To save the profession I think it’s necessary to
cater to the consumer. The first consumer is the
student. What keeps us from offering a completely
different curriculum at each of the schools,
allowing the potential student the opportunity to
choose the path he or she will best benefit them?
The quick and dirty answer is CPME? There may be
CPME members with academic titles, but there are
no dedicated educators with hands on, contact,
advanced education degrees in philosophy, methods
or curriculum.
Let’s say the New York College wants to offer the
traditional four-year DPM degree to the students
with a bachelor’s degree and emphasizes the
current three-year residency. They fine tune their
curriculum to complete that mission and advertise
their unique plan in a universal advertisement
that will describe all the schools’ programs. All
the schools. All the schools together in one
advertisement. Unity will not only save money but
describe our unity in diversity.
Temple may opt for the six-year straight out of
high school DPM degree and still push students
toward a three-year residency. These students will
enjoy nine years of podiatric training and because
of the three-years of residency could stress
rearfoot and ankle trauma and reconstructive
podiatric surgery. These Philadelphia students
will be younger when starting school so maturity
and readiness to learn would have to be assessed.
Administrators at Philadelphia may tell a
student,” We think New York may be a better fit
for you after college or perhaps the Ohio Kent
State School after two years of college. Don’t be
afraid, another school may say, “We think
Philadelphia may be a better fit for you. Let me
make a phone call for you.” It’s not like we’re
almost out of seats!
Des Moines might plan their curriculum differently
and stress admission to the DPM program after two
years of college. Des Moines University has been
known to issue a BS degree to students who have
not completed an undergraduate program elsewhere
but complete a doctorate in Des Moines. Some of
these students have entered college after a year
or two gap between high school and the first year
of college. These students may be mature enough to
know they do not want a high stress surgical
career and may opt for a residency that emphasizes
more common surgery and traditional podiatric
care.
Chicago might stress wound care and limb salvage
along with research into the diabetic foot. To
gain admission into this program, potential
students would need to spend an undetermined
number of hours with a practice that devotes most
of their time to limb salvage so the student
understands the work and dedication required to be
successful in saving patients’ limbs. After four
years of school the student would take the next
step in a three-year residency devoted to limb
salvage, Charcot reconstruction, diabetic
education and research. This program would be for
the truly dedicated student.
Conservative care is still the most common
podiatric CPT code. The aging population needs
this sub-specialty. I don’t know about the rest of
you 70-year-olds, but my feet might as well be in
another ZIP code when it comes to self-care. What
about the training? How long does it take to learn
how to cut nails, trim callouses and yes, apply
pads to the foot where needed? And just as
important, when to refer. It is a truism that I
must still be able to recognize pathology to refer
it. What does an amelanotic melanoma look like?
Maybe we call these folks podiatric gatekeepers.
People who want to specialize in areas like sports
medicine, geriatrics, and dermatology do not need
a three-year surgical residency but need to be
trained. I don’t know how long the training takes,
but they may qualify for a three-year DPM program
after college and a two-year residency that
stresses these specialties. To become board
certified they would need a board different than
are currently approved by our friend CPME.
What’s important with these radical ideas is that
schools and podiatrists work together and everyone
accepts their role, starting with the school, the
residency and the practice. Working together for a
common goal would be new to podiatry, but all of
us can see where a bunch of independent
contractors has gotten us. The most common
specialties in podiatry today are undermining and
backbiting. We need leaders who are pro…fession
and not pro…ducts.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
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