Residency Insight -- A PRESENT Podiatry eZine

Guest Editorial: Greetings and Happy Almost Thanksgiving! This week we have a great piece of insight from Orthopedic Foot and Ankle Surgeon Dane Wukich of UPMC in Pittsburgh, PA. Knowing that it would be controversial for both he and us, I very much appreciate the fact that Dane agreed to write this piece. Even more so, I appreciate the way in which Dane presents his points and observations, most of which I agree strongly with. As a member of the AOFAS who is actively involved in training podiatric residents and fellows, Dane clearly does not stray away from a challenge. This week is Part One and we will print Part Two next week along with your comments. Please read below and have a great holiday!

—John Steinberg, DPM, PRESENT Editor

Dane Wukich, MD
Associate Professor of
Orthopaedic Surgery,
Assistant Residency Director,
Department of Orthopaedic Surgery
University of Pittsburgh
School of Medicine

Podiatry from the Perspective of an
Orthopedic Surgeon in 2009: Part 1

I would like to thank Dr. John Steinberg for asking me to present my views regarding the orthopaedic surgeon’s perspective on the field of podiatry. It is important to point out that these comments are solely mine and in no way should be construed as opinions endorsed by any orthopaedic organization. By way of introduction, I am a full time academic orthopaedic surgeon who is fellowship trained in foot and ankle surgery. My practice at the University of Pittsburgh Medical Center is devoted to foot and ankle surgery exclusively. By the end of the 2009-10 academic year, 51 senior orthopaedic residents (PGY 4 and 5), 20 podiatric residents (PGY 3) and four podiatric fellows (PGY 4) will have completed formal rotations with me. In addition, 11 junior podiatry residents (PGY 1) will have spent time on my service. Approximately 50 podiatry students rotate through our program at UPMC each year.

The most important thing that I have observed has been how well residents in orthopaedic surgery and podiatry have worked together in the clinic, operating room and in social situations. Our combined foot and ankle service had changed the perspective of many orthopaedic residents in a positive way. I have personally witnessed the rise in academic caliber of our podiatric residents, and there is no question in my mind that many of them would make outstanding orthopaedic residents in our highly sought after orthopaedic residency program.

I have discussed my thoughts with my podiatry residents, and quite frankly, they share the same viewpoints that I am about to express. Firstly, I believe that there is a great heterogeneity in the quality of podiatric training programs. Some are superb but others fail to meet my expectation for training surgeons. It is anticipated that more podiatric students will graduate in the future, and there is an impetus to increase the number of residency programs. In my opinion, the solution is not to increase training slots because you have more graduates. Rather, I would eliminate those programs which are substandard and reinforce the quality programs. This would allow the better programs to recruit more faculty and improve the quality of training already offered.

Training residents is not a part time job, and consideration should be given to hiring full time faculty dedicated to patient care and education. Secondly, not everyone who graduates from podiatry school should be able to practice foot and ankle surgery. This is true in medical school as well. Some doctors are best suited for non operative care, rehabilitation and diagnostic endeavors. Training programs should be geared to what strengths and interest a podiatrist possesses. Perhaps a separate residency program should be developed to train podiatrists to provide routine foot care, rehabilitation, orthotics etc.

As a surgeon, I would like to see only the best and brightest graduates enter a surgical residency. Residencies in foot and ankle surgery should be highly competitive just like every other surgical subspecialty such as orthopaedics, ophthalmology, urology and otolaryngology. The Department of Orthopaedic Surgery at the University Of Pittsburgh receives nearly 600 applications for eight orthopaedic resident slots per year, and we interview approximately 100 of these candidates. Please don’t increase residency slots to accommodate an increasing number of graduates.

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Two intriguing eTalks on the subject are taking place right now on Podiatry.com: