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08/30/2024 Brian Wm. Zale, DPM
Who Decides Who is a Physician? (Rod Tomczak, DPM, MD, EdD)
I was sued some 25 years ago by an attorney who I believe just hated podiatrists. PICA was my medical liability company at that time. The patient had bilateral bunionectomies by another podiatrist previous to seeing me. She also had some plastic surgery on her right ankle for a brown recluse spider bite that looked horrible. Needless to say, she was unhappy with the bunionectomies I performed and I was sued along with my assistant surgeon and the resident on the case. She sued me for all the normal things of lack of informed consent, chronic pain, inability to have sex, unable to work, loss of future income, etc.
They had an economics guru expert from University of Houston to figure out her future loss of income. Their expert witness was a "Board certified foot and ankle orthopedic surgeon" from San Antonio who hated podiatrists. My expert was a Board certified podiatrist from Houston.
During the voir dire (the process of picking the jurors and summation of the case by both attorneys), the plaintiff’s attorney tells the potential jury that us podiatrists aren't doctors and we don't even go to medical school. Then he asks the jurors if anyone ever had any foot or ankle surgery by a podiatrist. A lot of hands went up. Then he asks each one if they knew that we were not Medical Doctors if they would have had their surgery. Some said no, others said yes and one nurse said that she had to have a Podiatrist correct the failed procedure that an Orthopedic Surgeon did on her so she could walk again. One little Spanish lady in the front row raises her hand and says that her Doctor was so smart he was chief of staff at the hospital and had so many plaques on his wall there wasn't any room for more and "HE SCREWED UP MY SON"!
Another person asked my attorney, "How much are these non-doctors getting paid to have to go through this?" His answer was nothing, they are here to prove their innocence. That juror ended up being the foreman.
As the case goes on for 4 days, the plaintiff's attorney asks his board certified foot and ankle orthopedic expert how much he is getting paid to come here to Houston and leave his booming practice and come here to do the right thing to testify against these non-doctors who screwed up his client. He responds with $15,000. There were some whispers among the jurors.
The plaintiff’s attorney then starts showing pictures of her brown recluse spider bite plastic surgery trying to somehow convince the jury that I had something to do with that.
Finally it goes to deliberations the next morning. I'm not feeling good about anything since I see the jurors are bringing their sack lunches with them into the deliberations room at 9AM..
About 45 minutes later, 12-0 acquittal. Defense verdict! So, here is my take on if we are a physician. First off, there is only one God, and he is the only one who could heal people. He is the greatest physician who ever lived. There are no other Gods who could actually heal people. Secondly, if I can get sued for the same amount as a medical doctor, then we are equal, no matter what the degree is after our name. I am blessed to be a podiatrist!
Brian Wm. Zale, DPM, Rosenberg, TX
Other messages in this thread:
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
08/26/2024 Jack Reingold, DPM
Who Decides Who is a Physician? (Rod Tomczak, DPM, MD, EdD)
I graduated from CCPM in 1979 and retired in 2023, practicing in San Diego, CA the whole time. Luckily, there were hospitals in the area that let me have surgical privileges when I started. Within 15 years, all the hospitals in my area granted podiatrists virtually full surgical privileges (including ankle) and admitting privileges. Managed care arrived and discovered that podiatrists delivered excellent, cost-effective care and began hiring them in great numbers. Kaiser Permanente Medical Group went from none to currently 21!
Hospitalists started calling us and begging us to take patients. Nobody seemed to care about our degrees, caring only if we could take care of their patients (and perhaps off their hands). The hospitals wanted us to take positions on many committees (of course they were none paid). I am not even sure if all the physicians in my community realized we had a different degree. Many of them became patients and never even mentioned it.
In my 41 years of practice, I do not even recall a patient asking me what degree I had or if I was a real doctor! The biggest problem with the DPM degree is that we are often overlooked by our legislators regarding new laws and regulations, which takes a lot of energy to correct.
Medicare and private insurance cannot always identify a MD or DOs specialty and their use of billing codes as easily as they can with a DPM after their name. This sometimes results in unfair, over scrutinizing of our claim. We are as knowledgeable in our area of expertise as any other specialty! Sure, in certain moments it would be easier to be an MD but, I would not lose any sleep over it.
What a great time to be a podiatrist. As I use to tell my son, "have fun, learn something and do some good."
Jack Reingold, DPM, Encinitas, CA
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
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