Worried about pod school..

[meritdoc]

I gotta say that I've read and heard some very disturbing things from both current pods and people familiar with the field.

I was speaking to my neighbor who is a dermatologist a few days ago - his son went to pod school and then a 3 year residency at Kaiser. He was offered several jobs out of school and everyone of them turned out to be garbage.

Red tape at the hospitals didnt allow him to do rear foot work since there was a MD who specialized in it. His admitting privelages were very limited at another hospital.

So I started a little more research and my general concerns are as such -

1) Pods have no universal scope of practice;
2) very difficult times getting on insurance panels;
3) only are allowed to do certain procedures in certain hospitals;
4) have no govt loan forgivness (as MD/DO/DDS do);
5) schools take anyone with a pulse and can sign the loan docs;
6) have a very very high loan default rate;
7) are second to MD and DOs;
8) residency training although is getting better has no standardization and can be very subpar;
9) no board certification without a 36 mo. residency;
10) very little referrals and surgical calls from MD and DO;
11) schools have approx. 700 seats to fill yet they can only fill 50%;
12) reimbursements are at an all time low for podiatry procedures. In fact, some insurance companies wont even cover podiatric care; and
13) nurses, PTs, chiropractors, and other health care professionals are doing orthotics and wound care and other basic podiatry procedures.


This is a list of just a few of the crappy comments I found by talking to my neighbors son and reading some literature.

Are all of these thoughts unsupported because it seems like everyone here is gung-ho! for podiatry school.

Your thoughts?

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[Podman]

I gotta say that I've read and heard some very disturbing things from both current pods and people familiar with the field.

I was speaking to my neighbor who is a dermatologist a few days ago - his son went to pod school and then a 3 year residency at Kaiser. He was offered several jobs out of school and everyone of them turned out to be garbage.

Red tape at the hospitals didnt allow him to do rear foot work since there was a MD who specialized in it. His admitting privelages were very limited at another hospital.

So I started a little more research and my general concerns are as such -

1) Pods have no universal scope of practice;
2) very difficult times getting on insurance panels;
3) only are allowed to do certain procedures in certain hospitals;
4) have no govt loan forgivness (as MD/DO/DDS do);
5) schools take anyone with a pulse and can sign the loan docs;
6) have a very very high loan default rate;
7) are second to MD and DOs;
8) residency training although is getting better has no standardization and can be very subpar;
9) no board certification without a 36 mo. residency;
10) very little referrals and surgical calls from MD and DO;
11) schools have approx. 700 seats to fill yet they can only fill 50%;
12) reimbursements are at an all time low for podiatry procedures. In fact, some insurance companies wont even cover podiatric care; and
13) nurses, PTs, chiropractors, and other health care professionals are doing orthotics and wound care and other basic podiatry procedures.


This is a list of just a few of the crappy comments I found by talking to my neighbors son and reading some literature.

Are all of these thoughts unsupported because it seems like everyone here is gung-ho! for podiatry school.

Your thoughts?

Hello there, To answer your questions i have to say that I'm not very familiar with your neighbour's son situation and to tell you the truth it seems a bit far fetched to have someone coming out of Kaiser's residency and not be able to land a stable career - unless of course, your neighbour's son is a difficult person to work with. I will tell you from my experience with other colleagues, friends, and family - I have yet to meet or experience what you mentioned above - I will answer your concerns to the best that i can:

1) Pods have no universal scope of practice;
-That is true, the scope of practice will vary from state to state - and this is something being addressed by the APMA. they set a goal to have this problem completely solved by 2015. However, that does not mean that you can't practice podiatry in all states - some states will vary, so it depends on what you want to do as a professional.

2) very difficult times getting on insurance panels;
-Not true at all. Maybe that was the case a decade ago when the training was mostly inconsistent but with today's standard of training - this is becoming less of an issue.

3) only are allowed to do certain procedures in certain hospitals;
-Some hopsitals are run with alot of politics. However, if the state allows for a certain advances scope, and the podiatrist is trained with board certification, then the hospitals usually will grant him the previlidges.

4) have no govt loan forgivness (as MD/DO/DDS do);
I'm not too familiar with that issue so I won't comment. However, I have yet to meet a podiatrist who struggled to repay his loans .

5) schools take anyone with a pulse and can sign the loan docs;
Not all schools do that. However, the schools that do that tend to weed out the weaker students by the end of the 2nd year. Do I think it is unethical to do so? Absolutely. However, we have to understand that some podiatry schools are businesses and need to insure tuition money in the bank.

6) have a very very high loan default rate;
Not true. I would imagine you heard this from a disgrunted or older podiatrist with no training whatsoever - but last time i checked, all my podiatrist collegues are making a very very comfortable living.

7) are second to MD and DOs;
I don't understand what you mean by second? We are not MD's or DO's. We are DPM's. Do you mean we get treated like "second class citizens"? Not true at all. On the contrary, we are very respected for our knoweldge and expertise in the lower extremity. This is something our senior members can testify for as they have done hospital rotations and residencies. From my experience, I've experienced nothing but respect from both types of professions.

8) residency training although is getting better has no standardization and can be very subpar;
It is in the process of standardization and in fact by 2009 all residency will be PM&S24 or 36.

9) no board certification without a 36 mo. residency;
Not true, you can get board certification for forefoot surgery after 24 mo. residency and with an ABPS certification you can get hospital previlidges. However, you can not get a rearfoot or reconstructive surgery certification which makes sense i think. More training = more certifications for more procedures. I think thats fair, don't you?

10) very little referrals and surgical calls from MD and DO;
Again, very subjective. Where are you getting this from? All DPM students do hospital rotations and residencies now so we work with many MD's and DO's. I'm not saying that EVERY podiatrist will get referrals from MD's and DO's but if you are good, well trained, and are very pleasant to work with - you will get referrals - business ethics i guess.

11) schools have approx. 700 seats to fill yet they can only fill 50%;
-there are more than 350 podiatry students at the 8 colleges of podiatric medicine. Many of the schools are placing a limit on how many seats to fill - so again, outdated information.

12) reimbursements are at an all time low for podiatry procedures. In fact, some insurance companies wont even cover podiatric care; and
-reimbursements are at a low for many surgical procedures at the moment. However, podiatry procedures are still covered and podiatrists are still getting paid. This is a problem in the health care in general not just podiatry.

13) nurses, PTs, chiropractors, and other health care professionals are doing orthotics and wound care and other basic podiatry procedures.
-So? Foot and ankle Orthopoedic surgeons do great Foot and ankle procedures as well. Whats new with that? Many professionals do different aspects of foot and ankle treatments. However, name me one professional who can do ALL procedures and treatments.

I appreciate your concerns and they are valid. However, you probably should understand that these questions are not new despite the fact that profession is continuing to progress forward. I'm sorry for your neighbour's son's experience but if I was to do research about this field, I would ask more recent PM&S 36 grads. In fact, I would probably call up some of the residency programs and speak with the residents directly and ask them very openly about their job offers and job market because they probably have the most accurate picture of the current state of the profession.

Hope that helps and good luck with your endeavours

 

[teefRcool]

Hello there, To answer your questions i have to say that I'm not very familiar with your neighbour's son situation and to tell you the truth it seems a bit far fetched to have someone coming out of Kaiser's residency and not be able to land a stable career - unless of course, your neighbour's son is a difficult person to work with. I will tell you from my experience with other colleagues, friends, and family - I have yet to meet or experience what you mentioned above - I will answer your concerns to the best that i can:

1) Pods have no universal scope of practice;
-That is true, the scope of practice will vary from state to state - and this is something being addressed by the APMA. they set a goal to have this problem completely solved by 2015. However, that does not mean that you can't practice podiatry in all states - some states will vary, so it depends on what you want to do as a professional.

2) very difficult times getting on insurance panels;
-Not true at all. Maybe that was the case a decade ago when the training was mostly inconsistent but with today's standard of training - this is becoming less of an issue.

3) only are allowed to do certain procedures in certain hospitals;
-Some hopsitals are run with alot of politics. However, if the state allows for a certain advances scope, and the podiatrist is trained with board certification, then the hospitals usually will grant him the previlidges.

4) have no govt loan forgivness (as MD/DO/DDS do);
I'm not too familiar with that issue so I won't comment. However, I have yet to meet a podiatrist who struggled to repay his loans .

5) schools take anyone with a pulse and can sign the loan docs;
Not all schools do that. However, the schools that do that tend to weed out the weaker students by the end of the 2nd year. Do I think it is unethical to do so? Absolutely. However, we have to understand that some podiatry schools are businesses and need to insure tuition money in the bank.

6) have a very very high loan default rate;
Not true. I would imagine you heard this from a disgrunted or older podiatrist with no training whatsoever - but last time i checked, all my podiatrist collegues are making a very very comfortable living.

7) are second to MD and DOs;
I don't understand what you mean by second? We are not MD's or DO's. We are DPM's. Do you mean we get treated like "second class citizens"? Not true at all. On the contrary, we are very respected for our knoweldge and expertise in the lower extremity. This is something our senior members can testify for as they have done hospital rotations and residencies. From my experience, I've experienced nothing but respect from both types of professions.

8) residency training although is getting better has no standardization and can be very subpar;
It is in the process of standardization and in fact by 2009 all residency will be PM&S24 or 36.

9) no board certification without a 36 mo. residency;
Not true, you can get board certification for forefoot surgery after 24 mo. residency and with an ABPS certification you can get hospital previlidges. However, you can not get a rearfoot or reconstructive surgery certification which makes sense i think. More training = more certifications for more procedures. I think thats fair, don't you?

10) very little referrals and surgical calls from MD and DO;
Again, very subjective. Where are you getting this from? All DPM students do hospital rotations and residencies now so we work with many MD's and DO's. I'm not saying that EVERY podiatrist will get referrals from MD's and DO's but if you are good, well trained, and are very pleasant to work with - you will get referrals - business ethics i guess.

11) schools have approx. 700 seats to fill yet they can only fill 50%;
-there are more than 350 podiatry students at the 8 colleges of podiatric medicine. Many of the schools are placing a limit on how many seats to fill - so again, outdated information.

12) reimbursements are at an all time low for podiatry procedures. In fact, some insurance companies wont even cover podiatric care; and
-reimbursements are at a low for many surgical procedures at the moment. However, podiatry procedures are still covered and podiatrists are still getting paid. This is a problem in the health care in general not just podiatry.

13) nurses, PTs, chiropractors, and other health care professionals are doing orthotics and wound care and other basic podiatry procedures.
-So? Foot and ankle Orthopoedic surgeons do great Foot and ankle procedures as well. Whats new with that? Many professionals do different aspects of foot and ankle treatments. However, name me one professional who can do ALL procedures and treatments.

I appreciate your concerns and they are valid. However, you probably should understand that these questions are not new despite the fact that profession is continuing to progress forward. I'm sorry for your neighbour's son's experience but if I was to do research about this field, I would ask more recent PM&S 36 grads. In fact, I would probably call up some of the residency programs and speak with the residents directly and ask them very openly about their job offers and job market because they probably have the most accurate picture of the current state of the profession.

Hope that helps and good luck with your endeavours

Good Response

TEEF backwards

 

[jonwill]

I gotta say that I've read and heard some very disturbing things from both current pods and people familiar with the field.

I was speaking to my neighbor who is a dermatologist a few days ago - his son went to pod school and then a 3 year residency at Kaiser. He was offered several jobs out of school and everyone of them turned out to be garbage.

Red tape at the hospitals didnt allow him to do rear foot work since there was a MD who specialized in it. His admitting privelages were very limited at another hospital.

So I started a little more research and my general concerns are as such -

1) Pods have no universal scope of practice;
2) very difficult times getting on insurance panels;
3) only are allowed to do certain procedures in certain hospitals;
4) have no govt loan forgivness (as MD/DO/DDS do);
5) schools take anyone with a pulse and can sign the loan docs;
6) have a very very high loan default rate;
7) are second to MD and DOs;
8) residency training although is getting better has no standardization and can be very subpar;
9) no board certification without a 36 mo. residency;
10) very little referrals and surgical calls from MD and DO;
11) schools have approx. 700 seats to fill yet they can only fill 50%;
12) reimbursements are at an all time low for podiatry procedures. In fact, some insurance companies wont even cover podiatric care; and
13) nurses, PTs, chiropractors, and other health care professionals are doing orthotics and wound care and other basic podiatry procedures.


This is a list of just a few of the crappy comments I found by talking to my neighbors son and reading some literature.

Are all of these thoughts unsupported because it seems like everyone here is gung-ho! for podiatry school.

Your thoughts?

Don't let the horror stories scare you. Many of your concerns are true throughout medicine in general. And some of the things said by your neighbor are just flat out not true. For instance, most of our patients come from MD/DO's and we get tons of surgical consults from them. Residency is standardized and just like MD/DO residencies, some are better than others. Reimbursments are at an all time low for everybody! It is very tough for anybody to get on an insurance panel but unless you're starting your own practice from scratch (very few people do), that really won't be a concern. I could go on but the bottome line is that for every "horror story" there are many more success stories.

 

[meritdoc]

Thanks. I am excited to make the journey. I havent been in college for about 2 years now. I've decided on making the long journey and getting it done.

Thanks for all your insight.

 

[jonwill]

The problem with podiatric medicine is that some schools will take ANYBODY. They push them through school and ultimately, they are unsuccessful. They then become very critical of podiatry. The problem has been compounded by the fact that over the past few years, there have been many more residency slots than students so even poor students get very good residencies (sometimes undeservingly). The story still ends the same in that they are unsuccessful and then speak very badly of podiatric medicine.

The second problem comes from stagnant MD's that don't realize how much podiatric medicine has changed over the years. They are often very critical of podiatry because they think of us as "doctors" that trim nails, corns, dispense orthotic, and occasionaly fix a bunion. I have personally seen this and when you enlighten them, they say "I had no idea that podiatrists did that."

As I have rotated around the nation this year (in major hospitals), I have seen podiatric physicians treated with great respect and as equals amongst other docs. Occasionally, you find an ignorant doc that needs to be enlightened and I always take the opportunity to do so!

 

[IlizaRob]

It sounds like you just cut and pasted your concerns from some outdated site by a old, disgruntled pod. Most of them are not true and have been addressed already by podman. I only want to comment on one thing, and that is loan forgiveness. This is only granted under specific circumstances such as working in a low-income community that is not offered adequate health care. So, your average doctor does not qualify for loan forgiveness. People, especially disgrunted pods, like to talk about this as if any MD or DO can get their loans forgiven. The fact is, that same disgrunted pod would not qualify even if he did have an MD or DO degree. Unfortunately, some people think that going into medicine automatically gives you a free ride to success. We live in a capitalistic society people, nothing comes free. Work hard and you will do fine.

 

[Cheetos]

I gotta say that I've read and heard some very disturbing things from both current pods and people familiar with the field.

I was speaking to my neighbor who is a dermatologist a few days ago - his son went to pod school and then a 3 year residency at Kaiser. He was offered several jobs out of school and everyone of them turned out to be garbage.

Red tape at the hospitals didnt allow him to do rear foot work since there was a MD who specialized in it. His admitting privelages were very limited at another hospital.

So I started a little more research and my general concerns are as such -

1) Pods have no universal scope of practice;
2) very difficult times getting on insurance panels;
3) only are allowed to do certain procedures in certain hospitals;
4) have no govt loan forgivness (as MD/DO/DDS do);
5) schools take anyone with a pulse and can sign the loan docs;
6) have a very very high loan default rate;
7) are second to MD and DOs;
8) residency training although is getting better has no standardization and can be very subpar;
9) no board certification without a 36 mo. residency;
10) very little referrals and surgical calls from MD and DO;
11) schools have approx. 700 seats to fill yet they can only fill 50%;
12) reimbursements are at an all time low for podiatry procedures. In fact, some insurance companies wont even cover podiatric care; and
13) nurses, PTs, chiropractors, and other health care professionals are doing orthotics and wound care and other basic podiatry procedures.


This is a list of just a few of the crappy comments I found by talking to my neighbors son and reading some literature.

Are all of these thoughts unsupported because it seems like everyone here is gung-ho! for podiatry school.

Your thoughts?

From my own experience, you have take in account that the attitude of the Pod sometimes depends on the decade that they graduated in. For example, the Pod that I shadowed several times last yr finished his residency a few yrs ago and loved it. It was a great experience and he kept mentioning all of the benefits of being a Pod. Last month, I went volunteer with a different Pod who works in a hospital and he made the 4 hour experience a nightmare. He graduated in the 1970s when Podiatry was going through a tough time and there were limited residencies. Also the Vietnam war vets were given preference over the general population for all grad schools. He was just another bitter old Pod who's basically bored with his job but only keeps because the pay is good is what he told me. So yea, it is all very biased. Podiatry has changed a lot since then. I've noticed the newers grads are loving it and residencies are in plenty.

Also to comment on #7 Pods are second to MD and DOs;
In the healthcare field, as a physician you and your colleagues will be too busy to care about what you're title is and where you went to medical school

 

[dpmgrad]

4) have no govt loan forgivness (as MD/DO/DDS do)

There is an equivalent of a government loan forgiveness program for DPMs. There is a program with the Indian Reservation Health Services where a DPM can work on the Indian Reservation and get a percentage of the student loans forgiven each year that the DPM works for the Indian Reservation Health Services. This program unfortunately is not the easiest to get into and is not readily available to all DPMs.

 

[lillytwig]

n

 

[meritdoc]

It sounds like you just cut and pasted your concerns from some outdated site by a old, disgruntled pod. Most of them are not true and have been addressed already by podman.

Not to be a troll or anything but podiatry has more than its fair share of problems. There are more DPMs that I've spoke to that discourage this profession than any other medical professional I've come into contact with.

I believe this profession will work for me, so I'll stick with it. My father who is an OB/GYN cant understand why you'd want to go 4 years + residency with all of the crap shoots in podiatry. A MD/DO/DDS has many options should their desired speciality not work out according to plan.

DPMs dont enjoy that option.

 

[jonwill]

Not to be a troll or anything but podiatry has more than its fair share of problems. There are more DPMs that I've spoke to that discourage this profession than any other medical professional I've come into contact with.

I believe this profession will work for me, so I'll stick with it. My father who is an OB/GYN cant understand why you'd want to go 4 years + residency with all of the crap shoots in podiatry. A MD/DO/DDS has many options should their desired speciality not work out according to plan.

DPMs dont enjoy that option.

I agree that podiatry has its fair share of problems, as does medicine in general. However, I must disagree in that podiatry is definitely not a "crap shoot". If you are a strong student and a hard worker, you will do very well. As I stated above, the main problem is that unlike other areas of medicine, weak students can get into and often through podiatry school. These people usually become our biggest critics because they ultimately fail.

 

[gustydoc]

I agree that podiatry has its fair share of problems, as does medicine in general. However, I must disagree in that podiatry is definitely not a "crap shoot". If you are a strong student and a hard worker, you will do very well. As I stated above, the main problem is that unlike other areas of medicine, weak students can get into and often through podiatry school. These people usually become our biggest critics because they ultimately fail.

truer words were never spoken...regarding this profession anyways.

 

[cool_vkb]

1) i was talking to a girl who just finished PA school. she told me that 14 out of 45 of the students in her class had MD's. they were going back to school to become PA's b/c they were sick of dealing with bull**** and malpractice and everything. i couldn't believe it!!! who knows if that is 100% accurate, but she isn't the type who just makes stories up. MD does not equal happiness!!
!

oh common do u really believe what she said . what she said is true but she didnt said u the whole truth. so lemme complete the whole truth here. There are many MDs who are joining PA schools. thats true. but those MDs are foreign medical graduates who have failed to get in residency or reguarl Practicing MDs whose licenses got suspended or expired. Many Foreign Medical Graduates are not getting into residencies and they join PA school as it is a good alternative and short course.

I wud laugh rolling on the floor to hear that a Physcian who has a valid license to practice will leave his practice and join PA school to work as a PA. Just think, what is the function of a PA. the same as a Physician. So it makes no sense if a MD is bored of his profession why wud he join again PA school. And that too PA school. ha ha ha! tats unbelievable. if she wud have said many MDs are joining law school or Engineering school or even podiatry i wud have belived. as there are many MDs who change their mind and change their profession as a whole.

This trick is equally being also used by Admission's office of many schools. last week my cousin went to radiography school open house. and here was the dean who was saying proudly "many of our past graduates were MDs' and we were like what MDs? and on later investigation it turned out that they were foreign medical graduates who were not even licensed to practice or completed any residency.

 

[lillytwig]

oh common do u really believe what she said . what she said is true but she didnt said u the whole truth. so lemme complete the whole truth here. There are many MDs who are joining PA schools. thats true. but those MDs are foreign medical graduates who have failed to get in residency or reguarl Practicing MDs whose licenses got suspended or expired. Many Foreign Medical Graduates are not getting into residencies and they join PA school as it is a good alternative and short course.

I wud laugh rolling on the floor to hear that a Physcian who has a valid license to practice will leave his practice and join PA school to work as a PA. Just think, what is the function of a PA. the same as a Physician. So it makes no sense if a MD is bored of his profession why wud he join again PA school. And that too PA school. ha ha ha! tats unbelievable. if she wud have said many MDs are joining law school or Engineering school or even podiatry i wud have belived. as there are many MDs who change their mind and change their profession as a whole.

This trick is equally being also used by Admission's office of many schools. last week my cousin went to radiography school open house. and here was the dean who was saying proudly "many of our past graduates were MDs' and we were like what MDs? and on later investigation it turned out that they were foreign medical graduates who were not even licensed to practice or completed any residency.

yeah, you are probably right. that didn't make a ton of sense to me when she said it, but what you're explaining sounds a little more realistic. funny in any case, right?

 

[krabmas]

I gotta say that I've read and heard some very disturbing things from both current pods and people familiar with the field.

I was speaking to my neighbor who is a dermatologist a few days ago - his son went to pod school and then a 3 year residency at Kaiser. He was offered several jobs out of school and everyone of them turned out to be garbage.

Red tape at the hospitals didnt allow him to do rear foot work since there was a MD who specialized in it. His admitting privelages were very limited at another hospital.

So I started a little more research and my general concerns are as such -

1) Pods have no universal scope of practice;
2) very difficult times getting on insurance panels;
3) only are allowed to do certain procedures in certain hospitals;
4) have no govt loan forgivness (as MD/DO/DDS do);
5) schools take anyone with a pulse and can sign the loan docs;
6) have a very very high loan default rate;
7) are second to MD and DOs;
8) residency training although is getting better has no standardization and can be very subpar;
9) no board certification without a 36 mo. residency;
10) very little referrals and surgical calls from MD and DO;
11) schools have approx. 700 seats to fill yet they can only fill 50%;
12) reimbursements are at an all time low for podiatry procedures. In fact, some insurance companies wont even cover podiatric care; and
13) nurses, PTs, chiropractors, and other health care professionals are doing orthotics and wound care and other basic podiatry procedures.


This is a list of just a few of the crappy comments I found by talking to my neighbors son and reading some literature.

Are all of these thoughts unsupported because it seems like everyone here is gung-ho! for podiatry school.

Your thoughts?

this and a few of your other posts seem like you are unsure of podiatry and maybe are looking for an easy way to get around MD school. (maybe that is not a correct statement - I don't know?)

in any case if you are unsure about becoming a pod and need others to re-assure you then do not do it. you should not let others talk you into a career or out of it. if it is something you really want to do you will not need others to re-affirm that, and if pod is what you really want you will not let others talk you out of it.

there is nothing wrong with making sure it is a lucritive idea, but not everyone is a top earner in any field, even MDs.

Hard workers and business savvy people will make it in any field. If you like what you are doing it is easier to work hard at it.

I do not think you should look to this forum to talk you into podiatry. We do not need anymore disgruntled pods that were talked into it.

 

[Podman]

Not to be a troll or anything but podiatry has more than its fair share of problems. There are more DPMs that I've spoke to that discourage this profession than any other medical professional I've come into contact with.

I believe this profession will work for me, so I'll stick with it. My father who is an OB/GYN cant understand why you'd want to go 4 years + residency with all of the crap shoots in podiatry. A MD/DO/DDS has many options should their desired speciality not work out according to plan.

DPMs dont enjoy that option.

Yes podiatric medicine has endured problems, and that is something we can all agree upon. However, to those of us who continue to puruse this profession, the benefits supercede the problems - besides, what medical or healthcare profession does not have any problems?

I think you can find from the topics in this forum that this profession carries alot of benefits and is certainly not for everyone - just like any other profession. I think it would be very constructive if you shadow a DPM and call up residencies to inquire about the training and the profession. If you feel that this is right for you, then proceed with it. If you feel that you'd rather wait and go for MD/DO/DDS then by all means wait and go for what makes you happy - there is nothing wrong with that.

I don't think your father's assertion or that of the DPMs that you've spoken to is a complete picture of podiatry - that is why i recommend you to shadow a DPM if you're interested in that line of work, and speak to residents and recent grads, if you need to be reassured of the stability of the profession.