Question about fellowships

[Robin-jay]

I was just thinking about the all too common scenario "what if the residency I go to doesn't end up teaching me the tools I want to succeed as a highly skilled podiatrist and surgeon".

1. Is there a difference between low tier and high tier residencies in terms of education of in clinic care, and also surgical care? If so, to what extent? Big difference or minor?

2. If one were to get a residency that is much more limited in surgery, etc. than other residencies, can one join a fellowship after residency, to understand how to do these skills that weren't present in the residency?

3. What is a typical fellowship, and how long are they?

4. How much do you guys think income is really influenced by what residency you went to?

This scenario would mean that those who had below average or poor tools in residency would be able to have a second chance to learn successful and more advanced techniques during fellowship before becoming an attending before possibly losing the chance to learn them.

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[deleted1097413]

good fellowships usually pick people from good residencies.

hopefully you get a good residency and just skip out on the fellowship process all together. there’s a handful of good ones, and if you can’t get those you’re probably better off just joining the workforce.

But I’ll defer to the ones more experienced than me

 

[Robin-jay]

good fellowships usually pick people from good residencies.

hopefully you get a good residency and just skip out on the fellowship process all together. there’s a handful of good ones, and if you can’t get those you’re probably better off just joining the workforce.

But I’ll defer to the ones more experienced than me

I was thinking that the fellowship doesn't have to great, just decent. A decent fellowship after a below average/poor residency should be able to give you more adequate skills before becoming an attending I'd imagine. I don't see why this couldn't be a logical move.

 

[Feli]

...1. Is there a difference between low tier and high tier residencies in terms of education of in clinic care, and also surgical care? If so, to what extent? Big difference or minor?...

Massive.

 

[Robin-jay]

Massive.

What's the difference? Does it necessarily translate or correlate to higher income as an attending?

I've heard some podiatrists do very well with income pursuing the path to allocate a lot of orthotics, where that doesn't take a higher tier residency for example.

 

[Feli]

What's the difference? Does it necessarily translate or correlate to higher income as an attending?

I've heard some podiatrists do very well with income pursuing the path to allocate a lot of orthotics, where that doesn't take a higher tier residency for example.

You question was about the clinical and surgical training and education. You have to figure out what you want.

 

[Robin-jay]

You question was about the clinical and surgical training and education. You have to figure out what you want.

True.

It would make me comfortable if I knew that income didn't rely "heavily" on residency tiers. Perhaps I was looking for some confirmation that this could be the case.

That being said, of course I want to look for a residency with the greatest doors open to myself.

 

[Weirdy]

True.

It would make me comfortable if I knew that income didn't rely "heavily" on residency tiers. Perhaps I was looking for some confirmation that this could be the case.

That being said, of course I want to look for a residency with the greatest doors open to myself.

I go to no-name "un-tiered" program.

Residents graduating have gotten very solid job offers and are extremely competent in both running clinic and doing surgeries. 99% of them did not have to do a fellowship after because their training was adequate.

Name brand will increase your chances of getting a fellowship after.

 

[Robin-jay]

I go to no-name "un-tiered" program.

Residents graduating have gotten very solid job offers and are extremely competent in both running clinic and doing surgeries. 99% of them did not have to do a fellowship after because their training was adequate.

Name brand will increase your chances of getting a fellowship after.

You question was about the clinical and surgical training and education. You have to figure out what you want.

If this is the case, then are there residencies out there that don't adequately prepare students for clinic or surgery that don't provide "solid job offers"?

I guess I'm not really sure what the higher tier residencies offer that low tier/"un-tiered" residencies don't.

 

[Feli]

True.

It would make me comfortable if I knew that income didn't rely "heavily" on residency tiers. Perhaps I was looking for some confirmation that this could be the case.

That being said, of course I want to look for a residency with the greatest doors open to myself.

There are all kinds of residencies. The things to look for are good surgical volume, diverse experience, strong attendings and many of them, and that you feel you fit.

The names/history only matter in that some of those are more reliably good (so why not take that if you can?) and might have more doors open to you afterwards for alumni networking, jobs, fellowship, etc. There are dozens and dozens of sleeper or upcoming programs also that are plenty fine in quality yet largely under the radar... if they give you the skills, that works fine too (you might just have to work a little harder after to sell your training/skills/logs to jobs you apply to). It is easier to sell Grant than Hennepin Healthcare on your CV to a fellowship or job , but most places would consider a good candidate from either if they had good logs and interview well.

The problem is that there are many joke programs out there that don't give exposure and volume that they should, don't have as many attending as they need and/or accept more residents than they should. This is an issue for MD/DO programs also, but it is a significant issue for DPM training. If you do a program where clinic consists of almost all toenails and wound care and "surgery day" consists of a ray amp and McBride or neuroma one day per week at Brooklyn Community or VA Chicago, you aren't going to be very comfortable when you're an attending and a varus ankle fx malunion or a cavus foot or a RA forefoot derangement walks in. If you get subpar residency training, you only have two choices in those more complex situations: fake it and try to do the care and maybe the surgery (yikes)... or refer it out. It would be better to get good/great training and keep as many patients and offer as many services as possible (not necessarily yourself, but within your group). That is all, and fortunately there are a whole lot of quite adequate programs... but you can't just take any place and hope for the best.

As far as the making money part, you already learned injections and ingrowns and orthotics and stuff like that in school. Residency is time to learn the surgery and diagnostics and prep to get board qual/cert so that you have as much to offer the patients and as many career doors open to you as possible. Someone who can work up and perform a triple arthrodesis well can definitely give a heel pain inject or write a PT Rx, but the converse is not always true.

 

[air bud]

Obviously I can't speak for other specialities, but one of the things about podiatry is that a HUGE amount of your success will fall upon your shoulders. Whereas if you go into Ortho, you can pencil in 500k salary plus without ever having to worry (absent location). Match into anesthesia...you will always have endless jobs to choose from at 400k plus. Podiatry even IF you go to a big name program, you will still be required to make your success. NOTHING is handed to you in podiatry. This can be good or bad depending on the personality. If you are the right type of person you can find ways to augment your training and increase your chances of success.

 

[Carpe Phalanges]

Is there any value to the wound care fellowships? (“Value” defined as significant increase in expertise, marketable skills, or income potential.) Do you still do surgery in such programs, or are you wasting a year in terms of boards numbers?

 

[icebreaker32]

One person I know did a wound care and limb salvage fellowship, so it was more than just wound care. They originally did regular PP for a couple years, but eventually ended up employed for a hospital in a somewhat academic position doing mainly limb salvage.

I think the fellowship along with the connections they had helped them get the job.

You really need to know the local market of where you want to work and the type job you are looking for. It might give you an edge for a particular position. You will not make any more money than anyone else who gets a good job without a fellowship, but it might give you a better chance to get a good job. Sadly even with all of our years of training not everyone gets a good job.

The majority of jobs are still PP with mainly office and surgery a half day a week. More and more are doing MSG and Ortho, some doing surgery 2 full days a week or more, but this is still not the majority.

Not all wound care is glamorous where you just get to choose whatever high tech wound care product you want for the patient. It is a lot of very sick and/or non compliant patients that often do not live long and often have poor insurance.

A good residency and being geographically open probably helps more than a fellowship, to both find the type of job setting you want and at a better salary, but some people for numerous reasons can not be geographically open when looking for a job. In a saturated market standing out in someway is often important for a good job. Things such as a fellowship, being board certified in surgery with 3 years of experience, connections or a charismatic personality (if get an interview) become more important.

 

[wakaflocka88]

One person I know did a wound care and limb salvage fellowship, so it was more than just wound care. They originally did regular PP for a couple years, but eventually ended up employed for a hospital in a somewhat academic position doing mainly limb salvage.

I think the fellowship along with the connections they had helped them get the job.

You really need to know the local market of where you want to work and the type job you are looking for. It might give you an edge for a particular position. You will not make any more money than anyone else who gets a good job without a fellowship, but it might give you a better chance to get a good job. Sadly even with all of our years of training not everyone gets a good job.

The majority of jobs are still PP with mainly office and surgery a half day a week. More and more are doing MSG and Ortho, some doing surgery 2 full days a week or more, but this is still not the majority.

Not all wound care is glamorous where you just get to choose whatever high tech wound care product you want for the patient. It is a lot of very sick and/or non compliant patients that often do not live long and often have poor insurance.

A good residency and being geographically open probably helps more than a fellowship, to both find the type of job setting you want and at a better salary, but some people for numerous reasons can not be geographically open when looking for a job. In a saturated market standing out in someway is often important for a good job. Things such as a fellowship, being board certified in surgery with 3 years of experience, connections or a charismatic personality (if get an interview) become more importan.

Good post, I echo similar thoughts. This has been dissected in prior threads about jobs after fellowship of any type. Your chances of landing something similar to what you did your fellowship in (minus limb salvage) is slim to none. Obviously demand for limb salvage and wound care is much greater and available almost anywhere but if you think your TAR fellowship means you’re slapping those in from day 1 and every week, you’re delusional. PP jobs likely will never go away and the terrible pay will continue, I can’t imagine the cycle breaking when 600+ new grads each year need jobs. There just isn’t 600 MSG/ortho jobs. My MSG gave me 1.5 block OR days but I’ve upped it to 2 since it’s been busy and they encourage me to maximize my surgical block and skills. Surgery for me on a RVU system is profitable and as long as I keep costs reasonable, the ASC and hospitals love the business. In the past 3-4 hospital jobs in large metro non-rural cities, all have been filled recently with good pods that I know with at least 2-3 years of real work experience, none did a fellowship. So ya, fellowship guaranteed them absolutely nothing when it came to applying for those above jobs. Good luck

 

[Carpe Phalanges]

Thank you both so much!