03/18/2024 Allen M. Jacobs, DPM
APMA Policy Proposition 2-24: One Board in Podiatric Medicine & Surgery (Steven Spinner , DPM)
In my opinion, Dr. Spinner is correct. Podiatrists
are a heterogenous group of health care providers
treating one localized area of anatomy. Our
profession boasts many individuals with particular
interest and expertise in a variety of focal
pathologies. Dr. Spinner suggests a partiality to
the dental specialty boards recognized by the ADA.
I believe there are 12 such boards. As Dr.
Spinner, I am in the "twilight" of my career (some
might argue seasoned practitioners ala Harvey
Penick, the great golf instructor).
It is, as an aside, interesting to note the age of
many passionate individuals who are older
(seasoned ?) practitioners responding to the
question of board certification in podiatry. Dr.
Spinner, as I have observed the incredible growth
of this profession during the lifetime of our
professional career. Dr. Spinner has devoted much
of his life to the education of students and
residents, and in participation in the committee
work which was necessary to have advanced our
profession to its current status.
As such, his opinion carries great weight to my
thinking, more so than the opinions of those who
have invested little if anything in advancing our
profession. He, like some who have written into PM
News on the subject (eg: Dr's Tomczak, Oloff,
Lombardi, and others) have by virtue of their bona
fides earned the right for a respectful
consideration of their opinions. Others who have
invested no time in advancing this profession
beyond their own personal or political needs,
remind me of Mark Twain's classic statement that "
I have never been one to confine my remarks to the
restraints of actual facts'. PM readers should
examine the guidelines of the ADA with reference
to multiple board certifications. It is somewhat
analogous to podiatry, as suggested by Dr.
Spinner. Localized anatomical care, multiple
potential areas of expertise within that area are
the circumstances under which we practice.
I respect and learn from individuals such as
Guido LaPorta, Jack Shuberth, and many others with
regard to surgery. However, it would not occur to
me to ask these surgical leaders about the
differential diagnosis of a difficult ankle
dermatitis. Nor do I believe they would hold
themselves out to maintain expertise in these
areas. I respect and learn from Bryan Markinson,
Tracy Vlahovic, and others in dermatology. Would I
ask them about their preference for Charcot's
joint fixation ? Not likely. Again, I suspect
neither would pretend to hold particular expertise
in this area. One unified board will not and
cannot provide credible accreditation in our
profession. From dermatology to sports medicine to
office routine care to ulcer management to
pediatric care to diabetic foot care, the
diversity of potential areas of interest and
expertise is to my estimate too broad to allow
effective inclusion under one board.
The answer is to maintain CREDIBLE and
legitimate boards in the manner of the American
Dental Association. Hospital DOP's should be
appropriate to the training and experience of that
individual, and should not be restricted to one
particular board. As Dr. Spinner, I believe the
ABFAS has been vilified and the testing associated
with that board misrepresented by some with sub
rosa agenda. This does not serve the profession
nor the public.
Beginning practice in Philadelphia in 1975,
few if any major hospitals allowed podiatry
practice. We were restricted generally to staff at
smaller community hospitals. Surgical practice
DOP's were generally limited. When I arrived in
St. Louis in 1980, I recall driving down route 40
one evening. There were very few (3 I believe)
ne'er-do-well hospitals which allowed limited
podiatry participation. I recall thinking " this
is what Detroit must have looked like to Earl
Kaplan" at the start of what was to become his
illustrious career. When we finished our residency
at Kern, Dr. Kaplan made it clear to each of us
that our responsibility was to participate in
growing the profession through education of
others, and to fight the necessary political fight
when necessary.
If you had told me in 1975 that in the future
podiatrists would be at most major hospitals,
medical colleges, universities, treating major
deformities, trauma, included in insurance plans,
I would have responded with the proverbial " from
your mouth to God's ears". Somehow, someway, we
are there now. I believe the majority of advance
was the result of podiatrists at the local level,
with podiatrists integrating into the medical
establishment and demonstrating competency. Now is
not the time for unnecessary internal disruption
that benefits neither the profession nor the
public. Consider the dental model of board
certification. Maintain credible multiple boards
within our specialty. Respect those boards and
award appropriate DOP's based on the competency
and experience of each individual. I have
witnessed excellent care by non-ABFAS podiatrists,
and conversely I have witnessed what I believe to
have been very poor surgical care by "board
certified podiatrists".
Finally, we need to return to the missionary
spirit of our profession. This profession was
built in no small way by dedicated educators (and
politicians when necessary) too numerous to name.
These unselfish individuals gave their time and
efforts to advance quality training and care. The
profession brought competent care and quality care
to the public which resulted in the success of
podiatry to its current status. I do not wish to
wake up one morning, drive down route 40, and
wonder how we lost what we had accomplished.
Allen M. Jacobs, DPM, St. Louis, MO
