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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
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