02/04/2021    Randall Brower, DPM

It's Time for Parity with MDs and DOs (Samuel Cox, DPM)

I have to push back a bit regarding the whole
parity argument. This argument is frankly old and
tired. We are podiatrists. I did a 3-year
residency in Detroit at DMC from 2001-2004. Yes,
the first year, we did a 4-8 week course of
internal medicine, ICU, ER, trauma, general,
vascular and plastic surgery rotations. Yes, we
have a very small overview knowledge of these
general medicine and surgical specialties. But,
Dr. Cox, what do you want to do with a parity
degree?

We are both somewhere between 15-20 years in
practice. Medications, disease management and
surgical approaches have changed significantly in
the past 2 decades for all specialties. I think
you might be overstating that you, or I, have
vastly more knowledge in medical treatment of the
whole body. That is simply not a correct
statement. Tell that to an internist, or an NP,
and they will laugh you out of the physician
lounge.

Orthopedic, general and ENT surgeons, for
example, don't even draw labs or write for
medications or do surgery outside their specialty
scopes. You may say that they could if they
wanted. I push back that, from a medical legal
perspective, they would have just as much
liability treating patients outside their
specialty scopes as podiatrists would. I recently
asked a general surgeon friend of mine the last
time he did a venipuncture. He replied it had
been 30 years. I see a huge boon for malpractice
attorneys if grandfathered podiatrists start
treating heart disease, and doing surgery on
other parts of the body. We just are not
adequately trained in the increasingly
specialized medical/surgical world we live in.

We need to come to terms, as a profession, that
we are podiatrists and always will be
podiatrists. Specialists. I am not so sure where
the anger comes from. We all knew what the
limitations were when going into this profession.
My suggestion is to focus on being the best
podiatrist you can be, and enjoy this great
profession that has largely been recession proof
and for many of us, covid-proof. We are a blessed
group of specialists.

Randall Brower, DPM, Avondale, AZ

Other messages in this thread:

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02/10/2021    Michael M. Rosenblatt, DPM

RE: It's Time for Parity with MDs and DOs (Samuel Cox, DPM)

There was a time when I expected “a degree of
consistency” for American medicine and licensing
(pun intended). I was extraordinarily naïve. It
took the irregularities of the pandemic to prove
that to me. I actually EXPECTED the U.S.
healthcare system to even-handedly handle Covid
and allow allopathic physicians to prescribe and
follow their own internal scientific guidance.
Well known medications were politicized and
forbidden, no matter your license.

I just wrote three sentences and deleted them
because the Editor can’t print them. That tells
you everything you need to know. Consistency and
loss of freedom of speech were the first
casualties of the pandemic. Consistency in
licensure no longer applies to MDs and DOs. Why
would we expect it to exist for us? Now to
podiatry. Because of my age, I witnessed the
transformation of DPM from the earliest meetings
to “beg” my local hospital to let me on, to the
fact that DPM’s are now welcome at hospitals and
large group practices all over the US.

Podiatry itself was a shock to me. After my
training at a VA hospital and Army hospital, I
expected to be prescribing orthotics and doing
routine foot and ankle procedures. THAT was
before the HIV AID’s crisis hit. I found myself
actively treating patients with HIV.

I had the medical and prescribing freedom to make
some spectacular mistakes. I worked in
partnership with MDs and DOs to actively treat
infections that the founders of podiatry would
never imagine. When I got my Medicare Certified
Surgical Center licensed, a local anesthesia
group had a bloodbath of firing. Soon I got calls
from (previously employed) physicians asking to
“take me to lunch” in search of a new job with me
and my ASC.

I agree with the value of a plenary license. I
just did not personally find the lack of it to be
a problem. An argument can be made that I had TOO
much freedom for my training and experience. I am
just trying to be completely honest about it.
There were days I was prescribing openly for
diseases and medications not actually within my
licensure. I never got into trouble. Perhaps I
should have.

I believe I am the only DPM who actively
publishes on Medscape, using my real name and
degree. I publish on data that is not involved in
my degree or training. I am sure that some
readers think ill of me because of that. But I
know they read me. It is time that they
understand that some podiatrists write really
well.

I don’t expect anything of value from Government,
with the exception that I got a REAL license to
do medicine and surgery from several states. It
was an amazing and deeply appreciated “ride.” The
more I think about it, the more I realize how
deeply I was honored to become a DPM.

Michael M. Rosenblatt, DPM, Henderson, NV

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02/09/2021    James DiResta, DPM, MPH

It's Time for Parity with MDs and DOs (Samuel Cox, DPM)

I always find the comments related to parity for
podiatrists on PM News to be so interesting but
unfortunately of such little value. I can't help
but equate this to the "cowboy" activity of my
early years in practice when EBM equated to "in
my hands". Probably the lowest level of evidence
yet we listened to this as dogma, and yes we
truly knew no better. Yet, today some of our most
esteem colleagues and I might add some of the
brightest in our profession reflect on their own
experiences alone when commenting on this topic
and we need to be mindful of this before arriving
at any conclusion.

The bias in their comments and the diversity of
opinions on this topic are largely influenced by
one’s age, previous and present level of
training, provider practice experiences,
socioeconomic status and a host of other biases.
What we ought to be doing is looking directly at
our present cohort of podiatric medical students
and ask ourselves are we making their careers
less valuable because we have determined what was
good for us should be equally as good enough for
them? Shouldn't we want to see how our students
measure up to present day allopathic and
osteopathic medical students?

In doing so we also need to be mindful that all
medical students are not created equal. Yes there
are levels of minimal competency but it wouldn't
take a rocket scientist to discover that a
student at a less demanding program may not meet
even the lowest level of competency at a highly
competitive medical school. Finding the
appropriate place to get ones medical education
is not necessarily at the school with the most
competitive admission stats. It's finding the
right fit and the right environment at which you
can learn and thrive. Ultimately you will need to
pass the licensing exam whether that be the USMLE
or the COMLEX to reach parity.

As you know, the USMLE step 2 CS exam has been
dropped and come next January 2022 the USMLE Step
1 will be pass/fail (similarly COMLEX level 1
goes pass fail as of May 2022). I think myself
that the majority of our podiatric medical
students given the appropriate level of
preparation can be successful in passing USMLE
step 1 and if provided the additional training
can pass the USMLE step 2 CK exam.

The pathway to parity is needed for a number of
reasons. I am not advocating to do away with our
profession or with the DPM degree. My hope is
that all of our students will remain as
podiatrists with a plenary license which will
allow real change in practice scope for the
future of our profession and not based on
anatomical level except perhaps for our surgery
practice. We all want to achieve equal pay for
equal work. Our students deserve this future.

As a group, podiatrists can be quite aggressive
when they need to and will prepare themselves
with the education and experience needed to
achieve this goal. Those of us who are
approaching retirement broke so many barriers to
get where our profession is today. It's mind
boggling to even fathom what we achieved. This
last piece, achieving parity by exam, is a no
brainer. I get it i.e. the political hurdles in
gaining access to these exams but it's very
doable. We can do this. We should do this. Please
let's get this done before many of us "kick the
bucket".

James DiResta, DPM, MPH, Newburyport, MA

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02/08/2021    Steven Kravitz, DPM

RE: It's Time for Parity with MDs and DOs (Samuel Cox, DPM)

I find it interesting that for the past many
years, the question of “parity” keeps arising. In
the meantime, it also appears to me that the vast
majority podiatrists are satisfied with their
practices. It probably is a quiet majority ----
those who do not participate in writing articles
or commentary these kinds of publications are
busy practices and are earning what they feel is
a satisfactory income with a healthy family
lifestyle. I understand the concerns many of my
colleagues presented. I also think that their
frustration is not related just to podiatry, but
is in fact with all medicine.

Limitations of practice is generic and part of
how we treat medicine today. Ophthalmologists
refer cardiac questions to cardiologists and do
not think about trying to treat these problems. A
dermatologist I worked with did not do extensive
wound care, but referred to me and my colleagues.
As I see it, podiatry provides full scope license
allows us to do anything we need to do in our
anatomical area of practice. The limitation in
anatomical areas well defined before when chooses
the field. If one wants a broader anatomical area
treat and choose another medical field.

Additionally, nurse practitioners, physician
assistants have become an increasing partner with
many podiatrists across the country. This is
especially true in wound healing. As president of
wound healing Association, I can attest that many
members have requested that nurse practitioners
and physician assistants who work with them
become part of the organization. They work with
these colleagues on a regular basis and share
patient care. This is a trend go through medicine
and podiatry alone cannot stop the process.

Podiatrists are best trying to work with it, work
with your colleagues, get to know a few nurse
practitioners and physician assistants who are
open to working with you and move forward. I am
not very familiar with other fields of practice
anymore because of past 20 to 30 years, I have
been limited to wound healing. But in that area
of practice, I can tell you without a doubt the
partnerships between our advanced practice
providers and podiatrists keeps on growing and
will continue to do so.

Steven Kravitz, DPM, Winston-Salem, NC

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02/03/2021    Bryan C. Markinson, DPM

It's Time for Parity with MDs and DOs (Samuel Cox, DPM)

The usual flurry of parity-related posts are once
again upon us. Clearly, the frustrations of any
DPM when it comes to the limitations (both
anatomical and procedural) of varied Podiatry
practice acts is totally understandable. Not at
all intending to place anyone’s veracity in
question, unfortunately, this frustration also
leads to statements that strain credibility,
which are not helpful, but detrimental in any
quest for parity. For example, Dr. Cox states, "I
completed a 3-year PM&S residency in which I was
required to be the physician covering literally
thousands of patients through my course of those
3 years, I was not just the podiatrist, I was the
doctor for these patients granted I did have
coverage and oversight, but it was a learning
environment." Thousands?

Let’s assume conservatively that "thousands"
means 2,000. That means in a 5-day work week over
three years he was the "required physician" for
over 10 patients daily. Although certainly
believable if he is talking about daily inpatient
rounds as part of a team, but "covering
physician" is what he states. What about state
work hour limitations for residents? What about
those MAVs? I’ll leave that there. Dr. Cox
clearly states that if he were to have parity, he
would not all of a sudden be doing surgery out of
his specialty, just as orthopedic spine surgeons
do not do bunion surgery. But although we seek a
license that does not restrict us, the kind that
the MDs have, and now as he outlines, the nurse
practitioners increasingly have, we have to be
careful how we justify it in public.

Dr. Cox supports the argument with the statement
that "My training is so far superior in all
aspects of the human body to hers (referring to a
NP who he employs in Arizona)." Although I have
no idea where his NP was trained, any DPM who is
hospital based as I am knows that this is
patently untrue, especially the part about "all
aspects of the human body." Nurse practitioner
training, at all levels, including 2-3,000
supervised hours under an MD or DO to become
independent is totally different than that of a
DPM, as is their daily experience in total
patient care. I did not say superior, I said
different. If Dr. Cox’s training is truly
superior, he is in a distinct tiny minority of
one.

One thing will never change, and that is that if
you desire the practice life and license of an MD
or DO, or Nurse practitioner, don’t go to a
school of podiatric medicine. But for me, and I
would say the majority of my colleagues, the
attaining of the DPM degree, with all its
limitations and frustrations, was the best
decision of our lives. The key is not parity,
unless you think that draining a paronychia on a
finger is practice Nirvana. Yes, a plenary
license would solve a lot of issues, but I
suggest taking a new picture with a different
lens, as life below the ankle for me has been
intellectually as rich as I could have ever
dreamed. How about it colleagues? Is all practice
dissatisfaction due to external factors? Or
better yet, isn't the great fulfilling practice
more in your control than you realize? Or am I in
the minority of one? Chime in please.

Bryan C. Markinson, DPM, NY, NY