05/20/2016    Carl Ganio, DPM

AAOS and the Department of Veterans Affairs Provider Equity Act

After almost 3 decades in private practice, I now
work for the VA as a podiatrist. The AAOS
misrepresented the facts in my opinion. The
Department of Veterans Affairs is well aware of the
training and scope of practice of the Podiatrist.
Parity has nothing to do with the old turf battle
between our professions. It has nothing to do with
what we are capable of doing, procedures, the OR,
etc.

It is about being considered a “physician” by the VA.
Our dental colleagues are included as physicians in
Title 38… they follow the same pay scales that
orthopedic surgeons do… Why not podiatry?

Yes, It would allow for a salary bump in most cases…
but that is not the whole story. I came into the
clinic this week at 6 AM with my colleagues, the
cardiologist and infectious disease specialist
I stayed later than they did.
I am required to take ACLS like the other docs.
I am required to do chart review like the other docs.
I work in the Specialty Clinics at our Center.
I attend the Sub-Specialty meeting every week.
Every specialist in the room is paid on a scale
different than myself. Each one is entitled to
incentives and bonus pay that Podiatrists do not
qualify for.

Mind you, I am not complaining, I just wanted to
clarify from my perspective.I am proud to serve our
veterans. They inspire me.

It was a shame to see the letter from the chest-
thumping AAOS trying to make us look inferior.
Perhaps a few letters from the medical colleagues who
appreciate what we do would be appropriate!

Carl Ganio, DPM, Fayetteville, NC

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05/19/2016    Joseph Borreggine, DPM

AAOS and the Department of Veterans Affairs Provider Equity Act

This battle for parity will wage only until those
that are "protecting" the podiatry profession from
our independent and identifiable autonomy ceases to
exist. We are no longer the profession that we once
were. We are well-trained and educated in the field
of foot and ankle medicine and surgical orthopedics
and have continued to evolve through these past many
years from palliative care podiatrists to foot and
ankle surgeons.

However, this profession will forever be recognized
as a "lesser than" an MD/DO medical profession as
long as we continue to educate our students with
current curriculum model that we have been using for
years. The Council on Podiatric Medical Education
(CPME) will never be equal to the American Council on
Graduate Medical Education (ACGME) and hence as long
as we continue to believe they are, then we will
never win this battle.

The salient points of the letter are plainly said by
the AAOS:

"Podiatric education and training today remains
variable, and a number of boards certify in specific
areas of podiatry with standards that continue to
evolve. The varying requirements have resulted in a
range of limited licensed practitioners with varied
training and skills."

"There is a place for the DPM on the healthcare team,
but it is a limited role in all respects and should
remain so unless future education and certification
standards are elevated to the same unified standard
that now exists for MD and DO and the American
Council on Graduate Medical Education (ACGME), the
American Board of Orthopaedic Surgery (ABOS), and the
American Osteopathic Board of Orthopaedic Surgery
(AOBOS)".
The plain truth in these few sentences in essence is
saying that DPM does not equal an MD or DO degree
period.

We make think otherwise, but this is plain fact.
Because no matter what we think we are in the eyes of
the public and legislators, the AAOS will always be
there to remind them otherwise. It is not that the
AAOS believe we believe we do not fulfill a role in
health care in the VA system as stated in the letter,
"...there is a place for the DPM on the healthcare
team...", but rather they opine that the DPM is not
equal to the orthopedist based on the surgical
training, "Podiatrists attend podiatry college and
have 0-3 years of residency training with relatively
limited exposure to the comprehensive educational
path of an orthopaedic surgeon - and in some cases
little exposure to ankle surgery".

This last statement may be untrue, but I have to
agree that our evolution and variability in our post
graduate training over the past 25 years speaks for
itself and the AAOS knows it, "Podiatric education
and training today remains variable, and a number of
boards certify in specific areas of podiatry with
standards that continue to evolve. The varying
requirements have resulted in a range of limited
licensed practitioners with varied training and
skills". We have done this to ourselves. We are
disjointed profession trying to be everything all at
once. We are podiatrists and should except that fact.
Our license is limited and that will be true until
the necessary changes occur. Yes, the DPM has many
opportunities to sub-specialize into whatever they
desire to do after they graduate and are trained. So,
being a DPM is not so bad.

Unfortunately, we have an arm of this profession who
believes otherwise. They only recognize themselves as
"foot and ankle surgeons". This title is in name only
because no matter what they call themselves the three
letters at end of their name is "D.P.M.: Doctor of
Podiatric Medicine". With that said, just because it
may look like a duck does not mean it is one. The
AAOS knows that and will do everything it can to make
sure that it is known anytime we think that we are
equal to an orthopedist, let alone an MD/DO, "A board
certified orthopaedic surgeon specializing in foot
and ankle surgery will have attended 4 years of
medical school after college, a 5 year orthopaedic
surgery residency and likely an additional year of
subspecialty fellowship training
(http://orthoinfo.aaos.org/topic.cfm?topic=A00274)".

So, my call to the powers that be, whether you are
involved with education (AACPM or CPME), a state or
national level (State Affiliates or the APMA), the
podiatry medical/ surgery boards (ABFAS and ABPM)
along with the podiatry surgery groups (ACFAS and
ASPS) all need to work together to give podiatry the
ability to achieve definitive and the eventual parity
that we have wanted for so long.

They only way may just be to partner with ACGME and
conjoin this profession with this organization to
change the podiatric curriculum and training to equal
the MD/DO degree or at least give the DPM student to
decide if they just want the DPM or the DPM/MD or DO
dual degree. Then, the problem will be solved. Those
that want to be DPMs only can be that and those that
want the DPM/MD or DO can opt to do that if they
choose. Once this process occurs, then the choice to
do one or the other, will then be the only reason
that parity would and can finally could happen

Therefore, the battle will wage on and on as long as
those "in charge" sit idly by and continue to accept
the status quo for whatever reason and do nothing to
make the dramatic changes and sacrifices to allow
parity and full scope license in this profession to
finally come to fruition.

Joseph Borreggine, DPM, Charleston,IL