03/30/2020    Bryce Karulak, DPM

Podiatrists' Role in the Coronavirus Pandemic

One colleague asked last week, do we have more of
a role rather than keeping diabetics out of the
hospitals? It begs the question for me of why is
our residency training so in depth if we have no
other role than to decrease the burden to the
health system. Yes, it IS important to keep those
with a laundry list of co-morbidities out of the
hospital, especially when pedal manifestations of
disease will be the reason they are admitted. But,
don’t we have another place in the health system
during crisis?

I spent 5 months of rotations on varying types of
medicine. One of those months was with critical
care where we managed patients on vents. I also
did a month of anesthesia, again with vent
management. I step foot into a hospital on a daily
basis. We treat the sickest patients in medicine
besides vascular.

I understand that not all of us had these
experiences but there are a lot of us who have.
If we want to progress, this is the time that we
offer our help and expertise. If we have the
training, we have a moral obligation to help. If
the opportunity presents for me to treat patients
because there is no other provider, I will do the
right thing.

If we choose not to, then 1) medicine will never
see us as equals because we won’t step up 2) PA’s
and NP’s will be more respected than us 3) we
should change residency training to be technical
and not medical. It is truly a waste of time to
do these extra rotations only to never use this
type of training.

This is a crossroads for our future. I see the
choice being that we are allied health with
assisting to keep patients out of the hospital.
If that is what we want then we need to make the
appropriate changes and not burden residence with
extra training they don’t need and will never use.

I was listening to NPR regarding NY’s epidemic.
Their plan was to call up the retired, then
dentists, foreign doctors, then medical students.
I don’t know about you but I would prefer a
recently trained podiatrist over a medical student
if I’m hospitalized.

I would be interested in hearing what the younger
practitioners think about our role?

Bryce Karulak, DPM, Fredericksburg, TX

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03/31/2020    Tilden H Sokoloff, MD, DPM

Podiatrists' Role in the Coronavirus Pandemic (Bryce Karulak, DPM)

I would like to respond to Bryce Karulak, DPM’s
post. He is smack on. Response below. Bryce, your
comments are heartfelt and I have had them since I
too was a resident at Highland General Hospital
1967-1969. In California, under our practice act,
we can train under the unlimited umbrella of the
medical practice act for up to 5 years of
training. After that is over we revert to our
scope of practice act forever. It is a waste of
the same training our brethren get to peruse other
specialties. The difference is they practice under
a plenary license that is for life.

In reality an ENT, ophthalmologist dermatologist,
etc. would not want to be called to the ICU,
emergency room, or Cardio lab. They aren’t trained
in those areas during their specialty training but
yet in times of need because of a simple plenary
license, they are free to answer the call during
emergencies and a pandemics. Most do not but can
if they chose to. We were the last ones out of the
barber shop. As I have written for a very long
time, we are not a profession, but rather a
specialty of medicine. We diagnose, treat
independently, perform surgery, we have unlimited
prescriptive rights in all states, we have
unlimited DEA Registration.

We can do admission history and physicals to the
hospital independently. In California we can be
first assistants on any surgery from top to bottom
and get paid for it and PICA covers us. You are so
right, the time is now for podiatric physicians to
be unencumbered by old laws that do not reflect
the training of today. We need a license that
says: The practice of podiatric medicine is the
diagnosis and treatment of the Human condition by
any and all means, with a surgical focus of the
foot and ankle. That short sentence achieves
parity with our MD/DO brethren and leads to
vertical integration into the MD /DO Graduate
education system. Thank you for raising this
question, it’s been asked for over 40 years and if
not now, when. We have the leadership on the APMA
Board to make this happen now.

Tilden H Sokoloff, MD, DPM, Alamo, CA