Are there enough RESIDENCY slots this year?

[Podfather]

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Ok so we have a residency shortage back in the day. We go out and start residency genesis. It works so everyone gets a residency and we see Podiatry advance with job opportunities, enhanced scope, and we are cruising. During the residency genesis push several bad programs open. Grads from those programs can't pass boards/ cause issues. The profession takes a step back, enrollment drops and boom residency surplus. Next programs close(both those who should and those who are decent) due to lack of applicants, plenty of great programs go unfilled but overall there is a shortage of trained DPMS and value goes sky high. Next evolution leads to even better opportunities. Next thing applicant pool increases we have great students and now we have a shortage. So we basically say anyone please open a residency. But the shortage means some great students say risk 4 years of expensive education with a possibility of no residency forget it. So the schools go back to accepting marginal students and bam 4 years later residencies have poor residents and they enter marginal programs. Profession takes a step back and applicant pool drops residency surplus. Ugh......

Solution is simple. Schools only take enough students for existing spots. Provide stability and only accept quality students. The profession has a set number of quality grads who enter good programs and the value increases. As it does other hospitals see the value and open quality programs and the schools then take more.

Simple math.

 

[Podfather]

Let's talk turkey here. Although many in the profession ( including me) were accepted or could have been accepted at allopathic or osteopathic medical schools but chose Podiatry ( a smart choice for me) many choose the profession as a back up. No problem in my eyes since many enjoy the profession and have contributed significantly. Our hey day for acquiring those applicants was when there were a few foreign MD schools and financial assistance was poor.

Then a proliferation of solid Caribbean schools with loan availability developed. Many of these legit/good schools now provide a significant amount of residents in MD programs. Now for those second choice applicants there exists a second option. Podiatry, Dental, Optometry, Chiropractic, and PA schools see a drop in quality applicants.

A dirty little secret..............................................................

 

[air bud]

Yeah, what the Podfather said.

except for lumping chiropractors in there. But that is another story for another time....

 

[UNVME2]

maybe those 12 should have been a little more personally accountable for their podiatric education?

Are you assuming they were are all poor students, and somehow responsible for creating their own residency spot? It doesn't make sense. Whether they were no 1 or 100 in their class, any way you cut it there were 12 less spots than students eligible to match.

Seriously, if you're "minimally competent" to become a podiatrist by said entity, who's fault is it that there are no spots for you to train. You've paid your tuition and proven yourself fit to enter residency. Granted, that doesn't entitle you to Yale or Harvard, but it does entitle you a spot.

 

[ldsrmdude]

It's unfortunate that these cycles exist. It always seems like either the number of students is trying to catch up to the number or residency spots or vice versa.

Ok so we have a residency shortage back in the day. We go out and start residency genesis. It works so everyone gets a residency and we see Podiatry advance with job opportunities, enhanced scope, and we are cruising. During the residency genesis push several bad programs open. Grads from those programs can't pass boards/ cause issues. The profession takes a step back, enrollment drops and boom residency surplus. Next programs close(both those who should and those who are decent) due to lack of applicants, plenty of great programs go unfilled but overall there is a shortage of trained DPMS and value goes sky high. Next evolution leads to even better opportunities. Next thing applicant pool increases we have great students and now we have a shortage. So we basically say anyone please open a residency. But the shortage means some great students say risk 4 years of expensive education with a possibility of no residency forget it. So the schools go back to accepting marginal students and bam 4 years later residencies have poor residents and they enter marginal programs. Profession takes a step back and applicant pool drops residency surplus. Ugh......

Solution is simple. Schools only take enough students for existing spots. Provide stability and only accept quality students. The profession has a set number of quality grads who enter good programs and the value increases. As it does other hospitals see the value and open quality programs and the schools then take more.

Simple math.

In my mind the solution isn't quite that simple just because residency spots open or close or grow or shrink every year for many reasons, and trying to correlate that with the number of students that will graduate 4 years in the future without knowing attrition rates sounds about as accurate as forecasting the weather 4 years in advance. I could be wrong since I am not involved in any of that, but it makes sense to me.

 

[air bud]

Are you assuming they were are all poor students, and somehow responsible for creating their own residency spot? It doesn't make sense. Whether they were no 1 or 100 in their class, any way you cut it there were 12 less spots than students eligible to match.

Seriously, if you're "minimally competent" to become a podiatrist by said entity, who's fault is it that there are no spots for you to train. You've paid your tuition and proven yourself fit to enter residency. Granted, that doesn't entitle you to Yale or Harvard, but it does entitle you a spot.

The school may have said you are "minimally competent." That doesnt mean a residency thinks so. Podfather and others on here have repeatedly said they would rather a spot go unfilled than some idiot get it (okay, idiot was my choice of language.) The way I see it, a residency is a job. You don't hire people you dont want to work for you. I think the residency directors are doing the profession a favor and being a little more selective than some schools have been. Life isn't fair. "Said entity" is not paying you money to treat patients there. "Said entity" is not responsible for you barely passing pharm and giving somebody KCL too quickly. "Said entity" does not have to pay the family of the patient you just killed.

Wait, here is an idea. How about instead of being "minimally competent," you actually apply yourself, and do things to put yourself in a position to have your choice of residency. Or, be minimally competent and ask the other guy if he likes blondes or brunettes. When he says he likes brunettes, you can say "good, because I will take anything."

 

[jonwill]

I think enrollment is the key. That is really the only thing that can be controlled fairly easily. But the CPME and schools all have to be on the same page (and I believe it is the CPME that sets the cap). Not to mention the APMA jumping in saying that there is going to be a huge podiatrist shortage in the future which is a whole other story.

Could it be that as a profession, we're just not very organized? Why can't it be as simple as the CPME looking at the number of residency slots, looking at the number of schools and their admission caps, take a certain attrition percentage into consideration, and cut admissions across the board. Every year wouldn't be perfect but it would be close. And PLEASE don't open anymore programs. But I'm not sure the CPME even has that power. Anybody?

This would even increase competition and the quality of candidates.

 

[air bud]

DMU's dean is the president of the CPME. I am under the impression that he has said that the CPME can only make recommendations, but mostly have no direct control over the individual schools. There are a few schools that are trying to push forward and a few schools that are not willing to do so. This is one of the reasons that board scores are not published, there is no uniformity within curriculum and why some schools accept different admission tests.
So really, it comes down to the Deans of the individual schools.

EDIT: Just found this on the CPME.org website

The Council on Podiatric Medical Education is an autonomous accrediting agency for podiatric medical education. Deriving its authority from the House of Delegates of the American Podiatric Medical Association, the Council is empowered to develop and adopt standards and policies as necessary for the implementation of all aspects of its accreditation, approval, and recognition purview. The Council has final authority for:

The accreditation of colleges of podiatric medicine, the approval of fellowships and residency programs, and sponsors of continuing education.

The recognition of specialty certifying boards for podiatric medical practice.

 

[Feli]

Ok so we have a residency shortage back in the day. We go out and start residency genesis. It works so everyone gets a residency and we see Podiatry advance with job opportunities, enhanced scope, and we are cruising. During the residency genesis push several bad programs open. Grads from those programs can't pass boards/ cause issues. The profession takes a step back, enrollment drops and boom residency surplus. Next programs close(both those who should and those who are decent) due to lack of applicants, plenty of great programs go unfilled but overall there is a shortage of trained DPMS and value goes sky high. Next evolution leads to even better opportunities. Next thing applicant pool increases we have great students and now we have a shortage. So we basically say anyone please open a residency. But the shortage means some great students say risk 4 years of expensive education with a possibility of no residency forget it. So the schools go back to accepting marginal students and bam 4 years later residencies have poor residents and they enter marginal programs. Profession takes a step back and applicant pool drops residency surplus. Ugh......

Solution is simple. Schools only take enough students for existing spots. Provide stability and only accept quality students. The profession has a set number of quality grads who enter good programs and the value increases. As it does other hospitals see the value and open quality programs and the schools then take more.

Simple math.

This is crazy talk. Having a finite number of intelligent and well trained people enter a career field? Nonsense. A strategy such as the one you are suggesting sure has crashed and burned for dermatology, ENT, ortho, plastics, allergy, etc. We all know those professions' guys get no respect, are lucky if they find a job, and face a daily struggle to avoid going bankrupt. On second though, maybe you're on to something. 😉

...I agree that we have way too many mediocre DPMs out there "teaching" just so that residency genesis can keep pace with greedy pod school enrollment and "everyone can get a residency." You don't see F&A ortho doing that; they generally have only the most dedicated, most interested, and well read attendings teaching in their fellowships. Come to think about it, you don't see any other (respected) medical profession doing that.

In the future, we will have a lot of well trained DPMs - both medically and surgically - and we really need to decide who the future teachers should be. Residency and fellowship teaching responsibilities should be reserved for the individuals who want to educate - not just those who want to build their practice volume, put "attending physician for residency X" on their website/CV, get their name out there, etc. PM&S directors should be able to pick the best and brightest attendings as the teachers of their residents, not be stuck sending them to scrub with whoever is on staff since CPME is rapidly increasing the program's total number of residents and they're trying to reach MAVs at any cost. I think it's absolutely to our benefit to have all grads (who pass boards) get 3yr post-grad training - esp since that's the req minimum for MDs and DOs. Right now, as you said, "anyone please open a residency" is the attitude, but it's a stop-gap and not the best long term answer... and I think we all know that.

 

[krabmas]

This is crazy talk. Having a finite number of intelligent and well trained people enter a career field? Nonsense. A strategy such as the one you are suggesting sure has crashed and burned for dermatology, ENT, ortho, plastics, allergy, etc. We all know those professions' guys get no respect, are lucky if they find a job, and face a daily struggle to avoid going bankrupt. On second though, maybe you're on to something. 😉

...I agree that we have way too many mediocre DPMs out there "teaching" just so that residency genesis can keep pace with greedy pod school enrollment and "everyone can get a residency." You don't see F&A ortho doing that; they generally have only the most dedicated, most interested, and well read attendings teaching in their fellowships. Come to think about it, you don't see any other (respected) medical profession doing that.

In the future, we will have a lot of well trained DPMs - both medically and surgically - and we really need to decide who the future teachers should be. Residency and fellowship teaching responsibilities should be reserved for the individuals who want to educate - not just those who want to build their practice volume, put "attending physician for residency X" on their website/CV, get their name out there, etc. PM&S directors should be able to pick the best and brightest attendings as the teachers of their residents, not be stuck sending them to scrub with whoever is on staff since CPME is rapidly increasing the program's total number of residents and they're trying to reach MAVs at any cost. I think it's absolutely to our benefit to have all grads (who pass boards) get 3yr post-grad training - esp since that's the req minimum for MDs and DOs. Right now, as you said, "anyone please open a residency" is the attitude, but it's a stop-gap and not the best long term answer... and I think we all know that.

I couldn't agree more.

On the PM news email yesterday there was an add looking for people to start programs since there are 12 students currently without a residency. There is a link to a website with a "residency starter kit". What are these people thinking?

 

[air bud]

Yeah, there is a link on the CPME website for the same thing. Also there was a big ad in the recent APMA mag. Although I was going to focus my efforts on finding an established program for a variety of reasons, you guys raising an interesting point. Why would you want to go to a new program. Who knows how good these attendings are. They may be great technicians, but we all know teaching is different. When McDonalds wants to open a new franchise, do they look for anyone? Nope, you have to have a million net worth and other stuff. They want people who want to be successful, and have already proven it. Now if you want to start your own envelope stuffing business from home, thats another thing...

 

[podpal]

Yeah, there is a link on the CPME website for the same thing. Also there was a big ad in the recent APMA mag. Although I was going to focus my efforts on finding an established program for a variety of reasons, you guys raising an interesting point. Why would you want to go to a new program. Who knows how good these attendings are. They may be great technicians, but we all know teaching is different. When McDonalds wants to open a new franchise, do they look for anyone? Nope, you have to have a million net worth and other stuff. They want people who want to be successful, and have already proven it. Now if you want to start your own envelope stuffing business from home, thats another thing...

How will any NEW programs ever open up? Shouldn't the students be trying to prove that they will be a good fit for a new program rather than vice versa? Those willing to open up new residency's should be commended, not criticized.

 

[air bud]

How will any NEW programs ever open up? Shouldn't the students be trying to prove that they will be a good fit for a new program rather than vice versa? Those willing to open up new residency's should be commended, not criticized.

I agree, students should be working harder. And I apologize if it came across that way. I don't mean to criticize those who would consider opening up a residency. I applaud somebody who wants to further educate others. But those risks are absolutely possible, and to ignore them would be wrong.

 

[Podfather]

Instead of saying there is a residency shortage, we should start to say there is a graduating DPM surplus. Perhaps this would put the looking glass back on the schools?

I believe every graduating DPM who passes the boards should be entitled to practice. If they do not obtain a residency something should be available to them for the transition year. However, even if we have exactly the number of residency positions as graduates there will be students who do not match because of poor planning for the interview process, personalty issues, or marginal skills. A good program with good residents will not risk bringing a person with personality issues or poor skills. That being said positions to graduates is a start and would limit those who do not match and would allow for residency position growth in a proactive rather than reactive approach.

 

[PADPM]

I'm not going to repeat most of the comments above that I'm already in agreement with, but I do find it interesting that there is NOW a campaign heavily advertising and seeking DPM's to consider creating a residency program for the present shortage.

However, there are some problems with this concept. First, and most important is the fact of this being just a little poorly timed. It almost seems to be an act of desperation that maybe should have been considered during the admission process or when they were approving a new school's accreditation. Maybe, just maybe they should have had these residency positions "lined up" when they were counting their admitted students or approving new schools.

And as Podfather will attest to, approving a new residency and/or getting a program off the ground and running AND approved does not take place overnight. Additionally, as has already been mentioned, you also hope that the Council considers the quality and background of those willing to start programs, and isn't looking to simply fill positions. In desperation, you don't want to compromise quality for quantity.

Although some grads may certainly not be flocking to a new unknown program with no track record, basically, beggars can't be choosers. A program with an unknown background may ultimately be better than no program at all.

But ultimately and ideally, this problem should never have existed. I don't believe there will ever be a time where all programs will provide equal training, since there will always be some programs stronger than others, but I do believe that every graduate deserves the ability to obtain post graduate training.

 

[dyk343]

I spoke personally with a spokesmen for the APMA the other day and my #1 main question was the residency shortage and what they are doing to fix it.

Of course he was a spokesman and will tell me only good things but he made it sound like the next couple years will be rocky but by the time the class of 2014 graduates the problem should be fixed.

Forgive me because im not familiar with the "language" yet, but the APMA spokesman said its easier to generate podiatric residencies than other professional residencies such as MD and DO. He said something about hospitals having a cap on the number of residents they are allowed to accept. Podiatric residents are not included in this cap and the APMA is actively approaching hospitals and educating them about bringing on more podiatric residents even if their cap has been hit (enticing them with more use of their surgical center/$$$ generated). He made it sound as if they were in the works of generating quite a few residencies at the present moment.

Maybe someone with more experience can clarify what I just said a little better.

 

[podpal]

I spoke personally with a member of the APMA the other day and my #1 main question was the residency shortage and what they are doing to fix it.

Of course he was a spokesman and will tell me only good things but he made it sound like the next couple years will be rocky but by the time the class of 2014 graduates the problem should be fixed.

Forgive me because im not familiar with the "language" yet, but the APMA spokesman said its easier to generate podiatric residencies than other professional residencies such as MD and DO. He said something about hospitals having a cap on the number of residents they are allowed to accept. Podiatric residents are not included in this cap and the APMA is actively approaching hospitals and educating them about bringing on more podiatric residents even if their cap has been hit (enticing them with more use of their surgical center/$$$ generated). He made it sound as if they were in the works of generating quite a few residencies at the present moment.

Maybe someone with more experience can clarify what I just said a little better.

It's true that DPM programs get full DGME Medicare funding while DO/MD programs may not. A big problem we've encountered is convincing the MD/DO group that it's worth their while to train a podiatrist in the non pod rotations.

For example, in my location, we have amazing surgical pods doing groundbreaking work, completely ready, willing, and able to direct a residency program. We have no location, no hospital willing, at this time, to support such a program. We have "pitched" to the hospitals how much $ they will make/resident but have been denied by 4 teaching hospitals in the past year. It's very frustrating, and very difficult to establish a "new" program. I'd LOVE to train with these guys, they are amazing. You guys would learn so much from them too. Perhaps after residency training I'll gain some leverage, ie bring surgical cases in, help them make $, and they'll be more receptive to starting a residency. We have a LOT of support of the podiatric medical community and NONE from the MD/DO community. IDK if this is a problem with starting up other programs; it's the only thing holding us back. 🙁

 

[Podfather]

It's true that DPM programs get full DGME Medicare funding while DO/MD programs may not. A big problem we've encountered is convincing the MD/DO group that it's worth their while to train a podiatrist in the non pod rotations.

For example, in my location, we have amazing surgical pods doing groundbreaking work, completely ready, willing, and able to direct a residency program. We have no location, no hospital willing, at this time, to support such a program. We have "pitched" to the hospitals how much $ they will make/resident but have been denied by 4 teaching hospitals in the past year. It's very frustrating, and very difficult to establish a "new" program. I'd LOVE to train with these guys, they are amazing. You guys would learn so much from them too. Perhaps after residency training I'll gain some leverage, ie bring surgical cases in, help them make $, and they'll be more receptive to starting a residency. We have a LOT of support of the podiatric medical community and NONE from the MD/DO community. IDK if this is a problem with starting up other programs; it's the only thing holding us back. 🙁

True podiatry and dental positions are not capped and can add to a hospitals resident pool. However, recently with the anticipated flood of new Patients in a few years from health care reform, Medicare is loosening the restricitions on primary care positions.

Hospitals are reluctant to add "new" programs of any type for financial reasons. Yes Medicare does reimburse a hospital but not until the program is approved. So say a hospital starts a podiatry program. They have to front all of the start up costs then the program gets provisional approval. They start a couple of residents but Medicare will not reimburse the hospital until it obtains complete approval (off of provisional). So a hospital with salaries, benefits, start up costs, directors salary, etc may be out several 100,000 dollars over the 2-3 years until this occurs and then be reimbursed. With the Medicare budget always in the news many hospitals do not like taking the risk especially if the DPM case volume is average. Even existing residencies adding new positions is an issue. Say a program with high surgical volume doubles their positions. Medicare does a three year rolling average on FTEs so for the first several years they actually take a loss. Yes 5-6 years out they should see a profit but that's a lifetime for a CFO and budgets.

It's not as much of a slam dunk as one would think financially.

 

[Podfather]

Also, because of recommendations made decades ago, Medicare only recognizes 2 years of postgraduate training for DPMs. Therefore, the third year of residency for Podiatrists is only reimbursed at half of the direct costs. Something that will hopefully will be corrected once all programs are 3 years in length.

As far as other financial considerations for a hospital. Many teaching hospitals use the MD/DO residents to provide coverage in clinics, the ER, and to cover in patients(ICU, night call). This either generates income for the hospital or lowers costs with not having to hire more attending staff. Unless there is a busy Podiatry clinic this is not often the case for Podiatry. I am not saying that the DPM residents do not rotate through services and help but they usually can not staff the general surgery clinic solo.

 

[podpal]

Also, because of recommendations made decades ago, Medicare only recognizes 2 years of postgraduate training for DPMs. Therefore, the third year of residency for Podiatrists is only reimbursed at half of the direct costs. Something that will hopefully will be corrected once all programs are 3 years in length.

As far as other financial considerations for a hospital. Many teaching hospitals use the MD/DO residents to provide coverage in clinics, the ER, and to cover in patients(ICU, night call). This either generates income for the hospital or lowers costs with not having to hire more attending staff. Unless there is a busy Podiatry clinic this is not often the case for Podiatry. I am not saying that the DPM residents do not rotate through services and help but they usually can not staff the general surgery clinic solo.

This is exactly the reason a podiatry residency program consideration was denied at a really great teaching hospital here. They chose to expand their current family medicine residency program, expand their OWN clinics, and did not have the room, time, or finances to get a pod residency going. BTW, this facility had over 30,000 podiatric encounters last year that were treated by their OWN family practice staff. They agreed that a pod clinic would SOLVE a problem yet are unwilling to implement it. When push came to shove they opted to expand and as I was told, "take care of our own" family medicine residents.

If there were some other structure, whereby pods could take care of pods and not have to beg the MD/DO community this could resolve the shortage. If a residency could be established from a podiatry practice location or surgical center with the focus on volume and breadth of surgical cases along with appropriate clinic experience, programs would be able to begin in locations with strong podiatry practices.

If the residencies were based out of a podiatry office/clinic, and the handful of NONpodiatric rotations were allowed to be outsourced to an Affiliated hospital there would be no shortages. Most hospitals are WILLING to AFFILIATE, but not SPONSOR the pod residents.

 

[Podfather]

This is exactly the reason a podiatry residency program consideration was denied at a really great teaching hospital here. They chose to expand their current family medicine residency program, expand their OWN clinics, and did not have the room, time, or finances to get a pod residency going. BTW, this facility had over 30,000 podiatric encounters last year that were treated by their OWN family practice staff. They agreed that a pod clinic would SOLVE a problem yet are unwilling to implement it. When push came to shove they opted to expand and as I was told, "take care of our own" family medicine residents.

If there were some other structure, whereby pods could take care of pods and not have to beg the MD/DO community this could resolve the shortage. If a residency could be established from a podiatry practice location or surgical center with the focus on volume and breadth of surgical cases along with appropriate clinic experience, programs would be able to begin in locations with strong podiatry practices.

If the residencies were based out of a podiatry office/clinic, and the handful of NONpodiatric rotations were allowed to be outsourced to an Affiliated hospital there would be no shortages. Most hospitals are WILLING to AFFILIATE, but not SPONSOR the pod residents.

The majority of approved residencies enjoy incredible support of the MD/DO faculty. I could not educate our residents without their unpaid support.

Residencies belong in a hospital period. Yes cases and clinical experience in surgery centers and offices are essential but is actually a small part of what today's residencies need or do. Basing them out of offices makes no sense from any aspect of education including financially. That would be a huge step back. What's next preceptorships? Ugh!

Rather than taking a step back, I will state again: Great residencies and limit the acceptance to that number. More quality residencies will come about as our residency grads mature and then we can increase entry positions.

 

[podpal]

The majority of approved residencies enjoy incredible support of the MD/DO faculty. I could not educate our residents without their unpaid support.

Residencies belong in a hospital period. Yes cases and clinical experience in surgery centers and offices are essential but is actually a small part of what today's residencies need or do. Basing them out of offices makes no sense from any aspect of education including financially. That would be a huge step back. What's next preceptorships? Ugh!

Rather than taking a step back, I will state again: Great residencies and limit the acceptance to that number. More quality residencies will come about as our residency grads mature and then we can increase entry positions.

The problem is that the entry positions have already been expanded.

I'm not suggesting preceptorships or going to 1 year positions. An example of outsourced affiliated rotations is: There already exist podiatry residency programs where the resident performs the vast majority of their rotations at affiliated institutions, not the sponsoring institution. I personally know of someone who spent only 3 months out of 12 at the sponsoring facility. He did general surgery, internal medicine, and most other "core" rotations at an affiliated hospital. This "model" already exisits. An affiliated facility may have terrific MD instructors and be a most valuable rotation. Simply because a hospital sponsors a program doesn't mean they are better at training than an affiliated facility.

My suggestion was to allow a podiatry practice with qualified pods to begin a residency program and Affiliate one or several Hospitals for "core" rotations. The only drawback is funding with this model. If the schools are willing to assist with funding for the new grads they are generating this type of model could be developed. BTW, ALL 4 of the teaching hospitals we approached were willing to affiliate, but not sponsor a program. The rotations for general surgery, internal medicine, behavioral science, etc. would be exactly the same as if they sponsored the program. The only change would be the financial "shift" from the institution to the individual podiatry practitioners.

 

[Podfather]

The problem is that the entry positions have already been expanded.

I'm not suggesting preceptorships or going to 1 year positions. An example of outsourced affiliated rotations is: There already exist podiatry residency programs where the resident performs the vast majority of their rotations at affiliated institutions, not the sponsoring institution. I personally know of someone who spent only 3 months out of 12 at the sponsoring facility. He did general surgery, internal medicine, and most other "core" rotations at an affiliated hospital. This "model" already exisits. An affiliated facility may have terrific MD instructors and be a most valuable rotation. Simply because a hospital sponsors a program doesn't mean they are better at training than an affiliated facility.

My suggestion was to allow a podiatry practice with qualified pods to begin a residency program and Affiliate one or several Hospitals for "core" rotations. The only drawback is funding with this model. If the schools are willing to assist with funding for the new grads they are generating this type of model could be developed. BTW, ALL 4 of the teaching hospitals we approached were willing to affiliate, but not sponsor a program. The rotations for general surgery, internal medicine, behavioral science, etc. would be exactly the same as if they sponsored the program. The only change would be the financial "shift" from the institution to the individual podiatry practitioners.

Accrediting issues aside this is simply a step back. Your idea is OK if it is reversed. Practices affiliate with the hospital. (this is done now) And, the hospital is training the residents when they "affiliate" with another facility. The residents time at the affiliate is the same as if they are actually in the hospital. The hospital determines what it's program needs to satisfy accrediting guidelines, volume, and education and affiliates accordingly.

I hope you reach your goal of obtaining a residency. You will be surprised how much residencies have changed (for the better) since you first graduated. I have seen some who enter residencies after prolonged practice time shocked as to what is required in today's educational models. The same is true with a senior attending who has not been involved in residency training and returns to it. The we have a big practice with lot's of cases isn't enough anymore. In a typical 3 year model less than 2 years is surgical time. And many senior DPMs are shocked that a resident is missing a bunion to do a Psych rotation.

 

[PADPM]

I find this thread particularly interesting, especially since the training of residents has significantly improved. Quite a few years ago, a group that was actually owned by a hospital decided to open a group of several surgical centers throughout my geographic area.

The higher ups were pretty business savvy and actually offered me a nice incentive to start a podiatric residency to have a podiatric resident rotate through the surgical centers and receive his/her core rotations at one of their main hospital facilities.

Their offer was not altruistic. They saw what they believed was a great opportunity. They believed that if they had a podiatric resident, they would attract a lot of DPM's to their surgical centers to fill the O.R.'s and of course make them money.

I said I would think about the idea provisionally, and actually set up the proper rotations at the hospital, etc., and they allowed a young doc we had "preceptoring" with our group to act as a temporary resident to assist with any DPM's performing cases.

Well, it ended up that I was the only guy doing cases regularly, and although I do a fair number of cases, NO resident is going to get adequate training from one attending, even if I fulfilled the numbers.

So I opted out. However, at the time there were residencies that WERE surgical center based.

Hopefully, as per Podfather, we've moved past that and we won't be looking back.

 

[UNVME2]

The school may have said you are "minimally competent." That doesnt mean a residency thinks so.

I agree, but you're commenting on a different premise. If there were a surplus of residency positions for these students to scramble to because the applicants didn't fit a program's criteria, fine. But at least you have a chance at matching to a scrambled program. But with the current situation, after the scramble there is a net shortage of positions so those who scramble don't even have places to scramble to. Point being, there could be very competent people not matching and not because they are bad students, but because there aren't spots.

...Shouldn't the students be trying to prove that they will be a good fit for a new program rather than vice versa?

They do, but again if programs aren't feeling you as a student at least in the past during the scramble there were enough excess spots for all the students in the scramble. If you didn't match in that case, yes then it's on you, but that's not the reality today.

Those willing to open up new residency's should be commended, not criticized.

If this was directed at me, I was NOT criticizing those trying to open positions, I was criticizing their blatant denial of the problem and refusal to act immediately. Creating positions is great in the longrun IF WE LIMIT OUR ENROLLMENT! We're putting a band aid on a leaky dam people, and this Gregg guy is not only missing the point but just being downright dishonest by stating school's enrollment isn't the problem. We know the quickest way to solve this problem is to limit enrollment until we can educate all these students post graduation.

The fact is that creating more spots is great in the longrun, but ignores the immediate "crisis" as we know it takes a long time to get these programs up and running. If you can't acknowledge the problem, you're not going to get a solution. Unfortunately they care more about the financial interest of the schools than the financial and professional interest of the butts that fill the seats.

Gross.

 

[pod2021]

its all politics

 

[347932]

This is my first post on this forum, but I've been following this topic nationwide for some time now.

A little background on me. I graduated from the 1st Temple Unviersity graduating class way back when and did three years of residency. The first year I was unmatched and landed a PPMR residency (do you all know what that is anymore?), then worked very hard and reinterviewed and scored a 2 year advanced level Surgical Residency. The issues every one is rightfully discussing has been around for ages. First it was the complete lack of surgical residencies. Then it was the major shortage of surgical residencies. Then it was the expanding years in residency. Then it was "did you get a one year, two year or three year residency?". The story continues.

I've since been very involved with the APMA and the schools and many of the politics involved with our profession.

The APMA's vision 2015 revolves around achieving parity in training to match our allopathic colleagues and to stim some of the criticisms regarding our competency as practioners, and the confusion surrounding what our training encompasses.

There is a major push by the CPME and COTH to expand the number of residency positions available to new graduates, but this is a difficult task to achieve. Starting a residency from ground up is a daunting task. Many residencies were closed because they did not comly with CPME standards anymore or refused to comply with the upcoming standards that were proposed. This was the case with the residency I did, which is no longer in existance, even though I performed about 2000 procedures in my 2 years there. They just didn't want the compliance headache, so they closed.

The schools can't really tell you whether you will get a residency or not. If they promise you will get training, then they are lying to you and you need to do some more research. Even if there are enough residnecy programs NOW, that may not be the case in four years when you graduate for a huge variety of reasons that can't be anticipated, the least of which is that a Residency Director burns out and there is no one to take his or her place.

I would like everyone to take heart. If you work hard, do your due diligence concerning residency programs, visit and apply to as many as you can afford (not five), things will work out for you. I've been there. Yes, its very stressful, but I would not change the road I traveled at all.

Good luck to all.

 

[footpodguy]

Have not been here for a while...still a shortage?

From the people that I have talked to via phone, there was still a shortage of slots & some students did not get placed. I did not even try , since I graduated a while ago. Also been a while since I talked to these people.

I have talked to:
AACPM
Podiatry schoool
And the organization on starting new programs.

Since some of you wanted to know where I got my info...there you go. Those are my sources. Maybe I should have mentioned them earlier, to see if you got the same info. It seems only a small amount of people knew where to go. No I have not kept on on all these posts.