06/24/2022    Bryan Markinson, DPM

"Who wants to be a podiatrist/" (James DiResta, DPM, MPH)

It's sometimes hard to be truthful about our
problems without being accused of being anti-
podiatry, and in the case of Dr. DiResta's post,
partially responsible for the decreased interest in
podiatry among college students. In my experience
with a few thousand students and a few hundred
residents, and the vast majority of my colleagues,
I am quite sure that not a single one ever
questioned my passion and love for podiatry.

Dr. DiResta states emphatically that he has no
problem with podiatrists saying they went to
medical school. Ok, but people who did go to
medical school, and regulate and certify medical
schools, do have a problem with it. When that
problem is solved, by "filling in the gaps" as he
says, who does Dr. DiResta think will be saying
they went to podiatry school? The answer is
probably no one, and certainly not enough to
support enrollment in what is now 10 and soon to be
11 podiatry colleges, or whatever they would be
called after the "gaps" were filled in.
We will have to disagree on whether or not
podiatric medicine would be a popular residency
choice for those completing a MD/DO education, but
what is certain is that our ranks would decrease,
not increase, when the residency choices become so
numerous.

He also joins many that offer that our education is
close and implores our schools to "fill in the
gaps." I am on the record stating that our
education is different, not inferior to MD/DO, when
it pertains to training future podiatrists. But
"close to" and needing some "gaps" to be filled is
simply not true. I have been in the milieu of both
colleges of podiatric medicine and a major academic
medical center that includes a medical school.
Those gaps are more like oceans. The paper syllabus
is the least important evaluation measure when
making the comparison. We keep hearing that some
kind of commission in California has studied this
and declared some sort of equivalency. So what has
followed that? Nothing I can see.

Lastly, Dr. DiResta states, "While I appreciate the
comments made by Dr. Markinson that the AMA is
rapidly mobilizing against increased scope of
practice for ANPs and PAs, I must say that train
has already left the station. There are now 25
states that provide full autonomy for NP and that
surprisingly now includes my state of
Massachusetts, one of the few states not providing
ankle privileges for podiatrists." Anyone
following the current state of affairs in medicine
knows that we are in the midst of an acute primary
care shortage, estimated to sharply increase, which
is far and away the major factor that is fueling
the advancement of NPs and PAs. In addition, not
everyone in the medical community is in support of
this.

I certainly don't have the answer to full parity
for the profession of podiatry, but only what the
MD/DO world has told us. And that is "just do what
we did." If we do, I believe initially podiatric
services will be golden (provided by us dinosaurs)
and in demand with paying patients, but then we
will be fossilized, as too few will be waiting to
step in, and even more important, not trained to do
what podiatric medicine now does. Do we want that?

Bryan Markinson, DPM, NY, NY

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