PRESENT Town Hall Meeting Podiatric Residency Shortage and The Future of Podiatric Residency Education Moderator Alan Sherman, DPM, CCMEP CEO and Co-Founder.

PRESENT Town Hall Meeting

Podiatric Residency Shortageand

The Future of Podiatric Residency Education

ModeratorAlan Sherman, DPM, CCMEP

CEO and Co-FounderPRESENT e-Learning Systems

Background• All aware – shortage of residency positions last 2 years• Supply <> Demand mismatch• Most here – fortunate, you matched and are set for your

training• ~50-70 senior students just graduated, and graduated a

year ago, not matched• Impacts all of us – reputation, public perception, new

applicants to schools • Warranted a open meeting where all can speak their minds

Goals1. Bring all up to speed on

• What happened• Why it happened• What’s being done to help the current unmatched students and• Prevent the problem from compounding year after year

2. Polling

• Find out what this group really thinks on a number of the key issues using Audience Response System

• Largest gathering of the residency education community

3. Recommendations

Recommend action steps to address 2 key separate issues:

• How to best correct shortage of residency positions

• How do we stop the problem from continuing to compound into the future

Ground Rules• This program is being done as a service for our members by PRESENT e-Learning

Systems

• PRESENT is not an official spokesman for anyone or anything other than PRESENT

• We run education programs and provide other services for the podiatric residency education community – this is another one

• Facts and figures being presented are all from publically available documents published by entities such as CPME and APMA. References are given wherever possible. This Powerpoint file is being made available in it’s entirety on the RedEd Summit website, Town Hall Meeting page of the conference website:

http://bit.ly/13kqQaQ

Ground Rules• Keep it constructive• No blaming• Assume everyone has acted in their view of the best interests of the

profession• Acknowledge that even the best decisions can have unintended

consequences• Everyone who wishes to speak will be given a chance to speak• To speak, use microphone in aisle

POLL – Who is Here Today ?

Are you a

A. ResidentB. Residency DirectorC. Attending at a residency

programD. Non-residency affiliated DPM

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Response

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Residency Shortage Issue – What Happened ?

Residency Shortage Issue – What Happened ?

New Standards - New version of CPME 320 Adopted October 2010 by Council on Podiatric Medical Education, went into effect July 1, 2011. establishing the PMSR standard

“The adoption of the documents marked the end of a two year revision process that solicited and responded to ongoing feedback from many in the CPME community of interest (residency programs, student and young member organizations, professional organizations, and podiatric physicians). The process was highlighted by six open forums, which were attended by more than 300 program directors, residency faculty, and other interested parties. The Council also received more than 150 written comments about the proposed document changes.” - CPME

The two-year conversion process to PMSR programs was completed this July.CPME adopted these standards after getting feedback from the profession…

What changed with new standard ?• A single 3 year category – PMSR Podiatric Medicine and Surgery Residency

(many 2 year programs became 3 year programs, some closed)

• Requirement to pass part I and II of boards prior to beginning residency (Used to be ~10-12% failure rate. In 2013, failure rate was only 2.5% > more students eligible for residency training)

• Compensation for program director (required funding from GME/hospital)

• Option to grant RRA Reconstructive rearfoot and Ankle credential

Unintended/Unexpected Consequences

• Total enrollment of residents has increased – we have more podiatrists in residency training now than ever before

• Ended up with a SUPPLY <> DEMAND mismatch – Not enough program positions

http://www.aacpm.org/pdf/AACPM_Residency_Statement_Apr10_2013.pdf

Residency Shortage By the Numbers• April 11, 2012 letter from AACPM entitled “The Residency Shortage: Continued

Efforts to Find a Solution ”

• Even with the opening of Western U and Midwestern U, the total number of graduates has not increased. • Graduating class size across all podiatry colleges 572 in 2013. It had been as high as

582 during the 90’s.

• 572 graduates from podiatry colleges this year• 621 applicants for 1st year positions this year (50 carry over from 2012)• 525 positions available (100 shortage, now reduced to ~60)

http://www.aacpm.org/pdf/AACPM_Residency_Statement_Apr10_2013.pdf

CPME Residency Position Survey- Re-Assessment• June 2013• 700 responses – students, residents, APMA HOD, private DPMs• Results reported Aug 5 -Supported by majority• No changes should be made to structure of residency training• CPME should not relax its requirements, eg. Resident stipend, surgical

procedure minimum, program director compensation

• Resulting action taken by CPME at it’s Aug 5 meeting• Request that Council’s Accred Committee consider reducing enrollment at

schools• Ask schools to confirm that all prospective students be made aware of issue• Continue to support development of new programs and new positions

http://www.apma.org/WorkingForYou/NewsDetail.cfm?ItemNumber=8517

This is now the official policy under which podiatric residency programs are being run

What Happened ?

• CONCLUSION - The combination of an unusual high number of eligible students needing programs, and the reduction in positions by hospitals due to the move to the 3 year PMSR model…lead to the shortage this year.

http://www.aacpm.org/pdf/AACPM_Residency_Statement_Apr10_2013.pdf

The Solution – What’s Been Done and Still Being Done

The Solution- Recent Report by APMA

On August 1, 2013 meeting, APMA issued this update:• Of the 80 eligible students still seeking a residency position, 15-20 likely will be

able to secure a position by this Fall• Since May 1, CPME has approved eight 1st year positions• CPME is evaluating 5 new programs with 7 positions that could be available by

this Fall• 24 prospective new programs are working on applications, which could result

in 75 positions for the 2014-2015 year• CPME has notified 77 eligible existing programs of the ability to add 114 new

positions. Only 11 of those positions have been formally accepted.• They are….

http://www.apma.org/workingforyou/NewsDetail.cfm?ItemNumber=8490

Institutions that have accepted CPME’s authorization to increase positions, effective July 1, 2013

• Community Westview Hospital, Indianapolis, IN, one PMSR/RRA position• DeKalb Medical Center, Decatur, GA, one PMSR/RRA position for 2013–2014 year only• Detroit Medical Center, Detroit, MI, one PMSR/RRA position• Henry Ford Wyandotte Hospital, Wyandotte, MI, one PMSR/RRA position• Kennedy University Hospital, Stratford, NJ, one PMSR/RRA position• Massachusetts General Hospital, Boston, MA, one PMSR position, effective July 1, 2014• Montefiore Medical Center, Bronx, NY, one PMSR/RRA position• Morristown Memorial Hospital, Morristown, NJ, one PMSR/RRA position, effective July 1, 2014• New Mexico Veterans Affairs Health Care System and Kaiser Foundation Hospital,

Albuquerque, NM and Sacramento, CA; one PMSR/RRA position• Jerry L. Pettis Memorial VA Medical Center, Loma Linda, CA, one PMSR/RRA position • Rush University Medical Center, Chicago, IL, one PMSR/RRA positionhttp://www.cpme.org/residencies/content.cfm?ItemNumber=6915&navItemNumber=7202

CPME Announces 14 New First-Year Residency Positions in Progress

On Aug 9, CPME announced Four new residency programs eligible for on-site evaluation:

• Chino Valley Medical Center, Chino, CA (PMSR/RRA, 2/2/2 positions, scheduled for visit on August 23);• Faxton St. Luke’s Healthcare, New Hartford, NY (PMSR/RRA, 1/1/1, visit TBD);• Southwestern Vermont Medical Center, Bennington, VT (PMSR/RRA, 2/2/2, visit TBD); and• St. Joseph Hospital, Bethpage, NY (PMSR, 1/1/1, PMSR/RRA, 1/1/1, visit TBD).

Four new programs provisional approval for the 2013–2014 training year:• Tuscson Medical Center and Midwestern University Arizona School of Podiatric Medicine, Tucson, AZ

(PMSR/RRA, 2/2/2);• Phoenixville Hospital, Phoenixville, PA (PMSR/RRA, 2/2/2);• OSF Saint Anthony Medical Center, Rockford, IL (PMSR/RRA, 2/2/2); and• Salem Veterans Affairs Medical Center, Salem, VA (PMSR, 1/1/1).

Solutions Suggested for Residency Shortage Issue• Reduce enrollment or close college or two: this would not have any effect on the problem for

four years from inception, but would help thereafter. In fact, we are not graduating more students today then we were during the 90s ( both about 582 vs 572, despite more schools)

• Increase the number of residency positions. Many feel this is the best solutions, but it requires grassroots efforts in the practice community to bring cases and patients to hospitals which support residency education, ie. from surgery centers and offices.

For Unmatched Graduating Students – practicing in a state that doesn’t require a residency for licensure is an option

• Connecticut• Hawaii• Kentucky• Ohio• Pennsylvania• Puerto Rico

Two are even states with Podiatry Colleges.http://www.fpmb.org/compendium.asp Federation of Podiatric Medical Boards

States that Don’t Require a Residency for Licensure

How is the Profession Responding ?• After a thorough review of the information that that I’ve gathered on

the residency shortage issue, I’ve concluded:• The institutions in podiatry (CPME, AACPM, APMA) do ongoing surveillance of

the supply <> demand issue in Residency Education• They were surprised that the factors in place, all contributed to a quickly

rising shortage issue: the increased standards of the new CPME 320 (3 year programs, funding issues), the high pass rate on the national boards.• They have made, and continue to make, a strong and valiant effort to correct

the problem• A lot depends now on new programs opening and existing programs agreeing

to open new positions – will take another 1-2 years to resolve.

http://www.aacpm.org/pdf/AACPM_Residency_Statement_Apr10_2013.pdf

What percent of podiatrists across the country do you think participate significantly in residency training ?

A. 10%B. 25%C. 50%D. 75%E. 85%

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POLL – How Many Podiatrists are Engaged in Residency Education ?

Response

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How many DPMS contribute significantly to the education of residents in your program ?

A. 1B. 4C. 7D. 9E. >10

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POLL – How Many Podiatrists are Engaged in Residency Education ?

Response

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What do you think is the best option for the students unmatched to residency programs ? What would YOU do ?A. Seek jobs or internships or

precepterships in states that don’t require residency training for licensure (CT, KY, OH, PA, HI)

B. Apply again next yearC. A & BD. Give up

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POLL – Best Options for Unmatched Students

Response

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Discussion – What is Best Option for Unmatched students ?

What steps do you favor to reduce the residency shortage long term ?

A. Reduce enrollment at collegesB. Close a college or twoC. Increase number of residency

positionsD. 1 & 2E. 2 & 3F. 1,2 & 3

0 0 0000

POLL – Steps to Reduce Residency Shortage

Response

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Are you in favor of reducing the size of podiatry school classes 10-15% to decrease the need for residency slots 4 years from now ? Remember, there will be financial consequences for the colleges….

A. YesB. No

0%0%

POLL – Reduce Enrollment at Colleges ?

Response

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Discussion – What are the Best Options to Reduce the Residency Shortage ?

More and more podiatry cases today are being done in freestanding ambulatory surgery centers that residents are not participating in. What percentage of podiatric bone surgery cases do you think are done in freestanding non-hospital affiliated surgery centers today ?

A. 10%B. 25%C. 50%D. 75%E. 85%

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POLL – Surgery Centers 1

Response

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In your residency program, do residents scrub on cases at freestanding ambulatory surgery centers ?

A. YesB. No

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POLL – Surgery Centers 2

Response

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For those of you who do have residents scrubbing cases at freestanding ambulatory surgery centers, what percentage of all the cases residents do are at these surgery centers ?A. 10%B. 25%C. 35%D. 50%E. 75%

0% 0% 0%0%0%

POLL – Surgery Centers 3

Response

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Are We Training Today’s Podiatrist for What They Will Be

Doing in Practice ?

Survey done by PMNews

• A quarter of all podiatrists don’t do any bone surgery• Most consider between 1-25% percent of their practice to be bone

surgery• Less than 9% consider bone surgery to be more than half of their

practiceWhy are we training every podiatrist to be a comprehensive bone surgeon ? Many won’t be using most of the skills they spend so much time learning during residency.

What does this survey show ?

http://www.podiatrytoday.com/will-recent-cpme-320-residency-changes-including-new-three-year-residency-standard-be-beneficial-pod?page=1

Survey done by Podiatry Today

Poll – MAV Case minimum requirementsMAV (Minimum Activity Volume) requirements have been in place in the last few CPME 320 standards versions.

Would you say that what residents learn in your residency program prepares them well for what they will actually be doing in practice ?A. Yes, strongly agreeB. Yes, agreeC. MaybeD. No, disagreeE. No, strongly disagree

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POLL – What is Learned in Residency Education ?

Response

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Do you feel that your residency program offers enough office practice training experience to residents ?

A. Yes, strongly agreeB. Yes, agreeC. MaybeD. No, disagreeE. No, strongly disagree

0% 0% 0%0%0%

POLL – Office Practice Learned in Residency

Response

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What percentage of your residency education IS focused on surgical training ?

A. 10%B. 25%C. 35%D. 50%E. 75%F. 85%

0% 0% 0%0%0%0%

POLL – Surgery Balance in Residency Training

Response

Counter

What percentage of your residency education do YOU think SHOULD be devoted to surgery ?

A. 10%B. 25%C. 35%D. 50%E. 75%F. 85%

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POLL – Surgery Balance in Residency Training

Response

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