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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,
[email protected]
Other messages in this thread:
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,
[email protected]
08/05/2013 ***Richard J. Miller, DPM
Unmatched Residency Placements Currently Stand at 80
I have been avidly following the plight of those
graduates who have not been placed into a
residency program and share my colleagues dismay
at this situation. Perhaps my concern is more
personal since my son is starting podiatry school
this year and have an obvious stake in this
debacle.
I have read numerous opinions about the solutions
but am most upset that the APMA has not
communicated thoroughly or at all with the
general membership on what they are proposing or
actually doing to help these graduates in the
short term and solve the crisis in the long term.
The national meeting was held recently and I
expected to hear some dialogue from the
leadership about what was hopefully discussed and
what the general membership can do to help this
situation.
I do not think it is enough to say: go start a
residency program in your town since many
podiatrists do not have the hospital resources or
affiliations to accomplish this arduous task.
These graduates need immediate help. What can
APMA do to help practitioners set up
preceptorships or emergency "programs" that could
ultimately lead to licensure in various states.
I believe the problem is multifactorial and see
the following issues:
1) Clearly the schools are taking too many
students and operate at a for-profit mentality
where the student is the commodity. Every school
should cut their class size 10 to 20% until there
are more residency programs than graduating
students. The schools need to get direction from
CPME and APMA and be bound monetarily to the set
number of students and not exceed this number. If
they go over then the school should be fined and
a fund set up to train the excess students down
the road.
2) CPME and AMPA should consider changing the 3-
year requirement immediately and allow a longer
period of time to achieve this goal. One and two
year "emergency programs" need to be set up
immediately to help to begin to train those
unmatched students with the goal of having more 3
year programs down the road. Some states only
require only 1 year of residency (North Carolina
is one).
3) I suggest that APMA use their emergency fund
to help practitioners set up preceptorship
programs and set up some guidelines and structure
so that those unmatched can have some office
based experience. I have not seen any
communication coming from APMA leadership to the
general membership seeking this kind of help.
In summary, the long-term solution of achieving
parity with allopaths is a lofty and laudable
goal, but not at the expense of recent and future
graduates. If we can not possibly have an avenue
to train every graduate who passes their boards
and completes 4 rigorous years of podiatry school
then we as a profession have not done our job to
ensure the viability of our field. It is unfair
to ask our students to give 4 years and hundreds
of thousands of dollars to be stuck in limbo
because we can not figure out a viable and
immediate solution.
APMA needs to communicate with us and tell us
what they are doing and what we can do to help
this situation. If any APMA leader has a child
going into to this field would they want their
child to be in this situation? Let us not sweep
this under the rug any further. It needs to be
dealt with now.
Richard J. Miller, DPM, Charlotte, NC,
[email protected]
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 cant 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 dont know
many who graduate that dont 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 isnt 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 dont 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 cant help us and is a
huge black cloud for our profession. This was
simple, simple math, graduates vs. programs.
Dont tell your second grade teacher, but someone
failed miserably here.
David E. Samuel, DPM, Springfield, PA,
[email protected]
08/06/2013 ***Unmatched Podiatric Graduate
Unmatched Residency Placements Currently Stand at 80 (Richard Gosnay, DPM)
Dr. Gosnays 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. Its 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 years 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 publics 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,
[email protected]
----------------------------/---------------------------
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,
[email protected]
Other messages in this thread:
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,
[email protected]
08/05/2013 ***Richard J. Miller, DPM
Unmatched Residency Placements Currently Stand at 80
I have been avidly following the plight of those
graduates who have not been placed into a
residency program and share my colleagues dismay
at this situation. Perhaps my concern is more
personal since my son is starting podiatry school
this year and have an obvious stake in this
debacle.
I have read numerous opinions about the solutions
but am most upset that the APMA has not
communicated thoroughly or at all with the
general membership on what they are proposing or
actually doing to help these graduates in the
short term and solve the crisis in the long term.
The national meeting was held recently and I
expected to hear some dialogue from the
leadership about what was hopefully discussed and
what the general membership can do to help this
situation.
I do not think it is enough to say: go start a
residency program in your town since many
podiatrists do not have the hospital resources or
affiliations to accomplish this arduous task.
These graduates need immediate help. What can
APMA do to help practitioners set up
preceptorships or emergency "programs" that could
ultimately lead to licensure in various states.
I believe the problem is multifactorial and see
the following issues:
1) Clearly the schools are taking too many
students and operate at a for-profit mentality
where the student is the commodity. Every school
should cut their class size 10 to 20% until there
are more residency programs than graduating
students. The schools need to get direction from
CPME and APMA and be bound monetarily to the set
number of students and not exceed this number. If
they go over then the school should be fined and
a fund set up to train the excess students down
the road.
2) CPME and AMPA should consider changing the 3-
year requirement immediately and allow a longer
period of time to achieve this goal. One and two
year "emergency programs" need to be set up
immediately to help to begin to train those
unmatched students with the goal of having more 3
year programs down the road. Some states only
require only 1 year of residency (North Carolina
is one).
3) I suggest that APMA use their emergency fund
to help practitioners set up preceptorship
programs and set up some guidelines and structure
so that those unmatched can have some office
based experience. I have not seen any
communication coming from APMA leadership to the
general membership seeking this kind of help.
In summary, the long-term solution of achieving
parity with allopaths is a lofty and laudable
goal, but not at the expense of recent and future
graduates. If we can not possibly have an avenue
to train every graduate who passes their boards
and completes 4 rigorous years of podiatry school
then we as a profession have not done our job to
ensure the viability of our field. It is unfair
to ask our students to give 4 years and hundreds
of thousands of dollars to be stuck in limbo
because we can not figure out a viable and
immediate solution.
APMA needs to communicate with us and tell us
what they are doing and what we can do to help
this situation. If any APMA leader has a child
going into to this field would they want their
child to be in this situation? Let us not sweep
this under the rug any further. It needs to be
dealt with now.
Richard J. Miller, DPM, Charlotte, NC,
[email protected]
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 cant 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 dont know
many who graduate that dont 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 isnt 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 dont 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 cant help us and is a
huge black cloud for our profession. This was
simple, simple math, graduates vs. programs.
Dont tell your second grade teacher, but someone
failed miserably here.
David E. Samuel, DPM, Springfield, PA,
[email protected]
08/06/2013 ***Unmatched Podiatric Graduate
Unmatched Residency Placements Currently Stand at 80 (Richard Gosnay, DPM)
Dr. Gosnays 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. Its 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 years 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 publics 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,
[email protected]
You do realize that "The Podiatry Post" is run by Dr. Stinehour, a heavily disgruntled former podiatrist who had his license suspended a long time ago for shady clinical practice (
