Residency Shortage

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OBI603

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  1. Pre-Dental
I was thinking about this problem and had a question. Obviously after the 4 years of school podiatrists must do residency to be licensed and practice. My question is instead of this, why can't podiatry be like dentistry where you complete the 4 years of school and then you can practice general podiatry leaving the residency only for those who want to specialize? Wouldn't this cut down on the amount of people going into residency?
 
The way the current curriculum is set up, 4 years of podiatry school only prepares you to become a resident. It does not prepare you to be a practicing podiatrist. If we started learning clinical skills from day 1, MAYBE 4 years would be enough without any surgery (meaning no surgical classes either...that time would be spent learning "general podiatry"). But for some students to go on to residency and some to not do a residency with the same education those 4 years...I don't think it would be enough.
 
Why do we go through residency you ask? We are physicians. Physicians go through residency. I have a lot of respect for dentists but they are generally not phycisians nor are they really pushing for parity. ( my dentist did say some do one year residencies but that is not to common now.

My thoughts are is there was something missing in the 25 that did not match. Yes they passed but there is a world of difference between being eligible for residency versus truly exceeding expectations and having your sh$&t together so that a program director is rushing to get your match offer sent out.
 
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The way the current curriculum is set up, 4 years of podiatry school only prepares you to become a resident. It does not prepare you to be a practicing podiatrist. If we started learning clinical skills from day 1, MAYBE 4 years would be enough without any surgery (meaning no surgical classes either...that time would be spent learning "general podiatry"). But for some students to go on to residency and some to not do a residency with the same education those 4 years...I don't think it would be enough.

I think this is where the change needs to be made. The clinical skills need to be started from day 1 so that people can practice. The whole idea of someone going to school for 4 years, doing well, accumulating $200,000 + in loans and still not being able to practice is down right suicidal to me. It's INSANE. I can understand the poor people that flunk out because maybe they didn't deserve to be in pod school but to those that still do well and don't match are **** out of luck. I just can't wrap my mind around that. They at least deserve to practice something. It may not be the highly lauded specialties the field provides but at least general podiatry.
 
As recently as 2 years ago I might have agreed with you guys. But towards the end of your 4th year, you'll see that while there's a lot you still need to learn, there's a lot you already know how to do. And, unless you're clueless, many attendings will trust you to take the reins for formulating treatment plans and interventions (for basic and common problems).

Do you think you'll become that much better at casting for orthotics between the time you begin and finish residency? How about debriding nails? Freezing/burning/hyfercating/lasering warts? Training at the right residency would surely improve your skill at heel pain injections, but so would 3 years as an associate in most offices.

I'll admit, the prescription pad is a thornier issue.

No, I'm not saying we should lift the residency requirement to practice. All I'm saying is that I have a LOT of training already, and I think it's perverse that the medical assistant with an associate's degree is more qualified to work in a podiatry office (under the eyes of the law) than I will be with my doctorate, until I find a program to train at.
 
I find it interesting of how people are proposing watering down their training and setting the profession back 20 years instead of focusing on building their own stats and CV. Life is going to kick anyone is the teeth pretty dam hard. Focus on how to rise to the challenge not on how someone will fix this problem or how you can lower the bar.
 
If you are fully qualified and spent 4 years getting a DPM degree, then you deserve to at least practice something. Simple as that. There should still be options for you.

Exactly! It's not a matter of rising to the bar at all. The residency shortage has kept people out of matching who have great stats simply because there aren't enough seats which is despicable to me. It pretty much says it doesn't matter of how hard you work because you're still not getting in anyways. That's wrong in every sense of the word. These people deserve to practice something. If you're going to work hard get the good grades and great GPA and still not get into residency with $200,000 in debt with no way to practice then the DPM degree isn't worth it. That could potentially have a bad effect on the field.
 
I find it interesting of how people are proposing watering down their training and setting the profession back 20 years instead of focusing on building their own stats and CV. Life is going to kick anyone is the teeth pretty dam hard. Focus on how to rise to the challenge not on how someone will fix this problem or how you can lower the bar.

how can it possibly be considered 'watered down' when the majority of podiatrists practicing today do not have a 3yr residency? Only very recently (within the last year or so) has the requirement been changed to 3yrs. Hardly jumping back in time 20 years 🙄 Not all podiatrists want to do reconstructive surgery and there is plenty of need for the 'family medicine types' in podiatry. 50% of the population is going to have diabetes before too long, and not all of them will need an ankle joint replacement or achilles tendon repair. I don't see the need or reason why everyone has to be trained to that level. Just look at dentistry...
 
I don't see the need or reason why everyone has to be trained to that level. Just look at dentistry...

I see a need/reason. Still not sure if I agree with it though.

For parity/scope of practice issues, creating a standardized three year residency program makes it much easier to educate others and defend our training. Will it suck years of life out of podiatrists who don't want the surgical training or will never use it? Absolutely. But it is for the greater good. Whether or not you think that reason is justified is up to you, but that is one of the prominent reasons anyways.

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If you are fully qualified and spent 4 years getting a DPM degree, then you deserve to at least practice something. Simple as that. There should still be options for you.
There is a wide degree of difference between meeting the minimum qualifications versus being so good at the field that the Program Director has made the decision that you are the best one for that spot. Whomever is taking on a resident is taking on a degree of liability that might come with that person. Even if they have a DPM and the PD does not feel they are up for the task they will not want that person at their site.

Other example on this, at my work we use Temps as a talent pipeline to entry level full time R&D chemistry positions. We had a temp, DePaul B.S. chemistry (30K a year college) and there was a full time spot waiting for him after 6 months. So he invested 4 years and well over 100K to get his bachelors. Long story he sucked at his job and was let go after 6 months. Did he invest significantly to get the degree and training YES, did he meet the requirements for the position YES. Did he prove himself unworthy of a job that was practically going to be handed to him and mess up on having months to prove himself (notice how our temp to full time path is kind of similar to clerkship to residency, just an observation) OF COURSE YES.

Exactly! It's not a matter of rising to the bar at all. The residency shortage has kept people out of matching who have great stats simply because there aren't enough seats which is despicable to me. It pretty much says it doesn't matter of how hard you work because you're still not getting in anyways. That's wrong in every sense of the word. These people deserve to practice something. If you're going to work hard get the good grades and great GPA and still not get into residency with $200,000 in debt with no way to practice then the DPM degree isn't worth it. That could potentially have a bad effect on the field.
I would really love to see the stats of the roughly 25% of grads that did not match. I am guessing there are not many who graduated in the top 10% of their class that are in that company. There is highly likely some red flag in their application, be that grades, interpersonal skills, clinical skills, recommendation letters.
Lets face it, just about anyone can get into one of the 9 POD schools, we have people with 15MCATs, sub 2.75 GPAs getting in. These people obvisously got through college and there are probably a few that get the minimum requirements to get the diploma. Getting back to the first point that just meeting the minimum does not really entitle you to anything. Just do not end up in the bottom of your class and you are probably going to be fine. For more ellaboration on this idea read the book Winning by Jack Welch. He keeps going on of how it was GEs policy to keep firing the bottom 20% of your workforce, you just do not want to have them around.
I see a need/reason. Still not sure if I agree with it though.

For parity/scope of practice issues, creating a standardized three year residency program makes it much easier to educate others and defend our training. Will it suck years of life out of podiatrists who don't want the surgical training or will never use it? Absolutely. But it is for the greater good. Whether or not you think that reason is justified is up to you, but that is one of the prominent reasons anyways.
Very well put Max, we have come a long way from being at the level of a DC and now getting to parity with the MDs and DOs. We did not do that by loosening standards or requirements. Becoming a physician is extremely hard work, lots of investment, lots of hoops to jump and a while lot of getting mired in BS along the way. I would not want to get treated by a physician who is only focused on the minimum of what they need to know.
I was thinking about this problem and had a question. Obviously after the 4 years of school podiatrists must do residency to be licensed and practice. My question is instead of this, why can't podiatry be like dentistry where you complete the 4 years of school and then you can practice general podiatry leaving the residency only for those who want to specialize? Wouldn't this cut down on the amount of people going into residency?
If the OP is interested in just having clinical knowledge and does not have much risk tolerance I would question whether DPM is the right field for them. This field has some risks and a lot of work ahead of it. If someone is interested in just hitting the ground running by dealing with patients perhaps PA or Nursing might be a better fit (both of which are excellent career fields I may add.)
 
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