06/22/2022    Richard M. Maleski, DPM, RPh

"Who wants to be a Podiatrist?"

I've been following with great interest the
different opinions as to why our applicant pool is
so low compared to the MD and DO schools and I'm
surprised that no one has mentioned one obvious
factor: "routine" foot care. I would imagine that
most main stream podiatric practices still involve
doing a fair amount of regularly scheduled RFC, and
I doubt that most young people interested in a
career in medicine want to spend a substantial
portion of their day trimming or debriding
toenails.

Is this part of practice necessary? Absolutely yes!
The need is there, especially in the geriatric and
at risk population. But why should a DPM, with 4
years of undergraduate education, 4 years of
Podiatric Medical education and 3 years of
comprehensive medical and surgical training be
required to be the ones physically doing this work?

Pharmacists have pharmacy techs counting pills,
physical therapists have techs applying ultrasound
and electrical stimulation treatments, dentists
have dental hygienists providing dental cleaning
services and even some superficial cavity work.
MDs and DOs have PAs doing a significant amount of
patient care. Nurses have CNA's doing the more
mundane activities of nursing care. These policies
are in place to allow these other providers to
concentrate their efforts on the aspects of care
that require the extensive knowledge and training
that they have.

RFC requires close attention, gentleness and
compassion, but not 11 years of advanced education
and training. Podiatrists should be evaluating the
patient, coordinating care, reviewing labs and
prescribing medications or other treatments, that
is, supervising the overall care, but not spending
the time to do the physical activity that can be
done by less trained personnel.

In my opinion, and I admit that I may be in the
minority on this point, our profession won't be
attractive to a large portion of prospective
medical students until we are allowed to supervise
ancillary providers to provide this service. As I
stated above, I don't think there are very many
young, accomplished students qualified for medical
school who would find RFC attractive.

Richard M. Maleski, DPM, RPh, Zelienople, PA

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06/09/2022    Eddie Davis, DPM

"Who Wants to Be a Podiatrist?"

Dr. Block asks, “Who wants to be a podiatrist?”
Dr. Fellner discusses how non-professionals appear
to charge more for routine foot care than
podiatrists.

Dr. Block notes that the applicant pool for
podiatric medical schools is too small. That is
interesting considering the fact that the applicant
pool for medical schools is hitting record highs:
https://www.aamc.org/news-insights/medical-school-
applicants-and-enrollments-hit-record-highs-
underrepresented-minorities-lead-surge. This
demonstrates that the lack of sufficient applicant
numbers is a podiatry issue.

We can encourage prospect students and tell them
about the wonderful services we provide as
podiatrists but have to be honest about the
challenges we face. APMA has operated under the
assumption that the way to elevate podiatry was by
emulation of the MD/allopathic education model. If
we are just like them, we will be better accepted.
Our educational system was modified with expansion
of our residencies to 3 years after graduation from
podiatric medical school.

So, 4 years of college, 4 years of podiatry school
and 3 years of residency for a total of 11 years
gives new podiatrists what? It creates
practitioners with a limited license without parity
in reimbursements, limited employment opportunities
which require most to go into more debt to be in
private practice. The numbers just do not add up!
The dental profession got it right as Dr. Fellner
realizes.

Dentistry has a limited scope but defends the right
to be fairly reimbursed and has vigorously enforced
state dental practice acts that limit the ability
of non-dentists to provide dental care. Dentistry
is well respected and did not need to emulate
allopathic medicine to survive and thrive.
A career in podiatry need make financial sense to
prospective students. Podiatry requires more
education/training than any medical specialty
relative to scope of practice.

Despite that, we seem to struggle to assert that we
are the premier providers of the foot and ankle.
That does not just mean assertion of that fact to
the public but to government and payors. We
deserve, based on our training, to be paid more,
not less for similar procedures. At the very least,
we should have parity.

My state organization, the Texas Podiatric Medical
Association, had the opportunity to promote
legislation providing parity in reimbursements but
declined to do so. I have seen no coherent national
plan from the APMA to achieve reimbursement parity.
Adjusted for inflation, I have insurance plans
paying about twenty cents on the dollar for
procedures I performed after I graduated from TUSPM
in 1983.

Yes, I hear that we can negotiate better rates and
drop poorly reimbursing health plans. Sorry, but
small and solo practitioners have little ability to
obtain better rates. Insurance plans often expand
market share by cutting rates to employers. Those
plans then obtain a large local market share, for a
period of a few years, and underpay providers.
That challenge in dropping such plans is just that,
they have a large local market share.

So with a failure to fight for fair
reimbursement/reimbursement parity and requiring
too much of a student financial commitment relative
to scope and earning potential our leadership has a
hard sell.

Eddie Davis, DPM, San Antonio, TX