To all 4th year students who matched

[PatchAdamsFan]

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I was wondering what individual students look for when choosing (if fortunate) a residency position? I understand that some residencies deal with certain aspects of podiatry more-so than others (ex. wound care vs. high surgical volume), but what are some more fundamental reasons? I would imagine looking at job placements, attending interactions, and location may play a role, along with a myriad of other factors.

 

[darazon]

Here is a list of questions I compiled of things I wish I would have known about programs;
• How many residents scrub into one case?
• How many inpatients do they usually have?
• do they medically manage their own patients?
• do they take "nail consults"?
• do they have ankle privileges in the hospital?
• does the OR call them for ankle trauma?
• do they have an ortho residency?
• how do they get along with ortho?
• What are the hours like as an intern?
• What are the hours like as a 3rd year?
• When do they typically get their numbers?
• What is the surgical focus of the program (ie wound care, rearfoot, trauma, elective, mix)?
• Do they get peds?
• Do the 3rd years seem confident in the OR?
• Do the attendings let the residents do much in the OR?
• Do the attendings like to teach?
• How many attendings do most of the surgery? (i.e a program may only have 1-2 attendings that do most of the surgeries even though the program may have lots on paper)
• Do the attendings have a "god" complex?
• What are the graduates doing after residency?
• Are any of the 3rd years having a difficult time finding a job?

For me, I wanted to find a program with great surgical training were I was the only resident scrubbed in, our at the most scrubbed in with a senior resident. No triple scrubbing (or quadruple, or quintuple -yes I have seen both).

I wanted to see a large variety of cases by a large variety of attendings. I wanted to see total ankles, Ilizarov frames, all the way down to toe amps.

I wanted to be with a program where the attendings are approachable and love to teach and they expect you to work hard.

I wanted a program where the other residents all got along and enjoyed each other and enjoyed the program (some residents are miserable).

I'm also not into small programs and small hospitals. I like people and having people around me and other residents from other specialties.

Location wasn't huge for me, but I am glad that my new location is wonderful!

 

[air bud]

Darazon brings up a lot of great stuff. One of the things that you will see is that your opinions change. You must approach each externship with an open mind. I went back and forth so many times on what I thought I wanted. In the end, I got what I wanted, but it was not at all what I though I would like when I started 4th year.

 

[PADPM]

Here is a list of questions I compiled of things I wish I would have known about programs;
• How many residents scrub into one case?
• How many inpatients do they usually have?
• do they medically manage their own patients?
• do they take "nail consults"?
• do they have ankle privileges in the hospital?
• does the OR call them for ankle trauma?
• do they have an ortho residency?
• how do they get along with ortho?
• What are the hours like as an intern?
• What are the hours like as a 3rd year?
• When do they typically get their numbers?
• What is the surgical focus of the program (ie wound care, rearfoot, trauma, elective, mix)?
• Do they get peds?
• Do the 3rd years seem confident in the OR?
• Do the attendings let the residents do much in the OR?
• Do the attendings like to teach?
• How many attendings do most of the surgery? (i.e a program may only have 1-2 attendings that do most of the surgeries even though the program may have lots on paper)
• Do the attendings have a "god" complex?
• What are the graduates doing after residency?
• Are any of the 3rd years having a difficult time finding a job?

For me, I wanted to find a program with great surgical training were I was the only resident scrubbed in, our at the most scrubbed in with a senior resident. No triple scrubbing (or quadruple, or quintuple -yes I have seen both).

I wanted to see a large variety of cases by a large variety of attendings. I wanted to see total ankles, Ilizarov frames, all the way down to toe amps.

I wanted to be with a program where the attendings are approachable and love to teach and they expect you to work hard.

I wanted a program where the other residents all got along and enjoyed each other and enjoyed the program (some residents are miserable).

I'm also not into small programs and small hospitals. I like people and having people around me and other residents from other specialties.

Location wasn't huge for me, but I am glad that my new location is wonderful!

I think that your list is well thought out and reasonable. However, you have one criteria that I'm concerned about. That is whether they "take nail consults".

I understand that it is a "surgical" residency, but contrary to many thoughts, doing "nail" consults will not make you a lesser man or woman. Some patients have been neglected and as a result have poor hygiene. These patients need and deserve care, and it shouldn't be beneath you to do these consults. When performing these consults you will often discover other pathology such as infections, sores/ulcerations, etc. It is part of what we do, and I can assure you that if you eventually obtain hospital privileges in private practice and refuse to do these consults, your referral base will begin to dwindle.

Our group receives a significant amount of consults, and the vast majority are for infections, wound problems, surgical consults, etc. But once in a while we get "nail" consults and we are happy to oblige. It's not glamorous but it helps pay the bills and lets the hospitalists know we are there for ALL their foot and ankle needs.

I understand, I really do, that surgery is the attraction and palliative care seems trivial. But the reality is that the great majority of you will perform great surgery when in practice and will also be in a situation where you will have a fair amount of patients requiring palliative care.

Both our associate and I perform a fair amount of surgery and palliative care patients are not very common on my schedule or his/hers. I saw 4 palliative care patients the entire day today, and I was happy to treat them.

Two anecdotal but TRUE stories. There was a well known, well respected university based vascular surgeon in my area. He was a dept chairman at a major teaching hospital. He walked around with a nail nipper in his pocket and would regularly take them out and trim any nails he thought may be detrimental to his patients well being when he was rounding at the hospital or when seeing the patient in his office.

I just spoke with a former resident who has a very successful practice and is ABPS certified. He has cut back on surgery and does under 20 cases a year. He sees the full spectrum of patients but the majority are palliative care. He has let it be well known in "his" hospital that he will be happy to do nail consults. He does a lot of them and as a result his practice has grown where he has hired a few new docs in a short time. He "gets it" and as a result brings home well over $300,000.

So I'm not even sure if your comment was negative, so I'm not casting judgement. I just wanted you and all to know that if you are called on in the hospital or office to perform palliative care, do it with a smile with the understanding that you just made money without firing a synapse. It's the easiest money you will ever make and the patients are always happy and appreciative. Win-win.

Just my thoughts. There is no wrong or right answer.

 

[GSRaw]

do they medically manage their own patients?

Not if they want a license!

 

[pacpod]

Here is a list of questions I compiled of things I wish I would have known about programs;
• How many residents scrub into one case?
• How many inpatients do they usually have?
• do they medically manage their own patients?
• do they take "nail consults"?
• do they have ankle privileges in the hospital?
• does the OR call them for ankle trauma?
• do they have an ortho residency?
• how do they get along with ortho?
• What are the hours like as an intern?
• What are the hours like as a 3rd year?
• When do they typically get their numbers?
• What is the surgical focus of the program (ie wound care, rearfoot, trauma, elective, mix)?
• Do they get peds?
• Do the 3rd years seem confident in the OR?
• Do the attendings let the residents do much in the OR?
• Do the attendings like to teach?
• How many attendings do most of the surgery? (i.e a program may only have 1-2 attendings that do most of the surgeries even though the program may have lots on paper)
• Do the attendings have a "god" complex?
• What are the graduates doing after residency?
• Are any of the 3rd years having a difficult time finding a job?

This is a good list, thanks for sharing!

 

[CapCrunch]

I think that your list is well thought out and reasonable. However, you have one criteria that I'm concerned about. That is whether they "take nail consults".

I understand that it is a "surgical" residency, but contrary to many thoughts, doing "nail" consults will not make you a lesser man or woman. Some patients have been neglected and as a result have poor hygiene. These patients need and deserve care, and it shouldn't be beneath you to do these consults. When performing these consults you will often discover other pathology such as infections, sores/ulcerations, etc. It is part of what we do, and I can assure you that if you eventually obtain hospital privileges in private practice and refuse to do these consults, your referral base will begin to dwindle.

Our group receives a significant amount of consults, and the vast majority are for infections, wound problems, surgical consults, etc. But once in a while we get "nail" consults and we are happy to oblige. It's not glamorous but it helps pay the bills and lets the hospitalists know we are there for ALL their foot and ankle needs.

I understand, I really do, that surgery is the attraction and palliative care seems trivial. But the reality is that the great majority of you will perform great surgery when in practice and will also be in a situation where you will have a fair amount of patients requiring palliative care.

Both our associate and I perform a fair amount of surgery and palliative care patients are not very common on my schedule or his/hers. I saw 4 palliative care patients the entire day today, and I was happy to treat them.

Two anecdotal but TRUE stories. There was a well known, well respected university based vascular surgeon in my area. He was a dept chairman at a major teaching hospital. He walked around with a nail nipper in his pocket and would regularly take them out and trim any nails he thought may be detrimental to his patients well being when he was rounding at the hospital or when seeing the patient in his office.

I just spoke with a former resident who has a very successful practice and is ABPS certified. He has cut back on surgery and does under 20 cases a year. He sees the full spectrum of patients but the majority are palliative care. He has let it be well known in "his" hospital that he will be happy to do nail consults. He does a lot of them and as a result his practice has grown where he has hired a few new docs in a short time. He "gets it" and as a result brings home well over $300,000.

So I'm not even sure if your comment was negative, so I'm not casting judgement. I just wanted you and all to know that if you are called on in the hospital or office to perform palliative care, do it with a smile with the understanding that you just made money without firing a synapse. It's the easiest money you will ever make and the patients are always happy and appreciative. Win-win.

Just my thoughts. There is no wrong or right answer.

That's an awesome response. If your practice is even HALF as successful as it seems, it's because of that attitude. It appears to be a common theme (as it should) that if you take care of them [the patients] then you will be taken care of in return. Looking forward to entering the medical field.

 

[questiondoc]

I think the question is a valid one, well worth including, I read it initially as how much nail care is being done, and didn't take it as a negative. If you are already in the mindset that PADPM suggests, it would give one a good idea to how the process is incorporated into the rest of the setting. Also serves to inform the other people who do not want to do nails, of what to expect.

 

[Podophile]

Maybe a better question is what percentage of hospital consults are for nails? While they may be easy and generate good feelings, they are not as high yield in terms of training experience. Some would argue that any patient encounter is a good one, but seeing only nail consults don't constitute a very advanced level of hospital training.

 

[darazon]

do they medically manage their own patients?

Not if they want a license!

Some programs actually have a podiatry rotation where the attending is a Internist and they medically manage all the podiatry patients even the train wreck COPDers with a foot ulcer.

 

[darazon]

I have no problems doing nail consults and I realize that my practice someday will probably include a lot of it. I like to know how much the program actually does. This is my time to get trained and cutting nails really doesn't have a learning curve.

I've seen some programs that the majority of the total consults are for nails. Typically it is of a pt being discharged that day after 3 months and wants their nails done before they go and they are not even diabetic. That stuff can wait for outpatient, it's not a emergent consult.

One program in Socal actually has a flag come up every-time somebody consults podiatry that basically says we are not a pedicurist service. The vascular guys thought it was funny.