Residency Shortage Question

[165007]

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[damhsoir]

This whole thread sounds quite like some of the my sorority vs. your sorority on juicy campus (Hmm wonder if the pod schools have juicy campus...awful awful website btw). Why can't we all just realize that no matter where you go you get the same exact degree? Does it really matter?

 

[podpal]

Let's bring back the PSR-12! Pod students have been treating patients for 2 years in 3rd & 4th year. EVERY pod who graduates should have a chance to do at least 1 year of surgical training, having learned conservative care in school already! THEY ARE READY!!!

If the requirement for residency directors to be ABPS certified were dropped, there could be substantially more programs overnight! Let's have everyone get the PSR-12 and if someone wants more surgical training, they can go for an "advanced training" residency program.

My friends who graduated eons ago and did 2-3 yr surgical residencies are lucky to do 1 surgical case/week, some do all conservative care.

From a patient's perspective, all pods are created equal. Shouldn't every pod be able to offer a patient hammertoe surgery either as an outpatient or in-office?

MYTH: those who don't match are bad students. In my class, most of us who didn't match were in the top 1/3 of our class. It's who you know, not WHAT you know!!!

 

[G0dFather]

wat?! so wat happened to the lower 2/3 ??

 

[dpmgrad]

Let's bring back the PSR-12! Pod students have been treating patients for 2 years in 3rd & 4th year. EVERY pod who graduates should have a chance to do at least 1 year of surgical training, having learned conservative care in school already! THEY ARE READY!!!

If the requirement for residency directors to be ABPS certified were dropped, there could be substantially more programs overnight! Let's have everyone get the PSR-12 and if someone wants more surgical training, they can go for an "advanced training" residency program.

My friends who graduated eons ago and did 2-3 yr surgical residencies are lucky to do 1 surgical case/week, some do all conservative care.

From a patient's perspective, all pods are created equal. Shouldn't every pod be able to offer a patient hammertoe surgery either as an outpatient or in-office?

MYTH: those who don't match are bad students. In my class, most of us who didn't match were in the top 1/3 of our class. It's who you know, not WHAT you know!!!

I would not say every POD who just graduated from podiatry school already know how to do conservative care. From my experiences with externs and also chatting with many residency directors at CRIP and externship / clerkship directors, some students from some schools are better than others clinically due to their clinic exposure from their school. (Of course, there are always exceptions to the previous statement.) I have 4th year externs from certain school consistently do not know how to do an acceptable (not necessarily perfect) orthotic cast for the labs, do a simple low dye strapping (I know that there are many variations of this), proper partial nail avulsion, etc... These students tell me that they may have learned this in class but really do not get to do any of this due to their poor clinic exposure/set up/etc...

 

[podpal]

If by graduation a podiatrist doesn't know how to cast, do nail avulsions, and basic conservative care, can you imagine the implications of putting even more pods out there without ANY post grad training?

The PSR-12 programs offered clinic opportunities too, not just surgery. We as a profession need to act upon the residency shortage. If some of the PM&S 24s & 36s could become PSR-12s then we would not have a residency shortage. All graduates should have a shot at a residency with at least some forefoot surgical training.

For the prior ?, the bottom 1/3 of my graduating class is doing very well.

 

[PodunkUDPM]

Personally, I think that changing PMS-36 to PSR-12 would be moving away from the direction our profession should be progressing. PSR-12 should only be created in emergency situations for one year until the applicant can gain a PMS-36 residency. Generally, the more training the better.

 

[dpmgrad]

If by graduation a podiatrist doesn't know how to cast, do nail avulsions, and basic conservative care, can you imagine the implications of putting even more pods out there without ANY post grad training?

The PSR-12 programs offered clinic opportunities too, not just surgery. We as a profession need to act upon the residency shortage. If some of the PM&S 24s & 36s could become PSR-12s then we would not have a residency shortage. All graduates should have a shot at a residency with at least some forefoot surgical training.

For the prior ?, the bottom 1/3 of my graduating class is doing very well.

I agree with PodunkDPM that creating PSR-12 would be diverting away from the goals of Vision 2015. I know that the eventual goal would be to create 3 year Podiatric residency programs. However, to address the shortage of residency spots, creating more PM&S-24 spots will be more sensible than PSR-12. ABPS, ABPOPPM, and ABMSP have already changed their residency requirements for board certification to a minimum of 2 years of residency training. Hence, a PSR-12 training now would not allow for the graduate to qualify for the board certification.

 

[podpal]

The profession better do something fast or we'll have more pods w/o post-grad training. What do you propose for VISION 2010? how about VISION 2011? Podiatry has lost VISION of the BIG PICTURE, all graduates deserve residency training and it simply isn't going to be available in upcoming years. Previous grads who didn't get into a program first time around should also have a shot at post-graduate training. When we have leftover people from year to year who actually WANT to do a residency and can't it sets up a bad situation for the profession. These people cannot have the type of practice that they spent so many years studying to achieve. They get discouraged. When a pod goes through CASPR 2+ times, goes into debt applying all over tim buck too, and gets shot down every time, we are hurting the profession. It's embarassing that pods treat one another so terribly. Those who are ABPS Certified are NOT opening up enough programs for the rest. The profession has very competent practitioners who are not board certified. Why not allow them to become residency directors? What suggestions do you have to SOLVE this crisis?

 

[PoddyMan]

The profession better do something fast or we'll have more pods w/o post-grad training. ... What suggestions do you have to SOLVE this crisis?

Who is accepting & graduating the students? The schools should be joining up with academic health centers, which is where their externships are or should be occurring, and setting up residency programs through them. Don't you think it is a little strange that the AACPM is placing the burden on the APMA?

 

[dpmgrad]

The profession better do something fast or we'll have more pods w/o post-grad training. What do you propose for VISION 2010? how about VISION 2011? Podiatry has lost VISION of the BIG PICTURE, all graduates deserve residency training and it simply isn't going to be available in upcoming years. Previous grads who didn't get into a program first time around should also have a shot at post-graduate training. When we have leftover people from year to year who actually WANT to do a residency and can't it sets up a bad situation for the profession. These people cannot have the type of practice that they spent so many years studying to achieve. They get discouraged. When a pod goes through CASPR 2+ times, goes into debt applying all over tim buck too, and gets shot down every time, we are hurting the profession. It's embarassing that pods treat one another so terribly. Those who are ABPS Certified are NOT opening up enough programs for the rest. The profession has very competent practitioners who are not board certified. Why not allow them to become residency directors? What suggestions do you have to SOLVE this crisis?

I know that it is a problem to not have enough residency positions for the podiatry school graduates. The goal of CPME was to set minimal standards so that the residents will get more uniformed training from residency programs. Starting a residency programs is not as easy as one thinks. Being an assistant residency director, I can tell you how much crap that we have to do to maintain our residency program accreditation status. Each residency program needs to meet the standards set forth by CPME in order to be approved. As one of my attendings at my residency program used to say, the days of a bunch of podiatrists creating a residency program so that they can have free labor or free help for their surgeries, office, clinics, etc... are over. The focus of those residency program was on getting free labor and if the residents learned anything, then it would be great. Many of the older PPMR / RPR / POR / and even PSR-12 programs were those type of programs. Most of those programs have closed. In regards to expanding the existing programs, (as Feli stated on one of the other threads on SDN Forum) no residency program is obligated to increase positions at the expense of lowering the quality of the residency training by having each residents scrubbing in less cases, seeing less patients in the clinic or the floors, etc...

CPME created a standard that all residency directors must be board certified, which is the same standard that exists in allopathic and osteopathic residency program requirements. CPME does NOT dictate that the residency director must be ABPS board certified. They must be boarded by board certification agency that is recognized by APMA. I know of a few residency directors that are only ABPOPPM certified and are running PM&S programs.

As for my solution, I think that some of the podiatry schools should lower their enrollment caps and focus on selecting the best candidates for their class. I know that there is a push to create more PM&S-36 programs. However, with the given shortage, we would need to temporarily create more or expand the existing PM&S-24 programs so that the graduating residents are eligible to sit for any of the boards. Another idea would be to bring back the 1 year RPR, where the resident can still be doing residency training and can reapply next year for one of the PM&S spots, since the number of positions should hopefully increase each year. The advantage of RPR year is that these candidates can also apply for PGY-2 positions that have been vacated by resident leaving after the PGY-1 year due to incompetence, personal issues, family issues, resident not liking the program, etc.... However, the if the podiatr school graduate decides not to pursue further residency training upon completion of RPR, he or she should understand that RPR will not lead to any board certification (since all of the boards require 2 years of residency training now) but may fulfill the requirement of 1 year residency training that many of the states require for full licensure if he or she decides to go into a non surgical practice. The goal of the RPR program is to provide similar training to the PGY-1 year in the PM&S programs. The RPR resident may be exposed to some surgical training, but it is not intended to be PSR-12. It would be a disservice to the podiatry school graduate when creating PSR-12 program since the graduate can not sit for board certification and many of the surgery centers and hospital would require them to be board certify (or at least board eligible) to obtain surgical privileges and to be credentialed at various insurance companies. Given the amount of non podiatry rotations that a resident needs to go through, the podiatry resident will not be surgical competent since they will get very little surgical exposure in one year of PSR-12 or RPR. The goals of the non podiatry rotations is to improve our medical knowledge, whether it may be internal medicine, doing full H&Ps, infectious disease, dermatology, anesthesia, pathology, radiology, etc.... I believe that if a podiatry school graduate that wants to do some surgery, they will need at least 2 years of residency training (if not 3 years) to be somewhat competent, given the current residency training models.

 

[podpal]

Most states require 1 year of residency training to practice. What are the new grads going to do in 2010 when a huge clump of them are unable to get into a residency program of any kind? If you believe that a graduate that wants to do some surgery needs at least 2 years of residency training, how do you plan to educate that person if there aren't enough residency slots available?

We have a grossly unfair process going on. Those who get matched are extremely lucky and they often take this for granted. Those who don't get matched and are destined to clip & chip for a living become unhappy with the field.

I agree that starting and maintaining a residency is a lot of work. I tried hard to get a program started in past years but couldn't find a board cert pod willing to act as director. It's a nightmare to try to start a program; even when the hospitals are ready willing and able to establish programs, the ABPS or ABPOPPM pods are not willing to direct the programs. In my opinion, the CPME should relax the requirement for the actual directorship of the program, so that a licensed podiatrist can act as director. During the first year, the resident will be rounding w/the MDs primarily and for podiatric surgery cases, some of the attendings will be ABPS certified. This would be a LOT easier, the training would be exactly the same, and it would work to solve this huge problem. A lot of the ABPS cert DPMs I've met were more than willing to teach residents, but were unwilling to take on a residency directorship.

 

[dpmgrad]

Most states require 1 year of residency training to practice. What are the new grads going to do in 2010 when a huge clump of them are unable to get into a residency program of any kind? If you believe that a graduate that wants to do some surgery needs at least 2 years of residency training, how do you plan to educate that person if there aren't enough residency slots available?

We have a grossly unfair process going on. Those who get matched are extremely lucky and they often take this for granted. Those who don't get matched and are destined to clip & chip for a living become unhappy with the field.

First, you have answered some of my questions that I have for you in my posting over at the possible residency shortage thread on the Podiatric Physician section.

It does not matter whether I believe that a resident needs to do a minimum of 2 years of residency training to get surgical training. Based on the current residency models, the PGY-1 residents do not actually gets to do too much surgery during the first year due to significant amount of outside rotations that are mandated in CPME 320. The amount of podiatric surgery seen by PGY-1 resident may vary from program to program. Some programs do move some of the outside rotations to the upper years.