Why It’s A Crime That Not All Residents Have Found A Matching Program

Stephen Barrett DPM FACFAS

There is not enough crime scene yellow tape at the national CSI headquarters to outline the prostrate victims of this incredible, all time crime of our profession.

The blogs are a fury, screaming with brash and ridiculous statements like: “… The primary culprits are the administrators at each of the podiatry schools. They knew, or should have known, that they enrolled more students than the number of residency programs available. They operate in their ivory towers, receiving huge salaries, with little regard of the postgraduate reality.”

The author of this statement needs to fill out the ID-10-T form and submit it as soon as possible to Planet Reality so that he may once again join the semi-informed. I will dispel this nonsense with facts as I have gained a high-level, double top secret agent with clearance to the real nitty gritty. He is one of the most informed in our profession to educate me about what happened here.

Bottom line: Don’t throw any rocks until you maybe get some facts, Dr. Misinformed. Oh, by the way, the “ivory” tower isn’t so ivory when you have worked in it. I have.

At first, the news was reported that there were initially only 104 victims of this travesty. As if that is not enough, we now know that the final victim count will reach more than 15,000. Yes, 15,000. Some are maimed and some are frankly clueless that they even are victims like this author referenced in the first paragraph but not the 104. The 104 I talk about are the young men and women who did not match in this year’s podiatric residency match.

Well, then who the hell are the 15,000 other victims? If you’re an active practicing podiatric surgeon or podiatrist (yes, I made the distinction purposefully because there is a difference—get over it), you need to look in the mirror and hum a few bars of Michael Jackson’s catchy “Man in the Mirror” (“I’m starting with the man in the mirror/ I’m asking him to change his ways …) and realize that you are both the victim and perhaps one of the perpetrators at the same time.

Those who practice podiatric medicine and surgery are the victims. Granted, they are not nearly as acutely injured and traumatized as the 104, but if you don’t understand how, I’m going to tell you. By the way, this is a full-blown rant and as Dennis Miller says, so therefore I rave because I love this profession and quite frankly, there are many of my colleagues who do not.

A Closer Look At The Scene Of The Crime

Is this really a crime? Damn right it is. Assuming you are not in the 104 (those in the 104 are still hemorrhaging and they know the deal) and you don’t realize how this is a crime, strap your bifocals on, clean the tightly packed cerumen from out from your ears (that’s for those who read aloud) and engage in this hypertensive epistle.

First, let us set the stage with the facts. Then we will narrow the suspect list down. Finally, maybe we can mete out a punishment for the perpetrators (keep humming the Michael Jackson tune) of this heinous act against our young and ourselves. Ultimately, maybe we can extract justice from this professional debacle. Perhaps we can even use this tragedy as a true catalyst, which will propel us forward.

The crime scene extends from coast to coast, from medical plaza suite to medical plaza suite, and from one discipline to another. It even transcends decades of struggle and sacrifice, which has lead to virtually the pinnacle of our profession, only now to be toppled by “the perfect storm.” Here is the deal (Imagine Dana Carvey playing Ross Perot in a scene in which he has a graph illustrating “measure twice—cut once”).

1. There were 104 podiatric medical school graduates who did not match with a residency program. This accounts for about roughly 17 percent of the total graduates this year. Interestingly, according to Ann Jobe, MD, of the National Board of Medical Examiners, there is a projection that as many as 5,000 MDs and DOs will not match this year. So it is not just us, my podiatric colleagues. There are a lot of bigger and more grandiose “ivory” towers in that sandlot.

2. Since the colleges of podiatric medicine have improved both their curriculum and student selection, 99 percent passed the part II National Boards this cycle. Previously, it was at a level of about 82 percent. Ergo, there were more people to match. So let’s beat up the schools because they have better testing results? Maybe we should beat up the boards for writing examinations that are too easy?

3. Student enrollment at all of the colleges has not increased the number of students for over the last five years. In fact, there has been a 10 percent decrease over this time. Too many students? No, sir. Ultimately, there are not enough. We need more and better pods if you want to be part of a profession that really means something and is still relevant in the future medical community. I do.

4. There are currently 108 residency programs accredited by the Council on Podiatric Medical Education (CPME) at this time. These programs have enough caseload to add one more slot. That’s right. If the 108 we have now just sucked it up somehow and added a slot, everyone is covered. But that is not happening. My insider tells me that a paltry six programs have agreed to do this, 16 just said flatly no, and the others have not responded. Now for the 16 who said no, let us ask them why. At least they had the cojones to say no and probably have some very compelling reasons for their unwillingness to open another slot. I bet we could pressure half of them to capitulate. For the six programs that have agreed, let us name them and give them some accolades. For the remaining 86 or so, come on, at least get some spheres and tell us yea or nay, and why.

5. The “primary culprits,” those nasty administrators who are the evildoers of all doers, are in reality fighting their butts off to get slots and residencies for these fine young professionals. For anyone trying to lay the blame on administrators, shame on them. They are simply clueless and I would conjecture that if you went to one of their offices, they would be bottom of the barrel type practitioners so disconnected that their opinion would be commensurate with their ability and acumen.

6. We must point a finger toward the CPME. The detectives have found traces of crime scene debris in their mitts. What would that be? Well, the times change and the CPME has not. While we must laud the council for all the great work it has done, the CPME has to become malleable and able to adjust on the fly so to speak. For example, we cannot have an annual scientific conference-based CPME accredited program, even if there is a complete meeting of all the rotation requirements with affiliates in other disciplines that the residents need to rotate through like radiology, etc.

This is easy to accomplish and I would proffer that if CPME could somehow amend its “hospital” requirement to include this type of program, we would have enough slots and some really good training. Why, you may ask? Well, Joe, the adept and successful practicing podiatric surgeon, is going to be taking his cases to his annual scientific conference, where he has a financial interest and not to the county hospital, which has a 45-minute changeover time between cases. Really successful podiatric surgeons make more money from their shares of their annual scientific conference investments than they do in the clinic. So can you really blame them for being successful?

Oh, for the guy who is filling out his form right now, the dedicated folks teaching in the “ivory” towers don’t make “huge” salaries. In fact, in my opinion, they make far less than the mediocre podiatrist who clips and chips. The CPME should also pressure like hell those residency programs that can add a spot and won’t. Hell, bribe them with more money or something like a trip to Disneyland. Do something and do it now.

7. It takes money to set up a program and with the Obama (Non) Affordable Health Care Act, hospitals are less likely to venture out on setting up a program. A podiatry residency can be profitable for a hospital but there are substantial upfront costs and a long time to eventually get the money from the government. Can you blame residency programs for not wanting to start something new with upfront costs? This is the government that has to pass a bill to see what is in it. That is not a warm and fuzzy thought for the hospital administrator who is amenable, in normal healthcare times, to set up a program or two.

How To Solve The Residency Problem

Those are some interesting facts and here is what I propose to solve the problem. First, keep humming that catchy tune because you are both part of the problem and can be a huge part of the solution.

If you remain apathetic, keep accepting your annually decreasing fees in spite of increasing workload, stop trying to increase your excellence with continuing education and implementation of new technology, and remain in the quagmire of “woe is me,” you are one of the perpetrators of this crime. Go home, shut up and do not waste bandwidth with your empty outrage.

However, if everyone steps up just a little bit and accepts the fact that podiatric medicine and surgery is now at its highest level in history, now is not the time to “dumb down” with some watered down levels of programs. We can virtually knock out any other specialty trying to tackle complex pedal pathology. We already are doing so.

For example, those posturing with a five-year residency in something unrelated to foot and ankle surgery with an added six or 12-month fellowship in foot and ankle simply cannot compare to an expert with seven years of dedicated focus and training in the subject. I will put up one of my intraoperative cage fighters against any of theirs, mano-a-mano, scalpel-a-scalpel, right now.

Let’s start realizing that without our youth — and they are excellent — our profession will wilt faster than an Easter lily in the 120° Sonoran desert in July. Let’s put some pressure on ourselves to implore those 86 programs (if CPME would reveal them) to add another slot this year and add some cases to their hospitals. Just a couple a month would be a game changer.

How about CPME? Can we get them to lighten up a little bit with the hospital restriction if an annual scientific conference could meet all the requirements?

This is not an easy problem but it just gets more complicated when we run off screaming and blogging at the “injustice of it all” without taking the time to look at what we as individuals have accomplished. We have the training and expertise, have impacted more lives positively than most Americans, and have a true profession that is simply the best in the world at taking care of very complex issues.

For the 104, they will ascend as attitude equals altitude.

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