post a response regarding fellowships. I just completed a fellowship so I am a bit biased on the topic. I spent the last year at Palo Alto Medical Foundation (Dr. Rush director). It was by far the best professional decision I have ever made. The year was extremely rigorous; the fellow works with 7 doc's and usually operates everyday including most weekends. The fellow has a great deal of responsibility and is expected to perform a great deal on his own. What makes the fellowship special is not all the trauma/reconstructive cases but high-powered attending’s that truly want to see the fellow learn and succeed. Feel free to contact me regarding fellowships. I truly feel fellowships are important for our profession.

There is no better resource than someone who just completed an excellent fellowship. Those with questions should absolutely take him up on his offer to contact him. Hearsay is weak at best, but speaking directly with a doctor who just finished a program is priceless.

 

[GrandHustle01]

Once again, I don't believe that there are realistically any bad fellowships at the present time. It depends on exactly what you want and how you will fit the program.

I appreciate that you have set goals for yourself and would like to prepare ahead. But since you haven't even graduated, have not yet obtained a residency and have not yet started a residency, I would concentrate on your studies, then concentrate on obtaining the best residency possible and THEN put your efforts into being the best resident you can be to allow yourself to be competitive with any fellowships that exist when you are ready to apply.

Once again, I appreciate that you are looking forward to the future and setting goals, but I think it may be a tad early, since a lot may change over the next several years.

I actually am a 3rd year resident.

 

[PADPM]

I actually am a 3rd year resident.

That's a whole different story. I could have SWORN that your information on the left side below your name said podiatry student.

Did you just recently change it to resident?

Since you're a 3rd year resident, you should see if there is a way to contact present and/or former fellows at some of the programs. You may want to also utilize local resources such as your residency director or attendings at your program to see if any of them know about the programs, have connections, etc.

Find out the types of doc who were accepted to see if there is a common denominator. Did most come from the same school, same residency, same geographic area? Are they looking for some particular trait?

Residency directors and fellowship directors often have a "type" of person they prefer, and to stay within the boundaries of those preferences. They take what works for them. So the more you can find out about the program and past/current fellows, the greater the chances of your success.

Goods luck.

 

[ldsrmdude]

I actually am a 3rd year resident.

If you are looking to start a fellowship next year, you might be a bit late for some programs. I just took a quick glance at the ACFAS website and it appears around half have had their application deadlines pass already for next year fellowships.

I spent a few weeks in Tucson at Dr. Armstrongs program there, and I thought it was a very interesting place. If you are interested in diabetic/limb salvage/"toe and flow" I think it's definitely worth looking into. The University of Arizona seems supportive of the program and the work they are doing. Just my view as a student there for a month. Plus, I think Dr. Armstrongs fellows end up well-published and well-connected.

 

[Feli]

Pretty simple solution here. Make yourself a great candidate for the "top" residency program. Then worry about it. The reality is many people from the "top" programs are the ones doing the "top" residencies

Were you trying to say that people who complete "top" residencies tend to do "top" fellowships?

If so, I'd say that really depends. It does make it a lot easier to get a good *name* fellowship if you have a good name residency with research or influential director/attendings. However, that also means chances are slim you'd be uncomfortable with your skills afterwards - esp if you do a name program which also has good case logs and lots of resident OR experience. A lot of the people who do a high power fellowship after completing a high power residency are shooting as much or more for the profesional networking than the slight skills boost, but everyone has their own reasoning.

 

[air bud]

I agree with the networking part. But I also can say from my experience so far 4th year that "high" powered residencies are not necessarily offering the best training. I wish I wouldn't have fallen into that trap. I have some seen some good programs, but there are definitely some other places i wish I would have visited. But that is just the way this whole process works.

 

[Feli]

I agree with the networking part. But I also can say from my experience so far 4th year that "high" powered residencies are not necessarily offering the best training. I wish I wouldn't have fallen into that trap. I have some seen some good programs, but there are definitely some other places i wish I would have visited. But that is just the way this whole process works.

Don't get caught up in names... maybe that mattered more 20 years ago, but it doesn't now.

If you just want good training and broad possibilities after residency (DPM group, multispec, etc), do a high volume program based at a teaching hospital with a director who cares about teaching. None of the multispec groups have ever heard of the majority of DPM residency hospitals anyways (aside from the obvious ones like the ivy league affialitated programs). If you want an ortho job after, pick a high volume program that has a fair amount of ortho attendings/rotations. If you are business oriented and definitely want to start/buy your own practice after residency, then pick a residency program with lots of office rotations and fairly lax hours so you can go to a lot of AAPPM meetings and shop for a practice in your senior resident years.

If you want to lecture nationally, be active politically within pod surg community, be a residency director down the line, and/or be a top candidate for fellowships, THEN you should probably pick a "name" value residency with well published and politically connected attendings. Just be aware that you will work long hours, probably have required research, and might sorta need that fellowship if the name program's volume is no longer where it once was. A lot of the most historic programs were high volume in the past since they were one of the only places in that metro where DPMs could get good privileging. Now, that's changed and most hospitals welcome our cases, so some of the old high volume programs have key attendings who are slowing down or taking cases elsewhere now. Similarly, newer programs have popped up and are offering pretty high quality training... even if they don't have any name value (yet). Pay attention on clerkships to whether residents are doing more watching or more operating; programs can change relatively fast based on director, area pod/ortho and hospital politics, and many other factors. GL

 

[air bud]

Don't get caught up in names... maybe that mattered more 20 years ago, but it doesn't now.

If you just want good training and broad possibilities after residency (DPM group, multispec, etc), do a high volume program based at a teaching hospital with a director who cares about teaching. None of the multispec groups have ever heard of the majority of DPM residency hospitals anyways (aside from the obvious ones like the ivy league affialitated programs). If you want an ortho job after, pick a high volume program that has a fair amount of ortho attendings/rotations. If you are business oriented and definitely want to start/buy your own practice after residency, then pick a residency program with lots of office rotations and fairly lax hours so you can go to a lot of AAPPM meetings and shop for a practice in your senior resident years.

If you want to lecture nationally, be active politically within pod surg community, be a residency director down the line, and/or be a top candidate for fellowships, THEN you should probably pick a "name" value residency with well published and politically connected attendings. Just be aware that you will work long hours, probably have required research, and might sorta need that fellowship if the name program's volume is no longer where it once was. A lot of the most historic programs were high volume in the past since they were one of the only places in that metro where DPMs could get good privileging. Now, that's changed and most hospitals welcome our cases, so some of the old high volume programs have key attendings who are slowing down or taking cases elsewhere now. Similarly, newer programs have popped up and are offering pretty high quality training... even if they don't have any name value (yet). Pay attention on clerkships to whether residents are doing more watching or more operating; programs can change relatively fast based on director, area pod/ortho and hospital politics, and many other factors. GL

Agree with everything you said.

 

[ldsrmdude]

Bumping this thread to get some more feedback. I'm hoping that diabeticfootdr has some input being as he completed a fellowship.

Had another question. I was looking through the ACFAS list of fellowships and noticed that some of the fellowships are at hospitals that have residency programs and some aren't. Anyone have thoughts as to which is better? I can see advantages to both.

 

[diabeticfootdr]

Bumping this thread to get some more feedback. I'm hoping that diabeticfootdr has some input being as he completed a fellowship.

Had another question. I was looking through the ACFAS list of fellowships and noticed that some of the fellowships are at hospitals that have residency programs and some aren't. Anyone have thoughts as to which is better? I can see advantages to both.

Not only have I done a fellowship, but I've hired only fellowship-trained DPMs and we now have our own limb salvage fellowship.

Fellowships in podiatry are completely superfluous. You don't need one to practice. They don't lead to special board certification like fellowships in the MD world. But I'll say, doing a fellowship was one of the best career choices I've made.

First, you have to understand how podiatry fellowships "work." Podiatry fellowships are really apprenticeships. There is no central approval process for fellowships. That's why there isn't a comprehensive list of DPM fellowships. Many are found by "word of mouth". There is only partial GME funding (since they don't lead to a specialty certification). Because of this, many are industry sponsored.

People do fellowships for different reasons.

Some want more cases. Some want the security of being a quasi-attending before fully jumping into practice. But I think, under the current system, you should do it because you want mentorship from the fellowship director. You become part of a small family afterward and it can really boost your career. Few podiatrists do fellowships. It gives you a step ahead of your peer group, on paper at least.

 

[PADPM]

This is interesting to me. I feel doing a fellowship would only make you more marketable to other DPMs looking to hire but would do nothing for you if you were looking to latch on with a multi-specialty or ortho group. If you think about it, the majority of the public is unaware of our standards of education and residency training and that goes for other medical specialists as well.

For example, I've been out doing my first podiatry core at Stroger Hosp and UIC this past month. I'm now at the UIC site and work a Foot and Ankle Ortho clinic with an attending and one of his F/A residents. I was talking to the F/A resident one day and he didn't even know we went to school for 4 years. He was flabbergasted that we had a "3 year surgical residency" on top of it. He thought we only treated the skin, cut nails and sold orthotics.

Yeah so that's one example and maybe in other parts of the country podiatry might be more recognized and respected but I still feel the profession has a long way to go before doing a fellowship would significantly impact your career or "set you apart from the pack".


On second thought, while we are discussing residency training...I feel that some of the programs that are considered "elite" in the podiatry community are enigmas to the rest of the medical professional world. I feel coming out of a program with a strong ortho influence is the way to go if you are really interested in getting a job with a medical practice composed of other medical professionals (i.e MD/DO).

I've had this same conversation with a well known podiatrist that I shadowed down in TN over my x-mas break as well. He graduated from West Penn when Mendicino and Catz were there together. Very knowledgeable guy and extremely skilled surgically. He is pretty much "the man" in the middle-of-nowhere-TN. He told me that he felt fellowship training was the only way to go in the future and that everyone would now need to get 4 years of surgical training. He never really explained that logic to me but he felt that was where the "profession was going".

So go figure...

There has been a similar conversation about fellowships in the present podiatry forum here: http://podiatry.com/etalk/Fellowship-a-good-idea-or-t8697.html#-1

Some posters, such as Dr. Laporta, have expressed similar views.

Sorry, but I don't believe for a minute that any F/A orthopod in training really thinks that all we do is the limited practice he mentioned. It was his attempt at an insult. He knows EXACTLY what we do.

 

[ManUnderFire]

This is interesting to me. I feel doing a fellowship would only make you more marketable to other DPMs looking to hire but would do nothing for you if you were looking to latch on with a multi-specialty or ortho group. If you think about it, the majority of the public is unaware of our standards of education and residency training and that goes for other medical specialists as well.

I'm curious to see how others feels about this... it sounds logical. But how does this notion play out in real life?

 

[dyk343]

A bunch of ortho residents (spine, hand, etc) were in the physician lounge and said to the 2nd year podiatry resident that podiatrists would be out of business if people took better care of themselves and we didn't have any diabetic ulcers to deal with. /QUOTE]

...kinda sounds like an insult as well.

 

[PMSIII]

As a current fellow, I'm going to chyme in on my experience and that of my current colleagues who are also fellows. First of all, I can tell you with full assertion that I chose to pursue this fellowship not to "get in" with ortho groups or multispecialty groups. My colleagues and I chose to invest in our training for an additional year because this is the only time we can do so. Podiatry residency training should in theory, prepare you for all facets of foot and ankle surgery but in reality, not all of us feel 100% ready for the "real world' after residency.

For me, fellowship has helped me build on my surgical skills, gave me the confidence to be more efficient in the OR, expand on my procedure experience, and publish/contribute to our literature. I also learned how to bill properly and this was a skill I needed to build on after my residency training. I did not do this to market myself to an orthopedic group but rather to invest in myself. While most of my colleagues from residencies are making 6 figures during their first year of practice, I chose to take a pay cut and invest in myself - best investment I could have made. I'll tell you right now also that I trained at a very respectable residency program and that fellowship was not an option for me to "fill" major deficiencies. I had a wide array of surgical and clinical experience after 3 years and most of you would agree that 3 years of comprehensive surgical training is sufficient. I took an additional year to build and expand on my experience. Fellowships are NOT a substitute to your residency training. Don't bother pursuing an additional year of training if you wasted 3 years prior to this.

Another point to consider is that not all fellowships are created equal - just like schools and residencies. If you are serious about considering a fellowship, then you must do your home work on the available programs and see what they offer. I understand this sounds intuitive but you'll be amazed how many applicants we had this past year who had very limited idea of what we did in our fellowship, and more alarmingly - what they want out of their fellowship.

In my mind, fellowships are not the solution to all of the issues in our profession and will not "equate" you to your MD/DO colleagues as some people out there believe, but they are rather a plat form to further enhance your experience and training, while giving you the opportunity to do more and be better prepared for private practice - regardless if you want to pursue ortho/podiatry/multispecialty/solo practices.

Hope this helps.

 

[Robert De Niro]

I view medical school as the mafia. They may let pods hang around but we will never be viewed as equals unless admission standards are similar, schools stop accepting GRE/DAT scores, and we take the USMLE. Even then F/A orthos would frown down upon us because they would never lets us take their F/A licensing boards.

We can never be "Made Men" haha if you were going for a "Goodfellas" reference I like it. From my limited experience working in a hospital, it seems orthopods don't really get along with many people. I've heard multiple Family docs/residents and IM residents mention they are @$$es, either on rotation or in conversation. Bc of this, any future comment I might get from orthopods or their residents will be taken with a grain of salt.

 

[Robert De Niro]

As a current fellow, I'm going to chyme in on my experience and that of my current colleagues who are also fellows. First of all, I can tell you with full assertion that I chose to pursue this fellowship not to "get in" with ortho groups or multispecialty groups. My colleagues and I chose to invest in our training for an additional year because this is the only time we can do so. Podiatry residency training should in theory, prepare you for all facets of foot and ankle surgery but in reality, not all of us feel 100% ready for the "real world' after residency.

For me, fellowship has helped me build on my surgical skills, gave me the confidence to be more efficient in the OR, expand on my procedure experience, and publish/contribute to our literature. I also learned how to bill properly and this was a skill I needed to build on after my residency training. I did not do this to market myself to an orthopedic group but rather to invest in myself. While most of my colleagues from residencies are making 6 figures during their first year of practice, I chose to take a pay cut and invest in myself - best investment I could have made. I'll tell you right now also that I trained at a very respectable residency program and that fellowship was not an option for me to "fill" major deficiencies. I had a wide array of surgical and clinical experience after 3 years and most of you would agree that 3 years of comprehensive surgical training is sufficient. I took an additional year to build and expand on my experience. Fellowships are NOT a substitute to your residency training. Don't bother pursuing an additional year of training if you wasted 3 years prior to this.

Another point to consider is that not all fellowships are created equal - just like schools and residencies. If you are serious about considering a fellowship, then you must do your home work on the available programs and see what they offer. I understand this sounds intuitive but you'll be amazed how many applicants we had this past year who had very limited idea of what we did in our fellowship, and more alarmingly - what they want out of their fellowship.

In my mind, fellowships are not the solution to all of the issues in our profession and will not "equate" you to your MD/DO colleagues as some people out there believe, but they are rather a plat form to further enhance your experience and training, while giving you the opportunity to do more and be better prepared for private practice - regardless if you want to pursue ortho/podiatry/multispecialty/solo practices.

Hope this helps.

Great information. What resources do you recommend using to find the right fellowship?

 

[zdlamkin8195]

This is the 2¢ from a lowly soon to be first year Pod student....
I have worked several years performing neurological monitoring for spine/brain surgeries. It was a DO anesthesiologist that pointed me to the idea of podiatry, but every ortho-spine (All MD's) or neurosurgeon (both the MD and DO's) had a clue that podiatry was 4 years of school. Most of the were also very surprised to hear about it being newly mandated that we must have A 3 year residency (but they did seem a little impressed). They also didn't realize that the MCAT was the test we took to get in. I have been pretty surprised by the lack of expectations other professionals have on my new career choice, although they all seemed very supportive and excited for my opportunity. I plan on calling on them whenever I finally get out!

And for the record, the ortho-spine guys I work with have a VERY good reputation within the spine industry and may be too wrapped up in the ortho-spine/Neuro world to really keep up with anything else as far as other specialties are concerned...

 

[Ferocity]

In my mind, fellowships are not the solution to all of the issues in our profession and will not "equate" you to your MD/DO colleagues as some people out there believe, but they are rather a plat form to further enhance your experience and training, while giving you the opportunity to do more and be better prepared for private practice - regardless if you want to pursue ortho/podiatry/multispecialty/solo practices.

Hope this helps.

Just out of curiosity, what would "equate" me to my MD/DO colleagues? Becoming a partner in an ortho group?

 

[PMSIII]

Just out of curiosity, what would "equate" me to my MD/DO colleagues? Becoming a partner in an ortho group?

My point was that being a fellowship-trained podiatrist does not "equate" you to an MD/DO. You earn your MD/DO colleagues respect by your work and competency. Do the right thing for your patients and be a good doctor. Sounds cliche but ultimately this is how you're judged in private practice. It really does not matter how many cases, lectures, publications, or patients you've treated because the bottom line is that you are only as good as you're next case or patient encounter.

Being a DPM, your work will always be under the microscope because believe it or not - many people out there do not believe we should be operating on arthritic ankles, treating complicated diabetic ulcers, or managing neuropathic patients. Thus, as a speciatly we have to elevate our standards and continue to provide the best care possible. I stressed the word "equate" in reference to being fellowship-trained. We are not MD's or DO's and spending the extra year of fellowship does not make us "equals". We are extremely well-trained in managing foot and ankle pathology and recognizing systemic pathology manifesting in the foot and ankle. But generally, we are not automatically granted the respect or benefit of the doubt until our work speaks for our competency and training. For me personally, I take it as a challenge and I welcome it because this forces me to continue maintaining the highest standard for patient care and performance in the OR.

Just some food for thought.

 

[PMSIII]

Great information. What resources do you recommend using to find the right fellowship?

The ACFAS website's fellowship initiative section should have a listing of all the ACFAS-recognized programs. But again, as I mentioned before, focus on getting the right residency first because your residency training sets the tone for your practice.

 

[PADPM]

My point was that being a fellowship-trained podiatrist does not "equate" you to an MD/DO. You earn your MD/DO colleagues respect by your work and competency. Do the right thing for your patients and be a good doctor. Sounds cliche but ultimately this is how you're judged in private practice. It really does not matter how many cases, lectures, publications, or patients you've treated because the bottom line is that you are only as good as you're next case or patient encounter.

Being a DPM, your work will always be under the microscope because believe it or not - many people out there do not believe we should be operating on arthritic ankles, treating complicated diabetic ulcers, or managing neuropathic patients. Thus, as a speciatly we have to elevate our standards and continue to provide the best care possible. I stressed the word "equate" in reference to being fellowship-trained. We are not MD's or DO's and spending the extra year of fellowship does not make us "equals". We are extremely well-trained in managing foot and ankle pathology and recognizing systemic pathology manifesting in the foot and ankle. But generally, we are not automatically granted the respect or benefit of the doubt until our work speaks for our competency and training. For me personally, I take it as a challenge and I welcome it because this forces me to continue maintaining the highest standard for patient care and performance in the OR.

Just some food for thought.

 

[Feli]

... I'll say, doing a fellowship was one of the best career choices I've made....

That's interesting.

Conversely, I would say that not doing a fellowship is the best career choice I've ever made... financially, educationally, and overall. JMO though...

"Can you really explain to a fish what it's like to walk on land? One day on land is worth a thousand years of talking about it, and one day running a business has exactly the same kind of value."
-Warren Buffett

I would likely be singing a different tune had I not selected such a fantastic residency program, attended high quality conferences, networked within my profession, etc. The beauty of medical education is that each person takes their own path. I guess I chose to walk on land a bit sooner... some people like to talk about walking on land longer than the required 3 residency yrs. To each their own.

 

[ManUnderFire]

That's interesting.

Conversely, I would say that not doing a fellowship is the best career choice I've ever made... financially, educationally, and overall. JMO though...

"Can you really explain to a fish what it's like to walk on land? One day on land is worth a thousand years of talking about it, and one day running a business has exactly the same kind of value."
-Warren Buffett

I would likely be singing a different tune had I not selected such a fantastic residency program, attended high quality conferences, networked within my profession, etc. The beauty of medical education is that each person takes their own path. I guess I chose to walk on land a bit sooner... some people like to talk about walking on land longer than the required 3 residency yrs. To each their own.

would you consider your case an exception or do you genuinely believe that MOST students will not benefit their career by completing a fellowship?

 

[Feli]

would you consider your case an exception or do you genuinely believe that MOST students will not benefit their career by completing a fellowship?

That depends on the individual, their residency quality, and their long term goals in the profession. My residency has graduated over 100 foot and ankle surgeons, and none has ever done a formal fellowship (a few did the AO observational trauma/fixation mini trauma+recon fellowships back when reps could sponsor that... but no formal fellowships). Dozens of grads of StJohn do big, big, big recon without formal fellowship. I am no exception. There always comes a time when you need to take the training wheels off, you know?

In a totally different science, some guy named Bill Gates left computer science college after a year or two, but some people go for a decade or more. Did he benefit from more formal education? Most would say he reached his potential early. Will most do better the "traditional route" of a computer PhD or whatever? Yup.

...For surgery, it all goes back to my basic 'four pillars' theory (kinda stole that from AO, but different applcation):
-Personal interest and motivation to learn, excel, thrive
-Education and training
-Natural innate and evolved ability to think 3D, see visual arts, and have coordinated eye/hand skills
-Confidence / balls

With fellowships, it's a "to each their own" thing. As LCR alluded to, more training will never hurt your academia and your CV to do fellowship (esp won't hurt that of your fellowship director). It can hurt your pocketbook (but pad that of your fellowship attendings), and it takes time. Time is money, and time is the one thing you can't buy in the world. Does ACFAS recognize and encourage fellowships? Yeah. Am I a big ACFAS proponent and are there many FACFAS guys more accomplished and experienced than me? Yup... so question everything and take everything I, or anyone, says on SDN or in JFAS editorials or wherever with a sizable grain of salt. Always consider the source, their motivations, and their integrity. JMO

 

[Podophile]

...For surgery, it all goes back to my basic 'four pillars' theory (kinda stole that from AO, but different applcation):
-Personal interest and motivation to learn, excel, thrive
-Education and training
-Natural innate and evolved ability to think 3D, see visual arts, and have coordinated eye/hand skills
-Confidence / balls

These are really insightful and cover a few of the major reasons why people would do a fellowship. So why would anyone from a great program end up doing a fellowship? Well if they are already well trained, then a lot of times it comes down to balls. Some people need to see or do a procedure once and then would feel totally confident booking one as an attending. Others just aren't sure of themselves and a fellowship could be their "training wheel" period. Some people are sure of themselves and would have the confidence to book a triple the first day out. This comes down to balls and confidence. Some people no matter how great their training are destined to never do the big cases (and thats totally ok). Others will book the large stuff with borderline training and skills. Personality becomes a larger issue than training.

 

[Feli]

These are really insightful and cover a few of the major reasons why people would do a fellowship. So why would anyone from a great program end up doing a fellowship? Well if they are already well trained, then a lot of times it comes down to balls. Some people need to see or do a procedure once and then would feel totally confident booking one as an attending. Others just aren't sure of themselves and a fellowship could be their "training wheel" period. Some people are sure of themselves and would have the confidence to book a triple the first day out. This comes down to balls and confidence. Some people no matter how great their training are destined to never do the big cases (and thats totally ok). Others will book the large stuff with borderline training and skills [or borderline prep or sketchy level of confidence]. Personality becomes a larger issue than training.

I fully agree with almost everything you said. (I added the bracketed remark)

I would add that some people will book the 'large stuff' banking on "luck" or resident help, neither of which prove reliable in my limited experience. For the sake of our profession's reputation, please don't ever be "that guy" who tries to learn by trial and error and boards stuff they can't handle (for any of my 4 pillars reasonings). "Practice makes perfect" is not for surgery IMO. And besides, I'm nobody special, but I will tell you that most good surgeons - of any specialty - hate doing revisions of a colleague's botched work.

You always have to "know when to punt." When you're young, you think asking for help is a sign of weakness. As you wise up, you learn it's a sign of wisdom... and it helps the patient greatly if each doc knows and respects their own skill set and limits

 

[diabeticfootdr]

With fellowships, it's a "to each their own" thing. As LCR alluded to, more training will never hurt your academia and your CV to do fellowship (esp won't hurt that of your fellowship director). It can hurt your pocketbook (but pad that of your fellowship attendings), and it takes time. Time is money, and time is the one thing you can't buy in the world.

We both have strong opinions on this, but I disagree with your assessment of what the value of a fellowship is. Can it help you bridge the gap of being a resident to an attending (confidence building)? Yes. But a fellowship can be much more, if you let it. During my fellowship, I wrote about 30 papers, started giving lectures, and was an investigator on about 15 trials. It propelled my career and was certainly better for my "pocketbook" than worse. I was pretty much able to create my post-fellowship positions. I was made a medical director immediately after fellowship. Now, I am an expert in lawsuits, and as a fellowship-trained podiatrist, my opinion is given more credibility in court.

In addition, I now run a fellowship now with Ron Belczyk. Your assumption that a fellowship pads all attending's "pocketbooks" is false. We don't make a dime from it. Instead, we spend extra time training a new limb salvage expert to do what we do (probably losing money). I also know my fellowship director, David Armstrong, didn't make a dime on me or Nick Bevilacqua either, because I wrote the grant for our fellowship.

 

[Feli]

... Now, I am an expert in lawsuits, and as a fellowship-trained podiatrist, my opinion is given more credibility in court...

Being an intelligent individual with a reasonable grasp on the medical literature and its innate financial and commerialized biases, I do hope you choose to do 90% or 100% defense work in the malpractice cases you choose to participate in and only rep the patient/complaintant if there was gross, gross violation of the standard of care and major damages? Well, who knows... everyone makes their own choices, don't they? Those democrats and trial lawyers tend to go together like PB&J (ask Bracko-Bamma).

Being a reasonably intelligent individual myself, I think my expert opinion might actually be given some value and credibility as well. Who knows, though... I'm a humble peon 7 months out from residency (and no fellowship either!)

I also know my fellowship director, David Armstrong, didn't make a dime on me or Nick Bevilacqua either, because I wrote the grant for our fellowship.

Would the venerable Dr. Armstrong have needed to pay a professional to write his fellowship and research grant paperwork had you and Nick not done it for him as (low) salary fellowship employees? Hmm. What does such a professional grant writer charge per hour? What do research RNs, PhDs, etc charge to write research papers for him? I know the hospital employed research department employees I know make good salaries. Waidumminit, waidumminit... you did that there at CLEAR as a (low) salary employee? Yep, he never made a dime.

Let me ask you this: would DA drive such a nice car, travel as much, or have such a nice house if he had paid researcher MS, PhDs, etc to write those grants and published manuscripts? Hmmm.

...Everyone always has their angle. C'est la vie

http://stuffwhitepeoplelike.com/2008/07/20/104-unpaid-internships/ (I know you were compensated a bit as a fellow, but still kinda funny... no?)

 

[Traum]

Spot on Feli! Right on. For a guy "only" 7 months out, you are critical, independant thinker. refreshing.

The exploitation, aggrandisement, and arrogance by many in the "research" community is well known.

Clinical or research fellows can be low paid wage slaves to write lengthy govt, foundation proposals, papers, posters, and the PI/Director gets most, if not all the credit, lucrative endorsements, consultantships, honoraria (which should be placed into a general non profit funds for patients/families--right??) under the guise of "learning" "experience" or titles or other non monetized items. Mostly manipulation and psych ops to 20-30 somethings who many lack life smarts.

Fellows are cheaper than NPs, PAs, real associates, or real partners, so it makes financial sense to those ethically challenged to entice gulliable/ignorant folks into even more "training", "experience", or other sales tactic. Grant writers can earn up to 150$/hr, and researchers 125-400+hour. That's reality. Cheaper to get an indentured servant (fellow) who is eager beaver and makes $20-30/h gross. post taxes maybe ~12-18$/h. Nice.

If 36 months of post grad training is not enough, something is very wrong with that particular residency.

Sure, they may throw you a bone or three, but in reality/real world and not PR, lapels, smiles, acting, stage presence, photo ops, or paper/foreign unlicensed MDs, the PI/Director is banking directly/indirectly. There are tons of examples.

The world's a stage.

 

[dyk343]

Well... this thread turned pretty hostile pretty quick

 

[PADPM]

I've said many times on this site that Feli is wise beyond his years.

 

[diabeticfootdr]

Being an intelligent individual with a reasonable grasp on the medical literature and its innate financial and commerialized biases, I do hope you choose to do 90% or 100% defense work in the malpractice cases you choose to participate in and only rep the patient/complaintant if there was gross, gross violation of the standard of care and major damages? Well, who knows... everyone makes their own choices, don't they? Those democrats and trial lawyers tend to go together like PB&J (ask Bracko-Bamma).

Feli, I take cases that have merit. If you take only plaintiff or defense cases, your testimony may be branded as biased by the opposing attorney. It is advisable to have a reasonable split in the types of cases where you are an expert.

There is no need to be so hostile and engage in partisan political attacks.

You didn't do a fellowship and you think they all suck. Great. You're one voice of someone who didn't have the experience of doing one. I'm one voice of someone who did. You need to learn to tolerate differing opinions and argue as an adult, instead of name calling. That's what's required in the research world and in the court room - the two fields you just disparaged. Name calling and ad hominem attacks work well in politics though, perhaps you should give that a try.

I believe I've made my opinion about fellowships clearly known to the OP, so I will refrain from replying to you further.

 

[Feli]

Feli, I take cases that have merit. If you take only plaintiff or defense cases, your testimony may be branded as biased by the opposing attorney. It is advisable to have a reasonable split in the types of cases where you are an expert. ...

That's respectable. Malpractice testimony is a road I personally hope never to go down, but who knows? I know it pays very well per hour, doesn't it? I generally find what's good for trial lawyers is not always good for doctors, but I try to learn from everyone.

... There is no need to be so hostile and engage in partisan political attacks. ...

I don't feel I did any name calling in this thread. If anything, my previous post complimented you as an intelligent and well read individual, LCR. Please feel free to quote where I did that, and I apologize in advance if I did? Traum did utilize some inflammatory language to those easily offended, and anyone who wishes may now taddle on him (or me, if I did insult or do name calling?)

...You didn't do a fellowship and you think they all suck. Great. You're one voice of someone who didn't have the experience of doing one. I'm one voice of someone who did. You need to learn to tolerate differing opinions and argue as an adult, instead of name calling. That's what's required in the research world and in the court room - the two fields you just disparaged. Name calling and ad hominem attacks work well in politics though, perhaps you should give that a try.

I believe I've made my opinion about fellowships clearly known to the OP, so I will refrain from replying to you further.

LCR, I never said fellowships "all suck." I merely presented the counterpoint. As I mentioned, none of the 100+ grads of my residency program have ever done a formal fellowship (assuming you don't count the 1yr residency +1yr "fellowship year" decades ago or the AO/ASIF corporate mini observational 6-12wk European trauma fellowships which were legal over a decade ago for the industry to sponsor docs to go do).

If you re-read my posts, I stated that fellowship training is done for all kinds of reasoning. There are all types of fellowships. However, please refer back to Warren Buffet quote if you don't want to take my word for it. I view fellowships after an accredited 3 year PMS-36 or PSR with RRA credential as being for those who do borderline inadequate residency, those who did not apply themself fully in residency, those looking to "peacock" and pad their CV with brand name training, ortho cred, or research. That's just my opinion. Its a minority opinion.

...Great surgeons come from all kinds of training models. I would consider the two best podiatric surgeons I've ever personally seen to be Rob Mendicino and Craig Camasta. I've seen a lot of very, very solid surgeons, and they were among the creme de la creme. Both attend a lot of conferences, have intense personal interest in their craft, have taught at high levels, lecture, etc. Neither did a formal fellowship that I'm aware of? RMendicino, the youngest ACFAS president ever (and his longtime practice partner, Alan Catanzariti, to my limited knowledge, did <3 years of post-grad training, but they nonetheless undoubtedly had a large hand in shaping the literature and overall standards of care. Besides, they have trained dozens of highly respected and driven West Penn program surgeons.

Great surgeons come from all kinds of training backgrounds... with or without fellowships, with or without high volume surg residency, with or without research chops, etc. It takes all kinds.

...FYI, I also see no reason to further reply in this thread. It's a good discussion, but my views and (limited) experiences have been stated. The last word is for whomever wishes to discuss it further. There are a lot of articles on fellowships (I'm attaching one). Most of all, there is great info on fellowships on ACFAS website

 

[PMSIII]

Interesting discussion but there are some misconceptions - The thought that fellows pursue the additional year of training secondary to inadequate training, mediocracy, or lack of confidence is inaccurate. I interviewed alongside some pretty solid candidates during my fellowship interviews more than a year ago. Some of those candidates trained at West Penn, Scranton, INOVA, OSU, Grant, and St. John's (Feli's program). I trained at a great program in Cleveland and acquired a great deal of experience during that time in managing complicated hindfoot/ankle pathology. Fellowship for me brought a new perspective and while that year was a "pay-cut", I look at it as an investment in my career and so far it's paid off. Most of my colleagues in fellowship would say the same as well. However, I cannot emphasize enough that your fellowship is not what exclusively defines your professional success but rather, it is your work ethic, residency training/experience...and Feli's pillars.

Anyhow, that's my thought on the matter. Fellowship or no fellowship - the ultimate goal here is to acquire the best training/education/experience that you can attain. We are fortunate to be a part of this generation of DPM's who have the resources and talent to be great foot and ankle surgeons.

 

[Feli]

Interesting discussion but there are some misconceptions - The thought that fellows pursue the additional year of training secondary to inadequate training, mediocracy, or lack of confidence is inaccurate. I interviewed alongside some pretty solid candidates during my fellowship interviews more than a year ago. Some of those candidates trained at West Penn, Scranton, INOVA, OSU, Grant, and St. John's (Feli's program)...

Yep, my co-grad in 2013 researched a couple fellowships; he would've been the first to do a true fellowship had he ended up accepting a fellow slot. Instead, he ended up taking a much higher paying podiatric surgery private practice job than the fellowship would've been. He is currently doing most of the major recon, trauma, and infections for his single specialty group... even without any training wheels. Just in case anyone was wondering....

Out of curiousity, PMSIII, what's your fellowship salary and publishing requirements? You could probably link to the page for the fellowship on ACFAS.org list or APMA.org list of accredited fellowships?

...Below is a link to a published paper on ortho fellowships (which, unlike DPM fellowships, are actually accredited and lead to societal or additional ABMS certs):
http://www.ncbi.nlm.nih.gov/pubmed/?term=gaskill+financial+fellowship

 

[PMSIII]

I know he's doing quite well - I kept in touch with him also. The point here is that the pool of applicants was quality and anything but mediocre.

As for my fellow salary and research requirements - I made $50,000 this year (like pretty much all other fellows) and was required to publish 2 publications in peer-reviewed journals - A requirement that I surpassed during my time here. I'm pretty sure most fellowships on the ACFAS-recognized list have similar requirements. You're also correct in that they are not accredited - but so what? The experience is what I signed up for and it has been worth it. Again, I am merely speaking from my experience and that of some of my colleagues who are fellows at different programs.

On another note - You going to the ACFAS conference next week?