DPMs Could Become a Footnote in History

Podiatrists Could Become a Footnote in History
by South Journal Business Journal

Podiatry schools face shrinking number of applicants

JP Bender


They're a shrinking breed of health care professionals and if the trend continues, there could be a day when the medical specialty disappears altogether.

The trend of shrinking applications for students entering podiatry school is spreading to the entire medical profession, according to admission directors in medical training institutions. Educators say that economic times have been good and students don't want to spend the additional six years in school and graduate with heavy student loan debt.

"While we have seen a general decrease in applicants and class size, it mirrors that of medicine all over," said Tom Melillo, president of the Ohio College of Podiatric Medicine.

Still, podiatrists are in demand. If a quarterback gets "turf toe," or a child suffers from flat feet or a diabetic has poor circulation in the feet, they probably will be treated by a podiatrist.

As a rule, podiatrists treat the parts of the body that take a pounding every day. When people think of podiatric medicine, they think of doctors who treat problems with the feet and ankles. Generally they're correct.

Different states have different laws. In Florida, podiatrists have the right to care for patients from the soft tissue and bone just above the knee to the toes. In Ohio, a podiatrist treats from the ankle to the toes and the wrist to the end of the fingers.

Dr. Barry M. Tuvel, 44, a podiatrist who works from three offices in Miami-Dade County is concerned about his profession, which has changed a lot in the past 15 years.

"Medicare and insurance companies have lowered the allowable charges and reduced payments to an unacceptable level," he said. "The stress to maintain a financially solid practice and still be able to make an appropriate living is unreal. I realize that all professionals are faced with difficult choices and decisions, but our profession seems to be effected by external influences more than others."

Tuvel, who graduated from the Ohio College of Podiatric Medicine in Cleveland and completed a two-year surgical residency, said he's not sure ­ if given the opportunity ­ he would do it over again.

"It's often long, hard work and sometimes not very attractive," he said. "Podiatrists can find themselves having to reinvent themselves and their profession, just to keep their patients happy."

But caring for people with a variety of foot- and ankle-related ailments are generally what podiatric medicine is all about. The shrinking enrollment is a major concern to the seven schools in the United States that offer postgraduate courses to students in podiatric medicine and surgery.

In South Florida, Barry University has a 15-year-old program. Director of Admissions Marc Weiner has seen applications decline in the past five years. In 1996, there were 300 student applications while in 2000 that fell to 175.

"A lot of potential students have chosen to go to business school," Weiner said. "Economic times have been good and a lot of students wanted to start earning money immediately. While this is a major concern in podiatry, I've seen student applications drop significantly at pharmacy schools, too."

Weiner said the drop in applications is a concern, but so far the school has been able to fill the slots without lowering admission standards.

Tuition costs $18,500 a year at Barry and Weiner said nearly 40 percent of students receive some form of scholarship funding.

"From Barry University's prospective, we need to get out a better understanding of what our school is about," he said. "We recruit nationally and explain to potential students what doctors of podiatric medicine can do in the health care field. We also discuss quality of life issues and earning potential."

Problems echoed nationally
Chicago has the nation's oldest school of podiatric medicine, founded in 1912 as the Dr. William M. Scholl College of Podiatric Medicine ­ yes, the Dr. Scholl of foot pads fame.

Despite the school's pedigree, Associate Dean of Students Thomas C. Taylor has cut the number of enrollment slots from 110 in 1996 to 90 last year.

"Whether we actually enroll that number this year depends upon the number and quality of applicants applying," Taylor said.

Taylor said tuition is $22,000 a year, 38 percent of students receive scholarship assistance (spiking to 80 percent for first-year students) and the average student loan indebtedness for seniors is $135,000.

"This situation is cyclical," Taylor said. "When times are good, college students get good positions with high pay and sometimes even signing bonuses. They think spending four more years in college with an additional two years in residency will deny them the fast track to financial success. When the economy turns sour, you will see a rise in admissions."

Taylor said he thinks podiatry has been particularly hit hard in recent years but can't say when and if it will turn around.

"Most podiatrists have a balance in their profession and have control over their own life," Taylor said. "They don't work the 70 -80 hours like osteopaths and allopaths."

At the Ohio College of Podiatric Medicine in Cleveland, founded in 1916, tuition is $19,000. Nearly one-third of first-year students get scholarships, said Kelly Lie, director of admissions.

"About 97 percent of [all] students receive some form of financial aid."

There has been an enrollment target of 130 freshmen in each of the past five years. Five years ago there were 676 applications and the school accepted 141 students. In 2000, there were 341 applications and 75 students enrolled. According to Lie, the school will have 85 openings this fall.

"We recruit nationally to fill our classes," Lie said. "But we need to get the message out to college seniors interested in the health care profession that ours is an opportunity to have an excellent job and that we provide a necessary service."

According to Lie, most of the graduating seniors at the Ohio school will have an average of $113,000 in student loan debt. Lie said that college students interested in the medical field need to understand there are viable options and podiatry offers a lot of flexibility.

"Our profession allows for a quality of life and a balance in your personal life," Lie said. "While podiatry offers a six-figure income, you can still spend quality time with the family. No beepers and no after-hour emergencies. This is an ideal profession for women who want a career and have the ability to have a family."

At the 87-year-old California College of Podiatric Medicine in San

Francisco, student enrollment is dropping faster than elsewhere. The freshman class in 1995 enrolled 125 students while the 1999 class enrolled 66 students, said Philip White, the associate director of admissions.

White also said he believes a strong economy is to blame for declining student interest.

"It's easy to get a degree here in California and then enter the job market and become a Web monkey starting at $50,000," he said. "We are seeing a turnaround in that industry and many students will be recognizing there's no future in the fast buck."

On a different foot
But not all see the declining numbers as negative.

It's a small profession and any drop off has the tendency to be magnified, said Dr. Robert Yoho, dean of the College of Podiatric Medicine and Surgery in Des Moines. He declined to provide year over year application data, but did say enrollment had been declining.

"I see a silver lining on the reduction in students," he said. "We in the profession should now focus on developing public awareness as to what podiatric medicine is all about."

Yoho said with the reduced numbers of graduates, the profession should take the opportunity to match the number of graduates with the multi-year surgical residency programs.

"If we can get our students into those important surgical residencies then we won't get caught up in the desire to increase students, but we can focus on providing the public with quality graduates offering excellent health care services," Yoho said.

Tuition is an issue too, said Dr. Mitch Kasten, the assistant director of enrollment at the New York College of Podiatric Medicine in New York City, where tuition is $18,800 a year.

"We need to explain our profession to freshmen interested in pre-med while they are still undergraduates," he said. "Ours is an allied health profession and students should not just view it as an alternative if they can't get into medical school."

Kasten said the New York school now sponsors conferences with students in pre-med and chemistry clubs. The school also talks with students in physiology and occupational therapy schools and tries to demonstrate that podiatry can be the first choice ­ not an alternative.

"Our profession must unify and this slowdown is an opportunity," Kasten said. "We have a diversified scope of practice and we must show students that podiatrists are well respected. Financially, not many people are aware that during the past 10 years, podiatrists earnings were equal to heart surgeons."

Kasten said he thinks the playing field is leveling with other health care fields and the lack of interest has caused some administrators to rethink their recruiting methods.

"Now we should look to younger students and compete with medical schools," he said. "We should recruit confident students who want our profession and should work with them to provide compassionate care. When you're secure with yourself, then you'll be successful."

Another problem: students often don't perceive the profession as an alternative to medical school, said Anthony McNevin, president of the American Association of Colleges of Podiatric Medicine in Rockville, Md. He said the drop in podiatric student enrollment is because of a mixture of reasons.

"In the minds of some students, the profession doesn't enjoy the same prestige and esteem as regular doctors," he said. "I believe that podiatric medicine suffers from not being in the mainstream of higher education. We in the profession have not been successful in getting it identified in the academic centers around the country."

But McNevin said in talking with schools and students, he sees a gradual turnaround in the near future.

"Generally, a bad economy or a war will increase student applications to medical schools," he said. "Of course, I certainly hope that doesn't happen. But I do see a trend with a slow and deliberate increase in the next year. I hope the schools can hold on and maintain the current tuition costs.

"On a national level, I think the Congress will have to pump additional money into the schools to make them more viable."