04/29/2013 Robert Kornfeld, DPM
104 Applicants Not Matched for Residency Positions (Brian Kiel, DPM)
Dr. Kiel points out that there are some podiatric
medical school graduates that are not qualified
to do a residency. I do not think this is the
point. On this thread, there are those who have
made valid points, those who have blamed the
leaders, those who have called for change, those
who say we need to decrease enrollment, etc.
However, I have not seen anyone coming forward
with a plan to address this in real time.
I personally offered the 104 a pre-residency
fellowship in integrative podiatric medicine on
this forum. This would be a grand undertaking on
my part, but with the help of all DPMs, colleges,
state associations and APMA, it is not only
possible, but will train these DPMs in the
eventual and unavoidable paradigm shift in
medicine. I received many e-mails from interested
graduates who would like to become Fellows.
I sincerely wish to extend my invitation to this
profession to lend their support to my efforts. I
have partnered with a non-profit organization and
any donations made to our cause will be fully tax
deductible. Over 14,000 DPMs who read PM News
every day. I am willing to turn my life in a
totally different direction to give back to this
profession by creating a serious and
comprehensive training program for these
podiatrists. But I cannot do it alone. I need
this profession to rise to the need and partner
with my efforts.
This is a great profession. Just think how you
would feel if you were one of the 104. Let's do
this together and make it a win for podiatry. As
I said in an earlier post, I welcome conversation
and inquiries from all in this profession.
Robert Kornfeld, DPM, Manhasset, NY,
Holfoot153@aol.com
04/27/2013 Andrew Cassidy DPM, MS
104 Applicants Not Matched for Residency Positions
Once again, the leaders of our schools and the
CPME have missed the boat. I was one of those
unmatched residents 13 years ago. I ended up with
an unmatched residency that was new and not up to
par compared to other residencies. I ended up
opting out of that residency's second year and
then had to try the match system the next year.
As a person going through the match a second
time, I can tell you that there is a stigma
attached to them, whether they deserve it or not.
There are many reasons why someone may not match,
but it is beholden to the schools and CPME to
make sure everyone that has put in the time and
money and met the appropriate requirements to
have a position when they graduate with over
$200,000.00 in debt.
The financial burdens on new graduates are 10
fold what they were 20 years ago. I was lucky to
get a good fellowship and then finish my second
year of residency at another institution. My
advice for those unlucky 104 is to keep plugging
away at it, because those powers that be will do
little to help.
As for those who say that we should regress back
to the days when there were multiple type of
residencies. Are you serious? It is hard enough
in this profession to deal with the public as
well as other physicians not giving us the credit
we deserve for our skills, but to have our own
peers try to make it less clear and more
confusing is absolutely crazy!
I was fortunate to finally get the training I
needed, but it was all do to my own efforts and
without the help of my school or CPME. The onus
is on the leaders of the schools to make sure
that their enrollments match the number of
residencies period. Saying that some of our
graduates should not be surgeons is incredulous.
Either they should decide that before they go
into podiatry or decide it after they finish a
surgical residency. I truly feel for those
unmatched graduates. Keep open to all options and
good luck.
Andrew Cassidy DPM, MS, Austin, TX,
andy@lonestarpodiatry.com
04/19/2013 Jeffrey Kass, DPM
104 Applicants Not Matched for Residency Positions
I was wondering if there was any update on the
residency crisis other than CPME offering to
allow existing programs the ability to increase
their residents if they wanted. This "solution"
is at best anemic as evidenced by the response
the current programs have given. Is this the best
and only response we as a profession can offer?
Fellowships are typically offered after residency
programs. I propose we do things backwards
as after all, this is how we seem to have gotten
into this quandary. Offer these deserving
students fellowships. I would propose mandating
the podiatry schools open one-year fellowships
for the students they took money from for 4
years, and give some of it back to them, in the
form of a fellowship. This way, the student will
not lose a year as they can still be involved in
the field, they can respectfully have some form
of salary, the schools will have
a "responsibility" in the students they decide to
accept into their programs.
The school can decide on the type of Fellowship.
Look what Thompson Reuters report has done, well
why not publish more of these types of studies?
The fellows can work on this. Why not offer some
diabetes fellowship or biomechanics fellowship,
concentrate on something non surgical in nature,
maybe, even a fellowship stipend to Lobby on
behalf of the profession - whatever it may be.
The above idea may not be fool proof, but it is
something that current leadership is failing to
do or at least failing to do publicly. Readers on
here, and the unmatched are crying for a proposal
of some sort, doesn't anyone hear them?
Jeffrey Kass, DPM, Forest Hills, NY,
jeffckass@aol.com
04/19/2013 Joe Agostinelli, DPM
104 Applicants Not Matched for Residency Positions
Let's think out of the box on this. Is it time to
consider a radical change in our podiatry world?
Should we have a goal of letting the DPM degree
sunset, having our students attend regular MD or
DO medical school for four years, complete a one-
year internship, where you learn to be a
physician first, then complete a two-year
residency in podiatric medicine/surgery with
follow on specialty fellowships to develop
a "regional foot and ankle specialist" MD or DO
physician?
Please do not comment that we are
already "physicians" according to some federal
definition that has no practical application when
it comes to Medicare/Medicaid, or military/VA, or
various scopes of practice.
I have followed this residency crisis on this
venue and others, and am amazed that many are so
now concerned when this situation should have
been foreseen. The solutions I am hearing are
indeed confusing and impractical - pre residency
fellowships? Additional no- pay additions to
present residencies?- preceptorships?
There was a plan to increase residencies several
years ago. Did not the colleges project how many
residencies were going to be available to the
graduating students, thereby accessing that
number?
I do not think placing blame on individuals will
solve anything, but it seems to be the way
general society has become in dealing with
complex issues.
I think we need a total abolishment of our
present educational system and start from scratch
to develop a new path to a regional foot and
ankle specialty fully accepted by the public and
professional medical communities, not the
patchwork acceptance we now have.
I remember the residency crisis several years ago
when the solution was to quickly develop
additional residencies that miraculously appeared
out of nowhere. We will see....
Joe Agostinelli, DPM, Niceville, FL,
jmpa21@cox.net
04/19/2013 Leonard A. Levy, DPM, MPH
104 Applicants Not Matched for Residency Positions
Jumping to Conclusions about the Current
Residency Crisis: An Evidence-Based Approach
The number of podiatric medical students failing
to match in the current residency cycle has
nothing to do with number of schools. First year
student enrollment in 1985 was far fewer than the
number enrolled today, even though there are now
more podiatric medical schools. Furthermore, the
U.S. population in now more than 308 million
compared to 281 million in 2000. Also, today more
than 40 million people are age 65 and over
compared to 35 million in 2000.
By the year 2020, when newly enrolled podiatric
medical students will be completing their
training, the need for podiatric physicians will
be ultra-acute with almost one of every five
Americans being 65 years of age and older. Each
of these people have an average of five chronic
diseases, most with disorders having pedal
manifestations, stressing podiatric medicine and
the entire health care system. In addition, the
current epidemic of diabetes with its devastating
complications in the foot will be paled by the
much wider distribution of that disease in 2020.
Due to the aging population, degenerative
arthritis will run rampant, a prime cause of many
podiatric medical problems. To point to the New
York Metropolitan Area as the litmus test
negating national need for podiatric physicians
is also absurd and a disservice since that part
of the U.S. currently has only 3 percent of the
nation’s population.
In addition, suggestions to shorten the required
period of residency to 2 years is retrogressive,
the antithesis of achieving parity with
allopathic and osteopathic medicine. The current
age distribution of DPMs will, like in the case
of MDs and DOs, lead to a major cohort of these
physicians retiring in the next five years. It is
clear that we must increase the number of
residency positions expeditiously. But it is also
clear that we must increase the number of new
podiatric physicians. Not to do so will surely
increase the number and types of lesser trained
health workers performing tasks that requires the
care of fully licensed podiatric physicians.
Leonard A. Levy, DPM, MPH, Fort Lauderdale, FL,
levyleon@nova.edu
04/15/2013 Simon Young, DPM
104 Applicants Not Matched for Residency Positions (Robert Eckles, DPM, MPH)
I reviewed Dr. Eckles comments and beg to
disagree with his conclusions and comments.
Firstly, I do believe there are too many colleges
of podiatric medicine matriculating too many
students. In my opinion there is no shortage of
podiatrists, at least not in the NYC area. In the
NYC area, I can count no more than 20 orthopedic
foot and ankle surgeons. For example, the spinal
surgeons are all thriving. They are thriving
because there aren't many in the market to
provide their services and they have a strong MD
and hospital referral base.
Dr. Eckles feels with about 400 DPMs in the NYC
area, that there is a shortage- I strongly beg to
differ. I still feel there is no shortage in
these truly hard economic environment with
increased overhead, decreased patient flow,
decreased reimbursements and decrease income.
There is nothing wrong with a profession being in
demand which allows its members to better thrive
in challenging times of this medical
metamorphosis.
The new NYS scope of practice law will impact
only a certain few and will have minimal impact,
especially with dwindling insurance
reimbursements.
Dr. Eckles, being a faculty member of the NYCPM,
argues and implies that colleges are not tuition
driven and that certain faculty members earn
market rate incomes. I know many of the schools
have low level faculty members who do not earn
significant sums of monies. A select few do very,
very well. I believe all the schools of podiatry
are tuition driven and subsequently place our
future graduates in economic trauma and hardship.
I beg to disagree with Dr. Eckles that NYCPM or
any podiatry school is excellently competency
driven. I would like to hear from the current
students. My personal experiences and
observations have been different.
I agree with Dr. Eckles about abolishing the abcs
of residency. I feel mandating a PSR-36 for
everyone would fail since in my opinion there are
not enough rearfoot/ankle cases to graduate
hundreds and hundreds of competent podiatrists.
In, NYC with its restricted laws, it can not be
done without orthopedic foot and ankle
participation. I see no problem with reverting to
a majority PSR-24 and select PSR-36 format. It is
simple, non-confusing, and will fulfill our
professional needs.
This shortage in residency positions is a
travesty. We need information from federal,
state, and local governments as to what their
long-term goals are, and which hospitals are in
jeopardy of closing. We will solve the problem by
closing some schools, matriculating less students
than there are residency slots, improving our
education in podiatry school and residency, and
reverting to PSR-24 and PSR-36 formats, which
will result in more competent practitioners.
Simon Young, DPM, NY, NY, simonyoung@juno.com
04/15/2013 Michael J. Schneider, DPM
104 Applicants Not Matched for Residency Positions
According to the CPME website, there were 113 new
first year residency positions this year. I
empathize deeply with the unmatched graduates who
qualified but were not afforded the opportunity
of a residency. The issue that strikes me is that
things have dramatically changed in the practice
of medicine since I graduated NYCPM in 1983.
Upon graduation we had the option of opening a
practice, entering a one or two-year residency,
or doing a preceptorship. A podiatrist could then
go on to open his own practice bearing the cost
of equipment (usually financed), rent etc. The
podiatrist would open his/her doors
and “Bam”!...a practice was born.
We dealt mostly with indemnity insurance along
with Medicare and Medicaid. We submitted our
claims and were paid “usual & customary” by the
indemnity insurers and received reasonable
Medicare reimbursements.
Things have changed. We are (all disciplines in
medicine) now burdened with mountains of rules,
regulations, constraints, meaningful use, fixed
reimbursements, rejections and mounting threats
of audits. The reimbursements are pathetic. For
example, if you see a compromised patient in a
nursing or skilled care facility here in Colorado
and perform a nail debridement (11719) the
Medicare reimbursement is between $7.00-$8.00.
Where are these 200+ graduates going after
graduation and or residencies? How many will be
able to afford to go out on their own to fulfill
the dream of owning their own practice? Most
students and residents graduate with incredible
debt. To add to that there is the monumental cost
of complying with all of the above mentioned
mandates, EMR etc. Unless daddy is wealthy, it
may be very difficult to accomplish the dream of
private ownership.
That leaves employment by a large podiatry or
multi-specialty group and I get the impression
that option is quite limited. Limited in the
number of positions available and limited to
the “braniacs” of podiatry. As posted on PM News,
many states require a three-year residency for
licensing. Where does it leave the podiatrist who
didn't get a residency and the podiatrist who
completes his residency with nowhere to go?
Moreover, with the aforementioned onslaught of
rules, regulations, etc. and more of the same
coming as the Affordable Care Act implements over
the next few years, physicians and the populous
just might be forced into universal healthcare
and socialized medicine. Many believe that was
the original intent of this administration. The
government will control all aspects of
healthcare.
I was one of the lucky ones. I had a terrific
podiatrist join my practice in 1997. He became my
partner and purchased my interest in 2011.
In “retirement” I see home bound patients on a
fee for service basis and do some pro bono work.
Not financially profitable but it keeps me
busy..and....I have not had to fill out a HCFA
form or deal with the insurance bureaucracy in
quite some time. I sincerely hope that viable
options open up for the 104 and all podiatry
school graduates in the future.
Michael J. Schneider, DPM, Denver, CO,
podiatristoncall@gmail.com
04/11/2013 Jeff Kittay, DPM
104 Applicants Not Matched for Residency Positions
As usual, Drs. Jacobs and Markinson have hit two
nails on the head with one hammer. The gall that
CPME, AACPM, and the collective colleges have to
continue to recruit innocents, take their
borrowed money, and then put them on the street
with a half-hearted "well, we never promised you
a rose garden", is nothing short of criminal.
APMA and the ridiculous Projects 2015, or 2020,
or 3000 just don't get it. Not every DPM wants
to be a surgeon and no one should not be
required to become one.
The state societies who have lobbied state
legislatures to pass restrictive (and, I
believe, unconstitutional) laws requiring 3-year
surgical programs while there are insufficient
programs for all graduates, are unconscionable
and a disgrace to our profession. They do not
lift us up, but simply keep larger slices of the
insurance pies for themselves while professing
to be raising the standards. And if I hear or
read the word parity one more time, well, just
be glad I don't own a gun.
Parity is equality. DPM is not the same as MD,
never was, never will be. If parity is what you
want, change the degree at the podiatry schools
or attend an allopathic or osteopathic
institution. We are podiatrists; some surgeons,
some palliative, some sports medicine, some
dermatologists, some wound specialists, but most
generalists that like the variety of different
patient care scenarios.
I graduated NYCPM in 1979 and was denied a
residency at the school and was informed
that "We thought that some of your classmates
really needed the extra training more than you
did." This after telling us for four years that
we would be unable to make a living without a
residency. The unfortunate 104 this year have
infinitely larger debts than I did, but at least
I could practice.
Open up the schools immediately to all 104
unmatched DPMs, take them in today and provide
them with whatever training and paper
documentation they need to practice. You have a
moral obligation to them. And then
systematically dismantle the AACPM and CPME.
They have proven themselves unworthy of the
responsibilities they have been given.
Jeff Kittay, DPM, Boston, MA,
twindragons2@verizon.net
04/10/2013 Bryan C. Markinson, DPM
104 Applicants Not Matched for Residency Positions (Robert Eckles, DPM)
Dr. Robert Eckles is a scholar and a gentlemen
who I have known for several years. Regarding
his explanation on how all involved are doing
what they can, he states "It is a personal
affront to hear how we all care so little about
our students when few making these comments have
even been to a DPM college in the past 10
years." I, in fact do deal with former and
current students at many schools regularly. He
goes on to catalog efforts at NYCPM to
encourage, remediate, and support the students,
while creating a friendly environment for a
great student experience. I am sure this is
true, and I am sure all the colleges' respective
administrations feel similarly about their
efforts.
Be that as it may, admitting any prospective
student to any college of podiatric medicine
before they sign on the dotted line without full
disclosure of what they may be facing upon
graduation, and then bringing them into the
freshman class, is absolutely NOT CARING. Dr.
Eckles, and all well-meaning officials like him
across the country do not have the right to be
personally affronted until the disclosure I
describe is made. Once disclosure is made, and
students accept the risk (yet another question
of who would), then everything he states is
beautiful and just and correct. However, until
such routine disclosure, what he describes is
like promising to lead them to OZ and then
having an earthquake swallow up the yellow brick
road at the 'one more mile' marker.
Bryan C. Markinson, DPM, NY, NY,
Bryan.Markinson@mountsinai.org
04/10/2013 Thomas Graziano, DPM, MD
104 Applicants Not Matched for Residency Positions
This discussion may go on indefinitely because
the leadership in our profession has failed to
address an important key issue. Podiatrists are
limited license practitioners. Our model should
parallel that of another limited license
profession that has done well for quite some
time, namely dentistry. The powers that be have
painted our profession with a rather broad brush
stroke. They are working toward a mandate that
everyone that enters podiatry school have a 3-
year residency program and be a "surgeon."
Any of us who have been in the business long
enough realize that this is a ridiculous notion.
Some graduates are not meant to be surgeons.
It's almost like we are forcing their hand
towards that end. Those in dentistry who wish to
become oral surgeons go on to do a surgical
residency. Many graduates of podiatry school are
more comfortable with podiatric medicine,
orthopedics, etc. They don't need a 3 year
residency.
In year's past when residency were not available
to every student colleges exposed and prepared
students for the clinical situations they would
encounter in the office. Let's revisit that
concept. A one-year internship in internal
medicine would then be made a mandatory
requirement by all states to add to the
knowledge they hopefully gleamed during their
years of clinical training in podiatry school.
This will better prepare them to understand
medicine and work comfortably with their medical
peers once they enter practice. Let them become
board certified in podiatric medicine and be
recognized by insurance panels. The APMA should
work toward that inclusion.
Ethical guidelines also need to be addressed. A
surgical case should be referred out to a
trained and qualified surgeon, again following
the lead of dentistry. Let those students who
wish to be surgeons go on to do a surgical
residency. The number of residency slots will
then be filled with only those candidates and
the shortage solved.
Thomas Graziano, DPM, MD, Clifton, NJ,
TGrazi6236@aol.com
04/08/2013 Joseph Borreggine, DPM
104 Applicants Not Matched for Residency Positions (Robert Eckles, DPM)
Finally, a voice of reason and clarity. Dr.
Eckles is the only person who makes sense. I
suggest that Dr. Eckles attend and speak at
every upcoming major DPM convention this year.
You need to speak to the masses. He has
summarized everything that should have been said
weeks ago when this happened.
He is right. I was one of the first critics who
responded to this matter on PM online and did
not have anything good to say because I was
reminiscing more about what happened to me 25
years ago. I did not have any facts to back up
what I was saying. For that, I sincerely
apologize for my ignorance on the matter.
You should make sure that these facts are
resounded by the APMA and CPME to the membership
and/or anyone who may know the facts. Silence
has been the mantra of these two organizations
as a response to this "so-called" crisis. Yes,
they both recently responded in a format letter
to the membership to explain what they are doing
for the profession in regards to policies
already in place regarding podiatry residency
programs. However, this did not even come close
to what you provided in your recent post.
Just one question? What took you so long? This
knowledge and impeccable wisdom you have on this
subject is exquisite to say the least.
I have been trying to establish new in roads in
downstate Illinois to develop podiatric
residencies ever since I was president of the
Illinois Podiatric Medical Association in 2009-
2010.
In the coming weeks, the IPMA and myself will be
trying to establish a meeting with the acting
CEO of the HSHS Medical Group, Melinda Clark
(mclark@hshs.org).
HSHS is the Health Sisters Hospital System
(www.hshs.org) and is 13 hospital system in
Illinois and Wisconsin that has the ability to
have multiple 3 year podiatric residency
programs. This would be a great success for not
only the profession, but for Illinois if this
were to happen.
I have been an active staff member at one the
hospitals affiliated with HSHS since 1999 which
is St. Anthony's Memorial Hospital located in
Effingham, Illinois. There are two other
podiatrists on staff there, but they do not do
as much surgery as I do since one of them does
more at a local surgery center and the other is
involved with the hospital's wound care center.
I probably do on average 2-3 cases a week which
is probably not enough to support a podiatric
surgical residency, but if we were to combined
the cases of two other hospitals that are within
the HSHS system this may be feasible.
The other hospitals of which I speak of are St
Mary's Hospital in Decatur, IL and St. John's
Hospital in Springfield, IL. These hospitals are
located in much larger metropolitan area and
have many more on staff podiatric surgeons that
would increase the number of surgical cases
necessary to establish a 3-4 position 3 year
podiatric surgical residency.
Therefore, I strongly urge and suggest that you
assist me in this endeavor and send an email
correspondence to Melinda Clark at HSHS and to
one of her colleagues Peter Mader
(pmader@hshs.org) educating them on exactly how
and why a podiatric surgical residency program
should established at HSHS.
As a side note, Melinda Clark is an RN, BSN and
is quite knowledgeable of the podiatric
profession and its importance in health care
because was a affiliated with a podiatric
residency when she work in Texas as a hospital
administrator.
There are also other opportunities in Champaign,
IL that could be another place for a podiatric
residency, but for some reason none have ever
been established.
There are leaders in our profession who
currently practice in Champaign, IL that have
yet establish a podiatric residency. Drs. Kim
Eickmeier (PICA board member) from the Christie
Clinic and Sean Grambart (ACFAS Board member)
from Carle Foundation Hospital who I have tried
to contact on many occasions in the past few
years regarding this matter, but to no avail
there has been little or no action or response
on the matter.
If you could also help me in educating these
individuals by contacting them personally, I
would greatly appreciate it.
Another concern that is currently affecting
Illinois podiatrists is the legislation that was
passed in July 2012 to help save $7.9 billion in
the Public Aid program. This law called the
SMART act restricted the ability for DPM's in
Illinois to only see children from ages 0-19 and
only diabetics from 20-64.
This restriction of patient access has
unfortunately eliminated the ability for the
podiatric residencies to see these patients and
hence has decreased the number of potential
surgical cases that may be seen by a podiatric
residency as compared to a year ago.
This is unfortunate and could be damaging to
currently established or the potential
development of new podiatric residency programs
if it is not remedied.
The IPMA is currently working to solve this
issue by trying to carve out any hospital or
teaching institution from the SMART act that is
currently training and/or educating podiatric
students or residents. This will allow these
institutions to see public aid patients without
restriction of age or disease and be reimbursed
fully for the services provided. It will also
provide the ability for those patients requiring
care to receive proper, timely, resolute, and
cost-effective care by our profession.
Again, I thank you for clarifying what is and
has been happening regarding the podiatric
residency shortage along the pertinent facts and
necessary solutions to this situation. I look
forward to your response and assistance in
developing residency genesis in Illinois.
Joseph Borreggine, DPM, Charleston, IL,
footfixr@consolidated.net
04/06/2013 Bret M. Ribotsky, DPM
104 Applicants Not Matched for Residency Positions
To the 100+ graduates of podiatry school without
a clear path today, I want to share a lesson in
life that you will learn to embody, “Sometimes
your worst times become your best.” I have had
the opportunity to interview over 210 (so far)
of the best podiatrists in the country on Meet
the Masters and there are a few distinctions
that are evident. Regardless of any bad
situation (divorce, death of a family member,
hurricane, or fire), what you focus on that will
affect your destiny and in turn, your life.
Dealing with the problem in front of you today,
I offer a few suggestions for you to consider:
• Contact residency programs and offer to attend
without compensation. Even if you do not get
credit, you will gain experience that will
assist you the following year with the match.
• Find/develop a research year with a doctor,
college, etc. Consider it a research year.
There are many projects that need to be done.
Physician-initiated research is a great source
of income for many doctors from Big Pharma, and
to quote master Richard Pollack, DPM, “it’s the
last source of retail medicine.”
• Explore working for a successful DPM for a
year, even as a medical assistant. What you will
learn in this “practice management fellowship”
will return to you great value.
There is no question, you have been wronged, and
the leadership of this profession is working on
a plan to assist you, but you must STAND UP and
use this injustice to catapult your success.
Many great companies were started in a
depression (Apple, IBM, SouthWest Airlines) SO
CAN YOU.
Just to make this empathic as opposed to
sympathetic, here is my story. In 1988, when I
graduated, about 45% did not get residencies. I
matched with my 21st choice and attended a one
year podiatric orthopedic residency. I could of
focused on all the promises I was given, etc.,
or figure out how to make this the best year of
my life. I volunteered to teach at PCPM (TUSPM
today) and learned the foundation on how to
become a great lecturer. I re-applied into CASPR
and obtain a great 2nd and 3rd year surgical
residency in Utah. That first year, which was
not where I was hoping to be, has lead me to get
involved in podiatric orthopedics that many
years later, lead me to become president of
ACFAOM.
I leave you with a mantra that has served many
great leaders throughout time. Ask
yourself, “What is great about this?” and ask it
over and over and over again. In the beginning,
you will answer “nothing” but keep asking, as
learning to ask better questions (of yourself)
will get you a life with overflowing abundance.
Control your Focus!
Bret M. Ribotsky, DPM, Boca Raton, FL,
ribotsky@gmail.com
04/06/2013 Robert Eckles, DPM, MPH
104 Applicants Not Matched for Residency Positions
Regarding the current residency position
shortage, I feel compelled, after review of the
dozens of online comments made on PM News and
elsewhere, to write from the position of
Graduate Placement Director and Associate Dean
at one of the 9 colleges of podiatric medicine.
There have been many assertions made in recent
weeks, generally summarized as:
• There are too many colleges of podiatric
medicine.
• There are too many students in the colleges.
• The Colleges care nothing about the students;
their interests lie only in tuition dollars.
• Deans and other college faculty earn “huge”
sums of money in education.
• There should not be mandatory 36-month
residency training for graduates.
Without exception, these comments are untrue and
reflect either unfamiliarity with the numerical
facts of the situation or understanding of the
whole of podiatric GME in the U.S.
To start, let me agree with one point that has
been made over and over. It IS tragic and
heartbreaking that a qualified student/graduate
cannot enter post-graduate training. We all
acknowledge that and since we deal with students
on a daily basis, we are closer to it than
anyone else out there. The question is what do
we do about it? Many have complained about the
problem without offering real solutions to it.
Let me tell you what I think.
It is important to note that admissions numbers
for each of the colleges is determined by the
CPME, not by the AACPM and not by the design of
the colleges. The CPME sets these numbers based
on each institution’s proven ability to provide
required training resources. All Colleges, as a
result of the Council’s understanding of the GME
issues at hand, had their entry intake- 2012-
reduced by 10% in 2011. What is little known
however, or reflected upon, is where we now
stand in terms of matriculants and graduates,
historically. In the 1979 when 5 colleges
existed, the number of graduates was 572.
This number fluctuated in the 80’s and 90’s, but
bottomed out in the mid- 2000’s, when a decade-
low average number of graduates- 432-sought
residency positions. The fact that we will, in
May, graduate 578 individuals from the 9
colleges indicates how fragile the argument for
further reduction in class size or number of
colleges is.
Does anyone really believe that our profession
will do better, especially at a time of
documented need, with fewer podiatrist
practitioners? Does anyone really believe that
we have such universal recognition and standing
as providers and as physicians that we could
survive a reduction in numbers? Remember that
when there is a void in lower extremity clinical
practice, the cry will not be ”let’s have more
podiatrists!” it will be, thanks to physical
therapists, nurse practitioners, general
practitioners, pedorthists and orthopedists; “WE
can do those procedures.” Marked reductions in
the number of highly credentialed graduates of
residency programs will lead to only one thing-
marginalization of the profession in ways that
could be catastrophic.
Clearly, college enrollment and tuition create
an economic calculation for each college, and no
college will want to further reduce enrollment,
but it is clear that while the colleges are the
portal through which graduates enter residency,
they are not running the spigots wide open; most
colleges could in fact effectively train more
students than they have been permitted to
enroll. And let me advise here that faculty of
podiatric medical colleges, and let’s include
administrators like myself, do NOT earn salaries
that are out of proportion to the private sector
and are in most cases, well below what that
individual could earn elsewhere. To state
otherwise is to create a fiction and to degrade
the commitment and professionalism of faculty at
these colleges.
It is a personal affront to hear how we all care
so little about our students when few making
these comments have even been to a DPM college
in the past 10 years. Let me offer an open
invitation to anyone who wishes to come to NYCPM
and visit, to actually see what we do here to
provide excellent, competency-driven education
for our students, to remediate them when they
struggle, to compassionately assist in their
personal lives where we can (or must), and to
prepare them, finally, to become qualified to
enter residency training.
So, what about the residency positions
themselves? Well, here are some more facts. In
the past 90 days the CPME has approved an
additional 108 positions in currently accredited
residency programs. This is a rare offering, and
is in fact round TWO of such offerings (the last
in 2011), where all a program has to do in order
to officially open more positions is to
respond “YES” to the Council’s letter.
Basically, what the Council offered in 2011 and
is currently offering, if effected by the
programs, would eliminate the position shortage
in 24h. In addition, in the transition to the
PMSR model- 2011-2013, the Council also lowered
required surgical training volumes for 3-year
programs to the 2-year levels (apart from
reconstructive RF and Ankle procedures) to make
program compliance uniform and easier. So any
argument that CPME has not responded to this
issue is also invalid.
But how many programs have said yes? Another
fact- that number is 5- 5 positions have
resulted from this effort. Less than a 5%
return. Of course, there are numerous reasons
why programs may hesitate or decline this offer.
GME reimbursement flows to hospitals based on 3-
year averages of residents, so hospitals do not
automatically increase their GME money flow on
day 1 of such an increase. Too, and importantly,
programs have an obligation to their current
residents and to the overall approval standards
under which they operate to NOT stretch the
training volumes to the place where residents
graduate without achieving competency.
As a program director, I get this (and yes, my
application to open another position is in).
Still, only 5 out of 108?
So why not unwind the current podiatrist GME
requirement altogether? Do we really need 3-year
residency trained podiatrists? I vote,
unequivocally, yes. As someone who used to
administer, from the old alphabet of residency
designations, RPR, POR, PPMR, PSR12, and PSR-24
programs, and who completes credentialing
requests from hospitals, insurance companies,
and surgery centers every day, I can only advise
that multiplicity in podiatric GME confuses the
public and may lead to serious scope and
liability issues. In fact, the advanced scope of
practice bill in NY which will come into effect
in February of 2014 could NOT have passed, had
the legislature not seen that GME training was
finally consistent and fully grounded in this
advanced scope, academically and clinically.
You may argue that in the course of podiatric
practice complex presentations don’t come along
that often. You may be right, but again, I think
not. Practices and practitioners grow based on
exactly where their expertise is. Those who have
particular proficiency in wound care or sports
medicine, OR reconstructive surgery grow
practices that thrive and reflect these specific
interests. No one can really say “these cases
just aren’t out there” for the simple reason
that if you don’t do this work there is no
reason why a patient would be referred to you
for it. The unification of GME training models
into 3-year training creates competence,
consistency and importantly, parity with
allopathic and DO GME training. Why would we
ever entertain going backwards?
Let me make one final comment. The voices rising
in outrage over this shortage blame everyone and
everything for the problem except themselves.
Not one person has ever written to ask, “what
can I do?” Here it is, and it is something I
have been saying in front of our CME audiences
for years. Do you do office or surgery center-
based surgical procedures where there are no
residents? Don’t. YOU may be the one who
determines how many positions a hospital can
qualify for. Take these cases to a teaching
hospital near you. Invest your time in the
training of residents.
If you feel you are connected sufficiently to
this profession to complain about where we are
then do something to change the future.
Robert Eckles, DPM, MPH,
Dean, Clinical and Graduate Medical Education,
Director, Podiatric Medical Education-
Metropolitan Hospital PMSR/RRA, reckles@nycpm.edu
04/05/2013 Barry Finkelstein, DPM
104 Applicants Not Matched for Residency Positions
I would like to add my thoughts to lend
encouragement to the students who did not match
for residency positions.
I found myself in a similar situation in 1997
when my residency ended abruptly after one year
without proceeding to the surgical year(s). I
ended up joining the work force and then
returning to a 3-year surgical residency several
years later. It was the best professional move I
have made. To be sure, the financial strain was
enormous; however, the rewards have been worth
it. I would be glad to speak with anyone in this
situation, if for no other reason than to remind
him/her that there is hope.
I would like to propose a limited suggestion,
although I admit that I do not know the
feasibility (financial, liability, etc.) of
implementing this idea.
Perhaps the schools could set up mentorship
programs with practicing doctors for their
graduates who do not match. These graduates
would scrub cases and work part time with the
mentor doctors. Upon completion of a one-year
program (or longer if necessary), the mentor
would complete an evaluation form and letter of
recommendation to assist the graduate in
obtaining a residency (Graduates would also
complete evaluation forms of the mentors).
If mentors were accurate in their assessments
and provided proper training to the applicants,
residency directors would hopefully come to rely
on the mentors, giving greater credibility to
the program. Obviously, no Medicare funding
would be available for such programs, so my
recommendation would be for these programs to
function part-time.
If the mentors did not have to pay the
graduates, I believe both parties would benefit
and doctors would be eager to mentor. The
podiatry schools would also benefit in that they
could maintain their enrollment numbers. The
proposed program would need to be available only
for a limited number of graduates, otherwise the
applicant pool would keep growing (not
diminishing) each year.
Back when I was in the position of the
applicant, I would have eagerly joined such a
program, if the program was known to properly
position applicants to obtain desired residency
positions.
Barry Finkelstein, DPM, Bronx, NY, bf1818@aol.com
04/03/2013 Robert Bijak, DPM
104 Applicants Not Matched for Residency Positions
Numerous opinions have been proffered to solve
podiatry's educational problem except the
correct one. The correct solution is to realize
that the foot and/or ankle is too narrow of an
anatomical/disease entity to necessitate the
present number of graduates and residents.
The answer is to change the DPM to a full scope
specialty emphasizing lower extremity and gait
uniquely, as Osteopathy is full scope with its
unique philosophy of musculoskeletal-nervous
system etiology. This will immediately make the
graduates useful to hospitals and patients who
in reality need residents deemed to be FULLY
medically educated for the myriad of disease
entities and trauma seen in the real world, not
ELECTIVE, MINOR medical conditions and surgery
that makes up MOST of podiatry now.
This is not a new concept, and has been heralded
by the majority of the profession with the
exception of the colleges and APMA, who choose
to cling to their anachronistic fiefdoms.
Perhaps then, the American Board of Podiatric
Medicine can have more relevance than being a
consolation prize for those who didn't qualify
or pass the surgical boards.
Calling ourselves physicians is not enough. We
must actually become physicians. Podiatry is
like dentistry in many ways, and it is just as
inappropriate to tell students they're becoming
physicians as it is for a dentist to introduce
himself as a physician at a cocktail party.
Let's become real doctors, or stay podiatrists,
accept our limitations, and shut up. We can't
straddle the podiatrist- doctor fence any
longer. Jump on one side or another.
Robert Bijak, DPM, Clarence Center, NY,
rbijak@aol.com
04/03/2013 Leslie Levine, DPM
104 Applicants Not Matched for Residency Positions
Call me cynical, but here is my take on the 104
unmatched students. It's all about playing in
the insurance company reimbursement sandbox.
First, we need a little history. Back in
late '60s or so, a group of podiatric surgeons
from the American College of Foot Surgeons
grandfathered themselves in as Fellows, and in
doing so, convinced insurance companies that
they should be allowed to form panels.
A short while later, the sandbox was getting
full. The Fellows then formed the American Board
of Podiatric Surgery, guess who were
grandfathered in as Diplomates?
When it became obvious that the sandbox will
soon be crowded again, the state podiatry
associations which are usually top-heavy in
ACFAS and ABPS members managed to lobby various
state legislatures that it would be in their
constituents best interest to require
podiatrists to have a 3-year residency. The fact
that the public was served quite well for years
with non 3-year residency podiatrists did not
concern them.
Now enter the formation of the Podiatric Medical
Assistant. What a wonderful thing - the 104 non-
matched students and future non-matched students
can now work for a podiatrist. They can earn a
living (how they are supposed to pay back their
students loans is of little interest) but not
crowd the sandbox.
Leslie Levine, DPM, Orangeburg, NY,
LILevine@aol.com
04/03/2013 Chuck Ross, DPM
104 Applicants Not Matched for Residency Positions
I have been following the ongoing discussion
relative to the residency shortage and would
like to supply a little historical perspective
as I have not yet seen this appear.
Approximately 15 years ago, I was fortunate to
have been employed at NYCPM and was asked to
participate in a meeting of a coalition of
podiatric organizations that met in Washington,
DC to cover a variety of important issues.
My most memorable experience was being chastised
by one of the members representing the APMA, who
later became one of or Presidents. (I absolutely
knew from where this was coming and it was not
taken as a personal chastisement). The discourse
went as follows (please allow some
editiorialization due to the passage of time).
Q: What is NYCPM doing to reduce the number of
new students as we are faced with a tremendous
shortage of residency programs? (remember this
was 15 years ago and the 3-year mandated model
was not even a pipe dream).
A: I am unaware that there were restrictions
that were required to reduce the number of new
students. (Also remember that ALL the colleges
were tuition-driven at that time with several
experiencing some financial difficulties)
Q: Can you speak for your president?
A: How can anyone in this room speak for their
president in making a decision to reduce the
number of students? (How could I be expected, as
an Associate Professor in Biomechanics &
Orthopedics and a newly assigned Dean for
Student Services, be expected to make such a
monumental decision for my president. How could
I possibly know all the inner workings of the
College and why would the president assign me
that task-not that I would expect that he would).
So you see, we had a problem 15 years ago and
this is not new. What transpired during that
time may best be left for the greater minds in
Podiatry to ponder as to what may have been done
differently. Like everyone else, I too have my
own opinion but shall remain silent as I do not
believe many wish to hear what I have suggested
for a long time.
This is not meant as a condemnation of anyone
involved, but merely as a point of historical
information of what occurred 15 years ago with
no apparent long term proposals. Perhaps no one
could have anticipated this outcome but I
believe that there were always some visionaries
who could have created change if those in
authority cared to listen with an open mind.
Chuck Ross, DPM, Pittsfield, MA,
cross12@nycap.rr.com
04/02/2013 Hilaree Milliron, DPM
104 Applicants Not Matched for Residency Positions
Let’s say there is an imminent nuclear attack on
the United States. Mass panic occurs throughout
the nation. What do you expect your leadership,
the President, to do? The citizens would demand
some form of public address with a plan of
action in response to that imminent threat.
This may seem like a melodramatic metaphor for
our residency shortage predicament, but on a
scale of zero to bad, this is very bad for our
profession. Our leadership needs to step up and
go public with a specific plan of action now.
Desperate people often do desperate things.
Just look at the panic among us, who already
practice, in response to this problem. Our jobs
as “citizens” should be to decrease panic under
the guidance of our leadership while we get this
mess straightened out. Our office, in response
to this crisis, took on one of these unmatched
doctors as an employee in our clinic. This
doctor functions as a medical assistant and x-
ray technician, and is referred to as an intern
in front of patients. Sure, the pay is not
great, but it is a job and allows the doctor to
have hands-on experience, interact with patients
and other doctors, observe surgeries, and learn
practice management while waiting to get placed
into a program. I am certain there are many of
us around the country that would be willing to
allow for similar “internship” experiences if
asked to help.
We cannot develop Vision 2015, and then get
cataracts. Our profession needs consistency now
more than ever. If we compromise on our
training requirements after working so hard to
become more consistent, we will not progress. I
never had a guarantee of anything, but I
wholeheartedly believe these doctors deserve no
less than a guaranteed residency position
because we allowed this to happen to them. We
have to build trust and gain their confidence
again. These are our colleagues and we have to
find a way to help them without compromising how
far we have come.
Leadership: Make and implement a 3-year or 5-
year plan to put a cap on class sizes in all 9
schools to be less than the number of
residencies available to guarantee these doctors
get trained soon. Then use that time to figure
out how to never let this happen again. Find
people across the country willing to let these
doctors work and learn in the meantime. Make an
area publicly available to advertise on the
website to get these 104 doctors placed into a
temporary internship or something similar. I
can only speak for myself, but count me in if
you need help in ANY way making things happen.
I would guess quite a few will be willing to put
their time, energy, and money where their mouth
is and become part of the solution.
Hilaree Milliron, DPM, Jacksonville Beach, FL,
millirondpm@gmail.com
04/01/2013 Mark A Caselli, DPM
104 Applicants Not Matched for Residency Positions
As a former professor of orthopedic sciences,
director of both residency and fellowship
programs, and concerned podiatrist, I
respectfully submit this emergency plan to
provide our current unmatched graduates a
residency program that will qualify them for a
state license to practice podiatry.
1) The CPME must re-instate the RPR/PPMR/POR/PSR-
12 one-year residency programs. The guidelines
are already established.
2) The CPME must permit the colleges of
podiatric medicine to sponsor one-year residency
programs. The colleges already have qualified
faculty/clinicians to train the residents as
well as having established clinical rotations
into which the residents can be placed. Even
though this would be a tremendous amount of work
for the colleges, they have a moral, ethical,
and potential legal obligation to place their
students. This would also be financially
advisable for the colleges by protecting their
recruitment and enrollment of new students as
well as retaining their current students who may
now be thinking of leaving. Hospitals as well as
other health care facilities should also be
encouraged to pursue this path.
3) These new residency positions must be ready
to take in students in July, 2013 in order to
decrease the compound effect of the residency
shortage for future graduating classes.
4) The ABPM must provide a provision for
graduates of these one year programs to obtain
board certification.
5) This emergency plan must remain in effect
until there is at least a slight surplus of 3
year residency programs.
This proposal may not provide the ideal
residency experience for all, but it would
provide an educational experience at least as
good as that attained by the numerous (probably
majority) of competently practicing podiatrists
who are products of one of these one year
programs. In addition to aiding our students, it
is vital that this residency situation be
immediately resolved to maintain the credibility
of our profession.
Mark A Caselli, DPM, Ramsey, NJ
markcaselli@gmail.com
04/01/2013 Alan Sherman, DPM
104 Applicants Not Matched for Residency Positions (Bryan Markinson, DPM)
It is remarkable how often I agree with Dr.
Markinson – and his last comment on this topic
is no exception. Going back to a preceptorship
model is just wrong, we do need a lot more
podiatrists, but we don’t need to train more
advanced podiatric surgeons. There is a catch-22
situation in podiatric training that isn’t
discussed much (I’m not sure why) but it is
the “elephant in the room” during every
discussion on podiatric post-graduate education.
It goes like this:
In order to get on insurance panels, you must be
on a hospital staff. In order to be on a
hospital staff, you must be board certified or
board eligible. In order to be board certified
or eligible, you must do a recognized residency
program
So in effect, in order to get paid by insurance
companies, even for non-surgical services, you
must do a surgical residency and get trained as
a surgeon. So in recent years, since the change
to the 3-year PM&S model and now Vision 2015,
all podiatric residency programs are now
surgically-oriented and there is a shortage of
them. What we need is advocacy to hospitals that
a podiatrist needn’t be a reconstructive surgeon
to be a valuable member of the medical staff.
I think that with the growth of hospital
affiliated wound care centers, they would
understand that every staff podiatrist doesn’t
need to do reconstructive surgery or
amputations. And then we need to develop the
infrastructure of podiatric medical training
programs – not because there isn’t enough
surgery, but because we need more podiatric
physicians.
Alan Sherman, DPM, Boca Raton, FL,
asherman@presentelearning.com
03/30/2013 Michael J Marcus, DPM
104 Applicants Not Matched for Residency Positions (Lawrence Oloff, DPM)
About six years ago, a college grad called my
office and asked me if he could shadow me. He
spent several weeks with me. In time, he became
turned on to our profession. He applied to the
colleges, was accepted to Scholl, and did
satisfactory in his didactics. As March 20th
approached, I spoke to him and wished him luck.
At the same time, a student from Temple is
rotating in my clinic. He too was anxiously
awaiting the big day. The fourth year student
from Chicago didn't get a match.
My present student was fortunate to get a good
solid program. He was ranked in the top 20% of
his class. However, he has told me that some
students who had ranked even ahead him didn't
match. These students are frustrated,
discouraged, mad, and in a financial bind.
It appears that this calamity has caused many of
us to write in our thoughts. I have read my
respected friend, Dr. Larry Oloff's words
carefully-- his frustration and disgust about
this situation is apparent. This situation not
only affects these unmatched students-it affects
us all.
For more than twenty years, I have been involved
in residency training. In the last few years, I
have been increasingly impressed with the
quality of the surgical residents. However, I
didn't always feel this way.
Something needs to be done now to help these
unfortunate students, and something needs to be
done to prevent this from happening again
A task force needs to created ASAP to see if
positions or new residencies can be established.
I personally have worked with a program that is
closing. Why? Possibly, they should be contacted
and encouraged to continue to offer positions.
Dr. Oloff's suggestions should be considered.
The colleges need to reduce class sizes, either
through matriculations procedures or by
increasing requirements for college acceptance.
It is evident that there are too many graduating
students with not enough residencies - as a
profession. The association that most of us pay
handsomely to, must make a decision--do we want
quality or quantity? An explanation from our
association would be appreciated. I too am
discouraged, saddened and surprised by this
apparent lack of vision and consideration to
these students.
Michael J Marcus, DPM, Montebello/Irvine, CA,
ftmed@aol.com
03/30/2013 Joseph D. Pasquino, DPM
104 Applicants Not Matched for Residency Positions (Jeanne M. Arnold, DPM)
In an answer to certain of the concerns about
the Residency Shortage raised in the letter from
Dr. Arnold, I direct PM News readers to
Resolution 13-13
(http://www.apma.org/files/secure/index.cfm?
FileID=22091)presented to the March 2013 APMA
House of Delegates by the Pennsylvania Podiatric
Medical Association and seconded by the New
Jersey State Podiatric Medical Association. This
Resolution is on the APMA website and it
contains the most up to date facts concerning
residency development that we could determine.
If the current programs in development are
authorized, we are told that will have a
sufficient number of first year residency
positions within 12 to 18 months. That period of
development, however, will cause there to be
well over one hundred prior graduates who are
not matched.
The purpose of this Resolution was to foster the
development of educational opportunities which
would keep those hundred plus graduates involved
in podiatric education until they can match.
This Resolution calls upon all stakeholders in
this profession to contribute to this effort to
create opportunities for these graduates. We
need the APMA to publicize this effort, we need
the AACPM and the CPME to define the
requirements for opportunities which would be
effective and we need practitioners to open
their doors, undertake these opportunities and
help these graduates.
AAPPM has created a model. This may not be the
only one, but it is a demonstration that relief
can be manufactured. Last year their program
served over 20 graduates and the vast majority
of those participants matched a residency this
year.
Many of Dr. Arnold's other points are quite
valid and should be employed in an examination
of the lack of foresight that led us to this
point; however, right now we need to press
forward and solve this shortage as well as care
for the disenfranchised graduates who will need
opportunities in the next three years.
What we MUST convey to the students is that the
profession knows about this problem, cares about
this problem and is doing something to eliminate
it. Discussion such as this is an important
element in conveying that message to the future
of this profession.
Joseph D. Pasquino, DPM, President, Pennsylvania
Podiatric Medical Association,
jdpasquino@comcast.ne
03/30/2013 Bryan C. Markinson, DPM
104 Applicants Not Matched for Residency Positions
At last year's APMA Annual Meeting, the
COMEDIAN, of all people, told a packed room at
the conclusion of his act that the expected
surge in diabetes in the United States, (perhaps
a quadrupling in 20 years) is staring us right
in the face. He stated that we would be fools to
squander that opportunity. I felt bad that
something so obvious to him had eluded our
consciousness.
The federal government two years ago,
highlighted a study that indicates a severe
manpower shortage in podiatric medicine that
could not be met by even tripling the current
admission numbers to our schools. At the same
time, Vision 2015 was fully in place, a Vision
that told the world that from the top down and
the bottom up, from our schools, from our
residencies, and from our boards, that our
destiny was to create foot and ankle orthopedic
surgeons, whether our students wanted it or not.
Now due to the residency shortage, some of us
are clamoring for the closure of some schools
and/or reducing class size. All over the
country, colleagues speak of the difficulty and
frustration of starting new residency programs
in spite of having resources from APMA to
facilitate that process. And now, the idea of re-
inventing the preceptorship process is gaining
legs.
So we now find ourselves as a profession:
1) Unable from a manpower standpoint to provide
podiatric medical (emphasis on medical) care to
the segment of society that will need us most in
the next two decades.
2) With ample supply of podiatric reconstructive
foot and rearfoot/ankle surgeons who will be
peering out their office windows wondering where
the surgical cases are, and for those who may be
busy, finding those surgical services
increasingly de-valued by third party and
government payers. Even if all of them revert to
medical podiatry, the manpower shortage study
already has included them in their calculations.
3) Witnessing podiatric medicine being done by
PAs, NPs, and other physician extenders, partly
due to the manpower issue, and partly due to the
maniacal emphasis on surgery.
4) Reverting to a preceptorship culture, after
reversing that over the last thirty years, and
now needing the state licensing authorities to
recognize them again so our graduates can work.
We need more podiatrists, not podiatric
reconstructive surgeons. We need residency
programs in podiatric medicine. We need
residents lives not to be run by surgical
numbers which leads to neglect of non-surgical
aspects of training and embellishment of their
actual surgical experience, no matter how
vehemently their directors deny it.
We need the surgical boards and their leaders
and practitioners to stop treating non-surgical
podiatrists like crap at every level from
hospital credentialing to advising insurance
companies. Yes, that is a generalization and may
be unfair to a lot of people, but not enough
people to make it untrue.
Well, it looks like the result to me is a
comical "opportunity squandered." I call it
comical only to prevent me from crying.
Bryan C. Markinson, DPM, NY, NY,
Bryan.Markinson@mountsinai.org
03/29/2013 Parent of Podiatry Student
104 Applicants Not Matched for Residency Positions (Lawrence Oloff, DPM)
I am disturbed that the student’s point of view
has not been discussed. As the parent of a
current student, I have to bring up what is
happening in the schools now. The students are
freaking out over this. The rumors flying around
are that the pathway to fixing this problem is
to fail as many of them as possible, if not
through the 4 years, then by making the boards
harder to pass. This is totally unacceptable.
They are stressed enough getting through the
rigorous curriculum without having to worry
about residency shortages.
When our child was applying, we were told time
and again that “everyone who passes the boards
gets a residency.” First, we have to make sure
that someone is overseeing this to protect all
of our students. We need transparency: we need
to know the number of students who entered each
class (for the last 6 years or so), how many
dropped out, how many were added after the class
began (for example, failed one year and re-
entered), how many graduate, how many passed the
boards and how many got a residency and how many
residency applicants are applying from prior
year classes. We also need to know how many
approved and functioning residency positions
there are.
As to solutions:
1. The first step is to immediately move back
the requirement for 3 years of residency until
such time that there are enough positions.
2. Change Vision 2015 to Vision 2020. Include in
Vision 2020 the need to closely link admission
rates to number of residency positions.
3. Or perhaps consider changing the 3 years
of “residency” requirement to 3 years “post
graduate training” – which would allow 1 of
those years to be a preceptorship. Change some
of the 3 year residency programs back into 2
year programs and link them to a preceptor year.
4. Put a temporary limit on the number of
students accepted into the schools until the
residency shortage resolves, and ensure that all
current students will not in any way be
sacrificed.
5. It is not acceptable to “fix” the problem by
failing current students at a higher rate than
previous years. This is not the fault of the
students.
6. The schools must accept responsibility and
not accept students just to get increased
revenue from tuition. If there are too many
students, why accept more students in January?
This problem should be addressed by the schools
with honest, open discussions with the students.
All students get PM News and are reading about
this problem. They should be assured by the
schools that there will be no attempt to fail
students to solve this problem.
Finally – there are rumors that schools are
handling this problem differently. Some schools
are intentionally trying to force students out
by lowering grades so more fail, but other
schools take the opposite track – inflating
grades so their graduates have a better chance
of getting a residency.
Parent of Podiatry Student
03/29/2013 James J DiResta, DPM, MPH
104 Applicants Not Matched for Residency Positions
I rarely miss a morning read of PM News. In
fact, I often compare myself sitting at my
laptop reading PM News to my dad, who years back
each morning would survey the morning paper
drinking his coffee before leaving for work.
I could often sense his emotions as he looked at
the national headlines, box scores, and of
course the results of horse races from the
nearby track.
I wonder now what those around me are thinking
when I read entry after entry about this
enormous shortfall that our profession has left
with these unmatched residency applicants. Can
they feel my blood boiling? The moral obligation
here with so many unmatched student doctors is
to confront the problem at hand and fix it. No,
I don't mean a reasonable solution of attrition
over time, and no I don't mean for next year, I
mean right now.
I have a deep swallow solution. I believe one of
our profession's leaders, Larry Oloff, expressed
it clearly when he cited the colleges have the
obligation to provide each graduating student
with a residency opportunity. Convene a summit
now. The colleges need to have assistance
from CPME and APMA and other stakeholders to get
conditional approval of programs. As they
accepted these students, sold them on this
wonderful profession of ours, now it's time to
get it done and I'm tired of hearing it
can't be done. This is where money talks the
walk.
If you need to raise lots of monies quickly then
do it, and borrow as you need to and literally
suck it up. Provide the private funding for the
slots your college applicants have come up short
on. Get your alums to help where you can. Plan
to provide funds not just for the resident's
salary, but for the programs infrastructure as
well to incentivize to do it BUT freakin do it
and do it now.
There is a solution here. Get your heads out of
the sand and get the temporary fix done, and
then work diligently to get a long-term solution
in place. Do it now.
James J DiResta, DPM, MPH, Newburyport, MA,
james.j.diresta.DMS04@alum.dartmouth.org
