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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
Other messages in this thread:
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
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
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
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
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
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