Resident: Dr. Garrett Nguyen
Year: PGY 1
1) What residency program are you at?
Advent Health East Orlando – Podiatric Medicine and Surgery with Rearfoot Reconstructive and Ankle Surgery. I am currently a 1st-year resident, a “PGY-1”.
2) What are your thoughts on completing a fellowship vs. going straight into practice after residency graduation?
As the push for parity between MD/DO and DPM Foot and Ankle Surgeons continue to grow closer, I believe the training requirements and expectations of Foot and Ankle Surgeons should continue to expand as well. It’s becoming apparent that the shift for further fellowship training is becoming more of a necessity to display surgical competency, rather than as an educational option. These trends are also occurring in general surgery, neurological surgery, and across all other surgical specialties. As such, the number of fellowship programs will begin to increase to meet that demand.
In addition, a financial investment can also be seen when completing a fellowship. A recent study conducted by Rushing et al. reviewed Podiatric Foot and Ankle Surgeons with and without fellowship training. What they found was a cumulative net income of $4.2 million and $3.03 million respectively, over 30 years, a difference of $1.2 million. Interestingly, the mean comparative annual income difference was $69,145.00.
Ultimately, the decision to pursue a fellowship will be based on each individual’s goals, focus, and work environment. My goal is to join an Orthopedic group focusing on lower extremity reconstruction, trauma, and joint replacement. For this, a fellowship is a necessity.
3) What is the best part of residency, in your opinion?
The ability to perform, while having attendings look over your shoulder to correct you if needed, allows you to become confident while learning and growing from your experiences.
In my opinion, the best part of residency is having the ability to work with a wide variety of attendings displaying a myriad of techniques, and having the ability to learn from them while being allowed to make mistakes. The ability to perform, while having attendings look over your shoulder to correct you if needed, allows you to become confident while learning and growing from your experiences. Only in residency, do you have that security blanket that you can fall back on. I think that’s the true beauty in a good residency program.
4) What is your surgical case volume and type in a typical week at your program?
In a typical week, we have about 60-70 surgical cases spread out throughout the week, not including add-on trauma/infection cases. We cover approximately 20+ attendings, both MD/DO and DPM, at over 14 different hospitals and surgery centers. Our cases range from bread-and-butter forefoot cases, to complex hindfoot reconstructive surgery. This includes severe Charcot neuroarthropathy, revisional trauma cases, and total joint replacement.
We have attendings who also focus on Orthoplastics that utilize muscle flaps, split-thickness skin grafts, and limb lengthening techniques. Our program requires half a day of the clinic a week with an opportunity to follow-up on all of our post-operative patients, including those at other outpatient clinics. With that said, our current 3rd-year residents are closing in on 2,500 cases with over 4,000 procedures. For the majority of residents, we typically obtain all of our numbers within the 1st year between late December to March.
5) If you had to pick again, would you pick podiatry and your program?
6) What advice do you have for a (4th year) podiatry student?
Work hard and make every opportunity a chance to learn and improve on your technique, no matter how mundane the task may be.
As a 4th year student, your experience parallels that of a 1st-year resident: you are exposed to a plethora of techniques, to new experiences, and to new locations. It’s a unique situation that I don’t think a lot of students take advantage of. Even on your off-service rotations: arrive early, stay late, and always ask if there is anything else that needs to be done. Showing enthusiasm can make or break a rotation. Treat it as a “junior” intern year so that by the time you start residency, you can hit the ground running with a strong background of information/experience.
When focusing on choosing or applying to a residency program, ask yourself where you want to be in 5 years and then in 10 years. Once you determine where you want to be, you can determine the type of training that is required to be able to attain practicing in that location/private practice/orthopedic group. Lastly, make an effort to visit as much as possible. Doing so will show your interest and give you a step ahead of the competition.
7) What is your favorite surgery?
Ankle/Pilon fractures, Charcot reconstructions, and/or total joint replacement.
8) What has been your favorite outside rotation?
9) What do you see for your future practice? Has this changed since you were a student?
In 2010, a massive earthquake struck the heart of Haiti, and then 8 weeks later, I found myself standing in an airport on the way to Haiti to go help with incredible individuals, including surgeons, doctors, and nurses. During my stay, I was exposed to life-saving limb salvage operations and multiple lower extremity deformity corrections. During that experience, I found my passion and desire to become a Foot and Ankle Surgeon. I created a 10-year plan and worked backward with the goal of working for an Orthopedic group treating lower extremity reconstructions, trauma, and joint replacement.
Since then, I have been extremely fortunate to have been able to shadow and surround myself with several great leaders in foot and ankle surgery while I was a student. Those leaders have become mentors and are now my attendings. That being said, my plans have not changed, but instead have further propelled me forward towards my end goal.
10) Finally, everyone is constantly learning, and new information is more available now than ever before. When you’re finding that things you’ve done or learned in the past are not correct, how do you respond to this?
I believe that to become a great physician/surgeon, you must be able to acknowledge, overcome, adapt, and then move forward.
Medicine is ever-changing and there is rarely a clearly defined right or wrong answer. For the majority of cases, the decisions we make as a student, resident, and/or physician are often grey with only our experience and training to guide us towards one treatment versus another.
It is our responsibility that we are adequately prepared and current as to new data and techniques so that we can ultimately choose the appropriate treatment for each patient. As Albert Einstein once said, “Intellectual growth should commence at birth and cease only at death.” Medicine is a life-long learning process. I believe that to become a great physician/surgeon, you must be able to acknowledge, overcome, adapt, and then move forward. Sometimes, we must make mistakes in order to learn from them.
Interview by: Rob De Los Santos, HCA Kingwood Residency
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