AMA: Podiatry resident

What allowed you to cinch your residency? Tips for success? Stats going in?

Are the hours/workload worse compared to podiatry school or is it a different kind of hard?

Did you have to fight any turf wars with ortho or was everything pretty established?

What kind of research interested you? Any ongoing projects?

What was the fellowship process like? How competitive/rare are they? Reason you decided to pursue one?

What are your plans after fellowship?

Did you do all of this while raising a family? If so, what were some challenges?

Any fun stories about work, colleagues, patients?

How much swing do the residents have in ranking 4th years/prospective residents? I understand this varies program to program but, perhaps you can comment on your program specifically and maybe what your general gauge of this practice is? As I understand it- having alumni of your school as residents usually helps and rarely hurts.

Really helpful information @Ankle Breaker .

Thanks for responding. Best of luck in your new job.

Ankle Breaker said:

I was interested in fellowship training because I thought I needed it because I was not getting exposure to certain procedures in residency training.

Click to expand...

And now he's seen the light

Good idea for a thread, I'll bite.

I am currently finishing my 2nd year of residency at a very large program based out of a large hospital system with both academic and community facilities. I am planning on applying for reconstructive fellowships. I would like to eventually be in a multispecialty or ortho practice or in a hospital based practice.


What allowed you to cinch your residency? Tips for success? Stats going in?
Always showed up early, always volunteered to stay late. Worked hard, never complained. Always asked the resident what I could do to help, even if it was 10pm and I had been at the hospital since 4:30am. Learned to recognize patterns quickly and therefore anticipated what the next step would be, whether it was helping out with floorwork, clinic, or in the OR. Always smile. Actually looked up answers to pimp questions I didn't know and discussed it with the resident/attending the following day. Go to social events with residents if you are invited. Be friendly, kind, and courteous with EVERYONE, not just the attendings and residents but also your fellow externs and the rest of the hospital staff such as OR circulators, scrub techs, etc. Not talking over other students and especially not over residents/attendings. Not always volunteering the answer--people want smart residents but not insufferable ones. I was in the top 20% of my class, had received several scholarships and academic/graduation awards. I was very involved in my school.

Are the hours/workload worse compared to podiatry school or is it a different kind of hard?
Overall it's worse, but it depends on the rotation. Some off service rotations have relatively chill hours. Any surgical services are way worse than school. But I am in a pretty intense program that takes on a lot of primaries.

Did you have to fight any turf wars with ortho or was everything pretty established?
Overall we have a pretty good relationship with ortho. The ortho trauma service gets all ankle and hindfoot fractures. However, we rotate through ortho trauma during PGY1 and PGY2 so our interns see the initial consult as they hold the pager and the PGY2 goes into the OR for F&A (or any other) cases.

What kind of research interested you? Any ongoing projects?
I have some interest in diabetic limb salvage but I have greater interest in reconstructive and elective surgery outcomes. I have a couple projects ongoing however it is not a personal focus of my residency training.

What was the fellowship process like? How competitive/rare are they? Reason you decided to pursue one?
The process of obtaining a fellowship is pretty competitive as there aren't very many out there relative to the number of grads. My program provides good exposure to rearfoot cases (we end up with 3x the minimum numbers) but I would like an additional year of doing a ton of those kinds of cases. I am aiming for a fairly specific geographic location after I am done with training so I want to have the most competitive CV as possible.

What are your plans after fellowship?
See above.

Did you do all of this while raising a family? If so, what were some challenges?
I got married between graduation and the start of residency. We did long distance for all 4 years of podiatry school, which was challenging but we managed to see each other once a month.

Any fun stories about work, colleagues, patients?
Too many to talk about....

How much swing do the residents have in ranking 4th years/prospective residents? I understand this varies program to program but, perhaps you can comment on your program specifically and maybe what your general gauge of this practice is? As I understand it- having alumni of your school as residents usually helps and rarely hurts.
It depends on the program. For my program the residents have a huge say in who we choose. In the end, our program director has the final word but he essentially goes with what we recommend with the exception of maybe 1 candidate that we would rank-to-match. However, if any resident is absolutely against a certain candidate for a good reason, you can be sure that they will be ranked either very lowly or unranked.

I want to offer my perspective. The people who have written above have all clearly worked hard and are to be congratulated for their efforts, but I have some different/alternate views on answers to these questions. I'm sure we'll disagree on things, but different programs expect different things from students, and so what's right one place will be wrong elsewhere.

What allowed you to cinch your residency? Tips for success? Stats going in?
Generally agree with what was written above with respect to working hard. I was in the top half of my class, which is another way of saying I was in the middle of the pack in terms of grades. Personally I think there was a huge element of luck in my story, which I have written about in detail elsewhere. During my reapplication year, I matched at a program where applications are so competitive I don't understand how I got interviewed. I did well enough in my interview to get ranked, and ranked highly enough to match. But it's like climbing a mountain, a tiny ledge can be a foothold that gets you closer to the top.
Some other advice:
1) The simple act of putting your face out there can count for a lot. Sometimes, it will make enough of an impact that the program director spends an extra 10 seconds looking over your CV and puts you in the "yes" column when it comes down to who to rank and how high. Other times you'll make a visit and no one will care, maybe they give you the finger, and that sucks because you probably racked up a lot of travel expenses. Don't like it? Hate the game, not the players.
2) Make a list of your best attributes and accomplishments. Now cross off anything related to school, research, podiatry, medicine, surgery, academics in general. Anything that's left are the things that make you interesting. Those are the selling points that get you ranked a little higher.
3) First year students should seek out mentors among the upperclassmen. If I could have done only one thing differently it would have been that. I've always been a lone wolf, but life could have been easier in school if I had a bit of advice every now and then.

Are the hours/workload worse compared to podiatry school or is it a different kind of hard?
I think "different kind of hard" is an apt way of putting it. As a student your motivation is to impress the residents in hopes that they'll say kind things about you to the director. As a resident, your motivation is to do what's right for your patients, which for me anyway is more of a reason to get out of bed every day. I have a lot more autonomy now, so I don't necessarily care what anyone thinks about me, my work speaks for itself. In terms of hours, I worked like a maniac as an intern, but I'm in a position where I can delegate tasks now.

From a training perspective, you shouldn't be placed in a position where you're outside of your depth without having a senior resident or attending to call on for advice. (Adequate supervision is a residency accreditation requirement.) The only real life and death scenario a PGY-1 is ever faced with is "does this patient need emergency surgery?" and even then it's an attending call. Your first nec fash case will have your heart pounding, but even that you have a few hours to get your ducks in a row. Anything else can be discussed over teaching rounds.

Did you have to fight any turf wars with ortho or was everything pretty established?
We don't fight ortho over the trauma because we rotate with ortho and do trauma with them.

What kind of research interested you? Any ongoing projects?
Case reports are relatively easy to bang out, every PGY-1 should look out for something to write up. Anything else is harder and probably requires a coordinated effort. The hardest part is making sure you have the case volume to do anything meaningful and hopefully see the project completed before you graduate. If you can form a good team of like-minded residents and attendings, you'll be solid. Do a pubmed search for Adam Smasher and you can see what I've been up to.

What was the fellowship process like? How competitive/rare are they? Reason you decided to pursue one?
I made an attempt at applying to fellowships, but I resolved not to do a fellowship just so I could say I did one, so I was selective in my applications. What I found was that some fellowships you almost have to know the right people to be considered. The other problem is that while many fellowships offer an incredible experience, there are fellowships that are a waste of time. To be accredited by ACFAS, a fellowship director only needs to prove that there are 300 cases available for the training year. Fixing a pinky toe hammertoe counts towards that total.

In terms of salaries, most fellowships pay $50-60k, whereas a modest net income for a first year associate might be $100-110k. I'm not 100% convinced a graduating fellow can get much of a salary bump over what he could have gotten fresh out of residency. So that's $50k opportunity cost. What else could you do with $50k over the course of a year?

Still, it would have been nice to get involved in a fellowship where they have the case volume to base some nice papers and use that as a springboard to a more academic practice, though the money is a rather nice consolation prize.

What are your plans after residency?
I'll be joining a group practice that's continuing to expand locations. The starting salary is good, but nothing to boast over, but all the partners are approaching retirement age, and I could be heir to an empire before I'm 40. Yes, private practice is not what it used to be, but I think a group practice is still a viable model and I'll have plenty of autonomy. The business side of podiatry is rather interesting if you take the time to think about it.

Did you do all of this while raising a family? If so, what were some challenges?
Yes. It's hard. PM me.

How much swing do the residents have in ranking 4th years/prospective residents? I understand this varies program to program but, perhaps you can comment on your program specifically and maybe what your general gauge of this practice is? As I understand it- having alumni of your school as residents usually helps and rarely hurts.
Personally I don't get involved much with students. Don't get me wrong, I enjoy teaching, but I work more efficiently without students and I'm not going to make life hell for students like some residents made life hell for me. In my opinion, many residents enjoy a little too much being in a position of judgement over potential applicants. Really, a resident should be focused on their patients' needs and their own academic development. And if you're at a good program, you're going to match good applicants no matter where the chips may fall, so why obsess?

Also, I would caution against programs where the residents have too much pull, the interview process can deteriorate into a popularity contest.

Thanks to all who've taken time out of their busy schedules to comment!

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(1) Correlation between undergrad performance and performance in pod school? Think of: MCAT vs. Board exams and stuff like that.

(2) What are rounds like? Are the residents going at it with one another? Is it similar to what's often portrayed on TV with the chief leading the pac then he'll ask a question and call out a random resident to answer?

(3) Making the transition from classroom to clinic isn't always easy. How is it trying to connect the theory from textbooks and class exams to the practicals of clinic? Or did clinical rotations during school bridge that gap? (Ex, are you trying to recall the names of diseases and conditions you memorized for an exam? )

(4) Any rules / regulations during residency? What are the specific rules for your residency? I.e. - lateness, getting questions wrong, dress code, and that stuff

(5) Have you started tackling your loans yet (since you get paid during residency)?

(6) When you spend time with the other specialties (ortho, gen surg, etc), how well prepared do you feel compared to them?

(7) Any regrets? Would you really go through all of this again?

(8) They still giving out beepers or they've switched to something else now?

(9) Is there a strong demand for epidemiology research in podiatry?

dr.phoot said:

Thanks to all who've taken time out of their busy schedules to comment!

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(1) Correlation between undergrad performance and performance in pod school? Think of: MCAT vs. Board exams and stuff like that.

Click to expand...

Not a resident, but there is a study out there showing that the MCAT is not an effective predictor of USMLE performance for MD/DO students. Additionally, my anecdotal experience- we don't talk about our MCAT scores but of the few students that told me theirs, there is basically no correlation to how they're doing now. One of the highest scores on the MCAT I heard from one of my classmates (which I understand is likely inflated, but even if it was inflated by a lot- it was still a high score)- just scored a near impossibly low grade on a lab exam final. Another student who scored below a 20 on the old MCAT is definitely one of our better performing students.
Way I see it, MCAT grade only gets you in the door. Playing field is leveled after that. Past performance is not indicative of future outcomes.

This thread is awesome. Thanks to everyone posting

Loans question was a good one.

I don't think as pre-pods we fully understand what 3-5k a month will do to our future families yet.

(1) Correlation between undergrad performance and performance in pod school? Think of: MCAT vs. Board exams and stuff like that.
I had a significantly higher GPA in pod school than undergrad. then again, I put forth significantly more effort in pod school than undergrad. I will say that based on my own observations there was a correlation between caliber of undergrad and how well students performed in pod school. People who attended top 50ish schools pretty much all graduated within the top 50% of my class. There were plenty of people who went to local/regional colleges who also placed in the top in our class but they also made up the majority of the bottom 50%. I don't think the MCAT correlates with our board exams at all, but that's only because a) our average MCAT scores are so low and b) our board exams are terribly written.

(2) What are rounds like? Are the residents going at it with one another? Is it similar to what's often portrayed on TV with the chief leading the pac then he'll ask a question and call out a random resident to answer?
I think you're confusing medicine rounds with surgical service rounds. Surgical services don't have time to sit down at a conference table for perform mental masturbation for 3 hours to discuss 4 patients. We divide up the list amongst residents (with interns having to see more patients than seniors) and see them on our own. We meet at around 6:45am after we've seen our patients to "run the list" as a group where we report our findings (important labs, vitals, NPO status, drain/VAC outputs, any acute overnight events, share pictures of wounds/incisions, barriers for dispo, etc). Later in the day, we will round on patients with an attending.

(3) Making the transition from classroom to clinic isn't always easy. How is it trying to connect the theory from textbooks and class exams to the practicals of clinic? Or did clinical rotations during school bridge that gap? (Ex, are you trying to recall the names of diseases and conditions you memorized for an exam? )
Clinical rotations are fun because you are in podiatry school to see patients, not to sit in a lecture hall. It can be difficult though because it is a different skill set. I would say that clinical rotations do help bridge the gap but the responsibilities and day to day tasks you perform as a resident are way harder than what you do as a student. I probably learned the most during externships.

(4) Any rules / regulations during residency? What are the specific rules for your residency? I.e. - lateness, getting questions wrong, dress code, and that stuff
This question is too vague, but the answer is yes, there are lots of rules and regulations in any program. Most rules are common sense. Dress code is generally scrubs unless you're in clinic with an attending who cares about clinic attire.

(5) Have you started tackling your loans yet (since you get paid during residency)?
Fortunately I am dual-income with my spouse so yes, I have been paying a significant amount every month. At the very least, you should try and pay off the interest per month. My principle has gone down by about $15k since I started.

(6) When you spend time with the other specialties (ortho, gen surg, etc), how well prepared do you feel compared to them?
There are certain things that you will never be prepared for, but as long as you are a quick self motivated learner you will be fine. I have never felt overwhelmed when I rotate on other services and that includes times where I held the pagers for ortho trauma, gen surg trauma, burn, etc. Do not ignore the non-pod clinical courses in school!

(7) Any regrets? Would you really go through all of this again?
None, if I went back in time I would still choose this profession.

(8) They still giving out beepers or they've switched to something else now?
You will learn to hate the pager very quickly if you go to a program with a heavy inpatient load.

(9) Is there a strong demand for epidemiology research in podiatry?
There is a strong demand for anything better than a case study/series in podiatry.

(1) I understand in clinicals, y'all are evaluated. Is there some form of evaluations during residency? How does that work?

(2) After residency, are you on your own to find a permanent gig or there's a likely hood the hospital will give a select few of the pod residents a job? Basically educate me on the transition state from final year residency to landing your first job.

(3) I know you can't compare since you're only going to do one residency program. But what has been the weaknesses and strengths of your particular residency programs so far? What areas are lacking and could improve?