I have just completed a six-month search for a new associate to join my practice. This process has been an eye-opening experience in revealing the problems we have created in preparing residents for a career in podiatric medicine.
I just read the new blog (see http://bit.ly/nTcUGF ) by Christopher Hyer, DPM, FACFAS, and could not agree more with his observations that underscore my own recent experience. It appears that today’s post-graduate podiatric residency programs are training individuals for a sub-specialty that has little demand or opportunity in the real world.
I began my search with an advertisement on a widely read podiatric Internet listserv. I specifically outlined the type of practice I have and the training requirements for the qualified applicant. Specifically, I was looking for someone who was trained in reconstructive surgery of the foot and ankle. Most importantly, I was seeking an individual who had an interest or additional training in sports medicine. From over 50 responses, I saw the alarming direction our profession is headed.
1. The cover letters accompanying the curricula vitae (CV) were boilerplate and not specific to my practice offering.
2. All letters boasted of superior training in “complex foot and ankle reconstruction” as well as “extensive foot and ankle trauma” experience.
3. Many cover letters had gross grammatical errors and were poorly written.
4. Hardly any applicants were able to demonstrate any training in sports medicine and none showed any past interest or contribution to research in biomechanics, although my advertisement clearly stated this as a requirement.
What alarms me most is that current graduates of podiatric residency programs have been groomed to expect that the profession is in dire need of their exceptional training in reconstructive ankle and trauma surgery. Their expectation is that most existing podiatric practices require a new associate with this unique training who will instantly add value and income to the practice. Nothing could be further from the truth.
The fact is that most successful podiatric practitioners enjoy excellent hospital privileges and perform a significant number of reconstructive rearfoot and ankle surgeries. We are not anxiously awaiting the addition of a newly trained “super surgeon” to bring some new dimension to our practice. At the same time, most of us treat a wide variety of foot pathologies that require training well beyond reconstructive ankle surgery.
This type of training is sorely lacking in today’s podiatric residency programs. In simple phone interviews, I asked many applicants how they would work up a patient with sub-calcaneal pain or how they would evaluate a pediatric flatfoot. I was astonished with the lack of insight these individuals displayed.
The individuals with the most impressive CVs clearly wanted to join orthopedic groups or large multispecialty practices where they could work on a salary and be busy from day one. Most importantly, they all told me they envisioned spending their time equally divided between the operating room and “clinic time” seeing patients. What podiatric practice could offer this type of job description?
I agree with Dr. Hyer that a percentage of graduates from podiatric medical school need to go on and train for complex ankle surgery and trauma. At the same time, we have abandoned any other type of sub-specialty training (podiatric sports medicine, biomechanics, podopediatrics) and we certainly have neglected training the well-rounded general practitioner of podiatric medicine.
I was fortunate to have found a graduate of one of the few American Academy of Podiatric Sports Medicine (AAPSM) fellowship programs who appears to fit the needs of my practice quite nicely. Yes, he happens to have excellent training in trauma, forefoot and ankle surgery, but this will make little difference. What matters most is that he can explain to patients why they have heel pain and how he can help them.