Questions for Podiatry's Leaders

[diabeticfootdr]

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Ok, here are the ground rules for this thread. If you have real questions and can be polite, I will attempt to answer for anything that I have direct knowledge or control over (i.e. ABPM or other committees I serve on). If I don't know the answer, or if I'm not the best person to answer, I will email the appropriate leader and post their reply.

There will be no disrespect in this thread.

 

[DYK343]

Thank you for starting the thread. I promise to not go off topic or be disrespectful.

My main burning concern for podiatry is the upcoming residency shortage that I see coming after starting two new schools.

What is or will be done to generate slots for such a massive increase in graduates?

 

[diabeticfootdr]

OK but as president of the APMA I have some questions for you:

1) What is being done to prevent a residency shortage in 4 years?
2) What can be done to prevent oversaturation with 2 new schools opening up?
3) What can be done to help our young graduates obtain quality jobs upon graduation?

Were looking out for younger generations on here you just dont see it.
I know for a fact were triggering discussions at APMA delegates meetings.
Hopefully the above are being worked on by APMA. When western opened APMA/AACPM looked absolutely foolish. They had 4 years and did almost nothing.

1. What is the Profession Doing to Prevent Residency Shortage?
Firstly, there is no shortage currently, there is a surplus. As you noted, 4 years from now there will be 80ish more people in the match for residency programs. But the matriculants at the 9 other schools is also reducing, albeit, not by 80. So, in TX, TPMA is working closely with UTRGV to increase spots because Texans want to stay in Texas. UTHSCSA has applied to for a compliment increase from 3/year to 5/year starting 2023. UTSW is going to start a program, probably 2 per year to begin with. TPMA is looking at all academic medical centers to help recruit podiatrists who can be residency directors and keep our residents in the state and welcome them when they decide to practice here.

I will reach out to CPME and APMA to ask them if they have a national strategy to prevent a shortage and I will post their answers and who answered. More on that to come.

2. Is There Oversaturation of Podiatrists and What Can We Do to Prevent It?
I need to understand where there is oversaturation. Because the profession doesn't believe there is oversaturation. The need for foot and ankle care is only increasing, based on population, age, and diabetes prevalence. The numbers of podiatrists has not kept up with the projected need.

Is this a geographical thing?

For example, everywhere I've practiced I've never had a shortage of patients. When I moved to San Antonio, there were 1200 patients with diabetic foot problems on the waiting list to be seen. I'm literally booked for months.

Maybe because I'm in South Texas. Maybe because I'm at a university. Maybe because I'm "hospital-employed" (I'm really a university employee).

I can imagine you try to open a practice in Manhattan, or South Florida, or Chicago, perhaps there is a lot of competition for general podiatry.

Maybe this question is really is about not being enough "good, hospital-jobs" in certain markets.

If you're geographically locked into an area, you might have to compromise for a while. If you're willing to relocate anywhere, there is no saturation of podiatrists.

I'll address how to find hospital jobs in another thread.

3. What Can Be Done to Help Young Graduates Obtain Quality Jobs Upon Graduation?
This is a good question. I have some ideas, but not approved by ABPM or APMA yet. The profession has not previously had an organized approach to this. It has been left to mentoring and networking.

What are your ideas?

I'll ask one of the BOT at APMA and post their reply.

I believe I’ve respectfully asked you at least 3 times in separate threads on questions an elected president of a governing board can answer. That way, I can learn all I can. And then from there, I can improve the future generation of students’ lives with my knowledge and skills based on your answers. And ultimately, leave podiatry better than its current state because I can say the president of APMA addressed my and DYK’s questions that concerns the profession as a whole. Thank you.

Please repost here if I didn't address above.

 

[deleted285117]

Great thread!

 

[DYK343]

1. What is the Profession Doing to Prevent Residency Shortage?
Firstly, there is no shortage currently, there is a surplus. As you noted, 4 years from now there will be 80ish more people in the match for residency programs. But the matriculants at the 9 other schools is also reducing, albeit, not by 80. So, in TX, TPMA is working closely with UTRGV to increase spots because Texans want to stay in Texas. UTHSCSA has applied to for a compliment increase from 3/year to 5/year starting 2023. UTSW is going to start a program, probably 2 per year to begin with. TPMA is looking at all academic medical centers to help recruit podiatrists who can be residency directors and keep our residents in the state and welcome them when they decide to practice here.

I will reach out to CPME and APMA to ask them if they have a national strategy to prevent a shortage and I will post their answers and who answered. More on that to come.

2. Is There Oversaturation of Podiatrists and What Can We Do to Prevent It?
I need to understand where there is oversaturation. Because the profession doesn't believe there is oversaturation. The need for foot and ankle care is only increasing, based on population, age, and diabetes prevalence. The numbers of podiatrists has not kept up with the projected need.

Is this a geographical thing?

For example, everywhere I've practiced I've never had a shortage of patients. When I moved to San Antonio, there were 1200 patients with diabetic foot problems on the waiting list to be seen. I'm literally booked for months.

Maybe because I'm in South Texas. Maybe because I'm at a university. Maybe because I'm "hospital-employed" (I'm really a university employee).

I can imagine you try to open a practice in Manhattan, or South Florida, or Chicago, perhaps there is a lot of competition for general podiatry.

Maybe this question is really is about not being enough "good, hospital-jobs" in certain markets.

If you're geographically locked into an area, you might have to compromise for a while. If you're willing to relocate anywhere, there is no saturation of podiatrists.

I'll address how to find hospital jobs in another thread.

3. What Can Be Done to Help Young Graduates Obtain Quality Jobs Upon Graduation?
This is a good question. I have some ideas, but not approved by ABPM or APMA yet. The profession has not previously had an organized approach to this. It has been left to mentoring and networking.

What are your ideas?

I'll ask one of the BOT at APMA and post their reply.



Please repost here if I didn't address above.

Thank you for the response
1) is LECOM and UTRGV only accepting 80 students? I understand you are working in texas to generate programs but is LECOM doing the same? Texas has a handful of DPM residencies that take students every year that now presumably will be filling with UTRGV grads. So this puts pressure on the rest of the states to generate more residency positions. I appreciate and look forward to the APMA's response.

Number 2 and 3 are very closely linked. I see saturation directly related to poorly paying jobs for our graduates. Too many graduates are faced with 80-150k a year jobs with a doctoral degree, 7 years of hard work, and 300k debt. There simply are not good jobs for everyone. Supply and demand. If there was demand they would be paid more. My best solution is to limit the amount of matriculating DPM students. We have far too many DPMs and as others have said the amount of practicing podiatrists in the USA is about to pass the amount of practicing orthopedists in the USA (per quick google search it looks as though 741 MD students matched ortho residency this last cycle)

 

[dtrack22]

I need to understand where there is oversaturation. Because the profession doesn't believe there is oversaturation. The need for foot and ankle care is only increasing, based on population, age, and diabetes prevalence. The numbers of podiatrists has not kept up with the projected need.

Pick any popular healthcare job site. I just looked at practicelink. Why are there only 13 Podiatry positions listed in the entire country? Actually there are 14 when you search but 1 is an infectious disease position for an MD/DO that is mislabeled. There are 57 job postings looking for Orthopedic Foot and Ankle surgeons. Podiatry vastly outnumbers F&A ortho (somewhere between 10-20 times more DPMs), has arguably a larger scope of what we actually treat within the foot and ankle compared to Ortho, so why are there 80% fewer job listings on practicelink, for example? If not for oversaturation/lack of need?

There are over 400 CRNA job postings on that same site. Why am I not getting emails from recruiters daily like my Family Med partners? Why can’t I open up any major healthcare job/recruiting site and choose between hundreds of jobs all over the country like a majority of other healthcare providers can?

 

[pod squad]

If you're geographically locked into an area, you might have to compromise for a while. If you're willing to relocate anywhere, there is no saturation of podiatrists.

Podiatry is the only specialty/healthcare profession (maybe ANY profession) where you need to be willing to relocate to the middle of nowhere to land a 'good job'. To me, that's the definition of over-saturated

 

[DexterMorganSK]

No personal attacks or derailing. Warnings will be given if anyone breaks the TOS.

@Weirdy

 

[HardRoadPaved]

The only reason jobs aren't listed is that this is the best kept secret in medicine... duh

 

[dtrack22]

This is a crossover from the other thread since some people can’t keep their mouths shut so the grownups can have a discussion…

For example, is there something APMA can do to help improve connecting young DPMs with good jobs?

Sure, kill AAPPM or infiltrate from within to help end the existence of the “typical podiatry associate contract.” Or, make a big organized push for hospital/MSG employment for podiatrists. The latter would be more palatable for the APMA folks (can’t mess with their AAPPM buddies livelihoods directly), and would in theory lead to better PP contracts as they would have no choice but to offer more when they can’t fill their associate revolving door with desperate new grads as easily.

 

[air bud]

Great thread. I do believe given the success of UTSA and the model of the UT system that Texas can be the model for increasing podiatry presence in hospitals and academic centers.

 

[DexterMorganSK]

Who is derailing? Are you ABFAS certified? You moderate this forum like you are only certified by ABPM and show blatant favoritism to Rogers

I moderate this forum as an Admin of the site. Don't worry about my qualifications. As long as everyone follows the TOS, I have no issues.

 

[deleted285117]

Would be nice to have a better relationship with orthopedics across the country to see DPMs joining ortho groups becoming more mainstream. Therefore, better paying jobs and opportunities! (And then I woke up, right? 😞)

 

[Pronation]

1. What is the Profession Doing to Prevent Residency Shortage?
Firstly, there is no shortage currently, there is a surplus. As you noted, 4 years from now there will be 80ish more people in the match for residency programs. But the matriculants at the 9 other schools is also reducing, albeit, not by 80. So, in TX, TPMA is working closely with UTRGV to increase spots because Texans want to stay in Texas. UTHSCSA has applied to for a compliment increase from 3/year to 5/year starting 2023. UTSW is going to start a program, probably 2 per year to begin with. TPMA is looking at all academic medical centers to help recruit podiatrists who can be residency directors and keep our residents in the state and welcome them when they decide to practice here.

I will reach out to CPME and APMA to ask them if they have a national strategy to prevent a shortage and I will post their answers and who answered. More on that to come.

Obviously there isn't a current residency shortage - just like there wasn't a residency shortage prior to the graduating class of the last inappropriately opened podiatry school. Increasing from 3 to 5 residents per year at a program... What you are proposing is twisting the arms of residency directors to water down the already diluted nonuniform training. Instead of shutting down some of the worst programs in the country that have no business graduating residents, we will continue to encourage them to use residents as free labor in exchange for some of the worst training imaginable.

2. Is There Oversaturation of Podiatrists and What Can We Do to Prevent It?
I need to understand where there is oversaturation. Because the profession doesn't believe there is oversaturation. The need for foot and ankle care is only increasing, based on population, age, and diabetes prevalence. The numbers of podiatrists has not kept up with the projected need.

Is this a geographical thing?

For example, everywhere I've practiced I've never had a shortage of patients. When I moved to San Antonio, there were 1200 patients with diabetic foot problems on the waiting list to be seen. I'm literally booked for months.

Maybe because I'm in South Texas. Maybe because I'm at a university. Maybe because I'm "hospital-employed" (I'm really a university employee).

I can imagine you try to open a practice in Manhattan, or South Florida, or Chicago, perhaps there is a lot of competition for general podiatry.

Maybe this question is really is about not being enough "good, hospital-jobs" in certain markets.

If you're geographically locked into an area, you might have to compromise for a while. If you're willing to relocate anywhere, there is no saturation of podiatrists.

The profession doesn't believe there is over saturation? Are you sure it's not just our glorious leaders making this claim? Because I have a feeling that the opposite response would surface if you were to send out an anonymous surveymonkey poll to non-political attendings who are less than 10 years out from training. Of course there is no shortage of patients when you are hospital employed (or "university employed" as you put it). As has been reiterated to you many times, there are FOURTEEN advertised hospital/MSG employed positions nationally, and a good portion of these are in rural markets. That means a majority of grads will go into pod private practice, where the salary ranges from $80k to $125k (occasionally you get a couple offering 150, throughout the whole damn country).

No, this question is really about good hospital jobs in any markets. If you're geographically locked into an area, you have a near zero chance of obtaining a good paying hospital job and will be stuck with a 100k private practice job. I strongly disagree with your state of "If you're willing to relocate anywhere, there is no saturation of podiatrists.", and I bet a surveymonkey poll would prove this. If you want a good paying job, you essentially have to be willing to relocate anywhere, and that anywhere has a considerable probability of being rural, BECAUSE OF THE SATURATION! Again, feel free to poll members who are/were trapped in a low paying PP job and are early in their careers - how many dozens/hundreds of applications and how many months/years they spent applying to get that coveted hospital/MSG job.

3. What Can Be Done to Help Young Graduates Obtain Quality Jobs Upon Graduation?
This is a good question. I have some ideas, but not approved by ABPM or APMA yet. The profession has not previously had an organized approach to this. It has been left to mentoring and networking.

What are your ideas?

I'll ask one of the BOT at APMA and post their reply.

The above supports the solution we've reiterated many times, supply and demand. The increasing demand is not there, contrary to what our leaders are trying to lead us (and potential applicants) to believe.

 

[icebreaker32]

1. Is there something in place to limit total podiatry seats to say 10 percent below the previous years number of residency slots to avoid a residency crisis ?

2. Could we have a response from AACPM to explain the unmet demand they stated exists? Future hypothetical demand based on diabetes is not acceptable as that has been claimed for decades. They stated there is unmet demand now.

3. While it is not the schools or residencies job to ensure employment, are the colleges letting the prospective students know that the majority of jobs are not organizational jobs and still in private practice and most will be small business employee or owner either solo or buying in as a partner?

4. Has their been any discussions amongst leaders to explore the possibility that the profession would potentially benefit from drastically reducing enrollment in the colleges?

5. Has there been any studies done to ask podiatry students and residents if they would rather have organizational jobs or be a small business owner or employee?

6. Has there been any meaningful attempt to have ABPM and ABFAS merge to create one board for our profession?

 

[newfeet]

Pick any popular healthcare job site. I just looked at practicelink. Why are there only 13 Podiatry positions listed in the entire country? Actually there are 14 when you search but 1 is an infectious disease position for an MD/DO that is mislabeled. There are 57 job postings looking for Orthopedic Foot and Ankle surgeons. Podiatry vastly outnumbers F&A ortho (somewhere between 10-20 times more DPMs), has arguably a larger scope of what we actually treat within the foot and ankle compared to Ortho, so why are there 80% fewer job listings on practicelink, for example? If not for oversaturation/lack of need?

There are over 400 CRNA job postings on that same site. Why am I not getting emails from recruiters daily like my Family Med partners? Why can’t I open up any major healthcare job/recruiting site and choose between hundreds of jobs all over the country like a majority of other healthcare providers can?

I would go with lack of need, over saturation and no one understands why a podiatrist can do.

 

[zeepod]

please note that you will not see the vast majority of podiatric surgery opportunities as there is a large private practice presence in which word of mouth is how those spots are filled.

 

[icebreaker32]

I would go with lack of need, over saturation and no one understands why a podiatrist can do.

There is only so much foot pain and bunions that can be treated in a community.

Increasing hospitals awareness of what podiatry can do can lead to a few more jobs along with hospital system monopolies that want every specialty under their umbrella. Many of those jobs will go to established podiatrists in the community.

There has been either the false hope, data that seemed to make sense that never materialized or just spin that claimed diabetes would cause a shortage and we needed many more schools decades ago. The kind of shortage we have now with RNs etc. For better or worse podiatry has very, very slow growth and we mainly replace the existing podiatrists that retire. The boomers aging never caused more demand, maybe when they retire it will create a few good jobs.

 

[icebreaker32]

please note that you will not see the vast majority of podiatric surgery opportunities as there is a large private practice presence in which word of mouth is how those spots are filled.

This has been claimed for years. There certainty is some truth to it. I would say the majority of good jobs these days are organizational jobs and are required to post the job even if they know who they want to hire. If there was more demand we would still lots of jobs being posted.

 

[wakaflocka88]

What is being done or will be done for residency programs that for obvious reasons 1)do not deserve the RRA accreditation and 2)programs that lack volume?

Increasing spots is not a good idea. Only a handful of programs have the volume to accommodate increasing slots. Majority do not.

What about programs that routinely triple scrub toe amps and TMAs? Or have to scrape by seeking out foot ankle ortho cases just to barely meet numbers? These are all red flags that I feel needs to be addressed. It all circles back to yes, it is over saturated across the country because of this

 

[zeepod]

let's not generalize and make broad strokes. the area in which I practice for the past 19yrs is composed of 99% private practice employment/partnership. the composition will vary from area to area. I can confidently tell you that all recent graduates that have stayed in the area found their positions through personal or mutual contacts.
as far as residency programs are concerned, there is a rigorous accreditation process and I have been involved with two different programs and at least 4 separate site visit reviews. at this time (2022), there is an excess of resident spots in comparison to the number of graduates. yes, there are programs that have many residents scrubbed in, but our logging system does not allow for multiple residents to take credit for the same case. there are stronger programs than others, but this is not unique to podiatric surgery residency programs.
I would also like to share the following information regarding salaries that was recently published by Bjorn Auto, Drug Genius (12/5/22):
Podiatric Surgeon average salary by site
Glassdoor- $191,639
Indeed- $137,486
Comparably- $116,475
ZipRecruiter- $127,539
Overall- $143,285

please note that averages will vary based on cost of living in that area, but this gives you a ballpark figure of what is possible. remember, these are AVERAGES. my personal experience is that if you are motivated and willing to work, you can earn more- no different than any other health or non-health profession.

 

[dtrack22]

please note that you will not see the vast majority of podiatric surgery opportunities as there is a large private practice presence in which word of mouth is how those spots are filled.

Why does this “majority of jobs are word of mouth” hiring practice really only exist within podiatry? What about Dermatology? A medical specialty that is still very heavily PP/Group Practice. Why are there 399 Dermatology openings on this same job site when they too are heavily PP?

 

[air bud]

@diabeticfootdr who has the authority to hold residency programs to existing standards? What are thresholds for changing these standards (i.e. it takes 4/5ths of senate, 1/3 of non binary congress entities and human sacrifice of Donald Trump to change the constitution)?

Even without significant RRA focus, we can all agree 10 percent of programs should be shut down tomorrow.

Edit - or put it like this: Give me an estimate of the percentage of programs from which you would almost never consider a potential fellow due to the lack of training across the board during their residency.

Saying there is an excess of residencies is like saying because there are approximately 4.2 billion women in the world, there is an excess of women that are suitable matches for Tom Brady to date.

 

[diabeticfootdr]

1. Is there something in place to limit total podiatry seats to say 10 percent below the previous years number of residency slots to avoid a residency crisis ?

No, there is nothing in place besides supply and demand.

I don't think the profession (meaning APMA or CPME) has the authority to do this. It would infringe on the rights of the educational institutions.

What they can do is build more demand for seats to increase supply to meet the demand.

2. Could we have a response from AACPM to explain the unmet demand they stated exists? Future hypothetical demand based on diabetes is not acceptable as that has been claimed for decades. They stated there is unmet demand now.

I will ask them and post any reply here.

3. While it is not the schools or residencies job to ensure employment, are the colleges letting the prospective students know that the majority of jobs are not organizational jobs and still in private practice and most will be small business employee or owner either solo or buying in as a partner?

I don't know what they tell prospective students. I would assume they don't word it like that.

4. Has their been any discussions amongst leaders to explore the possibility that the profession would potentially benefit from drastically reducing enrollment in the colleges?

No, there has not, and again, I don't think APMA or CPME has that authority.

5. Has there been any studies done to ask podiatry students and residents if they would rather have organizational jobs or be a small business owner or employee?

Not to my knowledge.

6. Has there been any meaningful attempt to have ABPM and ABFAS merge to create one board for our profession?

ABPM offered to meet with ABFAS most recently at the APMA BOT meeting in October. But there has been nothing scheduled.

 

[deleted1138023]

let's not generalize and make broad strokes. the area in which I practice for the past 19yrs is composed of 99% private practice employment/partnership. the composition will vary from area to area. I can confidently tell you that all recent graduates that have stayed in the area found their positions through personal or mutual contacts.
as far as residency programs are concerned, there is a rigorous accreditation process and I have been involved with two different programs and at least 4 separate site visit reviews. at this time (2022), there is an excess of resident spots in comparison to the number of graduates. yes, there are programs that have many residents scrubbed in, but our logging system does not allow for multiple residents to take credit for the same case. there are stronger programs than others, but this is not unique to podiatric surgery residency programs.
I would also like to share the following information regarding salaries that was recently published by Bjorn Auto, Drug Genius (12/5/22):
Podiatric Surgeon average salary by site
Glassdoor- $191,639
Indeed- $137,486
Comparably- $116,475
ZipRecruiter- $127,539
Overall- $143,285

please note that averages will vary based on cost of living in that area, but this gives you a ballpark figure of what is possible. remember, these are AVERAGES. my personal experience is that if you are motivated and willing to work, you can earn more- no different than any other health or non-health profession.

do you think $140,000 is good when you're $300-350,000 in debt with a 7 year investment(11 if you count undergrad)?

 

[icebreaker32]

let's not generalize and make broad strokes. the area in which I practice for the past 19yrs is composed of 99% private practice employment/partnership. the composition will vary from area to area. I can confidently tell you that all recent graduates that have stayed in the area found their positions through personal or mutual contacts.
as far as residency programs are concerned, there is a rigorous accreditation process and I have been involved with two different programs and at least 4 separate site visit reviews. at this time (2022), there is an excess of resident spots in comparison to the number of graduates. yes, there are programs that have many residents scrubbed in, but our logging system does not allow for multiple residents to take credit for the same case. there are stronger programs than others, but this is not unique to podiatric surgery residency programs.
I would also like to share the following information regarding salaries that was recently published by Bjorn Auto, Drug Genius (12/5/22):
Podiatric Surgeon average salary by site
Glassdoor- $191,639
Indeed- $137,486
Comparably- $116,475
ZipRecruiter- $127,539
Overall- $143,285

please note that averages will vary based on cost of living in that area, but this gives you a ballpark figure of what is possible. remember, these are AVERAGES. my personal experience is that if you are motivated and willing to work, you can earn more- no different than any other health or non-health profession.

Yes lets not generalize. Healthcare can be very local. In some areas it is monopolized by healthcare systems (podiatry included) in other areas their is a lot of private practice. In some areas their are legitimate opportunities for partnership with podiatry groups and in others there is a lot of associate turnovers and many opening solo practices.

 

[icebreaker32]

No, there is nothing in place besides supply and demand.

I don't think the profession (meaning APMA or CPME) has the authority to do this. It would infringe on the rights of the educational institutions.

What they can do is build more demand for seats to increase supply to meet the demand.

I will ask them and post any reply here.


I don't know what they tell prospective students. I would assume they don't word it like that.


No, there has not, and again, I don't think APMA or CPME has that authority.


Not to my knowledge.


ABPM offered to meet with ABFAS most recently at the APMA BOT meeting in October. But there has been nothing scheduled.

Thanks for the response.

 

[diabeticfootdr]

@diabeticfootdr who has the authority to hold residency programs to existing standards? What are thresholds for changing these standards (i.e. it takes 4/5ths of senate, 1/3 of non binary congress entities and human sacrifice of Donald Trump to change the constitution)?

CPME has the sole authority and responsibility ensure residency programs follow the Standards in CPME Document 320 via the Residency Review Committee which conducts onsite visits and meets and makes decisions on residency programs.

Here how the standards are changed:

Once every 6 years* (just happened in 2022), CPME convenes an ad hoc committee of stakeholders (ABPM is a major stakeholder and appoints 1 representative) to review the Standards of the Podiatric Medicine and Surgery Residency and propose major changes. The ad hoc committee meets and presents changes to other committee members and receives initial comments from the major stakeholders. Then the ad hoc committee votes on changes and sends a draft of the revised standards to CPME. CPME calls for public comments on the standards. At this time anyone can comments. The ad hoc committee meets again to review all the comments and makes further changes. The draft is sent back to CPME with the ad hoc committee's recommendation. If the CPME votes to accept, it becomes adopted, otherwise the CPME can send it back to committee for further revisions.

There are really a lot of people involved in these changes. CPME, APMA, ABPM, ABFAS, COTH, and members at large appointed by CPME.

*minor changes are made at the 3 year mark between major changes

Even without significant RRA focus, we can all agree 10 percent of programs should be shut down tomorrow.

I disagree that they should be closed tomorrow, that would harm programs and residents in training.

But I agree that programs which perform poorly should be put on probation and then closed if they can't remediate.

ABPM advocated to the CPME 320 rewrite committee that the PMSR follow ACGME Common Program Requirements and instead publish only Specialty Requirements for podiatry, like all the other specialties in medicine.

Part of the ACGME requirements is an evaluation of the residency program based on board certification pass rates:

"V.C.3.d) For specialties in which the ABMS member board and/or AOA certifying board offer(s) a biennial oral exam, in the preceding six years, the program’s aggregate pass rate of those taking the examination for the first time must be higher than the bottom fifth percentile of programs in that specialty."

If the residency program is in the bottom 20% of pass rates for the specialty's certification exam, they would be in non-compliance with standards and at risk of probation or closure.

We support that.

 

[diabeticfootdr]

help end the existence of the “typical podiatry associate contract.” Or, make a big organized push for hospital/MSG employment for podiatrists.

These are good ideas. Perhaps even offer a review of associate contracts for PP or new pods.

 

[GoSpursGo]

Not to derail this thread, but for transparency we banned CutsWithFury for continually de-railing legitimate threads and baselessly attacking our moderator volunteers. I also want to make it clear that @DexterMorganSK was not involved in this decision.

Sorry, again I don't want to de-rail this thread. If anyone has questions or a problem with this decision please PM me directly.

 

[dtrack22]

These are good ideas. Perhaps even offer a review of associate contracts for PP or new pods.

Reviewing contracts would be a nice membership benefit, but many (like myself years ago) will get advice and still have no choice to sign on the dotted line because it’s essentially the only job they could find in the area and need to accept something. It’s really why increasing opportunities for new grads is much more important.

Does APMA have a presentation with revenue figures for systems with employed podiatrists that they disseminate to facilities and health systems without employed DPMs? If that doesn’t exist, why the heck not? $$$ talks, and I would assume that hospital admin would be open to hiring a DPM after learning he/she can reasonably generate a few million $ in revenue while only commanding $250-350k in pay.

HCA is the largest healthcare organization in the country and has zero job postings for a Podiatrist. Trinity Health employs 7,500 physicians, oversees 90+ hospitals and has zero postings for a podiatrist. Community Health Systems doesn’t even list podiatry as a Physician specialty and has no job postings. Tenet Health also does not list Podiatry as a specialty in their search filter, and has no job openings. Providence has 1 job listing for a Per Diem Podiatrist. So, 5 of the 10 largest healthcare organizations in the country, and there is 1 per diem job posting. How can anyone tell us SDN attendings that there is any meaningful demand for podiatry services?

Granted, many of those systems might say, “why should we hire a DPM when our community has a local army of PP docs who bring cases and provide inpatient coverage at no cost to us?” Which would be the case in a location like @zeepod described where 99% of the podiatrists (attendings and residency directors included) are PP based and not hospital employed. It would still be a better use of resources than much of what APMA attempted with student recruitment campaigns that ultimately flopped. I tried to help them 8-9 years ago with that but they didn’t listen to me, because what would a student who just went through the application/admission process know lol? Nah, the APMA BOT was much more in tune with student recruitment and how students find out about podiatry. I don’t suspect they’d listen now…

Edit: forgot about LifePoint. No podiatry job listings. So 6 of the 10 largest orgs aren’t looking to hire a podiatrist for any of their thousands of hospitals/outpatient clinics.

Edit to the Edit: let’s round out the top 10 so I’m not accused of cherry picking; Universal Health Services is the VA which obviously hires DPMs and pays them less than real doctors still. Encompass wouldn’t really apply since they are post-acute care/rehab. Ascension I thought did hire podiatrists but they currently have 0 podiatry jobs available. And finally, CommonSpirit who definitely employs podiatrists and has 1 per diem job listed and 1 full time job listing in Arkansas. So, of the top 8 non-VA healthcare employers in the country, they are looking for a combined 2 per diem podiatrists and 1 full time podiatrist. Somebody explain to me how this doesn’t scream, “lack of demand” for our services?

 

[air bud]

Yes lets not generalize. Healthcare can be very local. In some areas it is monopolized by healthcare systems (podiatry included) in other areas their is a lot of private practice. In some areas their are legitimate opportunities for partnership with podiatry groups and in others there is a lot of associate turnovers and many opening solo practices.

Houston is the 4th or 5th largest city in the country. 3 hrs from San Antonio. Let's say there are 15 pods doing surgery employed by hospitals in the city? And that may be generous.

 

[air bud]

Reviewing contracts would be a nice membership benefit, but many (like myself years ago) will get advice and still have no choice to sign on the dotted line because it’s essentially the only job they could find in the area and need to accept something. It’s really why increasing opportunities for new grads is much more important.

Does APMA have a presentation with revenue figures for systems with employed podiatrists that they disseminate to facilities and health systems without employed DPMs? If that doesn’t exist, why the heck not? $$$ talks, and I would assume that hospital admin would be open to hiring a DPM after learning he/she can reasonably generate a few million $ in revenue while only commanding $250-350k in pay.

HCA is the largest healthcare organization in the country and has zero job postings for a Podiatrist. Trinity Health employs 7,500 physicians, oversees 90+ hospitals and has zero postings for a podiatrist. Community Health Systems doesn’t even list podiatry as a Physician specialty and has no job postings. Tenet Health also does not list Podiatry as a specialty in their search filter, and has no job openings. Providence has 1 job listing for a Per Diem Podiatrist. So, 5 of the 10 largest healthcare organizations in the country, and there is 1 per diem job posting. How can anyone tell us SDN attendings that there is any meaningful demand for podiatry services?

Granted, many of those systems might say, “why should we hire a DPM when our community has a local army of PP docs who bring cases and provide inpatient coverage at no cost to us?” Which would be the case in a location like @zeepod described where 99% of the podiatrists (attendings and residency directors included) are PP based and not hospital employed. It would still be a better use of resources than much of what APMA attempted with student recruitment campaigns that ultimately flopped. I tried to help them 8-9 years ago with that but they didn’t listen to me, because what would a student who just went through the application/admission process know lol? Nah, the APMA BOT was much more in tune with student recruitment and how students find out about podiatry. I don’t suspect they’d listen now…

Edit: forgot about LifePoint. No podiatry job listings. So 6 of the 10 largest orgs aren’t looking to hire a podiatrist for any of their thousands of hospitals/outpatient clinics.

I recently stopped performing surgery/taking inpatient consults at a life point hospital. Life point is private equity owned. Before me no podiatry presence in town. After me 180 cases last year in a critical access hospital. When I left, 160 of those cases were gone and not coming back via the current providers. On top of that, an ASC was in the talks to further hurt the hospital. Let's say my previous group hires another pod and 75 percemt of those cases go to the ASC and Ortho takes 25 percemt of their cases to the ASC. At the same time a competing hospital in the process of being built in another sister city. These are multiple SIGNIFICANT converging threats to the hospital. And the hospital knew given my situation how desperate I was given the likelihood that I would have to leave the area. I even offered to do locums work so I could keep working and they could keep cases.

But they did nothing to try and replace me or hire another pod ASAP. It was easy. They could just run the numbers of before me and then with me. Black and white. But they did and have done nothing. And the CEO of my hospital had hired pods within life point at another hospital.

Sometimes we give hospitals way too much credit.

 

[Adam Smasher]

First of all I want to thank Dr Rogers for coming back day in to let everyone dogpile on him and yet he's still able to be mostly gentlemanly. Plus it's been entertaining to watch the drama continually unfold.

My question is this. When the powers that be say we're not oversaturated, that we face a rising demand for "podiatry care" or "foot and ankle care," do they make a distinction between real disease/injury that requires treatment/management and nails that need trimming?

This is the topic of a longer thread that I want to write, but I have legions of patients coming to my practice for nailcare but comparably little else. That's fine, I'm busy, I'm making money. But over time I'm concerned I'll get a reputation for being a common cutter of toenails. I would LOVE to hire some kind of nurse/mid-level person to do this and do it legitimately. I can't afford to pay airbud's salary and benefits.

So that's my question, is the perceived need for nail trimmers of something else? Because if we as a society need more nail trimmers they need not be doctors.

 

[AttackNME]

@diabeticfootdr Can you provide us with data regarding the current surplus of residencies? And the projected supply of patients and the unmet demand? Otherwise many of us just won’t believe what your saying

 

[Lord_stark]

Most recent class has 350 students + those at new texas school.

There is about 6-700 residency slot a year. Some of 350 students won’t pass board or graduate from the program.

Every student who meets the minimum competency into match process will get multiple offers. “Top programs” for everyone in this class.

 

[deleted285117]

Well, if there’s one thing that’s quite commendable... it’s one of our respective Board’s President ( @diabeticfootdr ) being active on this forum, answering questions and helping where possible.

It’d be nice seeing one of ABFAS’ respective Board Members on here... would provide good conversation / insights.

 

[air bud]

Well, if there’s one thing that’s quite commendable... it’s one of our respective Board’s President ( @diabeticfootdr ) being active on this forum, answering questions and helping where possible.

It’d be nice seeing one of ABFAS’ respective Board Members on here... would provide good conversation / insights.

Too busy with yearly meetings in Panama....oh man I remember my director/ABFAS board member talking about the meetings in Panama City....not the one in Florida. And some fantastic restaurants in San Franciso.

 

[Pronation]

Can somebody help me? I’m not a smart man. I have hard time understanding all this political mumbo jumbo. I just come into work, chop off a few toes, maybe pop in a TAR, sometimes appropriately fixate a foot with no open wounds and a Charcot’d lis franc with internal fixation hardware instead of doing it with only external fixation and have everything fall apart 2 months later, and then I go home for the day so I can refresh SDN all evening long. So can someone tell me if we got any of the answers we were looking for?

 

[icebreaker32]

Most recent class has 350 students + those at new texas school.

There is about 6-700 residency slot a year. Some of 350 students won’t pass board or graduate from the program.

Every student who meets the minimum competency into match process will get multiple offers. “Top programs” for everyone in this class.

View attachment 363124

Podiatry has and will continue have more than its fair share or problems.

It might be a questionable ROI for many, but a few more cycles like this and it might lead to not only decent residencies for most, but a mediocre job market.....of course that is 7 plus years away.

If for some reason all the seats are filled and this was a one of application cycle, then a residency crisis will likely happen again and the job market will be a dumpster fire.

 

[icebreaker32]

Can somebody help me? I’m not a smart man. I have hard time understanding all this political mumbo jumbo. I just come into work, chop off a few toes, maybe pop in a TAR, sometimes appropriately fixate a foot with no open wounds and a Charcot’d lis franc with internal fixation hardware instead of doing it with only external fixation and have everything fall apart 2 months later, and then I go home for the day so I can refresh SDN all evening long. So can someone tell me if we got any of the answers we were looking for?

Answer I got was that there is no oversight/power to control the number podiatry school seats based on the number of residencies.

Currently there is a good surplus, but if there are more seats than residencies (might happen if they could actually fill all the seats with the new schools).....well some have a worthless degree.

I think someone said on another thread that their admission to podiatry school said they can not guarantee the availability of residencies.....maybe to avoid lawsuits if a residency crisis ever happens again.

 

[DYK343]

Deleted. Posted in wrong thread.

 

[diabeticfootdr]

I received a response from Dr. Javier LaFontaine, Dean of the UTRGV School of Podiatric Medicine, to the following slightly rephrased question I sent him:

What is UTRGV doing to help create residency programs to avoid a shortage when your first class (and LECOM) graduates?

Dr. LaFontaine Response:

We secured funding from the state to create new and expand existing residencies within the Texas.

In 2021, the State of Texas passed a HB 2509 supported by the Texas Podiatric Medical Association granting funding to start podiatry residencies in Texas.

My background explanation:

Since the first year of any new residency spot (MD, DO, or DPM) is unfunded by the federal GME program of CMS, it is an obstacle to starting new programs since sponsors eat the cost of the first year. This law now reimburses sponsors from the State for the first year.

Link to announcement of new Texas law:

State funding for podiatry medical residencies in the Valley – supported by DHR Health to increase care for Texans with foot, ankle, and leg problems – approved by House of Representatives and Senate Committee on Higher Education. - Titans of the Tex

FEATURED, FROM LEFT: Joe E. Vega, Parks Director, Cameron County; Pete Sepulveda, Jr., Executive Director, Cameron County Regional Mobility Authority; Speaker

edinburgpolitics.com

 

[diabeticfootdr]

Also, I reached out to APMA, CPME, and AACPM leaderships and I will post the responses to the questions I asked them.

 

[DYK343]

I received a response from Dr. Javier LaFontaine, Dean of the UTRGV School of Podiatric Medicine, to the following slightly rephrased question I sent him:

What is UTRGV doing to help create residency programs to avoid a shortage when your first class (and LECOM) graduates?

Dr. LaFontaine Response:

We secured funding from the state to create new and expand existing residencies within the Texas.

In 2021, the State of Texas passed a HB 2509 supported by the Texas Podiatric Medical Association granting funding to start podiatry residencies in Texas.

My background explanation:

Since the first year of any new residency spot (MD, DO, or DPM) is unfunded by the federal GME program of CMS, it is an obstacle to starting new programs since sponsors eat the cost of the first year. This law now reimburses sponsors from the State for the first year.

Link to announcement of new Texas law:

State funding for podiatry medical residencies in the Valley – supported by DHR Health to increase care for Texans with foot, ankle, and leg problems – approved by House of Representatives and Senate Committee on Higher Education. - Titans of the Tex

FEATURED, FROM LEFT: Joe E. Vega, Parks Director, Cameron County; Pete Sepulveda, Jr., Executive Director, Cameron County Regional Mobility Authority; Speaker

edinburgpolitics.com

At least theyre trying. Maybe Airbud will open a residency.

Any information on LECOM?

 

[DYK343]

I just realized I posted the comment 2 above in the wrong thread. Will delete and add to the correct thread.

 

[icebreaker32]

At least theyre trying. Maybe Airbud will open a residency.

Any information on LECOM?

Agree, but there is no way they are creating 80 residencies. I would like to be wrong.

LECOM will probably only create a handful at most.

Lets keep a running tab on how many new residencies are creates by the new schools.

 

[diabeticfootdr]

Agree, but there is no way they are creating 80 residencies. I would like to be wrong.

Lets keep a running tab on how many new residencies are creates by the new schools.

There is no reason to create 80 residency slots right now.

Texas will do its part. UTRGV students are from TX and most want to be trained and practice in TX.

 

[DYK343]

There is no reason to create 80 residency slots right now.

Texas will do its part. UTRGV students are from TX and most want to be trained and practice in TX.

Texans love nothing more than Texas. But will UTRGV really only accept Texans going forward?

There are 6 texas residency programs with 18 residency positions. If those all now move towards UTRGV this will strain the applicant pool especially with LECOM opening.

I sincerely hope AACPM/APMA are doing everything they can to prevent this from developing into a disaster. With historically low applicant pools this will obviously help them but what happens if we get a surge in applicants/normal applicant levels?

I know i've been harsh but I honestly do care about the matriculants and their future.

Not to derail... but what is the obsession with Texas? I love that they love it so much. Their loyalty is pretty awesome and I like it. But its flat, hot, and spread out. I've only been to Dallas, Houston, and Austin so im not an expert. The BBQ is top notch. Ill give them that!

 

[de Ribas]

Texans love nothing more than Texas. But will UTRGV really only accept Texans going forward?

There are 6 texas residency programs with 18 residency positions. If those all now move towards UTRGV this will strain the applicant pool especially with LECOM opening.

I sincerely hope AACPM/APMA are doing everything they can to prevent this from developing into a disaster. With historically low applicant pools this will obviously help them but what happens if we get a surge in applicants/normal applicant levels?

I know i've been harsh but I honestly do care about the matriculants and their future.

Not to derail... but what is the obsession with Texas? I love that they love it so much. Their loyalty is pretty awesome and I like it. But its flat, hot, and spread out. I've only been to Dallas, Houston, and Austin so im not an expert. The BBQ is top notch. Ill give them that!

There are bunch of unfilled VA spots and NY/NJ every year. Plenty for whoever gets so lucky.