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I still want to know who Chuck and Nick are??
Podiatry becoming more non surgical at major metro areas
- Thread starter JewOnThis
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Yes fellowship trained.
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One guy left to go back to private practice (I shadowed the PP before podiatry school) and a few years later I googled him and was surprised to see he went back to work at Rothman, I guess PP just wasn’t for him
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But they also have their tentacles in Jefferson, so as Jeff expands they go with them
LOL, Chuck Langman and Nick Taweel. They were Pods working for Rothman at one time, but now I don't see them on the Rothman website anymore.
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Ain’t capitalism beautiful? /sarcasm
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It’s amazing how butt hurt some orthos can get knowing that we can do what they can do with less residency and no fellowship.
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I wanted to look these guys up to see their background. They are on the site when I just checked.
Foot & Ankle | Rothman Orthopaedic Institute
Rothman Orthopaedic Institute brings some of the best podiatrists in the country to the Philadelphia and New Jersey area.
rothmanortho.com
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Apparently they are still there.
Foot & Ankle | Rothman Orthopaedic Institute
Rothman Orthopaedic Institute brings some of the best podiatrists in the country to the Philadelphia and New Jersey area.
rothmanortho.com
If they do actually do that in a market where there aren't many ASCs/Hospitals they would be opening themselves up to a "restriction of trade" lawsuit.
I think anyone who’s been doing this job long enough have seen the discrimination by MDs. It only takes one vocal MD to screw an entire Pod squad. I am involved in a residency program and do keep contacts with a lot of the residents. Some of the stories I hear are horrific.
Google Roy Sanders, MD. I sure a lot you posters have seen the sanders classification. He single handedly stopped all podiatrists from doing any surgery at one point at a MAJOR hospital. Now, he’s allowing a few pods to do a little more than toe amputations.
Remember, DPM is DPM. ABFAS only matters to podiatrists. If a hospital or a vocal MD says you can’t operate, it doesn’t matter if you have 3 fellowships or certified by every board in podiatry.
Apparently they are still there.
Foot & Ankle | Rothman Orthopaedic Institute
Rothman Orthopaedic Institute brings some of the best podiatrists in the country to the Philadelphia and New Jersey area.
Google hates me sometimes. Thanks for the clarification. Appreciate it.
Agreed. But there are plenty of options in the area. And Rothman has very deep pockets. They pay over $1M a year to be able to say that they are the Orthopedists for the Eagles.
The issue is not that it isn't possible (it is) but that it's improbable based on economics- hospitals in the end are businesses, they are going to do what's in their best financial interest. Perhaps the ortho group is paying off the hospital so that they will prevent pods from operating? It's possible, but highly risky. It not only would open up the ortho group to litigation (as well as the hospital itself) but runs afoul to other anti-trust statutes .
The other issue is that there's a lack of specifics. This is anonymous forum (unless your name really is Dr. JewOnThis which would be a really cool name btw), so I don't really see why you can't at the minimum name the hospital/university medical center that's doing this. A name to go with the story would add a lot more credence. Plus it would add awareness to the issue among the greater pod community allowing us to respond with strength in numbers.
Lastly, I'm always generally skeptical of these stories to begin with. The worst of them seem to be always 3rd or 4th hand stories (I know a pod guy who knows another pod guy and his friend says that they heard a hospital in "xyz" stopped podiatrists from operating all together). The only somewhat verifiable story I've ever heard in a local hospital near me called Syosset Hospital where an ortho group was trying to limit a certain pods ability to do rearfoot/ankle work. From what I heard, that pod had their lawyer send a strongly worded letter to the admin and the whole thing was dropped quickly. This happened around 10 years ago and from what I've heard that pod is still doing rearfoot/ankle stuff.
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Podiatry makes a TON of money for hospital systems, I would think these stories of restricting surgical cases are exceedingly rare. Now ED call turf wars are a different story... Here's an example of a lawsuit filed in AZ:
Can click on the document PDF for details. TL;DR - podiatry group claimed collusion between the hospital system and ortho in preventing access to ED MSK pathology. Judge basically told them to eat crow, and the group coincidentally changed their name.
This can really only occur in larger cities and metro areas with a large population and ortho presence, in which case who cares? Go to a different hospital system in the area. But completely limiting rearfoot/ankle procedures in a full-scope state? Don't know about that.
Can click on the document PDF for details. TL;DR - podiatry group claimed collusion between the hospital system and ortho in preventing access to ED MSK pathology. Judge basically told them to eat crow, and the group coincidentally changed their name.
This can really only occur in larger cities and metro areas with a large population and ortho presence, in which case who cares? Go to a different hospital system in the area. But completely limiting rearfoot/ankle procedures in a full-scope state? Don't know about that.
Podiatry makes a TON of money for hospital systems, I would think these stories of restricting surgical cases are exceedingly rare. Now ED call turf wars are a different story... Here's an example of a lawsuit filed in AZ:
Can click on the document PDF for details. TL;DR - podiatry group claimed collusion between the hospital system and ortho in preventing access to ED MSK pathology. Judge basically told them to eat crow, and the group coincidentally changed their name.
This can really only occur in larger cities and metro areas with a large population and ortho presence, in which case who cares? Go to a different hospital system in the area. But completely limiting rearfoot/ankle procedures in a full-scope state? Don't know about that.
I can name a long list of hospitals at “full scope “ states with heavy restrictions on rear foot and ankle.
Google Roy Sanders and Tampa General Hospital. Last time I check Florida has the “best” scope of practice for podiatrists.
Hospitals can't prevent podiatry from practicing or doing surgery anywhere.
State podiatry associations just may not want to fight that fight, but truly, push comes to shove, hospitals can't prevent any physician from practicing within that hospital without cause.
DPM or not, a hospital should know that they are looking at a potential lawsuit if they deny a doctor from practicing within their scope of practice within their facility.
I hate to tell you, but that's usually because some high and mighty podiatrist instituted harsh requirement that only he or she could satisfy. I've seen this all over the East Coast.
I've also known of podiatrists who've sued hospitals for denying privileges because of an Orthopedist who runs the Surgery Department, and win the cases. They were highly trained, RRA certified, and basically provided the state scope of practice regs. The hospital had to relent or face an unwinnable case. It is a fight, but legally, these other specialists have no case to be able to do that.
And yes, if it isn't fought, it will go through, because it can. Not because it should.
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Yeah it's those gate keepers like @Pronation keeping the mustache pods like you out. Stick to the nippers Bud
But, but, but...I wanna be a Fellowship trained Foot and Ankle Surgeon!!!
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We are no longer podiatrists, and we are no longer foot and ankle surgeons. I was recently at a lecture and the “young” guns are now referring to themselves as “lower extremity surgical specialists״.
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I have friends that refuse to call themselves a podiatrist
LMAO...ohhhhh GAWWWWD...
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If calling yourself something will "make" you into it then I will put "Nail and Flexor Tenotomy Surgeon" on my scrubs.
Their degree is doctor of podiatric medicine.
I never understood this mentality. I know people who are the same.
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Every month I review my surgical eob remind me why I care less and less about surgery. Bring on the ingrown and warts!
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Muscle flaps and micro nerve surgery for EVERYONE
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I never thought about doing a fellowship, but I also never thought that was what people were doing at fellowships. Ugh.
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Such a small subset of people needing these advanced procedures... it’s amazing the wakeup call these docs get once they finish their fellowship training.
You reminded me of a hilarious story when I was in residency. One of my attendings was so proud that he completely a "micro nerve surgery workshop" and he booked this "BIG" case and asked for this monstrosity of a microscope, blah, blah, blah. Eventually when we got to the nerve, it was as big as an earthworm, and everyone could see it with their naked eyes. This guy was going on and on about how little it must have been, because he didn't take his eyes off the microscope eyelets at all. Turns out he was at the lowest magnification, and the nurses could barely hold back at how funny the whole situation was. 20+ years later and I'm still laughing about it.
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Yeah, I have done that class microvasc class, a lot of people have. When the rubber meets the road, most facilities don't even have that equipment, the facilities that do have plastic/vasc surgeons who do free flaps or dialysis access or micro stuff almost daily and are much better than any DPM, the cases take forever, and the cases are exceeeeeedingly rare outside huge tertiary univ settings. All I can say the week long course really gave me is appreciation for real microsurgeons and the basics to do a basic repair.
I operate more than the average pod, I have hit the PT a few times (err, the resident did... yeah) with dissection or Ilizarov pins while doing hindfoot recon (usually huge BMI diabetics, revision surgery, smoker, etc... back when I was young and brave and way too smart to just cast that stuff until they get their inevitable BKA). I have also seen some damaged dorsal vessels and tendons from crush injuries or lacs and what I'm pretty sure were severed common digital and various cutaneous nerves during revision surgery also. I think anyone who does a decent amount of RRA (or even midfoot stuff) has hit all kinds of things with guide pins, and they often didn't even know. It is simply not the end of the world to repair iatrogenic or trauma damage (when possible) or compress the Ilizarov pin site for awhile.
If people think the sural and the dorsalis pedis and peroneal nerve branches past the ankle and stuff like that are in dire need of identification during dissection or extensive prolonged repair attempts if damaged or cut, I think they forgot A&P. That is sorta a little man problem in podiatry. We want to do pretty surgery and perfect surgery. In actuality, a numb dorsal foot or a toe needing some collateral flow is NOT a big deal, lol. I swear that over-dissecting that stuff probably causes more problems than it solves. I am perfectly fine never seeing the sural in a calc fx ORIF or Achilles, never seeing the medial dorsal cutaneous on Lapidus, not seeing the PT nerve on a flat foot or triple, etc. I would rather not see them... certainly won't go looking, just go slow if you are in the neighborhood.
In actual practice, the prudent thing to do if I see an acutely severed major artery or nerve (and in the foot and ankle, the PT would be the only one I'd call "major") from open fx trauma or resident jitters or whatever, I would simply do a washout with half-decent vessel/nerve approximation (for which you don't need loupes or scope) and have vascular or plastics do what they're good at when they're available (if it is the PT). That is precisely what ortho does with the GSWs and traumas that hit meaningful radial, femoral, brachial, etc nerves. They simply span or fix it, lavage, tag the nerve or do a cursory re-approximation, put the pt on abx, and call plastics/hand asap. If it is is a digit or limb re-plant, they co-scrub with plastics. They don't try to be a cowboy... they do what's best for the pt. They also know what actually needs repair and what is semi-expendable. We don't seem to get that last part. The toughest part of those cases where the foot was run over, hit with spinning boat prop, high calibur GSW, etc is just figuring out if the salvage is even worth it. Many times, the salvage will fail and or the foot won't function or will have CRPS anyways even after multiple surgery attempts and rehab and brace and etc. You are better off just doing the BKA in some. There are very few pods who get called for any significant amount of trauma with PT nerve or artery damage, though. I just don't think a handful of cases in fellowship makes us the authority (on micro or TAR or anything)... if it did, ER docs would be doing deep I&Ds and amps and ORIFs in the trauma bay and wouldn't even need us, lol.
The rotation flaps and pinch skin grafts are more useful, and I do those when appropriate (again, no loupes needed). It is getting to be a lost art to just be very ridiculously good at podiatry cases, though... so, we keep adding more and more obscure stuff... probably because our training is too long? I just don't see how DPM loupes are needed... but it makes sense if it's a dentist or plastics/vasc/neuro. Those DPMs who use the mag for neuromas or tarsal tunnel or even regular closure on stuff might need to have the DMV eye test? Maybe they are doing it to "keep the microvascular skills up," but that just shows them there aren't anywhere near enough true loupe/micro cases in podiatry to stay proficient. If any DPM wants my microscopic flap and vascular and neuro cases, they certainly can have them. All one per year (maybe... some in years).
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Fellowship trained Reconstruction Foot & Ankle Orthoplastic Surgeon
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Yes yes, when appropriate. And strictly by the book. "the flap was elevated and rotated...."Yeah, I have done that class microvasc class, a lot of people have. When the rubber meets the road, most facilities don't even have that equipment, the facilities that do have plastic/vasc surgeons who do free flaps or dialysis access or micro stuff almost daily and are much better than any DPM, the cases take forever, and the cases are exceeeeeedingly rare outside huge tertiary univ settings. All I can say the week long course really gave me is appreciation for real microsurgeons and the basics to do a basic repair.
I operate more than the average pod, I have hit the PT a few times (err, the resident did... yeah) with dissection or Ilizarov pins while doing hindfoot recon (usually huge BMI diabetics, revision surgery, smoker, etc... back when I was young and brave and way too smart to just cast that stuff until they get their inevitable BKA). I have also seen some damaged dorsal vessels and tendons from crush injuries or lacs and what I'm pretty sure were severed common digital and various cutaneous nerves during revision surgery also. I think anyone who does a decent amount of RRA (or even midfoot stuff) has hit all kinds of things with guide pins, and they often didn't even know. It is simply not the end of the world to repair iatrogenic or trauma damage (when possible) or compress the Ilizarov pin site for awhile.
If people think the sural and the dorsalis pedis and peroneal nerve branches past the ankle and stuff like that are in dire need of identification during dissection or extensive prolonged repair attempts if damaged or cut, I think they forgot A&P. That is sorta a little man problem in podiatry. We want to do pretty surgery and perfect surgery. In actuality, a numb dorsal foot or a toe needing some collateral flow is NOT a big deal, lol. I swear that over-dissecting that stuff probably causes more problems than it solves. I am perfectly fine never seeing the sural in a calc fx ORIF or Achilles, never seeing the medial dorsal cutaneous on Lapidus, not seeing the PT nerve on a flat foot or triple, etc. I would rather not see them... certainly won't go looking, just go slow if you are in the neighborhood.
In actual practice, the prudent thing to do if I see an acutely severed major artery or nerve (and in the foot and ankle, the PT would be the only one I'd call "major") from open fx trauma or resident jitters or whatever, I would simply do a washout with half-decent vessel/nerve approximation (for which you don't need loupes or scope) and have vascular or plastics do what they're good at when they're available (if it is the PT). That is precisely what ortho does with the GSWs and traumas that hit meaningful radial, femoral, brachial, etc nerves. They simply span or fix it, lavage, tag the nerve or do a cursory re-approximation, put the pt on abx, and call plastics/hand asap. If it is is a digit or limb re-plant, they co-scrub with plastics. They don't try to be a cowboy... they do what's best for the pt. They also know what actually needs repair and what is semi-expendable. We don't seem to get that last part. The toughest part of those cases where the foot was run over, hit with spinning boat prop, high calibur GSW, etc is just figuring out if the salvage is even worth it. Many times, the salvage will fail and or the foot won't function or will have CRPS anyways even after multiple surgery attempts and rehab and brace and etc. You are better off just doing the BKA in some. There are very few pods who get called for any significant amount of trauma with PT nerve or artery damage, though. I just don't think a handful of cases in fellowship makes us the authority (on micro or TAR or anything)... if it did, ER docs would be doing deep I&Ds and amps and ORIFs in the trauma bay and wouldn't even need us, lol.
The rotation flaps and pinch skin grafts are more useful, and I do those when appropriate (again, no loupes needed). It is getting to be a lost art to just be very ridiculously good at podiatry cases, though... so, we keep adding more and more obscure stuff... probably because our training is too long? I just don't see how DPM loupes are needed... but it makes sense if it's a dentist or plastics/vasc/neuro. Those DPMs who use the mag for neuromas or tarsal tunnel or even regular closure on stuff might need to have the DMV eye test? Maybe they are doing it to "keep the microvascular skills up," but that just shows them there aren't anywhere near enough true loupe/micro cases in podiatry to stay proficient. If any DPM wants my microscopic flap and vascular and neuro cases, they certainly can have them. All one per year (maybe... some in years).
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These stories are endless. The instagram posts are endless. I seriously have no clue why these graduating residents doing an orthoplastic or muscle flap or peripheral nerve fellowship means that it’s 100% what they’re doing day 1. Out of my class of co-residents, none of them are doing anymore rear foot or recon stuff and they stick with the simple stuff. All highly trained - but in 1.5 years realized that territory comes with its headaches. Hope y’all graduating residents take note - it’s fun in residency but when it’s you dealing with it daily, you better be ready.
I have friends that were given the “MD” badge separate from their name badges and they still use it. Haha. Met a few fresher pods around town not too long ago and they themselves think they’re more than just a podiatrist. Amazing.
There’s a residency program in a full scope state with over 20+ attending, all of them being acfas cert. These attendings lecture regularly at your acfas and apma conferences. The program is a super academic and the has been around for a very long time. The kicker is that they have to drive 45 min away to another hospital in the same state to perform ankle surgeries. Why? Because the orthopedists do not allow podiatrists to practice their “full scope” of practice. One of my former co residents in that program is “fellowship” trained with a foot and ankle orthopod that used to be in our program, and he’s rra cert as well.
Let's break this down a bit.
First, if that is truly the case, the state podiatry association should launch a class action lawsuit against the hospital and ask the APMA for financial assistance with the lawsuit.
Second, this sounds an awful lot like TX, where the ankle laws are constantly being disputed. And here's why. Yes, you are permitted to perform surgery on the ankle-ish. The dispute comes where, if you are using a frame, you are placing large pins in the mid to upper Tibia. Same with IM nails. The nail goes far beyond the ankle.
Where I initially practiced there was a lawsuit about this. Also a "full scope" state, but one of the podiatrists broke the tibia midshaft, while putting in an IM nail. He obviously couldn't fix the fracture and had to call in an Ortho to fix the problem. This caused quite the stir.
I also encountered this problem when one of my frame patients ended up at a rehab facility, and they did not care for it like I ordered. One of the tibial pins pussed out, and she ended up in the ED. They called an Ortho doc, who recommended a Vascular consult for a BKA. They then realized she was one of mine, and called me. I ended up taking out the tibial pin, and ID helped me out, but it was touch and go with the state laws at the time.
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All of these are reasons to practice rural where Ortho sees you as a friend because you do all the stuff they don't want to (don't like, not worth the time/money) and will leave you alone....
Honestly, I've been practicing in areas strife with Orthos that hate podiatry my whole career. And they leave me alone. And our profession for the most part. Their shenanigans don't effect me at all. And they don't just hate podiatry. It seems like they hate everyone.
The only time I've ever butt heads with them is when I fix their mistakes and they hear about it. One even called me once to yell at me for treating "his patient". I literally told him to eff off and do better work next time. Never heard from him again.
Reminds me of another funny story.
I had three bread and butter cases at a small community hospital. In another OR an old, Army "Foot and Ankle" Ortho who HATED podiatry was doing a Lapidus. He literally had every Synthes tray the hospital had in there and BOTH C-Arms. This was one of those d-bags that did everything he could to give our profession a bad name and block us from working in the hospital. We ignored him, as he was all bark and absolutely no bite. He treated everyone like he was still in the Army and everyone was his subordinate. Volcanic temper, as well.
I finished all three of my cases, and he was still cursing his way through the Lapidus. Took him over 4 hours. For a Lapidus. I heard he broke a few screws in there as well. SMDH.
I had three bread and butter cases at a small community hospital. In another OR an old, Army "Foot and Ankle" Ortho who HATED podiatry was doing a Lapidus. He literally had every Synthes tray the hospital had in there and BOTH C-Arms. This was one of those d-bags that did everything he could to give our profession a bad name and block us from working in the hospital. We ignored him, as he was all bark and absolutely no bite. He treated everyone like he was still in the Army and everyone was his subordinate. Volcanic temper, as well.
I finished all three of my cases, and he was still cursing his way through the Lapidus. Took him over 4 hours. For a Lapidus. I heard he broke a few screws in there as well. SMDH.
I get what you are saying. I am pretty sure our Apma organization knows about these issues. The podiatrists who are getting restricted are our more prominent “lecturers”. Most of these guys hold or have held higher positions in our organization.
Being smart at doctoring rarely equates to being smart at other things. It might be a "picking your fights" kind of thing. Truly, the law is on our side. They just have to know how to use it.
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For sure. When you walk up to a brick wall, there's always a choice to go over it, around it, or through it.
jfernandez2026
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Where Do we apply?
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One does not simply just apply for job.
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Learning this the hard way. Looking for some sort of karmic chant for the non-fellowshipped at this point.
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I know of a few recent open positions with MSG/hospital in my area/network of friends that did not hire pods that are in fellowship. And these are the more “well known” fellowships too. I didn’t do a fellowship either.
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This could be a thing. We need to design a cool crossing beaver blade and 18ga needle logo.
...and the S in surgeon is obviously going to be a dollar $ign.
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Maybe we just need to be doing more 2 week bako fellowships and then can call ourselves fellowship trained. How long were those AO fellowships like month? But who really defines "fellowship" anyways....I feel like some gray area to be exploited here. Maybe just fellowship trained foot and ankle specialist? Then can slide into these non op jobs easier without having to raise questions. " Yes, I did an extra 1000 cases in fellowship, but I didn't do it to learn surgery, but rather to know who I need to punt to my orthopaedic partners (yes, I understand I will never be a partner)."
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If you made less than $100K a year your first 2 years in practice, that should be considered a "fellowship". Everyone update your resumes!
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Brilliant
