Residency Insight -- A PRESENT Podiatry eZine

Jay Lieberman, DPM, FACFAS,
Director of Podiatric
Medical Education,
Northwest Medical Center

A politically incorrect podiatrist speaks about
the proposed changes to CPME 320/330

By who else, but ........Dr. Jay Lieberman

I just returned from the CRIP’s in Dallas, Texas, the combined residency interviews. Most of the Residency Directors from around the country were there. We had the opportunity to discuss some of the proposed changes to the CPME. 320/330 while meeting with our fellow Residency Director.

Distilling it down to a few words, here are the proposed changes.

All residency programs will be three years. They will be referred to as “Podiatry Residencies”. The PM&S (Podiatric Medicine and Surgery) designation will no longer be used.

All residencies will essentially abide by the same requirements for a PM&S 36. Even if the graduating podiatrist has no desire to be a surgeon, he will be required to do three years of post graduate training. The hope is that these changes will create “uniformity in training” and allow for greater recognition from the allopathic community.

It appears to me that, in the short term, we may be inflating the training of the medical/orthopedic podiatrist and diluting the training of prospective foot and ankle surgeons. The plan to change the name and structure of our residency programs was only recently presented; however, I have been receiving requests to increase my residency program from three residents to nine residents for over a year. Apparently, our current surgical caseload is ripe for dilution between more residents.

I believe that there are two issues to address instead of proceeding to the course of increased residency slots. First, we, as a profession, should consider reducing the number of podiatry school slots until an appropriate number of surgical residencies are available. Secondly, our national associations must take action to help surgically trained podiatrists who find themselves excluded from hospital emergency rooms and with limited surgical privileges, due to pressure from the orthopedic community.

Theoretically, an aspiring surgeon would have to hope that their matched program has more than the required number of surgical cases. The minimum requirements called for with the proposed changes will not produce competent surgeons, in my opinion. Alternatively, they may choose to participate in a fellowship to enhance their training. Today there are many fellowship programs including those in “limb salvage.” However, the additional time required for training means that it would take many more years before they can start realizing a financial return on their educational investment.

Here is the undeniable truth. With the current medical climate, I foresee that allied health professionals instead of podiatrists themselves will perform a great amount of prophylactic foot care. As compensation drops, the average podiatrist may not be able to provide this service. They may use licensed ancillary staff to perform maintenance foot care. This would be a model in line with that used in dentistry as dental hygienists perform dental prophylactic dental care. As another example, “wound nurses” instead of “wound care podiatrists” provide much wound care today care. I see the trend in healthcare continuing towards these less costly approaches.

As I see it, the name of residency-training programs should continue to be Podiatric Medicine and Surgery. It is a mistake not to use the word surgery. As it stands now, some graduating residents have difficulty getting hospital/surgical privileges because our profession is best known for treating fungus nails and dropped arches, instead of foot and ankle trauma. I will never forget those who got us here, but we need to move on. We either do a better job marketing our podiatry profession or change the name to something that better reflects what we do on a daily basis. Perhaps we should consider making a clear distinction between the two entities rather than attempting to fuse them as they have done in dentistry. That profession has accepted general dentists and oral surgeons. I believe there is a place for two different specialists in our profession as well.

Have we created uniformity at the expense of the aspiring surgeon? Will the podiatric surgeon require one or two years of additional training beyond residency? Does the medical/orthopedic podiatrist really need exposure to such a large volume of surgical cases or can his training be entirely different? Either way, the name of the game is to have skill sets that can’t be easily reproduced by others. That will give us a competitive advantage and contribute to the overall health of our patients. Many podiatrists graduate with close to a quarter of a million dollars in loans that they need to start repaying immediately after their training is complete. With so much invested, will our graduates be able to pay back these debts?

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