08/28/2024    Paul Kesselman, DPM

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

This is a very interesting topic considering that
on this very day 47 years ago, I attended my first
classes at what was then referred to as the
Illinois College of Podiatric Medicine (ICPM) and
which is now part of the Rosalind Franklin
University (RFU). Almost fifty years later, ICPM
has been incorporated into the "mainstream" medical
educational system. For those who are unaware, RFU
hosts the Chicago Medical School, Scholl College of
Podiatric Medicine, School of Nursing, Pharmacy,
and several other programs in the medical field.

During my undergraduate podiatry rotations whether
at the VA, Naval Hospitals, there was no
distinction for medical (MD) vs. podiatry (DPM) vs.
DO students. We both were treated in the same
tough manner. Not once during those rotations did I
ever hear, "Oh you are a podiatry student we don't
expect you to ...... by any vascular or orthopedic
surgeon. For the most part, these attendings had no
idea who was an MD or DPM student. And if anything,
I made sure I was better prepared for my rotations
and grand rounds than others in order to avoid any
potential finger pointing.

At the University of Chicago, the podiatry
residents and podiatry students participating in
clerkships had the same rigorous schedules and
worked together. My colleagues at other schools
were not so lucky, nor were some of my own
classmates who were constantly reminded that they
had no business training in hospitals and were not
going to be doctors.

Office based surgical training and eventually board
certification in surgery and taking many, many
courses enabled me to compete with the fellowship
trained orthos at the time.

And so when I became an attending, I took ER calls
as often as I could. Nights, holidays and weekends
were filled with the same interruptions as my
colleagues in other specialties and sometimes more
so.. Performing an emergency TMA on a 22 y/o IDDM
patient w/gas gangrene in the middle of the night
because she was brought to the hospital in septic
shock was among the many train wrecks the podiatry
service and I confronted at one hospital. Missing
family events, holiday celebrations was routine due
to an on-call emergencies for many
attendings/residents of the podiatry department as
well.

Many ortho departments were happy to give the
foot/ankle surgeries which come into the ED because
these patients either have MCD, no insurance, no
fault or worker's compensation, all of which are
headaches of one form or another depending on your
state. But these same real doctors, while not
wanting to do these cases and handing them off to
me or others in the podiatry dept. would often
remind us we were not equal when it came to private
pay or private insurance.

I would often answer, if we weren't equal or
equivalent and in their minds, could in fact
endanger patients and the reputation of the
hospital, then why on earth would you refer these
patients and sometimes your own patients and
relatives to us for other non-emergency matters you
didn't want to handle? The answer was plainly
obvious, but they could not or would not admit it.

And yes there were some orthopedists, especially
the older ones who were extremely prejudiced
against DPMs. It took time especially at the
private hospitals for the orthos and general
surgeons to back down, especially after the other
partners in other specialties saw how much money we
were generating to the hospital. Interestingly
enough our best allies were a board certified
vascular surgeon, the radiology and anesthesia
partners. So as one of the original commentators on
this thread mentioned, money does talk! Especially
to hospital administrators!

Another outstanding issue is when insurance
companies pay us a different fee schedule due to us
having 3 letters rather than 2 (RD=Real Doctor)
after our name.

APMA and state associations should be fighting for
equal pay for equal work provisions on every level.
If the work is done equally well by both degreed
professionals, the pay should be the same, just as
it is under Medicare. And admirably while some
states have been successful in passing these
regulations, most have not.

In some cases, third-party payers are paying the
same or higher RVU for employed podiatrists who
work for large multidisciplinary groups and equal
or equivalent to the MD/DO. So they have found a
way to circumvent that bias but again, it should be
the same for all.

The title physician or doctor needs to be earned
through showing you can jump over the hurdles
(passing the licensing exams, etc.) . Additionally,
you must be able to prove you have the training and
can do the work. There are no shortcuts to any of
this nor should there be!

The DOs for the most part have proved they are
separate yet equivalent. DPMs may be able to prove
we can do the same work in our specialty as the
MD/DO colleagues, but
the MD/DO point to several critical course areas
which must be addressed by the podiatry schools
including comprehensive physical diagnosis (not an
issue at ICPM in the late 70's) and course and/or
rotations in psychiatry and OBGYN (again the latter
an elective at ICPM in the late ‘70s and definitely
not my favorite rotation).

As for who is defined as a "physician", that is
often left to the state in which they practice. In
many states podiatrists are not considered
physicians
In searching the NYS Higher Education database,
Podiatrists in NYS are not considered physicians,
yet under Federal and Medicare statutes,
podiatrists are considered physicians. This leads
to the potential for accusations of false
advertising and considerable confusion by the
public.

The solution: Is to prepare our students to take
the same or similar boards during their
undergraduate education as those of the MD/DO
profession. There is nothing wrong with separate
but equivalent. The DO profession for the most part
has solved this situation and it's high time we do
the same.

Lastly, there is a way for Medicare and others to
know what specialty you are. When you enroll in
Medicare, it is not your certification as a medical
provider or office location (PTAN) in Medicare that
distinguishes a podiatrist from a
gastroenterologist, psychiatrist, etc. It is your
taxonomy code which is way more than six digits.
That taxonomy code (and there are several for DPMs)
which you link to your Medicare enrollment tags you
to your specialty and your state's licensing
database is what provides you with the ability to
be reimbursed or not for a given procedure.

Paul Kesselman, DPM, Oceanside, NY

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