Residency Situation.

[JackedUp]

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I was just wondering about the residency situation as of right now. What is the ratio of Podiatric Residencies available to DPM graduates every year.?I know that in the past the number of graduates exceeded the number of residents. What is the current situation? Is there any reason to believe that something like that will occur again in the next few years. I will be starting at Scholl in the fall, and wanted to express some concern.

Also what should a student be doing in Podiatry School to help ensure that they could a snag a good residency upon graduation?

 

[Feli]

For your first couple years, just focus on getting the best grades you can and learning in each class. After that, study hard and pass boards (which should be no problem if you did well in classes). During the latter part of 2nd year, gather LORs and do your homework on residency programs. That way, you know where you want to do clerkships, and you can get your clerkship apps out right away. Worry about the clinical stuff when the time arrives, but it will benefit you to start learning a bit about the residencies before it's suddenly time to take boards, start clinics, and fill out your clerkship apps. That will sneak up on many people; it's a fairly hectic summer between 2nd and 3rd year.

...As for the residency:grad ratio, nobody really knows. There was a big surplus of residency slots in 2007, a slight shortage this year, there is predicted to be a bit more of a shortage this next year, and there is projected to be a significant shortage thereafter. It's impossible to say for sure, though. Residencies are created/closed or add/drop slots every year. Also, pod student attrition rate is higher than MD/DO since the pod schools are not currently as selective on the front end. Some years, 550 pod students might start and 400 graduate 4yrs later, but another class might see 650 start and only 375 graduate. You never know, so it's hard to predict how many residency spots will be needed 4yrs later for any given incoming class.

If you are concerned about the ratios, you should first learn about the situation and decide how you feel about it. Then, you may choose to ask your school's APMSA reps for details and/or write the APMA (CPME specifically) directly regarding investigating and, more importantly, enforcing each pod school's maximum enrollment cap. That wouldn't instantly solve the problem, but at least having more constant numbers of incoming students from year to year would be a good start. As it stands, some of the schools have greatly increased numbers of accepted students over the past few years in order to collect more tuition dollars.

In the end, I wouldn't let the potential of residency shortage deter your interest in podiatry, because, to be honest, it won't really affect you unless you are near the bottom of the barrel among graduates and residency applicants. You have picked a good pod program that will teach you well, and if anything, use the possibility of not getting a residency as motivation to study harder and eventually match with the best one you can. That said, having DPM grads out there who do not get residencies hurts everyone... even top practicing docs or students who just matched a "top 10" program. Lesser trained DPMs without residency training sure doesn't help the goals of parity or higher standards for the profession, and it's a problem that needs to be solved. Unfortunately, as students, there is really not a whole lot that can be done about it... besides making suggestions to those who are in position to do something.

 

[iceman69]

Approximately, how large is the shortfall of residency positions predicted to be in 2, 3, 4, and 5 years from now? Is there some one I can contact at the AACPM who would know? I'm curious as to find out.

 

[krabmas]

Approximately, how large is the shortfall of residency positions predicted to be in 2, 3, 4, and 5 years from now? Is there some one I can contact at the AACPM who would know? I'm curious as to find out.

If you ask the APMA they will report back that they are working very hard to prevent this. They will however give you no plan as to how they are preventing it. They did not expect a shortage this year until CRIPs happened.

They only thing that you can do is work hard. You can not control the amount of residency spots or your competition. You can only control how much you study and your ambition for obtaining a residency spot.

 

[iceman69]

Thanks for being honest and telling me what I already knew to be true.

 

[SportPOD]

If you ask the APMA they will report back that they are working very hard to prevent this. They will however give you no plan as to how they are preventing it. They did not expect a shortage this year until CRIPs happened.

They only thing that you can do is work hard. You can not control the amount of residency spots or your competition. You can only control how much you study and your ambition for obtaining a residency spot.

👍👍👍

 

[APMAHelp]

In August 2004, the American Association of Colleges of Podiatric Medicine (AACPM) Board of Directors established the ad hoc Committee on Balance between Graduates and Residency Positions. The Committee’s charge was to “collect data, analyze class size and enrollments and approved residency positions for the purposes of recommending strategies to ensure that there are enough entry-level residency positions for each graduating podiatric medical student.” The Committee consisted of representatives from AACPM Council of Deans, the Council of Teaching Hospitals (COTH), American Podiatric Medical Association (APMA), American Podiatric Medical Students Association (APMSA), Council on Podiatric Medical Education (CPME) and the Young Members Committee. In February 2008, the Committee membership was expanded to include the American Board of Podiatric Orthopedics and Primary Podiatric Medicine (ABPOPPM) and the American Board of Podiatric Surgery (ABPS).

Since March 2005 the Committee has been meeting twice a year via conference call, usually in February and September. Annual status reports are presented to the AACPM Board of Directors, APMA Board of Trustees and the APMA House of Delegates. It is through this process that the profession has been monitoring the number of training positions, particularly in light of the recent transition to the comprehensive podiatric medicine and surgery models (PM&S24 and PM&S36).

A face-to-face meeting of this group is scheduled to occur shortly. The short term plan is to increase the number of slots at existing programs. Since funding from the federal government is available for these programs, this potential major hurdle is alleviated. In fact, several programs have already begun the process of increasing slots where appropriate.

In the long term, new programs will be developed. The COTH has developed a reference guide to develop residency programs for use by interested individuals and institutions. This material includes access to current funding information. Additionally, the process to reformulate all programs into a minimum three-year program with uniform competencies will begin in the Fall of 2008. This is a tremendous opportunity for the profession, through collaboration between programs, to develop the necessary slots for all graduates. Again, because podiatric medicine, unlike other disciplines, is not subject to restricted funding for residencies, the funding of these programs already exists.

All that being said, it is important to note that that there will NOT likely be a shortage of positions for this year’s graduates. Unlike the last couple of years, the numbers will be close, but we just will not know until the completion of the residency scramble in the next several weeks. It has never been the case that the CASPR match numbers were the final indication of residency placements for each graduating class and we need to concentrate on placement stats.

Hang in there; there is a plan!

 

[JackedUp]

Thank You

 

[SubRosa]

From an incoming student, thanks. Encouraging at the least.

 

[krabmas]

In August 2004, the American Association of Colleges of Podiatric Medicine (AACPM) Board of Directors established the ad hoc Committee on Balance between Graduates and Residency Positions. The Committee’s charge was to “collect data, analyze class size and enrollments and approved residency positions for the purposes of recommending strategies to ensure that there are enough entry-level residency positions for each graduating podiatric medical student.” The Committee consisted of representatives from AACPM Council of Deans, the Council of Teaching Hospitals (COTH), American Podiatric Medical Association (APMA), American Podiatric Medical Students Association (APMSA), Council on Podiatric Medical Education (CPME) and the Young Members Committee. In February 2008, the Committee membership was expanded to include the American Board of Podiatric Orthopedics and Primary Podiatric Medicine (ABPOPPM) and the American Board of Podiatric Surgery (ABPS).

Since March 2005 the Committee has been meeting twice a year via conference call, usually in February and September. Annual status reports are presented to the AACPM Board of Directors, APMA Board of Trustees and the APMA House of Delegates. It is through this process that the profession has been monitoring the number of training positions, particularly in light of the recent transition to the comprehensive podiatric medicine and surgery models (PM&S24 and PM&S36).

A face-to-face meeting of this group is scheduled to occur shortly. The short term plan is to increase the number of slots at existing programs. Since funding from the federal government is available for these programs, this potential major hurdle is alleviated. In fact, several programs have already begun the process of increasing slots where appropriate.

In the long term, new programs will be developed. The COTH has developed a reference guide to develop residency programs for use by interested individuals and institutions. This material includes access to current funding information. Additionally, the process to reformulate all programs into a minimum three-year program with uniform competencies will begin in the Fall of 2008. This is a tremendous opportunity for the profession, through collaboration between programs, to develop the necessary slots for all graduates. Again, because podiatric medicine, unlike other disciplines, is not subject to restricted funding for residencies, the funding of these programs already exists.

All that being said, it is important to note that that there will NOT likely be a shortage of positions for this year’s graduates. Unlike the last couple of years, the numbers will be close, but we just will not know until the completion of the residency scramble in the next several weeks. It has never been the case that the CASPR match numbers were the final indication of residency placements for each graduating class and we need to concentrate on placement stats.

Hang in there; there is a plan!

Monitoring the situation is not a plan. Monitoring the situation implies reaction to the past, not forethought to the future.

Adding spots to residency programs means taking away cases and opportunities from other residents. I understand that all residents will still get minimum numbers, but minimum is not enough. I do not want to graduate w/ a sort of idea of how to do a bunion, I want to graduate feeling fully competent to figure out complications as they arise intra-op which does not come from minimal competencies. When I graduate, if I am an attending for residents I want to feel comfortable enough with my skills to hand the knife over knowing that I will be able to fix what ever the resident might do.

I would be very upset if all of a sudden there were 5 1st years at INOVA instead of 4. This would mean once less month of each rotation. One less month at georgetown, one less month on ortho trauma.... and 1/5 less cases on podiatry.

I think capping the schools is the answer. Churning out more podiatrists, but w/ less training is certainly not the answer or the way towards 2015.

 

[Feli]

Monitoring the situation is not a plan. Monitoring the situation implies reaction to the past, not forethought to the future.

Adding spots to residency programs means taking away cases and opportunities from other residents. I understand that all residents will still get minimum numbers, but minimum is not enough. I do not want to graduate w/ a sort of idea of how to do a bunion, I want to graduate feeling fully competent to figure out complications as they arise intra-op which does not come from minimal competencies. When I graduate, if I am an attending for residents I want to feel comfortable enough with my skills to hand the knife over knowing that I will be able to fix what ever the resident might do.

I would be very upset if all of a sudden there were 5 1st years at INOVA instead of 4. This would mean once less month of each rotation. One less month at georgetown, one less month on ortho trauma.... and 1/5 less cases on podiatry.

I think capping the schools is the answer. Churning out more podiatrists, but w/ less training is certainly not the answer or the way towards 2015.

I would tend to agree with this. It is not best to just keep putting out fires, and a more preventative attitude might be the most conducive to the profession's long term goals.

If a residency program adds new attendings and another hospital to cover cases at, then I could see adding a spot, but trying to rapidly add spots and watering down patient encounters and surgical case numbers just because the schools have accepted too many students doesn't really make sense. It also seems to delay the goal of getting all residencies up to quality 3yr program standards when there might not even be enough 2yr and 3yr programs combined for the graduating class sizes in the coming years.

I know that predicting the number of incoming students that will graduate (and therefore the number of residency positions needed 4yrs later) is not easy. Still, an enrollment cap at each school, based on outcomes such as the school's board scores and graduate competencies, is probably the best start towards getting a more predictable grad:residency spot ratio. Also, enrollment caps would help increase the app:accept ratio and improve incoming student quality, which ties into the #1 element in the 2015 parity goal: education. With higher overall incoming student quality, we would surely see less attrition at the schools, and then predicting the number of residencies needed would only get easier and easier in the future...

 

[Dr. Gangrene]

I think the key is an ENFORCED enrollment cap. Enrollment caps exist, but there is not really a penalty for exceeding. There has been talk of CPME (I think) making penalties, and hopefully that occurs. It seems to be you shouldn't accept hundreds more than the number of residency slots.

 

[efs]

Enrollment caps are not the answer. There is a predicted shortage of practitioners in the future, which means a need to increase enrollements. The trick is at the residency level not the graduate level.

Fortunately many of the programs see far more than the minimum or required numbers and are able to increase the residency positions. I think this is where the current push is.

Lots of good stuff out there now, and expect to see it increasing.

 

[stanza]

It is not the responsibility of residency programs to increase positions. That will only dilute the training. The root of the problem are the Schools. They are tuition driven and need to take more responsibility for the current situation.

 

[Feli]

...There is a predicted shortage of practitioners in the future, which means a need to increase enrollements...

I think the national shortage of pods (and doctors in general) is likely also, but there still has to be the student talent there in the applicant pool as well as the residencies spots available before enrollments go up. Just because a company needs to grow doesn't mean it hires the next dozen job applicants without even looking at their resume. The #1 part of resolution 2015 is education, which involves increasing app:accept ratio and the standards for incoming students as well as toughening up curriculum/boards. That is going to be hard to accomplish without significant talent in the people holding the pencils.

Some of the schools clearly do a very good job of being pretty selective of incoming students and then preparing them well for boards/residency with a tough curriculum. However, some of the schools have a nearly 1:1 app:accept ratio, and not all of the bad students will fail out. Some of the students who sneak through the cracks will end up having trouble passisng boards, getting a residency, and could end up having a tough time paying off loans and making good living. That is obviously detrimental to those individuals, but it also makes every other DPM out there, regardless of their personal competence, look bad when a colleague is not trained or can't function as a comprehensive lower extremity specialist that podiatry presents its practitioners as.

 

[Feli]

It is not the responsibility of residency programs to increase positions. That will only dilute the training...

I think that this is exactly right 👍

Last fall when applying for externships, a few of my own classmates were told by programs, "sorry, we don't have enough clerkship spots in that month you asked for a clerkship because we have to take school X students who need to do core rotations here." I have also personally offered to do extra days with local attendings and been told that it's a great idea... but they already have too many teaching responsibilities on many days with all of their clerks and residents. Between 3rd year students, 4th years doing clerkships, and then residents and fellows of various specialties, etc, most teaching hospitals are pretty packed and the attendings well covered. There's only so many people you can cram into an OR or exam room.

I think most residency programs will try to expand as they are able, and if they have cases/clinic/hospitals uncovered by students/residents, then they certainly should. The programs with ankle fx or flatfoot reconstructs going uncovered sure need to grow, but the ones with 3+ residents scrubbed in to do an Austin or some hammertoes obviously don't. Trying to push a program to expand just because the schools have accepted/graduated too many students might not be very sound reasoning...

 

[Dr. Gangrene]

Enrollment caps are not the answer. There is a predicted shortage of practitioners in the future, which means a need to increase enrollements. The trick is at the residency level not the graduate level.

Fortunately many of the programs see far more than the minimum or required numbers and are able to increase the residency positions. I think this is where the current push is.

Lots of good stuff out there now, and expect to see it increasing.

Actually, I think ENFORCED enrollment caps are the first step in a complicated answer. It is irresponsible to accept students into a school knowing they won't get sufficient training (i.e. residency) to be licensed to practice. Now, once residencies are increased, you can adjust enrollment. I know there will always be a gray area when trying to correlate these 2 things (enrollment vs. residency) but accepting 100+ more people than residency slots is wrong and unethical.

 

[SportPOD]

Enrollment caps are not the answer. There is a predicted shortage of practitioners in the future, which means a need to increase enrollements. The trick is at the residency level not the graduate level.

Fortunately many of the programs see far more than the minimum or required numbers and are able to increase the residency positions. I think this is where the current push is.

Lots of good stuff out there now, and expect to see it increasing.

Just like anything out there, things happen in cycles. I agree that we do need to have more practitioners out there, but increasing the class size will not be the way to go at this point. Until schools go away from being a tuition driven institution, enrollment caps should exist. This way there is at least a certain level of competence in the student, which will later translate into a better resident and then move on to a better practitioner.

With the way the economy is going alot of students out there will start looking to the healthcare field for a steady job (that pays well) and we will have alot more applicants. This happens on a cyclical basis and will continue to do so as the economy goes through it's cycles.

Increasing residency slots in an existing program does not make that program a better program, instead it will sacrifice training for the residents as it has already been alluded to on this post. We need to increase residency programs which will happen, but will take some time, in the meantime, we need to make sure that we get the quality out of the applicants out there and not focus so much on quantity.

(Just my two cents)

 

[GoldenGustie]

In my opinion, the responsibility is in every one of our hands: students, school administration, residency directors, and the APMA.

As far as students go, it would be great if we could all go back to our hometowns (or nearby) and chat with the local hospitals that currently have residency programs in other areas about starting a podiatry residency program. Also, simply by spreading the word to your undergraduate institutions about podiatry and what if offers gives students looking to do something other than the MD or DO route an "in" to the medical field.

As far as administration goes, they have to maintain the integrity of our profession by not simply accepting students just to pay the bills...of course easier said than done when the applications are not as high as one wishes they could be.

As for the residency directors, it has been mentioned many times in college meetings at DMU that additional spots could be added at programs nearly overnight if needed. I am not sure if this is only hear-say or if it is true, but I am sure it is possible at some programs.

And then there is the APMA, who have to do everything in their power to increase the number of attractive applicants to schools, without running into a big crunch for residency training like what happened in the early- and mid-90s. Along with this, they must continue to increase the profile of the profession in the eyes of those that still hold their old-school perceptions of podiatrists only being able to clip nails and shave corns...WE all know this isn't true, but some old-timers and lay public have no idea!

Overall I would just like to say that podiatry is such a unique specialty in that its numbers are very low making an extremely tight-nit group of individuals. Our profession has the capability of becoming the ultimate authority on lower extremity medicine and surgery (and in many places around the country already is). HOWEVER, if Vision 2015 is to succeed we all need to step up and do our share and not wait for the next person to take on the responsibility! 👍

 

[whiskers]

Plan accordingly would be my advice.

If you are concerned now, imagine how concerned you will be at year 3.5 with a 3.0GPA getting prepared to relocate anywhere in the states for whatever program you may or may not know nothing about.

Good luck.

 

[drmeggo]

Many people are very concerned now, especially my class, 2009 graduates. For those of us who have been hanging in there, middle of the pack type people, the stomach ulcer has just begun to form. All I know is that I am trying to shine on my externships and am already studying for CRIP interviews and boards next year. They tell us that the situation will be fixed by next year, but with 12 people going unmatched this year and then re-entering the match next year that is going to just put that much more of a strain on all.

I don't know who needs to do something, but it needs to be done now. Not later this year or when upwards of 25 people are jobless next March with > $130,000 in debt. Residencies and slots need to be put into generation now, not when there is a large shortage.

Not an expert, just a worried 2009 grad.

😕

 

[jonwill]

Many people are very concerned now, especially my class, 2009 graduates. For those of us who have been hanging in there, middle of the pack type people, the stomach ulcer has just begun to form. All I know is that I am trying to shine on my externships and am already studying for CRIP interviews and boards next year. They tell us that the situation will be fixed by next year, but with 12 people going unmatched this year and then re-entering the match next year that is going to just put that much more of a strain on all.

I don't know who needs to do something, but it needs to be done now. Not later this year or when upwards of 25 people are jobless next March with > $130,000 in debt. Residencies and slots need to be put into generation now, not when there is a large shortage.

Not an expert, just a worried 2009 grad.

😕

From what you say in your post, you probably aren't the type of student that needs to be worried. You'll do just fine. You sound responsible and you sound like a hard worker. "Middle of the pack" is fine for most programs as long as you have a good extern month. Programs tend to judge you on what they see, not what they see on paper!

At this point, the type of student that needs to be worried is the student that many would argue should have never been let into pod school in the first place. But you're right in that the problem needs to be better regulated and controlled while it is still small. The answer at this point is obviously not increasing enrollment at the schools!