01/05/2022    Bryan C Markinson, DPM

Preparing Podiatric Medicine for its Future Role in Healthcare: A Half Century is Much Too Long

The ongoing USMLE discussion on PM News tends to
embarrass me. Posts so far, giving thought to the
past 50 years detailing buddy relationships with
MDs, invitations to join professional MD/DO
societies, faculty appointments in medical schools,
task force generation, even teaching MD or DO
students and residents, etc., are minimally
interesting as historical and even present events.
Disclosure: I also have enjoyed and appreciated
much of the above in my four decades in the
profession. However, these “achievements” (sic),
no matter how they stroke the ego, never did, and
do not now, intimate anything close to recognition
(by organized MD/DO medicine) of the education and
training of Doctors of Podiatric Medicine as like
or equal in any way to that of MD and DO degree
holders. It is also true that they do not intimate
that the DPM degree is inferior to the MD or DO
degree, just DIFFERENT. These things are true
whether or not you are best friends with an
orthopedic surgeon, or play golf with a
neurosurgeon, or even if you operated on a member
of their family. These “relationships” may indeed
be advantageous to anyone’s individual sphere of
practice, but to allow anecdotes like this to be
presented in this forum as evidence of deserving a
seat at the USMLE exam is, well, embarrassing.

Do we deserve parity? Of course, in many areas, we
certainly do. We already have full parity in the
malpractice arena, 100% parity. On the legislative
front, for problems like insurance, inclusion or
exclusion from care programs, equal pay for equal
service, business arrangements, etc. certainly
raise issues unfair to podiatry and are important
to resolve, but they have nothing to do with USMLE
exams and more to do with failed or inadequate
legislative/lobbying efforts. I understand visceral
reactions to unfairness. I agree that MD/DO
practitioners have an unfair advantage in these
areas that have more to do with political lobbying
than any degree designation. I realize that those
representing podiatry in the forefront of the
legislative fights see firsthand what the MD/DO
degree designation means for ease of formulating,
changing, or blocking legislation in one’s favor.
However, trying to cast a shadow of our education
experience as something that it is not will never
be the answer. That is what we are doing by
perpetuating the illusion that we are close enough
in our educational experience to the MD/DO
experience to sit for the USMLE.

The letter Dr. Levy received from the USMLE 50
years ago, and the one the combined DPM/MD Task
force recently received said the exact same thing
and indeed provides the total answer for all
podiatrists who hunger for parity but refuse to
acknowledge the difference between the medical
school and podiatry school experiences. Emphasis on
“difference,” with no declaration of inferior,
superior or equal.

The powers that be say calmly and simply, when a
student completes a course of study at an
accredited medical school, they can sit for the
USMLE. That means a course of study that involves
total patient care on an observed and challenged
and examined basis, with rigid performance measures
on a daily basis in the third and fourth years.
It’s different than the “syllabus on paper” that
podiatry keeps holding up as just missing a couple
of courses and presto, we are the same. It is
different than the day being over when podiatry
clinic ends. Not inferior, DIFFERENT.

Richard Bloch, executive director of the Maryland
PMA, seems to really get it……that podiatry has
developed its identity and that the “profession
should be proud of its distinction.” I could not
agree more and have always felt this way.

The worst thing for podiatrists is to not value
their own special and distinct skill set.
Unfortunately this is a serious problem even at the
student level, as our graduates continually and
increasingly refer to their undergraduate years as
“medical school” and not “podiatry school” or
“podiatric medical school.”

Our residents who do a three-week rotation at a
nationally prominent podiatric pathology laboratory
actually record that experience on their curriculum
vitae as “fellowship” or “mini-fellowship” training
in dermatopathology. Outrageous, bordering on
fraudulent. (To be fair, that laboratory does NOT
encourage this in any way)

I cannot address anyone’s personal disappointment
at their ultimate career choice, but I see and know
and interact with former podiatry students and
residents who love what they were trained to do and
become amazingly talented practitioners who
actually don’t have time or desire to dwell on why
they can’t be something else.

If we want parity where we are truly disadvantaged
as mentioned above having nothing to do with what
exams we take, perhaps we should get better in our
lobbying or public marketing abilities. Perhaps
non-podiatrists may do a better job at spearheading
these activities?

In any case, the podiatric college curriculum
prepares the student to practice as a podiatrist.

If we pursue the USMLE route, podiatry colleges
will have to retrofit and become medical schools.
Our successful students who pass the USMLE should
then have access to all other specialties of
medicine. If any algorithm that develops excludes
them from that choice, we will have a bigger
problem than we have now. In any case, it is
unlikely that enough will choose lower extremity
medicine to keep the DPM viable either as a degree
or as profession.

Bryan C Markinson, DPM, NY, NY

Other messages in this thread:

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01/17/2022    Leonard A. Levy, DPM, MPH

Preparing Podiatric Medicine for its Future Role in Healthcare: A Half Century is Much Too Long (Richard Bloch))

Richard Bloch, Executive Director of the Maryland
Podiatric Medical Association, disagrees with my
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.).” Furthermore, he describes podiatric
physicians as being "generically licensed" and
says that their specialization is by training,
certification and/or self-designation. He also
concludes that “podiatrists elect to specialize by
attending podiatric medical school and that the
profession should be proud of its distinction in
that regard”.

Mr. Bloch claims that whether the doctor has taken
a particular exam is not something a patient looks
at in deciding which doctor to consult with but
a recognition of that doctor’s specialty and
reputation.

Indeed, I do want the public to recognize
podiatrists as physicians specializing in diseases
and disorders affecting the foot and ankle
but due to their education and training which
prepares them to succeed in an exam demonstrating
their ability as being equal to other allopathic
and osteopathic physicians. Paraphrasing the bard,
a rose by any other name is still a rose. Podiatric
physicians do not “treat feet and ankles.” They
provide medical and surgical care of people who
seek care for problems affecting that part of their
body.

It must also be recognized that in the last two
decades there have been major changes
in the education of osteopathic and allopathic
physicians. In addition to passing the USMLE,
there also needs to be significant modification in
the education and training of the podiatric
physician. This is not a statement based simply on
opinion and/or didactic knowledge but on experience
I accumulated over the 16 years I served as
Associate Dean for Research and Innovation at Nova
Southeastern University (NSU)

Dr. Kiran C. Patel College of Osteopathic Medicine
as well as serving on the Curriculum Committee of
the College of Allopathic Medicine at NSU. I also
was invited to and served on the National Board of
Osteopathic Medical Examiners. This required
passing a qualifying examination authorizing me to
write questions for Part II of the osteopathic
licensing board in public health and preventive
medicine.

Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL

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01/06/2022    Robert Kornfeld, DPM

Preparing Podiatric Medicine for its Future Role in Healthcare: A Half Century is Much Too Long

As a 1980 graduate of NYCPM, I can say it’s now
been 41 years of the same old story - Podiatry
lamenting its role and position in healthcare.
Podiatrists feeling less than and instead of
calling themselves podiatrists, they introduce
themselves as foot and ankle surgeons and say they
went to medical school. 41 years of podiatry as a
“second class” profession. To be honest, I have NOT
had a good experience being part of this
profession.

I now avoid interacting on a professional level
with other podiatrists. However, I have had a
wonderful and rewarding career and at 67 years of
age, have no plans to retire. I love what I do and
how I practice. But I have found the overall
mentality of most podiatrists to be negative and
disappointed in their career choice. Many “hate”
podiatry. Most have a long list of grievances. It’s
too late for me to care any longer. To me, this
profession has been on a long and steady course to
crash and burn and die holding onto the DPM degree.

After 41 years of striving for parity which still
has not come, it seems obvious that podiatry needs
to become just another residency choice after
completing MEDICAL school and receiving an MD
degree. I can just ride out the remaining years I
will have in practice. But my honest prediction is
that Podiatry as an allied health profession is not
going to survive. Nurses, PAs and technicians are
being trained in general podiatry services and are
already providing similar care.

This would not be an issue if podiatrists were MDs.
I’m really tired of attending seminars where you
have to click on your specialty to register and
podiatry is not a choice, yet chiropractic, NP and
PA is. We have been and will continue to be the
overlooked profession because we do not market
ourselves to the public to build value and
reputation. The public STILL DOES NOT KNOW WHO WE
ARE AND WHAT WE ARE TRAINED AND LICENSED TO DO. My
frustrations with this profession are decades old.
My disappointments as well. What are we holding
onto? I say a sinking ship.

Robert Kornfeld, DPM, NY, NY

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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

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12/22/2021    Leonard A. Levy, DPM, MPH

Preparing Podiatric Medicine for its Future Role in Healthcare: A Half Century is Much Too Long

More than 50 years ago, while I was serving as
Dean and Vice President of Podiatric Medical and
Curricular Affairs of the then California College
of Podiatric Medicine, efforts were under way
requesting that CCPM students be able to take Part
I of the National Board of Medical Examiners
(NBME). A formal request was made through a letter
that I sent on May 26, 1971, to John P. Hubbard,
MD, President and Director of the NBME.

Dr. Hubbard responded June 7, 1971, with a brief,
perhaps dismissive letter which stated, “We
appreciate your interest in the possibility of
using the examinations of the National Board of
Medical Examiners for your students. I must advise
you, however, that admission to the examinations
of the National Board of Medical Examiners is
limited to students or graduates of approved
medical schools in the United States or Canada.
Thank you for sending me the informative material
about your program.”

Slightly more than two weeks later (June 24,
1971), Eugene M. Farber, MD, Professor and
Chairman of the Department of Dermatology at
Stanford University School of Medicine, and a
member of the Board of Trustees of CCPM, also sent
a letter to Dr. Hubbard. Sometime before Dr.
Farber also had invited me to serve on the
dermatology faculty of Stanford (I was appointed
as clinical associate professor of dermatology and
spent Tuesday mornings at Stanford training
dermatology residents, students at the medical
school who elected clerkships in dermatology and
was invited by the California Medical Association
to give a presentation to members of the
dermatology section. (I was invited to become a
member of the American Academy of Dermatology and
am now a Life Member).

Dr. Farber indicated in a letter to Dr. Hubbard
that he had become acquainted with the curriculum
of CCPM and had reviewed its basic science
curriculum to “become familiar with the goals of
this center.” He also indicated that it would be a
great deal of benefit for Dr. Hubbard to visit
CCPM at the college’s expense, in hope that the
chairman would find some way to persuade the NBME
to allow the students to take its examination.
Slightly more than two weeks after receiving the
letter from Dr. Farber.

Dr. Hubbard responded to him indicating that the
availability of the NBME examinations to a college
of podiatric medicine would involve new policies,
was premature, and would need to come to the
Executive Committee of the Board. He requested to
receive more information regarding our proposal to
take the NBME examination. An additional letter
was sent by me to Dr. Hubbard which was prepared
in collaboration with Dr. Farber.
This was followed up by a letter from Dr. Hubbard
indicating that the proposal was placed on the
agenda of the Executive Committee which claimed
that the Committee gave earnest consideration to
the request but concluded that, “at the present
time it was not advisable to depart from its
policy of limiting admission to the examination to
those who are students or graduates of US or
Canadian medical schools”.

Fifty years have passed since this formal
initiative and except for pockets of interest in
the podiatric medical education community, there
does not appear to 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 that period, the curriculum of podiatric
medical schools and the depth of graduate medical
education that DPMs complete (i.e., residencies)
has expanded enormously. Such an initiative by
podiatric medical leadership needs to become part
of the mission of the profession. This is not only
for the benefit of the profession but is in the
interest of the population that we serve.

While there have been pockets of interest by
several groups in the podiatric medical education
community addressing such efforts, the need for a
major, formal strategic plan towards this end is
long overdue. Healthcare in the United States is
currently undergoing major changes in such areas
as its delivery, scientific initiatives, and
addressing major changes underway in the aging of
the population, and the need to address major
increases in the prevalence of chronic diseases
such as type II diabetes. More than ever,
podiatric medical practice including the
organization of its educational process, and the
need to become an integral part of mainstream
medicine is desperately needed.

Initiatives by the profession toward these ends
need to receive the highest priority so that the
public can be better served. The profession has
grown enormously in 50 years and is more than
ready to accept the new role such changes have
generated. It would be a major mistake for the
profession not to engage in such efforts as its
highest priority, preparing podiatric medicine for
its future role in healthcare.

Dr. Levy is Professor Emeritus at Nova
Southeastern University Dr. Kiran C. Patel College
of Osteopathic Medicine after 16 years as
Associate Dean for Research and Innovation and was
a Fulbright Scholar in 2009.