My residency is nose diving.

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Footfxr

Footfxr
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My resdidency program is going down hill. I'm one of two PM&S 36's and our numbers are terrible. This has been going on for the past 2 years. It just gets worse and worse. We have a total of 12 residents and we are doing less than 40 cases a month. Many of these are soft tissue/wound care. Rearfoot is non-existent, as we compete with ortho. Elective cases are few. There are many reasons for this. Bottom line, our residency director is doing noithing to improve this situtation. I only have 6 months of training left and I am very worried. What can i do? Please help.
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Footfxr said:
My resdidency program is going down hill. I'm one of two PM&S 36's and our numbers are terrible. This has been going on for the past 2 years. It just gets worse and worse. We have a total of 12 residents and we are doing less than 40 cases a month. Many of these are soft tissue/wound care. Rearfoot is non-existent, as we compete with ortho. Elective cases are few. There are many reasons for this. Bottom line, our residency director is doing noithing to improve this situtation. I only have 6 months of training left and I am very worried. What can i do? Please help.
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It sounds like it should not be a PM&S-36. As the state of NY has terrible laws for pods, I can very easily believe that rearfoot is non-existent. The few programs in NY that are semi-successful get their rearfoot numbers by scrubbing cases with ortho. I consistently try and stear friends away from NY for residency (no offense). Are you going to get your numbers?

It sounds like you are in a tight spot. One thing I would do is contact the CPME and let them know what is going on. Just my opinion though. If you feel that your training is not sufficient, you may want to try to find a program that has a 2nd or 3rd year slot open and apply for it. With the small class sizes right now, they are out there. Good luck.
 
Footfxr said:
My resdidency program is going down hill. I'm one of two PM&S 36's and our numbers are terrible. This has been going on for the past 2 years. It just gets worse and worse. We have a total of 12 residents and we are doing less than 40 cases a month. Many of these are soft tissue/wound care. Rearfoot is non-existent, as we compete with ortho. Elective cases are few. There are many reasons for this. Bottom line, our residency director is doing noithing to improve this situtation. I only have 6 months of training left and I am very worried. What can i do? Please help.
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It is sad to see that residents pay the price for residency programs that spiral downhill. My recommendation is to contact the Graduate Medical Education Director at your hospital to discuss about your concerns. If you don't have a GME Director, perhaps, you can talk to the Chief Medical Officer in your hospital or the Chief of Podiatric Surgery at your hospital. Explained to them that you are rather concerned about the surgical volume and the residents' ability to meet their numbers. The case volume are important when you take your ABPS board examinations. After taking and passing your ABPS written exams (Foot Surgery and Reconstructive Rearfoot Surgery), ABPS will review your residency resource logs to ensure that you have met the required number of cases for each category before granting you Board Qualification status. If you don't have the required case volumes, you will not be granted Board Qualification status, even though you had passed the written exams. Since you have six more months left, if there are certain categories that you are lacking numbers in, I would work on getting remainder of the required case numbers.

If no one else can help you, you can contact CPME for assistance. However, you have to becareful of this. CPME may intervene and may place the program on probation. It may also consider shutting down the program. If they do shut down the program before you graduate, you might have to transfer to another program to complete remainder of your residency training. It is possible that CPME intervention may be a wake up call for your residency director and he might decide to take action. Of course, it is also possible that your residency director may find out that it was you who reported the program to CPME and may give you a hard time.

Lastly, if you feel that your training is incomplete and you are still lacking in require case volume, you might want to consider transferring to another program to get further training (as Jonwill suggested, a 2nd or 3rd year position). If you feel that your training is incomplete and you do have all of the required case volume, you might consider doing one of those rearfoot fellowships.

This is my two cents. If there is anything that I can be of assistance or you have any questions, feel free to PM me. Good luck.
 
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Thank you so much for your honest advice. I have alot to think about.
 
dpmgrad said:
If no one else can help you, you can contact CPME for assistance. However, you have to becareful of this. CPME may intervene and may place the program on probation. It may also consider shutting down the program. If they do shut down the program before you graduate, you might have to transfer to another program to complete remainder of your residency training. It is possible that CPME intervention may be a wake up call for your residency director and he might decide to take action. Of course, it is also possible that your residency director may find out that it was you who reported the program to CPME and may give you a hard time.
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I definitely understand your concern about contacting the CPME. I guess your point of view comes from the fact that you have been through residency and mine comes from the fact that I am still a student (for another 6 months anyway).

As a student, I would be terrified to think that some program that I am interested in would be lying about their numbers to recruit me and then screw me over. I WOULD want the CPME to intervene in order to avoid hurting future residents. But you have very valid points concerning the welfare of the current residents. This is indeed a tough one!
 
Hey all, I was just wondering if this is something common with the NY residencies because of the strict scope of practice? Such as not getting enough cases/rearfoot surgery. For new york city, isn't there a good number of 3 year PM and S residency programs? I don't know much about them but I thought I heard on here that one of them is even a 4 year (St. Barn's I think but I may be wrong). I assumed there would be a pretty high patient volume and cases because of being in such a big city (8 mil).

Is it an issue when teaching the residents ankle and lower leg surgery in NY? I understand about the resident training license and being able to scrub in on BKA's, shoulder surgery, etc to further your education (even though you won't use them during practice).
I'm guessing the doctors teaching the residents these techniques (at/above the maleoli?) are orthopedic surgeons? As footfxr said, the pod residents have to compete with the orthopedics department for cases. Is this common? I'm just curious about this because of the different scopes of practice makes it confusing. Seems like if one did a 3 year residency in NY, they would be trained in forefoot, rearfoot, ankle procedures...but they could only perform surgery and treatment at/below the maleoli? if they decided to stay and practice in NY. Please correct me if I'm wrong...I'm applying to pod schools next fall and learning about different aspects of the profession. Thanks guys.
 
JEWmongous said:
Hey all, I was just wondering if this is something common with the NY residencies because of the strict scope of practice? Such as not getting enough cases/rearfoot surgery. For new york city, isn't there a good number of 3 year PM and S residency programs? I don't know much about them but I thought I heard on here that one of them is even a 4 year (St. Barn's I think but I may be wrong). I assumed there would be a pretty high patient volume and cases because of being in such a big city (8 mil).

Is it an issue when teaching the residents ankle and lower leg surgery in NY? I understand about the resident training license and being able to scrub in on BKA's, shoulder surgery, etc to further your education (even though you won't use them during practice).
I'm guessing the doctors teaching the residents these techniques (at/above the maleoli?) are orthopedic surgeons? As footfxr said, the pod residents have to compete with the orthopedics department for cases. Is this common? I'm just curious about this because of the different scopes of practice makes it confusing. Seems like if one did a 3 year residency in NY, they would be trained in forefoot, rearfoot, ankle procedures...but they could only perform surgery and treatment at/below the maleoli? if they decided to stay and practice in NY. Please correct me if I'm wrong...I'm applying to pod schools next fall and learning about different aspects of the profession. Thanks guys.
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Not all NY residencies are like that - in fact, there are quite a few excellent programs in NYC - one of which is st. barnabas that you mentioned. The scope of practice should not influence what you learn as a resident because the scope doesn't apply to you - residency is part of your training and education so instead of working with DPM attendings for ankle cases - you'll be learning from experienced orthopoedic surgeons. St. Barnabas for example (since it was mentioned) do not have orthopoedic residents - at least that is what I was told from the director and the residents - so they scrub in for alot more hip, knees, shoulders -- and on top of that, they get to operate hands on for the foot and ankle cases. It's pretty intense - not to mention that it is a level I trauma so as you can imagine, it gets pretty busy.

The scope of practice only defines your legal limits as an attending not as a resident. As a resident you are expected to complete a certain number of cases for board certification. I sympathize with the OP to be put in such a situation but this is definitely a problem with the specific program (and director) not all the programs and directors in the state of NY
 
jonwill said:
I definitely understand your concern about contacting the CPME. I guess your point of view comes from the fact that you have been through residency and mine comes from the fact that I am still a student (for another 6 months anyway).

As a student, I would be terrified to think that some program that I am interested in would be lying about their numbers to recruit me and then screw me over. I WOULD want the CPME to intervene in order to avoid hurting future residents. But you have very valid points concerning the welfare of the current residents. This is indeed a tough one!
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I agree with you in regards to having CPME intervening in order to prevent hurting future residents. As you said, it is also very tough for the existing residents when CPME intervenes. I am not trying to discourage footfxr from contacting CPME in regards to his residency. I just wanted footfxr to be aware of some of potential actions that CPME may take on the residency program. Of course, CPME intervention may be a wake call for the residency director and it would make the residency director take action in regards to the residency program situation. It is always difficult for residents to have to relocate to another program when a program closes (especially the ones with family). I know that residents in residency programs that are COTH members can receive financial assistance from CPME under the rescue fund if they need to relocate to another residency program due to closure of their existing residency program. It is never easy to relocate to another residency program, especially for those only had a few months to go in order to complete the residency training. Of course, CPME may also allow the exisiting third year residents to complete rest of their training before shutting the program down.
 
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