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.
