Podiatric Foot And Ankle Fellowships: Are They Worth It?

I am a fellowship-trained podiatric foot and ankle surgeon. Oftentimes, residents and medical students who train at our institution ask, “Was it worth it?” After three years of surgical residency in Detroit, I felt my program was well-rounded and had set me up to do whatever I wanted to do surgically when I was out on my own. Yet, I chose to do a year of further training in Atlanta. At the time, some of my attendings and mentors questioned why I even wanted to do it. They argued that I was getting great training and that I did not need a fellowship. They said the fellowship wasn’t going to give me anything more in terms of skill or edge. 

I did the fellowship to make myself a better surgeon and a more attractive candidate for potential employers. Now as I enter my third year of practice, I am now more happy than ever that I pursued that extra year of training. 

One year of fellowship provided me multiple years of equivalent real-world experience. During my three years of residency, I completed just shy of 1,300 surgical cases. While that is a good number and was much more than the minimum requirement, in comparison, I completed just over 1,000 surgical cases in my fellowship year alone. A busy practitioner may perform in the range of 200 to 350 surgical cases a year. Having the opportunity to do that many surgical cases was real-world experience that would have taken me years to obtain without the fellowship. Additionally, I had my own fellows’ clinic where I had my own patients with no supervision or attending to present to like in residency. This really helped me refine my efficiency and flow so by the time I was out on my own in practice, I was really able to hit the ground running. 

Certain jobs really do look for that extra year of training and fellowship diploma. One of the things that helped me get my job in a large university-based health system in Washington D.C. was my fellowship training. Almost all of my partners are fellowship-trained, being either surgical or research fellowship trained. This was not a secret when I applied and was almost a requirement for the position to have the extra training. Furthermore, almost all my friends who have graduated in the last several years and have positions in university-based systems, large health systems or large orthopedic groups are all fellowship-trained as well. The reality is that the extra year does set you apart from others and it can only help you. 

Fellowship training helps with hospital privileging. In addition to what I have observed in my early career, I have heard accounts from several colleagues that when it came time to apply for privileges, fellowship training was advantageous in avoiding restrictions on privileges for things like total ankle replacement (TAR), pilon fractures and advanced external fixation. Being able to document subspecialized training really closed the door to anyone trying to limit my ability to treat the pathologies I wanted or was trained to treat.

Fellowships are also the norm in other specialties. Specialties such as orthopedics and general surgery have 90 and 80 percent of current grads pursuing fellowships respectively.^1-3 In comparison, about 10 to 15 percent of DPM residency graduates currently go on to fellowships based on the number of fellowship positions currently available. This number will continue to rise as more fellowships become available. This likely has to do with the advancement of medicine and surgery, and the need for further training to truly become comfortable with performing and managing certain procedures and pathologies. Soon, we may find that hospitals may not want to grant new residency graduates privileges in certain procedures if they do not have fellowship training and this may already be happening in certain places.

Recognizing That Fellowship Training Is Not For Everyone 

While I believe the argument for completing a fellowship is a strong one, at the same time, we need to understand that not all graduates have the same goals when it comes to their ideal practice setting. Some do not want to and have no interest in being the busy reconstructive surgical specialist in their group or the academic research scientist. Others may have interests in forefoot surgery or wound care, and some may like to have primarily office-based practices altogether. Those are all great choices and not one is greater than the other. Furthermore, it is important to note that some of those environments do not necessarily need a candidate to be fellowship-trained to make the individual successful in achieving his or her professional goals. 

Final Notes 

In the end, I am glad I pursued fellowship training and recommend it to my residents who are interested in joining a similar practice to mine. At the same time, I emphasize that it may not be for all of them. 

Dr. Ali Rahnama is a fellowship-trained foot and ankle surgeon and an Assistant Professor at the Georgetown University School of Medicine in Washington, D.C. You can follow him on Instagram @DrAliRahnama for interesting cases and educational material. 

References

1. Almansoori KA, Clark M. Increasing trends in orthopedic fellowships are not due to inadequate residency training. Education Research International. 2015. Available at: https://doi.org/10.1155/2015/191470 . Accessed September 18, 2020.

2. Coleman JJ, Esposito TJ, Rozycki GS, Feliciano DV. Early subspecialization and perceived competence in surgical training: Are residents ready? J Am Coll Surg. 2013;216(4):764-771.

3. Bucholz EM, Sue GR, Yeo H, Roman SA, Bell RH Jr, Sosa JA. Our trainees’ confidence: Results from a national survey of 4136 U.S. general surgery residents. Arch Surg. 2011;146(8):907-914.