How An Unmatched Podiatry Graduate Is Forging Ahead

Patrick DeHeer DPM FACFAS

Every once in a while, I have a guest blogger write for me. This month, I have asked Aaron Warnock, DPM, to contribute his thoughts on going unmatched for a residency program and his future. I met with Dr. Warnock and was pleasantly surprised by his positive outlook on the whole situation. I offered him a position within my practice to continue his education and bridge this year until he starts a program. He has been a revelation — hard working, dedicated and patient centric. It has been a pleasure working with him. Whoever is lucky enough to bring him into a residency will come to the same conclusions I have.
— Patrick DeHeer, DPM

My experience as an unmatched, qualified graduate has been full of ups and downs. First, I never expected to be in this situation. It took a few weeks for me to accept that I had gone unmatched. I scrambled and I had what I thought were potential positions but nothing manifested. I have to admit it was the worst few weeks of my life. Going through the scramble was terrible. However, my daughter was born eight days after the match deadline and that added much needed rays of sunshine to a gloomy forecast.

Secondly, I had to decide very quickly how to proceed. I tried to secure a preceptorship with a podiatrist in the Ohio area, but unfortunately he was unable to take me on. I then met with Hal Ornstein, DPM, to speak with him about the preceptorship program.

Our conversation was candid to say the least. He asked me if I had secured a residency position. When I responded “no,” he quickly responded, “good.” Dr. Ornstein told me it takes six months or more to train a recent graduate on patient communication, billing, coding, dispensing durable medical equipment and working as an associate. However, he was very confident that after completing a preceptorship, I would obtain a residency position due to having a distinct advantage over a great number of graduating residents. The fact that I would know how to run an office, handle patients and make the practice money would add significant value for me after completing a residency.

I found his rationale to be uplifting. Thus, I set out to obtain a preceptorship in my home state of Indiana while continuing to scramble.

Any unmatched graduate can go forward a few different ways. One is to utilize the American Academy of Podiatric Practice Management (AAPPM) to obtain a preceptorship. The group takes your Centralized Residency Interview Program (CRIP) application and places you with a podiatrist in the area where you want to live. There is not an interview process. Secondly, the graduate can personally seek out the DPM with whom they want to complete a preceptorship. A third way is that the graduates can take on odd jobs, shadow podiatrists with whom they already have a relationship, begin research projects, take part three of the boards to obtain a license from states that do not require completion of at least one year of postgraduate training, or give up.

I chose to seek out a podiatrist with whom I could gain the best experience and someone I could begin with as soon as possible. Essentially many of the preceptorships begin in July after the scramble is over. I chose to try and begin mine at the end of May. I contacted many podiatrists in the Indianapolis area and communicated my situation to them. Unfortunately, I did not get much response. I began a serving job at a local Italian restaurant to pay the bills.

I then contacted Dr. DeHeer at Hoosier Foot and Ankle. I emailed him and asked if I could at least shadow him part time as I knew it was of utmost importance to stay connected with the profession. He called me about 10 minutes after I e-mailed him and we met for lunch. He offered take me on as a preceptee, give me a stipend, and allow me to continue to scramble for a residency position. I knew I would have a great experience with him as he currently has four practice locations surrounding the greater Indianapolis area. In addition, he constantly contributes to medical literature, is Past President of the Indiana Podiatric Medical Association, sits on the board of many professional organizations and is the founder of Wound Care Haiti.

What My Day Is Like With Dr. DeHeer

Currently, I function as an extension of Dr. DeHeer. I triage 90 percent of the patients. I order X-rays, counsel the patients on their condition, formulate treatment plans, and discuss non-operative and operative techniques with patients. Additionally, I perform in office diagnostic ultrasound and ultrasound guided injections, bill, code, book surgeries, trim nails, debride ulcers, remove sutures, and cast for orthotics. I also work closely with the office manager to troubleshoot inefficiencies within the practice. We are currently gearing up for ICD-10 and continuing to train the office staff to meet meaningful use properly. I plan to write current protocols for Dr. DeHeer after the first of the year as he plans to take on an associate next July.

Dr. DeHeer is always pushing the limits of the practice and all of those involved within it to get better, more efficient, and to continue to offer an experience to the patient unlike any other medical practice that they visit. He expects everyone, especially the office manager and myself, to operate at the highest level to fulfill this goal. I wholeheartedly welcome the responsibility that he has given me and the opportunity to excel within his practice.

The clinical experience and surgical training that I have received has been second to none. I am fortunate to have scrubbing privileges at two surgical venues. On average, Dr. DeHeer performs seven to 10 surgeries per week. Keeping my own personal surgical log, from May through December, I have logged 52 first assists and 92 second assist cases ranging from digital amputations, transmetatarsal amputations, ankle fractures, bunions, hammertoes, gastrocnemius recessions, application of mini-rail external fixators and numerous soft tissue and bony procedures.

In addition to the opportunity to gain clinical experience, I felt it was also extremely important to pair myself with someone who has made numerous literary contributions. I believe one’s knowledge of medicine must continue to evolve. Thus, in the last six months I have co-authored and published a complete chapter in Clinics in Podiatric Medicine and Surgery, titled “The Lower Extremity Pediatric History and Evaluation.” I also co-authored an article for Podiatry Today, titled “Key Insights On Conservative Care For Adult Flatfoot,” which will be in the January issue. Dr. DeHeer and I are currently working on a retrospective research paper that compares the reduction of the first and second intermetatarsal angle of a severe bunion with either a Lapidus procedure or first metatarsophalangeal joint (MPJ) fusion. We also have a few other research projects on the horizon. I will definitely have a lot to talk about at interviews in a few weeks.

I have read many op-eds and suggestions on the topic of the residency shortage. Of course, everyone has a different opinion on how the profession should move forward. Who is to blame for the shortage? It is a pretty simple equation. The number of graduating students should equal the number of residency positions available. Those who decided to open new schools without the addition of residency positions are fully to blame.

I don’t care what the excuses are or who has them. It is a disgrace to the profession. In the day and age when podiatry is fighting an uphill battle to gain equality in the field of medicine, how is it benefiting anyone to throw qualified graduates out into the cold?

I do know this is going to be a continued problem in the future. This is just the beginning. At some point, the number of unmatched could possibly reach into the hundreds. I greatly appreciate the efforts of the Council on Podiatric Medical Education (CPME) to open new positions. I have personally worked with them to start a new program with Dr. DeHeer as the program director but the hospital was not able to move forward with the possibility.

From my direct experience, the hospitals are on board with creating new programs as long as they do not impact existing programs in the area. I also find it interesting that there are multiple states in the United States that do not have residency programs. I find it hard to believe that states such as North Carolina cannot support the podiatry profession. Maybe the focus of the CPME should be on those states instead of trying to force existing programs to expand. I truly believe we can only rectify the shortage rather quickly if everyone makes an effort.

At a very early age, I realized that one can either become bitter and spiteful in the face of adversity or forge ahead with a positive attitude and make the most out of a lousy situation. That is what I have done and will continue to do. My dream of becoming a practicing podiatrist still lives on. I have full faith that I will secure a residency position somewhere, somehow.

I would just like to say that I am thankful a million times over for the kindness, compassion and mentoring from Dr. DeHeer. I want to thank all of the current podiatrists who are housing preceptees. If were not for you, our ships would not continue to sail.

— Aaron Warnock, DPM
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