Whoa! Stop what you are doing. I have an apology that I have to make.

We recently spoke about salaries for new hires out of residencies and I was beating the drums as loudly as anyone else, saying they deserved big salaries because they had done three-year residences. They were bringing new skills into the practice. They deserved $100-150K.  "Don't insult them with lousy offers!"

Let me apologize for those words I spoke just days ago. Now this does not apply to everyone, but apparently it does apply to some people graduating from some "noted" residncy programs - unfortunately. How sad is this. Let me explain.

I had an opportunity to visit with former colleagues tonight and they filled me in on the status of a former "top ten"program and that status was not good. Of course, all programs have their heyday and then their low point but that is usually based on "Popularity." But this was based on hands-on experience. 

Let's say a particular program was known for using a particular piece of hardware worldwide. You would expect residents graduating from that program to be experts in the use of that hardware but instead these residents had never used it at all! Only the attendings and fellows had used it. Even 3rd years are graduating without being able to do bunions and hammertoes, neverless being able to use the famed "hardware."

That makes me very wary of saying "pay them the $100-150K" and I would recommend having prospective hires demonstrate for you their skills. Although it might seem demeaning, after hearing this story tonight, if I were a hiring physician, I would ask a prospective hire to demonstrate a:
* hammertoe
* Austin bunionectomy
* Lapidus bunionectomy
* STJ arthrodesis

At a minimum.

I would have never thought this before my conversation tonight with my former colleagues. Who would have thought it? There has always been an under

As much as I am an advocate for the young practitioner, there is no denying that chosing an associate who you've never seen with patients would be difficult.  I don't know about being able to have the prospective associate perform many procedures for you before you hire them, but you should of course see their surgical logs and be satisfied with the numbers of each type of procedure that they've taken part in during their training.  Then after narrowing down to the candidate you think you may hire, have them in the OR with you to see their surgical skills and more importantly have them in the office with you for a day to see how they are with patients.  Many of my friends who are on their 2nd or 3rd job in 5 years would have chosen better if they had seen their original boss in action as well.  The two practitioners I joined were my attendings during residency so everyone knew what they were getting.  It's hard for this match to be so easy and successful when you've just met.

I just realized that the last paragraph of my comment was cut off. Sorry about that. I don't know how that happened.

I basically had said that as an educator, residency attending  and residency site evaluator, I had thought that a 3-year residency graduate was golden. I assumed a graduate would come out with all the skills necessary to become a financial and personal success. It just shocked me, frankly, to learn that there are some programs (and apparently the one that we spoke of is NOT the only one) where a 3rd year can graduate and not be comfortable performing a bunion surgery.

How in the heck is that happening and what can our profession do something about it?

Or should we do anything about it?

I think it will probably take care of itself but I do feel badly for the trainees. I agree with Erika's comments. Stick with known "commodities." If you are hiring out of a residency program with which you are associated, you know exactly what you are getting.

It is true that it is easier to be confident selecting residents from within a program with which you are associated, although there is an element of 'in-breading' for a lack of a better word which can exist in that situations.  Regional training differences can provide practitioners with the opportunity to learn new things (and alternative ways to skin the proverbial cat), which can ultimately enhance the practice and the skill-set of everyone involved.

I agree, though, it is important to know what you're 'buying."  I would definitely recommend spending time with potential hires both in the office and in the operating room.  My current employers did this with me, and I took the opportunity to demonstrate to the group of orthopedic surgeons what we as a profession are capable of, and the value that we can bring.