General comments:
This is a very well balanced training experience that I would highly recommend. Excellent exposure to total ankle replacement, good volume, three approachable attendings with fairly diverse practice settings, diversity of rotations including four months without residents in a boutique private practice setting and eight months in academic setting with resident help, in a nice place to be.
My background, motivations for seeking out this program, and general experience:
I have a bit of an atypical background in that I already did a foot & ankle fellowship with two awesome mentors at Brown from 2022 – 2023. I was in practice for a short time and had some issues with my contract causing me to be basically up the creek without a paddle by the summertime, seeking out opportunities outside the match. I had a great conversation with Dr. Anciano who gave a fair and accurate representation of what has been my experience at U of L. I was very intrigued by the potential for a somewhat higher volume and little bit higher level of complexity than what I had done previously (more emphasis on Charcot, pilon and hindfoot fractures, and significantly more exposure to total ankle replacements—this definitely bore out to be totally true). I was also intrigued at the prospect of autonomy on call (with considerable supplemental income associated with this) at a relatively low-acuity call setting, which would be great for my career goals of continuing to take general call at a level III center.Unfortunately, my hopes for an extremely rapid turnaround time (6 weeks) for insurance and hospital credentialing proved to be unrealistic, motivating me then to pursue a less structured “go where you want” preceptorship-type experience. I did not have access to the EMR and could not scrub in, which did impact my experience in terms of being prepared for the cases I observed, but I still learned a ton through just asking about thought processes, talking to the reps, and seeing tips and tricks I had not seen previously. I can only imagine how much more fruitful the experience would be with actually getting the full fellowship experience.
FACULTY AND THEIR PRACTICES/ROTATIONS:Dr. Anciano can confirm, but what I was told initially was that the intention is to do two two-month rotations with each attending, in concert with PGY2 ortho, PGY5 ortho, and PGY2/PGY3 DPM residents.Dr. Victor Anciano: Dr. Anciano was highly approachable and extremely enthusiastic about education. His overall pace and zest for clinical practice are pretty impressive, seeing about 45 patients before 230pm most clinic days and, when demand is seasonally there, cranking out up to 9 real cases in a day as I saw when I visited in July 2024. His communication was excellent regarding the status of fellowship developments, and his attitude for trying to help me advance my career was plainly obvious. He was even flexible about the duration of my training experience (starting first as potentially a full year, negotiating to a 6-month fellowship to help me figure out next moves given my previous foot & ankle fellowship, and ultimately being pivotal in administratively facilitating my proctorship type experience that I ultimately went through with). I greatly enjoyed working with him and look forward to bouncing a case or two off him for the next few years for sure.Dr. Anciano’s practice is relatively diverse. He does a decent bit of diabetic deformity and some of the wound care that comes along with it but certainly plenty, plenty of rotational ankle fractures, ankle arthritis, calc fractures, ankle instability, arthroscopy, and really the full gamut of foot & ankle. Notably he does MIS bunion surgery, which I had not been exposed to previously. As above, he will see about 40-45 patients most clinic days, with a PGY5 ortho resident and often a PGY2 or PGY3 podiatry resident on service (which I was told may be subject to change with the permanent installment of a fellow). He generally has two full clinic days and about 2.5 OR days per week, operating at Mary & Elizabeth and Medical Center South. Of additional note, Dr. Anciano is a wizard with billing and coding and clearly learned a ton at OrthoCarolina about practice management, which I would highly encourage fellows to capitalize on.
Idiosyncratically, my time (mid-August to late September 2024) was evidently one of the slowest periods these surgeons have all seen in the past few years, so I did not see as much Charcot deformity or ankle/hindfoot trauma as I might have otherwise.
Dr. John Lewis: Dr. Lewis is an incredibly personable surgeon and great guy to work with. I spent time in his office (which uses Athena, an often-adopted EMR for many private practices these days) and most Mondays at Baptist Health in their version of an ASC where he typically had two rooms and would do 5-6 good size cases. There was an administrative issue at the Physician’s Medical Center ASC barring me from going there, but he may do 8 or more cases there in a day on Wednesdays, generally smaller-ish stuff. He has a great stable crew in the office in the OR, and it is a very pleasant and enjoyable vibe. He has two nurse practitioners but is often on his own in the OR with just him and a scrub tech (sometimes two), so seeing that things can be done this way without too much trouble was very reassuring for someone like me who will not be joining a big academic center with a bunch of residents to hold retractors, for example. He is very well liked by all of his staff, and I paid close attention to his demeanor with his patients, which I believe is a component of what has made his practice very successful.Dr. Lewis’s practice is composed of a little different payer mix than the university setting, with perhaps a bit more sports-injury type pathology thrown in, but he is still doing plenty high level of complexity, including revision hindfoot fusions, TTC nails, complex deformity correction, and the full gamut of ankle arthroplasty (averaging about one per week) including takedown of ankle fusions. I believe the exposure to his practice setting and watching him operate within this setting was one of the most valuable components of this experience to me (who, as above, was someone administratively barred from scrubbing in). At my previous fellowship, my mentors’ practices were both structured pretty similarly, so this degree of diversity of practice settings is a big plus, and having three mentors here is I believe a perfect mix of variety and manageability of diversity of preferences, locations, etc. Dr. Lewis also clearly absorbed a great deal of billing and coding knowledge from OrthoCarolina and is happy to teach many valuable lessons about practice management and setup. I will have adopted several of his principles in my private practice job starting in about a month now.What I enjoyed most about working with Dr. Lewis was his thoughtful approach to any line of questioning I threw at him. He never made me feel like he was too busy to teach and is clearly enthusiastic like Dr. Anciano is about sharing his knowledge, which is quite impressive. As above, he is also just incredibly down-to-earth and made it easy to feel like I belonged in a pretty short period of time even in a fairly unprecedented role. Without residents on his service, this was a true one-on-one mentorship type of experience, and his sole educational focus is on the fellow. This makes for a very highly representative picture of being a busy, thoughtful, evidence-based high-complexity private practice true-blue foot and ankle surgeon. Dr. Todd Hockenbury: Dr. Hockenbury deals with a pretty high degree of complexity and routinely did the craziest stuff I saw in my brief time at U of L (horrible Charcot, revision total ankles, conversion of abx spacers to TTC fusions, rheumatoid pan…foot—forefoot midfoot hindfoot indeed--, etc.). He is a bit no-nonsense and will state very plainly what he thinks about the quality of work or right clinical course of action but is still a pleasure to be around. He has an impressive understanding of the U.S. Healthcare system and regulation and some of the implications of politics on the practice of orthopedics, so there is a great deal to learn from him on those topics. He had a PGY2 ortho resident and PGY3 podiatry resident on service with him full-time during my preceptorship, so it is hard to say how the degree of operative autonomy would translate to a fellow, but with two two-month rotations I believe that there would be plenty of time even in the most complex cases to have a meaningful level of involvement.Dr. Hockenbury’s practice is not quite as high volume due to the degree of complexity, but the richness of pathology is certainly there. He was typically doing four to five generally pretty big cases in a day, usually with two rooms so still done usually at quite a reasonable time. Due to scheduling issues I spent the least amount of time with Dr. Hockenbury but have nothing but great things to say about working with him and about the educational value of doing so. Locations & living situation:
Louisville is a nice (and affordable!) place to spend a year, with lots of availability on FurnishedFinder of units amenable to being fairly central to the fellowship locations. I The total number of locations traveled to is more than I was accustomed to, but within a given rotation, this is very manageable (usually three total locations per rotation between clinics and ORs). Dr. Anciano had recommended living in St. Matthews on the east side of town (which would put you less than 10 minutes from Dr. Lewis’s clinic and his OR at Baptist, and probably 20-25 minutes from his surgery center which is just north of the river in New Albany Indiana, where he goes one day a week; would also put you very close to Medical Center East where Dr. Hockenbury operates one or two days per week and sometimes has clinic). St. Matthews was a bit out of my budget range. Mary & Elizabeth hospital is on the west-central end of Louisville in what’s called Shively; Dr. Anciano and Dr. Hockenbury operate there about once per week and have clinic there one to two times per week, so living toward there might be reasonable, but Dr. Anciano had expressed some safety concerns, and I would tend to agree. An alternative might be Old Louisville which is pretty central to everything (15-20 minutes), but probably not < 10 minutes from any individual location. Call & supplemental income:
When I was in the midst of considering doing a full fellowship experience, I was offered the potential to do call at Mary & Elizabeth, taking Dr. Anciano’s primary calls and getting paid pretty handsomely for it. It would be administratively allowable to take call also at Jewish Hospital and probably also at South. (Note that Medical Center East is basically an office plus ASC, with no inpatient admissions or ER). I was told you would always have an attending to back you up, and the joints fellows are a good resource to talk to about involvement in the call pool. From what I understand, operating on the weekends is pretty rare, but Dr. Anciano is happy to keep call cases for the fellows’ benefit if desired (and also happy to pass off to other partners if not interested). Supplemental income with call can be substantial, and it may be feasible to gross an extra $4000-6000 per month if you worked hard at it (that would probably be pretty taxing).I was told there is also an opportunity to staff an orthopedic urgent care for 4-hour shifts. My insurance payer applications got paused when I truncated the duration of my fellowship, otherwise I absolutely would have pursued this. This is available on the weekends and is coordinated by the office manager Missy Kersnick. You would share shifts with the joints fellow and possibly some other providers. My understanding is there is a base of about $500-600 per shift, plus you can bill for RVUs including injections, and I was told it is not uncommon to gross up to about $1000 in a shift with this. Parting thoughts:
My only regret about this experience is that I didn’t get to stay longer. I would be happy to answer any questions at any time and give my full support to Drs. Anciano, Hockenbury, and Lewis. Contact me any time! Sincerely,
Gregory Max Gosey, MD, MAS
Orthopedic Foot & Ankle Surgery
Cell Phone: (303)-748-4337
This email address is being protected from spambots. You need JavaScript enabled to view it.
