Are There Too Many Podiatry Colleges?

While statistics point to a growing demand for podiatrists, concerns about graduation rates, recruitment efforts and a diminishing applicant pool raise lingering questions about the podiatry colleges and the best path forward. Accordingly, this author speaks to leading educators in the field and students for insights on whether there are too many colleges, just the right amount or not enough.

Demographic trends in the United States strongly suggest that the country needs more podiatrists, not fewer.

One estimate projects that the number of Americans 65 years of age and older will more than double from 46 million in 2016 to over 98 million in 2060.¹ A November 2015 National Center for Health Statistics report estimated that over one-third of U.S. adults are obese.² A 2017 report from the Centers for Disease Control and Prevention (CDC) indicates that 30.3 million Americans (9.4 percent of the country) have diabetes and nearly 24 percent of those people are undiagnosed.³ Citing increased demand for foot and ankle care in the aging, diabetic and obese populations, the Bureau of Labor Statistics estimates that employment of podiatrists will increase 10 percent between 2016 and 2026.⁴

Will the current nine colleges of podiatric medicine be able to help facilitate this kind of growth and demand for podiatric services? Should there be more colleges? One would think that would be the case but concerns over four-year graduation rates, a diminishing applicant pool and the viability of the profession’s recruitment efforts have raised significant questions. Three of the nine podiatry colleges have four-year graduation rates that currently average less than 75 percent.^5-7 There has also been a steep decline in total applications to podiatry colleges in the past two years, going from a high of 1,194 applications in 2015 to 892 in 2016 and 868 in 2017, according to Moraith North, the Executive Director of the American Association of Colleges of Podiatric Medicine (AACPM).

Should there be fewer colleges? There appears to be a divide in the podiatric profession on this issue. In a June 2017 Podiatry Today online poll, “Are There Too Many Podiatry Schools?,” 47 percent of the respondents voted “yes” and 53 percent voted “no.”⁸

Jeffrey C. Page, DPM, the founder and former Director of the Arizona School of Podiatric Medicine at Midwestern University in Glendale, Ariz., is unequivocal on this subject.

“In my mind, we do not have enough schools of podiatric medicine,” maintains Dr. Page, who was previously in private practice, a Chief of Podiatry at the Carl T. Hayden Veterans Affairs Medical Center in Phoenix and a Dean at the California College of Podiatric Medicine. “The profession lacks a broad awareness because it is too small. We have too few podiatrists, not too many. But that said, the emphasis should be on the quality of the education at the individual schools of podiatric medicine, not on quantity of students.”

Is quantity over quality when considering applicants a possible factor for some of the colleges that have lower four-year graduation rates? John Grady, DPM, the Scientific Chair of the Midwest Podiatry Conference, says “the watering down of the applicant pool and the acceptance of unqualified candidates” may contribute to this dilemma. Dr. Page notes that the entering qualifications of students who are admitted “certainly” impact a college’s four-year graduation rate.

“I believe it is true that the schools that are more selective have higher overall graduation rates,” says Dr. Page.

In reviewing the admission requirements Website pages of the various colleges, the 90 semester hours of undergraduate work at an accredited college or university is standard across the board. It is also fairly common to require letters of recommendation, including one from a DPM, who has allowed a student to “shadow” him or her so the student can gain an appreciation of what a DPM does.

There are some differences when it comes to minimum GPA requirements for incoming students. “To be most competitive,” the New York College of Podiatric Medicine (NYCPM) says incoming students should have science and overall GPAs over 3.0, and notes that those candidates with less than a 2.75 GPA “should consult the Office of Admissions before applying.”¹⁰ The College of Podiatric Medicine and Surgery at Des Moines University (DMU) calls for a science and cumulative GPA of 2.7 or higher, and the Arizona School of Podiatric Medicine (AZPod) at Midwestern University requires incoming students to have a “minimum cumulative and science GPAs of 2.75 on a 4.00 scale.”^11,12 The Dr. William M. Scholl College of Podiatric Medicine at the Rosalind Franklin University of Medicine and Science seeks “competitive overall and science GPAs.”¹³

There is a similar vagueness when it comes to the Medical College Admission Test (MCAT) score requirements for some of the podiatry colleges. The requirements page on the Barry University School of Podiatric Medicine Website asks for “current scores from the (MCAT)” but doesn’t cite a specific minimum.¹⁴ The AZPod requirements page notes “competitive (MCAT) scores.”¹² While the Western University College of Podiatric Medicine “requires a current MCAT score,” the college’s application requirements page notes that “Currently, there is not a minimum MCAT score requirement for the Doctor of Podiatric Medicine program.”¹⁵

Does Smaller Class Size Make A Difference?

That said, eight of the nine colleges provide “profile” snapshots on their Websites of recent incoming classes that acknowledge average GPA and MCAT scores.^7,11,15-20 The AZPod program boasts the highest average science GPA (3.49) and average overall GPA (3.57) for incoming students in the Class of 2020. The AZpod program also is tied with the California School of Podiatric Medicine (CSPM) at Samuel Merritt University for the highest four-year graduation rate at 90 percent.^11,21 Do the smaller class sizes for the AZPod program (30) and the CSPM program (48) make a difference?²²

“A small class size allows us to work individually quite closely with students,” offers Dr. Page. “We assign each student a faculty mentor and a big sibling from an upper class. We have free counseling services, free tutoring, free private sessions with test taking and study experts, and so on. These efforts have paid dividends in Arizona.”

In 2015, the College of Podiatric Medicine and Surgery at Des Moines University (DMU) and the Kent State University College of Podiatric Medicine (KSUCPM) reported almost identical average GPA numbers and MCAT scores for their incoming students.23,24 However, there is a significant disparity on the current average four-year graduation rates with DMU (incoming class size of 53 in 2015) noting an 88 percent rate and KSUCPM (incoming class of 125 in 2015) noting a 71 percent rate.^7,23-25 But does the class size correlation to higher four-year graduation rates always hold true? The Western University College of Podiatric Medicine reports an incoming class size of 37 for 2017 but currently has a four-year graduation rate of 69.65 percent.^5,18

A Closer Look At The Possible Impact Of Four-Year Graduation Rates On Recruiting

Ryon Wiska, DPM, a second-year resident at the Beaumont Hospital in Wayne, Mich., says the “concerning” topic of low four-year graduation rates for some of the schools is related to “recruitment of qualified candidates.

“While it is difficult to judge a student’s drive and passion for the field solely based on a brief application and campus visit, many of these qualities can be gauged after their first year,” adds Dr. Wiska.
Doug Richie, Jr., DPM, notes that a substantial number of second-year students fail to pass Part 1 of the American Podiatric Medical Licensing Examination (APMLE) national boards and adds that a small but significant number of students fail Part 2 of the APMLE boards as well.

Based on three-year averages (mostly from 2014-2016), three of the colleges report above a 90 percent pass rate for their students taking Part 1 of the APMLE boards for the first time but two of the colleges report 80 to 81 percent pass rates.^6,7,11,25,26 When it comes to the three-year average pass rates for Part 2 of the APMLE written component, six of the colleges cite 89 percent and above pass rates for first time exam takers.5,6,11,25,27,28 Three podiatry colleges report 83 to 84 percent pass rates for the Part 2 written component.^7,21,26

“Students who fail to pass the national boards should have never been accepted to podiatric medical school,” claims Dr. Richie, who served as the Chair of the Podiatric Medical Education Committee at CSPM from 2010 to 2013.

When considering the investment of four years and upward of $160,000 in tuition alone for four years of podiatry school, Dr. Richie says the lower APMLE pass rates and four-year graduation rates for some of the colleges may dissuade prospective students from applying to podiatry college.

Rami Basatneh, a National Delegate for the American Podiatric Medical Students Association, says four-year graduation rates and residency placement rates are key factors for students.

“Some prospective students consider these factors heavily when applying and others consider them as a part of a bigger picture regarding a school’s competency,” points out Mr. Basatneh, a second-year student at the Temple University School of Podiatric Medicine (TUSPM). “Personally, these rates were important to me as were APMLE pass rates and the school’s clinic.”

Stephanie Tine, a third-year student and presidential ambassador at CSPM, recalls asking about graduation rates and residency placement rates when she was interviewing and applying to podiatry colleges. While she feels these rates aren’t the ultimate deciding factors, Ms. Tine says “the rates give students a good feel for how the school prepares the student for the future.”

Dr. Wiska believes these rates play an important role in choosing between podiatry colleges.

“When I was applying to podiatry school, not all of the schools published their graduation and residency placement rates,” recalls Dr. Wiska. “The ability for potential students to now have access to that information is very beneficial as they are comparing schools. I would presume that having this awareness would play a large part in a potential student’s decision-making process.”

However, Ms. North and Dr. Page both point out that many factors contribute to a student not successfully completing the DPM program in four years. While some are academic in nature, other factors may be more personal.

“For example, there are students who graduate in five years who have encountered legitimate challenges with their health or their family who need a leave of absence, and then return to resume their studies,” points out Dr. Page.

He also notes the overall four-year graduation rate doesn’t take into account students who are pursuing a dual degree program, which may require more years in college.

However, dual degree programs currently aren’t attracting many podiatry students. At TUSPM, only one student graduated with a DPM/MPH degree in 2017 and there are currently no other enrolled podiatry students pursuing the dual degree option, according to the university’s Office of Admissions. At NYCPM, two students graduated with the DPM/MPH degree in 2017 and there are four first-year podiatry students currently on the DPM/MPH track, according to Lisa K. Lee, the Dean of Student Services and Enrollment at NYCPM. She notes that NYCPM averages between two to five students a year in the dual degree program. Mark G. Danes, the Chief Strategic Communications Officer for Des Moines University, notes that over the last seven years, DMU has averaged four podiatry students a year in dual degree programs. No one graduated with a dual degree this past May from the Barry University School of Podiatric Medicine, according to Dave Fletcher, the college’s Director of Admissions.

Ira H. Kraus, DPM, the President of the American Podiatric Medical Association (APMA), notes the Council on Podiatric Medical Education (CPME) examines and evaluates graduation rates of the podiatry colleges. He points to CPME Document 120, which states, in regard to graduation rates: “The college is expected to demonstrate a graduation rate, averaged over the most recent three years, that is not lower than one standard deviation below the mean when compared to colleges nationally.”²⁹

Keeping the four-year graduation rates in perspective, attrition has been an issue in the MD community as well. In a May 2014 report from the Association of American Medical Colleges (AAMC), four-year graduation rates for MD-only students declined to approximately 83 percent in the 1980s and have not strayed far from that percentage since then.³⁰ The AAMC report cited an 81 percent four-year graduation rate for MD-only students for the spring of 2013.³⁰

Addressing The Recruiting Of Prospective Students

Despite the aforementioned demand for podiatry services and employment in the future, student recruitment appears to be a problem as evidenced by the dramatic decline in podiatry college applications (326 fewer) from 2015 to 2017. This wasn’t always the case. From 2005 to 2013, there was a fairly steady increase in applications from 696 in 2005 to 1,194 in 2015.

Dr. Kraus says the APMA became “actively involved” in student recruitment and career promotion in 2001 after the APMA House of Delegates in 2000 called for the organization to assess and develop a strategic plan for student recruitment. Between 2001 and 2011, Dr. Kraus notes the APMA devoted a team of staff and two committees for student recruitment and career promotion. During this time, Dr. Kraus recalls successful promotional campaigns such as “Today’s Podiatrist,” an enhanced online presence and extensive exhibiting in order to reach pre-health advisors and prospective students.

“These significant—and successful—marketing and recruitment efforts resulted in the increase in applications (from 2005 to 2013),” notes Dr. Kraus.  

In the early 2000s, Dr. Page says there was a “sharp downturn” in all medical school applications that was largely due to the “dot com craziness.”

“When the bubble burst, undergrads began again to consider graduate schools,” explains Dr. Page. “What followed was an increase in the (podiatry college) applicant pool for seven years in a row.”

In 2012, Dr. Kraus says there was a shift of priorities after an APMA-hosted stakeholder summit. At this time, Dr. Kraus says the AACPM assumed “primary responsibility” for student recruitment. Since then, the APMA has focused more on promoting the podiatric profession to help generate career awareness but Dr. Kraus says the APMA still “collaborates closely with the AACPM” and supports its work through social media outreach to prospective students and a “significant advertising investment of close to $250,000.” He adds that the APMA’s #OperateLikeAGirl social media campaign in July 2017 generated more than 1 million impressions on Twitter alone that month.

Ms. North maintains that the individual podiatry colleges as well as the AACPM devote “significant financial and personnel resources” to reach prospective students interested in health careers.
“AACPM and the schools collaborate in many ways, including in-person recruiting events, outreach to student influencers such as advisors as well as content messaging through social media outlets,” notes Ms. North.

What explains the dramatic downturn in podiatry school applications in the past two years? Ms. North says there are multiple factors, including simultaneous expansions of MD and DO colleges nationally. Dr. Page says the dip in applications may be partly due to the loss of a key employee at AACPM who was responsible for promoting career awareness and took more than a year to replace. He is complimentary of Mandy Nau, the AACPM’s new Career Promotion Strategist, and says her efforts have begun to have a positive impact on the applicant pool.

Dr. Richie says the podiatry colleges do not have enough resources to implement an effective recruiting program and maintains that the APMA needs to take more of the ownership for addressing “the low number of quality applicants.” While Dr. Page appreciates what the APMA has done over the years in regard to recruiting and promoting career awareness, he thinks more can be done. Specifically, Dr. Page recalls a Podiatric Medical College Visitation program, jointly funded by the schools and the APMA, which encouraged influential college pre-health profession advisors to visit podiatry college campuses for what he calls “indoctrination” about podiatry as a career alternative.

“We found the meetings to be very helpful and converted several advisors to be advocates for the profession,” notes Dr. Page. He says the program was discontinued a few years ago but would like to see it reinstated.

Dr. Kraus says the Podiatric Medical College Visitation program enabled the individual colleges to submit grant requests to the APMA for this program and the APMA included a $12,500 matching grant for each of the colleges. The program began in 2002 and continued until the 2011-2012 academic year, according to Dr. Kraus. However, at this point, he says the colleges’ enthusiasm for the program waned and “grant requests diminished.” With the aforementioned shift of student recruitment responsibility in 2012, Dr. Kraus says a new grant program was established to allow the AACPM to seek APMA support for recruitment activities.

While Mr. Basatneh is aware of the efforts by the colleges and components of the APMA to address recruiting of prospective students, he says “there is still a lot of work to be done.

“We need a revitalized marketing effort that focuses on the brand of the profession and not just volume of impressions,” emphasizes Mr. Basatneh. “For the nine schools to barely reach 1,000 applicants a year tells me we have fallen short. I believe the potential is much greater. … This past year, podiatry schools had a 95 percent (residency) match rate for graduates. We’re talking about a golden opportunity for a career in medicine that just not enough people are giving a chance. The ultimate question is not just whether we are reaching enough pre-med students but whether our message is resonating with them.”

Rebecca Van Dyke, a third-year student at TUSPM, notes she found out about podiatry through her own independent research as an undergraduate student researching options in the medical field. She doesn’t think recruitment is where it should be but recommends greater outreach to career fairs and more advertising in pre-health offices on college campuses.

“I believe that many great potential applicants forego applying just due to the lack of awareness of our amazing field of practice,” notes Ms. Van Dyke.

Ms. Tine concurs and advocates hands-on activities at recruiting events. She notes that a couple of months ago, the University of California, Davis hosted a pre-health day in which Western University podiatry students and CSPM students taught undergraduate students how to suture and cast for orthotics. “I personally know a handful of current students who were recruited after attending these workshops,” notes Ms. Tine.

Determining what motivated current podiatry students or alumni to choose their respective college could be another avenue of marketing to prospective students. Going beyond the statistical breakdown of the standard “class profile,” DMU offers some individual student profiles on its class profile page. The CSPM’s “subject-based learning” was more appealing than the systems-based curriculum that many medical colleges are switching to, according to Ms. Tine. Well into his second year in a residency program with a high emphasis on trauma and reconstructive surgery, Dr. Wiska says he is grateful for the strong knowledge base he received from the faculty at KSUCPM. At TUSPM, Ms. Van Dyke says she started taking a “Principles of Podiatric Surgery” course in her second year and notes that this isn’t done in allopathic medical schools. “Therefore, pretty much from the beginning, we are immersed into the world of thinking and decision making for our patients,” points out Ms. Van Dyke.

That said, Mr. Basatneh notes that the majority of his student colleagues learned about podiatry incidentally, whether it was through a visit to a DPM or having a family member who knows a podiatrist. Recognizing this, in December 2016, the AACPM relaunched the DPM Mentors Network (www.dpmnetwork.org ), a site that helps pre-health students get together with potential DPM mentors. The network originally debuted in December 2000 and a 2009 Podiatry Management article noted the network had 500 DPM members.31 Currently, the DPM Mentors Network has 300 DPM members and 100 student mentors, according to the AACPM.

Does Podiatry Need More Colleges Or Fewer?

Ms. North says the issues and concerns over graduation rates and student retention are not related to the amount of colleges but are due to the “shockingly low applicant pool.

“The onus for this rests squarely on the shoulders of the entire profession,” claims Ms. North. “It is the responsibility of every practitioner to bring an awareness of what they do as a podiatric physician to the public.”

Dr. Grady feels there are too many podiatry colleges. If there were fewer colleges, there could be a consolidation of resources and fewer slots, facilitating more applicants per slot and higher quality per student, notes Dr. Grady, the Podiatric Residency Director at the Advocate Christ Medical Center and Advocate Children’s Hospital in Oak Lawn, Illinois.

Dr. Richie disagrees and says competition for the best students is a good thing.

“Schools now have to fight for the best students, which makes them strive to improve,” maintains Dr. Richie. “It also forces the schools to find funding for the students, which is also good.”

Mr. Basatneh doesn’t feel there are too many colleges but also doesn’t believe more are needed at this time. “When you look at the number of applicants the schools get every year and consider that we are only a few years out of a residency shortage, it is difficult for me to see a case being made for a new school opening right now,” explains Mr. Basatneh.

Dr. Page maintains the problem is not too many colleges or graduates, but not enough.

“With the retiring baby boomers leaving the profession and small class sizes in comparison to historical numbers, the profession is poised to diminish in prominence and impact,” warns Dr. Page. “And this is occurring at a time when the needs of the public for quality foot and ankle care have never been greater.”

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