08/17/2024    Rod Tomczak, DPM, MD, EdD

Who Decides Who is a Physician?

So, are we or are we not physicians and who
decides the answer? Does someone in an ivory tower
get to ratify our decisionsand are the legal
repercussions if we answer in the affirmative, but
another group asserts we made the wrong choice? Is
there some knight in the background counselling us
to, “Choose wisely!”

Chiropractors call themselves chiropractic
physicians in several states, perhaps over 30. It
seems ludicrous to think there are chiropractic
physicians and not podiatric physicians, but yet
here we are, and it is happening. How can this be?
I think the problem begins with which medical
board holds sway over a certain discipline. Every
state has a chiropractic board that more or less
governs chiropractors within the framework of the
state law. Where ambiguities exist, the state
legislature and attorney general turn to the
governing board to interpret and advise on these
questions.

In many states, optometrists and chiropractors can
call themselves physicians without controversy.
The state seems to have the final say over whether
members of a profession call themselves
physicians. Every state has its own optometric and
chiropractic board, and most can call themselves
physicians. Now it would be nice if every podiatry
graduate accepted the challenge to take MD boards
and passed which would put an end to the
podiatrist physician controversy. Knowing NBME and
USMLE won’t allow podiatrists to take the test,
foot and ankle MDs clamor for podiatrists to take
the test knowing they are safe from us picking up
the USMLE gauntlet and succeeding.

I seriously wonder why podiatry, in some states,
is under the aegis of the state medical board when
every other health care profession seems to be
governed by its own board. I ponder what the
advantage is to having podiatry governed by the
medical board. The first response is that we are
medical and maybe chiropractic or optometric
isn’t. It’s not a question of diagnostic and
treatment philosophies, but professional
overwatch. In at least twelve states osteopathy
retains its own board meaning full licensure can
be granted through USMLE or COMLEX and DOs and MDs
have the same unrestricted license regardless of
which test is passed depending on degree granted
by an accredited school.

No one ever suggested podiatry come under the
watchful eye of osteopathy. Is it possible that in
some states podiatrists once looked through rose-
colored glasses and thought if podiatry was under
the same board as MDs, we would have parity with
MDs? Is it possible for podiatry to return to
self-governing and decide we want to be called
physicians because we know we are? Is it that
simple or do others want to control us and have
final say over our existential choices? Is it just
to have ten MD board members for every one
podiatrist deciding our name?

Rod Tomczak, DPM, MD, EdD, Columbus, OH

Other messages in this thread:

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08/24/2024    Name Withheld

Who Decides Who is a Physician? (Rod Tomczak, DPM, MD, EdD)

Early this morning I had just finished my coffee
and reading the latest PM News forum. Once again,
we, as podiatrists, were discussing the DPM vs.
MD/DO parity issue and whether or not we are
physicians. As usual, many in our profession
believe we are on par with the MD/DO group and
should be treated as such by all and the other side
believes we should remain as we are, our own
profession.

I have to admit that there had been many times in
my now 35 plus year career as a podiatrist that I
have wished that I had gone the MD or DO route so I
could be a “real doctor, a physician” but that had
not been my path. I was daydreaming about what it
would be like to be that “real doctor” and
contemplating a second cup of coffee but my cell
phone rang. It was a hospitalist standing in the ED
at the local community hospital asking me to stop
and see a diabetic with a foot infection that she
was admitting. I agreed to do so, particularly
knowing that I was headed to the hospital for
surgery anyway so a consult would be easily
accomplished between cases.

I was tired. I had been up a good part of the
night, in surgery. The ED had called about 11 PM
and asked me to come in to see a 15 year old who
was visiting from out of town and had fallen at a
local hotel and had cut the top of her foot on a
metal door. A tendon was severed and readily
visible through the wound. They had already called
ortho, which they typically do for trauma, but
there was no bone involvement so ortho deferred to
me (probably they didn’t want to go in at that time
of night). I had gone in and as an on call team
for the OR had just finished an appendectomy they
were available to set up to repair this injury. I
got home about 3:30 AM.

My day was already busy, over busy really. First to
surgery, then the consult, then a stop to see the
patient I had done and I & D on earlier in the week
that was being discharged. Then to the office where
I had two peer to peer calls to do to get MRIs
approved, a call with the vascular surgeon I worked
with regularly and I knew that there would
obviously be calls that come in of some variety or
another that would have to be dealt with, this on
my afternoon “off” as no clinic patients were
scheduled. Not having seen the new consult yet I
had no idea if it would be a call to the OR to get
some time that afternoon or evening or if it would
be a “ follow” the patient with the hospitalist,
non-surgically.

As usual, we had some family plans on the weekend
with grandkids involved but my children knew well
what I did for a living, having grown up with it
and so they understood that plans sometimes were
bumped or delayed, usually only by a few hours but
none the less, sometimes were altered by a patient
need or the hospital.

While at the hospital one of the internists stopped
me in the hall and asked me to see his wife the
following week for heel pain he could not resolve.
Surgery went well and fortunately, the I&D from
earlier in the week was going home, the patient was
very gracious in praising me, “thank you doctor,
for saving my leg” (those always embarrass me for
some reason). The consult would be treated
medically as agreed with infectious disease and the
afternoon ended calmly.

Name Withheld