The Fellowship Experience: Goals and Expectations

Dr. Jennifer Spector:

Welcome to Podiatry Today Podcasts, where we bring you the latest in foot and ankle medicine and surgery from leaders in the field. I'm Dr. Jennifer Spector, the Assistant Editorial Director for Podiatry Today. This episode marks the first of a two-part series on the fellowship experience, both from the point of view of a participant, and as an attending and leader thereof. In this first installment, our guests will share their respective pathways to and through fellowship, including their thoughts and opinions on the goals and the benefits of the experience. Jeffrey McAlister, DPM, is a fellow of the American College of Foot and Ankle Surgeons and practices at the Phoenix Foot and Ankle Institute. Jacob Wynes, DPM is a fellow of the American College of Foot and Ankle Surgeons, and is an assistant professor in the Department of Orthopedic Surgery at the University of Maryland Medical Center. We'll pass it off now to Dr. McAlister to get the conversation started.

Dr. Jeffrey McAlister:

This evening I want to welcome our young members and listeners to this Podiatry Today podcast. It's a beautiful podcast and what we want to talk about with Dr. Wynes is really an introduction of us and how we are able to contribute to a thought process of fellowships, and how fellowships have become mainstream and more inclusive and more accepted in today's podiatric medical education. And so my name is Jeff McAlister, and Jake, I'll give you the floor and allow you to introduce yourself.

Dr. Jacob Wynes:

Great. Thank you Dr. McAlister. I'm really excited to take part in this podcast. It seems like this is a very popular topic and very timely. I did a residency program that I felt provided me with a lot of really good fundamentals and even advanced principles. And from my perspective personally, at University of Pennsylvania Presbyterian Medical Center, I felt that I got a wide range of pathology, I felt that everything was very much well orchestrated, very thought out with respect to the educational experience. I felt that... Not to belabor what I did in residency, but certainly I felt that I had a wide range of surgical exposures and clinical exposures that made me who I am today.

But my story is a little bit unique in that I had met Dr. Brad Lamm, at that time from Sinai Hospital Rubin Institute for Advanced Orthopedics, as part of the International Center for Limb Lengthening through my grandmother who he had operated on for limb salvage, and didn't know much about the line of work that he did, but always knew that he would be one of my professional mentors. And through my process of entering residency in Philadelphia, I'd always kind of kept that in the back of my mind as to what it would be like to learn a little bit about what he did. So what ended up happening was I spent some time during my off time, which was unfortunately very limited, but was able to kind of spend some time and see the kind of work that was done over at the Rubin Institute, which for all intents and purpose was principle-based, but from a different perspective, looking at deformity correction, looking at external fixation.

And again, all things that I had seen and been exposed to, but in a much more consistent manner. And dealing with pathology, that was a little bit more esoteric at the time, which sort of brings me to my journey in that, while I felt that, like I said, I got a wide range of exposure and really phenomenal training from my mentors, the likes of Dr. Mlodzienski, Dr. Scot Malay, Dr. Michael Downey, Dr. Steven Shannon, and even people that are more contemporary, like my senior residents, in addition to some of the most phenomenal co-residents I could ever ask for.

I felt that there was always the opportunity to learn more. And seeing what fellowship offered allowed me the opportunity to advance my training, and provide an experience and an opportunity to be able to learn more and take my education to the fullest. So with that, that's what prompted me to not necessarily do something that was in areas that I felt that was lacking in, but more so in an area that I felt would add more, I guess to a proverbial armamentarium of skills. And it was sort of interesting, it wasn't met with a tremendous degree of acceptance or support, but it certainly was something that nobody was ever really against. And to my knowledge, I believe I was one of the first to do a podiatric surgical fellowship. And at that time, I'm not even sure how many there were that were offered.

I was a little bit geographically restricted, which kind of influenced a bit of my decision, but I was almost very much set that if I got this fellowship opportunity, this would be the one that I would pick. So that's my long-winded evolution as to why I picked the fellowship.

Dr. Jeff McAlister:

That's great, Jake. So the listeners know, our conflicts include that we were in the same class at TUSPM. So I was able to see Dr. Wynes grow and we were able to mentor each other and help each other through these processes. He did an extended four-year residency at the Great Presby Hospital in Philadelphia. I went on from to TUSPM after Jake and I parted ways, to Inova. And then I ended up gravitating towards a program that, without such elaborate words as Jake used, allowed me to get into research and industry, as well as learn kind of the business side of foot and ankle surgery and pediatric medicine. And I gravitated towards a program that did allow me to do things that I didn't see during residency as much. And that includes total ankles for the most part.

What I wanted to gain was OR efficiency, the business acumen, and the wherewithal to grow on the industry side of things and know how to navigate through the murky waters of a surgeon in a field that allows us to play on both sides of the railroad tracks. And I did three total ankles, I think maybe four... Less than five during residency, which is odd. I think these days for most residencies, I think you're definitely doing in your low teens if you will, at least second scrubbing them. And so I really felt like that was my passion. And so I sought out a program that heavily focused on total ankles, business research, and OR efficiencies. And I landed onto the Columbus doorstep and just moved on from there. So my take on it is mentorship for sure, finding a program that allowed me to utilize their ability to garner the... Starting to use big words like Jake... Garner the skillset to run to OR rooms and move quick, and focus on the foot and ankle sports med side.

So that's kind of my nutshell. Mentors up and down the board. I'm not going to name-drop like Jake did, but definitely Brad Lamm is one of the few that have allowed me to become confident. That's the easiest way to say it, to be honest with you, is confident through the field of foot and ankle surgery. And I think that's why Jake and I are talking now. So the common question that we get through our fellowship applicants, and obviously there are more fellowships now than there when we applied. There were probably 10 and now there's 50. So do you think doing a fellowship garnered you a better job? That's the simple question that we get every day.

Dr. Jacob Wynes:

I really appreciate that question. And I think that's the most poignant thing, because at the end of the day, educational growth is one aspect of it, but in the end, you want to make sure that you can provide and earn a good living. That's really important, I think. And I think it is a misnomer and a misconception that by doing a fellowship, you're guaranteed a better job.

Dr. Jeff McAlister:

Agreed.

Dr. Jacob Wynes:

It's still how you sell yourself. I think it's still right place, right time. Because unfortunately, jobs don't always follow, especially good jobs in my opinion. They don't always follow the academic timetable. Would you agree with that?

Dr. Jeff McAlister:

I mean, it's all timing. Yeah.

Dr. Jacob Wynes:

It's never July to July or August to August. They might just have lost one of their associates and it could be a really great job opportunity, and indirectly you might just fall right into when they're looking. And I think those are optimal scenarios. So even fruitful job opportunities may not necessarily be on the same timetable that you might be once you end your fellowship experience. Now, I do think that through mentorship, and not to say that residency directors don't look out for the residents, but there's a whole different aspect to a fellowship director looking out for their fellows, in my opinion. And I believe that is something that sort of helps. And I also think that in my situation, I was able to geographically, and due to job opportunities opening up, pivot over to University of Maryland, which happened to be in the same town as Sinai Hospital.

Now, is it related to my fellowship? Indirectly, because as it turned out, there was that collegiality between Dr. John Herzenberg and my boss at the time, which was Dr. Andy Pollack, who's an orthopedic traumatologist. And not to say that got me a job, but it certainly allowed there to be some discussion. And then also just by virtue of the Baltimore Department of Veteran Affairs Residency Program, having rotated through Sinai Hospital, I was then able to establish camaraderie with Dr. Ricky Adams, who was the residency director at the time. So kind of a long-winded explanation for how it helped me get my job, but certainly it's not the fellowship itself, it's the opportunities and doors that a fellowship can potentially open. It may not necessarily open by residency alone.

Dr. Jeff McAlister:

Agreed. And for the listeners, every fellowship has its family, if you will, of other previous fellows. And that opens doors. It's all about timing. I think fellowship allows you to garner the skillset to get a better job. So you have more to talk about and more to show for yourself and more to do. You have the skillset to be able to do different surgeries, you have something to carry on to the practice that you are trying to go to, whether it's a small private practice and you're doing a fellowship to specifically focus on reconstruction and put buttress frames on, et cetera, and that practice needs that demographic taken care of by a fellowship trained person. That is different from saying that every fellowship applicant and successful finisher gets a, quote unquote, "orthopedic type job," because that is not true.

And so it all depends on timing, situation, what you want as a fellowship applicant and a fellowship graduate, and what type of practice you want. And to Jake's point of earning a living, et cetera, a lot of this obviously has to come down to what you want to do and how you want to live your life, and how you want to run your clinics, Monday through Friday or Saturday if you're one of those cats. But I think that you bring a skillset to be able to bring to the demographic that you want to move to and take care of. So whatever that is for you.

Dr. Jacob Wynes:

I think it takes a lot of thought to be able to determine, once you're done residency or approaching the end of your residency, to really truly ask yourself what type of practice you want to settle into. And the opportunity to apply to a fellowship, especially with so many different offerings at this time, I think really allows you to do that more so than even when we were applying. And that you could really fine tune, like you pointed out, the type of practice that you want to have when you're out. There are different types of programs out there, and I think many of them will provide the right fit for the right person. And I think that's another thing to really look into is really deciding, is a director and mentor relationship going to be something that's going to work for you for that year that you're there as well?

Dr. Jeff McAlister:

And the caveat of all of this, young listeners, is that you don't have to do a fellowship to get a good job. That is a fact of life, and it is not "if, then, good job." That does not matter.

Dr. Jennifer Spector:

Well, on behalf of Podiatry Today and all the listeners, thank you so much to both of you for sharing your thoughts so far, and we look forward to hearing more in the next installment of this topic. For additional episodes, make sure to head to podiatrytoday.com, our channel on SoundCloud, Apple Podcasts, and Spotify. You can also find us on some more of your favorite podcast platforms.