President's Perspective May 2013

Jordan Grossman104 Left Without a Job
By Jordan P. Grossman, DPM, FACFAS, ACFAS President

Make no mistake; this residency shortage is a crisis. Was it…

A Miscalculation? …yes
Careless?…maybe
Egregious? …doubtful
Unfortunate? …without question

I’m not going to assign blame to anyone or any organization. No one wanted this and everyone regrets the situation. It’s what they call an unintended consequence of well intentioned actions.

There are, however, a lot of sidewalk superintendents out there who are criticizing and demanding action, yet have contributed little, if anything toward residency training during their entire careers. As they say, “Those who live in glass houses shouldn’t throw stones.”

Of the 208 residency programs, 146 of the residency directors are ACFAS members -- that's over 70 percent. But, that’s only 4 percent of all Fellow and Associate members. I am pretty sure that the majority of ACFAS members are involved in some capacity of a residency training program. However, if you are in the other 96 percent, are you putting your time and wisdom where your mouth is? If not, the time to get involved is NOW.

ACFAS has been very concerned and active in addressing this crisis. We are participating (both financially and with a representative) on the AACPM Residency Genesis Task force not to mention extensive member promotions. I was the ACFAS liaison to this task force from 2010 to 2013 and John Steinberg, DPM, FACFAS, is now serving in that role. Please be aware that we can’t force any member into action – it’s all up to you.

Again, I urge every ACFAS member to get involved with resident education in your community. You have plenty of options for doing so:

  • Offer to lecture to the residents
  • Invite residents to spend time with you in your clinic
  • Participate in research projects
  • Most importantly, offer your cases for the residents to scrub

These opportunities provide valuable experiences for the residents and may even provide enough volume of cases for the program to be eligible to offer another position.

And, should you be so inclined, starting your own residency program will obviously have a tremendous effect to help solve this crisis. For information, contact the National Residency Facilitator Edwin Wolf, DPM, FACFAS, by emailing edwin.wolf@rcn.com.

Trust me, I know that there are several confounding variables that make this particular option challenging. You will discover, though, that your participation in a residency not only provides valuable resources to the program; but you will enjoy an incredible fulfillment by becoming a mentor to these young minds – and that’s a legacy you just can’t buy.

Certainly reducing the number of applicants that our schools accept will help to prevent an even larger backlog of our students without a residency program. Unfortunately, decreasing our school’s class size will not help the 104 students who didn’t match this year. We won’t see the effects of this for at least four years.

I’ve read that there are “more than 158 additional positions” that CPME has approved at residency programs around the country, but I’ve been told that only a small fraction of these positions have been accepted by the residency program directors.

With the “blame game” at a crescendo, I hope that the individuals responsible for training our residents are not being criticized. I hope that any deflection of “blame” is not even being considered to fall on their shoulders. These are the individuals who are helping to solve this crisis and some of the very few in our profession who have dedicated their lives to post graduate education.

Understand that once a residency program is approved for additional positions, it is not a unilateral decision that the residency director can make to accept those additional approved positions. Funding for approved residency positions can be a significant obstacle to overcome. Hospital budget constraints obviously need to be considered.

Also, managing one or several more residents can be remarkably challenging for a director and faculty.

The harmony and cohesiveness of the existing residents and challenges of increased competition amongst them is also a concern. Dilution of surgical cases and the residency experience is probably the most common trepidation that a director has. It is a daunting task as a director to take on more residents when your resources are already stretched to the maximum. The faculty that participates in residency training is pivotal to providing satisfactory minimum activity volume and sufficient academia for the program.

This alludes back to my “simple solution.” The most immediate answer to this crisis is for more of us to get involved with our local residency training program(s). If you have ever thought about doing this “at some point in your career,” now is the time.

Questions for Dr. Grossman? Write him at president@acfas.org.

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