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Unmatched graduate writes PMNews ...
- Thread starter diabeticfootdr
- Start date
That was an eloquent, thoughtful, and poignant letter. What will these indebted, untrained, graduates do? From my understanding there are six states that do not require post-graduate training. Will these graduates, if they choose to work in any capacity, be forced to move--even if it's not their desire--to one of those states? It appears that podiatry as a profession and its leaders spare no expense in corralling prospective students, implying that there will be "jobs," or they will become "surgeons," or somehow employed by the larger medical community. I believe there is an abundance of misinformation regarding employment of podiatrists by group practices, hospitals, or "other" medical specialties as all of the aforementioned await the upcoming shift in the tides of healthcare provider reimbursement, and the uptick in less costly physician extenders. I have noticed that the majority of DPM graduates ultimately enter private practice, similar to dentists. This lack of post graduate training suggests that the schools graduate more students than there are positions to fill, and people as noted above ultimately find in the end, the profession abandons them.
One year is a long time when there is interest accruing on student loans, and in any profession you lose the intellectual momentum garnered in school. The lag period without guaranteed training for graduates from an American professional school is shameful. Whatever planning or lack thereof resonates throughout professional circles regarding the machinations of podiatry, its training, and the end product. There has been, as noted, a less than favorable public image, the fact that 82 graduates are left without a path to achieve their goals bodes poorly for the profession as a whole. Furthermore, the three year post graduate training does not ensure the end product will be universally similar akin to the ABMS medical specialties where the programs, protocols, and metrics to evaluate each trainee is nationally uniform. The suggestion that the three year training program in podiatry was instituted to limit the number of competing podiatrists--whether that is conjecture, or fact remains speculative. Nonetheless, no matter how many years training the variety of scopes of practice remain unchanged.
D
dyk343
I think that's a pretty interesting take to help "solve"the crisis. Which programs would be forced to take a resident? How would that be delegated? What qualifies as "remaining active"? I see problems with that statement,
I don't see this ever happening, but I wouldn't oppose it either.
Knowing the people I know who are in the scramble... It can happen to any student. Good or bad. It's such an ugly scar on the profession right now. Something needs to be done, fast.
I don't see this ever happening, but I wouldn't oppose it either.
Knowing the people I know who are in the scramble... It can happen to any student. Good or bad. It's such an ugly scar on the profession right now. Something needs to be done, fast.
I find it funny that the 3 largest DO schools pump out more DOs in a year then all 9 podiatry schools combined.
The problem I have with this idea is it does not directly address the underlying problem (students>available slots). I actually gave this more thought though. If you wanted to do this, what if APMA "pays" the 9 schools the equivalent of 50-100 students worth of tuition (split between the schools) to keep 50-100 seats empty in the class of 2018. This is a temporary and more costly way of buying time to create residencies.
step 1: Give the 86 students in question something to do (paid research, paid intern, maybe assist in paper work for residency creation as APMA employees - they will be very motivated in creating residencies 🙂 )
step 2: Rolling guaranteed residency as was proposed
step 3: Pay schools to keep seats open in 2018 to buy time to create a surplus of residency slots.
The real issue though is creating residency programs. I really wish I knew more about how to create one (funding etc.).
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Interesting take indeed, but I can't see it being feasible. How do you guarantee a program to someone if they sit out a year? As dyk343 asks, which programs will be forced to take a resident they may not want? I feel for the unmatched grads, but forcing residencies to take them isn't the answer either, even as a short term measure, IMO. I'm not sure I know what the best short term answer is. Long term I think that increasing the number of high quality residencies would be best, of course. There are many states without residencies and many hospitals that could support programs, I would think. I know not every attending wants to be involved with training residents, and even fewer want to sacrifice the time and energy it takes to be a program director. I think that's where the long term answer lies and where continued focus should be placed.
D
dyk343
Doesn't most Pod schools have residency programs? I know NYCPM, Temple and Scholl has one. Force those residency programs to accept students from their own school that didn't match the year before.
Will it place every unmatched residents? No. But it will help get some of them placed.
Will it place every unmatched residents? No. But it will help get some of them placed.
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They are coming out in droves on. PMNews, and they are not happy...
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I guess I just don't like the idea of forcing residents on a program. If you say that programs affiliated with schools are forced to take residents that didn't match every year, what do you think that does to the program? No students would voluntarily visit if they knew only previous graduates were going to match there. Any "prestige" the program had would be gone. I think a more fair middle ground would be to somehow incentivize programs to take previous graduates by offering something to programs, either a grant from APMA or some other benefit. I just don't like forcing programs to do things they don't want.
It appears that the "need" for podiatrists, especially "DPM foot surgeons," in the United States has been exaggerated by those who promote podiatry education, or benefit from goods or services to or for podiatrists. The facts remain that the profession implied, suggested, and gave the reasonable expectation that DPMs would be trained for an increasing demand. The marketplace does not support those theories. Furthermore, the notion that following the allopathic three year postgraduate training would somehow bring about "parity," and greater acceptance in the mainstream. This is unsupported because there have been little if any changes in the state scope of practice laws. National budgetary restraints will further compound diminishing post graduate training programs, along with decreasing reimbursements for podiatry services, and suggests further disarray. Although comparisons to medical and osteopathic have been made, there remain an abundance of opportunities to repay loans in several industries, in the US, and abroad--this is not a feature available to DPM graduates. I do not see how, podiatry schools, school administrators, podiatry organizations, and podiatry leaders can continue to market podiatry education as a viable career path with similar opportunities for all graduates. It has been suggested that the additional years of training served to preclude competition within the podiatry population as a restrictive measure rather than to enhance the unmeasurable knowledge and skill set acquired by the trainees. Unfortunately podiatric credits are not transferrable to medical, osteopathic, or PA programs which would serve those--whose numbers are projected to increase with increased enrollments in schools, and decreasing postgraduate training--suggesting considerable outstanding balances on student assistance. This lack of postgraduate training, podiatry's exclusion from some state Medicaid programs, and diminishing inclusion in medical specialty arenas should give podiatry leaders, pause for concern. This may be the time to reevaluate the DPM curriculum, revisit the USMLE and core clerkship venues, and prepare the graduates for lifelong learning, complete inclusion beneath the ABMS umbrella, and modifications stemming from those in leadership positions to work toward ensuring a nationally recognized scope of practice.
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How so? How do compare physician shortages with residency shortages? The residency marketplace and the practicing podiatrist marketplace are two very different things. The residency shortage is directly affected by the number of practicing podiatrists who are willing to train us. Unfortunately there are still over 12,000 DPMs who would rather write in to PMnews and complain than do anything themselves to help. Hospitals not wanting to finance a DPM residency program also has little to nothing to do with the need for podiatrists and everything to do with the financial climate within the healthcare industry. There is also plenty of ignorance on the hospitals end as to whether or not Podiatry residency programs are capped. A couple of the new programs were ones who originally said "no", because they believed they weren't going to be reimbursed. Once they found out that was not the case, they went ahead and approved the program to begin CPME paperwork. If you want to actually make the above claim, you would have to have some sort of evidence that residency graduates (not students) aren't able to find jobs, due to some made up marketplace that doesn't need "DPM foot surgeons." You can't though, because that's not the case.
Your statement is no different than somebody going on to the allopathic forums and telling them that they are being lied to. "There really isn't a physician shortage, as evidenced by their inability to open new residency programs."
The intellectual dishonesty is your prerogative. It's just a little sad knowing that a couple people will come on these forums and actually believe many of the things you post.
Thank you for pointing out a typographical error of omission in the first sentence: [...exaggerated by those who promote podiatry education, or benefit from goods or services to or for podiatrists." As a corollary to your suggested posting analogy regarding a "physician shortage," there really is not a shortage of podiatrists. Simply peruse the general medical--non podiatry generated--literature, and topics pertaining to diabetic foot care, (the heavily marketed rallying point for would-be podiatry need). The foot does not exist in a vacuum. Often a foot condition spreads via its natural history beyond state scope of practice law and resources must be diverted to podiatrists who may have gotten involved in an awkward situation. Furthermore, an MD or DO must sign off on podiatry services for diabetics (and other systemic disease). You will find that across the spectrum of providers the same or similar services are already performed more cost effectively by nurses, NPs, DNPs, PAs, and an array of medical specialties, all uniformly trained. This is an easily searchable concept with regards to content, facts, figures, and other metrics.
As far as intellectual dishonesty, maybe some introspection is in order.
As far as intellectual dishonesty, maybe some introspection is in order.
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Gee, I wonder who this is...the verbiage seems familiar. Along with the inability to wander outside of the same talking points. There will be no debate or discussion with Zill, because Zill will continue to pump out the same repetitive rhetoric we've grown accustomed to.
I'll try again. If there is no marketplace to support podiatry, why are more and more new DPMs finding work in non-podiatry based practices/clinics/hospitals? And why is anyone paying them a $200k base to work for them? Where are the DPMs who are unable to find work after residency?
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Take this for what it's worth, but the US bureau of labor and statistics says DPM unemployment is something like 0.3%.
So, there aren't any unemployed DPMs....
The majority of podiatrists are self-employed, or work as independent contractors. "Salaries," are based on performance by way of the amount of patients brought into a practice, and how much they bill out: the procedures performed, reimbursements, and monies brought into a practice. Because podiatrists have the unique ability to code for a number of procedures across systems podiatry services can be lucrative for a any group practice. The majority of these services: injections, skin and soft tissue structure debridement, incision and drainage, wound care (to an extent), nail procedures, and many surgeries including but not limited to bone spur removal at the digits, tendon release, arthroplasties, are all office based. The fact remains that reimbursements for many procedures to correct deformities are less lucrative, and the profitability for podiatry remains in an office setting. Granted the podiatrists who joins a "group," practice--whether that is a group of podiatrists, or group of MD, DO specialists or generalists, the expectation is that the podiatrist perform in such a manner as to build a following. Patients do not fall off trees, and regardless of training, the podiatrists has to advertise, market, and develop his or her following. Salesmanship is another skill set required to realize that 200 thousand dollar gross reimbursement which, the podiatrist will consequently realize a portion thereof. As to the statement of a base salary of X amount of dollars paycheck the above mentioned factors must be taken into consideration. Furthermore, the contractual relationship often contains a non-compete clause whereby the podiatrist cannot "take" his patients with him if he decides to move along and open up an office elsewhere. The fact that the "200 thousand dollar a year," salary is based on services rendered, and when, as a consequence of an audit--not infrequent--repayment for billing anomalies, irregularities, upcoming, etc., the podiatrists is liable for repayment even after leaving the "group."¶Those features of a podiatric practice being stated--If I am imprecise please--only from a practicing podiatrist, not a student who still dreams of a life of full time hospital surgery--advise. The most salient question is why is it imperative to train someone for three years post DPM to do exactly what traditional podiatrists have done, and done well for the past half century? Why aren't the schools adequately training the students to simply hang out a shingle and go to work after graduation akin to dentists? The suggestion of internecine competition within practicing podiatrists has been suggested. Divide the profession into the "surgeons," and "non-surgeons," thus eliminating opportunities for listings on provider panels published by third party carriers, modifications of hospital bylaws to exclude practitioners from staff privileges (a requirement to be on any managed care panel), and many more exclusionary ploys to whittle down the competition new practitioners bring to marketplace. The letters from unmatched graduates (I have read several) have an ongoing theme: many do not want "parity," or have any desire other than going to work. Are students, and graduates mindful that the profession spends the lion's share of national and state dues, donations, and fees largely for lobbying fees, and courting legislation at the state level to decrease competition to continually raise the bar for graduates to find meaningful work if they do not comply with "newer, more MD-like, post-graduate training?" Hasn't it occurred to trainees that market forces within this tiny profession are essentially protecting their own turf rather than competing for a "parity," which will not come? The three year residency for podiatrists appears to be from a practical sense, a ploy to cut competition within the field. Three additional years to "learn," the nuts and bolts of office practice? The irregularities across "residencies" remains as unpredictable as ever, with little if any real-world use in performing the material and substantial duties required to earn a living.¶It is not a stretch of the imagination that podiatrists can earn 2,3, 400 thousand dollars a year and beyond, however, as students, you should be aware of the fact that this money isn't handed to you, no. You have to bring patients into a practice, or what good are you?¶There is little incentive for shrewd, seasoned practitioners to invite competition, especially in a field where competition for patients isn't a reality until you don't have them, or find someone else--another podiatrist--is luring them in.¶Hopefully this information directed to people in leadership roles will transmit this to a larger audience, and this debacle where "untrained" DPMs have to grovel for a job at a fast food restaurant post haste.
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Zill.. I grow weary of your vexatious vernacular..
leaving Zill aside, that letter was well written.
There seems to be more solutions generated by students and graduates then the powers that be.
Its alot easier to blame schools and students. I get that. But someone needs to step up.
As for protecting residency directors, believe me there are programs who do that just fine. In my opinion, though, none of the higher ups believe it is thier duty or obligation to give back to the profession: the students or unmatched graduates.
You can get put off by that statement, but if residencies were guareenteed for this batch of unmatched graduates it would send the message that podiatry takes care of thier own. The unmatched graduates I believe would work thier butts off for that chance. The schools would sort themselves out. Pre pods would feel better about thier chances and we look better as a profession.
Right now whats going on is quiet as its kept. What no one wants is media attention to this. We have enough bad press.
There seems to be more solutions generated by students and graduates then the powers that be.
Its alot easier to blame schools and students. I get that. But someone needs to step up.
As for protecting residency directors, believe me there are programs who do that just fine. In my opinion, though, none of the higher ups believe it is thier duty or obligation to give back to the profession: the students or unmatched graduates.
You can get put off by that statement, but if residencies were guareenteed for this batch of unmatched graduates it would send the message that podiatry takes care of thier own. The unmatched graduates I believe would work thier butts off for that chance. The schools would sort themselves out. Pre pods would feel better about thier chances and we look better as a profession.
Right now whats going on is quiet as its kept. What no one wants is media attention to this. We have enough bad press.
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more from PM news. enjoy
08/01/2013 ***Unmatched Podiatric Graduate
Unmatched Residency Placements Currently Stand at 86
I completely agree with the comments my colleague
who is in the same dilemma as me made about
enforcing the 3-year residency program. I joined
podiatry school to become a podiatrist, not an
MD. I did not intend to do much surgery, although
I believe I can be very good at it after having
spent much time in the OR for the last 2 years.
Why were these changes made in the field of
podiatry in order to be in par with orthopedic
surgeons? There are multiple fields in allopathic
medicine that do no require surgical options, so
why can't graduates have a choice to do what they
like. If I had known this BS would occur, and
that I would be saddled with thousands of dollars
in debt, I would have gladly accepted admission
to MD school, but I chose podiatry because I
wanted to specialize and did not want an intense
workload like some other doctors.
Who gives right to these administrators to just
play with students lives and futures. I am a very
able candidate and I deserve a residency spot,
and so do many my colleagues. I have been working
under a DPM for 8 months now. All I have done has
impressed my attendee, and even the orthopedic
surgeons, but because of this man-made residency
crisis, I fell through the cracks and am left
pondering my future. I have not got a good
night's sleep in months.
The leaders at APMA and CPME have no idea the
pain and hard-ship this MAN-MADE residency crisis
has caused me, my unmatched colleagues, and their
families. All I have to say is that I hope these
leaders can get a good night's sleep every night,
thinking that their actions have caused such
suffering for so many good people that deserve
better.
I am going to continue to find a work and accrue
clinical experience and hang tough in this time
of hardship. Even if I do get a residency, I will
never forget what these leaders did to us. Shame
on them and shame on anyone who supports them.
This is a crime, an absolute crime.
Unmatched Podiatric Graduate
Other messages in this thread:
08/01/2013 ***Unmatched Podiatric Graduate
Unmatched Residency Placements Currently Stand at 86
I am also one of the unmatched graduates from the
class of 2013 who has been waiting since March to
see what happens with this long brewing and self
created debacle. Nearly everyday, I have been
reading the posts that have poured into PM News
to gather any bit of information that could have
helped me. Needless to say, there was a lot
of "finger pointing", "now is not the time to
blame anyone" and "we must work together."
I applaud programs who have taken an extra
resident, two, or three in the meantime. However,
this is only the tip of the iceberg. The vast
majority of those without a program are still
unmatched and waiting for answers. Here is my
take on some of the issues that have been
discussed:
CPME: Caps are not being enforced: I have seen
this firsthand in both my institution and other
colleges. The fact of the matter is that we
started with a record class size in my year, and
then lost more than 25% of those matriculants.
What does that say about my college and some
others? To me it suggests that they are so
obsessed with chasing the dollar bill, that they
would admit someone while fully well knowing that
he or she may not be able to finish the
curriculum. And let's not forget that the record
class sizes were taken when knowledge of a
possible shortage was in plain view of college
officials.
APMLE: Dr. Edwin Wolf wrote sometime ago that
part of the reason this crisis exists is "An
unusually high Boards Part II pass rate." So am I
correct in assuming that our boards were designed
for us to fail? Was there an expectation that
enough of us would fail so as to stabilize class
sizes? I agree with my co-student who wrote that
the test does not test minimal competency, and is
a poorly written hodgepodge of minutia that
serves little to no purpose in clinical
practice. How can we even compare this test as
being alike to the USMLE/COMLEX?
APMA: Dr. Gastwirth's salary is publicly known,
and I have seen him at multiple meetings. But has
he ever once taken the stage to take
responsibility and voice concern of the residency
shortage? How can we be taken seriously as a
profession when our own leaders are so myopic?
Might I add in here that podiatry is not
recognized by ACGME as a medical specialty, and
one can only wonder why...
CPME: While I understand that their role is to
monitor and enforce standards related to
residency training, the survey that they released
was a half-hearted attempt at validating their
own existence and meekly asking if they alphabet
soup of residencies should be brought back. And
as far as the release of information goes, should
the public not be allowed to know some of the
pertinent information regarding residency
development? Why is this information guarded like
gold at Fort Knox?
It is the public who will eventually apply,
matriculate, and graduate the colleges. And why
has there not been a public disclosure to
applicants that there is an ongoing shortage of
residencies is beyond me...buyer beware.
I urge all of those involved in the profession to
ask yourselves if we really have made progress by
mandating the current guidelines that have been
set. Or in the name of progress, have we labeled
some as sacrificial lambs who have been doomed to
slaughter? And my last point: If the colleges are
truly not-for-profit institutions, then give the
unmatched graduates their money back, as we paid
for a service, and it was not delivered.
Unmatched Podiatric Graduate (KSCPM1)
08/01/2013 ***Unmatched Podiatric Graduate
Unmatched Residency Placements Currently Stand at 86
I completely agree with the comments my colleague
who is in the same dilemma as me made about
enforcing the 3-year residency program. I joined
podiatry school to become a podiatrist, not an
MD. I did not intend to do much surgery, although
I believe I can be very good at it after having
spent much time in the OR for the last 2 years.
Why were these changes made in the field of
podiatry in order to be in par with orthopedic
surgeons? There are multiple fields in allopathic
medicine that do no require surgical options, so
why can't graduates have a choice to do what they
like. If I had known this BS would occur, and
that I would be saddled with thousands of dollars
in debt, I would have gladly accepted admission
to MD school, but I chose podiatry because I
wanted to specialize and did not want an intense
workload like some other doctors.
Who gives right to these administrators to just
play with students lives and futures. I am a very
able candidate and I deserve a residency spot,
and so do many my colleagues. I have been working
under a DPM for 8 months now. All I have done has
impressed my attendee, and even the orthopedic
surgeons, but because of this man-made residency
crisis, I fell through the cracks and am left
pondering my future. I have not got a good
night's sleep in months.
The leaders at APMA and CPME have no idea the
pain and hard-ship this MAN-MADE residency crisis
has caused me, my unmatched colleagues, and their
families. All I have to say is that I hope these
leaders can get a good night's sleep every night,
thinking that their actions have caused such
suffering for so many good people that deserve
better.
I am going to continue to find a work and accrue
clinical experience and hang tough in this time
of hardship. Even if I do get a residency, I will
never forget what these leaders did to us. Shame
on them and shame on anyone who supports them.
This is a crime, an absolute crime.
Unmatched Podiatric Graduate
Other messages in this thread:
08/01/2013 ***Unmatched Podiatric Graduate
Unmatched Residency Placements Currently Stand at 86
I am also one of the unmatched graduates from the
class of 2013 who has been waiting since March to
see what happens with this long brewing and self
created debacle. Nearly everyday, I have been
reading the posts that have poured into PM News
to gather any bit of information that could have
helped me. Needless to say, there was a lot
of "finger pointing", "now is not the time to
blame anyone" and "we must work together."
I applaud programs who have taken an extra
resident, two, or three in the meantime. However,
this is only the tip of the iceberg. The vast
majority of those without a program are still
unmatched and waiting for answers. Here is my
take on some of the issues that have been
discussed:
CPME: Caps are not being enforced: I have seen
this firsthand in both my institution and other
colleges. The fact of the matter is that we
started with a record class size in my year, and
then lost more than 25% of those matriculants.
What does that say about my college and some
others? To me it suggests that they are so
obsessed with chasing the dollar bill, that they
would admit someone while fully well knowing that
he or she may not be able to finish the
curriculum. And let's not forget that the record
class sizes were taken when knowledge of a
possible shortage was in plain view of college
officials.
APMLE: Dr. Edwin Wolf wrote sometime ago that
part of the reason this crisis exists is "An
unusually high Boards Part II pass rate." So am I
correct in assuming that our boards were designed
for us to fail? Was there an expectation that
enough of us would fail so as to stabilize class
sizes? I agree with my co-student who wrote that
the test does not test minimal competency, and is
a poorly written hodgepodge of minutia that
serves little to no purpose in clinical
practice. How can we even compare this test as
being alike to the USMLE/COMLEX?
APMA: Dr. Gastwirth's salary is publicly known,
and I have seen him at multiple meetings. But has
he ever once taken the stage to take
responsibility and voice concern of the residency
shortage? How can we be taken seriously as a
profession when our own leaders are so myopic?
Might I add in here that podiatry is not
recognized by ACGME as a medical specialty, and
one can only wonder why...
CPME: While I understand that their role is to
monitor and enforce standards related to
residency training, the survey that they released
was a half-hearted attempt at validating their
own existence and meekly asking if they alphabet
soup of residencies should be brought back. And
as far as the release of information goes, should
the public not be allowed to know some of the
pertinent information regarding residency
development? Why is this information guarded like
gold at Fort Knox?
It is the public who will eventually apply,
matriculate, and graduate the colleges. And why
has there not been a public disclosure to
applicants that there is an ongoing shortage of
residencies is beyond me...buyer beware.
I urge all of those involved in the profession to
ask yourselves if we really have made progress by
mandating the current guidelines that have been
set. Or in the name of progress, have we labeled
some as sacrificial lambs who have been doomed to
slaughter? And my last point: If the colleges are
truly not-for-profit institutions, then give the
unmatched graduates their money back, as we paid
for a service, and it was not delivered.
Unmatched Podiatric Graduate (KSCPM1)
For the unmatched podiatric physician I say, welcome to the club my friend. If you plan to sue the podiatry schools let me know. Sounds like a plan. At least someone would be doing something about the mess that this field is in. And it would be helping the field of law. Let us not be jealous of those who picked a better field to study. As others have mentioned, no one wants you. You suggest that programs would be forced to take a candidate like you....or me, so let's not force anyone to pick a qualified candidate outside the current graduating class. And please please please people, refrain from picking on those in the food industry. It can me much more lucrative than podiatry and everyone has to eat! Healthy and rewarding.
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The take on this is another forum topic-malignant residency programs. If programs can treat residents and students as they will, and are autonomous in that respect- why not have programs like that give back and take unmatched graduates? It won't hurt the top students who would go elsewhere. It wouldn't diminish their "prestige" because students and would be residents wouldn't pick these programs by choice ( if what you read on SDN is true) so then, what's the harm?
Residency programs protect themselves. IMHO the sentiment that having a DPM that has graduated in a residency program some how brings the program down needs to be changed. Because as the letter stated, the DPMs are not going to just "go away". They will be around the healthcare/ research/ academic sector somehow. That makes the profession look bad more so than accepting a DPM into a residency program.
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It seems like you're assuming that these programs would just be added to the programs we have now. If that were the case, then it wouldn't be such a big deal if those programs were forced to accept unmatched graduates. I don't think that the "prestige" of a program goes down in the choose an unmatched graduate as a resident. I certainly never said it did. What I said is that forcing a program to take unmatched residents would bring it's stock down. The point is we need more programs, not to force the programs we now have to take unmatched graduates.