Don't be too scared about the "residency shortage"

[hightower]

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Who knows, maybe this has been mentioned before on these boards (it just does not stick out to me and I frequent these forums fairly regularly) but I would like to address one issue of the so called "residency shortage". I learned from one of our school's APMA student reps. that although there are technically not enough residency spots for all students who are graduating, you do not have too much to worry about and this is why: There are always a certain number of graduating students (maybe between 20-30?) who have not passed either part I, part II or both parts of the NBPME. I can't give you exact numbers off the top of my head (maybe someone on here can) but when you throw out those students that do not qualify for a residency the actual number of qualified students who will not get a residency is very few, I want to say less than ten but I am just throwing that number out there. The bottom line is that you should really not be too worried if you are a hard working student and can study hard and pass part I and II of the NBPME exam and stay away from the bottom tier of your class. Yes, everyone who qualifies for a residency should get one and hopefully that can be worked out in the very near future.

 

[Careersearcher]

so does that mean that people who do not pass teh first time boards step 1 or 2 can never have residencies, will it feel like now i just wasted 2 yrs at pod school and since i did not pass the first time i have nowhere to turn (some people do not really "backup" talents after spending two years in school). Does that mean that bottom classmates never get residencies either?

There are people in medical school who do not pass boards the 1st time but they can residencies but limited and they compete with student from abroad and Caribbean schools.

 

[hightower]

No, you can take the boards at least a second time, maybe more (I am really not the best source for every detail) but there are those who still do not pass the second time, etc. I think there may be some residencies that will take you without having passed both part I and II but I mean the boards are there to make sure you are a competant physician so I think you eventually are going to have to pass them at some point. Maybe someone can pipe in and say exactly how everything works, but my main point for the original post was to give hope and dispell the fear of some huge residency shortage.

 

[Brodiatrist]

This has been discussed before, look http://forums.studentdoctor.net/showthread.php?p=8899779#post8899779. These numbers they quote are for the c/o 2010 and I've already laid out why there is reason to be concerned, especially for your class. Anyone who tells you not to be concerned, especially a school rep, is just deceitful. They have no control over the residency issue and really only care about damage control and securing funds. After you graduate, you're not their concern, nor are your residency woes. With the new school graduating more students, and current schools upping their student load 10-15 students/year, don't count on new residencies or other students failing to secure you a spot. In short, this is just going to get worse for the following classes because class sizes are increasing far beyond residency genesis. This year it may be a shortage of 20-30 spots, but the following year it will be worse, etc. Nobody likes to hear this, and believe me, none more so than those of us graduating, but it is the reality. To downplay the issue is to ignore your future , and that's exactly how we got here in the first place. Students have a voice, and I encourage everyone to use it. It's the only way to get legislation in order so that every minimally competent student has a residency, which is currently not the case.

 

[hightower]

The intent of my post was in no way to say that no problem exists or to have people just sit on their feet. I agree that everything that can be done needs to be done to make sure all qualified students have a residency. On the other hand I think we need to avoid a fatalist attitude about the situation and have some confidence that things will work out. We don't want to scare the applicant pool away from podiatry. If a large residency shortage develops that will hurt the schools directly and the goals of 2015. It would be very hard to attract a higher number of quality applicants to schools and to the profession if their training leads to a dead end. Also I think to say that schools don't care about you once you graduate is untrue. The schools pride themselves in placing students in quality residency programs (at least mine does). And it is in the schools best interest to make sure their students succeed after graduation and to make sure all their students can obtain a residency. The profession at large also has an invested interest in making sure that graduating students can succeed. To this end I am confident that the people tied to the profession (schools, faculty, podiatric organizations, students, etc) will work hard to make sure it will be resolved. I agree that we need to voice our opinion and get involved but I am optimistic that things will work out.

 

[Brodiatrist]

I understand the purpose of your post. Please know the same damage control measures used by admissions some time ago are the same they are using today. They told us (when the shortage was projected, not a reality) not to worry, don't deter applicants, there will be no shortage. Well now there is, and I hate to see the same song and dance peddled to incoming students because it's not like this shortage is not a reality. It is, and will get worse for you as it did for us should we not get involved and hold the schools responsible. You have reason for concern and don't think things will magically resolve because it's not. Again, we were peddled the SAME lines and schools continued to increase enrollment, open new schools, etc with no concern for the students post graduate education. Don't be fooled into thinking the same administrators who let this happen will suddenly resolve things. Schools cannot directly create positions, nor can they promise you one. You are not their responsibility after graduation and while they may help you scramble, that's about it.

 

[diabeticfootdr]

There are always a certain number of graduating students (maybe between 20-30?) who have not passed either part I, part II or both parts of the NBPME.

It's not that simple. Some schools will not graduate students who have not passed the boards. Other schools will. And just because you don't pass Part I or II, doesn't mean you are ineligible for a residency. We had a co-resident at my residency who graduated from NYCPM without passing Part II and was placed in our program. The director did not know until about 6 months into the program that the resident hadn't passed. He falsely assumed 2 things. 1. That NYCPM wouldn't graduate a student who hadn't passed the boards, and 2. NYS wouldn't give a resident license to a DPM who hadn't passed the boards. Both were incorrect.

There will be a real shortage that will get larger over the next few years. The main issue with this shortage is that most states now require you to have post graduate training to get a license to practice (hence, make any money). In the past, there were 1 year programs available. No longer. Now you have to do 2 or 3 years (soon to be only 3). If you don't get a residency, you have to waste a year of your life and reapply to match since you can't practice or earn any money related to what you've spent the last 8 years learning. When the unmatched people reapply to the next years match, it will further increase the applicant pool, making an even greater shortage. That will compound on itself. If you don't get a residency, you can't practice, and you can't pay off your loans. Will schools forgive your loans since they irresponsibly accepted too many students? I bet not.

 

[MaseratiGT]

On the other hand I think we need to avoid a fatalist attitude about the situation and have some confidence that things will work out. We don't want to scare the applicant pool away from podiatry. If a large residency shortage develops that will hurt the schools directly and the goals of 2015. It would be very hard to attract a higher number of quality applicants to schools and to the profession if their training leads to a dead end.

If students are scared away from podiatry because of the very real residency shortage, it's not because of what other students have said on SDN. It's the fault of the many facets within the profession, none of which are the fault of current students. I 100% understand student concerns. More students are graduating each year, with another class in 2013.

I understand the dynamics of getting more residency spots...but why are we accepting people until our schools explode at the seams? (I do know the answer to this...)

 

[MaseratiGT]

I can't give you exact numbers off the top of my head (maybe someone on here can) but when you throw out those students that do not qualify for a residency the actual number of qualified students who will not get a residency is very few, I want to say less than ten but I am just throwing that number out there. .

10 is not the number that the Ad Hoc Committee for this issue sent to all students in October. It was 35 for '10. It doesn't seem like much, but those students will spill into '11, who probably have a larger class size, leaving even more to spill into '12.

I just hope that this issue can be resolved quickly, before the number of DNR graduates goes well over the number of residencies that can be generated within some given time period. We need to have a collaborated effort from ALL leadership involved to remedy the situation.

Disclaimer: If you are a hard working student, with decent grades and good work ethic in the clinic, you're probably going to get a residency. You just probably don't want to rank on the lower side of the spectrum for those attributes.

 

[jonwill]

This is nothing new. This happened back in the 90's and it totally tanked enrollment. As students involved in the APMSA, a lot of us saw this coming and spoke ad nauseum to the CPME and APMA 5-6 years ago, both of whom told us that they were "watching it closely". However, enrollment continued increasing and new schools continued opening. We now find ourselves in the current predicament.

I guess what I'm saying is that all the things that these two entities are now telling you don't hold a whole lot of weight in my book. I know that they are asking some residencies with very high numbers to take more residents and they are attempting to create new programs which is easier said than done.

I do sympathize with them in that it is difficult to correlate the number of residency slots with graduates as the number does constantly change from year to year. I personally think that they should solve the problem by creating 30-40 one year residencies (similar to MD/DO transitional years) at hospitals across the country that didn't have the numbers for the PM&S models. This would give those that didn't land residencies (presumably some of the weaker students) another year of experience, another year to improve, a paycheck, and a chance to re-enter the next years match. As graduate rates are constantly flucuating, it would eventually even out.

I hope it works out. I'd hate to see another year of 450 applicants nationwide.

 

[diabeticfootdr]

I personally think that they should solve the problem by creating 30-40 one year residencies (similar to MD/DO transitional years) at hospitals across the country that didn't have the numbers for the PM&S models. This would give those that didn't land residencies (presumably some of the weaker students) another year of experience, another year to improve, a paycheck, and a chance to re-enter the next years match. As graduate rates are constantly flucuating, it would eventually even out.

That is a real good idea.

 

[hightower]

Thanks for all the responses. I definitely am not educated too much on the subject and I didn't mean to come on here acting like I know a lot about it or claiming to have all (or any) of the answers. I must have missed a lot of the discussion on this subject even though I have been a fairly regular observer of the forum for the last few years. Anyway, a AMPA student liaison at our school passed on some info from a meeting and it sounded like there was not too much to be concerned about. I was trying to pass on that optimism. Maybe the info was directed more toward the class of 2010. From the comments here it sounds like there are some big problems that need to be worked out.

Just a few questions, do DO and MD graduates face any sort of similar residency shortage when new medical schools open? Since the respective number of students in those programs is greater than podiatry it seems an even larger shortage could potentially occur. How do they avoid this and could a similar model be applied to podiatric residencies? Maybe primary care residencies are much easier to set up than podiatric residencies?

 

[Careersearcher]

you may want to actually read up on sdn and actual article it sounds like in four years and i quote i think was someone in the medical forum on sdn it will be a "blood bath". Because they compete against foreign and caribbean students. do podiatry students compete against foreign students. I looked up the pdf file of the residency matching site this match year there were like 22,--- some odd spots and there were (i think of the exact number ) 28,---some odd poeple applying so you can only think what will happen if class keep increasing. PLEASE someone correct me if i am wrong or if read the pdf file wrong. so it sounds like there will be problem in four years. I don't think the new bill adds spots but reallocates them (again correct me if i am wrong).

I just hope the liasons or the school directors aren't making the look picture pretty so they can attract students.

I just have a question or more of a scenario, with more medical (DO and MD) schools opening if there were students who were using podiatry school as back up would not use podiatry as a back hence decrease applications and enrollment in the future is that possible or are we seeing increase in application? This is important questions for me because i am looking to apply in this coming cycle or the one after that.

 

[whiskers]

Wrong, you should be worried about the residency shortage. You have no idea where you will end up in Podiatry.

Don't go in blind and undestand the consequences of every aspect because it can be a big loss if you don't get a residency.

But then again, people always think that they are more special than the next guy and it won't happen to them...

 

[spo01]

The threat of a residency shortage was the main reason I applied to start in 2008 (class of 2012). When I found out Western Universitys first graduating class would be 2013 I didn't want to compete with them. If anyone can explain why Dr. Harkliss opened up this program amidst a residency shortage I'd appreciate it because I sure don't understand why. I've heard "he's going to open up and create new residency programs" but I just don't buy it... atleast I don't buy that it's going to be enough to balance the amount of new grads the school will be graduating.

On another note I don't feel too worried about the residency problem. However, I would be much more concerned if I was at the bottom of my class or if my grades were bad. Like anything in life, I feel it's a risk, and it may sound stupid but I put a lot of "faith" in podiatry that my hard work in school will pay off. 10 years ago I wouldn't have said this by no means, but I honestly believe things have changed for the better. Yeah yeah there's no guarantee in life, save it. I'm speaking in generalities here. I just don't see how podiatry could dwindle down hill and be back to where it was in the earlier days. Specialization is needed more than ever. Doctors these days are becoming the trick of all trades and master of none and the government (and society) expects them to do and know everything. On top of that they tell you what tests you can and can't do and then wonder why malpractice soars through the roof.

Do this: google a 3 year podiatric residency curriculum and compare it side by side to a 5 year Orthopoedic residency curriculum. In the latter you'll see they only spend about 3 months solely dedicated to the foot and ankle. 3 MONTHS (granted there is some overlap with the rotations but still). Even if they do a fellowship that is only 1 year and 3 months on the foot and ankle, compared to a podiatrists 3 YEARS (and possibly 4 years with fellowship). My point of all this rambling is if you imagine some random person from the general public looking for someone to fix their foot pain or do a surgery for them, which do you think someone is going to choose? Someone who spent 3 months or 3 years on the foot and ankle? And sure many don't know about our training but I can't help but believe word will spread and the general public will become informed as long as we graduate well trained podiatrists.

 

[PoddyMan]

The threat of a residency shortage was the main reason I applied to start in 2008 (class of 2012). When I found out Western Universitys first graduating class would be 2013 I didn't want to compete with them. If anyone can explain why Dr. Harkliss opened up this program amidst a residency shortage I'd appreciate it because I sure don't understand why. I've heard "he's going to open up and create new residency programs" but I just don't buy it... atleast I don't buy that it's going to be enough to balance the amount of new grads the school will be graduating.

I recently posted the following comments in another thread that address your concerns:

...data has shown that there is a great need for podiatric care in southern CA. That is why WesternU was created. And its creation has enabled its top administrators, who are and/or have been directly involved in creating major residency programs, to "commit" matriculating students to hospitals for externships and, therefore, residency programs. (Hospitals expect commitments and the "guaranteed" potential for income generation.

A major goal of WUCPM's administration since day 1 is to improve the residency shortage situation. WUCPM has been actively creating residency programs while setting up externships. Its goal is to create (at least) as many residency slots as the number of students it graduates. Graduates will still have the opportunity to apply anywhere, but at least the number of slots should increase proportionally, thus not generating any additional burden and possibly improving the situation.

I believe that they are nearly halfway there.

...the existing schools should create spots for THEIR students (which is what WesternU is doing). The shortage existed prior to WesternU, and was predicted long ago (probably even prior to AZpod). They all expected someone else (APMA) to be responsible. And, the only thing that some other schools have done is "cut enrollment" (which we won't know is true until the Class of 2014 numbers are announced next August).

Cutting enrollment is not "short term"; that will only work for the graduates in 2014! The best short term solution is to create programs NOW! The APMA (CPME) has provided the opportunity for that to happen.

It is obviously easier to cut enrollment than to create new residency slots (though some of the schools may have financial difficulty by doing this). Given the data on the shortage of DPMs in the near future (http://forums.studentdoctor.net/showthread.php?p=8523870#post8523870) and the increasing number of patients that will need foot care, it would behoove the schools to put the extra effort into creating more residency positions and keeping the existing student enrollment. This requires a lot of work and persistence, and WesternU is serving as an innovator in this arena.

 

[PADPM]

Obviously, the schools are tuition driven, therefore have a conflict of interest. Although it certainly will add to the school's status and credibility if they can quote a higher residency placement than a competing school, on the other hand the more students they enroll, the more dollars they earn.

It's really the APMA and CPME that are to blame, not the schools. The schools don't create the rules or create residency positions. Dr. Harkless is extremely well respected and has done a lot for our profession. However, was there REALLY a need for another school? Was there REALLY a need for a school in Arizona?

Instead of the APMA and CPME approving these schools, which basically diluted the applicant pool to the other schools and also added more slots, these organizations should have put their joint efforts into creating enough QUALITY residency positions for all graduates.

Additionally, this would allow acceptance standards to be tightened up so that all students were capable of passing the boards I and II.

Lately the APMA has been advertising and campaigning for doctors interested in creating residency programs. But as a doc that has been through this process, I can attest to the fact that it's a long and laborious process and then the program has to become "approved".

In the interim, jonwill has an excellent idea.

Opening the new schools was purposeless. The doctor's involved could have used their knowledge, skills and talent to improve existing schools while at the same time not diluting the present situation.

 

[toe]

Although the information regarding this matter is quite sparse, the University of Alberta is apparently matriculating it's first DPM class in 2012, so this is just going to add an additional 30 students attempting to attain a residency spot. There are currently no residency programs in Canada (except for the 2-year program at Vancouver General Hospital, which I don't think even exists any longer). Hopefully some program will open up in Canadian hospitals.

 

[Careersearcher]

PADPM
what do you mean diluted the pool can you explain that?
as for the qualified applicants, what do you consider qualified? right now its 3.2 overall with 3.1 science gpa average , I know this sounds low but that is current one and the western lady predicted this will go up.

you said that adding new school is not a good idea, does that mean that most podatrist don't believe in the shortage of podiatrist that is being predicted and it says that school need to be graduating three times as many students as they are currently are to meet the supply. do you think this is being overstated?
I am assuming creating quality residencies requires more money, would creating high quality residencies require more money hence instead of opening new residencies they put money into creating quality, and that could create scare of residencies.

 

[PADPM]

When I state dilute the pool, it may have been a poor choice of words. What I was referring to was the fact that the schools have a specific number of seats they want to fill for budgetary reasons. If there are X number of applicants and there are more schools popping up, the applicant pool is being diluted and some schools may begin to lower standards to fill open positions in order to be able to keep their doors open. Tuition drives the budget.

In addition to the GPA, maybe the schools should also increase the average MCAT score per applicant. GPA scores can be extremely variable depending upon the undergraduate school attended. A student can graduate from a small local college that does not have the highest standards with a 3.1, and another student can graduate a top tier or Ivy League school with a 3.1 and there's a world of difference. MCAT scores in my opinion level out the playing field with some form of standardization.

I won't even argue this point, because I've been exposed to kids that have graduated some colleges with low acceptance standards and some of their science courses were not exactly challenging. And I've met kids that graduated top schools and these kids were brilliant and struggled through the same courses at their respective schools. There IS a difference. That's why top schools have the reputation they have earned and are difficult to get into.

I personally believe that the DPM shortage has been considerably over emphasized, though it may be present in the future.

Creating residencies is really not a costly venture, it is a time consuming and tedious venture since there are a lot of requirements, there is a lot of paperwork and a huge time committment on the part of a new residency director. You also need the cooperation of the hospital and other local DPM's to drive and support the program.

 

[hightower]

Creating residencies is really not a costly venture, it is a time consuming and tedious venture since there are a lot of requirements, there is a lot of paperwork and a huge time committment on the part of a new residency director.

Where is the money coming from to pay the residency director and attending physicians? I understand the director and attending have their own offices and patients but I know they receive an additional chunk of change for being a director/attending. Does it come solely from the money they bring in from seeing patients and performing surgery at the respective hospital/clinic etc? Or is there additional money being funneled in from other sources?

 

[PADPM]

Some residency directors collect a stipend, some do not. Where did you ever get the idea that attendings get paid for performing surgery by the hospital or by the residency program?

You said you "know" they receive a "chunk of change". Apparently your source of information is inaccurate.

Hospitals do receive funding to support residency programs and that's how the hospital pays the residents. That's often why hospitals are amenable to support podiatric residency programs. They are paid X amount of dollars per resident per year.

Remuneration for a residency director is not a given and the source of that money can differ depending upon the program. As a residency director, I never took ONE PENNEY.

Attendings do not get "paid" by the residency or hospital to perform cases and do not receive a kickback. That's called illegal.

The only time an attending gets paid by the hospital is if they are employed by the hospital. As a matter of fact, I am on staff at several hospitals and actually have to pay annual or biannual DUES to the hospital to maintain those privileges. Yes I PAY the hospital "staff" dues which are usually several hundred dollars.

The only reimbursement I receive, and the attendings I know receive for performing surgery, admitting patients or treating patients in the hospital are the reimbursements from the insurance carriers we privately bill from our OWN offices.

In the 20+ years I've seen and treated patients from the emergency room, I've probably only been paid once or twice, since the majority of those patients are urban patients with no insurance and major trauma. But those cases were amazing learning experiences for the residents and for me.

So sorry to blow this urban legend, but the attendings aren't getting rich from residency programs or getting paid by hospitals to perform surgery. And although some residency directors may be collecting a "stipend", it's usually not a very significant number and NOT directly related to the number of cases performed. I believe incentive based earnings like that are not legal.

Profit sharing is OK if you are the owner or partial owner of a surgical center, but once again the profits are split based on shares owned, not how many cases one particular surgeon performs.

That's all controlled by the Stark Laws.

 

[diabeticfootdr]

Where is the money coming from to pay the residency director and attending physicians? I understand the director and attending have their own offices and patients but I know they receive an additional chunk of change for being a director/attending. Does it come solely from the money they bring in from seeing patients and performing surgery at the respective hospital/clinic etc? Or is there additional money being funneled in from other sources?

Most residency directors I know get a stipend of $35-50k per year. One got a stipend of $150k to be the residency director and chair of the department. This was in addition to his private collections.

Some attendings get paid to be faculty, but usually small stipends, like a few thousand dollars per year. Others got paid to do cases, but only if they were cases of patients with no insurance.

Residency programs get funding from Medicare (called GME funding). They get a set amount of dollars per resident depending on what percent of the health systems patients are Medicare patients. The range is $90-120k per year per resident. It is not much profit, however. If a resident makes $45k per year, there is 28% fringe, so $60k per year. That leaves $30k per year for program administration, assistant, residency director, etc. The hospital also receives IME funding, which is kind of a little extra percentage reimbursement of the Medicare patients since they are in a "teaching hospital".