Residency Shortage 2017

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Adam Smasher

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Coming back after a long hiatus. Four years ago, I received the news that I didn't match and would begin my long and arduous year as a reapplicant. I did match on my second go around, into a very solid program too, and I have some reasonably nice prospects waiting for me afterwards. So it's possible (but not easy) to get over the hump.

The reason I'm posting now is that the worst year for the residency shortage was the year I graduated, 2013, but it wasn't really in anyone's forecast until about 2010, and it hit a lot of us by surprise. I'm curious how a lot of current students thought about the shortage throughout school. Did you know about it? Did you know before you applied or did you find out after you started in school? Was/is going unmatched a concern, or do you feel like the odds are good enough that you don't need to worry?

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Welcome back / glad things worked out for you. I read your posts with interest during the last fiasco. I didn't know how bad this year was until I saw the stats posting. *Cringe* That's essentially a school worth of unmatched kids.
 
The way it was sold to me (a 1st year) when applying were various forms of the same two sentiments:
1) 'We know about it, working on it, and it won't be a concern when you graduate' and
2) 'You don't have to worry about that, just work hard and don't be in the bottom 10% of your class!'

I know that part 1 is partially true (the working on it bit) and part 2 is also partially true. I have heard stories of decently competitive graduates not matching.

Paraphrasing a 1st year resident- "When I looked around the classroom during my 1st year, I just assumed the kids that wouldn't match were the booger eaters in the back of the auditorium. When I saw who did and didn't match... I realized that it's not exactly the case."

My perspective... Keep my head down, work my tail off, network, be professional, support the APMA, and hope it doesn't happen to me.
 
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It's not as big a concern as it should be. Most DPMs are so far removed and have so many other concerns that they can't be bothered by it. I suspect most students figure either the shortage won't affect them, or they can work hard enough that they'll come out on top. That's not an entirely irrational belief either, over the years, around 90% of students consistently have placed into residency the year they graduate. Obviously, we're not going to hear from the pre-health students who learned about the shortage and were deterred from podiatry because of it, since they won't be reading this forum.

In terms of trends, a few things stand out:

1) The shortage has been improving over the past few years. From 92 (2013) to 78 (2014) to 60 (2015) to 64 this year. I've been keeping track of the official AACPM published data over the years (can't find 2016, sorry) and the number of graduates who haven't placed seems to diminish each year, though I'm curious to see if instead of eventually reaching a zero shortage we simply have a plateau (more on that below).

2) The number of active residency positions is in flux. From 529 (2013) to 542 (2014) to 598 (2015) to 571 this year. Increasing spots may seem good from a student perspective, but it makes things a little dicey on the back end. Supply and Demand, if you get my drift.

3) Class sizes were decreasing but are making a rebound. From 572 (Graduating class of 2013) to 564 (2014) to 541 (2015) back up to to 576 this year. I'll leave it to other commenters to analyze how intelligent this move is.

What I am curious to see is whether or not the residency shortage becomes a permanent feature of our profession. In 2013, there was much collective outrage with letter-writing and calls to action. We're not seeing that now. So podiatrists by and large don't seem to care, and prospective podiatry students seem not to be deterred. We're watching a cat-and-mouse game to see if the residency directors can place all the graduates the schools produce, and the unmatched graduates are stuck in the middle. Call me overly sensitive, but I don't think that's fair.
 
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@Adam Smasher Congratulations on Matching!!

As a pre-pod, I am interested in knowing what you did differently the second time around for a successful match? Was it better networking, applying broadly, academic/research type stuff to improve CV/ or was it just a regular match? Thank you!
 
Not having everyone place could be a good thing to. Do you want a Podiatry student who did not really do that good in school and barely get passed their boards after a couple of times being your podiatrist some day? Maybe some student just are not qualified to become a Podiatrist after 4 years of school... just a thought.
 
Not having everyone place could be a good thing to. Do you want a Podiatry student who did not really do that good in school and barely get passed their boards after a couple of times being your podiatrist some day? Maybe some student just are not qualified to become a Podiatrist after 4 years of school... just a thought.
But some people who don't get placed are near the top of their class. Although maybe then someone could argue that they lack the requisite social skills to get placed.

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Just a thought. I have no idea what their grades or class ranking were but yes, their personal skills could be very lacking. It takes more than a brain to be qualified to be a provider of any kind in medicine today. I have seen patients leave MD/PhD physicians because they have no bed side manners.
 
Just a thought. I have no idea what their grades or class ranking were but yes, their personal skills could be very lacking. It takes more than a brain to be qualified to be a provider of any kind in medicine today. I have seen patients leave MD/PhD physicians because they have no bed side manners.

I've seen this too surprisingly.

Even more surprisingly the MD in question was extremely courteous but chose not to sugar coat the severity of the patient's condition should they choose to continue with their lifestyle.

Didn't realize people actually walked out of doctor offices cause of that.
 
You have to know how to handle each patient presented to you as a patient. I have learned that through my scribing experience with an amazing physician. And yes sometimes you have to be blunt to a patient but there is a right way to do that for each person also. You have to be able to read each patient and handle them accordingly. That my opinion on the matter but I'm just speaking as if each person who did get place where at the bottom of the barrel. I have no idea if they actually are or not. Just speculations.
 
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Not having everyone place could be a good thing to. Do you want a Podiatry student who did not really do that good in school and barely get passed their boards after a couple of times being your podiatrist some day? Maybe some student just are not qualified to become a Podiatrist after 4 years of school... just a thought.

I have personally known people who graduated in 2013 and have still not placed. Yes, they were flawed candidates, and now their lives are basically ruined.

So I have to disagree that the shortage is a "good thing."
 
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I have personally known people who graduated in 2013 and have still not placed. Yes, they were flawed candidates, and now their lives are basically ruined.

So I have to disagree that the shortage is a "good thing."
Is there a specific reason that they didn't place? (GPA, applied to one program, etc) or were they completely blind sided by it? I can't imagine
 
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I understand that not getting a residency would complete ruin some people's lives but it is on them for not performing well enough while in school. I will be a first year this summer but if I end up not getting a residency that is on me for not putting more effort in succeeding. If I am not getting the grade and understanding the materials like I should then I should not become a podiatrist because that is not fair to your patient to not have the proper care. Medicine is not about us, it is about the patient. That my take on the situation though.
 
I have personally known people who graduated in 2013 and have still not placed. Yes, they were flawed candidates, and now their lives are basically ruined.

So I have to disagree that the shortage is a "good thing."

Well.. This is pretty stressful to think about.
 
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A couple of faulty assumptions underlie your logic:
1) You guys assume that placing into residency is proof of a candidate's categorical "goodness" and not placing is proof that the candidate is categorically "bad." In reality it's not so much "good" vs "bad", it's more of a continuum with some being better than others. Residency applications are very competitive, and the shortage means that some of the "good" candidates will be not good enough. Under different circumstances they could have gone on to become perfectly competent podiatrists, but we've made it needlessly difficult for them.

2) You also assume that, but for the shortage, every single graduate would place into residency. Program directors aren't that stupid. Every year, our colleges graduate a very small number of students who truly don't have what it takes. These people aren't hard to recognize in the interview process and won't be selected. That's why in the pre-shortage years we saw programs that would sooner leave spots unfilled then take certain people.

Why don't people get programs? Same reason people do get programs. It's a combination of objective things (GPA, clinical evals) subjective things (personality, professionalism, rapport) strategy (where you apply, how many programs) and no insignificant amount of luck.
 
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- Speak when spoken to

I agree with your post for the most part, but If I were a student I would not be interested in a program where I was not able to talk unless spoken to.

Different programs have different vibes. If a student does not talk or interact at the program I am at I won't remember them.

I would rather select a student who I know gets along with the attendings/residents than a smart rock in the corner who only talks when spoken to.

But that's whats hard about being a student. Different programs look for different things.

Side note: Applicant pool is WAY down this year. It's a serious problem. The residency shortage issue is not helping.
 
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I agree with your post for the most part, but If I were a student I would not be interested in a program where I was not able to talk unless spoken to.

Different programs have different vibes. If a student does not talk or interact at the program I am at I won't remember them.

I would rather select a student who I know gets along with the attendings/residents than a smart rock in the corner who only talks when spoken to.

But that's whats hard about being a student. Different programs look for different things.

Side note: Applicant pool is WAY down this year. It's a serious problem. The residency shortage issue is not helping.

When you say the the applicant pool being down is a "serious problem", what exactly do you mean? What future problems do you foresee as a result of the applicant pool being WAY down this year?
 
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When you say the the applicant pool being down is a "serious problem", what exactly do you mean? What future problems do you foresee as a result of the applicant pool being WAY down this year?

The lower the applicant pool the more unqualified students that get accepted which worsens our problem. Not all students who do not match are unqualified. I know some that I feel got really unlucky or didn't play their cards right. But I also know some who I wouldn't want treating my family...

Podiatry does a very poor job of attracting top applicants. We have very few mentors who accept students to their clinics, speak at colleges, etc etc to promote the profession. Most students out there have no idea that podiatry even exists. For how small we are we can't afford to have ~300 less applicants in a cycle.
 
The lower the applicant pool the more unqualified students that get accepted which worsens our problem. Not all students who do not match are unqualified. I know some that I feel got really unlucky or didn't play their cards right. But I also know some who I wouldn't want treating my family...

Podiatry does a very poor job of attracting top applicants. We have very few mentors who accept students to their clinics, speak at colleges, etc etc to promote the profession. Most students out there have no idea that podiatry even exists. For how small we are we can't afford to have ~300 less applicants in a cycle.

Surely there are more than 300 applicants this cycle? Just curious how you know the applicant pool is so much lower this year.
 
Surely there are more than 300 applicants this cycle? Just curious how you know the applicant pool is so much lower this year.
They said 300 fewer applicants, not 300 total.

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... Different programs have different vibes. If a student does not talk or interact at the program I am at I won't remember them. ... But that's whats hard about being a student. Different programs look for different things... .
This x 100

I rotated at programs which were almost militant and ones that were uncomfortably laid back. There are pros and cons on each end of the spectrum but @dyk343 hit the nail on the head - you have to gauge each program and see where you fit into the mix. Personally, I would not have fit into one extreme or the other and found a program that fit my liking. There is a lot of truth in what @Ankle Breaker said - The quickest way for me to write you off is to argue with me when I'm quoting literature and you are going off of "what they said at school".

Like everything in life, being in 4th year is a balance with no clear cut answer. Unfortunately @Adam Smasher is all too right. You can do EVERYTHING right and just have bad luck resulting in scrambling or worse going without a program. It happens every year. Don't take anything for granted. Don't believe promises of being ranked #1 no matter how many assurances you have. The unfortunate truth is people lie/change their minds when it comes to rankings and good people can get burned.

Man, that kind of turned into a downer but these are things every student needs to know. Do your best to perform well and be helpful on rotations. Protect yourself when it comes to ranking/matching.
 
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Just curious how you know the applicant pool is so much lower this year.
I know people who are active in the political side of podiatry. It's hearsay but my source is credible. But I'm just an anonymous resident on the internet so take it for what its worth.

...The applicant pool is WAY down.
 
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This thread is very depressing :(

Any insight as to why applications are so far down this year? I'm really wondering if this trend continues what the longterm effects will be...

It says that the growth rate for podiatry is about 14%, but if there aren't enough students/residents being graduated how grim could this all get?

I know people who are active in the political side of podiatry. It's hearsay but my source is credible. But I'm just an anonymous resident on the internet so take it for what its worth.

...The applicant pool is WAY down.
 
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This sounds like a never ending nightmare.

What are these people doing now in order to pay back the debt? Are they still trying to match and being rejected year after year?

I have personally known people who graduated in 2013 and have still not placed. Yes, they were flawed candidates, and now their lives are basically ruined.

So I have to disagree that the shortage is a "good thing."
 
The lower the applicant pool the more unqualified students that get accepted which worsens our problem.
Perhaps, but in this past cycle (for class of 2020) when applications were down many schools went with a number of empty seats rather than accepting subpar applicants.

There were certainly more than the 600 or so applicants necessary to fill every seat if all schools were looking for was a payday. But that's not how it went down.

I suppose we won't know for sure until official stats for all the schools are released, but schools did reject students even though their seats weren't full and I'm assuming the reason is because they didn't want a drop in quality (whatever quality is the norm for us), so the GPA and MCAT data for class of 2020 and 2021 will probably still be within the range of what it usually is, even though applications have been down the last couple of years.


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This sounds like a never ending nightmare.

What are these people doing now in order to pay back the debt? Are they still trying to match and being rejected year after year?

I haven't stayed in touch with everyone, and I don't want to give too many specifics. One person filed an ill-fated lawsuit against his school. Impressively enough, he tried to appeal the case at the U.S. Supreme Court. But that story is googleable.

To answer your question, I will say this. I believed 4 years ago I only had one shot to get a program, because the people who were 2+ years out had match rates in the 30% range. So, I had to make my second attempt count, because there wasn't going to be a third. So I sacrificed everything I ever valued. If I matched, hooray. If not, I figured I could get some administrative job with a non-profit health system, put in a decade of work while paying the bare minimum on an IBR plan, then get my debts forgiven. Under that scenario, I'd be debt free and could contemplate my next career move. And who knows? The tables could turn by 2023 and we could have a shortage of applicants to residency programs.
 
There are still several months to fill seats but we are currently about 300 applicants lower than usual for this time of year.

People are actively trying to recruit podiatrists to start promoting the profession at the university level and even high school level as well as open up their clinics for shadowing.

...So basically the same old strategy they have been trying for awhile.
 
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Adam Smasher is right. This is a great post.

If you are the top of your class you can still go unmatched if you externed at all the "top programs". The cream rises to the top but strategy goes a long long long way. I externed at top programs but I also manipulated my off service schedule to free up time so I could visit a lot of programs too. Programs that were either new and had a lot of potential or programs that had a good reputation for quality training but were not considered "top" programs in podiatry. At the end of the match process I had offers from some of the programs I visited. You need create opportunities along with performing well on your externships. I went deep into my pocket (and my parents pocket) to travel and visit extra programs when I had the chance. If you really want to increase your chances of matching that is what you need to do.

Other things you need to do that fall under "personality traits":

- Do not look at your phone during surgical cases, academic events or rounds (red flag).
- always listen to the resident (whether you agree with their thought process or not)
- Never chime in when a resident and/or attending is speaking to their patient in clinic (red flag)
- Speak when spoken to
- Do as your told and do it well and in a timely manner
- Read/feel the resident and/ or attending out before you open your mouth think it is ok to freely talk or ask questions.
- Never complain
- Follow directions
- Never be late
- Never ask to go home early
- Do not do the bare minimum to try and get by. Try to stand out without kissing ass.
- If interesting cases are going on during the weekend, ask if you can come in (you are there to learn first and foremost, it is not a vacation)
- Follow directions when it comes to presentations. If they want them done in a certain time limit, do not go over time! (red flag)
- You are a student and you don't know $hit (ingrain that into your brain)

All of the above should be common sense but time and time again I see students come through the program and violate the above "common sense" rules described above.

It is the ones that don't who really really really stand out. If all the residents like you that will go a long way when it comes to ranking. Doesn't matter what your GPA is.

If you have the best GPA out of all the other candidates and even perform the best on the interview but all the residents do not like you or some residents do not like you I PROMISE you will not get ranked to match. I've done the ranking process for students three years now and it always happens. Great students on paper will get ranked way lower on the list if their personality does not jive with the current residents...it is a fact

All podiatry students out there need to read this, print it off, share with classmates, memorize it. Great advice.
 
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A few things...

for bright students who are socially normal and work hard on rotations, it is totally an insignificant amount of luck that will get them a program on match day. The individuals who go through externships, the scramble and still don't have a spot have a major flaw or flaws.

Either the shortage or the poor applicant pool (or both) will continue until the schools do something different. I had what I thought were good ideas (at the time) and was in a position to discuss them with the AACPM, COTH, etc. Of course one idea meant less $ in the pockets of a couple of schools and the other meant potentially more work for the residency directors and residents. What I took away from it all was that schools aren't willing to cut operating expenses (i.e. fire some of their buddies who would probably be out of work without a faculty position at the school) for the sake of the profession. And neither residency directors nor the CPME have much interest in trying to help create a more robust applicant pool. Good programs get good residents and bad programs continue to get warm bodies that provide attendings (or a VA) with some cheap labor, neither have the incentive to do anything different. But what do I know? I mean, the APMA's Today's Podiatrist campaign and youtube videos were obviously wildly successful...
 
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The solution starts with the schools. If the pool is down, the schools just need to think about the profession and have empty seats. Problem is when there is $ involved they won't do that, at the expense of hurting our profession. Class size needs to come down too at about 4-5 schools, but that is a whole other issue.
 
The solution starts with the schools. If the pool is down, the schools just need to think about the profession and have empty seats. Problem is when there is $ involved they won't do that, at the expense of hurting our profession. Class size needs to come down too at about 4-5 schools, but that is a whole other issue.
There were empty seats left at multiple schools for class of 2020, this past application cycle.

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For those who are interested, CPME has a link that regularly posts the new residency programs approved:
New Residencies Eligible for On-Site Evaluation | CPME

I think the situation is certainly not ideal, but we are definitely doing much better compared to couple years ago. Yes the applicant pool may be down, but it was even much lower 20 years ago when the economy was booming. So podiatry isn't going anywhere for the prepod or pod students who are worried that this profession is dying. For sure the schools and organizations can do a much better job, but remember the problems are not unique to our profession. Everything just seems to be magnified due to the small size of our field and the typical SDN environment.

For pre-pods, keep shadowing and do understand that podiatry is a medical specialty that requires hardwork. It is not an easy way out. You have to work hard in school to be responsible for your patients and for your own success. It is a great field with much potential.

For pod students, stay away from SDN and read something else (lecture notes, journal articles, textbooks, X-rays, etc.). That's what I did. I certainly believe there is a big demand for podiatrists, surgical or not. When I was a first and second year student I also thought about these issues. But the only controllable factor is you - so work hard.

Then you will get a residency spot, and don't forget to give back to the profession: help your underclassmen, give advices, don't be the resident that is a big douche to the students, talk about your program, talk to your undergraduate about the profession, and be supportive.

Podiatry has come a long way to become what it is today. We are the new faces of podiatry, and it's only up to us how we define our profession.
 
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We are the new faces of podiatry, and it's only up to us how we define our profession.

tumblr_m9fp59CwzA1rynk4uo1_500.gif
 
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For those who are interested, CPME has a link that regularly posts the new residency programs approved:
New Residencies Eligible for On-Site Evaluation | CPME

I think the situation is certainly not ideal, but we are definitely doing much better compared to couple years ago. Yes the applicant pool may be down, but it was even much lower 20 years ago when the economy was booming. So podiatry isn't going anywhere for the prepod or pod students who are worried that this profession is dying. For sure the schools and organizations can do a much better job, but remember the problems are not unique to our profession. Everything just seems to be magnified due to the small size of our field and the typical SDN environment.

For pre-pods, keep shadowing and do understand that podiatry is a medical specialty that requires hardwork. It is not an easy way out. You have to work hard in school to be responsible for your patients and for your own success. It is a great field with much potential.

For pod students, stay away from SDN and read something else (lecture notes, journal articles, textbooks, X-rays, etc.). That's what I did. I certainly believe there is a big demand for podiatrists, surgical or not. When I was a first and second year student I also thought about these issues. But the only controllable factor is you - so work hard.

Then you will get a residency spot, and don't forget to give back to the profession: help your underclassmen, give advices, don't be the resident that is a big douche to the students, talk about your program, talk to your undergraduate about the profession, and be supportive.

Podiatry has come a long way to become what it is today. We are the new faces of podiatry, and it's only up to us how we define our profession.
I 100% agree with this. It is a great profession. I have an amazing job lined up and so do all my close friends. Of my close friends (the ones I'm comfortable talking salary with) I don't know anyone starting or projected (after incentives) to start at less than 240k despite what some posters in private pod clinics say or indeed.com salary says. The profession itself is stable and doing fine and is well respected in the hospital systems - at least where I am at/have been at. There is an applicant pool problem and a slight residency shortage. This situation is not ideal but the profession will continue on.
 
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I had great patient reviews, was an attending, taught residents, treated 1000s
Of patients, was board certified in podiatric
Medicine and approx 4 years ago I got
Denied from a hospital when I applied for residency training. If the applicant pool goes down I might eventually get a spot.
In order to medically take a punch biopsy
Of the ankle in nys I need such residency
Training. To medically treat the ankle is so important.
Please wish me good luck especially since
I got denied again on my third attempt. I do not want to apply and get denied again.
 
I had great patient reviews, was an attending, taught residents, treated 1000s
Of patients, was board certified in podiatric
Medicine and approx 4 years ago I got
Denied from a hospital when I applied for residency training. If the applicant pool goes down I might eventually get a spot.
In order to medically take a punch biopsy
Of the ankle in nys I need such residency
Training.

I-dont-believe-you.gif
 
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I had great patient reviews, was an attending, taught residents, treated 1000s
Of patients, was board certified in podiatric
Medicine and approx 4 years ago I got
Denied from a hospital when I applied for residency training. If the applicant pool goes down I might eventually get a spot.
In order to medically take a punch biopsy
Of the ankle in nys I need such residency
Training. To medically treat the ankle is so important.
Please wish me good luck especially since
I got denied again on my third attempt. I do not want to apply and get denied again.


Interesting haiku, I hope you are able to get a spot!
 
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