![Spacer](images/spacer.gif)
![Spacer](images/spacer.gif)
![Spacer](images/spacer.gif)
|
|
|
|
Search
03/13/2024 Lawrence Oloff, DPM
A Short History of Podiatric Discontent and Frustration (Rod Tomczak, DPM, MD, EdD)
Let me start off by saying I am happy with my chosen profession. I have read the posts over the years about the profession and its frustrations. As a side note, I wish such discussions did not surface on public forums as I fear that this likely has had a negative impact on student recruitment, but I guess that is the way of the world in an era of social media. Why we should be happy with our chosen profession is a complex discussion and probably needs two parts. Here is Part 1. What I find interesting is that people think that these claims of unhappiness, discord, frustration, the haves and have nots is unique to podiatry. I can assure you it is not. I have had many podiatry lives: Dean of a podiatry school, practice in an orthopedic group who managed professional sports teams, large institutional medicine, and as the first podiatrist in the orthopedic department at Stanford with an academic appointment. I have worked the majority of my practice life along side both allopathic medical doctors and podiatrists. This is what I have observed. Allopathic doctors have the same gripes. Many say they would not do it again, although they were happy with their choice. Many complain about colleagues for having what they have and they don’t, reimbursement, paperwork, and many more. The reason for haves and have nots has an explanation. Allopathic medicine has been much the same over the last hundred years. Podiatry has not. Podiatry has gone through a major evolution over the years. This evolution has contributed to a schism, due to the type and duration of training for podiatrists . I imagine that podiatry will evolve to a state like allopathic medicine, where the difference between podiatry practitioners is not as wide. That gap gets smaller all the time. The board certification issue is part of the haves and have nots. This problem is reported as having political overtones but it is actually much simpler than that, despite all the dialogue. Podiatry works in an allopathic medical world, not a podiatry world. Allopathic medicine make the rules. if you want to be part of that world you need to play by those rules. Hospitals are part of that allopathic medical world and their rules are pretty clear. You need board certification to do surgery. On rare exception you can advocate privileges based on experience by providing operative reports. An orthopedist at one of the hospitals I work at was asked to leave because his privileges were contingent on elevating his board eligible status to board certification. He had trouble passing the exam and was asked to leave. These rules are pretty straight forward. Board certification is part of that evolution. We started with board certification for surgery, mirroring allopathic medicine. Not every podiatrist’s individual experience and training allowed them to pass this exam. Different state laws didn’t help. As a result surgery board certification was broken down to a foot and foot/ankle versions to accommodate the differences in state law and training. This was a partial solution. Further adjustment was made many years ago to create board certification in podiatric medicine as an alternative pathway. Now the politics have resulted in the podiatric medicine board evolving into an alternative way to obtain surgical credentials via CAQ.I am not here to argue in favor or against this approach. I will say that it does not follow the allopathic model for hospital privileges that podiatry wants to be part of. I think that it will fail as a result. If the surgery board exam is too difficult, a cleaner/simpler way is to look at the exam itself. Is the pass/fail rate similar to allopathic medicine certification exams or not? If too high then adjust accordingly. I think trying to circumvent the surgical privilege process just makes podiatry look bad and serves no one. We have come so far. It is not wise to go backwards. Time will solve these issues - evolution. In fighting will not. We are no different then our allopathic colleagues. I share an office with a young orthopedist who is in the middle of his board certification process. One board, one process. I asked him what he thought. He said it was difficult but that was the way it should be. One board may be our answer, but not one that is watered down. Some may argue that evolution is not always good. I think it has been for podiatry. The only negative is that as we have strived to advance as a profession we are leaving one of the distinguishing features that make podiatry unique behind - biomechanics. This is not a good idea. So to be a good surgeon, you better understand how the foot works. To be continued…… Lawrence Oloff, DPM, Burlingame, CA
Other messages in this thread:
03/07/2024 Allen Jacobs, DPM
A Short History of Podiatric Discontent and Frustration (Rod Tomczak, DPM, MD, EdD)
Waiting for Godot? Vladimir and Estragon waited and waited. As you know full well Dr. Tomzack, Godot never arrives. The play was an offering of the theatre of the absurd. Is this the arena in which we as a profession now function? Yes there are “haves and have nots”. The Joshua tree you refer to (actually a plant and not a tree) has branches which include rather complex surgical interventions performed by some podiatrists. Charcot joint reconstructions, deformity corrections with external fixation, distal leg and ankle trauma management are a long were from the DSC days you fondly recall.
Our first responsibility is to protect the public and assure that those providing advanced care with significant responsibilities process adequate training and experience. To a large extent, DPMs are entrusted with the authority to determine those qualifications. We must do so in an effective and ethical manner. I do not believe that lowering the standards to obtain “Board certification”, or the creation of boards which require minimal demonstration of experience and academic accomplishment is the answer. I know you do not believe that either. Godot send messages to Vladimir and Estragon. But he never arrived.
Like you, I recall the early days when today’s thought leaders were trained by non-certified DSCs and early DPMs. They provided credible and effective services in the office and the operating room. However, there is difference between a McBride and Keller and a Lapidus. There is a difference between treating an ingrown toenail with paronychia and necrotizing fasciitis. And there is a difference in residency and fellowship training of today’s school graduates and those of yesteryear.
I have no answer to those who feel disenfranchised. However, we are now trusted to evaluate and treat serous pathology. The scalpel is now vertical, not horizontal as you note.
Allen Jacobs, DPM, St. Louis, MO
03/06/2024 Michael A. Uro, DPM
A Short History of Podiatric Discontent and Frustration (Rod Tomczak, DPM, MD, EdD)
I just read Dr. Rod Tomczak’s response to “A Short History of Podiatric Discontent and Frustration”. I whole-heartedly agree with all he had to say. I have enjoyed practicing podiatry for 45 years. I was fortunate enough to have enjoyed the era before managed care. A time when we were paid 2/3 more for surgery than we are today. The reimbursements for surgery today are an insult to the training, experience and risks that podiatric surgeons take every time they walk into an operating room.
When I came to Sacramento, I was welcomed by the podiatric, MD and DO community. I am grateful to those mentors such as Mitch Mosher, DPM, Larry Gerelli, DPM, Randy Sarte, DPM, Oscar Mix, DPM. There are many others, DPMs, MDs and DOs of all specialties. Too many to list. We enjoyed dinners, barbecue’s, wine tastings etc. in each other’s homes. The camaraderie was incredible. We assisted one another in surgery and helped run a colleague’s office when he was out due to illness. This was at no charge I might add. It’s what you did. We had coffee and donuts in the doctor’s lounge of the hospital where we communed with doctors of all specialties.
It has been a good ride. Would I do it again, or would I recommend podiatry to an aspiring college student, sadly, I would not. Ever since I was a podiatry student I have heard that we have the same training as MDs and DOs. You all know that is not true. How many of you have delivered babies, actually managed an ICU patient, etc. We are not MDs. We are podiatrists. If you want to be an MD, then go to medical school.
This is not to say that our profession has not progressed. Those podiatrists recently out of residency or fellowship can run circles around us old geezers! As it should be. I applaud them. However, not all foot problems are surgical. On the last day of my orthopedic clerkship at UC San Francisco, the attending orthopedic surgeon was celebrating his last day in practice. His parting words were “If I can impart any words of wisdom to you all today, it is that I have performed more surgery over the years than I needed to.” Let that sink in.
So, there is and always will be room for and need of chiropodists, podiatrists and podiatric surgeons. Don’t disrespect your predecessors anymore than you would your parents or grandparents. Be kind. Be generous and not pompous with your new found skills and knowledge.
Michael A. Uro, DPM, Sacramento, CA
|
|
|
|
|