03/29/2016    Pete Smith, DPM

Class sizes at podiatry schools should...

First, I would like to congratulate APMA and
its leaders who back in the early 1990s saw fit
to move our profession forward by requiring
three-year residency programs vis-a-vis Vision
2015 and who are currently working to move us
forward. The recent graduates and current
residents are getting a medical and surgical
education on par with their MD/DO brethren and
certainly much more extensive than most of us
(Class of 1988) had. That being said, the move
to these residencies has led to some unintended
consequences including a shortfall of
residencies, a capping of the school class size
and an over reliance on rearfoot surgical
residencies.

The Pennsylvania Podiatric Medical Association
saw the need to boost the number of residencies
9 years ago when, in conjunction with a few
other states, formed our own 'Residency Genesis
Program' which was later ceded over to APMA
which has worked to close the shortfall gap.
Residencies have been created, but
unfortunately at the same time almost the same
number have closed leading to minimal gain. In
order to maintain the residency to graduate
ratio CPME has capped the class size to our
schools at 600 (this while opening new schools)
and the cap is causing financial hardship for a
number of the schools which could readily take
more students.

The current three-year residency structure
allows for residencies that are not rearfoot-
oriented, but a combination of medical/forefoot
or medical/forefoot/rearfoot. We are currently
now very top heavy- 80-20 on rearfoot programs.
While this has produced some of the best
rearfoot and ankle surgeons out there, it has
it also stifled the growth of residencies which
are primarily medical/forefoot?

I feel there needs to be a turnaround in the
percentages in how our profession is trained:
80 % basic medical/forefoot surgery and save
the other 20% rearfoot for the 'cream of the
crop.' This should allow many areas and
hospitals where there may not the rearfoot
numbers to open up new residencies. It would
also increase the number of forefoot cases and
podiatric medical training for the others under
the current structure while maintaining a three
year residency. There should be a podiatric
residency at every hospital where there are
medical residencies!

Finally, our profession must grow if we are to
remain relevant. If we continue to limit the
number of students admitted, we will not grow
and other professions will creep into our
niche. The cap needs to be lifted on incoming
students and we need to go to every university
and college to recruit new talent to our
profession. To this end, Pennsylvania will be
starting a grassroots campaign to do just that
- going from college to college and university
to university to promote podiatry. Podiatrists
are the premier medical care givers of all
things foot and ankle bar none. We need to
grow!

Pete Smith, DPM, President, PPMA

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03/30/2016    Joseph C. Smith, DPM

Class sizes at podiatry schools should... (David E Samuel, DPM)

In response to Drs. Samuel’s and Ross’ comments
regarding students, schools, and residencies, I
first must congratulate the actions that took
place last week in Washington, DC by the APMA
Board and the 2016 House of Delegates. A
conscious effort was made to address those very
issues. Those issues are much more complex than
just creating new residencies or lowering the
number of students allowed in our schools.
They are issues that greatly affect our
profession and must be dealt with on many
different levels. Our profession will fail and
we will cease to exist if these issues are not
addressed and changes are not made soon.

We, as a profession, need to address three
things to grow and remain relevant. First, we
need to market and create additional forefoot
surgical residency programs, not just the
rearfoot programs. Currently, there are 225
residency programs available on the CPME web
site. Of those 225 programs, only 14 are
Podiatric Medical and Surgical Residencies
(PMSR) and the rest (211) are Podiatric Medical
and Surgical Residency programs with the
additional Reconstructive Rearfoot/Ankle
Surgery Certification (PMSR/RRA).

I believe that the key to the residency issue
is to let potential residency directors know
that they can create a program that only
focuses on forefoot surgery and medicine
(PMSR).

Secondly, we need to do a better job at
marketing our profession to undergraduate
colleges/universities. This year at the APMA
HOD, our State Association invited two students
from the Temple school to observe what happens
at the House. One of the students was from
Villanova and the other was from U Mass and
neither of them heard about podiatry from a
counselor at their respective schools.

We need to find a way to incentivize these
counselors, just like the allopathic and
osteopathic schools do, to direct students to
our profession. We also need to go back to a
grass roots approach to recruiting qualified
students. It is our responsibility to go back
to our alma maters and talk to potential
students.

Finally, we need to take the caps off of our
school’s enrollment. While other health
professions are increasing their numbers by 25
to 35%, we are preventing our own growth. By
limiting the number of qualifies students that
the schools can take, we are preventing the
growth of our profession. In a time when the
Affordable Care Act has introduced millions
more into the ranks of the insured and when
diabetes has become an epidemic, we have failed
to grow our numbers.

In essence, we are creating our own vacuum,
allowing the likes of certified nurse
practioners and physician assistants to step in
and fill the void created by an inability to
grow the profession and meet the needs of the
public.
In his inaugural speech, the new APMA
President, Dr. Dan Davis has committed to
immediately addressing these issues. The APMA
realizes that the larger qualified applicant
pool, the increased number of students, and the
residency availability are all related and are
crucial to the growth of our profession. In
the next few months, Dr. Davis and the APMA,
with the help of all related parties, will
draft an action plan to address these problems
so that we can correct them and continue to
make our profession grow and prosper for the
benefit of all.

Joseph C. Smith, DPM, Reading, PA, Past
President, Pennsylvania Podiatric Medical
Association