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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 Since these postings appeared APMA has announced that AMA has withdrawn the posting.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
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