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06/12/2013    David E. Samuel, DPM

Podiatric Residency Crisis - Where Are We? (Robert Kornfeld, DPM)

I read about the new graduates who do not have a
residency and feel sad, and frankly embarrassed
that we as a profession, have done this to them.
I have a great idea. Have whoever makes the
decision on opening new schools open even more of
them. That will work out great, right? That is
what happened over the last several years. Are
you kidding me? I spoke with others about this a
few years ago, and I hate to say I told you so,
but….It is ridiculous that we allowed that to
happen, and now have students who are being
cheated out of advanced training, with huge debt
and no way to get the training to pay it off.

First, we need to strongly look into who allowed
that to happen and do something about that
leadership. It is completely irresponsible to
allow this to happen and not be able to see how
many programs are out there and how many
graduates are coming out. It seems like simple
math to me. Also, we need to consider closing
these newer schools down. UNLESS we as a
profession, can GUARANTEE there will be advanced
post graduate training for our new colleagues,
and/or make sure that with EVERY pre Podiatric
Med School interview, the perspective students
are told and GIVEN IN WRITING, that there is ‘no
guarantees you will have a residency to advance
your training, THAT IS REQUIRED FOR YOU TO EVERY
PRACTICE’, it is wrong to keep taking students
money, then have them standing around after the
cap and gown service, trying to figure out what
to do now.

The respective deans of these colleges, governing
boards, etc. should be held accountable for non-
residency placement. What to do? I don’t know,
but perhaps pay the loans of these new graduates
(or their parents or them for that matter) for
every year they are left without a program?

Offering preceptorships is very kind and shows
the caliber of doctors we have out there, but
sadly this will get these new colleagues, no
closer to making a living. Now the following
year, they are back out scrambling for a spot,
with hundreds more new graduates flooding the
market. It is a snowball effect. With the amount
of time they may have to spend trying and waiting
to finally match year after year, they could have
become neurosurgeons.

When I finished school, there were 6 schools of
podiatric medicine and it was still not a
guarantee you would get a ‘good’ program or one
that would train you to be a good all-around
podiatrist who can do things from regular care
and biomechanics to foot/ankle surgery. I was
never told that prior to enrolling, and frankly
may have thought a little harder about saying
yes, if I was.

I was one of the lucky ones who got a good
surgical program that allowed me to learn and be
prepared to make a solid living in this field and
be able to pay back my debts. Now we flood the
market with podiatrist, who either can’t get
residencies to advance their training or accept
students to fill slots, just to pay the bills for
these new schools, and of course older ones too,
that should not be doctors and surgeons. With
allopathic and osteopathic medicine, those that
can’t make it through surgery or who do not have
the aptitude to be surgeons can pursue, or are
asked to pursue, non-surgical specialties.

As podiatrists, we do MANUAL work, as our bread
and butter. We use our hands besides our brains.
Please don’t jump all over me about those of our
profession who do not do any surgery, and are
making a happy living with sports or
biomechanics, etc. I completely appreciate that
and have the utmost respect and admiration for
those who have found that niche as podiatrist.

This is not meant to put them at any lower peg
than those with a surgical practice, as clearly
that is not the case, and it is just meant to
make a point. We are basically a surgical
specialty at this point, augmented with our
palliative and biomechanical training, makes for
what I feel is the highest level foot/ankle docs
out there.

Hospitals for the most part, look for SURGICAL
training to credential us in the hospital. Is it
right, probably not, but that is for the most
part, how it works. Surgery makes up a
significant portion of my income, as I suspect
does for many out there. That training should be
available to all of those graduates, as there is
no saying,

‘I’d rather be an internist than a surgeon”, upon
graduation. Is it time podiatric medicine and
Surgery work to just become an allopathic
specialty?

We need to be selective in who becomes
podiatrists. If we as a community, are going to 3
year surgical programs for all and claim to put
out the best foot/ankle people out there, then we
sure better try to show that with the caliber of
residents we train and send out into the world. I
am proud to be a podiatrist and also am very
fortunate to help train 12 podiatric residents
each year and we are also quite fortunate to have
some really good ones. But, as has also been
suggested, adding more residents to existing
programs can also be a mistake.

Unless the surgical numbers show SIGNIFICANT NEED
for additional residents, more residents in each
training program just diminishes their hands on,
and does not make for better training. I really
don’t know the economics for the hospitals and
others involved who run the programs, in adding
more residents, but I was told could be quite a
bit. If so, I am sure the hospitals may push to
add more slots, regardless of the training
experience available to that resident, but unless
the surgical volumes are such that more residents
won’t impact the hands on for the others, it will
not enhance the experience of the other
residents.

We need to have less schools, that put out the
highest level doctor and give them ALL the
highest level training. If not, all we do is
weaken our product. Opening new schools and not
having enough slots, now leaving these new
podiatrist out to dry, is just wrong and should
be the main priority of the APMA and CPME, to
look into and have a plan before the 2014
graduates get out and have the exact same problem.

David E. Samuel, DPM, Springfield, PA,
desamuel@comcast.net

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