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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
Other messages in this thread:
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
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
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
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