05/11/2021    Alan Sherman, DPM

AMA To Consider Resolution With Goal of Allowing DPMS to Take USMLE Exams

I read the announcement by the APMA and reporting
by PM News with great interest regarding the
joint effort of the APMA, ACFAS, AOFAS, and the
AAOS (Joint Task Force of Orthopaedic Surgeons
and Podiatric Surgeons) to petition the American
Medical Association and the National Board of
Medical Examiners to allow podiatrists to prove
that they ”demonstrate(s) the core competencies
to practice medicine” by taking and passing the
USMLE exam. I have long felt that merely stating
that our education was equivalent and demanding
an MD degree was a pointless, sophomoric
exercise. Power and exclusivity are never ceded
voluntarily. Rights to so valuable a commodity as
a professional degree is always only achieved by
proof, and that proof is testing by our peers.

If we are asking for an MD degree, it’s always
been a foregone conclusion that we must pass our
MD peer’s exam, the USMLE. Even once we gain the
right for our graduates to take the USMLE, it’s
likely that, at least initially, some podiatry
school graduates will pass and some will fail. I
have confidence that the schools will improve
their education over time in regard to the
material needed to pass the USMLE and eventually,
the pass rate will be high.

This is an excellent set of developments. It is
my hope that when the AMA studies the CPME
accreditation standards, they find they are
comparable to Liaison Committee on Medical
Education (LCME) standards and sufficient to meet
the requirements which would allow DPMs to take
all parts of the USMLE. The road ahead will be
rocky but I believe this is the right road for us
to be on at this time for the continued
professional development of podiatry. Kudos to
the 4 associations involved, particularly our own
APMA and ACFAS, for this terrific work.

Alan Sherman, DPM, Boca Raton, FL

Other messages in this thread:

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05/14/2021    Frank Kase, DPM

AMA To Consider Resolution With Goal of Allowing DPMS to Take USMLE Exams

For those of you who have taken the time to read
the white paper as well as the Resolution I think
you will find that many of the comments that have
been made by some PM News readers are incorrect,
let me give you some of the tenets of the
Resolution:

1. The document has been developed to allow
GRADUATES of a CPME approved podiatric medical
schools to have access to take the USMLE.
Remember that the NBME controls who can sit for
the USMLE, and at this time podiatric medical
students are prohibited from sitting for the
exam. The resolution asks for the AMA to evaluate
if the CPME is COMPARABLE to the LCME not to
replace the CPME. It says GRADUATES, without
specifying present students and residents. So
potentially, anyone who is a graduate from a CPME
accredited podiatric medical college, would be
eligible to sit for the Exam; no one is left
behind.

2. There has been again misrepresentation that in
order for a podiatric physician or student to be
able to sit for and pass all three parts of the
USMLE that they graduate from an LCME approved
college that is 100% false

3. There has been speculation that Podiatry
residency programs must be ACGME approved. That
too is not correct. One of our goals is that the
residencies are considered COMPARABLE not equal
to.

4. Our board certification process will not be
changing. Submission and hopefully passage of
this resolution at the AMA House of Delegates is
the next step in the evolution of our specialty.
Passage of this resolution and the eventuality of
our podiatric medical students being able to sit
for and pass the USMLE, the standard exam for
recognition and eventual licensure as a
physician, is the best chance for ensuring the
success and future of our schools and the new
generation of physicians with a specialty in
podiatric medicine and surgery.

Please read the documents and white paper and be
sure that you understand them. Do not be swayed
by those who have obviously misinterpreted or do
not understand the content of the documents. Our
specialty will continue to thrive and flourish
and this resolution will only positively impact
its future and its members.
Thank you for listening.

Frank Kase, DPM, Burbank, CA

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05/14/2021    Bryan C. Markinson, DPM

AMA To Consider Resolution With Goal of Allowing DPMS to Take USMLE Exams From:(Allen Jacobs, DPM)

Since the backslapping, and kudos, and
misinterpretation and queries about existing DPMs
taking the USMLE have begun, I feel compelled to
state my take on it. Dr. Allen Jacobs' very
accurate, but hidden assessment is one I 100%
agree with. The AAOS and AOFAS seems to have put
APMA and ACFAS into a full nelson without any
resistance whatsoever and forced them to cry
"uncle." Any DPM with an iota of self-respect
must condemn this statement in its entirety. For
those who support it ask yourselves the
following:

1) What do you think will happen if the AMA takes
up this resolution to "study" our education from
the top down to see how it compares to MD/DO?
I'll tell you....it will be disemboweled pure and
simple. You will see how the retrofit about
simple addition of gynecology and psychology
class that we have been espousing, will be the
laughing stock of the medical community. Front
and center you will see that the differences in
the educational experience of a DPM will be hung
out to dry publicly simply on how it does not
match up. No mention will be made about anything
good we hold as the domain of the DPM specialty
training.

2) What makes you think that the NBME and the
LCME will take on the project? If they do, the
resolution already states that curriculum change
will have to result in equal, not be "like."
What DPM courses will be sacrificed to
accommodate this? The second two years of
podiatric medical education will be decimated.
(See question 1)

3) Why would any talented college student commit
to an MD curriculum AND a limited license to
practice podiatry?

4) Have you taken a look at what else the AMA
HOD has in store for us...mainly that you can't
refer to yourself ever as a physician...thanks so
much to all of our graduates in the past few
years who have insisted on saying they went to
"medical school" unchecked, unimpeded, not asked
to stop.

5) Has the AACPM signed on this or even been
consulted? Doubt it.

Also, consider this, the amount of retrofitting
and change will be so monumental as to nullify
this plan at its outset, and the "you can’t call
yourself doctor" will pass and they will lobby
every state legislature to follow it.

Have I misunderstood? I don't think so. If I
have, then the ACFAS and APMA need to clarify.

Bryan C. Markinson, DPM, NY, NY

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05/12/2021    James R. Christina, DPM, Patrick (PJ) Andrus, CAE

AMA To Consider Resolution With Goal of Allowing DPMS to Take USMLE Exams

The longest journey begins with a single step.
The announcement by the Orthopaedic and Podiatric
Surgeons Joint Task Force of the AMA resolution
and the white paper was the first step on a long
journey. It took the task force three years to
get to this point. If the resolution is approved,
it will certainly take several more years until
we will even know if NBME will grant podiatrists
access to take the USMLE. If and when we gain
access to the USMLE, we don’t know for sure what
direction the process will take. But as it stands
today, there are varying definitions of the term
“physician,” and at this point we have a map to
gain recognition as “physicians” (as defined by
the AMA) by AOFAS and AAOS and then hopefully by
AMA and AOA. How this recognition could
eventually affect podiatrists and their licensure
is unknown at this point. For now and the
foreseeable future, the podiatry licensing boards
will be the only ones licensing podiatrists for
practice, and any change to the exam used (APMLE
from the NBPME) would have to go through state
legislatures. APMA and ACFAS will always protect
our current licensees and their ability to
practice.

This paragraph from the white paper is essential:
There is a lack of consensus among the four
organizations as to whether DPMs should currently
be considered to be physicians. All four
organizations agree that DPMs who meet the four
goals listed at the end of this white paper would
be considered physicians within their scope of
practice. This white paper does not address the
different uses of the term physician within both
state and federal laws and should not be
construed as supporting the removal of any rights
currently held by DPMs, nor supporting any effort
to prevent DPMs from practicing under their
title, status, or scope of practice as currently
recognized by state and federal law and non-
governmental entities. Furthermore, all four
organizations agree that irrespective of their
differences regarding the current definition of
the term physician, DPMs, similar to MDs and DOs,
should not be restricted in their ability to
appropriately care for patients within their
respective scopes of practice, nor in their
access to patients based upon type of insurance.
APMA and ACFAS leadership are always happy to
answer any questions.

James R. Christina, DPM
Executive Director/CEO, APMA

Patrick (PJ) Andrus, CAE
Executive Director, ACFAS

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05/11/2021    Allen Jacobs, DPM

AMA To Consider Resolution With Goal of Allowing DPMS to Take USMLE Exams

Everyone with an interest in this “step toward
equality” is obligated to read this document, the
related motions to the AMA house, and other
related documents not specifically referenced in
the white paper. Should you do so, I believe you
shall find yourself anything but enthusiastic
regarding the prospect of equity. Personally, I
am shocked that the APMA and ACFAS would have
signed off on this document. State delegates to
the APMA HOD should be urged by you not to
consider any approval of this document as
presently constructed. It is a complete and total
repudiation of your education and degree.

There are four major components this proposal. It
is not a simple matter of allowing a podiatric
student to sit for and pass the USMLE.

#1. PRIOR to sitting for the USMLE, a student
must graduate a school approved by, and meeting
the standards of, the LCME. Who shall determine
those standards? LCME, not the CPME. Not podiatry
and podiatrists. What changes will be required
will and would the colleges maintain the
capability for such changes? How much podiatry
curriculum and clinical experience must be
sacrificed to satisfy any proposed changes? Do we
substitute gynecology and obstetrics for
peripheral vascular disease training? The
decisions regarding approved schools will rest
with the LCME, not CPME. In other words, the AMA
and AAOS have announced “your education within
the colleges of podiatry is insufficient “. And
the APMA and ACFAS signed off on this? So much
for Vision 2021.

#2. Podiatry students must pass all three parts
of the USMLE. That is, IF they graduate a LCME
college. In other words, any podiatry related
assessment, such as the national boards, are not
considered adequate. They in essence mean
nothing. This is a further denial of your
education as adequate to be considered a
physician. The contents of the USMLE, as you are
aware, are not podiatry specific and do not in
any detail evaluate to competency of a school
graduate to evaluate and treat foot and ankle
pathology.

#3. Podiatry residencies must reach the standards
of ACGME to be accepted. Who determines that? Not
CPME, not APMA, not any podiatric organization.
Why? Podiatric standards are, by implication,
inadequate by MD standards, and they will
determine the requirements for residency
training. Do you know that AMA documents suggest
the terms residency, resident, fellow,
fellowship, be restricted to MD/DO post graduate
training only?

#4. The board certification process will be
determined by non-podiatric physicians. So much
for ABFAS, CPME.

#5. In the finality, should all of these
concessions be made, there is no change in your
scope of practice. NONE. You are still a
podiatrist, a health care provider with a limited
license.

#6. Are you aware that the AMA has a proposed
discussion on limiting the term doctor to MD/DO
only. Are you aware that they would have you
required to introduce yourself to patients as a
non-physician health care provider? is that what
you desire? Who is the AMA to suggest that the
term doctor (noun) be restricted to an MD/DO? Is
that the parity of Vision 2021? You are not a
doctor, that is, your DPM has no D.

Absent some exculpatory explanation, I believe
the agreement with these documents and their
content was irresponsible by the APMA and ACFAS.
It tells the world “we agree, we are not good
enough “. IF such major changes were to be made,
you are still a podiatrist with a limited
license. You will have given up DPM regulatory
autonomy for no purpose. Your professional life
will not change.

Are you aware that AMA documents suggest that
advances in the scope of practice by podiatrists
is the result of legislative fiat and not by the
tremendous advances in post graduate podiatric
education experiences?

Please read these and related documents prior to
any celebration. This is a set-back, not a
victory of any type. Tell your APMA HOD delegates
to say NO. By agreement, you are allowing the AMA
and AAOS to verify the inferiority of you
education by demonstrating that podiatry itself
agrees with its inferiority as health care
providers. In the end, you will still be a
podiatrist with limited scope of practice. The
AMA and AAOS gave up nothing. They would maintain
total control. In the end, your life would not
change much if at all.

Allen Jacobs, DPM, St. Louis, MO

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05/10/2021    Lawrence Oloff, DPM

AMA To Consider Resolution With Goal of Allowing DPMS to Take USMLE Exams (Bret Ribotsjy, DPM)

I just read the white paper from APMA. I am
familiar with similar efforts by CPMA. As with
Dr. Ribotsky, I too am trying to understand what
this agreement accomplishes. I keep hearing
mention made that this is important to Podiatry
if we are to gain acceptance by MDs. I thought
that Podiatry acceptance by MDs was obtained by
providing good medical care. Isn’t that how we
gain the greatest acceptance? A limited license
will still label Podiatry as different. I think
it is a mistake to throw out all the advances
made in postgraduate education which defines
podiatry as it exists today.

I remember when I was Dean at the California
College many years ago, a group from the state
came in to compare Podiatry education with
Allopathic Medical education. The capsular
version of their results was that the educational
process was essentially the same, with the only
major exceptions being women’s medicine and
behavioral medicine. That was it. If the
profession feels that it is important for the AMA
to call us limited physicians, then add these
courses. Make our medicine courses more robust.
After that, who now decides which courses are
thrown out to make room for more courses on
psychiatry? Should we cancel biomechanics?

Dr. Ribotsky brings out some good points. I would
add this: what has been proposed is a slippery
slope. Examinations often steer the education
process. Faculty from colleges presently sit on
our examination committees. These same faculty
take back to their respective college
perspectives on examinations and how curriculum
should be fashioned for students to successfully
complete those exams. This is the case of the
tail wagging the dog - doctors being trained to
pass an examination, not trained on what makes
the best doctor. This is just the way of the
world. Will podiatry faculty be sitting on USMLE
examination committees? If not, then our students
will be disadvantaged when they take the
examinations. Also, it takes time for curriculum
to adjust to a new exam. I would not be surprised
if our students did poorly the first few years or
longer after the change to the USMLE. This
performance would in no way reflect the quality
of our students, but rather the inability of our
college faculty to adjust to the new examination
in a timely fashion. Would this poor performance
record by our students than be negatively used
against us by adversaries? I just feel
uncomfortable that this has not been thought out
deep enough.

We all have had podiatry insecurities at some
time. I remember when I was a second year
student, and was feeling those insecurities about
podiatry. I applied to medical school and was
accepted. For many reasons I turned that down. I
am happy that I made that decision. You want to
be accepted and treated like any other physician,
the bottom line is just do good work.

Lawrence Oloff, DPM, Daly City, CA