Desperation for enrollment at NYCPM

[Weirdy]

You are waaay late to the party, brah.
You are trying to apply logic and ROI and common sense, but this recruit crisis is basic insider knowledge, fam:

We already know from reading Podiatry Sideways, which we keep getting whether we un-subscribe ten times or not, that all podiatry recruitment and enroll problems are - and always were - the fault of ... (drumroll) ... SDN ! "10-15 users" to be exact.

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​ ​ Be a Positive Influence for Podiatry​ Podiatry is a wonderful profession full of dedicated physicians who practice our specialty. We save feet from amputations, fix fractures, cure infections, and keep people active. We treat infants through seniors. We work in offices, clinics, hospitals, and surgery centers. We are a respected part of the healthcare team with parity in our recognition among medical staff, in the VA, in universities, and government agencies. There are so many opportunities in finding or creating the ideal job for any podiatrist. So, why aren’t more people choosing a career in podiatry? That’s a question asked by Dr. Douglas Richie in his recently published blog where he provides valuable insight into the student recruitment crisis. Dr. Richie reviewed AACPM data which showed a 29% decrease in podiatry school applications since 2020 and a 21% decrease in the last year alone. In 2022 there were 716 applicants for 697 seats. This excludes the new Texas school which has its own in-state applicant pool.​

​ ​ ​ ​ Dr. Richie surmises that one particular online forum is having a direct negative impact on podiatry school applications. We think he’s right. The forum is hosted on the website www.StudentDoctor.net (SDN). SDN is a non-profit with a noble mission where prospective health career students can research about the professions and engage with senior students or practicing professionals. The problem is that the three Podiatry Forums (Pre-Podiatry, Podiatry Students, Podiatric Residents & Physicians) have a significant volume of the posts by 10-15 users who are disgruntled practicing podiatrists. They actively discourage students to go into podiatry and they drown out any positive comments. Thousands of prospective students read these forums before deciding if they want to be a podiatrist. We don't think it has to be this way. Now the ask … We need you to help us move Podiatry Forward by being a truthful advocate for podiatry. Follow these easy steps: 1. Go to https://forums.studentdoctor.net/ and click “Sign Up” in the top right. 2. Register with a screen name. Stay anonymous or use your own name. 3. Review the Forums and respond to inaccurate information. Be a trusted source for students considering podiatry. 4. Tips for Positive Engagement​ Do post frequently, in response to an existing thread or create your own thread Do use links to data and useful sources Do show your pride in the profession ​ Don’t use personal attacks or belittle others Don’t be dissuaded by anonymous bomb-throwing posters (far more people are silent and reading) Do report posts that violate the community standards (link: https://www.studentdoctor.net/online-service-agreement/) to the moderators. We believe in podiatry. We believe that our profession can change lives both for our patients and our practitioners. We believe in moving Podiatry Forward. Thank you for your support.​

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Makes me sad that when I see stuff like this. Makes me want to walk away from these forums.

Hope all of you keep contributing to the discourse. As politely as you can.

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[icebreaker32]

What is also interesting is how class profiles are also shifting to more women than men.

https://aacpm.org/wp-content/uploads/App-by-Sex-2013-2022-10-2022.pdf

I know this is a generalization but women usually want to settle down and start a family. This impacts the financials if many are not giving 100% of their time to podiatry in their young production years.

Yah another disadvantage with podiatry.

In many other professions your degree and working 40 hours (or 30 in some cases) is enough to have financial success and a decent work/life balance.

In podiatry you often have to make your own success.

 

[diabeticfootdr]

You are waaay late to the party, brah.
You are trying to apply logic and ROI and common sense, but this recruit crisis is basic insider knowledge, fam:

We already know from reading Podiatry Sideways, which we keep getting whether we un-subscribe ten times or not, that all podiatry recruitment and enroll problems are - and always were - the fault of ... (drumroll) ... SDN ! "10-15 users" to be exact.

"

​ ​

​ ​

​ ​ Be a Positive Influence for Podiatry​ Podiatry is a wonderful profession full of dedicated physicians who practice our specialty. We save feet from amputations, fix fractures, cure infections, and keep people active. We treat infants through seniors. We work in offices, clinics, hospitals, and surgery centers. We are a respected part of the healthcare team with parity in our recognition among medical staff, in the VA, in universities, and government agencies. There are so many opportunities in finding or creating the ideal job for any podiatrist. So, why aren’t more people choosing a career in podiatry? That’s a question asked by Dr. Douglas Richie in his recently published blog where he provides valuable insight into the student recruitment crisis. Dr. Richie reviewed AACPM data which showed a 29% decrease in podiatry school applications since 2020 and a 21% decrease in the last year alone. In 2022 there were 716 applicants for 697 seats. This excludes the new Texas school which has its own in-state applicant pool.​

​ ​ ​ ​ Dr. Richie surmises that one particular online forum is having a direct negative impact on podiatry school applications. We think he’s right. The forum is hosted on the website www.StudentDoctor.net (SDN). SDN is a non-profit with a noble mission where prospective health career students can research about the professions and engage with senior students or practicing professionals. The problem is that the three Podiatry Forums (Pre-Podiatry, Podiatry Students, Podiatric Residents & Physicians) have a significant volume of the posts by 10-15 users who are disgruntled practicing podiatrists. They actively discourage students to go into podiatry and they drown out any positive comments. Thousands of prospective students read these forums before deciding if they want to be a podiatrist. We don't think it has to be this way. Now the ask … We need you to help us move Podiatry Forward by being a truthful advocate for podiatry. Follow these easy steps: 1. Go to https://forums.studentdoctor.net/ and click “Sign Up” in the top right. 2. Register with a screen name. Stay anonymous or use your own name. 3. Review the Forums and respond to inaccurate information. Be a trusted source for students considering podiatry. 4. Tips for Positive Engagement​ Do post frequently, in response to an existing thread or create your own thread Do use links to data and useful sources Do show your pride in the profession ​ Don’t use personal attacks or belittle others Don’t be dissuaded by anonymous bomb-throwing posters (far more people are silent and reading) Do report posts that violate the community standards (link: https://www.studentdoctor.net/online-service-agreement/) to the moderators. We believe in podiatry. We believe that our profession can change lives both for our patients and our practitioners. We believe in moving Podiatry Forward. Thank you for your support.​

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"

I’m going admit, perhaps I was wrong.

Over the past few months, I have received a steady stream of requests for assistance - 3 just yesterday. Many, but not all, are related to Board Certification.

The problems are even exacerbated by the impact COVID has had on medical education and the healthcare system, reducing the caseload and diversity of several whole classes of younger DPMs in practice. As a result, people are losing their privileges and their livelihoods.

These aren’t the only problems I’ve recently encountered. I’ve received some first-hand accounts of ridiculous low-ball offers for new grads. And even atrocious discrimination of young women podiatrists in the hiring process.

The scope of the problem needs to be determined and steps taken to urgently remedy it.

 

[Pronation]

The scope of the problem needs to be determined and steps taken to urgently remedy it.

Supply and demand... but you already knew all of this so stop blowing smoke up our Dremels.

 

[thepoddude]

I’m going admit, perhaps I was wrong.

Over the past few months, I have received a steady stream of requests for assistance - 3 just yesterday. Many, but not all, are related to Board Certification.

The problems are even exacerbated by the impact COVID has had on medical education and the healthcare system, reducing the caseload and diversity of several whole classes of younger DPMs in practice. As a result, people are losing their privileges and their livelihoods.

These aren’t the only problems I’ve recently encountered. I’ve received some first-hand accounts of ridiculous low-ball offers for new grads. And even atrocious discrimination of young women podiatrists in the hiring process.

The scope of the problem needs to be determined and steps taken to urgently remedy it.

How do you plan on addressing these concerns?

 

[dtrack22]

The scope of the problem needs to be determined and steps taken to urgently remedy it.

Well, we shall see if the ABPM has the guts to call out the problem. The problem we have all recognized on SDN for years now. We are over saturated as a profession. Our residency training, while standardized, is watered down at too many programs. We do not need more schools/seats/graduates. We need less.

I appreciate ABPM pushing for increased scope and easier certification/credentialing. They are the only org that acts like nursing organizations do, and advance the profession regardless of what MD/DOs think. But if the leadership can’t realize they’ve gone way to far with the “rah rah Podiatry” mindset to the detriment of current members. Or at least to their detriment in the near future as we continue to graduate 100-200 more foot doctors than we really need. Then ABPM leadership is dumber than I thought…or just as dishonest as the rest of them.

 

[malleolusman]

Well, we shall see if the ABPM has the guts to call out the problem. The problem we have all recognized on SDN for years now. We are over saturated as a profession. Our residency training, while standardized, is watered down at too many programs. We do not need more schools/seats/graduates. We need less.

I appreciate ABPM pushing for increased scope and easier certification/credentialing. They are the only org that acts like nursing organizations do, and advance the profession regardless of what MD/DOs think. But if the leadership can’t realize they’ve gone way to far with the “rah rah Podiatry” mindset to the detriment of current members. Or at least to their detriment in the near future as we continue to graduate 100-200 more foot doctors than we really need. Then ABPM leadership is dumber than I thought…or just as dishonest as the rest of them.

Applaud you for being in leadership and acknowledging that this profession does indeed have some serious problems. Part of that problem is the rest of the spineless leadership (looking at you ACFAS/ABFAS) that won’t acknowledge these problems exist either out of willful ignorance or just plain TFP stupidity.

Folks on this forum are not exaggerating about it being a dog fight out in practice. Would love to see if APMA/ABPM formally address and acknowledge these concerns. If there was a consistent calling out of bad behavior and bad actors (schools/new schools/bloated class sizes//market over saturation/a terrible job market/lack of consistent scope/terrible job at branding of what we do) publicly and loudly - maybe the needle could get moved. Anything else is just another round of PM news. Weak.

 

[call1800doctorb]

Well, we shall see if the ABPM has the guts to call out the problem. The problem we have all recognized on SDN for years now. We are over saturated as a profession. Our residency training, while standardized, is watered down at too many programs. We do not need more schools/seats/graduates. We need less.

I appreciate ABPM pushing for increased scope and easier certification/credentialing. They are the only org that acts like nursing organizations do, and advance the profession regardless of what MD/DOs think. But if the leadership can’t realize they’ve gone way to far with the “rah rah Podiatry” mindset to the detriment of current members. Or at least to their detriment in the near future as we continue to graduate 100-200 more foot doctors than we really need. Then ABPM leadership is dumber than I thought…or just as dishonest as the rest of them.

This is exactly how the profession should behave. Work to advance our profession with no regard for what MD/DOs think of us. We should do nothing to appease them. What they think of us is irrelevant.

 

[wakaflocka88]

Applaud you for being in leadership and acknowledging that this profession does indeed have some serious problems. Part of that problem is the rest of the spineless leadership (looking at you ACFAS/ABFAS) that won’t acknowledge these problems exist either out of willful ignorance or just plain TFP stupidity.

Folks on this forum are not exaggerating about it being a dog fight out in practice. Would love to see if APMA/ABPM formally address and acknowledge these concerns. If there was a consistent calling out of bad behavior and bad actors (schools/new schools/bloated class sizes//market over saturation/a terrible job market/lack of consistent scope/terrible job at branding of what we do) publicly and loudly - maybe the needle could get moved. Anything else is just another round of PM news. Weak.

A monumental step will be to first eliminate PM news. Might wreck the minds of TFPs..

 

[Shiyuan]

A monumental step will be to first eliminate PM news. Might wreck the minds of TFPs..

I soooo look forward to those 3:30am updates 😜

 

[Adam Smasher]

This isn't going to be a top down solution by any one person or group of people or group of organizations. We're all subject to the same laws of supply and demand.

I hate to keep requoting myself, but here are your salient facts.

-250k student loans
-7 years
-$140k avg salary (according to PM News survey)

We need to change at least 2 of those 3. That's why I wrote that post in the prepod forum about Australian DPMs (that no one cared about) because I thought it was really interesting how they streamline podiatry training. I admit their scope is much less than what we have, but a limited scope podiatrist is all most of our patients really need.

But really we're past the point of no return. Reducing enrollment will help but it's not a permanent solution. Say we cut enrollment and now mean salary goes from 140 to 180k. Then schools are going to say "see there's some great opportunities here in this profession, let's open 3 new schools!" And we're back where we started.

 

[DPM TRUTH]

It is absolutely unreal to hear the "gurus that graduated in the 80's" trying to place the blame on the forums for low enrollment.

Ladies and gentlemen this sums up the abfas/acfas leadership's view in our profession "don't tell them the truth".....how dare we educate our young before they sign over the gov loan checks for over 200k! Why are they so scared that people hear the truth? From what I have read, there is nothing on here fictitious.

The funniest thing about "these gurus making statements" is they got and took advantage of getting grandfathered into the surgical boards 30 years ago! Wonder if these individuals would be running their mouth if they didn't have the grandfathered in/alternative process to certification when they went through the process!

So to all my grandfathered in collegues from the 80's/90's please understand 99% of you could not pass (or have the case diversity) to pass today's abfas exam. Heck, you guys don't even have the minimum requirements to sit for the ABPM CAQ in surgery with your PSR 12/24!

 

[deleted682934]

I’m going admit, perhaps I was wrong.

Over the past few months, I have received a steady stream of requests for assistance - 3 just yesterday. Many, but not all, are related to Board Certification.

The problems are even exacerbated by the impact COVID has had on medical education and the healthcare system, reducing the caseload and diversity of several whole classes of younger DPMs in practice. As a result, people are losing their privileges and their livelihoods.

These aren’t the only problems I’ve recently encountered. I’ve received some first-hand accounts of ridiculous low-ball offers for new grads. And even atrocious discrimination of young women podiatrists in the hiring process.

The scope of the problem needs to be determined and steps taken to urgently remedy it.

Over saturation is a race to the bottom.

Poor training because of inadequate case load (and yes, greatly affected by covid. What happens when your 3 year residency in New York started in July of 2019, you spend 6 months on off service rotations. Then covid happens and you don't pick up elective cases until late 2020 or mid 2021. Now you have a year or less of already subpar New York training. One life event or pregnancy and you basically didn't train.)

Lower insurance reimbursement because supply and demand works in favor of insurance companies

Poor quality incoming students because higher quality students know better than take on 300k debt for this mess

Worsening impressions amongst patients and other medical professionals because we are putting out weaker and weaker doctors.

Surgeons need to operate to produce quality results. I don't know the number but if I wasn't doing at minimum 3-5 cases a week I would be concerned. Most do less than this a month. When I need surgery I want a busy surgeon who has been busy for a long time. Hard to do that when 500 more foot surgeons graduate a year

 

[Pronation]

Over saturation is a race to the bottom.

Poor training because of inadequate case load (and yes, greatly affected by covid. What happens when your 3 year residency in New York started in July of 2019, you spend 6 months on off service rotations. Then covid happens and you don't pick up elective cases until late 2020 or mid 2021. Now you have a year or less of already subpar New York training. One life event or pregnancy and you basically didn't train.)

Lower insurance reimbursement because supply and demand works in favor of insurance companies

Poor quality incoming students because higher quality students know better than take on 300k debt for this mess

Worsening impressions amongst patients and other medical professionals because we are putting out weaker and weaker doctors.

Surgeons need to operate to produce quality results. I don't know the number but if I wasn't doing at minimum 3-5 cases a week I would be concerned. Most do less than this a month. When I need surgery I want a busy surgeon who has been busy for a long time. Hard to do that when 500 more foot surgeons graduate a year

Everything you’ve said is spot on. The only thing I’ll say is that subpar New York training is a bit of an understatement. I wouldn’t trust a majority of NY trained TFPs to do anything other than foot care and maybe blocking 2 hours of OR time to take off a toe.

 

[bloxxeeey]

Well, we shall see if the ABPM has the guts to call out the problem. The problem we have all recognized on SDN for years now. We are over saturated as a profession. Our residency training, while standardized, is watered down at too many programs. We do not need more schools/seats/graduates. We need less.

I appreciate ABPM pushing for increased scope and easier certification/credentialing. They are the only org that acts like nursing organizations do, and advance the profession regardless of what MD/DOs think. But if the leadership can’t realize they’ve gone way to far with the “rah rah Podiatry” mindset to the detriment of current members. Or at least to their detriment in the near future as we continue to graduate 100-200 more foot doctors than we really need. Then ABPM leadership is dumber than I thought…or just as dishonest as the rest of them.

I think ABFAS has to do a midfoot certification as well.

 

[Adam Smasher]

WAAAY off topic, but how many of us had to take a lengthy surgery hiatus because of COVID? For me, the hospital where I operate had a no-elective surgery policy for about 3 months in 2020, so I wasn't doing anything other than amputations. Afterwards, they opened up to elective cases that would not result in overnight admissions, so no TKAs, but I was back on track and generating income for their OR.

Reason I bring this up is I understand this resulted in a dip in case numbers but I would assume residents were still doing amps and ORIFs during the height of the pandemic, but I doubt 3 crappy months out of 3 years would be truly devastating to a podiatry resident. Yes it's not ideal, but the pandemic wasn't ideal for any of us.

 

[DYK343]

WAAAY off topic, but how many of us had to take a lengthy surgery hiatus because of COVID? For me, the hospital where I operate had a no-elective surgery policy for about 3 months in 2020, so I wasn't doing anything other than amputations. Afterwards, they opened up to elective cases that would not result in overnight admissions, so no TKAs, but I was back on track and generating income for their OR.

Reason I bring this up is I understand this resulted in a dip in case numbers but I would assume residents were still doing amps and ORIFs during the height of the pandemic, but I doubt 3 crappy months out of 3 years would be truly devastating to a podiatry resident. Yes it's not ideal, but the pandemic wasn't ideal for any of us.

A lot of places didnt let a resident to scrub with an attending for 6 months or so. Social distancing applied to the OR. They got screwed.

I had similar 3 months nothing then anything that would result in no overnight stays. That said I still had to get a bunion or something approved and there were 20 surgeons fighting for the 2 elective rooms so I didnt get to do much. They took the highest reimbursing cases.

I texted my old director and they were teaching residents via camera for the procedure. Ridiculous but thats how the resident got to see the case.

 

[Pronation]

They took the highest reimbursing cases.

@ExperiencedDPM hopefully took this into consideration when he had an op note sitting in front of him with 10 CPTs for fixing a bunion.

 

[podwho]

Tbh all this stuff is great and spot on about the profession but really need to acknowledge that many of these small private practices have zero clue how to run a business. “Opening up shop” isn’t what it used to be. Healthcare industry has changed so much no physician should be running their practice anymore. That’s why you get embarrassingly low offers from doctors who don’t know what they are doing. That is very pervasive within this specialty and is killing other specialties too.

You don’t need to do surgery in 2023 to clear 180K in any part of the country. It’s either abuse or bad business management. So while I agree surgical training has its issues, if new grads and others job hunting were being paid well there would be no enrollment issue or complaints about boards. Podiatry is doomed to be swallowed up by private equity like many other specialties and there’s nothing this professions leadership can do to stop it because they are the problem and future pods will probably be better for it.

 

[Feli]

Tbh all this stuff is great and spot on about the profession but really need to acknowledge that many of these small private practices have zero clue how to run a business. “Opening up shop” isn’t what it used to be. Healthcare industry has changed so much no physician should be running their practice anymore. That’s why you get embarrassingly low offers from doctors who don’t know what they are doing. That is very pervasive within this specialty and is killing other specialties too.

You don’t need to do surgery in 2023 to clear 180K in any part of the country. It’s either abuse or bad business management. So while I agree surgical training has its issues, if new grads and others job hunting were being paid well there would be no enrollment issue or complaints about boards. Podiatry is doomed to be swallowed up by private equity like many other specialties and there’s nothing this professions leadership can do to stop it because they are the problem and future pods will probably be better for it.

Why do you suppose the vast majority of MD specialists are in PP, then?
I agree that small or medium doc groups are becoming more common than solo, but for plastics or ENT or ophtho or derm or IM fellowship docs or basically any specialty surgeon etc etc etc, private practice are still the path for the majority - rare exceptions to CT or onco surgeons that are basically relegated to univ settings because they need ICU and huge support team. All in all, as a specialist - and sometimes even as a generalist, you simply make more money and have less hospital admin/politic BS by doing it that PP way in most areas.

In the end, the best things in life, such as fitness and happiness and hobbies and family and romance don't cost anything. Sure, you need the security of money and the time to do them, but exotic travel or a 7br house or a boat are just not needed. For some, PP, is also a bit of a hobby. It can be fun to run a business and have the creativity and the autonomy and the ability to employ others. I suppose it's like how some people like to buy their own stocks or tinker with customizing or repairing cars while others just index fund or drive factory model autos.

At the end of the day, you will see again and again that in poor insurance areas or suburbs, most of the docs tend to work for the hospitals (let the facility handle the troublesome payers and the no-pay visits), and in the well insured areas, most are in private practice (especially the specialists) in solo office or groups, based on preference and the size of the town/city/metro.

...I'm not sure what changes in medical practice or private office trends has to do with the podiatry enrollment interest dips, though. It's a saturation problem for podiatry... through and through. That damages DPM worth in any setting. Good DPM jobs are rare, and the jobs on average pay far too little overall for the tuition + time ROI factor, and that's the core issue. There should be many, many more podiatry hospital jobs than there are, but that's supply/demand. Hospitals don't need nearly as many "foot and ankle surgeons" as the schools churn out; a lot of the hospital FTE jobs for DPMs use only a fraction of the skill set from a good residency (limb salvage + general podiatry). Similarly, most podiatry PP jobs should or could probably pay more, but why would they if they get plenty of apps and associate interest due to too many grads? Those problems fix themselves for most MD specialties... because they regulate their residency ratios and earnestly critique the quality of their training programs. Podiatry doesn't do any of that well; there always were and always will be the haves and have-nots. I like that pre-health applicants are voting with their feet. It's the only way to affect changes and curb the greed.
Look on the bright side, pod is much better than chiro (virtually zero hospital job options, few associate jobs, nearly no choice besides solo PP). On the other side of the coin, DC don't pile up as much debt with residency years that DPMs do. Unfortunately, you can use chiro to easily figure where podiatry is headed as it continues to add schools without quality residency spots or market demand or jobs to back them up.

 

[air bud]

Except some pediatricians and maybe some PCPs most MDs make way more than 190-200k.

Yeah peds are making way more than 200k these days. Probably closer to 3

 

[Feli]

Yeah peds are making way more than 200k these days. Probably closer to 3

year 2000 hospitals = "we don't hire DPMs"
2020 hospitals = "we have all the DPMs we need, the post got over 300 apps but was filled internally... it's closed, good luck"

2000 podiatry PP = associate base salary 100k and 30%
2020 podiatry PP = associate base salary 120k and 30%

2000 podiatry residency grad debt = $100k student loans
2020 podiatry residency +/- fellowship grad debt = $350k student loans (plus credit cards)

 

[ExperiencedDPM]

@ExperiencedDPM hopefully took this into consideration when he had an op note sitting in front of him with 10 CPTs for fixing a bunion.

???

 

[Feeter]

I’m going admit, perhaps I was wrong.

Over the past few months, I have received a steady stream of requests for assistance - 3 just yesterday. Many, but not all, are related to Board Certification.

The problems are even exacerbated by the impact COVID has had on medical education and the healthcare system, reducing the caseload and diversity of several whole classes of younger DPMs in practice. As a result, people are losing their privileges and their livelihoods.

These aren’t the only problems I’ve recently encountered. I’ve received some first-hand accounts of ridiculous low-ball offers for new grads. And even atrocious discrimination of young women podiatrists in the hiring process.

The scope of the problem needs to be determined and steps taken to urgently remedy it.

Thanks for at least acknowledging the issues people have brought up here.

Next let's come up with a realistic plan from the "leadership" to improve the profession over the next decade.

Start with better residency training that actually trains you to be a foot and ankle surgeon. Lower number of graduates annually. Advocate for podiatrist so reimbursement isn't ridiculously low for what we do. For example comprehensive diabetic foot check up visit should at least pay 1 wRVU instead of $20 that it pays for trimming toenails. Let's not just be stuck at boards infighting. Continue to support young pods who are bullied around for privileges by there pods and orthos and come to you for help. ABFAS has been useless in that regard. ACFAS has done some work but not close to what they should be.

 

[HardRoadPaved]

$20 that it pays for trimming toenails.

That's an easy one to fix. Ask for deletion of these codes by each payer. Cant wait for the day I can be proud I'm reimbursed higher than a nail salon.

Want em cut... That'll be $X.

No more "btw, can you trim my nails as I'm walking out"

 

[bloxxeeey]

Thanks for at least acknowledging the issues people have brought up here.

Next let's come up with a realistic plan from the "leadership" to improve the profession over the next decade.

Start with better residency training that actually trains you to be a foot and ankle surgeon. Lower number of graduates annually. Advocate for podiatrist so reimbursement isn't ridiculously low for what we do. For example comprehensive diabetic foot check up visit should at least pay 1 wRVU instead of $20 that it pays for trimming toenails. Let's not just be stuck at boards infighting. Continue to support young pods who are bullied around for privileges by there pods and orthos and come to you for help. ABFAS has been useless in that regard. ACFAS has done some work but not close to what they should be.

Best we can do is an additional board certification. First Ray Surgery Certified surgeon, not to be confused with a Lesser Digit Surgery Certification.

 

[diabeticfootdr]

Let's not just be stuck at boards infighting. Continue to support young pods who are bullied around for privileges by there pods and orthos and come to you for help. ABFAS has been useless in that regard.

Please understand that the Boards aren’t fighting just to fight. The ABPM could do nothing. Then there would be no infighting. Is that better?

Instead, we choose to fight for fairness and transparency. And the ABPM will not back down. If necessary, this will continue long after my term as president. The entire BOD is behind this 100%.

ABPM isn’t fighting for power, money, or for the sake of fighting. The ABPM’s goal is to help the profession create a single board with fair standards. Both boards would have to give up some power and money to do that. But it is the right thing to do.

There has been a large recent increase in pleas for help from Diplomates and younger podiatrists. We received so many requests this week - on Friday alone there were 3 - from podiatrists experiencing hardships and discrimination that are ruining their careers and their lives.

One of the issues on Friday was such an outrageous injustice against a recent residency graduate. I spent about 18 hours this weekend working on the matter. The hospital violated their own bylaws to remove this doctor over lack of ABFAS certification. It probably wouldn’t surprise you to find out another podiatrist was behind this, as these issues are usually anticompetitive. But it’s even worse than that. One of the ABFAS BOD is there.

What happened to this young DPM is indefensible.

But I’m hearing more and more of these cases and they’re exacerbated by the pandemic. Residency classes 2018/19/20 are particularly affected. Reduced surgical volumes and employment gaps during the pandemic coupled with the unreasonably rigid ABFAS requirements, are leading to a wave of privileging issues right now and I think it’s only the beginning of a coming tidal wave.

I sent a passionate letter to the APMA President and ED last night, asking them to lead on this issue. There is a BOT meeting Monday night.

These accounts from young DPMs are tragic and deeply personal. The profession is failing them.

Podiatry’s leadership has been encouraging ABFAS leadership to come to the table and just have a discussion about solutions to the problems. But, we won’t wait forever. The problem is urgent and many podiatrists are losing the ability to make a living right now. There will come a point when it will be too late for ABFAS. If they fail to act, the profession will leave them behind. This isn’t hyperbole. It will happen.

 

[Feeter]

Please understand that the Boards aren’t fighting just to fight. The ABPM could do nothing. Then there would be no infighting. Is that better?

Instead, we choose to fight for fairness and transparency. And the ABPM will not back down. If necessary, this will continue long after my term as president. The entire BOD is behind this 100%.

ABPM isn’t fighting for power, money, or for the sake of fighting. The ABPM’s goal is to help the profession create a single board with fair standards. Both boards would have to give up some power and money to do that. But it is the right thing to do.

There has been a large recent increase in pleas for help from Diplomates and younger podiatrists. We received so many requests this week - on Friday alone there were 3 - from podiatrists experiencing hardships and discrimination that are ruining their careers and their lives.

One of the issues on Friday was such an outrageous injustice against a recent residency graduate. I spent about 18 hours this weekend working on the matter. The hospital violated their own bylaws to remove this doctor over lack of ABFAS certification. It probably wouldn’t surprise you to find out another podiatrist was behind this, as these issues are usually anticompetitive. But it’s even worse than that. One of the ABFAS BOD is there.

What happened to this young DPM is indefensible.

But I’m hearing more and more of these cases and they’re exacerbated by the pandemic. Residency classes 2018/19/20 are particularly affected. Reduced surgical volumes and employment gaps during the pandemic coupled with the unreasonably rigid ABFAS requirements, are leading to a wave of privileging issues right now and I think it’s only the beginning of a coming tidal wave.

I sent a passionate letter to the APMA President and ED last night, asking them to lead on this issue. There is a BOT meeting Monday night.

These accounts from young DPMs are tragic and deeply personal. The profession is failing them.

Podiatry’s leadership has been encouraging ABFAS leadership to come to the table and just have a discussion about solutions to the problems. But, we won’t wait forever. The problem is urgent and many podiatrists are losing the ability to make a living right now. There will come a point when it will be too late for ABFAS. If they fail to act, the profession will leave them behind. This isn’t hyperbole. It will happen.

I guess my point is there are a lot more problems with the profession than just ridiculous board cert situation.

Profession would like the leadership to acknowledge those problems as well such as high number of graduates, low quality training, low pay, low reimbursement etc. They've been talked about here.

Is there any plan even interest in working on these non board issues from the leadership that you know of?

Unless CPME forces ABFAS out I don't see how it is going away. ABPM should submit to be part of ABMS if it wants broader recognition (?)

 

[Shiyuan]

ABPM should submit to be part of ABMS if it wants broader recognition (?)

Not sure if possible... but I like it!!!

 

[Pronation]

I guess my point is there are a lot more problems with the profession than just ridiculous board cert situation.

Profession would like the leadership to acknowledge those problems as well such as high number of graduates, low quality training, low pay, low reimbursement etc. They've been talked about here.

Is there any plan even interest in working on these non board issues from the leadership that you know of?

Unless CPME forces ABFAS out I don't see how it is going away. ABPM should submit to be part of ABMS if it wants broader recognition (?)

He’s obviously dancing around the main problem. The board cert nonsense is such a low priority to address this profession’s massive problem, but not for him, since he has an agenda.

 

[diabeticfootdr]

Not sure if possible... but I like it!!!

It’s not allowed by their bylaws.

 

[shadesofgrey]

I feel some of us are being a bit hard on Dr. Rogers. At least he has continued to interact with SDN pods and is now acknowledging that the profession's new graduates are in trouble. Where is the rest of the ****ing leadership for this profession? They are still trying to solve the student recruitment crisis, and honestly what can the ABPM really do on it's own? There are problems all over the place with podiatry. Finding a solution will take all our leaders coming together and, making choices that are painful for some but are for the good of the profession. It remains to be seen if any others will step up.

 

[newfeet]

I feel some of us are being a bit hard on Dr. Rogers. At least he has continued to interact with SDN pods and is now acknowledging that the profession's new graduates are in trouble. Where is the rest of the ****ing leadership for this profession? They are still trying to solve the student recruitment crisis, and honestly what can the ABPM really do on it's own? There are problems all over the place with podiatry. Finding a solution will take all our leaders coming together and, making choices that are painful for some but are for the good of the profession. It remains to be seen if any others will step up.

He is going to get rough up that's part of leadership.

 

[diabeticfootdr]

He is going to get rough up that's part of leadership.

Don’t worry about me. I can take it.

Instead, start calling and emailing the leaders who aren’t doing anything until THEY can’t take it anymore.

 

[diabeticfootdr]

He’s obviously dancing around the main problem. The board cert nonsense is such a low priority to address this profession’s massive problem, but not for him, since he has an agenda.

First, I’m president of a certifying board, I’m not the monarch of podiatry.

That being said, this is the United States of America and I am entitled (as is the ABPM as a “corporate person”) to voice my opinion and advocate on behalf of any issue affecting us or the profession.

The BC issue is not low priority at all. It is the singular reason that many DPMs are either being denied privileges or being “not renewed”. Non-renewal is a major issue because you are not afforded all the remedies in the bylaws (like an appeal). This actually makes litigation more likely, since it is the only redress these podiatrists have. These people are losing their livelihood because the profession let them down. Damn right we’re going to stand up for them.

You keep saying I have an “agenda.” We all have agendas. My agenda is that every podiatrist being given equal opportunity to become board certified and that the certification process be fair. It’s not a secret agenda. It is very public. And some say I’m “unpredictable.” It’s quite the opposite. If a podiatrist gets screwed over because of the unfairness that exists in the process. It is extremely predictable what the ABPM will do … we will stand up for that podiatrist and we won’t back down. Pretty simple.

 

[BillNyethePODGuy]

As a 1st year, this just looks like two parents (ABPM and ABFAS) fighting over custody of the kids. Regardless of how I personally feel about ABFAS exam vs the CAQ, this infighting isn't a good look for the profession. You don't see the board of radiologists and interventional radiologists goin' at it.

Also that email didnt just occur at NYCPM. If I remember correctly (ill check my school email) my school, Kent, did the same thing. Wasn't super confidence inspiring...

ABPM should submit to be part of ABMS if it wants broader recognition (?)

This is one piece of the puzzle by which we can further legitimize our field. I think, as an uninformed baby 1st year, there needs to be an effort to put our boards together. Podiatry is indelibly a procedure-heavy field since we treat the local manifestations of systemic diseases. No one board is more important but they need to be unified as every podiatrist should be skilled and examined in ALL aspects of the medicine and surgery we perform. Put the boards together: American Board of Podiatric Medicine and Surgery, boom. You don't like/want to do surgery? So what, Im sure theres an ED doc out there doesn't like doing pelvic exams when indicated, but they're educated on it and can perform it, regardless of wants. Being a part of the ABMS will show that we can self-assess and regulate as well as are on par with our MD/DO colleagues. I'd take it a step further regarding the CPME, but i digress.

It’s not allowed by their bylaws.

Bylaws can be changed with enough sway from DPMs and participating MD/DO efforts. That task force, while not successful, is a decent proof of concept that in some capacity MDs/DOs are willing to bring us into the fold to standardize training and be on par in our practice as well as recognize that DPM are physicians (just don't tell the AMA that.. they'll write a strongly worded letter). We can't hold ourselves out as practitioners of medicine and call ourselves physicians, but get mad when people point to deficiencies in our training or profession. It's on us as those that wish to practice medicine, to be at the standards set by those already practicing.

This weird tactic of statutorily expanding our scope of practice also makes no sense to me. Don't get me wring, I wholly recognize the effort that Pods past have put in to get our scope to where is it now, nor am I saying state advocacy has not or will not continue to produce results for our profession. However, if the AMA/AOA wanted to, they could throw enough money at state candidates to repeal any changes, expansions, or wording on our scope language. It puts our scope on unstable footing, especially given how temperamental state legislatures can be. Like it or not, these are the groups that run American medicine, our laws just codify their positions.

Idk, after a semester and 3/4 of school and working with other Pod students, residents, and attendings, it seems like we're in need of a fair amount of shifts in our profession if it is to last another hundred years as it exists now. Recruitment, like any market condition, will follow when we've created a stable ecosystem of new, mid, and retiring pods that leave good fair-paying positions that arent plagued with ethical billing conundrums or pods sniping another's privileges at a hospital.

 

[diabeticfootdr]

As a 1st year, this just looks like two parents (ABPM and ABFAS) fighting over custody of the kids. Regardless of how I personally feel about ABFAS exam vs the CAQ, this infighting isn't a good look for the profession. You don't see the board of radiologists and interventional radiologists goin' at it.

Infighting might look bad. But what looks even worse are problems that no one is willing to fix. ABPM is standing up for the young DPMs facing an unfair process with an atrocious pass rate, which is later used as a tool of anti-competition by other podiatrists to keep you off the staff of their hospital, essentially strangling young DPMs. Unless ABPM stood up, nothing would happen. Nothing would change.

Put the boards together: American Board of Podiatric Medicine and Surgery, boom.

We agree! We proposed that.



There is a single, standardized, 3-year residency in podiatric medicine and surgery. There needs to be a single recognized board for that residency. Every other ACGME program/specialty has a single recognized board and a SINGLE TIER for certification.

Bylaws can be changed with enough sway from DPMs and participating MD/DO efforts. That task force, while not successful, is a decent proof of concept that in some capacity MDs/DOs are willing to bring us into the fold to standardize training and be on par in our practice as well as recognize that DPM are physicians (just don't tell the AMA that.. they'll write a strongly worded letter).

Podiatry is a different profession legally from medical doctors. While we work together and are a specialty operating inside of the healthcare system, we are legally separate. Let's own it and fix our own problems.

 

[GreenHousePub]

Infighting might look bad. But what looks even worse are problems that no one is willing to fix. ABPM is standing up for the young DPMs facing an unfair process with an atrocious pass rate, which is later used as a tool of anti-competition by other podiatrists to keep you off the staff of their hospital, essentially strangling young DPMs. Unless ABPM stood up, nothing would happen. Nothing would change.




Podiatry is a different profession legally from medical doctors. While we work together and are a specialty operating inside of the healthcare system, we are legally separate. Let's own it and fix our own problems.

Anything that involves having to do a fellowship to get the certification is a thumbs-down in my book.

 

[Feli]

...Podiatry is indelibly a procedure-heavy field since we treat the local manifestations of systemic diseases. No one board is more important but they need to be unified as every podiatrist should be skilled and examined in ALL aspects of the medicine and surgery we perform. Put the boards together: American Board of Podiatric Medicine and Surgery, boom. ...

This sounds like an incredibly easy solution.^
Your thinking is not unsound, but at your stage in the game, you don't know what you don't know.
You probably feel much different by DPM graduation day, even moreso by residency graduation, even moreso once out in practice.

Having everyone skilled and examined in all (99%) of aspects of their speciality is what MD programs do. Yes. That's the dream.
On the flip side, read the pod residency reviews thread. Talk to upperclassmen. Go out on your 3rd year local rotations and your clerkships. There are night and day differences in DPM residency programs. There are programs that do almost nothing but cut toenails and wound consults, many slop their way through diabetic cases (even for their "RRA" numbers), and others are doing much bona fide RRA trauma, others have many private elective recon cases... some have it all. Some have amazing attendings, but many have few or none. Likewise, the residencies will have tremendous variation in their in-training scores and board pass rates.

Even way before that, the pod schools are not selective on admissions... and they have different standards for graduation as well. Some try to be selective, but they all need to fill their seats. Most take measures of remediating students, accepting nearly anyone who did basic pre-med. You then have a mix of students who pass classes and national boards easily... and others who fail repeatedly. That will carry into residency match. That will carry into board exams. Some of those students who struggled even become "leaders" in podiatry. Podiatry is much more variable in terms of end products than MD, and that's mostly because of the loose admissions and evolving residency quality/variability. You will come to realize that unfortunate reality.

...So, what should it be:
-Make the tests (board exams) easier so all pass?
-Make the training better and more standardized in terms of volume/diversity? (this would mean closing and reduced spots at MANY programs)
-Make the admissions stricter to get better students who will become better residents? (this would mean closing pod schools, not adding)
...No easy answers, huh?

MD schools and programs choose all except the first option. They have very strict admissions criteria. They keep a residency surplus but regulate training to true teaching hospitals with verified case volume and monitor results. You just don't see them having VA hospitals or tiny community hospitals without real GME suppport be residency sponsors, quad scrubbing cases, programs with big deficiencies of certain surgery/pathology, whipping up bogus fellowships to try to compensate for a large % of residencies being inadequate. Ergo, MD board pass rates are good, they have much more uniform competencies, and they enjoy significantly better job markets.

 

[DYK343]

-Make the training better and more standardized in terms of volume/diversity? (this would mean closing and reduced spots at MANY programs)
-Make the admissions stricter to get better students who will become better residents? (this would mean closing pod schools, not adding)
...No easy answers, huh?

MD schools and programs choose all except the first option. They have very strict admissions criteria.

Nailed it.

 

[AttackNME]

Mission SDN in effect, let the natural selection process continue

 

[Pronation]

Mission SDN in effect, let the natural selection process continue

Perfect. You just know those 52 residencies are some absolute hot garbage that graduate doctors of pedicure medicine. Can’t wait to see them shut down.

 

[BillNyethePODGuy]

We agree! We proposed that.
There is a single, standardized, 3-year residency in podiatric medicine and surgery. There needs to be a single recognized board for that residency. Every other ACGME program/specialty has a single recognized board and a SINGLE TIER for certification.

You got my vote on that. I 100% agree and am glad that ABPM is open to working with AFBAS to be a unified board.

Podiatry is a different profession legally from medical doctors. While we work together and are a specialty operating inside of the healthcare system, we are legally separate. Let's own it and fix our own problems.

If it walks like a duck... We use the term "podiatric physician" and are performing surgery, prescribing meds, doing H&Ps, rounding on patients etc which by any other name is what a medical doctor does. Our problems (discrepancies in admissions, residency, boards in-fighting) and limitations (legislative scope of practice issues, pods sniping others in their own healthcare system, etc) seem to stem from the fact that we've legally emancipated ourselves from medical doctors. Prior to 1973 being an osteopathic physician was a legally distinct profession until they decided to play by MD rules to function in the same manner. I'm sure they sat down and said something along the lines of "our training isnt consistent, our jobs prospects aren't that great, and most people don't know what we're medically capable of." Then decided to change it while keeping the essence of what makes DOs different by integrating OMM into the 4 year curriculum. Our 'path to parity" and "podiatry 2020" puts us in that same footing (pun intended). Why would we want parity with a set of professionals from which we "legally differ"? I suspect we all know the reason. Let me be clear though, podiatry is a distinct enough set of skills and medical knowledge that it can, in my opinion, be its own specialty of medicine that exists alongside EM, FM, GI, Cards, etc. We should just (maybe need to) get all of the stakeholders (students, residents, physicians, boards, CPME, APMA, state components, etc) in a room and decide what the future of our practice should be because Podiatry 2020 and declaring "We have parity" doesn't really seem to have put us where we wanted.

Having everyone skilled and examined in all (99%) of aspects of their speciality is what MD programs do. Yes. That's the dream.

One that is attainable. It'll be painful and people will complain but a comprehensive exam is necessary. Yeah, scores will be crappy at first but I don't see how this would be a net negative for our field. If it came to fruition and I'm 10 years into practice, I'd still take it and hope theres no grandfather clause. Like I do to maintain my EMT license (i know its not the same in terms of content both depths and breadth)

On the flip side, read the pod residency reviews thread. Talk to upperclassmen. Go out on your 3rd year local rotations and your clerkships. There are night and day differences in DPM residency programs. There are programs that do almost nothing but cut toenails and wound consults, many slop their way through diabetic cases (even for their "RRA" numbers), and others are doing much bona fide RRA trauma, others have many private elective recon cases... some have it all. Some have amazing attendings, but many have few or none. Likewise, the residencies will have tremendous variation in their in-training scores and board pass rates.

Oh I have been and its an awesome resource for finding out what programs in which areas I'd want to visit/clerk at. If the differences are that profound then we (read all of us as students, residents, and practicing podiatric physicians) should be getting on the CPME and asking them to review training outcomes and residency programs. Yeah, it'll suck to be a crappy program PD since they'll be on the hot seat to adapt or get shut down. But that's kind of the point of becoming better at self-assessment, right?

Podiatry is much more variable in terms of end products than MD, and that's mostly because of the loose admissions and evolving residency quality/variability. You will come to realize that unfortunate reality.

This is something thats become crystal clear to me from my own (admittedly limited) observations. We can't just wake up tomorrow and make the admissions reqs 3.8 GPA and 515+ MCAT. There'd be no one in any school. Ditto for the subpar residency programs.

 

[diabeticfootdr]

Anything that involves having to do a fellowship to get the certification is a thumbs-down in my book.

The primary certificate (with documented training and experience) qualifies you to do anything in Podiatry. You don’t have to do a fellowship.

Fellowships are voluntary. But people want to do them. It’s a choice and why limit someone who wants to do one? For MDs all additional certificates are tied to additional training. In podiatry, they’re not. But should be.

There are currently 90 fellowships in podiatry. It’s about 1/6th of the graduating class. Only 17 are CPME-approved. CPME needs to take control of the process because it’s harming the profession if they’re not regulated. We wrote a thoughtful response to the CPME 820 revisions in process. I’ll find it and post it.

 

[Adam Smasher]

Fellowships are voluntary. But people want to do them. It’s a choice and why limit someone who wants to do one? For MDs all additional certificates are tied to additional training. In podiatry, they’re not. But should be.

I'm opposed to limiting people's options as well, but we should all acknowledge that if it becomes de rigeuer to do a fellowship year in order to be taken seriously in this profession, this reduces the ROI on the DPM degree and will only deter qualified pre-health students from pursuing a career in podiatry. So, Dr Rogers, by all means continue.

Also I find it hilarious that most of our fellowships aren't accredited (ACFAS is not an accrediting body) therefore just about anything can be a fellowship. Work a year for healthdrive, then say you're a fellowship trained foot and ankle surgeon specializing in foot and ankle mycology (FTFAS FAM)

 

[Bored Snorlax]

Decreased enrollment and more schools is a recipe for disaster. Now there is more competition for schools to maintain their financial upkeeps.

Podiatry: a decrease in demand
Response: increase supply

Instead of increasing recruitment (which may not even be the root cause of this), how about increasing incentives for students to apply to podiatry?

examples:

- cheaper tuition
- more scholarships
- better success rate (boards, graduation, etc)
- better salary
- better job prospects

etc.

 

[Feli]

I'm opposed to limiting people's options as well, but we should all acknowledge that if it becomes de rigeuer to do a fellowship year in order to be taken seriously in this profession, this reduces the ROI on the DPM degree and will only deter qualified pre-health students from pursuing a career in podiatry. So, Dr Rogers, by all means continue.

Also I find it hilarious that most of our fellowships aren't accredited (ACFAS is not an accrediting body) therefore just about anything can be a fellowship. Work a year for healthdrive, then say you're a fellowship trained foot and ankle surgeon specializing in foot and ankle mycology (FTFAS FAM)

F&A is already as far as ortho goes (and no additional cert, just a society).

For podiatry to delve into [recognized] sub-specialties for podiatry based on arbitrary fellowships is needless and rediculous.
We need to fix the issue: among ten DPMs who all did "three year PMRS/RRA surgical residency" just a few years ago (or even a few months ago):
only 7/10 can pass surgical BQ and
only 5/10 will pass the surgical board cert,
only 3/10 can do ankle or calc fractures the ER might call them for,
only 1/10 can do TARs and severe cavus...
...2/10 do only basic wounds and derm stuff but refer out all surgery,
and one never did a single surgery after residency and cuts nails for HealthDrive,
and so forth.

And we wonder why MDs are confused? We wonder why the public is confused??? Heck, I'm often confused myself. I know what a Rheumatologist can do. I know what a spine Ortho does. I know what an Endocrinologist does. In order to know what a podiatrist does, I would need to see their CV and case logs... and I'm a friggin podiatrist!

As for the fellowships, they can exist, but there is no point to specialize what's already a specialty limited to foot and ankle. That fellowship push takes good attendings out of residency training (podiatry's largest defect... well, ok, maybe #1a along with school admissions). Everyone in the profession knows the ACFAS fellowships are the only ones worth even considering... and even half of those are not too great. They're all superfluous if one did a good residency.

...Instead of increasing recruitment (which may not even be the root cause of this), how about increasing incentives for students to apply to podiatry?...
- better salary
- better job prospects
...

Those are entirely tied to saturation.
Good professions and lucrative ones sell themselves.

That is why sooo many people want to be MD - and especially Derm, ortho, ENT, plastics, etc.
That is why chiro and podiatry struggle for admissions, jobs, respect in the med community.

 

[iridocyclitiss]

Also I find it hilarious that most of our fellowships aren't accredited (ACFAS is not an accrediting body) therefore just about anything can be a fellowship.

I can't speak for every CPME approved fellowship but at least the one where i worked with the fellow they were doing very low level stuff, barely saw the or. Still couldn't find a job.

 

[Adam Smasher]

List of Approved Fellowships | CPME

www.cpme.org

Crazy how I've known more than a few of these directors. Not all bad either. Tons of wound care fellowships. Wyckoff has 5 openings! They can't even fill their residency slots! If you can't figure out wound care after 3 years of residency, a fellowship year won't clue you in any better.

 

[malleolusman]

I can't speak for every CPME approved fellowship but at least the one where i worked with the fellow they were doing very low level stuff, barely saw the or. Still couldn't find a job.

This is exactly what I have heard with the exception of a few choice programs.