It’s Déjà Vu All Over Again, Again

Laurence G. Rubin, DPM, FACFAS
ACFAS President

This 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.

It’s 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 over again.”

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.

While 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.