As we are roughly halfway to the end of another residency training cycle, hundreds of graduating third-year residents and, in some instances, fourth-year residents are contemplating their next ventures. The majority of graduating residents desire to transition directly into practice without obtaining additional training while others have been actively searching out and applying for various fellowship opportunities in order to obtain additional academic and surgical training. With the recent increase in the quantity and variety of podiatric fellowships, residents may want to consider this option.
Prior to the conclusion of residency, it is important to assess individual strengths and weaknesses. It is also vital to identify what you are passionate about in the profession as well as aspects of the profession that you are not so wild about. Conduct a true self-evaluation of your strengths and weaknesses. For example, one may assess criteria such as surgical competency and familiarity with procedures.
There are a multitude of practice settings in which you may be employed. You may be fortunate to have the luxury of working with other specialists and being able to query partners or colleagues about certain conditions and treatments. Others may work in remote areas where they are the only foot and ankle specialists. In such instances, the patient may not physically be able to be examined by another specialist. Luckily, there are numerous means of technology in order to conduct a virtual consult.
Another consideration in regard to whether or not to complete a fellowship is the financial aspect. We devote four years to podiatry school and due to the demands of school, working full-time and earning a substantial earning is unlikely. After school, residents receive financial compensation but may begin to have additional expenses such as loan repayment. The idea of earning an above average salary is extremely attractive after years of limited earning potential.
For short-term financial planning, it is important to consider the fellowship stipend amount. While the one to two years of fellowship stipend may be less than what one would make working “in the real world,” fellowships may make you more marketable in the long run and you may be able to negotiate higher salaries later. In addition, the skills you learn and additional exposure to business practices may allow you to develop a niche, leading to greater financial success and/or increased job satisfaction.
The goal of residency is to expose trainees to a broad variety of etiologies and patients. The hope is that although they are working countless hours, residents feel rewarded and begin to embrace the profession. During residency or even afterward, if you develop a strong desire to learn more about a subspecialty, a fellowship may provide an excellent opportunity. There is a wide range of accredited fellowship programs, including programs focused on sports medicine, trauma, dermatology, wound care, research and reconstructive ankle surgery. Fellowships are also advantageous because you may be able to start case collection for board certification, which may put you at an advantage over your peers, who may have to build patient volume and diversity, prolonging board certification for years.
The decision to apply for a fellowship does not have to occur immediately after residency. It is never too late to seek out a fellowship. Practicing podiatrists may decide to complete fellowships for a variety of reasons, including personal achievement, professional advancement or for the challenge. Also, as a fellow, you often have the unique opportunity to teach and train residents, which is an added bonus, especially if you have any interest in academia or being a staff attending.
With podiatry making huge strides toward achieving parity with other medical specialties, having additional training is advantageous and it may ease the medical facility credentialing process and further substantiate the granting of certain hospital privileges.
At the conclusion of residency, there are many roads to take and you should do a thorough analysis of them all. Sometimes taking the road less traveled makes all of the difference.
Dr. Ryans is in private practice in St. Louis.