07/22/2022    James J DiResta, DPM, MPH

AMA and Podiatry’s Scope of Practice (Allen Jacobs, DPM)

I read today comments by two of our most esteemed
podiatrists Drs. Allen Jacobs and Bryan Markinson
on podiatry's scope of practice. I'm certain they
are very honest in their comments but their remarks
are discouraging. These are two very bright and
wonderful people. When you leave their lectures you
always come away proud that you share the same
cherished profession as them. They are smart. Allen
can impress the best of us with his medical and
surgical knowledge and insight. As a student at
PCPM (TUSPM) in the '70s I listened intently one
day to a lecture he prepared on metal materials for
surgical fixation procedures. When I returned home
that evening, I didn't feel as smart as I did that
morning and frankly if I needed a little more
humility that day he provided it. In my podiatry
class at that time was another bright podiatrist to
be, Charlie Arena.

Later, Charlie and I would be residents at
Northlake Hospital but before that time while we
were doing externships our paths crossed at a
hospital in New Jersey. Charlie was on medicine
that month and I was on the orthopedic service. By
chance, I was walking in a hall outside a room
where the externs on the medical service were
meeting and the attending was belittling some of
the medical students as he would ask them questions
and when they couldn't answer correctly he would
then call on Charlie to answer. Charlie continued
repeatedly to nail it answering the questions
correctly. It didn't take long for the attending to
then ask one of the medical students what benefit
would he provide to Charlie and his patients when
Charlie might need medical clearance or
consultation.

I relate this story because I think it's important
to remember we have very bright students in our
learned profession and they need to be encouraged,
as we were, to improve our standing in the medical
hierarchy and to do so requires us to look beyond
our present limitations and to do whatever we need
to do as a profession so that we can expand our
scope of practice. Our limited scope has made us
comfortable as we profess to be equal to our
physician colleagues when we practice within our
limited licensure. However, if we fail to improve
upon this position we presently enjoy then we are
ultimately going to find ourselves further behind.
I don't believe our present position is
sustainable.

It continues to surprise me that as a profession we
have failed to see what PAs and NPs have achieved
relative to both independent practice and scope of
practice. They have positioned themselves well. NPs
certainly took advantage of the recent pandemic and
skillfully increased their scope and independence.
They are not uniformly where they want to be, yet,
but they are well on their way. Drs. Jacobs and
Markinson continue to remind me that our students
are just not equal to medical students but maybe
they ought to be. There are now 22 states that
provide NPs full independent practice. They can own
their own practices, have full prescription
authority, do a number of procedures, be primary
care physicians for third party payers and no
longer have any physician supervision requirements
in those states and many hospitals are changing
their bylaws to accommodate them. I know the AMA is
still applying pressure to hold PAs in under
physician supervision even as their scope of
practice continues to expand but can they be far
behind?

Our education model doesn't align with NPs and PAs.
Our 4-4-3 model although perhaps not equal still
mirrors more to an allopathic and osteopathic
medical school model and we can change our model to
be more in line with theirs and to find a way to
get the DPM degree on some level of equal playing
field with the MD and DO degree. Perhaps we need to
start thinking out of the box. We can improve on
the APMLE to mirror more like the USMLE and COMLEX
and maintain the podiatry elements we need in the
exam, keep it unique to us and at the same time get
independent authority to certify that it is of
equal standing.

There are many routes available for us to follow so
we can reach the position we know we need to get to
but holding everyone back is going to be our demise
and unfair to our new practitioners, residents and
students of podiatric medicine who have invested so
much of themselves in our profession.

James J DiResta, DPM, MPH, Newburyport, MA

There are no more messages in this thread.