01/03/2022    Richard Bloch

Preparing Podiatric Medicine for its Future Role in Healthcare: A Half Century is Much Too Long (Leonard A. Levy, DPM, MPH)

Dr. Levy, I congratulate you on your career and
efforts on behalf of podiatry. I am writing this
letter as an individual, not on behalf of the
Maryland Podiatric Medical Association in response
to your article, “RE: Preparing Podiatric Medicine
for its Future Role in Healthcare: A Half Century
is Much Too Long”

I have had the privilege of working as General
Counsel to the Maryland Podiatric Medical
Association since 1979 and also as Executive
Director since 1991. I am proud to be associated
with podiatry and have worked diligently to advance
the profession, especially to expand its scope of
practice legislatively, as well as recognition as
the only non-MD/DO profession that is licensed to
perform surgery. With the advent of the 4-4-3 model
that is equal to the MD/DOs, podiatrists achieved
“equality” in education and training. The issue of
whether to obtain the same licensure as MD/DOs is a
state by state decision.

I disagree with your statement that there should
…”be an organized effort by our profession taking
the National Board Examinations and/or acquiring a
license comparable to other medical specialties
(e.g., ophthalmology, ENT, etc.).” In fact,
M.D./D.O.’s are generically licensed. Their
specialization is by training, certification and/or
self-designation. Podiatrists elect to specialize
by attending podiatric medical school. In my
opinion, the profession should be proud of its
distinction in that regard. Whether their doctor
has taken a particular exam is not something a
patient looks at in deciding which doctor to
consult with. It is the recognition of that
doctor’s specialty and reputation.

It is not my role to determine the policies or
goals of MPMA or the profession. However, I think
putting these issues in the patient’s perspective
will help clarify how the profession should
approach the issues of “parity” and “equality”. Do
you want the public to recognize podiatrists as
specialists of the foot, ankle and lower leg for
their education and training, or because they take
an exam that somehow makes them equal to their
allopathic and osteopathic colleagues?

This issue is being debated at various levels
within the profession and the APMA is in the
process of collecting the views of numerous
stakeholders. This discussion is especially
important in light of the recent rejection by the
NBME of podiatrists taking the USMLE.

I hope that the profession can come together to
speak in one voice on the direction it should go.

Richard Bloch, Executive Director, Maryland
Podiatric Medical Association

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01/03/2022    Tilden H Sokoloff, MD, DPM

Preparing Podiatric Medicine for its Future Role in Healthcare: A Half Century is Much Too Long (Leonard A. Levy, DPM, MPH)

Leonard’s comments bring back a lot of history and
factual information. I was part of that movement
at the California College of Podiatric Medicine. I
had just finished my two year residency at
Highland Hospital in Oakland California under
Henri DuVries and Pacific Coast Hospital in San
Francisco. Leonard created the first two-year
program in podiatric surgery leading to a Master
of Science Degree in Surgery. I was Assistant
Chairman of the Department of Podiatric Surgery
and soon to be Chairman of that Department and
Chairman of Graduate education including our
surgical residency program.

John P. Hubbard, MD was President of the National
Board of Medical Examiners and he wrote a very
dismissive letter over 50 years ago and again we
just saw a letter from the USMLE in the same tone.

It not a matter of can we take the USMLE, we have
many DPMs who have taken the exam and gone off
into residency. It took being enrolled in a
medical school to accomplish that even if it was
for the shortest of time possible. There are many
DPMs who are boarded in many specialty areas of
medicine.

Our educational model at many of our schools, is
an old school model geared to train the students
to go straight into practice after graduation.
That is why we hear the responses that we can’t
cut that podiatric medicine course, biomechanics
course, surgery course to create space to add
curricular hours to educate our students in the
core medical model; with the necessary podiatric
content. Osteopathy does this and includes
osteopathic philosophy and osteopathic manual
medicine courses also. (OMT)

There is no need to teach students how to make an
orthotic in circa 2021, we have great bio
mechanics labs out there that make our appliances,
surgery beyond biopsies, ingrown toenails should
not be taught at the undergraduate level. Our
students today go into a 3 year residency program
and they will learn all the surgery they need to
do in their PGY programs.

Podiatric medicine and limb salvage fellowships
are popping up at great institutions. We no longer
have to teach “the go into practice model.” Dated
and in my opinion irresponsible and PGY programs
are required for licensure.

I know fiefdoms and powerful positions will go
away but it is way beyond time to enhance our
educational programs to satisfy parity within the
MD, DO, DPM, DMD, MD specialties. Taking the same
National Boards, call them what you wish is the
most important first step.

Let’s face the fact that podiatric medicine and
surgery is a specialty and practiced as one. This
is about the future podiatric physicians and
Surgeons that will be a part of an evolving
healthcare delivery model. Being part of the whole
is much better for our institutions and education
model and graduates than being on the sidelines.

Podiatric medicine and surgery, ophthalmology,
dermatology, orthopedics etc. are all specialties
of medicine and it’s time to make the necessary
changes to join the bigger medical education and
practice and scope model.

Now this is a very polarized topic but there
reaches a point where there needs to be
stewardship. Jeff DeSantis, DPM, President of the
APMA has put an action in place, some schools will
help to develop this program and be good stewards
of the future of Podiatric medical education and
others will resist and fight like hell for the
status quo.

The answer in my mind is simple, the applicants,
the future students of this great specialty will
choose wisely with their goals and desires and
tuition dollars. They will chose the schools that
give them the best opportunities.

Tilden H Sokoloff, MD, DPM, Ketchum , ID