04/12/2019    Joe Agostinelli, DPM

Using the DPM Degree Outside of Podiatry

I have been following this discussion closely and
would like to present comments from experiences
in my 23 year USAF active duty military career
and then 14 years in private practice as DPM in a
large orthopedic surgery/sports medicine group.
Ultimately it is not the "degree" that allows
other than podiatry utilization, but the
"person."

While in the military, I found that when it came
to additional duties such as -ACLS instructor and
affiliate faculty, trauma management lectures,
executive committees of medical staff, chief of
surgical services (including orthopedics), etc.,
my actual degree did NOT matter! It was the
individual performance and leadership potential
for advancement that was the key projector as to
what I was able to do besides my primary
specialty of podiatric medicine and surgery.

A good analogy in the military was "It does not
matter what uniform you wear to work every day
but your actions and behavior in that uniform are
what matters!". In the civilian sector, I have
noticed it is somewhat more difficult to obtain
similar additional duties beyond podiatric
medicine and surgery, but is attainable by
demonstrating expertise in your field, networking
with your medical staff associates at hospitals
and ambulatory surgical centers in filling needed
leadership and directive positions.

My take on all of this is that, of course, the
degree matters in certain issues (legislative
scope of practice, equal reimbursement,
government definitions of what we do, etc.),- we
deal with and still are obstacles in becoming
totally equal to our allopathic and osteopathic
counterparts. I totally agree with Dr. Allen
Jacobs on this - we cannot simply "say" we are
equal to make it so.

Years ago, I stated in this forum that radical
change is needed-ie- enter regular MD/DO medical
school ,obtain on graduation the MD/DO degree,
accomplish a one year internship ( to learn how
to be a physician), then enter a 4 year
"podiatric medical/surgical residency", to become
a "regional lower extremity specialist". This way
there is really no need for "colleges of
podiatric medicine", which then could be the post
graduate education centers of our future doctors.

Just by adding "Pediatrics/OB-gyn/Psychiatry" to
our podiatric curriculum does NOT then allow us
to legitimately obtain the MD/DO degree. I know
some will say that this idea really is for an
"orthopedic foot and ankle specialist" but ,in
reality it is not. I suggest that a study of
DPM's in orthopedic surgical practices will
objectively illustrate the differences. I have 37
total years of those experiences with orthopedic
surgical practices and am concerned that those
speaking on those issues have little if at all
any experiences that establish credibility on
this issue concerning equivalence of a fully
functional 2019 DPM graduate with 3 year post
graduate DPM and an MD/DO graduate with
orthopedic foot and ankle residency.

Joe Agostinelli, DPM, Niceville, FL

Other messages in this thread:

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04/13/2019    Ty Hussain, DPM

Using the DPM Degree Outside of Podiatry

I have to commend all these great physicians and
their inputs as to basically answer our question
of who we are and where is our profession headed.
I would love to be on a panel at any of our
national or regional meetings as this topic and
anything relevant to it will draw crowds by the
thousands.

After reading much of what has been stated, the
need for DPMs to be equal or this so called
parity to our MD colleagues will only begin with
us having the initials MD behind our names. That
being said, discussion has now led us to believe
that we need to take the USMLE as long as our
school curriculum offers the 3 topics we do not
take as students.

We are trying to conjure up ways to obtain this
MD degree by being in podiatry school. People, we
have MD schools for this degree. Going about it
in a roundabout way is frivolous. The mere
existence of podiatry and its history explains
why we formulated our own training in this
specialty.

The podiatric profession came up with the DPM
degree because the one thing that we do that no
discipline of medicine does is toenails, corns
and calluses. Any surgical aspect of podiatry is
treated by other MD disciplines regardless of how
good we are or they are. Our goal of wanting
parity in all levels; since we have changed so
much of our profession with a 3 year mandated
residency, to being on hospital staff, and
conducting each and every element as the MDs do,
starts with one stroke of being a cumulative
entity of the MD schools and podiatry being a
residency of the allopathic field.

There I say it. The existence of podiatry schools
will be no longer. It’s preposterous to
acknowledge having a podiatry school that will
allow students to just sit for the USMLE and get
an MD degree, because if that is the case it is
no longer a podiatry school. Podiatry one day
will be a specialty residency of medical school.
No denying this, as long as we strive to have
parity and all that comes with it.

Ty Hussain, DPM, Evanston, IL

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04/13/2019    Bryan C. Markinson, DPM, NY, NY

Using the DPM Degree Outside of Podiatry

I have stayed away from this discussion (but Alan
Sherman drew me in) because I feel the hard facts
as I see them regarding podiatric
medical/medical/DO equivalency are also going to
be hard truths.

First of all, the notion that a gynecology course
and psychiatry course evens up the score is an
outrageous fantasy. It does so only on paper.
The milieu, structure, oversight, support, etc.
in a medical school is different than that of a podiatry school. I did not say superior, I said different. I know
some of the DPM/MD's who have responded say its
equal, but I do not think they are being
completely forthcoming.

From my observation, medical students have a much
tougher grind hours-wise surrounding their paper
syllabus. They have FAR more in-patient care
experience AND responsibility than podiatry
students. There is even a program here where
medical students actually follow specific
patients to ALL of their outpatient appointments,
including podiatry so that they can get a more
global picture of their patients’ healthcare
experience.

Although I have worked and still work with some
unbelievably talented, smart and enthusiastic
podiatry students, unfortunately they stand out
too easily. The medical students I interact with
day in and day out just simply seem to be more
consistently on par. This is a very important
factor and critical to the ability of students to
take and pass the USMLE. Simply adding gyn and
psyche to the syllabus will not be the answer to
passing the test.

Having said that, I believe the core problem to
this intense desire for unlimited license status
is really internal to our individual professional
self esteem. If you are lamenting that you cannot
give a flu shot and a pharmacist can, you are
probably emotionally failing to such a level that
getting the ability to give a flu shot will not
help you. I think one needs to be far more
introspective about why they are unhappy as
podiatrists. You can make all the economic
arguments that you want, but that's not really
it, is it?

I personally find it a gift with unlimited
potential to have the ability to do all I do from
the ankle down. Some don't like to be associated
with cutting toenails, but they refuse to become
more expert in nail diagnosis and recognition of
nail changes as signs of systemic disease. That's
like slamming the door in your own face. There
are many examples of this across the spectrum of
podiatric care.

Lastly, what would result if this fantasy somehow
is indulged? Imagine all being appropriately
retrofitted so that podiatric medical students
are provided with accredited training and
experience to be permitted to take the USMLE,
thereby gaining the pathway to unlimited
licensure and choice of post graduate training.
Imagine it carefully. That would be the death
knell for the profession.

If I could make one thing happen that would
drastically change the unhappy amongst us that
would preserve our profession at its core amazing
ability to provide relief of pain and improve
lifestyle, it would be to finally get the
outrageously outdated, ridiculous routine foot
care restrictions eliminated. That is the noose
around the neck of this profession and everybody
knows it.

Bryan C. Markinson, DPM, NY, NY

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04/12/2019    Robert Kornfeld, DPM

Using the DPM Degree Outside of Podiatry

In the almost 39 years since I graduated from
NYCPM, it is my assertion that very little has
changed in the world of parity with MDs and DOs.
I will also say that very little has changed in
podiatric medical education in terms of teaching
our students cause and effect. We still focus on
attacking symptoms and when we fail, we turn to
surgery. The reality is that if every podiatrist
understood the reasons why his patients presented
to his/her office with a problem, we would be
light years ahead in our transition to parity.


Here is an example: I lectured to a group of
podiatric residents. I asked them what could be
the underlying cause of plantar fasciitis. Most
had no idea. Some offered up answers that amazed
me. Gastroc/soleus equinus, forefoot varus,
rearfoot varus, flatfoot, ankle equinus, and a
few other biomechanical maladies. And that was
it. So my question to them was, "Does every
patient with these biomechanical flaws have
plantar fasciitis? I asked them to think outside
the foot and come up with some possibilities.
They could not.

I mention this because I believe that we need
more work on understanding the human immune
system and its interaction with epigenetic
influences on health. Why does one runner with
gastroc-soleus equinus develop pathology and
another does not. And I am not talking about
stretching, training, running shoes, surfaces,
inclines/declines. I'm talking about patient-
specific physiology that leaves an immune system
burdened and incapable of efficient healing. With
that kind of training, we will not only equal the
MD/DO understanding of pathology, but could even
surpass it.

With this training etched into all DPM degrees,
more doors will open to podiatrists who would
like to work outside of podiatry and greater
public recognition of our expertise as medical
specialists will be sealed.

Robert Kornfeld, DPM, Manhasset, NY