06/02/2012    Ed Davis, DPM

Vision 2015, Vision 20/20

Podiatry has been a profession in a relatively
rapid state of evolution with significant
changes in the surgical training and privileging
occurring with each new generation of graduating
podiatrists. Vision 2015 of the APMA has
attempted to address these changes, but I think
it is time to take a longer term perspective for
which I propose APMA Vision 20/20. Here are the
steps that the APMA needs to take in order to
ensure the continued growth of our profession.

1) Lets face it, we (or many) really want to be
orthopedic surgeons of the foot, so we will need
to step up the training requirements, perhaps to
4 year and maybe 5 year residencies. But,
consider that after 4 years of college, 4 years
of podiatry school and another 4 years of
residency, can we still call such trainees
podiatrists? Perhaps not, so we will rename
individuals with such training "psuedopods" in
order to distinguish them from the rest of us
under-trained peons.

It is understandable that there will be those
who want do something unusual, like podiatric
dermatology. Such individuals should not be
disenfranchised, so APMA should initiate a
project to create board certification in the
area of podiatric nail laser treatment. We have
lost podiatric biomechanics, so let's not lose
the nail lasers!

2) APMA needs to take a strong stand on public
health issues in order to ensure respect from
health policy makers. My proposal is that APMA
focus on a critical health issue and devote a
large portion of our budget to finally end the
scourge of flip-flops. We will need to step up
the number of press releases on this public
health menace and perhaps approach Congress for
legislation to ban flip-flops.

3) Let's forget about efforts to gain parity
with our MD and DO colleagues with respect to
insurance reimbursement, but instead redouble
our efforts to ensure the permanent placement of
podiatry in the Medicaid system. After all,
Medicaid will probably be expanded to include
the majority of Americans by 2020, if current
trends continue.

4) APMA needs to take an active role in helping
to save Medicare for future generations of
senior citizens. APMA needs to establish a
permanent liaison to the AMA CPT committee to
assist with changing all those overvalued CPT
codes for foot procedures to codes with more
reasonable valuations. For example, we should
have a code for a "limited" nail debridement
which is paid at a lessor value when we don't
grind the entire nail plate.

Ed Davis, DPM, San Antonio, TX,
ed@sanantoniodoc.net

Other messages in this thread:

---

06/14/2012    Samuel S. Mendicino, DPM

Vision 2015, Vision 20/20 (Ed Davis, DPM)

I read all of the posts regarding post-graduate
training and it makes me chuckle. I just
attended a conference and at a roundtable
discussion I heard many senior DPMs complain
that “today’s graduates can’t even trim a
toenail, diagnose a wart, or even strap a foot.”

Then I move to the next table and I hear how our
students are all mainstreaming with
allopathic/osteopathic students and they should
be taking the USMLE exams. Move one table over
and a group of residency directors who have high
volume surgical programs are complaining there
isn’t enough time to teach all facets of surgery
in the combined models and what do you do with
the resident who has poor surgical skills?

At the the next table I see directors who teach
at excellent medical facilities with phenomenal
wound care clinics and biomechanics experts
complain about having to find all of these
rearfoot and ankle reconstructions to meet MAVs.

The problem is what it has been for decades; we
can not define who we are and where we are
going. Projects with dates only create more
confusion. I suggest that the first thing we do
is drop the whole “a podiatrist is a podiatrist
and that we are all the same” mantra. Everyone
knows this is not the truth and must admit we
will never achieve that goal. We have been
through two residency conversions in 10 years
and the end result is still two similar but
different residency models. All programs are 3
years in length, but wait until that confusion
hits credential committees across the country.

I have always been a modified dental model
advocate. After podiatric medical school, all
DPMs should enter a two-year residency. These
would focus primarily on medical and surgical
rotations (much like the third and fourth years
of medical school) and provide rotations with
DPMs in clinics/offices to hone their diagnostic
and treatment skills. There are probably more
than enough of these entry positions already
available and if not would be easier to start.
After this two year period, additional
residencies in any sub-specialized field we feel
as a profession is important would be available.
Lower extremity surgery and advanced
biomechanics/wound care are two that quickly
come to mind. Perhaps these additional
residencies could also offer a pathway to a
DO/MD degree (as is done in many maxillofacial
residencies).

Some may argue why so much training? It’s
simple, we practice multiple specialties but on
a limited anatomical location. We are the
dermatologists, radiologists, surgeons, etc. of
the lower extremity and thus must have
sufficient education and training in those
fields. Let’s embrace diversity and quit
thinking we should all be clones.

Samuel S. Mendicino, DPM, Houston, TX,
DrSMendo@aol.com

---

06/11/2012    Allen Jacobs, DPM

RE: Vision 2015, Vision 20/20 (Ed Davis, DPM)

The mandatory 3 year residency is fine in
concept, however, to suggest that this will
result in uniform educational experiences,
particularly in the area of surgical case volume
and diversity, is presently not consistent with
fact. Not everyone can be, should be, or wishes
to be "a surgeon".

It is about time that the APMA take some real
leadership in directing the future of the
profession. Establish definite guidelines,
goals, objectives, expectations, clinical
activities for primary care podiatry and for
surgery. Define once a for all exactly what a
primary care podiatrist is expected to do in
practice, then set about residency development
to accomplish this over three years. We already
have MAV's (minimal activity volumes) for
surgery.

Everyone completes the 3-year residency
experience. If the graduate has the MAV to sit
for ABPS certification, they may do so if they
wish. If they have the MAV for primary care
podiatry, they may sit for the medical board
certification should they choose to do so.

Students will find out quickly enough which
programs graduate which board qualified
individuals. The profession will recognize only
these legitimate boards, and agree to grant
appropriate clinical privileges for each at the
hospital level. Surgeons will practice surgery,
not medicine. PCP's will not attempt complex
surgery. There is really no alternative.

Please do this soon. I am weary of the radio ads
here in St Louis, in which 3-year surgical
trained residents advertise treatment for laser
toenail fungus treatment. And I am tired of non-
residency trained podiatrists doing subtalar
joint arthroereisis, I mean talotarsal
dislocation surgery, everyday in our surgery
centers.

Allen Jacobs, DPM, St. Louis, MO,
alllenthepod@sbcglobal.net