Raising Expectations By Reforming Residency Programs

I was pleased to learn the Council on Podiatric Medical Education (CPME) has declared a moratorium on one-year podiatric residency training programs that will take effect in 2008. Twelve months is simply not enough time to prepare young DPMs for the complexity and demands of our profession. I should know. I was a “12-month wonder.” The residency training in podiatry has come 180 degrees since I graduated from podiatry school in 1974. At that time, the top students competed for the few good training programs. In 2003, it’s the opposite. Good residency programs are competing for the top students. There are enough good programs and not enough graduating podiatrists. It’s the way it should be. In 1974, the Waldo program in Seattle had selected me for a one-month externship. They knew me and that’s the only program I applied to. In my interview, I told them they should select me because otherwise I would be a danger to society due to lack of training. That thought scared the hell out of them so they took me. There were a lot of really bright podiatry students applying for that program and I didn’t want to sound like the rest of them. It worked. The one-year program was a little like being tossed into a wind tunnel. You bounce around confused and 12 months later, you pop out of the exit hatch and you are still confused. In the one-year program, I “participated” in about 200 surgical cases. I held retractors a lot and did some of the easier procedures. Suddenly, it was July and I was done. I was scared, confused and ready to begin a practice. There were just a few jobs for new DPMs in those days. Most of us rented space in a shopping mall and hung up a sign. I still have my first sign. It cost $150 and the “M” fell off the first month. The CPME wants two- or three-year programs with three years being the gold standard for surgical programs. This will be a great move for podiatry. Young DPMs will walk into practice situations in which they will become full active members of hospital staffs. They will be thought of and treated as physicians. I was an “allied healthcare provider” in 1975. The expectations were not high. We need to get behind the CPME, the podiatry colleges and the residency programs to make this transition work. The colleges will need our financial support to keep high quality educational programs for fewer students. In the bad old days, the government gave capitation grants to medical colleges that made it financially prudent to keep enlarging the classes. This meant watered down training and not enough residency programs. The grants are gone so now the schools are tuition driven. That’s not good either. Ideally, the profession should provide 50 percent of the funds needed to run the schools. This would allow the colleges to compete for the best students. We need to support the residency programs by participation with our patients and giving our time as instructors. It’s no good to have three-year surgical programs when the numbers of cases and their complexity is watered down. Hospitals or surgical centers in our communities that have podiatric training programs should be our first choice for patient admission. We have been stewing over the crisis of decreasing applicants to podiatry college. This cloud may have a silver lining. The colleges and residency training programs will be able to do a more thorough job of training young DPMs if there are fewer to teach. Another way we can help is to guide bright young kids into a career in podiatry. That doesn’t mean handing them a slick brochure on podiatry schools. It means bringing them into our clinics or hospitals and letting them see what a great profession we have. It could also mean helping them with tuition and being a mentor as they progress through their training. I don’t want to go back to the bad old days. When I told the dean of my podiatry college that I wanted to do a one-month externship in 1973, he denied me permission. He was afraid I would return to tell my fellow students about the program and they would all want externships. I threatened to quit podiatry school. He didn’t want to lose that capitation grant so he let me go. I came back and told all my fellow students about my month of hospital training. The dean was right. They all wanted more training. Dr. McCord (pictured) is a Diplomate wtih the American Board of Podiatric Surgery. He practices at the Centralia Medical Center in Centralia, Wash.