Apollofx: My previous response was less of an analysis than a comment on the analysis by dtrack (his analysis quoted below). I really hope everyone who put forth an effort passes. I was just trying to say it would be ideal if there was enough positions to cover eligible new graduates. This would at least prevent a snow ball effect keeping the level of unmached residents stagnant. I admit this is not a true solution to the situation, but at this point residency genesis if not going to make up the difference in the numbers. The only way the numbers are going to come into line for this year is if the prophecy of dtrack is fulfilled. Either way it is a bad situation and a lower pass rate just pushes the problem off to a future time and place.
Unmatched c/o 2013 by School
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Apollofx: My previous response was less of an analysis than a comment on the analysis by dtrack (his analysis quoted below). I really hope everyone who put forth an effort passes. I was just trying to say it would be ideal if there was enough positions to cover eligible new graduates. This would at least prevent a snow ball effect keeping the level of unmached residents stagnant. I admit this is not a true solution to the situation, but at this point residency genesis if not going to make up the difference in the numbers. The only way the numbers are going to come into line for this year is if the prophecy of dtrack is fulfilled. Either way it is a bad situation and a lower pass rate just pushes the problem off to a future time and place.
I think my thoughts and intentions are being lost in translation. --> Read: Class of 2014, please don't kill me. I'm rooting for you guys.
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I agree, and it highlights the fact that we need a solid solution to the problem which is something I have not even yet seen a glimpse of. I know programs don't start overnight but from my perspective it seems that nothing is really happening, it seems no different than it was pre-shortage in terms of program creation in my opinion. This is especially true when you talk about the net addition of programs, given some programs which have closed. It is what it is for now I suppose.
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551 current seats is around 30 more positions that exist now compared to last year's match. 30 seats in less than a year seems like progress to me. It's 30 more seats than most MD/DO programs could generate in a year (outside of specialist programs like Derm that can often afford to pay residents with money that the resident is generating for the hospital system/academic institution, meaning they don't "need" GME money to support the entirety of a resident's salary).
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I have not heard that number and cannot confirm it, as I said it has been months since an update I have seen. If true, I agree BUT keep in mind that what makes the shortage so damaging for the unmatched in my opinion is that a DPM really has no use if a residency isn't obtained. It does not have the respect, recognition, or flexibility that an MD has and while it would still be difficult to be an unmatched MD it would be very easy to market yourself simply because you are an MD. For example you could pursue pharmaceutical sales etc....
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You don't need to confirm it. I did. And those numbers are from Oct....
Also, exactly what ankle breaker said
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I highly doubt your pay would compensate for the enormous debt you've accumulated, but that being said I agree the option would be worth pursuing for those who never match.
I guess I would like to see some more current numbers especially before everyone goes into boards and interviews, not ones three months old, but maybe I am asking too much.
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You aren't asking too much, you just aren't realizing that "numbers" (in terms of student participation in CASPR) have not and will not change until after the match. Part II board scores won't be released until Jan. 24 and even then everyone who didn't pass has a second opportunity to do so prior to the match. Once the second administration of Part II is scored and released, any individuals who still haven't passed will be automatically removed from the match. Until then, there won't be any fluctuation in the number of students participating in CASPR because there is nothing that would eliminate anyone other than voluntary withdrawals (maybe a handful of pre-2012 grads? Maybe).
So what do you want to see that's more current than the number of students who were enrolled in CASPR as of Nov?
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Dtrack!!! Someone might have dropped out since November!
On a serious note: don't we usually expect about 10% of programs don't participate in the match? I know we won't know for sure until the match happens, but if there are 550 seats, won't we expect to see ~50 not take anyone? I think I recall that from previous years... I'll admit I haven't been following this as closely now that I'm in school though, so I could be wrong about that.
On a serious note: don't we usually expect about 10% of programs don't participate in the match? I know we won't know for sure until the match happens, but if there are 550 seats, won't we expect to see ~50 not take anyone? I think I recall that from previous years... I'll admit I haven't been following this as closely now that I'm in school though, so I could be wrong about that.
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Shouldn't you be following more closely since you are in school? 😉
There usually are some programs that don't take residents but 50 spots sounds like more than what it usually is.
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You're thinking of the "approved" positions and programs that are always posted by the AACPM. An approved seat is just one that the CPME has accredited/authorized but the program has either voluntarily not opened the seat or hasn't secured funding for.
That number is around 590 (can't remember off the top of my head). It's about 30-40 more seats than the ones actively participating in CASPR as of Oct 31. Same goes for approved programs which was around 225, even though only 215 were active at that time.
I know of two programs that I visited and one or two others who are taking an additional resident starting this year. I know those couple programs are making those positions permanent ie if they were 2/2/2 they will be 3/3/3 by 2016. What I don't know is if those decisions were finalized with CASPR when this last report came out. So the number of seats could in fact be a tiny bit higher than my original post.
That number is around 590 (can't remember off the top of my head). It's about 30-40 more seats than the ones actively participating in CASPR as of Oct 31. Same goes for approved programs which was around 225, even though only 215 were active at that time.
I know of two programs that I visited and one or two others who are taking an additional resident starting this year. I know those couple programs are making those positions permanent ie if they were 2/2/2 they will be 3/3/3 by 2016. What I don't know is if those decisions were finalized with CASPR when this last report came out. So the number of seats could in fact be a tiny bit higher than my original post.
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Ahhh gotcha. Thanks!
And ldsrmdude, no way! I've got to study! I can't waste all my precious free time trolling SDN!
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You need to re-think your priorities. Would you rather have Internet stardom on SDN or an increased GPA in real life? SDN should win every time.
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If I made the decision you should but, sadly I do not. It should at least help and put one more thing on your side and show them you are serious about placing.
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Yea, its about doing as much as possible on the limited resources I have, considering blew most of my money flying around during scramble. Wasn't able to visit too many places since then, but I probably interviewed the most at CRIPS. If I match this year I'm gonna write a book on this inane process.
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chober, having had interviewed as a previous graduate what kind of reception did you get from programs? I hope you match this time around, every qualified applicant deserves a position and I'm sorry you found yourself in this horrible position.
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Reception was good, they wanted to see that the reapplicant has kept busy the previous year, preceptorships, conferences, observation in OR, Cadaver workshops, research etc. Toughest part is that reapplicants are competing against people that have externed at programs. Its difficult to match at a program if interviews is the first contact they had with you.
After talking with the Dean at Barry, 10 entered the scramble, 6 did not match, 4 of the 6 were placed in residencies by the end of the week of the match, and the last 2 who didn't place lacked or didn't have enough drive (I don't remember what the words were, exactly... But, that is how I perceived the last 2) to be placed.
I think what stood out to me regarding Barry is that they did eventually place 8 out of the 10, shortly after Match Day. I am sure there is more to the story about the last 2 that they didn't want to share because of how it will portray the school, but I can't make an assessment as to what that story is.
My friend in DO schools was offered a pre-match position in radiology at a hospital. Do they do that for pod residencies if they find a student to be an exceptional candidate? Or, is that unheard of?
I think what stood out to me regarding Barry is that they did eventually place 8 out of the 10, shortly after Match Day. I am sure there is more to the story about the last 2 that they didn't want to share because of how it will portray the school, but I can't make an assessment as to what that story is.
My friend in DO schools was offered a pre-match position in radiology at a hospital. Do they do that for pod residencies if they find a student to be an exceptional candidate? Or, is that unheard of?
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Prematch for DOs is illegal so I would wonder if he was being truthful or did he mean they are ranking him highly?
Nope. They offered her a prematched spot and she accepted. They still have to rank them as #1, etc. But, they guaranteed a spot for her, with a signed contract.
Follow-up to what I originally said:
I am doing some Google searches, but so far, prematching is not "illegal." If you accept a pre-match, you have to withdraw yourself from the NRMP and accept it as a pre-match, as well as sign the contract. This means that you aren't taking advantage of the system because they then aren't applying to other residencies even though they were guaranteed that spot, leaving those others open for other applicants.
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That still doesn't make sense to me and maybe I am not understanding but how can you "rank" someone if they are not participating in the match? Also I would be very hesistant to go to a program that has to prematch to fill? Also I think your right about prematching but the following criteria must be met(see below).....
How the All-In Policy Works: Some Details
Beginning with the 2013 Match:
During the past two years, the NRMP solicited and considered comments regarding the implementation of the All-In policy. Many comments focused on whether exceptions to the policy were warranted. The NRMP determined that a limited number of exceptions were needed to achieve a given aim. The following are not subject to the All-In policy:
How the All-In Policy Works: Some Details
Beginning with the 2013 Match:
- Any program participating in the Main Residency Match must register and attempt to fill all of its positions through the Match or another national matching plan.
- Programs must place all positions in the Match or no positions in the Match.
- The All-In Policy applies to all PGY-1 and PGY-2 positions for which the NRMP offers matching services.
- The All-In policy applies at the program level, not at the institution level. This means that some programs at a given institution can decide to go “all-in,” while other programs at the same institution can choose to go “all-out.” Programs are identified by their Accreditation Council for Graduate Medical Education (ACGME) number.
- This policy does not apply to fellowship programs.
During the past two years, the NRMP solicited and considered comments regarding the implementation of the All-In policy. Many comments focused on whether exceptions to the policy were warranted. The NRMP determined that a limited number of exceptions were needed to achieve a given aim. The following are not subject to the All-In policy:
- Rural Scholars Programs: students graduate from medical school in three years and commit to a primary care specialty at that school.
- Family Medicine Accelerated Programs: students make an early commitment to Family Medicine and are channeled into that track.
- Post-Supplemental Offer and Acceptance Program (SOAP) positions: positions created after SOAP for partially-matched applicants who failed to secure the PGY-1 position required to fulfill their binding PGY-2 Match commitment.
- Off-cycle appointments: training positions that would begin prior to February 1 of the year of the Match.
- Military applicants who train in civilian programs.
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Pre-matching for podiatry is "illegal" in the sense that you are thinking about it. By that I mean that it would be illegal to sign a contract before the match. There isn't necessarily anything against a program director saying "I'm going to pick you #1" and a student saying "I'm going to rank you #1." That is fairly common. Now because it isn't in writing and isn't binding, that means either side could screw the other side over without much in terms of retribution. That's why your clinical coordinators will all tell you not to trust a program when they tell you how they will rank you.
I must have not made myself clear...
She pre-matched and accepted. In order to do that, you withdraw your name from the match service because the contract is, indeed, signed before the match happens. By withdrawing your name from the application pool, you do not take over spots that other applicants could potentially match with. Is that not the same for podiatry?
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You made yourself clear. That does not happen in podiatry.
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My experience that if you are top (however many residents they take), you are told at interviews or shortly after. I know a few places also that will contact you if you are top 5-10, but won't tell you your specific rank unless its top (again, however many spots they have).
I'd venture to guess there are quite a few students who know where they'll be in July assuming they pass boards. Even more know where, "at worst," they'll end up because they are in the top at a program who isn't their #1.
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My experience has been similar to dtrack and anklebreaker.
The way the match works favors the students. It benefits the programs to try and convince you to rank them as high as possible therefore a good number of them will give you feedback. Some programs are vague while others will outright tell you "we are ranking you top 2/3/4/etc". A lot of programs are known to do this will do this year after year.
A word of caution. I've heard from previous years of students getting burned, so be careful. I would ask previous grads which programs traditionally stick to their word.
Wait, the 551 seats as of today will most likely change by the time Match day comes around. Didn't a bunch of programs back out last year a month before match day? Who is to say that won't happen this cycle?
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That was as of an Oct 31 report and it is likely to change before match. By how much and in which direction, I don't know. So far, it has been going up with more programs and seats being added than programs closing. Currently, Ochsner in LA is the only program that has closed (1 seat) since that report while more than 1 seat has been added.
By "a bunch" of programs do you mean 4-5? Because then, yes, "a bunch" of programs backed out before the match. But then several of them ended up taking residents after all (ie Baltimore VA) and new seats opened up. "A bunch" of programs could absolutely withdraw from CASPR this year. I don't think it will happen but you never know.
I guess I should be more specific. I remember it as being around 20 spots dropping out of the match? There was an article linked on SDN about it and how students were mad at the timing of the programs that dropped out.
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Yes, what I call a significant number of programs withdrew within the two weeks prior to match and this could definitely happen again so we truly wont know a representative number until the day of or day before match like last year. While I mean no insult dtrack22, I believe that your interpretation of the matter is rather rose colored and while some positions were added post-match if all the programs that withdrew never did so we would have a lower number of unmatched. You also have to keep in mind that for the unmatched that 1 position can be the difference between being able to practice or working at Walmart.
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http://www.podiatrym.com/search3.cfm?id=70343
It's gonna get ugly really fast. If too many pod students default on their loans due to not gaining a residency then fed loans may no longer be an option for podiatry students. Schools may begin to close. Something needs to happen.
It's gonna get ugly really fast. If too many pod students default on their loans due to not gaining a residency then fed loans may no longer be an option for podiatry students. Schools may begin to close. Something needs to happen.
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I agree 100%, the profession is on a dangerous path to self annihilation. You also have to keep in mind that those numbers have to potential to be dramatically different come match day if a large percent of students fail part II or we see a significant number of programs withdraw right before match again this year.... We will all know soon enough I suppose!
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True but it seems like officials are hoping and praying that students fail boards to help with the crisis. If thats the case that's messed up.
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Yes messed up indeed. It's also not a long term fix if students fail boards, it's a bandage that will help this year until they retake and pass.
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Schools have to start accepting less students. Here are a few numbers that the AACPM needs to look at.
Class of 2014: Expected 558 graduates
ACGME Orthopedic Residency Graduates (MD): 640
AOFAS F&A Fellowships: 72 spots
I think the numbers speak for themselves...
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@janV88: Eh, I disagree here. I would agree if every DPM graduate plans on being only a surgeon, but that simply isn't the case. There's a lot of money in other areas of podiatry that people routinely discount (you could argue that the only goal of the current residencies are to create surgeons, but that isn't the point here) when considering the numbers.
Quick math. Let's assume the average person get's their DPM at 27. Let's say they retire at 67. That's 40 years of practice (again, just to keep numbers easy). If we graduate 550 students per year for 40 years, and every DPM works 4o years, the DPM pool would be about 22,000. We currently have about 15k. I understand that is a 50% increase in DPMs over 40 years, however, medicine is moving toward the left and access to care has never been greater. This is not a discussion on reimbursements/salary, so let's just look at the need for a podiatrist. As the number of people with access to care increases dramatically, and we have an aging population, the need for a 50% increase in podiatrist over 40 years IS warranted. TONS of patients are currently not seeing their podiatrist for foot and ankle problems, but this will change as the current healthcare landscape is changing from a focus on primary care to specialists.
As I alluded to earlier, these numbers are sustainable once we realize that not every DPM is going to wield the scalpel 24/7. The APMA recognizes this, and Dr. Garoufalis said that he expects within 4-5 years (perhaps as soon as current 1st or 2nd years), they will completely change the look/feel to podiatric residencies. What he/I means by this is: removing surgical numbers from requirements of a residency so that programs that want to focus on limb salvage, wound care, private practice, biomechanics, etc. can thrive. Personally, I find the 4-5 numbers dubious, but at the very least we know the professional leaderships recognizes this problem and plans on addressing it once we've established a viable 3-year model that works for all qualified graduates.
Quick math. Let's assume the average person get's their DPM at 27. Let's say they retire at 67. That's 40 years of practice (again, just to keep numbers easy). If we graduate 550 students per year for 40 years, and every DPM works 4o years, the DPM pool would be about 22,000. We currently have about 15k. I understand that is a 50% increase in DPMs over 40 years, however, medicine is moving toward the left and access to care has never been greater. This is not a discussion on reimbursements/salary, so let's just look at the need for a podiatrist. As the number of people with access to care increases dramatically, and we have an aging population, the need for a 50% increase in podiatrist over 40 years IS warranted. TONS of patients are currently not seeing their podiatrist for foot and ankle problems, but this will change as the current healthcare landscape is changing from a focus on primary care to specialists.
As I alluded to earlier, these numbers are sustainable once we realize that not every DPM is going to wield the scalpel 24/7. The APMA recognizes this, and Dr. Garoufalis said that he expects within 4-5 years (perhaps as soon as current 1st or 2nd years), they will completely change the look/feel to podiatric residencies. What he/I means by this is: removing surgical numbers from requirements of a residency so that programs that want to focus on limb salvage, wound care, private practice, biomechanics, etc. can thrive. Personally, I find the 4-5 numbers dubious, but at the very least we know the professional leaderships recognizes this problem and plans on addressing it once we've established a viable 3-year model that works for all qualified graduates.
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Currently and in the past few decades this was the case but with new healthcare laws and bundled payments, I think the shift will go back to primary care in the coming years. All everyone seems to be talking about right now is the primary care shortage and the push to increase managed care (PCP gate keepers). Pressure from Washington and the introduction of bundled payments (which penalize PCPs for referring to specialists) may actually decrease the need for specialists.
As for the increase in access to healthcare. Before the ACA the uninsured number was around 15% (2012). Even if all 15% become insured, I don't think this number is large enough to warrant a 50% increase in Podiatrists.
True limb salvage and wound care is a surgical specialty. This patient population will develop acute infections. They will develop deformities that may need to be corrected to reduce risk in the future. They will have wounds that do not heal and amputation may be a better option. Charcot patients may need reconstruction or plantar planing. I didn't realize this until I spent a month at Medstar (Steinberg's program). They do a ton of amputations, TALs, STSG, washouts, etc.
Biomechanics isn't just all about orthotics, braces, and shoes. You will have patients where this is just not enough. Post traumatic patients may need fusions or arthroplasty. CP, CMT, and other neuromuscular patients may need tendon transfers, tendon lengthening, reconstruction, fusions, etc. The same can be said with PTTD, lateral ankle instability, cavus foot, etc.
I strongly disagree that Podiatrists are not surgeons. I agree that we are trained to do a lot of non-surgical care but in order to provide comprehensive foot and ankle care, we must be surgically trained. Or we can do what non-surgically trained podiatrists do...orthotics, clip toe nails, and refer out.
Sorry for diverting the thread.
