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01/22/2025
RESPONSES/COMMENTS (PODIATRIC EDUCATION) - PART 1
RE: Why We Need 3-Year Residencies
From H. David Gottlieb, DPM
The reason is, quite frankly, simple. Money. Money, and Medicare. In all U.S. jurisdictions (except Maryland which has a Medicare exemption), residencies receive most of their financial support through Medicare. Medicare rules state that, essentially, they will provide full funding for the MINIMUM number of residency years required for board certification. If only 2 years of residency are required for certification, then Medicare would only fully fund 2 years of residency. This creates a financial burden on all 3-year programs.
If you peruse the AACPM list of podiatry residency programs, you will see only about 10 do not have the Rearfoot/Reconstructive Ankle [RRA] suffix. If there was a single, initial certifying board, I believe that that ratio would eventually flip. Those who wish additional designation will be free to earn that. Also, the curriculum at podiatry colleges now has as their goal to prepare their students for residency, not practice. Who wants to go through residency to learn chip & clips?
H. David Gottlieb, DPM, Baltimore, MD
Other messages in this thread:
01/24/2025
RESPONSES/COMMENTS (PODIATRIC EDUCATION) - PART 1 A
From: Robert Scott Steinberg, DPM
Dr. Kass makes some excellent points about the medicine part of podiatric medicine. It's too bad that CPME, APMA, and the colleges don't bring podiatric medical education into this century. The curriculum must be expanded to include more medicine. The Illinois Association of Podiatric Physicians and Surgeons (ILAPPS) (formally IL Podiatric Medical Association) failed to convince Scholl College to switch from using candles to using light bulbs.
As someone who joined 209 out of 218 students at the Illinois College of Podiatric Medicine in the early 1970s who went on strike for two months against the college, I can tell you, as it was true back then, it is true now: Students are being cheated.
Robert Scott Steinberg, DPM, Schaumburg, IL
01/24/2025
RESPONSES/COMMENTS (PODIATRIC EDUCATION) - PART 1 B
From: Jeffrey Kass, DPM
Dr. Chaskin brings up an interesting point about the unfairness of the New York podiatry scope. I find it absurd that in order for a podiatrist in New York to treat skin above the ankle, the doctor must be board certified in forefoot and rearfoot surgery. What other medical profession has a board certification requirement by law to treat patients? This law is so absurd. I have younger colleagues who finished three-year surgical residencies and are adept at treating ankle conditions and performing ankle surgery, yet are forced to take their patients to New Jersey to treat their patients because the process in New York takes time to complete.
I agree with Dr. Chaskin that there are numerous lawsuits that can be brought to change the current status quo. Aside from what I mentioned above, there is the fact that “interstate commerce” is being affected. If a doctor is competent to perform an ankle surgery in New Jersey, then they are competent to perform it in New York. Every day I read how various professions are increasing their scope of practice....nurses, NPs, PAs, etc. I wonder when podiatry is going to jump on the bandwagon.
Jeffrey Kass, DPM, Forest Hills, NY
01/23/2025
RESPONSES/COMMENTS (PODIATRIC EDUCATION) - PART 1 B
From: Daniel Chaskin, DPM
I disagree with Dr. Spinner. Some state legislatures (for example, the NYS legislature) feel we are a specialty with only recognition of being board certified in surgery. When the NYS ankle law was discussed in 2012, there was no mention of the antitrust effects on members of the ABPM, prohibiting medical treatment of the ankle. Board certification in podiatric medicine is not recognized to “medically" treat the ankle. Yet board certification in surgery is required to medically treat the ankle, in the absence of a chronic foot ulcer.
If the written minutes or discussions of the New York State legislature had no mention of the anti-competitive effects on podiatrists who are board certified in podiatric medicine, this 2012 ankle law might be able to be rendered null and void as anticompetitive and not in compliance with federal legislation that prohibits antitrust activity. Scope might be increased to allow podiatrists board certified in podiatric medicine to medically treat the ankle.
Can state societies take political action to correct what might be classified as a possible restraint of trade against podiatrists only board certified in podiatric medicine? Do any members of ABPM have similar opinions? Did any state society ever contact the U.S. Dept of Justice and/or the Federal Trade Commission for their opinions on how to recognize the value of being board certified in podiatric medicine, and if not, why not? Problems like this might be a possible reason why there is such low enrollment in our podiatric medical colleges.
Daniel Chaskin, DPM, Ridgewood, NY
01/23/2025
RESPONSES/COMMENTS (PODIATRIC EDUCATION) - PART 1 A
From: Jeffrey Kass, DPM
Dr. Gottlieb gives a good explanation of why longer residencies are needed in terms of funding, but I thought he fell short on his last sentence. A non-surgical resident can be trained to do so more than “chipping and clipping”. Podiatrists can be trained much better in the “podiatric medicine arena”, whereby no one has to be afraid to treat podiatric conditions with broader systemic concerns. For example, many podiatrists might make a diagnosis of gout but then return the patient to the internist or rheumatologist to treat the gout. A well-rounded and trained podiatrist could/should be trained to treat this, as some currently do. Gout is just one example.
The scope of podiatry needs to be expanded and, in my mind, needs to be the same in every state. I think it is silly to force everyone into 3-year surgical programs when not everyone wants to do surgery or is not adept at doing it.
Jeffrey Kass, DPM, Forest Hills, NY
12/17/2024
RESPONSES/COMMENTS (PODIATRIC EDUCATION) - PART 1A
From: Robert Scott Steinberg, DPM
Nothing will improve until the mindset of CPME changes. They are living in the past and cannot see the future. We need to demand that CPME seek a more complete medical education. The colleges don't seem to want to do that. Case in point: The Illinois Association of Podiatric Medicine and Surgery (ILAPPS) - formally the IPMA, has run into a brick wall with the Scholl College at Roseland Franklin University (RFU), which includes the Chicago Medical School. We asked them to allow the podiatry students to take additional courses with the medical students. RFU refused. It will take CPME to force the issue. This is the only way we will see a long-term modernization of podiatric medical education.
Robert Scott Steinberg, DPM, Schaumburg, IL
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