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Why Aren’t More People Choosing A Career In Podiatric Medicine?

In 2007, the American Podiatric Medical Association (APMA) commissioned a study to investigate concerns of a pending shortage of podiatric physicians. According to the report entitled the “Podiatric Medicine Workforce Study” (prepared by the State University of New York, Albany), the number of graduating podiatrists needed to triple by 2014 in order to meet the health demands of an increasingly older, heavier and diabetic population.1,2 

That year, an article in Podiatry Management reported on the APMA study and stated that “the APMA has stepped up its recruitment activities for podiatry and efforts to increase the number of residency positions.”2 While there has been much debate about whether we actually need to graduate threefold more podiatrists today, nearly everyone does agree that we need to improve the quality and quantity of the application pool to schools of podiatric medicine.

Indeed, one of the five objectives of the APMA Vision 2015 Path to Parity is to “attract high quality applicants to colleges of podiatric medicine and thereby to the profession.”3

It is well known that after the 2007 report, the number of podiatric residency positions significantly decreased and is just now making a comeback to approach previous levels. That debacle, however, is not the purpose of my blog. Instead, I want to focus on the more overlooked crisis affecting our profession: the small numbers of qualified applicants to podiatric medical schools. These numbers have not substantially increased over the past seven years.

The APMA website provides a link on the Vision 2015 page for “Profiles in Progress” specific to student recruiting.4 The link takes you to a 2012 article in APMA News stating that: “In the early 2000s, the podiatric medical profession and the APMA in particular began to place a new emphasis on student recruitment and expanding the applicant pool for the colleges of podiatric medicine. In the ensuing years, the profession increasingly was able to attract the best and brightest potential students to podiatric medicine through a group of applicants that more than doubled over eight years (boldface mine).”

The same article shows a graph with data from the American Association of Colleges of Podiatric Medicine that shows the number of applicants from the year 2003 through 2011.4 Indeed, at first glance the number of applicants appears to have doubled. However, if you read the fine print, the number of applicants in 2003 and 2004 did not include applicants to the New York College of Podiatric Medicine so the data significantly underestimated the true starting point of applicants in 2003.

What is more relevant is looking at application totals after the year 2007 when APMA had discovered in its own study that a significant increase would be necessary in both the quality and quantity of podiatric physicians in the United States. In 2007, 853 people applied to podiatric medical school.5 In 2013, 1,020 applied. Clearly, the number of applicants did not double.

Conversely, researchers had projected a similar shortage of MDs as far back as 2002.6 The American Medical Colleges projected a national shortage of 92,000 physicians by 2020 but the American Medical Association (AMA) and the medical schools have worked together to answer this need. Since 2002, positions for incoming first-year students have increased by 23 percent at allopathic medical schools in the United States. Osteopathic medical school admissions grew by 117 percent between 2002 and 2013.

If we look at the seven-year time period after the APMA study, applications to medical schools grew from 42,000 in 2007 to 49,000 in 2014.7 Approximately 20,000 positions for first-year medical students were available in 2014 in the United States, an increase from 17,000 in 2007.

When looking a percentage growth, podiatric medical school applications and admissions look pretty good for the seven-year period after the APMA-SUNY study.

While applications to allopathic medical schools grew by 16 percent from 2007 to 2014, podiatric medical school applications grew by 19 percent.6,7 The number of positions for first-year students at allopathic medical schools grew by 17 percent while podiatric medical school positions grew by 37 percent.

The percentage increases for applicants and admissions look impressive for podiatric medicine, but are very misleading when you look at pure numbers. The numbers of applicants and students of podiatric medicine pale in comparison to the numbers of allopathic medicine so a slight increase in number shows a significant percentage change.

If you look at the numbers, admissions increased by only 150 spots for podiatric medicine while first-year positions increased by 17,000 for allopathic medicine. Remember that the APMA study stated that a 300 percent increase in admissions to podiatric medical schools would have to occur by 2014.1 This would mandate that 1,500 people would graduate from podiatric medical school every year. Presently, there are 600 graduates in the class of 2014 from all nine of the schools of podiatric medicine in the United States.

After a slight increase between 2004 and 2009, the applications to podiatric medical schools have leveled off and remained at around 1,000 applicants in 2014. Of these, 600 will gain placement into a podiatric medical school. This represents an acceptance ratio of 60 percent. This compares to allopathic medical schools that have an acceptance ratio of 40 percent.5,6

In terms of academic qualifications of students, there is a stark contrast comparing podiatric and allopathic medical school applicants and admissions. In 2011, the average GPA of applicants to podiatric medical school was 3.2 and the accepted average GPA was 3.3 while the average GPA of applicants to allopathic medical school was 3.53 and the accepted GPA average was 3.68.8,9 The MCAT average in 2011 for podiatry applicants was 20.2 and 20.7 for accepted students while it was 26.4 for allopathic applicants and 29.3 for accepted students.9,10

Even if you don’t agree that we need more podiatric physicians, the disparity of academic achievement of applicants to podiatric medical school in comparison to allopathic physicians is worthy of attention. I could not find any seven-year comparisons of the academic data but the current situation shows that Vision 2015 has not achieved a parity of quality of entering students when comparing podiatric medicine to allopathic medicine.

Compared to primary care physicians (family practice, pediatrics, internal medicne and endocrinology), podiatric physicians work fewer hours and have a comparable salary (see image at left).11,12 Tuition is lower at podiatric medical schools and the chances of acceptance are better than applying to allopathic medical schools. So why are so few qualified people applying to podiatric medical school?

The answer is not a fear of failing to obtain a residency upon graduation from podiatric medical school. The number of applicants has remained at the same level after the residency match crisis in 2011. Furthermore, many would be surprised to know there is a residency shortage in allopathic medical education, which has created significant concern.13

How To Increase The Number Of Podiatry School Applicants

In my opinion, the entire profession needs to take responsibility for increasing the number and quality of applicants to podiatric medical school. Most practicing podiatrists in the United States are detached from their alma mater schools of podiatric medicine and do not help with recruitment. At the same time, most schools of podiatric medicine do not reach out to their alumni and involve them in recruiting potential applicants.

The APMA bears a great responsibility for increasing the number and quality of applicants to schools of podiatric medicine. From my own observations and from my conversations with several administrators at colleges of podiatric medicine, the schools receive very little support from the APMA for student recruitment. A view of the APMA website searching for updates on student recruitment (a top objective of Vision 2015) reveals a single two-year-old article with distorted data from APMA News. I may be wrong about this observation and welcome input from any officer of APMA on this important issue.

As for me, I have an idea that could significantly increase the quality and number of applicants to podiatric medical schools. Each year, allopathic medical schools deny admission to over 29,000 qualified individuals. I do not know these applicants’ profiles but assume that a large number of them have GPA and MCAT scores at least equivalent to those of the average applicants to podiatric medical schools, and suspect that at least 5,000 of them have better GPAs and MCAT scores than the average admission class at any podiatry school.

Why doesn’t the Association of American Colleges of Podiatric Medicine (AACPM) approach the Association of American Medical Colleges (AAMC) and ask for access to all of the applicants to allopathic medical schools who were denied admission for the previous year? Why not make lemonade out of lemons for all of these promising applicants who have just been rejected? The AACPM could send an introductory packet to 29,000 people, most of whom have never heard of or considered a career in podiatric medicine. If only 10 percent of these people became interested and applied to podiatric medical school, the number of applicants would triple. I suspect that the overall quality of the applicants from an academic standpoint would also improve significantly. 

Whether you are for or against adding more podiatric physicians to the healthcare workforce, it would be hard to argue against any effort to improve the quantity and quality of applicants to the schools of podiatric medicine.

References

1. Available at http://system.suny.edu/media/suny/content-assets/documents/healthaffairs/sl-jefferson-lewis/ .

2.  Delisio ER. Looking ahead: will there be a DPM shortage? Podiatry Management. Available at http://www.podiatrym.com/pm/DPM%20Shortage.pdf .

3.  Available at http://www.apma.org/WorkingForYou/content.cfm?ItemNumber=4471 .

4.  Available at http://www.nxtbook.com/nxtbooks/apma/news_201202/#/18 .

5.  Available at http://www.aacpm.org/html/statistics/PDFs/AppStats/Historical%20TRENDS%20of%20apps%202004-2013%2010-2013.pdf .

6.  Available at https://www.aamc.org/download/411642/data/10282014.pdf .

7.  Available at https://members.aamc.org/eweb/upload/13-239%20Enrollment%20Survey%20201310.pdf .

8.  Available at http://www.aacpm.org/html/statistics/stats_applicants.asp .

9.  Available at http://www.jhsph.edu/offices-and-services/career-services/for-students/media-resources/BloombergSPH%20The%20Medical%20School%20Application%20Process%20From%20A-Z%201-25-12.pdf .

10. Available at http://www.aacpm.org/html/statistics/PDFs/MatrStats/Matriculant%20MCAT%202013.pdf .

11. Available at http://www.apma.org/files/secure/index.cfm?FileID=45679 .

12. Kane L, Peckham C. Medscape Physician Compensation Report 2014. Medscape. Published April 15, 2014. Accessed Nov. 7, 2014. Available at http://www.medscape.com/features/slideshow/compensation/2014/public/overview#1 .

13. Available at https://www.aamc.org/download/286592/data/physicianshortage.pdf .

Comments

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Dr. Richie’s thorough research and documented blog rings unfortunately very true but with it there seems to be a reasonable alternative presented for a possible solution to the future “shortage” of competent podiatric medical school candidates. As a former chairman of a podiatric medical school's admission program as well as 20+ year residency director, it seems that there certainly seems to be disconnect between the needs of the podiatric medical school and the efforts or lack of efforts in recruiting competent and highly qualified candidates. As chairman of the admissions program, the committee had to weigh the needs of the college to enroll certain numbers of “competent” students and the academic quality of the application pool. The college hired a recruiting officer that visited many colleges in search of competent and qualified student candidates. I am uncertain if the APMA had any type of coordination with the college or supported in any way in the recruiting efforts but as I recall there was none. The colleges at that time relied on tuition dollars to support their operations so it made complete sense that they would want their class size projections satisfied. I remember that the mantra was that there were x number of applications for a certain number of potential seats at the college but how many were academically qualified was only discussed in private. In order for podiatric medicine colleges to be comparable to allopathic medical schools, the student body must be academically equally qualified and at the present time it appears that they are not. Only by an effort by all the podiatric medical schools jointly and supported by an ambitious program by the APMA to attract academically highly qualified candidates can the profession begin to claim equality to allopathic medical physicians.
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