residency for podiatrists?

[nev]

What are the residency programs available for podiatrists? Also I would like to know the fellowship programs available.
Thanks
Nev

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[dpmgrad]

What are the residency programs available for podiatrists? Also I would like to know the fellowship programs available.
Thanks
Nev

There are a variety of residency program options for Podiatrists. They range from 1 - 4 years long. In a few years, most of the residency programs will have converted over to 2 or 3 year program model (with exception to the two existing 4 year residency program). The new residency structure will provide surgical training to all Podiatry resident, unlike the older residency program models. The 2 year residency program (PM&S-24) will allow for the Podiatry resident to sit for the forefoot surgery (aka Foot Surgery) board exam. The 3 or more year residency program (PM&S-36) will allow for the Podiatry resident to sit for both the forefoot surgery and reconstructive rearfoot and ankle board exams. You can access the latest listing of approved Podiatric Residency programs on the CPME website via CPME 300 document at:
http://www.apma.org/s_apma/seccpme.asp?CID=165&DID=9706

There are several fellowship options available for the graduating Podiatry resident. Some of the fellowship opportunities are listed on the CPME website via CPME 800 documents, which can be view at:
http://www.apma.org/s_apma/seccpme.asp?CID=300&DID=16842
There are some other fellowship opportunities that are not listed in the CPME 800 documents but residency directors do get mailing from these programs.
Many of the fellowship programs offer some additional training in Reconstructive Rearfoot Surgery (Dr. Jolly's Fellowship, Indiana Fellowship, Dr. Weil's Fellowship, one in California, etc...), Limb Deformity Correction (Dr. Paley's Fellowship), Sports Medicine (Virginia Mason Sports Medicine Center, Barry University, etc..), Diabetic and Limb Salvage (San Antonio, etc...), Wound Care, and Geriatrics. There are other mini fellowship opportunities for the Podiatry resident / graduate. These include the AO/ASIF Trauma Fellowship (1 -3 months long) and the Smith & Nephew Ilizarov Mini Fellowship in Kurgan, Russia (6 weeks long). One can apply for this Ilizarov Mini Fellowship through the American College of Foot and Ankle Surgeons.

 

[anxietypeaker]

Does that mean any new DPM (~4-6 years from now at least) will be podiatric surgeons. I mean what happens to the podiatrists who want to just do gen practice/ortho/nonsurgical/etc.?

 

[jonwill]

Does that mean any new DPM (~4-6 years from now at least) will be podiatric surgeons. I mean what happens to the podiatrists who want to just do gen practice/ortho/nonsurgical/etc.?

To some extent, yes. Everyone will receive some level of surgical training. Those that are less interested in surgery can do the PM&S-24 and at least certify in the forefoot. Regardless of what you do, it is up to you how you want to practice when you're done (surgical vs non-surgical). There is room for both. The idea is to standardize podiatric medical training (which has been a criticism of the specialty in the past).

 

[diabeticfootdr]

I mean what happens to the podiatrists who want to just do gen practice/ortho/nonsurgical/etc.?

The will eventually retire or expire and the profession will be a surgical subspeciality, where it belongs.

LCR

 

[krabmas]

If new podiatrists do not want to do surgery they will not have to. They must be trained surgically because in order to practice in all states except Hawaii you need a residency and all the residencies are surgical.

But once the whole residency (2-3 years) is over there are plenty of corns, calluses, PNAs (bearly surgical), orthotics and other non-surgical things to do like paddings and strappings.

The last class I sat through for orthopedics our prof told us that even the pods in private practice that call themselves surgeons and have a surgical practice it is only 30% surgical because surgery does not re-imburse as much as it use to. They still must cut nails and calluses and Rx orthotics. Also, if you do a bunion procedure and then do not Rx orthotics for that patient you only did half the job b/c within 10-20 years the bunion will be back. The surgery did not correct the deforming force on the joint. That is what orthotics attempt to do.

If you like podiatry and do not want to be a surgeon that is OK. Just suck up the surgery part for a few years then do what ever you want when you get out. I don't want to be a surgeon and I am here. I am way more interested in the biomechanics of the foot than cutting it open.

 

[RaiderNation]

So, would a podiatrist who did a 3-year residency make more money than a pod with a 2-year? I just think it would suck to have to refer something out to another pod because you didn't do the 3-year. Does this happen often or are most cases confronted in the private/multispecialty practice able to be covered by completing a 2-year?

 

[dpmgrad]

If new podiatrists do not want to do surgery they will not have to. They must be trained surgically because in order to practice in all states except Hawaii you need a residency and all the residencies are surgical.

But once the whole residency (2-3 years) is over there are plenty of corns, calluses, PNAs (bearly surgical), orthotics and other non-surgical things to do like paddings and strappings.

The last class I sat through for orthopedics our prof told us that even the pods in private practice that call themselves surgeons and have a surgical practice it is only 30% surgical because surgery does not re-imburse as much as it use to. They still must cut nails and calluses and Rx orthotics. Also, if you do a bunion procedure and then do not Rx orthotics for that patient you only did half the job b/c within 10-20 years the bunion will be back. The surgery did not correct the deforming force on the joint. That is what orthotics attempt to do.

If you like podiatry and do not want to be a surgeon that is OK. Just suck up the surgery part for a few years then do what ever you want when you get out. I don't want to be a surgeon and I am here. I am way more interested in the biomechanics of the foot than cutting it open.

I agree with Krambas that most Podiatric Surgeons today still have to do a fair amount of routine foot care and conservative treatments. It is very rare to see a Podiatric Surgeon who has a practice that is greater than 75% surgical. Those few surgeons are lucky to have a huge referral source from surrounding Podiatrists and Orthopedic Surgeons. An example of this would be Dr. Gary Jolly in Connecticut. There are some other Podiatric Surgeons whom are lucky enough to join an Orthopedic Surgery group, where he or she is the foot and ankle specialist in the group. Podiatric Surgeons in those groups often do not do too much routine foot care and have a pretty decent amount of surgical volume in the practice.

As Krambas also stated, not every single Podiatrist graduating from one of the new Podiatric Surgical residency model will want to do surgery. As mentioned earlier, the goal of the new residency models is to offer uniform training across the various residency programs.

 

[dpmgrad]

So, would a podiatrist who did a 3-year residency make more money than a pod with a 2-year? I just think it would suck to have to refer something out to another pod because you didn't do the 3-year. Does this happen often or are most cases confronted in the private/multispecialty practice able to be covered by completing a 2-year?

In my opinion, this not necessarily true. It is possible that the surgeons doing only forefoot surgery can make more than a surgeon doing rearfoot surgery. For example, a three hour reconstructive rearfoot case would pay X amount of dollars. However, in those three hours, a surgeon, who only does forefoot surgery, can do a bunch of forefoot cases that can add up to be more than that one three hour rearfoot case, in terms of reimbursement.

 

[efs]

The last class I sat through for orthopedics our prof told us that even the pods in private practice that call themselves surgeons and have a surgical practice it is only 30% surgical because surgery does not re-imburse as much as it use to. They still must cut nails and calluses and Rx orthotics. Also, if you do a bunion procedure and then do not Rx orthotics for that patient you only did half the job b/c within 10-20 years the bunion will be back. The surgery did not correct the deforming force on the joint. That is what orthotics attempt to do.

I think you only caught part of the message here.

For those not familiary with podiatry, in this sense orthopedics = biomechanical practices.

Whether Podiatric surgeons, General surgeons, Orthopaedic surgeons or others; a surgical practice is generally less than 30% surgery. This has to do with the nature of the practice and surgery, and has nothing to do with how surgery reimburses.

A surgical practice involves evaluating new patients and consults (not everyone needs surgery). Many of these people can be managed with conservative treatment which may include orthotics. In most elective cases, a course of conservative treatment is wise prior to recommending the OR. Some of the time (~30% or less) is spent in the OR. Then lots of postop visits (which are included in the global fee for the surgery as far as reimbursement).

From you statements it sounds like there are folks out there bringing in nail and callus patients to help subsidize their surgical practices. I'm not so sure this is accurate.

The statement about not providing orthotics post bunionectomy is way off. You might want to spend a bit more time reviewing biomechanics, in particular surgical biomechanics. A bunionectomy does in fact correct a deforming force (provided the appropriate procedure is selected). Same is true for flatfoot reconstructive procedures, rearfoot fusions, etc. I rarely find a need for orthotics after bunionectomies. Orthotics on the other hand do not attempt to correct the deforming force, rather support the foot in a more functional position. Unforunately the biomechanics involved in surgery is often underplayed by both the biomechnics professors and the surgery professors.

Hope this provides some food for thought.

 

[krabmas]

Efs - my original post was more about what Dr. Rogers said about pods becoming foot and ankle surgeons.

About not using orthotics after a bunion surgery - how long post op have you watched your patients? How do you know their bunion will not come back?

There are more deforming forces on the 1st MPJ than just the 1st ray and phalanges. When doing a bunion procedure do you do surgery on more proximal joints like the STJ, ankle, knee, hip? If there are torsional deformities in the femur and/or tibia, deformities in the frontal plane of the knee, equinus at the ankle - these can all lead to a bunion in the first place plus many more pathologies. If all of your patients are orthopedically perfect except for the bunion then I agree that they would not need orthotics.

And about orthotics holding the foot in a more functional position - doesn't more function imply less deforming.

 

[diabeticfootdr]

Efs - my original post was more about what Dr. Rogers said about pods becoming foot and ankle surgeons.

About not using orthotics after a bunion surgery - how long post op have you watched your patients? How do you know their bunion will not come back?

EFS is correct. If you choose the wrong bunion procedure then your patient will need orthotics (i.e. Austin when a Lapidus is indicated), if you choose the correct procedure and "surgically redirect" the deforming forces there is no need for orthotics. Routinely prescribing orthotics after surgery is purely a financially motivated practice . . . and unnecessary.

You don't have to be a doctor to prescribe orthotics and dispense. Why spend 8 years in school and 2-3 post-doc? You can be an orthotist, a PT, or a shoe store owner.

You don't have to be a doctor to trim nails. You can be a nurse or pedicurist. It takes a doctor to diagnose a nail disease and prescribe a treatment (Mrs. Jones, please have your nails trimmed routinely by a technician)

One can graduate with a DPM and have the title "doctor" but go through life being a technician.

The largest and most respected society in our profession is the American College of Foot and Ankle Surgeons (ACFAS) and our board the American Board of Podiatric Surgery (ABPS). Not the American Board of Nail Technicians or College of Shoe Dispensers. Every resident will now receive comprehensive surgical training. So rejecting this is denying the obvious . . . that our profession is a surgical subspecialty and moving more in that direction every year.

Another comment EFS made was that "surgeons" do more than "bill surgeries". This is true for orthos as well. An average ortho has a practice consisting of 16% surgical. The other time is spent in surgical evaluations, sports medicine, pain management, etc.

 

[efs]

Efs - my original post was more about what Dr. Rogers said about pods becoming foot and ankle surgeons.

About not using orthotics after a bunion surgery - how long post op have you watched your patients? How do you know their bunion will not come back?

There are more deforming forces on the 1st MPJ than just the 1st ray and phalanges. When doing a bunion procedure do you do surgery on more proximal joints like the STJ, ankle, knee, hip? If there are torsional deformities in the femur and/or tibia, deformities in the frontal plane of the knee, equinus at the ankle - these can all lead to a bunion in the first place plus many more pathologies. If all of your patients are orthopedically perfect except for the bunion then I agree that they would not need orthotics.

And about orthotics holding the foot in a more functional position - doesn't more function imply less deforming.

Changing the position of the 1st ray, and thus the functional position of the foot whether through orthotics or surgery can have an affect on the more proximal joints. The more proximal joints can also have an affect on the function of the foot.

How does the orthotic address the more proximal joints?
Do you think surgery on the foot (correcting position) might also have an affect on the more proximal joints?

Consider the effects of a Dwyer osteotomy vs placing the patient in an orthotic to address the same biomechaincal forces. If the patient is not wearing the orthotic, these forces are not being addressed. The osteotomy on the other hand is a more permanent correction.

I would agree with Dr Lee that placing all bunion patients in orthotics postop is probably more of a financially motivated choice rather that something that is truly needed.

I've seen some of my patients more than 2 years out with no recurrence. Lots of others (not my surgery) even longer. Without postop orthotics.

 

[krabmas]

I've seen some of my patients more than 2 years out with no recurrence. Lots of others (not my surgery) even longer. Without postop orthotics.[/QUOTE]


I do not think that every single bunion procedure needs post op orthotics.

Did that bunion take only 2 years to develop in the first place?

A question - if a patient comes to you for routine foot care, do you send them away telling them you are a surgeon and therefore do not do routine foot care?

 

[diabeticfootdr]

A question - if a patient comes to you for routine foot care, do you send them away telling them you are a surgeon and therefore do not do routine foot care?

The answer is YES. I do not and will not perform routine foot care. Currently, in our clinics we are too busy with patients who have real problems to keep seeing people every 63 days for nail trimming.

I am specializing in diabetic limb salvage. I will offer my patients a "diabetic foot risk assessment" (exam) and will either employ a nurse or pedicurist to offer nail service, but I will only bill for an exam (level 3) or the diabetic foot exam (under medicare) not for the procedure of nail trimming (CPT 11721)

If you go to a dermatologist and ask to have your hair cut, what will they say?

If you ask the cardiologist to personally perform an EKG, what will they say?

Dentists hire hygenists to perform routine cleanings so that they are free to provide more difficult services.

Same with toenail trimming.

These are remedial procedures below the level of a doctorate degree. In fact, in the UK, they're offering a certificate after 11 days of training to allow people to trim toenails of diabetics. Their Chiropody degree is a bachelor's level degree (B.Pod) which takes 3 years to complete out of high school.

If you'd like to perform "routine foot care", be my guest. I may offer you a job as a tech in my High Risk Foot Center in the future.

LCR

 

[krabmas]

Dr. Rogers,

There is no need to be hosstile and sarcatic. The point of my original post was let perspectives know that it was not necessary to be a podiatric surgeon once they graduate from residency.

If someone wants to be a surgeon then great, if not that is great too. I don't know about you but I do not think that everyone that graduates from pod school has the hands to be a great surgeon. It is pretty difficult to teach artistic craftmanship. And as much as surgery is about assessing the appropriate procedure it is also about performing that procedure which is similar to artwork.

I also do not disagree that being a doctor/ physician / whatever you want to call it is about assessment and diagnosis but in every job there is the mundane.

 

[efs]

A question - if a patient comes to you for routine foot care, do you send them away telling them you are a surgeon and therefore do not do routine foot care?

Essentially this is a yes. I am on active duty in the military, and our clinic works on a referral basis. A primary care provider must write a referral first, and our staff has a chance to review these. We have many more referrals than we can possibly see, so those that are not likely surgical in nature are deferred to other podiatrists. Currently our surgical backlog is about 100 patients, and wait times to get into the or may be 4-6 weeks. We also routinely see foot and ankle trauma, which may further back up our caseload. Needless to say, we just don't have time to fill a day with "routine nail care". Also don't see many people with ingrown nails either. The PAs and primary care docs usually take care of those cases and we don't usually see them un less it is recurrent and has failed previous treatment.

This is not a typical practice though.

 

[krabmas]

.

This is not a typical practice though.

I'm glad that you realize that the military is different than other practices.

 

[cg2a93]

The answer is YES. I do not and will not perform routine foot care. Currently, in our clinics we are too busy with patients who have real problems to keep seeing people every 63 days for nail trimming.

I am specializing in diabetic limb salvage. I will offer my patients a "diabetic foot risk assessment" (exam) and will either employ a nurse or pedicurist to offer nail service, but I will only bill for an exam (level 3) or the diabetic foot exam (under medicare) not for the procedure of nail trimming (CPT 11721)

If you go to a dermatologist and ask to have your hair cut, what will they say?

If you ask the cardiologist to personally perform an EKG, what will they say?

Dentists hire hygenists to perform routine cleanings so that they are free to provide more difficult services.

Same with toenail trimming.

These are remedial procedures below the level of a doctorate degree. In fact, in the UK, they're offering a certificate after 11 days of training to allow people to trim toenails of diabetics. Their Chiropody degree is a bachelor's level degree (B.Pod) which takes 3 years to complete out of high school.

If you'd like to perform "routine foot care", be my guest. I may offer you a job as a tech in my High Risk Foot Center in the future.

LCR

All I can say is, some of you are in for a rude awakening.

 

[diabeticfootdr]

All I can say is, some of you are in for a rude awakening.

That's the old mentality.

All I can say, is . . . watch.

 

[cg2a93]

That's the old mentality.

All I can say, is . . . watch.

I encourage every podiatrist to find their own niche in this profession. Although, I'm afraid that Dr. Rogers reality is not the reality of many recent residency graduated pods such as myself.
Good Luck
Charlton Woodly DPM

 

[IlizaRob]

I encourage every podiatrist to find their own niche in this profession. Although, I'm afraid that Dr. Rogers reality is not the reality of many recent residency graduated pods such as myself.
Good Luck
Charlton Woodly DPM

So in your opinion, what is the difference between you and the recent grads you are talking about, and those recent grads that are living the "reality" Dr. Rogers speaks of?

 

[krabmas]

So in your opinion, what is the difference between you and the recent grads you are talking about, and those recent grads that are living the "reality" Dr. Rogers speaks of?

Dr. Rogers is working in a hospital in the city. When he has to support a practice his reality might change too.

 

[IlizaRob]

Dr. Rogers is working in a hospital in the city. When he has to support a practice his reality might change too.

I was talking about the "reality" he speaks of that OTHER podiatrists in practice are experienceing (like the many that I have talked to). I said nothing about residency training. I am aware that the things you do in residency can be very different from practice. For example, I know a resident at the Salt Lake City VA who is rotating in the ER and is working up, stabilizing and refering the patients to the proper medical specialty by himself. That is not something you would do in practice.

 

[krabmas]

I was talking about the "reality" he speaks of that OTHER podiatrists in practice are experienceing (like the many that I have talked to). I said nothing about residency training. I am aware that the things you do in residency can be very different from practice. For example, I know a resident at the Salt Lake City VA who is rotating in the ER and is working up, stabilizing and refering the patients to the proper medical specialty by himself. That is not something you would do in practice.

I wasn't talking about the other medical specialty things that pods rotate thru. Many programs that I have read about say that by the 3rd year the resident is doing all podiatry surgical cases. Once in practice many people need to support their surgical passion with some other incoming funds like biomechanics and dermatology. The reimbursment for surgery is not that great expecially with the 90 day global fee, unless the practice does not accept insurance.

I'm sure some other people will post more responses.

 

[IlizaRob]

I wasn't talking about the other medical specialty things that pods rotate thru. Many programs that I have read about say that by the 3rd year the resident is doing all podiatry surgical cases. Once in practice many people need to support their surgical passion with some other incoming funds like biomechanics and dermatology. The reimbursment for surgery is not that great expecially with the 90 day global fee, unless the practice does not accept insurance.

I'm sure some other people will post more responses.

I understand that, the ER rotation was an etreme example to get my point across.

 

[Footfxr]

Dr. Rogers is working in a hospital in the city. When he has to support a practice his reality might change too.

In my opinion:

Through no fault of your own, you have a narrow point of view. From what I can tell you are either a 3rd or 4th year student that has yet had the opportunity to practice medicine/surgery outside the confines of the Foot Clinics of New york or the equiv.

As you aquire more experience, I am sure you opinions will also change as will you skill. Podiatry outside of the tri-state area is so much different than what we have been exposed to here in NY.

Dr. Rogers is speaking honestly and I thank him for that. More DPMs need to step-up, drop the clippers, and practice the medicine and surgery that we are trained to do.

I wish you luck....