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08/06/2024 Robert Boudreau, DPM
Discrimination Against DPMs (Jonathan Michael, DPM)
When I entered private practice in 1984, I wanted to apply at one of our local hospitals for surgery privileges. I called and made an appointment with the chief of staff, a gruff old cardiothoracic surgeon. When I showed up, rather than meet in his office, he chose to hold our meeting in the cafeteria. After going over my credentials and residency training, he said, “I’m sure we can grant you privileges. I often have patients that need a good toenail trimming.” I tossed the application in the hospitals round file cabinet.
Fast forward to the late ‘80s, early ‘90s when PPOs and HMOs hit the scene. The hospital came begging for podiatrists to come to their ORs and do outpatient surgery. I applied for privileges and was granted every privilege I asked for. As my practice grew, I had less time to travel to that facility (a 30 minute drive from my office), and since I held privileges with 2 hospitals within a 5 minute walk from my office, I made the decision to give up the privileges at the distant hospital. I wrote a letter stating my intentions to the grumpy chief of staff, and cc’d the hospital staff office. I sent copies of every operative report I performed over the 7 years I was on their staff. I told him to estimate how much revenue I had brought to their facility during my tenure, and how much the facility lost In the 6 years he had wanted me to occasionally trim one of his patients’ toenails.
I reminded him that those would have been “full fee” prior to HMO/PPO reduced fees. Within a week, the administrator called me, and I had the opportunity to tell him directly the events that had transpired when I initially wanted to apply. Money talks. The power of the purse is great. Sometimes we must use that leverage to our advantage.
Robert Boudreau, DPM, Jacksonville, TX
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08/02/2024 Rod Tomczak, DPM, MD, EdD
Discrimination Against DPMs (Jonathan Michael, DPM)
Jonathan, it’s a shame you can’t help your daughter put on her white coat for the first time in public, and, yes, I think it is a form of discrimination. For years, MDs looked down on DOs and still do, but it is much more subtle. They could always use the fact that DOs took the COMLEX licensing exams instead of USMLE and supposedly the COMLEX was easier to pass than USMLE. Now DOs can take USMLE so MDs don’t have the “we take a tougher licensing exam” platform to look down from. And, there are not enough MD graduates to fill all the residency slots in MD hospitals, so MD hospitals have generously condescended to accept DOs into their residency programs.
Don’t let the MDs kid you, there are huge economic incentives to suddenly treat DOs as academically equal to MDs, about a 100,000 reasons per resident per year. This becomes very important when rural hospitals are trying to keep the doors open and it doesn’t hurt big teaching hospitals either. Money talks, everything else walks.
DO hospitals were the first to let DPMs train residents in their hospitals, and there was the same “keep the doors open incentive.” DOs once had a rule that a DO graduate had to complete a DO PGY 1 to get hospital privileges in a DO hospital, so this helped economically. DPMs got to work in DO hospitals, but some DPMs thought they were the second-class citizens. From an economic view, it was wise to have DPMs on staff, but originally not as voting staff. It was a superficially appearing symbiotic relationship to the outsider, but inside the DO hospital walls, DOs wanted to make sure DPMs knew their place. Then MD hospitals began to see how profitable it was to have DPMs work in the MD hospitals, but initially not quite equal. For example, not getting block OR time or voting. Then, MD and DO hospitals tried to out attract each other to incentivize DPMs to work at their hospital. Who’d a thought?
I think there is a temptation to have someone to look down on. If I think subconsciously I am better than someone else, even if erroneously, and can falsely prove it by calling you “doctor” as a courtesy, I might feel better about myself. Hence, you as a DPM can’t hood or white coat your DO student daughter and this proves I am better than you. God forbid the DO school pulls this stunt and not let an MD hood a DO graduate relative. That leaves the DPM on a lower rung of the ladder of esteem.
As kind and gentle as Leonard Levy, DPM was, if you knew what buttons to push, you could get him riled up and he would act, sometimes shooting from the hip. The antiquated hooding and coating policy used to exist at the Des Moines school, and it was the same punitive rule you are suffering under today. The coating policy rubbed Dean Leonard Levy the wrong way and it was one of those buttons that could be pushed. To the DOs there appeared to be no economic benefit in letting a DPM on stage to hood or coat a DO student, and no appeal process at the university. There were some hurt feelings, and rightfully so when a DPM parent had to sit in the audience while a son or daughter received a DO hood or coat. Leonard’s face flushed and he stammered a bit, but he took up the gauntlet and taking a huge risk, invoked some Old Testament justice declaring no MD or DO could hood or coat a DPM student unless they also had a DPM degree. It was an enormous gamble on his part because it could possibly threaten the generosity of some benefactors and filter down to Leonard personally. Hopefully, Jonathan, it will assuage your feelings to know the policy changed that day as the faculty sighed in relief.
My advice is to let the DO school know you have changed the beneficiary on that life insurance policy you took out when your daughter started school. Originally you named the DO school as the sole recipient. Now, the DPM school who graduated you will someday benefit. Money still talks…
Rod Tomczak, DPM, MD, EdD, Columbus, OH
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