President's Perspective April 2017
It’s Déjà Vu All Over Again, Again
Laurence G. Rubin, DPM, FACFAS
is one of my favorite Yogi Berra quotes. Yogi made the comment after
watching Mickey Mantle and Roger Marris hit back-to-back homeruns over
and over again. It came to mind because it’s that time of year again:
the excitement, the anticipation, the thrill of victory and the agony of
defeat. No, I am not talking about the opening day of baseball, I was
referring to that other time-honored institution...the residency match.
hard to believe it has been 30 years since my own match day, and
surprisingly, it appears not much has changed since then. I remember the
day very clearly, and although I was fortunate to match my first choice
at St. Joseph’s Hospital, several of my friends and peers did not get
their first choice. Then there were those with no match at all left to
wonder their fate after investing four long and expensive years in
school. Students anxiously await this time of year to find out where
they will spend the next three to four years. When match day finally
arrives, some students are thrilled with their residency assignment,
some are disappointed and some are devastated. At times, it has become
so bad, we hear the word “crisis.” I think as a profession, we have
become so accustomed to students not matching that we have become
indifferent to the process. When we hear the numbers, “it’s déjà vu all
At the time of writing this Perspective, there
were 571 available residency positions with 576 applicants from the
class of 2017 and another 52 applicants from previous years. This means
10 percent of the students will not match a residency. We have seen
multiple attempts over the years to remedy this problem: increasing the
number of residencies, adding more residents to existing programs and
decreasing class size. None of these solutions appear to have worked.
Thirty years later, we are still having the same discussion. And now,
there is a new matter we need to consider—Fellowships. ACFAS has 38
recognized programs, and we anticipate 50 programs in the near future.
While writing this Perspective, I asked several prominent residency
directors for their opinions on the situation. Every one of them told me
they are considering a fellowship, and they all confessed there was a
concern of how it would influence their residency.
It is indisputable that fellowships will add to the diminution of residency positions.
I am a proponent of fellowships, having done one myself, we need to
realize that fellowships will add to the number of unmatched students
trying to attain a residency position. So, what is the solution? Should
every student get a surgical residency? Is this a “weeding out” process?
I think to wait until this point in students’ careers to “weed them
out” is not acceptable. That should have happened long (and many tuition
dollars) before this point in their career.
Perhaps we need a
new perspective; not everyone will be a surgeon, nor does everyone want
to be a surgeon. There should be the availability of postgraduate
training for those individuals who do not want to take the surgical
track in our profession. It may be time to revisit the concept of
nonsurgical residencies. This will take the pressure off the current
residencies to increase their number of residents and water down the
case volume. It will allow those who want to focus on podiatry and not
pursue foot and ankle surgery to be educated in their trade, and it will
provide an opening for the unmatched students.
If we continue
to do nothing, we will most certainly be talking about the growing
number of unmatched students at this time next year. And, this will be
déjà vu all over again, again!