Another fellowship thread...but RESEARCH!

[air bud]

A current JFAS article. I encourage all to read. About 50 percent participation (I think, I never did any research and vaguely remember stuff about alpha correlation coefficient?). Some interesting findings that stood out:

1. Number of surgeries per week male vs. female
2. Jobs obtained
3. HOLY CRAP READ TABLE 7

JFAS - Fellowships in Podiatric Medicine

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Members don't see this ad.

 

[josebiwasabi]

1. they mentioned it in the article, but the number of surgeries per week male vs female was definitely skewed since all 4 research fellowship respondents were female

 

[CutsWithFury]

A current JFAS article. I encourage all to read. About 50 percent participation (I think, I never did any research and vaguely remember stuff about alpha correlation coefficient?). Some interesting findings that stood out:

1. Number of surgeries per week male vs. female
2. Jobs obtained
3. HOLY CRAP READ TABLE 7

JFAS - Fellowships in Podiatric Medicine

Can't see it. Anybody want to post the PDF and attach it here for us to read?

 

[air bud]

1. they mentioned it in the article, but the number of surgeries per week male vs female was definitely skewed since all 4 research fellowship respondents were female

True, I did see that. But a research fellowship???

 

[air bud]

Can't see it. Anybody want to post the PDF and attach it here for us to read?

Maybe you should take your boards and maybe you should be a member so you have access...

 

[ConsciousCalc]

Can't see it. Anybody want to post the PDF and attach it here for us to read?

 

[619]

Tables 6, 7 and 8 are all interesting to read.

 

[619]

Highlights from table 7

"No guarantee for job afterward"

"Not being able to perform surgery"

"Looking for more reconstruction cases"

"Because it is a small private practice, little marketing was done for certain reconstructive procedures such as total ankle replacements. I only performed 2 during my year"

"No hospital privileges to scrub more complex cases"

"Lack of surgical procedures, given this is a research fellowship"

"Lack of total ankle replacement surgery"

"The 6-month orthopedic rotation. I was pinning hips and doing hand surgery, which sometimes made me feel that I was not concentrating on my profession"

"Not enough cases, too much control by residents"

"Director is not hands-on enough in the operating room; his associates let me do more but I mostly watched his surgeries, or he left me by myself with no pearls or instruction (in contrast to his associates who did provide such)"

"Little to no formal academics and lack of willingness on part of a couple attendings to be involved with educational requirements as set down by ACFAS"

 

[josebiwasabi]

True, I did see that. But a research fellowship???

I can't think of anything that sounds worse, lol.

But when I was applying to fellowships there were a couple out there that did directly lead to a job by the sponsoring academic institution, so I can see how a person would be enticed that by that prospect.

I think personally the fellowship that would have been the worst for me is the UMich Dept of Endocrinology. 2 years of clinic, wound care, and DM research with minimal OR experience.

 

[dtrack22]

Haven’t read the article but does it disprove my theory that worthwhile podiatry fellowships can be counted on one hand?

 

[DYK343]

-Lets break this down a little bit more. Table 7 looks bad. I agree. But that is only 1 table in the article.

-They had low response rate (45%) from fellows. Data is skewed right there. I have to raise the question that the very busy fellows did not respond while the fellows in less than desirable programs responded?

- one-third of fellows (n = 17, 34.69%) identified that their program had a combined focus across multiple podiatric specialties. Reconstructive surgery (n = 14, 28.57%), sports medicine (n = 9, 18.37%), limb salvage (n = 4, 8.16%), research (n = 4, 8.16%), and wound care (n = 1, 2.04%). This data suggest very little time spent slaving over wounds in a diabetic foot clinic though one could question what the combined focus providers were doing with their time.

- Fellows identified performing a mean of 11.23 § 10.33 surgical procedures per week. Fellows reported receiving a mean of 11.45 § 6.34 vacation days per year . Thats a fair amount of cases in a week. I typically did more than 11 cases a week in residency but depending on the cases performed by the fellow 11 cases could be a lot (recons, frames, etc, etc).

- Just over half of respondents were “very satisfied” with their program (n = 26, 61.90%), whereas 16 identified that they were “satisfied” with the program. No respondents were less than satisfied with their program. Fellows overall were happy with their training.

-Table 4 does not copy past well but fellows were upset they were underpaid. Overall they were satisfied with their training though surgical training satisfaction was at 4.43 on a 5.0 scale. Clinical training was 4.69 on a 5.0 scale. Its not all surgery clinic is important but I am wondering what brought the surgical training down as typically t hat is a big part of a fellowship.

-You guys conveniently left out table 6 which is what fellows LIKE about their program. There are a lot of positives in that table.

-Table 7 looks pretty gruesome but balance with table 6 and fellow satisfaction rating I personally take those comments with a grain of salt.

-I have patients up so I self admit I glanced over the rest of the article after table 7 but it looked mostly fluff.

-If you go to a non surgical fellowship and want surgery thats on you. There are a lot of subpar fellowships out there and we all know that. But there are also a lot of good ones. For some reason our graduating residents feel they are less than equal if they do not do a fellowship and will do one at all costs (mostly due to the vibe ACFAS puts off). I do not believe everyone needs a fellowship. If you went to a subpar residency yes but if you had quality training good jobs without a fellowship are there. There are certain fellowships (Hyer, etc) that regardless of quality of residency training would be beneficial for your career.

 

[DYK343]

“I’m paid $50K per year, easily 1/3 of what I would make as an associate”

Duke orthopedics (picked due to well known foot/ankle program) orthopedic residency stipend: The 2020-2021 yearly stipend ranges from $58,020 (PGY-1) to $67,788 (PGY-5/Chief)

They have an orthopedic foot and ankle fellowship (also takes DPMs) that does not state stipend but quick google search for other fellows is in the 60-80k region. I saw one that was 96k but they are 6 years training at that point.

The stipend is what it is. Dont like it dont do a year long fellowship. Its not much different than what a 4th year ortho resident would make. The value of a fellowship should not be the lower stipend.

 

[HardRoadPaved]

The stipend is what it is. Dont like it dont do a year long fellowship. Its not much different than what a 4th year ortho resident would make. The value of a fellowship should not be the lower stipend.

or those that picked 4 year residencies then feel like they still need a fellowship

 

[GreenHousePub]

Table 7 lol

 

[air bud]

Table 7 lol

Table 7 is what you say about residency. NOT fellowship.

 

[CutsWithFury]

Thanks for posting this and not being completely useless like tits on a bull like Air Bud. He's more useless on here than he actually is in actual practice. An amazing feat.

 

[air bud]

That hurts @CutsWithFury
Oh yeah, they buried the lead...64.52% of fellowship directors said they bill for care/procedures provided by the fellows. This is why there has been an explosion of fellowships. Not to help the industry achieve parity. Not to advance the training of residents and their peers. For money

 

[CutsWithFury]

That hurts @CutsWithFury
Oh yeah, they buried the lead...64.52% of fellowship directors said they bill for care/procedures provided by the fellows. This is why there has been an explosion of fellowships. Not to help the industry achieve parity. Not to advance the training of residents and their peers. For money

why would they EVER admit that?!

 

[DYK343]

That hurts @CutsWithFury
Oh yeah, they buried the lead...64.52% of fellowship directors said they bill for care/procedures provided by the fellows. This is why there has been an explosion of fellowships. Not to help the industry achieve parity. Not to advance the training of residents and their peers. For money

So if I get a fellow I can go home and still get paid? Sign me up.

 

[GreenHousePub]

Loving the billing portion.

Also:
"If my director who I spent the most time with doing surgery, gave me more opportunities to be hands on in the operating room, with some guidance and advice. He only either let me watch...."

"You have to earn the blade!" - Arrogant "fellowship" directors.

 

[CutsWithFury]

This article really shows how flawed our training is. If fellowships are like this I can NOT imagine what residency training is like at a lot of these weaker programs around the country. Scary. Very scary.

 

[DYK343]

This article really shows how flawed our training is. If fellowships are like this I can NOT imagine what residency training is like at a lot of these weaker programs around the country. Scary. Very scary.

You should probably retire. You're always so bitter. Did you even read the article?

This forum only concentrates on negatives.

Here is the positive remarks regarding fellowships:

-Orthopedic affiliation, complex pathology, external fixation and deformity correction,
fellow clinic and patient base

-Training within a teaching tertiary care/referral medical center with strong orthopedic
didactics, research, and surgery. The program is flexible and provides a variety of
possible areas of focus depending on interest

-High-volume total ankle replacement, reconstruction, sports medicine, and trauma
surgery

-Total ankle replacements, sports medicine, and reconstructive rearfoot surgery mentorship; time for research; resources

-Wound care, vascular surgery, limb salvage, clinic

-High patient volume, learning practice management

-Autonomy, case diversity
1. Complicated cases; 2. Fellow has their own clinic, own patients, own surgeries; 3. Able
to teach local podiatric medical students and residents

-All areas of foot and ankle reconstruction with some trauma

-Great training in limb salvage and infection management

-My fellowship director, he is an incredible teacher and mentor

-Large variety of pathology, autonomy, large patient volume

-Great exposure to a wide variety of cases that present. Strong evidence-based medicine

-Amount and variety of surgical cases

-Strong academics, strong research, strong clinical arm

-Case volume, case diversity, autonomy in the operating room. Pearls about running a
private group practice

-Complex deformity correction and limb salvage utilizing internal and external fixation,

-Charcot reconstruction, sports medicine, also high populations pediatrics, and healthy
young

-adult reconstructive foot and ankle surgery

-More elective reconstructive cases, higher volume than residency (about 30 cases
weekly), private practice perspectives on billing and coding as well as practice
management

-High surgical volume, diversity of cases, and pathology

-Surgical volume; all faculty are fellowship-trained; access to orthopedic surgeons; faculty
name recognition; industry training

-Large surgical experience with advanced reconstructive cases including larger exposure
to total ankle replacement, ankle scopes, trauma, and external fixation

-Rearfoot pathology, surgical volume, office exposure, and autonomy

-Sports medicine (conservative and operative), Level 2 trauma management and surgical
correction, elective reconstruction workup, and surgical correction, clinical patient
management, decision making, and treatment, orthotics/biomechanics

-Variety of cases and pathologies. Collective clinical experience of group

-Ethical, wide variety of pathology, huge surgical volume, attending input from training
across the country/globe, and a very academic environment at which to learn everything one should from a fellowship

-Sports medicine (clinic and surgical intervention), biomechanics/orthotics, reconstructive
surgery including joint-sparing procedures

-Autonomy and private practice experience − decision-making enhanced

-Very well-rounded experience in elective outpatient surgical procedures and office
experience. Strong biomechanics implementation in the office with practice in casting,
taping, and treating sports medicine-related injuries

-Surgical volume and diversity

-Busy department, I have my own clinic 5 days a week

-Our faculty members and the ability to work with residents

-I have an amazing fellowship director who is always available to teach his residents and
fellows. I get to learn how to critically evaluate research and journal articles. Also, as a
fellow,

-I get to attend lectures from the clinical epidemiology and biostatistics department
from the school of medicine that is affiliated with our hospital

-Continued knowledge and surgical experience with foot and ankle pathology and surgery
in the sports medicine setting. Research is another strong point

-Autonomy, self-directed

-Everything is a strength. Autonomy. High-volume reconstructive surgery, sports medicine
surgery, trauma surgery. A good high-volume clinic

-Volume of patients and exposure to very well-rounded array of surgical cases for forefoot
and rearfoot/ankle

-Autonomy, diversity of surgery

-Huge patient volume, a lot of surgical cases, and good diversity

-Independence, operating in the operating room as a primary surgeon without direct
supervision, your own wound care clinics to develop your own evidence-based
protocol

-Access to well-trained renowned surgeons

-Surgical volume and variety of pathology

-Detailed work up and surgical planning for complex deformity correction

 

[air bud]

Spoke with someone involved in a fellowship as an attending. This person themselves is fellowship trained from a very legit program. This person chose a person from a not great program who they thought showed potential. This person was obviously overruled by the committee for someone from a well known residency. When asked, this person said they thought the resident would benefit the most from the advanced training, not the person who already had excellent training.

This is a can of worms that acfas opened that cannot be put back. Shame on them.

 

[air bud]

You should probably retire. You're always so bitter. Did you even read the article?

This forum only concentrates on negatives.

Here is the positive remarks regarding fellowships:

-Orthopedic affiliation, complex pathology, external fixation and deformity correction,
fellow clinic and patient base

-Training within a teaching tertiary care/referral medical center with strong orthopedic
didactics, research, and surgery. The program is flexible and provides a variety of
possible areas of focus depending on interest

-High-volume total ankle replacement, reconstruction, sports medicine, and trauma
surgery

-Total ankle replacements, sports medicine, and reconstructive rearfoot surgery mentorship; time for research; resources

-Wound care, vascular surgery, limb salvage, clinic

-High patient volume, learning practice management

-Autonomy, case diversity
1. Complicated cases; 2. Fellow has their own clinic, own patients, own surgeries; 3. Able
to teach local podiatric medical students and residents

-All areas of foot and ankle reconstruction with some trauma

-Great training in limb salvage and infection management

-My fellowship director, he is an incredible teacher and mentor

-Large variety of pathology, autonomy, large patient volume

-Great exposure to a wide variety of cases that present. Strong evidence-based medicine

-Amount and variety of surgical cases

-Strong academics, strong research, strong clinical arm

-Case volume, case diversity, autonomy in the operating room. Pearls about running a
private group practice

-Complex deformity correction and limb salvage utilizing internal and external fixation,

-Charcot reconstruction, sports medicine, also high populations pediatrics, and healthy
young

-adult reconstructive foot and ankle surgery

-More elective reconstructive cases, higher volume than residency (about 30 cases
weekly), private practice perspectives on billing and coding as well as practice
management

-High surgical volume, diversity of cases, and pathology

-Surgical volume; all faculty are fellowship-trained; access to orthopedic surgeons; faculty
name recognition; industry training

-Large surgical experience with advanced reconstructive cases including larger exposure
to total ankle replacement, ankle scopes, trauma, and external fixation

-Rearfoot pathology, surgical volume, office exposure, and autonomy

-Sports medicine (conservative and operative), Level 2 trauma management and surgical
correction, elective reconstruction workup, and surgical correction, clinical patient
management, decision making, and treatment, orthotics/biomechanics

-Variety of cases and pathologies. Collective clinical experience of group

-Ethical, wide variety of pathology, huge surgical volume, attending input from training
across the country/globe, and a very academic environment at which to learn everything one should from a fellowship

-Sports medicine (clinic and surgical intervention), biomechanics/orthotics, reconstructive
surgery including joint-sparing procedures

-Autonomy and private practice experience − decision-making enhanced

-Very well-rounded experience in elective outpatient surgical procedures and office
experience. Strong biomechanics implementation in the office with practice in casting,
taping, and treating sports medicine-related injuries

-Surgical volume and diversity

-Busy department, I have my own clinic 5 days a week

-Our faculty members and the ability to work with residents

-I have an amazing fellowship director who is always available to teach his residents and
fellows. I get to learn how to critically evaluate research and journal articles. Also, as a
fellow,

-I get to attend lectures from the clinical epidemiology and biostatistics department
from the school of medicine that is affiliated with our hospital

-Continued knowledge and surgical experience with foot and ankle pathology and surgery
in the sports medicine setting. Research is another strong point

-Autonomy, self-directed

-Everything is a strength. Autonomy. High-volume reconstructive surgery, sports medicine
surgery, trauma surgery. A good high-volume clinic

-Volume of patients and exposure to very well-rounded array of surgical cases for forefoot
and rearfoot/ankle

-Autonomy, diversity of surgery

-Huge patient volume, a lot of surgical cases, and good diversity

-Independence, operating in the operating room as a primary surgeon without direct
supervision, your own wound care clinics to develop your own evidence-based
protocol

-Access to well-trained renowned surgeons

-Surgical volume and variety of pathology

-Detailed work up and surgical planning for complex deformity correction

Clearly you don't understand the point of anonymous online forums...
Or social media in general...

 

[DYK343]

Clearly you don't understand the point of anonymous online forums...

Except most of us long term posters know who eachother are... (not that that would be revealed publicly)

 

[dtrack22]

Except most of us long term posters know who eachother are... (not that that would be revealed publicly)

nah, pretty sure I’m completely anonymous...

 

[CutsWithFury]

Spoke with someone involved in a fellowship as an attending. This person themselves is fellowship trained from a very legit program. This person chose a person from a not great program who they thought showed potential. This person was obviously overruled by the committee for someone from a well known residency. When asked, this person said they thought the resident would benefit the most from the advanced training, not the person who already had excellent training.

This is a can of worms that acfas opened that cannot be put back. Shame on them.

Fellowship directors want well trained residents so they can leave their offices frequently to line their pockets with consultant cash doing weekend conferences and workshops. They want people that can do their work for them and they still bill for work they didn't do. It's really that simple

 

[CutsWithFury]

It should be noted that there are several fellowships that are based out surgery centers and not necessarily hospital systems. These surgery center fellowships sound cool because there is no call requirements but ultimately the podiatry fellow serves a certified first assist for all the other orthopedists doing hand, hip, shoulder, etc cases. The podiatry fellow can't leave the surgery center to cover other DPM cases at other hospital locations without permission from the surgery center. Most of the time these fellows are "training" doing cases in other body parts. Vital fellowship training time spent doing other orthopedic cases. Wow man. Wow.

That's high quality fellowship training right there.

 

[CutsWithFury]

Podiatry needs to hop on the legislative train and get full scope with 1 sweeping federal signature. Our residencies are already set up for it. Even (especially) the crappy NYC ones. All problems and bitterness solved.

It would solve a lot of problems

 

[Scrantonicity]

Podiatry needs to hop on the legislative train and get full scope with 1 sweeping federal signature. Our residencies are already set up for it. Even (especially) the crappy NYC ones. All problems and bitterness solved.

Isn't that what we pay the APMA for???

I think there are still some states that don't call us "physicians" so maybe they are working on that first lol

 

[GreenHousePub]

Isn't that what we pay the APMA for???

I think there are still some states that don't call us "physicians" so maybe they are working on that first lol

Getting Podiatric Physicians Access To USMLE Testing

Editor’s note: This DPM Blog was written by guest author James R. Christina, DPM, Executive Director and CEO of the American Podiatric Medical Association (APMA).

www.podiatrytoday.com

This is the most recent update. Although I'm not sure how much weight passing an APMA resolution really means.