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Trouble in Residency Land

by Jarrod Shapiro, DPM
PRESENT Resident Editor
Botsford General Hospital
Farmington Hills, MI

Here we are again. It’s the third week of our forum, and we’re starting to get a few more responses. Among the replies to my last editorial was a request for advice from one of our colleagues. This resident needs our help! They are unhappy in their residency situation and are requesting advice. I have edited this resident’s letter for their anonymity, and I’m dedicating this issue of the Residency Rap to my response. I’m sure this resident is not the only one in the country unhappy with their situation, so I’m calling on the rest of you to write in your responses and give some good constructive advice to her.

Here’s the letter:

Thank you so much for your creativity and willingness to share on issues very important to residents. My program changed to the PM&S 36 model and the director asked me to switch over to the new program. I hope it was the right decision.

My program leaves a lot to be desired. Some of the orthopedic surgeons don't like podiatry residents and won't allow us to scrub in on cases depending on their mood. Secondly, there is not much trauma. Third, no pediatrics. Fourth, the director holds journal clubs, but I do not get much out of them because he never likes my articles due to his disliking the authors.

I feel I need direction in what I should have accomplished by now and the direction I need to focus my reading. If you can offer any help please feel free to let me know.

Also, my fellow residents seem to discourage me in choosing podiatry as a career. It is my second career. I was a pharmacist first. I have heard this all throughout school and I am really sick of it. Also, how can I improve my suturing?

One more thing. I have been seriously considering changing over to a PA program. Can you tell me your motivations for becoming a podiatric physician?

Well, thanks very much for your forum. Take care.
Anonymous

Editor's Response

I’d like to start by telling you that you have my respect for your bravery in writing in and trying to take an active role in your residency education. I’m sorry you are in a situation that demoralizes you and makes you professionally and personally unhappy.

As for your co-residents who discourage you from choosing podiatry as a career: I’d tell them to shove off. Make it a practice to surround yourself with positive people who make you feel good about yourself and your choices in life. You asked me why I chose to be a podiatrist? First, ask yourself that question. I know you have your own reasons, and they must have been good enough to get you through four grueling years of graduate school and residency so far. Something keeps you waking up every morning and coming to work. For me, I love science, I wanted a career that provided me a stable income and time for my family, and - yes, it may be trite - helping people rewards me. Call me naïve.

Podiatry is still a very viable career option. We’ve all heard horror stories about how hard it is to practice medicine now-a-days, but all the podiatrists I’ve spoken to who are doing well (reasonably successful practice, happy home-life, some personal time, etc) tell me if you treat your patients well and practice ethically (and don’t rip off Medicare!) you’ll do fine. I’m sure you know the numbers of baby boomers who are hitting the 65-year age bracket – no shortage of patients as far as I can see!

On to your residency itself.

First, the orthopedists Experiences vary, but the Orthopods I’ve scrubbed with have been either horrible or wonderful. I’ll bet your experience mirrors many podiatric residents throughout the country. We threaten Orthopedists because podiatrists are the foremost experts in the foot and ankle. Just stay positive, motivated, aggressive, and learn as much as you can from them. Even if you can’t scrub you’ll learn a lot from them (often what not to do).

Let’s talk about didactics. My program’s pretty strong on this, so I can talk with confidence. I’m going to assume your program has a reasonable library. First, if you’re not already, you should read about what you see during your daily clinical experiences. It doesn’t matter how small. Keep in mind, if you knew it all then why would you need a residency? If I see a skin disorder I’ll read (CLICK on links for more info) Dr. Dockery’s Cutaneous Disorders of the Lower Extremity. Great book! Excellent pictures, to the point, not long winded. Whenever I have a surgical case I’ll start with two texts: McGlamry’s text Comprehensive Textbook of Foot and Ankle Surgery and Dr. Chang’s new book, Master Techniques In Podiatric Surgery: The Foot And Ankle. PRESENT Courseware lectures. For example, I watched Dr. Medicino’s lecture a couple of weeks ago prior to a Lapidus procedure I did, and it helped immensely. Journal clubs are a great idea, too. I would caution you, though, about taking the comments your director makes about the articles personally. Maybe he or she just doesn’t like the article. Try speaking to your director and chief resident about altering the format of your journal club. Sometimes focusing it on a theme (flatfoot reconstruction or wound care) or comparing 2 or 3 articles can add some spice to the journal club. I’d also recommend reading as many of the podiatry journals as you can on your own.

Suturing? Practice. Every day. Practice. Practice on cadaver limbs at your hospital, if available. Practice. If not, buy pigs’ feet or use chicken skin. Practice with different types of suture. Practice your hand ties. Senior residents are usually a good resource to critique your suturing. If not get together with some friends from another program nearby. Suture packets opened but not used during cases are just thrown out in many hospitals. Discretely ask the scrub nurse for them. After all, she may appear across a gurney as your patient in your ER some day and, if so, she'll be quite glad she let you have some extra suturing practice !

Here’s your focus clinically Involve yourself in EVERY surgery you can get your hands on. The more you see and do, the better you’ll be in practice. When you’re not in surgery, rounding, or doing consults, try to follow some of your attendings in offices. It’s important to learn how a practice runs. If it’s not part of your program, ask them about ICD-9 and CPT coding. It’s beneficial to learn this before you leave residency. Your director should have paperwork for the PM&S-36, listing goals and competencies. Get a copy and use it as a checklist for yourself.

If you don’t feel you’re getting enough out of residency, perhaps you might consider a fellowship after you graduate? There are always additional opportunities for training. Don't stop until you are confident.

One last thing I’d caution you against becoming a PA for several reasons. First, you’ve put a lot of time and money into podiatry. Second, Physicians Assistants have limited autonomy. What you are allowed to do is based on the relationship with your attending. As a podiatrist you ARE the attending. Third, why hire a PA when you can hire a nurse practitioner to do the same job for less money? Fourth, You’ll have to go back to school again. Perish the thought!

OK That’s a lot to cogitate on. For the rest of you out there, please write in and provide our colleague with your wisdom. That’s the point of the Residency Rap – to help each other out. To our friend, I’d ask you to remember that you’ve invested a lot of time and effort to get to where you are now. Consider carefully what you do next, but remember life is way too short to be unhappy! Best wishes and good luck. Keep us informed.

What do you think? Let the residency community hear your opinion…

SEND A MESSAGE TO ME

As with all PRESENT publications, all issues of Residency Rap will be stored on the PRESENT website, so if you miss an issue or you want to refer back to a prior issue, it'll be at:

http://www.podiatricresidency.com/residencyrap/

Talk to me,

Jarrod Shapiro, DPM
PRESENT Resident Editor
jarrod@podiatry.com

I am a second year resident at the Salt Lake City (was VA) University of Utah residency program. I am one of 4 residents in my year of a PM&S 36 (coming up for evaluation in the next couple of months). I graduated from SCPM. I have been married seven years and have three kids - ages six, four, and two. What a great idea to have this forum! There have been many times I have wanted to give a resident’s point of view on the Podiatry Online forum or PMNews but have second guessed my opinion or did not press the send button because I felt my view was not representative or not fully thought out. I hope that this can be a place where job search strategies can be discussed and other professional concerns can be aired. I look forward to the banter!

I'd like to hear about multispecialty practice opportunities and what inroads outgoing residents are making in cracking this potentially fruitful podiatric job market.

Benjamin Marble, DPM
Salt Lake City (was VA) University of Utah Residency Program
doctormarble@gmail.com

I am at St. Barnabas Hospital in the Bronx. I'm the chief resident this year along with one other resident. We were a pretty large program, but with the new PM&S structure, we had to cut back. We had 21 residents when I began 3 yrs ago, and now we are down to 9. So you can imagine handling all of podiatry and orthopedics in a level 1 trauma center in the middle of the Bronx.

I graduated from the NY school in 2002 (our director likes to use the full length of the PM&S for all). I am married and have a 2-year-old daughter. I think this is going to be beneficial in that it will show those that are always complaining that their program is so bad that there are others out there who are going through the same or worse situation. Don't get me wrong, but those who think the grass is greener on the other side really need to see what they have in front of them before making that decision. Our program is great in trauma, diabetes care, general podiatric surgery, and orthopedics. I feel that we could do more in terms of pediatrics and podiatric orthopedics. But in all reality, unless you market yourself as doing only pediatrics you are not going to get many of these cases. In addition, I feel that our education overall is OK, but with the little time we have to breath, it’s really hard to keep up with all the reading that we should all be doing. I don't mean to complain or offend anyone, but this is my reality. Take care and hope to read from other people out there.

Fernando Quirindongo, DPM
St. Barnabas Hospital
footdoc755@optonline.net

Editor's Response
I have to agree with Benjamin. I first encountered Podiatry Online as a medical student, and to be honest, I was intimidated to email my opinion. What did I know? I hadn’t been out practicing for years. Who’d want to hear my opinion? Well, now we’re all in a different situation. We’re all in the same boat, working our tails off, learning to be complete podiatric physicians, and VERY soon we’ll be out in practice. I believe there’s somewhere around 1200 or so podiatric residents in the country; that’s 1200 other people I could stand to learn something from. What a resource!!

Jarrod Shapiro, DPM
Editor - Residency Rap