What Kind of Podiatrist Do Today’s Residents Want to Be? – Survey Results
We currently offer a single path in podiatric education designed to train advanced foot and ankle surgeons. All podiatrists currently do three years of residency training heavily weighted in surgery, designed to produce advanced foot and ankle surgeons. Our education system has evolved in the last 50 years to put a heavy weight on surgical training. Even our basic values and self-image have evolved such that we tend to consider the podiatrists who do the most advanced surgery to be better and more successful podiatrists.
Advanced Foot and Ankle Surgery vs General Practice Podiatry
One BIG factor that distinguishes medical and podiatry schools is that medical schools offer a multi-track education, where students can become medical doctors or surgeons, internists, psychiatrists, cardiologists where currently, podiatric residency education has now been standardized to train us all to be advanced foot and ankle surgeons. The issue is that many of us are not inclined to be advanced foot and ankle surgeons, but are instead inclined to be great general practice podiatrists. We ALL don’t need to be advanced foot and ankle surgeons, so why are we putting all of us through this training? Most of us should be general practice podiatrists, because that is what best serves the public health needs. General practice podiatrists handle most of what patients need. Only a small portion of podiatry patients require advanced foot and ankle surgery.
Have We Lost Our Balance?
For some time now, I have questioned why we put ALL podiatric residents through an advanced foot and ankle surgery residency program? I believe that the momentum of our energized, righteous push to become THE advanced foot and ankle surgeon has led us to an over emphasis on advanced foot and ankle surgery, and a relative neglect of what most podiatry work is, which is office-based general practice podiatry.
Restoring the Balance
I have proposed that we re-assess how the structure of podiatric residencies can be changed to better meet the needs of ALL residents, as well as the needs of the profession, and the public health. Toward this goal, I have proposed a dual track 3rd year for podiatric residencies, in which we divide residents into a track for advanced foot and ankle surgery and a track for general practice podiatry.
This is a particularly important time to discuss podiatric residency education, as many of you know that the CPME has convened its Ad Hoc Committee to review the CPME 320 document, the requirements for podiatric residency programs. The review, reconsideration and possible alterations to this document will shape the nature of podiatric residency education until the next revision, and will go directly to the heart of what we’ve been discussing: the QUESTION – “What Kind of Podiatrist Do Today’s Residents Want to Be?” and “Do the Current Three Year Residency Programs Prepare All Podiatrists Best for the kind of podiatrist that they want to be?”.
The Survey Results – What do Current Podiatric Residents Want?
I wondered how current podiatric residents feel about these issues, so I designed a Residents Survey to assess their views on this topic and invited about 1,000 current podiatric residents to take it. The results were very interesting and I want to share them with you in the interest of moving this discussion forward.
I purposely gave the residents ample opportunity in the survey to write narrative explanations as to what exactly they want and why they want it, so reading through their responses reveals quite a bit of depth and nuance. This helps us to understand how they feel and what they want.
In reading through the responses, it’s clear that not all podiatric residents are alike and not all want to be advanced foot and ankle surgeons. When asked what type of podiatrist they intend to be, 66% of current podiatric residents stated that they intend to be advanced foot and ankle surgeons, with 34% stating that they intend to be general practice podiatrists.
Then we asked them specifically about what track they would choose for their 3rd year of residency education if both an advanced foot and ankle surgery, and a general podiatry practice track were offered. The responses show that, 74% or about ¾ of them would choose the advanced foot and ankle surgeon track and 26% or about ¼ would choose a general practice podiatry track. So 8% of the 34% that intend to be general practice podiatrists still want the training in advanced foot and ankle surgery. But the results show that we could be putting as much as ¼ of residents through a 3rd year of advanced foot and ankle surgery training that they don’t need or want.
8% of the 34% of podiatric residents that intend to be general practice podiatrists still want the training in advanced foot and ankle surgery
What Do We Make of These Results?
It can be argued that more education is always better…that even the 26% of current residents who do not aspire to be advanced foot and ankle surgeons are better off going through this training anyway. I would argue against that – for two reasons. First, those going on to general practice would be better served by doing higher volumes of office/clinic based patient care during their 3rd residency year, of the type and variety that they’ll be doing in practice. Secondly, surgical cases are being done by these general practice podiatrists that should be adding to the case volume of those going on to be advanced foot and ankle surgeons.
What Surgical Procedures Do General Practice Podiatrists Need to be Competent in?
To be clear, I am not advocating for taking away a podiatrist’s scalpel and replacing it solely with a prescription pad. We will ultimately need to decide what surgical procedures general practice podiatrists need to be competent in. I am merely trying to maximize the usefulness of the 3rd year of residency training, and compelling the profession to recognize that it doesn’t serve our best interests as a profession, nor the best interests of public health, for ALL podiatrists to be trained as advanced foot and ankle surgeons. We should recognize that most of what needs to be treated in a podiatric practice does not require an advanced foot and ankle surgeon. Note Question 6, “Which procedures do YOU think should be included in the list of those that a reasonably well-trained General Practice Podiatrist should do?”. I had suggested, Surgery on the digits (including HAV, hammertoes, etc), STJ arthroeresis, nail surgery, I&D abscess, and excision of soft tissue mass. The residents’ responses were all over the board, with some of them suggesting that procedures as advanced as Brostrums and ORIF of ankle fracture should be included in the training of the general practice podiatrists. I think there is some fear and trepidation involved with this discussion, as no one wants to be denied training during residency in any procedure that they may want to do in practice. This is not about taking away training from those who want it. It’s about not wasting training on those who don’t want it and won’t use it.
Most of what needs to be treated in a podiatric practice does not require an advanced foot and ankle surgeon. It doesn’t serve our best interests as a profession, nor the best interests of public health, for ALL podiatrists to be trained as advanced foot and ankle surgeons.
For those of you involved in podiatric residency education, I feel I need to acknowledge that I have the greatest respect for the work that you do in running your programs, and know that implementing anything like what I propose will be difficult. Change is ALWAYS difficult. Just as a patient accepts post-op pain as a consequence of the good that the surgery does for them, I think we need to consider whether a change in our residency training would result in enough improvement in the years ahead to warrant the difficult job of implementing it.
A New Direction in Podiatric Residency Training – Dual Track Third Year
Is Podiatry a Surgical Specialty or is Surgery a Sub-Specialty of Podiatry?
Practice Perfect 644 - Is Podiatry a Surgical Specialty? – A Response by Jarrod Shapiro, DPM
Further Discussion on Whether Podiatry is a Surgical Specialty, and Whether We Should go to a Dual-Track Third Year in Podiatric Residency Programs
Alan Sherman Submitted Comments to CPME 320 Ad Hoc Committee on the Structure of Podiatric Residency Education