Another Perspective On The Podiatric Residency Crisis
I have been following the struggles of the 86 podiatry school graduates who were not matched with residency training programs this summer. My heart goes out to these young people and I wish them the best.
Things were much different for podiatry graduates when I graduated from the Ohio College of Podiatric Medicine (OCPM) in 1974. There was one residency program for every four graduates. It was assumed that the cream of the crop would be selected and the rest of us would do a preceptorship under an established podiatrist or open a practice fresh out of school.
Since I was not of the upper crust of my class of 102, I planned to open a practice. One of my reasons for choosing podiatry was that I never wanted to have a boss again. Being a total smart ass got me fired a few times and I doubted I would do well working for another doctor or for a clinic.
I applied to one residency program, the quality Seattle program, then known as Waldo Hospital. I was honest and a bit of a smart ass when I interviewed with the director. I told him that I did not care for surgery. A surgery professor, Raymond Suppan, DPM, told my class that a quality podiatric practice only involved 15 percent surgery. I shared this with the director, noting that a year of a surgery residency would be a waste of my time and simply delay the inevitable fact that I would learn to practice podiatry by practicing podiatry, not by running around a hospital dressed in green pajamas, cutting holes in feet.
This did not impress the director, who admittedly dreaded the thought of me practicing in the state of Washington. I heard stories about the selection process where my name kept coming off as a threat to the profession. I had a few strikes against me.
The Seattle program favored graduates of the California College of Podiatric Medicine, which was considered the top school in those days. I came from the wrong school, had a bad attitude about residency training and was in the middle of my class standing.
Since I assumed I was toast in the selection of residents in the only program I applied for, I made the best of my last two years of podiatry school. I kept a relatively busy clinic schedule by dragging all of my neighbors into the clinic. I lived in a large apartment complex and introduced myself to all of my neighbors as a podiatry student who would love to help with their foot problems.
I was also a medic in the Army Reserve. Each summer, I volunteered to work in the podiatry or orthopedic clinics of the Army hospital where my unit served. I felt ready to tackle podiatry practice when I finished my fourth year at OCPM. A monkey wrench got thrown at me.
The Seattle program accepted me. I guess they felt that I needed rehabilitation.
The residency was not a waste of my time. I learned a lot and made peace with podiatric surgery. The program made a tremendous difference in my career. I had a larger range of options to offer my patients and the confidence to practice in a rural community where I was the only DPM for the first 15 years.
Now we must be innovative and come up with a solution for our 86 new colleagues without residency programs. It is no longer practical or, in most states, possible to get a podiatry license without at least a year of residency training. In 2000, the new gold standard for podiatry was a three-year residency. Most have a heavy emphasis on surgery. We should consider the option of training some podiatrists to do what podiatrists have done for the past century: simple foot and ankle care.
The podiatry schools need to do their part by training students to practice basic podiatry in the third and fourth years rather than chase them off to hospitals for externships. Every graduate should be capable of performing the basic duties of a podiatrist.
It was a pity when I was interviewing a three-year residency graduate for a job and she didn’t have the foggiest notion of how to perform a simple nail procedure. She then informed me that she didn’t plan to do nail care.
For now, the schools need to create a fifth clinical year for their graduates who do not match. That is how podiatric residencies originated. The schools also need to cut their class sizes so we do not have this problem every year. It is hard enough to recruit new students and our current mess could kill the profession.