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From PM news:
104 Applicants Not Matched for Residency Positions
04/06/2013 Robert Eckles, DPM, MPH
Regarding the current residency position shortage, I feel compelled, after review of the dozens of online comments made on PM News and elsewhere, to write from the position of Graduate Placement Director and Associate Dean at one of the 9 colleges of podiatric medicine.
There have been many assertions made in recent weeks, generally summarized as:
There are too many colleges of podiatric medicine.
There are too many students in the colleges.
The Colleges care nothing about the students; their interests lie only in tuition dollars.
Deans and other college faculty earn huge sums of money in education.
There should not be mandatory 36-month residency training for graduates.
Without exception, these comments are untrue and reflect either unfamiliarity with the numerical facts of the situation or understanding of the whole of podiatric GME in the U.S.
To start, let me agree with one point that has been made over and over. It IS tragic and heartbreaking that a qualified student/graduate cannot enter post-graduate training. We all acknowledge that and since we deal with students on a daily basis, we are closer to it than anyone else out there. The question is what do we do about it? Many have complained about the problem without offering real solutions to it. Let me tell you what I think.
It is important to note that admissions numbers for each of the colleges is determined by the CPME, not by the AACPM and not by the design of the colleges. The CPME sets these numbers based on each institutions proven ability to provide required training resources. All Colleges, as a result of the Councils understanding of the GME issues at hand, had their entry intake- 2012- reduced by 10% in 2011. What is little known however, or reflected upon, is where we now stand in terms of matriculants and graduates, historically. In the 1979 when 5 colleges existed, the number of graduates was 572.
This number fluctuated in the 80s and 90s, but bottomed out in the mid- 2000s, when a decade- low average number of graduates- 432-sought residency positions. The fact that we will, in May, graduate 578 individuals from the 9 colleges indicates how fragile the argument for further reduction in class size or number of colleges is.
Does anyone really believe that our profession will do better, especially at a time of documented need, with fewer podiatrist practitioners? Does anyone really believe that we have such universal recognition and standing as providers and as physicians that we could survive a reduction in numbers? Remember that when there is a void in lower extremity clinical practice, the cry will not be lets have more podiatrists! it will be, thanks to physical therapists, nurse practitioners, general practitioners, pedorthists and orthopedists; WE can do those procedures. Marked reductions in the number of highly credentialed graduates of residency programs will lead to only one thing- marginalization of the profession in ways that could be catastrophic.
Clearly, college enrollment and tuition create an economic calculation for each college, and no college will want to further reduce enrollment, but it is clear that while the colleges are the portal through which graduates enter residency, they are not running the spigots wide open; most colleges could in fact effectively train more students than they have been permitted to enroll. And let me advise here that faculty of podiatric medical colleges, and lets include administrators like myself, do NOT earn salaries that are out of proportion to the private sector and are in most cases, well below what that individual could earn elsewhere. To state otherwise is to create a fiction and to degrade the commitment and professionalism of faculty at these colleges.
It is a personal affront to hear how we all care so little about our students when few making these comments have even been to a DPM college in the past 10 years. Let me offer an open invitation to anyone who wishes to come to NYCPM and visit, to actually see what we do here to provide excellent, competency-driven education for our students, to remediate them when they struggle, to compassionately assist in their personal lives where we can (or must), and to prepare them, finally, to become qualified to enter residency training.
So, what about the residency positions themselves? Well, here are some more facts. In the past 90 days the CPME has approved an additional 108 positions in currently accredited residency programs. This is a rare offering, and is in fact round TWO of such offerings (the last in 2011), where all a program has to do in order to officially open more positions is to respond YES to the Councils letter.
Basically, what the Council offered in 2011 and is currently offering, if effected by the programs, would eliminate the position shortage in 24h. In addition, in the transition to the PMSR model- 2011-2013, the Council also lowered required surgical training volumes for 3-year programs to the 2-year levels (apart from reconstructive RF and Ankle procedures) to make program compliance uniform and easier. So any argument that CPME has not responded to this issue is also invalid.
But how many programs have said yes? Another fact- that number is 5- 5 positions have resulted from this effort. Less than a 5% return. Of course, there are numerous reasons why programs may hesitate or decline this offer. GME reimbursement flows to hospitals based on 3- year averages of residents, so hospitals do not automatically increase their GME money flow on day 1 of such an increase. Too, and importantly, programs have an obligation to their current residents and to the overall approval standards under which they operate to NOT stretch the training volumes to the place where residents graduate without achieving competency.
As a program director, I get this (and yes, my application to open another position is in). Still, only 5 out of 108?
So why not unwind the current podiatrist GME requirement altogether? Do we really need 3-year residency trained podiatrists? I vote, unequivocally, yes. As someone who used to administer, from the old alphabet of residency designations, RPR, POR, PPMR, PSR12, and PSR-24 programs, and who completes credentialing requests from hospitals, insurance companies, and surgery centers every day, I can only advise that multiplicity in podiatric GME confuses the public and may lead to serious scope and liability issues. In fact, the advanced scope of practice bill in NY which will come into effect in February of 2014 could NOT have passed, had the legislature not seen that GME training was finally consistent and fully grounded in this advanced scope, academically and clinically.
You may argue that in the course of podiatric practice complex presentations dont come along that often. You may be right, but again, I think not. Practices and practitioners grow based on exactly where their expertise is. Those who have particular proficiency in wound care or sports medicine, OR reconstructive surgery grow practices that thrive and reflect these specific interests. No one can really say these cases just arent out there for the simple reason that if you dont do this work there is no reason why a patient would be referred to you for it. The unification of GME training models into 3-year training creates competence, consistency and importantly, parity with allopathic and DO GME training. Why would we ever entertain going backwards?
Let me make one final comment. The voices rising in outrage over this shortage blame everyone and everything for the problem except themselves. Not one person has ever written to ask, what can I do? Here it is, and it is something I have been saying in front of our CME audiences for years. Do you do office or surgery center- based surgical procedures where there are no residents? Dont. YOU may be the one who determines how many positions a hospital can qualify for. Take these cases to a teaching hospital near you. Invest your time in the training of residents.
If you feel you are connected sufficiently to this profession to complain about where we are then do something to change the future.
Robert Eckles, DPM, MPH, Dean, Clinical and Graduate Medical Education, Director, Podiatric Medical Education- Metropolitan Hospital PMSR/RRA, [email protected]
104 Applicants Not Matched for Residency Positions
04/06/2013 Robert Eckles, DPM, MPH
Regarding the current residency position shortage, I feel compelled, after review of the dozens of online comments made on PM News and elsewhere, to write from the position of Graduate Placement Director and Associate Dean at one of the 9 colleges of podiatric medicine.
There have been many assertions made in recent weeks, generally summarized as:
There are too many colleges of podiatric medicine.
There are too many students in the colleges.
The Colleges care nothing about the students; their interests lie only in tuition dollars.
Deans and other college faculty earn huge sums of money in education.
There should not be mandatory 36-month residency training for graduates.
Without exception, these comments are untrue and reflect either unfamiliarity with the numerical facts of the situation or understanding of the whole of podiatric GME in the U.S.
To start, let me agree with one point that has been made over and over. It IS tragic and heartbreaking that a qualified student/graduate cannot enter post-graduate training. We all acknowledge that and since we deal with students on a daily basis, we are closer to it than anyone else out there. The question is what do we do about it? Many have complained about the problem without offering real solutions to it. Let me tell you what I think.
It is important to note that admissions numbers for each of the colleges is determined by the CPME, not by the AACPM and not by the design of the colleges. The CPME sets these numbers based on each institutions proven ability to provide required training resources. All Colleges, as a result of the Councils understanding of the GME issues at hand, had their entry intake- 2012- reduced by 10% in 2011. What is little known however, or reflected upon, is where we now stand in terms of matriculants and graduates, historically. In the 1979 when 5 colleges existed, the number of graduates was 572.
This number fluctuated in the 80s and 90s, but bottomed out in the mid- 2000s, when a decade- low average number of graduates- 432-sought residency positions. The fact that we will, in May, graduate 578 individuals from the 9 colleges indicates how fragile the argument for further reduction in class size or number of colleges is.
Does anyone really believe that our profession will do better, especially at a time of documented need, with fewer podiatrist practitioners? Does anyone really believe that we have such universal recognition and standing as providers and as physicians that we could survive a reduction in numbers? Remember that when there is a void in lower extremity clinical practice, the cry will not be lets have more podiatrists! it will be, thanks to physical therapists, nurse practitioners, general practitioners, pedorthists and orthopedists; WE can do those procedures. Marked reductions in the number of highly credentialed graduates of residency programs will lead to only one thing- marginalization of the profession in ways that could be catastrophic.
Clearly, college enrollment and tuition create an economic calculation for each college, and no college will want to further reduce enrollment, but it is clear that while the colleges are the portal through which graduates enter residency, they are not running the spigots wide open; most colleges could in fact effectively train more students than they have been permitted to enroll. And let me advise here that faculty of podiatric medical colleges, and lets include administrators like myself, do NOT earn salaries that are out of proportion to the private sector and are in most cases, well below what that individual could earn elsewhere. To state otherwise is to create a fiction and to degrade the commitment and professionalism of faculty at these colleges.
It is a personal affront to hear how we all care so little about our students when few making these comments have even been to a DPM college in the past 10 years. Let me offer an open invitation to anyone who wishes to come to NYCPM and visit, to actually see what we do here to provide excellent, competency-driven education for our students, to remediate them when they struggle, to compassionately assist in their personal lives where we can (or must), and to prepare them, finally, to become qualified to enter residency training.
So, what about the residency positions themselves? Well, here are some more facts. In the past 90 days the CPME has approved an additional 108 positions in currently accredited residency programs. This is a rare offering, and is in fact round TWO of such offerings (the last in 2011), where all a program has to do in order to officially open more positions is to respond YES to the Councils letter.
Basically, what the Council offered in 2011 and is currently offering, if effected by the programs, would eliminate the position shortage in 24h. In addition, in the transition to the PMSR model- 2011-2013, the Council also lowered required surgical training volumes for 3-year programs to the 2-year levels (apart from reconstructive RF and Ankle procedures) to make program compliance uniform and easier. So any argument that CPME has not responded to this issue is also invalid.
But how many programs have said yes? Another fact- that number is 5- 5 positions have resulted from this effort. Less than a 5% return. Of course, there are numerous reasons why programs may hesitate or decline this offer. GME reimbursement flows to hospitals based on 3- year averages of residents, so hospitals do not automatically increase their GME money flow on day 1 of such an increase. Too, and importantly, programs have an obligation to their current residents and to the overall approval standards under which they operate to NOT stretch the training volumes to the place where residents graduate without achieving competency.
As a program director, I get this (and yes, my application to open another position is in). Still, only 5 out of 108?
So why not unwind the current podiatrist GME requirement altogether? Do we really need 3-year residency trained podiatrists? I vote, unequivocally, yes. As someone who used to administer, from the old alphabet of residency designations, RPR, POR, PPMR, PSR12, and PSR-24 programs, and who completes credentialing requests from hospitals, insurance companies, and surgery centers every day, I can only advise that multiplicity in podiatric GME confuses the public and may lead to serious scope and liability issues. In fact, the advanced scope of practice bill in NY which will come into effect in February of 2014 could NOT have passed, had the legislature not seen that GME training was finally consistent and fully grounded in this advanced scope, academically and clinically.
You may argue that in the course of podiatric practice complex presentations dont come along that often. You may be right, but again, I think not. Practices and practitioners grow based on exactly where their expertise is. Those who have particular proficiency in wound care or sports medicine, OR reconstructive surgery grow practices that thrive and reflect these specific interests. No one can really say these cases just arent out there for the simple reason that if you dont do this work there is no reason why a patient would be referred to you for it. The unification of GME training models into 3-year training creates competence, consistency and importantly, parity with allopathic and DO GME training. Why would we ever entertain going backwards?
Let me make one final comment. The voices rising in outrage over this shortage blame everyone and everything for the problem except themselves. Not one person has ever written to ask, what can I do? Here it is, and it is something I have been saying in front of our CME audiences for years. Do you do office or surgery center- based surgical procedures where there are no residents? Dont. YOU may be the one who determines how many positions a hospital can qualify for. Take these cases to a teaching hospital near you. Invest your time in the training of residents.
If you feel you are connected sufficiently to this profession to complain about where we are then do something to change the future.
Robert Eckles, DPM, MPH, Dean, Clinical and Graduate Medical Education, Director, Podiatric Medical Education- Metropolitan Hospital PMSR/RRA, [email protected]
