09/09/2013 Robert Bijak, DPM
Unmatched Residency Placements Currently Stand at 80
The residency debacle is just a symptom of what
is wrong with podiatry. Let's ignore treating the
symptom (not enough residencies) and deal with
the etiology, "Just what is podiatry"? This
sounds like a naive statement, but it really is
the crux our problem. When we stayed with only
the foot, we were podiatrists. With our foray
into the ankle and tendons of the leg that affect
the foot, we are transitioning into orthopedic
surgery territory. We need to ask a hard
question. Is this foray redundant, and if it is,
than we do not need 3 years of training to do
basic foot surgery?
Is podiatric surgery really better than
orthopedic surgery? After all, the majority of
podiatrists do some type of surgery, and most
have had from 0- max 2 years training. For the
last 40 years, most podiatrists helped patients,
were generally satisfied with the challenges and
complications of basic surgery. Tell me who
hasn't done dozens of a procedure to see one fail
for "some unknown reason." Tell me there are no
challenges or need for improvement in foot
surgery alone. How many different kinds of
bunionectomies are there?
So, is the answer to become mini orthopods, or
should the emphasis be on strengthening our
medical training so we can deal with medical
issues (which outweigh the surgical). The
inferiority of podiatry cannot be mitigated by
doing more surgery to gain parity. The deficiency
is in the undergraduate medical education that
still keeps us with a limited license. I maintain
that if the podiatry schools took on a medical
paradigm ( like the DOs did) there would be
sufficient pathology to keep podiatrists busy and
proud and this zeal toward calling yourself a
surgeon (thus a real doctor) would be mitigated.
Of course, this would dilute some of the power
the DPMs running the colleges would have, but
their self interest must be made secondary to
advancing the profession. Podiatry must become a
plenary degree, like DO, and there will be 3
fields with an unlimited license, MD, DO, DPM
(or, preferable in my opinion PMD). I believe
our weakness and lack of training and license is
at the medical end, not the surgical. Sometimes
you need to take a step back and re evaluate your
present position to properly see where you are
going. It takes courage. Does the APMA and
deans have that courage to change the emphasis to
medicine and not surgery? If the hospitals see us
competent and equivalent in medicine, the surgery
will follow.
Robert Bijak, DPM, Clarence Center, NY,
rbijak@aol.com
09/03/2013 Ron Raducanu, DPM
Unmatched Residency Placements Currently Stand at 80 (Amram Dahukey, DPM)
I want to take issue with this statement Dr.
Dahukey made. "We" is all of medicine. The
states that require one year of training before
they issue a license is a requirement for ALL
medical professionals. We are not being singled
out, which is a good thing. This is want we
want, but then to not offer a single year
of "internship" or enough residencies for all is
the major problem here.
I don't think anyone wants to "reduce
requirements for licensure" or even suggested
that at all. The goal is that all graduates have
at least one year of training so they can then
get a license to practice. Without any type of
residency, our graduates can't even practice
Podiatry in most states.
There is also a pendulum which swings in the
direction of not enough residencies and too many
residencies. The onus is not just on the
schools. Say the schools only accept the number
of students that there are residencies for. Then
some students leave, for whatever reason,
throughout the four years, which will create a
surplus. This happens in every class. Ask the
schools. They will tell you. Then some students
fail their boards and the surplus numbers
increase.
Now you have programs which can't fill their
positions. This leads to a loss of funding for
those positions eventually. All of sudden (not
so much) the schools are faced with the same
issue they had before. Too many students, not
enough residencies. People (like you, thank you
for your efforts!) create residency positions,
but because of this "crisis", not as many people
chose podiatry or the schools take your advice
and take less students. Back and forth we go.
The pendulum was on too many residency as little
as 7-8 years ago.
I think that simplest and most reasonable
solution is revamp the residencies (again, I
know) and offer one-year residencies but only to
those who don't match. Bingo. Everyone gets a
chance to reenter the matching system if they
want, or be able to practice in any of the 50
states. Wouldn't that be nice?
Ron Raducanu, DPM, Philadelphia, PA,
kidsfeet@gmail.com
09/03/2013 Amram Dahukey, DPM
Unmatched Residency Placements Currently Stand at 80
For the past few months, I read so many articles
and letters in regards to the lack of residency
programs for all graduates, some even want to
reduce requirement for licensure so that
graduates can get license without a certified
program. This will only erase all the progress
of our specialty in the last few years.
Mach blame has been placed on various persons
and organizations. I believe that the problem is
going to worsen in the next few years. The
etiology of this problem is clear and facing all
of us. Schools accept number of students without
regards to number of residency programs that
will be available post-graduation. They believe
their responsibility ends with graduation; the
truth is far from it.
Because we require post graduate training we
must ensure that the number of students accepted
be at least the same number of residency
programs upon graduation. This is a business
decision by the schools and must be led by the
association of podiatric medical schools and
CPME.
I do not know the number of students beginning
their education this year, but did anyone bother
to check if the number exceeds the residency
positions that will be available and by how
many? This is called long-term planning and
unless it is done the problem may just get
worse.
For those already graduated and those that will
graduate in the next three years, a concerted
effort must be made to create more positions. It
is not easy, but with appropriate incentives and
assistance to those who work hard at managing
and developing residency program we could
develop more position.
(I have developed and opened two residency
position that began this past July at the
largest hospital in Tucson, AZ)
I am calling for ad hoc committee to propose a
road map for the future of residency program
availability.
Amram Dahukey, DPM, Tucson, AZ
drd@premiersurgeons.com
08/08/2013 George Pattis, DPM
Unmatched Residency Placements Currently Stand at 80
1) The dental profession gives reciprocity for
dentists licensed in any of 46 states. Why
doesn't podiatry have multi-state reciprocity for
a DPM licensed in one of 46 states? (hint - under
cover of protecting the public - the real meaning
is to restrict licenses.)
2) Can anyone explain to me why a NP or a PA can
treat multiple non-surgical common podiatric
problems with a 2-year Masters degree and a 4
year DPM graduate cannot?
3) Why can a nail tech with a 6 week coarse
legally trim diabetic nails with their license
and a 4 year DPM graduate cannot?
4) Why is it that podiatrists in other countries -
UK, Australia, New Zealand) with 4-year
undergraduate Bachelors degrees in podiatry
school can treat 30 patients /day - office
problems that walk in the door and support
themselves?
Maybe the saying that is appropriate is reaching
too high, too fast.
Suggestions - immediate reciprocity, lower the
number of student admissions, provide $30,000 to
all students left waiting for 1 year , and take a
real hard look at the 3-year residency
requirement. There is no limited license
profession that requires a-3 year residency for
licensure. IF we cannot develop enough
residencies or scope, then let's consider start
graduating DPM with an additional marketable
license - , PA, MBA, MPH. something. If you have
a degree but you cannot feed yourself, that
speaks for itself.
The leadership had lofty goals for expansion,
quality, competence, however the plan was
unattainable and failed for multiple reasons.
Reduce residency requirements, reduce freshman,
encourage reciprocity, or add some more option
degrees to DPM graduates. Most of all, I feel
sympathy for the 80.
George Pattis, DPM, Greenville, SC,
georgepattis@aol.com
08/06/2013 Unmatched Podiatric Graduate
Unmatched Residency Placements Currently Stand at 80 (Richard Gosnay, DPM)
Dr. Gosnay’s comment that the APMA or CPME are
not to blame for the residency shortage is
absolutely outrageous. The CPME is not just an
accreditation arm of the APMA, its also supposed
to make sure the colleges do not take too many
students. The CPME approved the addition of a
new podiatry college at the same time that it
recognized the likelihood that a residency
shortage was on the horizon.
At the same time as the latest podiatry college
was matriculating its charter class, the CPME
allowed at least one other college to take more
students than they were approved to take.
Dr. Gosnay suggests that unmatched students
should look at why they did not match, as if to
suggest that it was their own shortcoming for
not matching, and not because they were misled
by colleges that never disclosed that there was
a concern that a significant number of graduates
would not get a residency. It's like blaming the
poor woman who gets raped not on the rapist, but
rather on she herself for wearing a short
dress!
I know there were many podiatrists from past
decades who were unable to obtain a residency,
however, they could complete a preceptorship and
get a license and obtain board certification.
The APMA has taken away this pathway while at
the same time doing nothing to ensure that all
qualified graduates are able to get a residency.
This is unconscionable.
The fact that schools do not warn incoming
students that there is a residency crisis most
certainly should be considered a crime. If I
sell my house without informing them that the
roof leaks or the basement floods every spring,
I am legally responsible. Dr. Gastwirth and the
various greedy college deans are no different
than the CEOs from companies like Enron, who
claimed to have had no knowledge of what was
going to happen to investors’ money - they
received life sentences nonetheless. In this
case though, the victims were much more
vulnerable in that the money they invested was
generally borrowed!
Unmatched Podiatric Graduate
08/06/2013 Joel Lang, DPM
Unmatched Residency Placements Currently Stand at 80
For the past few weeks, I have read with sadness
and disbelief that our profession has created a
crisis in which as many as 20% of our successful
graduates may never be unable to practice their
profession, destined to a life of insurmountable
debt and inevitable despair.
The reactive postings about this tragedy have
varied from desperation, blaming our leadership
and our corporate hierarchy, and even blaming
the victims for not being creative enough to
solve their own problems. It’s a little like
blaming rape victims for their choices instead
of blaming the perpetrators for their choices.
One solution suggested that the 80 currently
unmatched victims to be granted 80 of the
available spaces to open next year. If the
disparity between number of graduates and the
number of available residencies remain the same,
this will result in 180 of next year’s graduates
being unmatched. This is an obvious Ponzi scheme
that in a few years will crash and leave all our
graduates in some future year unable to achieve
residency positions.
If we require our schools to reduce their
enrollment by 20%, some may have to close and
those remaining may have to reduce the quality
of their training. However, if, mathematically,
in five years, no graduates will have
residencies, then all our schools may have to
close.
When I graduated in 1960, there was only one
residency program available in the entire
country, then known as the then Civic Hospital
in Detroit. There were only one or two positions
available each year for the total number of
graduates from the then five podiatry schools. I
came to learn later that only the politically or
monetarily advantaged were chosen
(notwithstanding the inevitable denials to come).
Fortunately, residencies were not required for
licensure then. Graduates were able to take
boards and enter practice immediately on
graduation. With some informal mentoring,
attending lectures and workshops we developed
many skills that brought credit to our
profession.
Later on, my state of Maryland, over my personal
objection, but along with other states, adopted
regulations requiring varying lengths of
residency requirements for licensure. This
ostensibly was intended to assure that only
higher caliber doctors would gain licensure. It
is more likely that limiting the number of new
practitioners would solve the ‘perceived’
competition new practitioners supposedly brought
to the podiatry marketplace. Does this not sound
like the voter ID issues presently a concern in
so many states?
Perhaps there were a few who really thought that
increasing the excellence of the new
practitioners was the primary goal. Even they
could not have foreseen the unintended crisis of
consequence dooming as many as 20% of our
graduates to a life of struggle, failure and
eternal unmanageable debt.
There is no reason why every one of our
graduates could not become a proud and
successful practitioner. They may struggle a bit
at the beginning and may never achieve the
surgical acumen of residency beneficiaries.
However, they can still achieve great success by
providing the empathy and caring they
instinctively bring to their practice, which
cannot be taught in residency. They can gain
increased skills in multiple areas by shadowing
at the side of interested and caring more
experienced colleagues.
I have always credited what success and vision I
achieved to my opportunity to have stood of the
shoulders of giants. There is a responsibility
that now falls, however unrequested - but not
undeserved, on the shoulders of our state boards
to provide an alternative and achievable pathway
to licensure. They need to act quickly and
responsively to aid their collegial brothers and
sisters. The public’s health is not in jeopardy
by granting these graduates the privilege of
practice. Historically, the public benefitted
from the care of podiatrists for centuries
before residencies were ever envisioned.
Elitism has not served us well. This “I got
mine – now you get yours” selfishness is
shameful and destructive. As a profession, we
can fix this. It only takes the will and
kindness and a sense of responsibility to do the
right thing.
Joel Lang, DPM (retired), Cheverly, MD,
langfinancial@verizon.net
08/05/2013 David E. Samuel, DPM
Unmatched Residency Placements Currently Stand at 80
This was a horrible thing that was perpetrated on
these students. They were duped out of their
money and will not be able to pay back loans and
practice to make a decent living without a
program. This is going to happen again next year
and the year after, unless we stop the talking
and get to the source. Starting new programs for
those without a slot is a great idea, if and only
if they are strong programs that have volume and
appropriate work load, to put out good fully
trained surgeons. To throw programs together that
do not have the volume or the diversity, is only
going to weaken our product. .
Overloading existing programs with more residents
is less hands-on for the ones there. Again, less
quality training. New programs are maybe a start
but not going to help soon enough. Ask a simple
question. After opening the new colleges how many
did they graduate? Seems real close to the issue
we have now. IT WAS RIDICULOUS to allow these new
colleges to open, but the boys club needs to
stop. Shut these colleges down and start figuring
out where to move the presents students, or
perhaps offer some their money back, before their
law firm starts asking a little harder. They
should have never been opened and it was
completely selfish and irresponsible that they
were.
Stop spreading the ridiculous notion that we need
more podiatrists. I can’t swing a dead cat in my
area and not hit another podiatrist. If you open
new colleges, perhaps have the students sign a
form that they will all move to the middle of
nowhere, USA and start practicing. The numbers
are skewed based on the need for rural America,
with way fewer professionals moving there. I am
sure they need podiatrist there, but I don’t know
many who graduate that don’t want to live and
practice in an environment that they can make a
living and raise a family, and a drive to get a
gallon of milk isn’t 50 miles.
God bless those in rural America. I'm not
knocking them, but those silly numbers of how
many more podiatrists we need per capita sure
looks made up to me, if you go to Boston, NY,
Philly, DC.
Start with the new schools. Get them shut down.
Be selective in our choice of new students, not
filling the slots for the almighty dollar, which
is clearly the case. If we want parity, then put
out the best and don’t weaken our product. Be
selective in who get into school and make this a
field that ALL want to go into and not one that
becomes a second or third choice. Less and better
trained pods, means a higher level of regard for
our services, better pay, and those looking to
choose a specialty may look a lot longer and
harder at podiatry highly regarded needed
specialty, that is paid as such.
Stranding these students can’t help us and is a
huge black cloud for our profession. This was
simple, simple math, graduates vs. programs.
Don’t tell your second grade teacher, but someone
failed miserably here.
David E. Samuel, DPM, Springfield, PA,
desamuel@comcast.net
08/03/2013 Richard Gosnay, DPM
Unmatched Residency Placements Currently Stand at 80
One consistent sentiment seems to run through all
of the comments regarding the large number of new
podiatrists who have not moved on to postgraduate
training this year. The students, current
podiatrists, retired podiatrists, and educators
who have written about the subject are uniformly
appalled. Obviously, our new colleagues who are
living this nightmare are frustrated and angry. I
hope that they get some measure of comfort from
knowing that a great many of us do care about
their situation.
There have been many suggestions about what
should be done. These suggestions vary widely.
Many seem to be illogical and born more out of
frustration than of critical analysis of what is
possible. I hope that we, as a profession, will
keep working at this problem in order to do our
best to help new graduates. But confusing the
discussion with unfounded charges and impossible
suggestions is unhelpful. I have some
observations.
The CPME is an accrediting agency. It is not
charged with helping to produce residency
positions. Nor should it be. That would be a
conflict of interest. The CPME cannot credibly
represent itself as the unbiased evaluator of
podiatric education and training if it has
another role that creates an incentive for it to
be biased. By definition, the solution to this
problem cannot be found in the CPME. I understand
that where there is smoke, there is fire. We all
have heard many horror stories about how CPME
site visits and its application process were very
unpleasant. Perhaps the CPME could work on its
professionalism and its cooperation. (They
shouldn't be demanding doughnuts.) But that has
nothing to do with the current problem at hand.
If some of us have an axe to grind with the CPME,
I don't think that this is the time to grind it.
With respect to this problem, we all must agree
that the CPME is blameless.
Glenn Gastwirth is the Executive Director of the
APMA. He does not set its agenda. The APMA House
of Delegates and its Board of Trustees set the
agenda. Blaming Dr. Gastwirth for the current
residency shortage is like blaming a Colonel in
the field for decisions made in the Pentagon. It
makes no sense. If Dr. Gastwirth had been tasked
with doing things that he failed to do that might
have helped alleviate the residency situation,
then he would be subject to valid criticism. I
have not heard that this is the case. Has anybody
else heard that it is? If not, I suggest that
criticizing Dr. Gastwirth is an example of
illogical frustration that only serves to
distract. It is unfair, counterproductive, and it
helps nobody.
If students today are anything like we were in
the class of 2000, then there will be no magic
bullet that kills this problem. I suspect that
there are many different reasons why these 80 new
podiatrists do not have post-graduate training
after graduation. The number of available
residency positions determined that there would
be unmatched graduates. But it would serve these
86 podiatrists well to thoughtfully examine why
they are among this unfortunate group rather than
dreaming up schemes for revenge.
When I was a resident, I saw more than a few
students who were not cut out for careers that
demanded a certain level of commitment. And this
attitude problem followed many of them into their
residencies and careers. We periodically see
notices on PM News about some who cut corners and
come to grief. Other students may have been
difficult to work with on rotations. Some are not
punctual. Some are not able to quickly convert
what they have learned in class to a useful fund
of knowledge in the hospital. And, of course,
some were simply unlucky.
It is always beneficial to invest effort in
yourself. A new podiatrist who finds ways to
improve himself is enriched for life. Even if a
magic bullet could be found to make this problem
go away, it would not be nearly as rewarding as
finding ways to enhance an entire career.
Podiatry is a second career for me. I studied
classical trombone with members of the
Philadelphia Orchestra. When I received my
Bachelor of Music degree, I was loaded for bear.
There was not one piece in the symphonic
repertoire that I could not play well. I was
ready to perform. Yet I could not even get an
audition for a job in any orchestra that paid a
meager salary. I continued to practice and study
with my teachers. I taught, played some decent
gigs when they came up, and did some non-music
work. I enhanced my education by taking core
science courses and landed a technical job. This
eventually led me to podiatry. Was this fair? I
don't know. The people who did get symphonic jobs
during those years were pretty good! Some were
undoubtedly better than I was. Many were not. I
am quite sure that nobody cares.
The point is that (contrary to some comments made
in this forum) there are many people in many
careers who face roadblocks to their professional
development. Many lawyers don't practice law.
Many budding surgeons despise their family
practice jobs and count the days until
retirement. My co-resident was a terrific, young
podiatric surgeon. But she was locked into her
location because of her husband's business. She
got no realistic job offers, and she was not
about to open a new practice in a saturated area.
So she teaches high school science.
The most important outcome of my particular
career path is that I am happy. My co-resident is
too! Ambitious people need to have the strength
and resiliency to deal with disappointments. The
only other option is to be less ambitious.
As long as we have a tuition-based income model
for podiatric medical schools, the discrepancy
between residency slots and number of graduates
may remain a problem. Somebody is out there
planning to open up a new podiatric medical
school as soon as the business model becomes
viable. The existing schools are not going to
turn away many tuition paying students.
Until some genius figures out a way to reconcile
the number of matriculating students with the
number of residency positions anticipated four
years later, this problem defies solution. Until
then, we podiatrists must support training
residents in our hospitals. And the new graduates
will need to be strong and resilient.
Richard Gosnay, DPM, Danbury, CT,
glabroushead@gmail.com
08/03/2013 William Deutsch, DPM
Unmatched Residency Placements Currently Stand at 80
When I graduated in 1976, there were 5 or perhaps
6 schools of podiatry with class size of 50-60 or
so students and there was still a residency
shortage. The difference being that there were
only a smattering of states that required
residency for licensure, and the ability to do
surgery or gain hospital privileges depended upon
your ego, chutzpah, and who you knew. You could
still make a living without surgery or even
accepting insurance if you were a good salesman
and had average skills. Surgery on a see one, do
one basis was still possible, and if you had
average luck, you could avoid an untoward event
for several years.
Obviously, lack of residencies for graduating
students is only part of the problem. Incoming
podiatry students still don't know what the hell
podiatry is all about. Podiatry itself has an
identity crisis, so how can kids entering a
school where the administration apparently acts
like an Army recruiting office, promising
recruits a choice of bogus assignments and
careers, or worse, like used car salesmen, make
rational and meaningful life decisions?
Podiatry started outside of medicine, offering a
service not provided by MDs. Those basic skills
taught podiatry schools were to provide comfort
and relief to foot pain sufferers, and are today
denied services, and improperly billing them can
even put a podiatrist in jail. Imagine dentists
being indicted for filling dental caries? The
irony is overwhelming. Third-party medicine has
essentially declared basic podiatry services
verboten, and so podiatry has evolved to become
accepted by third-party medicine by performing
orthopedic foot surgery.
The residency training and emphasis is on board
certification geared towards surgery. That's
something not all podiatry school applicants have
the ability, aptitude, or desire to perform, but
more importantly, that's not what the majority of
patients requiring podiatry care need. But it
seems to be the only legitimizing effort made by
the powers behind podiatry politics.
The question is, "do incoming students know what
makes podiatry unique, but not in a good way? Are
admission interviews honest and ethical? Are
applicants given the knowledge and opportunity to
calculate the cost/benefit of education, the
possibility of not gaining a residency, meaning
failure to gain licensure in most states, and
thus acquiring a useless degree?
Podiatry can still be a rewarding and useful
profession, but at present it seems to be
ethically flawed from the ground up.
William Deutsch, DPM, Valley Stream, NY,
woollfy1@yahoo.com
