Dangers of the new schools opening

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ABPM then creates CAQs and some limb fellowships. To create their own haves for hospital and academic jobs.

It never ends and the line is always blurred on what is needed to get a good job versus just wanting an area of expertise. Usually more the former than later.

ABPM doesn’t create fellowships. It is a testing organization.

And yes, professions and specialties evolve.

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Very disappointing to see the same 10-15 posters relentlessly try to tear down the profession.

There is actually a surplus of residencies now. So much so that CPME had to change the rules on if a slot is unfilled for 3 years it’s automatically closed.

The anonymous members who post here keep writing how successful they are, yet discouraging others from joining the profession. It’s very strange. Maybe even anti-competitive.

Every profession can be improved. Some decide just to bash it on forums. Instead, why don’t you become an APMA delegate and bring up resolutions in the House of Delegates?

The best advice I can give pre-pods is to do research from reliable sources and shadow a podiatrist. Talk to someone you can verify is an actual podiatrist before you heed the advice from the dark web.

At least for me, it’s not that I’m trying to tear down the profession... I do love my profession! I am proudly involved in ACPM and CND. It just makes me sad seeing the state of affairs newly graduating residents face.

If every new associate position started in the mid 100s with good benefits (401k, decent vaca, insurance, cme, etc.), I think discussions here would be far different.

Unfortunately, it’s just not the case! Makes the non-podiatry group gigs (VA, hosp, ortho, endo groups, etc.) so darn sought after... and in many cases these jobs are “created” by the applicants purely asking if “they need a podiatrist.”
 
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ABPM doesn’t create fellowships. It is a testing organization.

And yes, professions and specialties evolve.
Yes I know, not everything I said was not completely accurate. ABFAS and ABPM are testing organizations……so you become board certified. ACFAS is an organization you can join and become a fellow once you are board certified and become a diplomat of ABFAS. APMA started one also ASPS for ABFAS diplomats after the split. Too many acronyms for a small profession. I did not even know the name of the organization ABPM diplomats could join, had to look it up….ACPM. If pre-pods are reading this their heads are probably spinning.

The fact remains for 7 years of training and everyone supposedly doing the same residency, things are still a mess as far as unity and the job market. It is OK for some to specialize further and complete fellowships, but it is getting out of hand.

We are one profession and supposedly have one type of residency, so we should have one board. 7 years of schooling and many other healthcare professions are in extreme demand. We deserve to have a good job market also. I can not think any other healthcare profession that requires 7 years of training (or more with fellowship) that is not in serious demand. Is it possible for our leaders to even consider we would benefit by having less students? I wish the best for your residents, fellows and the school you are associated with. However, for unselfish reasons I hope overall podiatry school enrollment stays low until the job market improves.

In the past no one really expected much from the podiatry job market, but as you said things evolve. People going into a profession that requires this much time, money and work now expect a decent job market with jobs offering a reasonable ROI when they finish.
 
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Very disappointing to see the same 10-15 posters relentlessly try to tear down the profession.

There is actually a surplus of residencies now. So much so that CPME had to change the rules on if a slot is unfilled for 3 years it’s automatically closed.

The anonymous members who post here keep writing how successful they are, yet discouraging others from joining the profession. It’s very strange. Maybe even anti-competitive.

Every profession can be improved. Some decide just to bash it on forums. Instead, why don’t you become an APMA delegate and bring up resolutions in the House of Delegates?

The best advice I can give pre-pods is to do research from reliable sources and shadow a podiatrist. Talk to someone you can verify is an actual podiatrist before you heed the advice from the dark web.

Yes SDN is ruining the profession….

Surplus of residency spots? One can argue that a lot of those spots are not justified as as a lot of residency programs don’t produce enough volume for their residents to graduate. I’d say most programs fabricate their numbers. It’s not uncommon for multiple residents to scrub a toe case claim first assist and the residency director signs off on it. This happens. Especially at the weaker programs trying to stay open. Nobody audits these programs.

I don’t have a problem with you here promoting podiatry but you don’t even acknowledge the short comings of the profession that we all lament on here as practicing attendings and you essentially ignore it and call us complainers. You are only adding fuel to fire.
 
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unfortunately when I was a pre-pod SDN was much more positive and I got suckered in. now the realities and truth is being spread and hopefully applicants avoid the mistake that most of us made.. I wish I could go back in time and do something else.
Unfortunately, when I was a pre-pod SDN was just as negative, and I got suckered in.

now the memes and reports is being spread and hopefully applicants avoid the mistake that most of us made.. I wish I could go back in time and do something else instead of being an SDN mod.
 
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Unfortunately, when I was a pre-pod SDN was just as negative, and I got suckered in.

now the memes and reports is being spread and hopefully applicants avoid the mistake that most of us made.. I wish I could go back in time and do something else instead of being an SDN mod.
We should all be extremely proud of the Meme Thread and it's future contributions to this profession. As the founding member, I am proud to have @heybrother @Feli @icebreaker32 @Pronation join me at the Midmark 4000 High Council.
 
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Hot take - the mods have rearranged the pre-pod forum so terribly that is hard to find info this the lack of posting in the pre-pod forum is not indicative of the overall appeal of podiatry.
 
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Good point. True. Fellowship trend is just another proof there is tight competition for not so many good jobs out there.
Yes, for sure.

It also speaks to the need for improvement in our overall residency quality. Sure, the great ones are great, but we're faaar from the overall consistency and uniform competence of MD programs. Board pass rates and volume/diversity logs (assuming not fluffed) absolutely speak to that.
 
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Unfortunately, when I was a pre-pod SDN was just as negative, and I got suckered in.

now the memes and reports is being spread and hopefully applicants avoid the mistake that most of us made.. I wish I could go back in time and do something else instead of being an SDN mod.
Lol. Yep, SDN has changed a bit but not drastically. Podiatry has always had the doom-n-gloom. Probably quadruple so for chiro schools.

I still have people PM msg me almost every week. Sometimes it's a parent of a pre-pod, pod, etc. Sometimes asking pod school, residencies, etc. People are reading... maybe not posting or posting very minimally, but reading. That's good they're out looking for info to make an informed choice. Practicing DPMs talk to me at conferences about SDN also, even speakers and stuff... a fair number read for entertainment or whatever but don't post. I guess I'm an easy target since I'm transparent on SDN.

My general response to the pre- and pod students is same as it was 10yrs ago... podiatry is good, good residencies are scarce. It's worth it if you liked the shadowing. ROI is questionable but doable. You have to work hard in school and secure a good residency. The difference between good and not good is life-changing, unfortunately. With the new schools, probably have to work even harder to get a good one.

"What do you call the guy who graduates last in medical school?" ... "Doctor."
"What do you call the guy who graduates last in podiatry school?" ... "400k debt, probably no residency."
 
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So this may be an ignorant question... but WHY exactly are PP associate jobs so poorly paid / bad benefits (there are certainly exceptions)?

1) Is it because DPMs get reimbursed so much less for CPT codes vs. MD/DO?

2) More “greed” in DPM PP owners trying to prey off new docs?

3) Both of the above?

4)____

I guess what i’m trying to get at... is HOW we as attendings can improve the above situation? I’m not certain getting involved in the state pod associations / APMA are going to change #1 much (and certainly not #2).

If any new endocinology/rheum/ortho/family doc/etc. was offered what we are in a PP gig, they would laugh and walk away (“80k + bonus!?? LOL”).

Any thoughts?
 
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So this may be an ignorant question... but WHY exactly are PP associate jobs so poorly paid / bad benefits (there are certainly exceptions)?

1) Is it because DPMs get reimbursed so much less for CPT codes vs. MD/DO?

2) More “greed” in DPM PP owners trying to prey off new docs?

3) Both of the above?

4)____

I guess what i’m trying to get at... is HOW we as attendings can improve the above situation? I’m not certain getting involved in the state pod associations / APMA are going to change #1 much (and certainly not #2).

If any new endocinology/rheum/ortho/family doc/etc. was offered what we are in a PP gig, they would laugh and walk away (“80k + bonus!?? LOL”).

Any thoughts?

Greed. 100%.

The standard protocol for private practice sleazebags is to hire an associate sucker to “grow” the practice (as in the patient load wasn’t there and the practice had no business bringing on another total toenail replacement surgeon)
 
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So this may be an ignorant question... but WHY exactly are PP associate jobs so poorly paid / bad benefits (there are certainly exceptions)?

1) Is it because DPMs get reimbursed so much less for CPT codes vs. MD/DO?

2) More “greed” in DPM PP owners trying to prey off new docs?

3) Both of the above?

4)____...
I think you already know the answer to that. If not, Pronation hit it.

There are basically two ways to run a PP (any specialty) :
1 churn associates, pay them as little as possible, promise/lie to keep then awhile, rinse and repeat... one owner or few owners
2 pay them well based on what they produce, give equal partnership or unequal partnership or just fair pay, keep docs awhile or forever

Number 1 (churn/burn) definitely happens in the MD/DO/dent world also, but it happens a ton more in podiatry because MD/DO have a lot more hospital jobs and type 2 PP jobs where they don't typically consider crap PP jobs... and most dent are just solo entrepreneurs.
 
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One thing I will say is that when I was looking for jobs, I met with a small MSG group... potential employer.

They had a consultant they were using to negotiate my contract, he told me that the typical salary and bonus structure for podiatry groups was something he said was unique to podiatry (and he didn’t mean that in a good way). He said he’s never seen it used for any other specialty (low base + __% of collections past ___k).
 
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One thing I will say is that when I was looking for jobs, I met with a small MSG group... potential employer.

They had a consultant they were using to negotiate my contract, he told me that the typical salary and bonus structure for podiatry groups was something he said was unique to podiatry (and he didn’t mean that in a good way). He said he’s never seen it used for any other specialty (low base + __% of collections past ___k).
in that setting though it should be MGMA based not private office based
 
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So this may be an ignorant question... but WHY exactly are PP associate jobs so poorly paid / bad benefits (there are certainly exceptions)?

1) Is it because DPMs get reimbursed so much less for CPT codes vs. MD/DO?

2) More “greed” in DPM PP owners trying to prey off new docs?

3) Both of the above?

4)____

I guess what i’m trying to get at... is HOW we as attendings can improve the above situation? I’m not certain getting involved in the state pod associations / APMA are going to change #1 much (and certainly not #2).

If any new endocinology/rheum/ortho/family doc/etc. was offered what we are in a PP gig, they would laugh and walk away (“80k + bonus!?? LOL”).

Any thoughts?
Greed but reimbursement is collapsing. In 2005 my practice got $900 for 28296- I found the fee schedule yesterday for a major evil corp. Today we get 400 from same company.
 
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So this may be an ignorant question... but WHY exactly are PP associate jobs so poorly paid / bad benefits (there are certainly exceptions)?

1) Is it because DPMs get reimbursed so much less for CPT codes vs. MD/DO?

2) More “greed” in DPM PP owners trying to prey off new docs?

3) Both of the above?

4)____

I guess what i’m trying to get at... is HOW we as attendings can improve the above situation? I’m not certain getting involved in the state pod associations / APMA are going to change #1 much (and certainly not #2).

If any new endocinology/rheum/ortho/family doc/etc. was offered what we are in a PP gig, they would laugh and walk away (“80k + bonus!?? LOL”).

Any thoughts?
Nails.

If everyone was seeing MSK then different ball game. 11721? Or x-rays and an injection.
 
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How does the fact that people are living longer and there is an increase population in the future, etc. weigh in this?

It seems that adding new schools is definitely not beneficial to the field in general, but won't the demand for podiatrists increase just based on an increase in older populations, and arguably less healthy populations, in the (near) future? I feel like some of the saturation will be mitigated?
 
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How does the fact that people are living longer and there is an increase population in the future, etc. weigh in this?
In my experience, 95% of geriatric care is trimming toenails and calluses. Obviously, this needs to be done by someone, but in a sane universe that person would not need a doctorate and a three year surgical residency.

See also my (unanswered) post in the "Questions to Podiatric Leaders" thread
 
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How does the fact that people are living longer and there is an increase population in the future, etc. weigh in this?

It seems that adding new schools is definitely not beneficial to the field in general, but won't the demand for podiatrists increase just based on an increase in older populations, and arguably less healthy populations, in the (near) future? I feel like some of the saturation will be mitigated?
Youre right on 0 of 2... a third idea is the only semi-legit argument for more pod schools / more DPM demand:
-the overall USA population is not going up, will soon be going down
-overall older populations and life expectancy is not going up
...(unhealthy + die younger cancels out older "healthy")... and overall life expectancy actually down with pandemic
-diabetic/obese is rising as a % of overall USA population

Most first world countries have negative population growth with better use of birth control and other social factors. USA is on the tipping point... still technically tiny "growth" on census due to a good amount of immigration, but birth rates decline, just like every first world country. "Growth" for USA is record lows and will soon be negative.

People are living a bit longer, bit that's only some of them. Some die much sooner due to unhealthy lifestyle and/or COVID, etc. The few who are age 90, 95 100, etc are uncommon and not as significant as you think in actual overall stats. Many of them are not living at home either. Modern medicine and nutrition/exercise knowledge are canceled out by obesity almost as fast. As mentioned above, the vaaast majority of seniors who have transportation and who you see in a podiatry office will be toenail, callus, arthritis care... nothing operative. It's all fine and good, and it still makes money and helps them, but many have lower activity, suspect bloodflow, etc where and procedure or surgery options are limited or zero (assuming the doc is conscientious). Basically, if I see 80yo new patient for "bunion" on my list, I'm not thinking surgery.... greater than 50/50 they will just get a bunion pad, perhaps an Xray if they wish... and 80% they'll also request toenail care. :)

...Our American love of over-eating, for better or worse, has been the only real boon to podiatry demand. We are the country that invented fast food and could probably turn Lionel Messi or Adriana Lima or Roger Federer or Bruce Lee into soft 300lb beasts given enough time. It's well-documented that Asians and their kids from low BMI countries tend to get high BMI when they come here. So, there is podiatry work on diabetic foot exams and cutting toenails due to Dunlap disease, but those are elementary skills a podiatry student learns within a couple months of 3rd year clinics. :(

If you're ethical, large and unhealthy folks are almost invariably not good elective surgical candidates, though. There will always be morbidly obese who need wound care or a toe amp... that demographic has steadily gone up a bit. I don't typically try to cash in off that at work. You will find DPMs doing lateral ankle work on 400lb Tiny Tiffany just like a few questionable Orthos do 3 three ACL jobs on her. Some DPMs will undertake hero Charcot nail + frame work and refuse to just cast on Bob BBQ who is a 300lb diabetic with A1c of 12% and stands 5'6" tall. The elective and semi-elective work is hiiighly suspect at best on the BMI 30, 35, 40+ set... especially diabetics with poor control. Some of it might be a function of poor training, some of it might be DPMs just wanting to do procedures or get paid... I really don't know. It often makes us all look bad. But, again, it's not unique to podiatry... it's seen in other specialties also: procedure$ clearly destined for a collision with the ol' iceberg.

Aging gets hopeless after a point also. American medicine will make you upset at times with a 90 year old (or 75yr old dialysis) patient with zero chance getting 4 revasc cath attempts, toe amp that predictably fails, more revasc... when the proper thing was simply betadine the toe, ultrasound, maaaybe one cath, and more betadine until BKA. Medicine, especially hospital medicine, loves to bankrupt patients, family, and taxpayers on clearly lost causes. Quite lame.

The infection and injury diabetic foot stuff will find you and it needs to be done well, but it's generally simple and NOT glamorous (hence MDs happily getting rid of it). Personally, to capitalize best and quickly on diabetes increasing, I just buy a lot of NVO shares. 😇

...these are the COMMON myths that one may encounter regarding podiatry - or any medical profession:
  • people are living longer (false)
  • population is increasing (false)
  • diabetes is on the rise (true, but not a panacea... and also fairly undesirable work)
  • USA has an active population (yes, some are... but that has been roughly the same size for decades... for every hardcore cross-fitter or IG model, there are probably 3 chubby videogamers)
It's fine to consider these things, but don't just take them at face value. Look up "United States life expectancy by year" and "United States population growth by year" and "first world nations population growth" and other stuff.
 
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My general response to the pre- and pod students is same as it was 10yrs ago... podiatry is good, good residencies are scarce. It's worth it if you liked the shadowing. ROI is questionable but doable. You have to work hard in school and secure a good residency. The difference between good and not good is life-changing, unfortunately. With the new schools, probably have to work even harder to get a good one.

I understand there are more desirable residencies than others, but based on some resident physicians I know, it doesn't seem to influence the job they get after residency as much as many podiatrists make it seem.

Podiatrists in general are getting more parity to MD/DO as time goes on as well. Wouldn't the best offered residencies 20 years ago be worse than the worst residencies offered today?

For example, at one point in time podiatrists couldn't even do procedures without an MD being in the room. A professor at my school mentioned this, maybe 30 years ago or so? I don't know.

It seems the podiatrists today benefit from the ongoing parity that keeps happening over time. Wouldnt it be acceptable to assume that the trend will keep going in that direction in the future and even the worst residencies today won't mean much in the future, in terms of finding a decent podiatrist job?

For residencies in general, schools churn out stats saying that students get a residency at a 99-100% rate each year. Personally I have known every student to get a residency and never heard of one not getting one in the classes above me. I even knew 3 or 4 that did scramble, and they found residencies fairly easy, and some of those residencies seemed perfectly fine as well.
 
...Podiatrists in general are getting more parity to MD/DO as time goes on as well. Wouldn't the best offered residencies 20 years ago be worse than the worst residencies offered today?

For example, at one point in time podiatrists couldn't even do procedures without an MD being in the room. A professor at my school mentioned this, maybe 30 years ago or so? I don't know...
To echo above: nope, not even close. Residencies were unequal then and are unequal now.

You don't know what you don't know.
Some of the old residencies were actually amaaaaaazing surgical numbers... more in 2yrs or even in one year than I did in my 3yrs. Look at the program I trained at ("St John Main")... it has since spun off 3-5 other programs from its alumni being directors, hospitals/attendings the mothership program used to cover now becoming their own residency, etc. Likewise, DMC program (made strong by one of our alumni) has had at least a couple spinoff programs with their alumni as directors. Imagine back when all of those cases went to a single set of residents. Awhile ago, podiatry could only have privileges at certain (usually smallish) hospitals, so some of those had absolutely HUGE surgical numbers. Now, podiatry has advanced and many programs have spread thinner.

But yes, on average, today's DPM residencies are very good in comparison to past (yet not every DPM got a residency and definitely not a surgical residency in the past). The best ones today are better than the best of the past. Those will give good and even phenomenal training and also tend to network their grads. Average now are better than the past. There are still many garbage ones, though. That's unfortunate... and it will be compounded with more schools. Don't believe for a minute that a residency is a residency... not true in MD, and totally not true in DPM.

So, match is not a huge problem if you graduate near the top of the class. The problem lies that nobody starts out planning to graduated bottom half or bottom third or dead last... yet many will (and the bottom of the class on grad day is not even bottom since 10-25% or more of those who start might flunk out or flunk classes switch to extended 5+ year program).
 
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To echo above: nope, not even close. Residencies were unequal then and are unequal now.

You don't know what you don't know.
Some of the old residencies were actually amaaaaaazing surgical numbers... more in 2yrs or even in one year than I did in my 3yrs. Look at the program I trained at ("St John Main")... it has since spun off 3-5 other programs from its alumni being directors, hospitals/attendings the mothership program used to cover now becoming their own residency, etc. Likewise, DMC program (made strong by one of our alumni) has had at least a couple spinoff programs with their alumni as directors. Imagine back when all of those cases went to a single set of residents. Awhile ago, podiatry could only have privileges at certain (usually smallish) hospitals, so some of those had absolutely HUGE surgical numbers. Now, podiatry has advanced and many programs have spread thinner.

But yes, on average, today's DPM residencies are very good in comparison to past (yet not every DPM got a residency and definitely not a surgical residency in the past). The best ones today are better than the best of the past. Those will give good and even phenomenal training and also tend to network their grads. Average now are better than the past. There are still many garbage ones, though. That's unfortunate... and it will be compounded with more schools. Don't believe for a minute that a residency is a residency... not true in MD, and totally not true in DPM.

So, match is not a huge problem if you graduate near the top of the class. The problem lies that nobody starts out planning to graduated bottom half or bottom third or dead last... yet many will (and the bottom of the class on grad day is not even bottom since 10-25% or more of those who start might flunk out or flunk classes switch to extended 5+ year program).

It seems like the major downside is that there is less of a workload (experience) that residents could get then and now because of "program thinning".

Individuals at top residencies still do well, individuals at average residencies are doing better than the past, and individuals at lower tier programs are even doing surgery.

Are there any residencies that don't offer surgery?
 
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It seems like the major downside is that there is less of a workload (experience) that residents could get then and now because of "program thinning".

Individuals at top residencies still do well, individuals at average residencies are doing better than the past, and individuals at lower tier programs are even doing surgery.

Are there any residencies that don't offer surgery?
All current ones will offer at least some surgery... but, again, some programs have much more overall surgery, much better attending docs, much more doing and less watching, much more of complex surgery, etc.

You have to realize that podiatry has made some fast changes. It is a FAR contrast from MD programs which were added very gradually, are nearly all in large teaching and university hospitals, and have always had a sizable surplus of residency spots.

Podiatry had some top grads get surgical programs and some get non-surgical (or no residency at all) for awhile... kinda like dent.
Later, it went to that everyone got a residency... some basically surgical and some minimal or non-surgical.
Then, they went to all 3 year residencies... many, many VA hospital podiatry residencies were created in a hurry to make that happen.
Now, with new schools looming, the urgency for more programs is here again. Stay tuned.

The last part is the crux of what you see all of the SDN and overall podiatry bickering and disagreements about now: new schools, more grads, not enough residencies to support them - especially good quality spots. There is also the overall creation of more DPMs than USA needs, but it's easier to focus just on the training/residencies. There have been some residency shortages in podiatry in the recent and distant past, and it's a real mess... people who borrowed a lot of money, passed boards, no residency training. There have also been a few years of residency surplus (no problem at all... great chance to close/consolidate the crummy ones... but the surpluses never last long).
 
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All current ones will offer at least some surgery... but, again, some programs have much more overall surgery, much better attending docs, much more doing and less watching, much more of complex surgery, etc.

You have to realize that podiatry has made some fast changes. It is a FAR contrast from MD programs which were added very gradually, are nearly all in large teaching and university hospitals, and have always had a sizable surplus of residency spots.

Podiatry had some top grads get surgical programs and some get non-surgical (or no residency at all) for awhile... kinda like dent.
Later, it went to that everyone got a residency... some basically surgical and some minimal or non-surgical.
Then, they went to all 3 year residencies... many, many VA hospital podiatry residencies were created in a hurry to make that happen.
Now, with new schools looming, the urgency for more programs is here again. Stay tuned.

The last part is the crux of what you see all of the SDN and overall podiatry bickering and disagreements about now: new schools, more grads, not enough residencies to support them - especially good quality spots. There is also the overall creation of more DPMs than USA needs, but it's easier to focus just on the training/residencies. There have been some residency shortages in podiatry in the recent and distant past, and it's a real mess... people who borrowed a lot of money, passed boards, no residency training. There have also been a few years of residency surplus (no problem at all... great chance to close/consolidate the crummy ones... but the surpluses never last long).
I think the thing to keep in mind is there really are unfortunately terrible programs out there. Read what happened to the Phoenix VA. There was apparently one point like no surgery going on at all. Maybe for the best because a student who visited there a few years ago showed me a picture they took of an intra-op xray of a lapidus. It was the most horrible thing I'd ever seen. Another friend at a VA showed me an x-ray where an attending put a full circular frame on for a 1st MPJ fusion... because they wanted to. I visited terrible programs during 4th year - just garbage labor. There are programs that are 3 years because that's just how long programs are. Its not because there's 3 years of good stuff happening.
 
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As a first year student, I was quite shocked to hear the news of these schools opening.

I have family members in pharmacy and the field is oversaturated. Pharmacists put in a lot of work, but because so many schools opened it's difficult for them to negotiate better salary. This leads to a lot of discontent and burnout.

Imagine someone interested in pursuing podiatry (7 years of gruesome hustle) and now having to compete with more people for a residency, I do not think that will attract them to the field.

I hope the higher ups of Podiatry will look at the example above and prevent that from happening in Podiatry. We need more residency spots and high quality residencies to promote the field and give patients the confidence they deserve when they visit a podiatric medical specialist.
 
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As a first year student, I was quite shocked to hear the news of these schools opening.

I have family members in pharmacy and the field is oversaturated. Pharmacists put in a lot of work, but because so many schools opened it's difficult for them to negotiate better salary. This leads to a lot of discontent and burnout.

Imagine someone interested in pursuing podiatry (7 years of gruesome hustle) and now having to compete with more people for a residency, I do not think that will attract them to the field.

I hope the higher ups of Podiatry will look at the example above and prevent that from happening in Podiatry. We need more residency spots and high quality residencies to promote the field and give patients the confidence they deserve when they visit a podiatric medical specialist.

They're not doing anything but dodging questions like gym dodge-ball game.
 
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