03/31/2024    Jay Wenig, DPM

PODIATRISTS AND THE USMLE

Passing the USMLE does not by itself mean a
provider can or should be FULLY qualified to
practice any and all aspects of medicine.

I spent the first 23 years of practice in the Air
Force and I saw what happened when medical
providers were forced to practice out of their area
of expertise. When I first went in the military all
of the medical doctors were forced to work in the
emergency room as the medical officer of the day
(MOD) on a rotating basis regardless of their
specialty. This no longer happens.

One night, one of the orthopedic surgeons I worked
with was at my house so we could watch a VHS tape
on doing a total knee replacement. He was going to
be doing the procedure the next day and I was to
assist him. After we watched the video twice, his
pager went off. A psychiatrist was the MOD. He said
a patient had a wrist fracture. The orthopedic
surgeon asked him to describe the fracture. All the
psychiatrist would say was that “it was a bag of
bones.” No amount of questioning got anything else
out of the psychiatrist.

I went in with orthopedist to see the patient. We
first stopped to look at the x-rays and the
orthopedist went and saw the patient. I was still
looking at the x-rays looking for a fracture when
the orthopedist came back. I could not find a
fracture. At that point in career, I could name all
of the carpal bones. I asked the orthopedist where
the fracture was. He said there was no fracture and
the psychiatrist thought the eight carpal bones was
a comminuted fracture. The psychiatrist thought the
wrist looked like the ankle. I am confident the
psychiatrist could treat within his specialty. Out
of his specialty? Definitely not elementary
orthopedics.

At the same base, a few months later four women had
miscarriages in one week. The base commander, a
two-star general (not a medical doctor) ordered the
hospital commander to make sure all women who were
pregnant and bleeding had to be admitted to the
hospital. At a professional staff meeting the next
week an OB-GYN got up and told everyone how to
determine if a woman was having a miscarriage. The
OB-GYN said to stick a ring forceps in the vagina
and if it went in, the patient was having a
miscarriage. If the forceps would not go in, the
woman was safe to be discharged. Another orthopedic
surgeon was sitting next to and when this was said
and he poked me in the ribs and said “Dr. Smith
(not his real name), exactly how many ring forceps
abortions have you done?” He said there was no way
he was going to do this.

Fast forward 20 years. I was stationed at another
base and we sent an orthopedic and general surgeon
to Turkey for manning assistance. They were sent
there to be primary care providers and not as
surgical specialists. The orthopedist saw a woman
who was pregnant and bleeding. He called a Turkish
OB-GYN to ask for assistance. The Turkish OB-GYN
said to admit the patient to the hospital and he
would see her the next day. The orthopedist
repeated he was an orthopedist and was not prepared
to intervene if something beyond observation was
needed. Both surgeons when they returned reported
up the chain of command that having them working
out of their field of expertise was tantamount to
malpractice. But they both passed the USMLE.

Passing the USMLE by itself does not mean anyone is
qualified to do everything. The schools need to be
preparing all students for the USMLE. How they
practice after graduation is their choice.

In the military, all medical providers are fully
qualified while podiatrists are best qualified. The
difference between the words fully and best means
podiatrists are not in the Medical Corp and this
has big implications and that could be a subject
for another discussion.

Jay Wenig, DPM, Dayton, OH

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