06/24/2024    Paul Kesselman, DPM

RE: APMA's Response to Egregious Messages from AMA

The recent posting by the AMA providing a
comparison between DPMs and MD is unfortunate but
is predictable. AMA continues to lose their share
of physicians they represent. They continue to
throw dirt at podiatrists and other healthcare
providers in an attempt to save themselves and to
look good to AAOS. When they mention various levels
of training between individual podiatrists, why is
that so harmful and is that really any different
than the MDs? Are they really suggesting that every
orthopedist represented by AAOS can equally handle
foot/ankle injuries? AMA and AAOS both know that is
not true! And any call by any patient to an ortho
office can prove that!

Is it inaccurate to also say that there are
differences between training of individual
orthopedists. The numbers of foot/ankle surgeries
required by orthopedic residents to complete pales
in comparison to those required of most DPMs who
are either in practice today having finished their
residencies or those currently training. Would AMA
dare to publish that truthful data and put those
numbers up for comparison? Likely not!

How many orthopedic surgeons in their ‘70s or ‘80s
never trained in foot/ankle arthroscopic surgery.
Likely the same or less than podiatrists of the
same age group.

AMA has only one reason they don't want to play
fair. It's because they will come out on the losing
side!

Poor outcomes are problematic for all. Surgeons no
matter their degree or specialty don't walk into
the OR looking for failure.

And let's not forget failures are often not the
fault of the surgeon. Oh but yes I must have
forgotten about all the botched Orthopedic
foot/ankle surgery I saw over 40+ years as a
clinician and now doing peer reviews for the past
25.

A biased article like AMA's comparing DPM to MDs is
no doubt the fault of the writer. They failed to
do their homework! Their intent was to produce a
biased article and in that they did succeed.

Paul Kesselman, DPM, Oceanside, NY

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06/27/2024    Paul Kesselman, DPM

RE: APMA's Response to Egregious Messages from AMA (Elliot Udell and Lawrence Rubin, DPM

Both Drs. Udell and Rubin provide a wonderful
synopsis of the issues we face and will continue to
face. Since these postings appeared APMA has
announced that AMA has withdrawn the posting. Those
who wrote AMA or spoke with their MD colleagues
demanding it be retracted are to be applauded for
doing what we do best. Communicate what podiatrists
contribute every day to the healthcare team.

Today an eye=opener appeared on my desk. An
insurance carrier asked for a review of 1300 pages
of medical records for a mid ‘50s well controlled
diabetic who sustained an unfortunate blunt force
crush injury. The highly trained MDs (vascular and
ortho) at a well known tertiary care hospital he
was admitted to wanted to amputate this patient's
foot on several occasions during the first few
weeks of care. No doubt twenty years ago that would
have happened, as DPMs barely were afforded nail
cutting privileges at that time in this
institution.

Fast forward to today, the wound care fellowship
trained podiatrists sought to continue to fight to
save this machinist's limb. No doubt the ability to
provide for his family would have come to an end
had it not been for the skills of the attending
podiatry team. The photos of the wounds and the
progress as documented are nothing short of
miraculous.

The patient's Lis Franc's joint was also open
reduced by the podiatric surgical team and he is
currently using a wound Vac with a 80% closure.
This all with the assistance of the excellent care
provided by the three year podiatric resident team
now in place at this nationally known institution.

Certainly most of the readership has seen similar
results and yet we continue to have these one sided
biased verbal assaults by AMA. Interestingly, you
don't hear or see this from the AOA because they
recently went through exactly what DPMs were
subject to. This is due to the shear arrogance of
AMA and mostly older MDs (as well documented by Dr.
Udell) and previously communicated to me by my
teacher Dr. Rubin).

In some areas of the country it is only recently
that DOs have been considered equals to MDs but
most if not all of my DO friends still tell me they
continue to face some bias from MDs, in particular
with employment at certain prestigious
institutions.

Reading more into this is the whole issue of AMA
bias, and an anticipated shortage of primary care
physicians and MD DO physicians, within the next
ten years. No doubt there are significant
complexities of this from continuing decreased pay,
increased training times and burn out along with an
artificially high admission bar. However, does
anyone out there really believe it is necessary to
have a >3.5 GPA to gain entrance into a medical
training program? And does this high bar just
continue to fuel arrogance?

So the real question that AMA must answer to
themselves and to the public is whose interest are
they really looking out for? To me it appears they
are only interested in maintaining a club's
exclusivity by setting up barriers with
artificially high bars and by acting like the
bully on the block.

The recent incident shows that once you fight back,
even if you scrape your knee a bit, they backtrack.
Unfortunately until the next time. And no doubt
there will be one!

In the orthotic and prosthetic industry there is a
term, which may work here for everyone, functional
equivalence.

If the DPM, despite not taking certain courses in
gynecology and psychiatry, can fix a Lisfranc
fracture equivalent to or even superior to the
MD/DO why all the focus by AMA about what you
learned during your undergrad medical education but
never use. What does that have to do with anything?
My friends both MD and DO, come to me for a host of
foot issues because not only have they forgotten
what was taught about foot issues, but they know
who the expert is.

If an AMA executive was in an accident and had the
choice of a general orthopedist fixing their
complex foot/ankle injuries or a well-respected
DPM who was trained in foot/ankle trauma, you can
almost count on them selecting the DPM.

Oh how when things hit home, how things change.

Thus functional equivalence. That's essentially
what the DOs proved using the term separate but
equal. And what DPMs must also continue to prove
and communicate!
So all parties need to ask, Can't we just all get
back into the sandbox, play nice, instead of
wasting precious resources and at what price for
society?

Paul Kesselman, DPM, Oceanside, NY