APMA News - September 2013 - (Page 32)

Letters to the Editor Solving Our Residency Crisis; Remembering Our Heroes The following letters do not necessarily represent the views of APMA. They have been edited for length, spelling, and grammar. Residency Genesis Dear Editor: Our profession is right to be urgently concerned regarding the crisis in available residency positions for our graduates, and to prioritize nationwide dialogue to force an expedient solution. Can there be anything more discouraging to students who, after having selected podiatry as a career and investing tens of thousands of dollars and several years of time to be awarded a doctoral degree, discover that there are an inadequate number of postgraduate positions? Without approved residency training, these new doctors are left, in most cases, unable to practice podiatry. From my vantage point as a private practitioner for more than 30 years, a residency director since 1983, and a survey chair for the Council on Podiatric Medical Education for more than 25 years, this is the singularly most critical issue affecting our profession. It is a matter of trust. And currently, we are failing to meet our roles as leaders and caretakers of the profession. Are there mitigating circumstances? Yes; there have been and continue to be overarching considerations that have resulted in an ongoing uncertainty and inability to closely balance the number of annual graduates and the number of entry-level residency positions. First, the number of programs and active approved residency positions are not static or regrettably as stable as desired. Institutional viability, access to training resources, and mergers are common factors influencing postgraduate education. And second, our profession has wrestled with agreement on the ideal length of postgraduate education, the proper calibration between surgical and non-surgical training, and the necessary residency curriculum and documentable experiences to become board-certified. All of these circumstances have made it difficult to predict the number of entry-level positions in forthcoming years. However, the growth in number of podiatric medical colleges and apparent uncontrolled class sizes have exacerbated the problem.1 1 Editor’s Note: At its October 2007 meeting, CPME implemented a moratorium on applications for new podiatric medical schools and increases in enrollment in existing schools. At its October 2010 meeting, CPME implemented a moratorium on the 10 percent enrollment buffer provided each podiatric medical school. Admissions to podiatric medical schools for the last four years have been stable: 688 in 2009, 671 in 2010, 678 in 2011, and 684 in 2012. The number of authorized CPME residency positions continues to match or exceed the number of graduates. 32 APMA News September 2013 To date, the primary and focused response of our profession to this problem has been to increase the number of residency positions. This is understandable and appears to be consistent with an understanding that there is a documented need for more podiatrists nationally. But, it is a reactive solution and impractical as it assumes that supply and demand market forces on a national level will translate into more residency positions on a local level. I see this as a fallacy because there is a disconnect between the national need for more podiatric services and current residency program curricular requirements, which is sadly manifest in the situation the profession faces today. The documented need for podiatric services on a national level and, from what I have observed, locally, is centered around common podiatric pathologies and treatment and most certainly wound care. Like it or not, that is where I believe most podiatric care is needed, and it is where the global medical community articulates the need for our participation. Undergraduate education in these clinical areas is adequate, and through the joint efforts of CPME with the [American Board of Podiatric Surgery] and [American Board of Podiatric Medicine], residents are well-prepared through further sophisticated and hands-on training. It is not a daunting task for active or prospective residency programs to maintain the resources neccessary to achieve this training and grow residency positions. Thus, based on that premise, there shouldn’t be a problem in developing entry-level positions. The fly in the ointment, however, is the added credential in Reconstructive Rearfoot/Ankle (RRA) training. Such a credential becomes a goal for most undergraduate students, and why not? It represents “added” training, a more prestigious credential, and is self-satisfying to a cohort of individuals who have been expected to competitively achieve for the last dozen or more years. Isn’t it normal to expect that most students will want the credential? And, the added credential is a desired status for most programs, for the same reasons noted above. To wit, which program wouldn’t want to match with the most competitive students? The crux of our current problem, I believe, is that the added credential is a real and limiting factor as to whether a program starts up or adds positions. Where other CPME numerical requirements can be more easily addressed by programs, acceptable volume and diversity in reconstructive rearfoot and ankle surgical procedures are not universally accessible. So, what is the solution? I believe that the profession should attempt an immediate hybrid approach addressing both elements of the problem. First, the APMA leadership should convene an all-in meeting with representatives from every podiatric college and the boards and affiliated organizations. The singular goal of the meeting should be to hash out a plan limiting the collective number of incoming freshmen based on a formula; let’s say no more than 95 percent of the total number of

Table of Contents for the Digital Edition of APMA News - September 2013

APMA News - September 2013
President’s Message
Contents
What Happens in Vegas: The 2013 Annual Scientific Meeting
Annual Scientific Meeting Sponsors
Humanitarian Surgical Missions: A Different Kind of Residency Training
Collaboration is Key at Limb Salvage Clinic
Center for Professional Advocacy Reviews Recent California Medicaid Lawsuit
Oregon Podiatrists Achieve Physician Status
Letters to the Editor: Solving Our Residency Crisis; Remembering Our Heroes
Resolutions Submission Deadlines
Reimbursement
ICD-10: How to Code for Painful Hammer Toes
Federal Advocacy Forum
Cosponsors to the Helping Ensure Life- and Limb-Saving Access to Podiatric Physicians Act
APMAPAC Chair Report
Coverage Corner
Bylaws Propositions Due
IT Consultant
Website Wisdom
On the Road with APMA
Small Business 101
CPME Update
In Short
Worthy of Note
Affiliates Corner
New Members
Death Notices
APMAPAC Update
Development Update
Classified Advertising
Dates to Remember
Advertising Index
10 Questions
Your APMA

APMA News - September 2013