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What kind of medicine can a DPM prescribe?

Discussion in 'Podiatry Students' started by Boilermaker, 04.05.08.

  1. Boilermaker

    Boilermaker

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    Is a podiatric surgeon a level 5? Can a podiatrist prescribe pain killers and narcotics? Basically what I am trying to ask is, can a podiatrist prescribe just as much as an MD?
  2. doclm

    doclm Senior Member

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    All I am going to say is that a DPM pays the same fee's and obtains the same DME license as any MD or DO......so what do you think???

    Why wouldn't a Pod RX pain killers or narcotics post surgically??

    What is level 5 anyway?
  3. SportPOD

    SportPOD Arizona Sports Pod Lifetime Donor

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    We have the same unrestricted DEA license as a MD/DO. If you want to manage those diabetic or high blood pressure patient, you are certainly entitled to and you can prescribe those medications. It's up to you if you have the time and the patience to medically manage everything.
  4. spo01

    spo01 Member

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    eeeek shouldnt that be the family physicians job to manage their blood pressure problems? even if it's a common simple problem it is not the pods responsibility and is just taking more of a risk in doing so. for instance, if a patient has a small infected cut on their abdomen, i'm sure a pod could easily take care of it and prescribe antibiotics, but that is still not the foot/ankle and shouldn't be done by them right? with crazy malpractice/lawsuits nowadays, i figured one would not want the extra burden.
  5. jonwill

    jonwill SDN Senior Moderator Moderator Emeritus

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    :thumbup::thumbup::thumbup: I sure don't!!!
  6. Dr_Feelgood

    Dr_Feelgood Guest

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    On the other side of the coin, are you or are you not a doctor? If a person comes in with HTN and you ignore it, or a DM comes in that has not gone to his primary care b/c of a tight money situation and you do not refill their insulin or metformin, ect are you not liable if they go into a DM coma?

    I agree with SportPOD, you can manage systemic disease you want, i.e. DM, RA, HTN, but do you want to dedicate that much time. The reason primary care has a storage is b/c FP and IM make on the bottom end of the salary spectrum. It costs you money to manage systemic diseases, that is why ortho won't manage HTN either.
  7. cool_vkb

    cool_vkb Member

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    This is a Podiatric forum! every thing we talk is podiatry oriented! Why would a DPM treat a cut in abdomen? Iam not a pro. but i also asked the same question during my shadowing and i also got the same answer. the logic is that if you get a patient with some foot ailment which is being affected by hypertension or diabetes. then in early stages/preventive stages many DPMs (including the one i shadowed) do prescribe systemic medicines. but these are like early stage. they dont wish to treat the systemic disease. they only prescribe it to prevent the foot ailment. if there is a patient with multiple ulcers or high diabetes then they would for sure ask consultation or referral
    :)

    Another thing is that all medications circulate in the body. So we already are in systemic zones. Lets say i get a patient with bacteial infection on the dorsal surface of foot and i prescribe him Tetracycline. Its not like the medicine will travel straight on Highway 100 aka FEMORAL ARTERY --> Popliteal Artery-->Ant Tibial Artery--->Dorsalis pedis (Dorsal Foot zone) . Its gonna affec the entire body! Thats the reason Pods are taught general biochemistry and general pharmacolgy and general physiology so that they appreciate the effects of medications they will prescribe in future and be responisble.
  8. NatCh

    NatCh Senior Moment

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    Our DEA license allows us to prescribe all schedule II through V drugs, just as MD's and DO's can.

    http://en.wikipedia.org/wiki/Controlled_Substances_Act

    I think most would consider managing systemic diseases such as DM or HTN to be out of scope. If you have a patient whose DM is not under control, you should refer him to his PCP.


    If you refer the patient to his PCP and he does not go, then it was his choice, not yours. You have not ignored it. You have referred him appropriately. My recommendation is that you do not take his financial situation into account and try to be the hero. If he had a fractured humerus and said he didn't have the money to go to the ER and Orthopedic Surgeon, then I would not try to set his arm fracture. Also, make sure you document that you referred to PCP. Some clinics will make the phone call for the patient before the patient leaves the office as a CYA move.

    If you decide to try to manage his systemic disease (and remember, this is a patient who already has a history of poor management -- he let his meds run out), then you are on the hook. MD's and DO's do refer a lot, and they do not seem to have ego issues with doing so. Even FP and IM refer to Endocrinology for medical management of DM sometimes. Share responsibility, both for the patient's welfare and for yours.

    An MD or DO may have unlimited scope, but if they choose to manage something then they are held to the standard of care of any specialist in that field. If you decide to manage DM, then you will be held to the standard of care of an Endocrinologist. The first question from a plaintiff's attorney might be, "So where exactly did you do your Endocrinology Fellowship?" "Uhhh, I didn't do a fellowship. I had a one month rotation during my podiatry Residency -- but it was a PSR-36!"

    "Many hands make a coffin lighter." - Jack Shuberth, DPM


    Edit: What's a Level 5? "This doctor goes to 5!" Never heard of it.
  9. spo01

    spo01 Member

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    doctor or no doctor, there are limits/scopes to everyones practice. i would *not* ignore the problem ofcourse, i would give them a referral or tell them to see their FM or IM doctor. podiatrists can play a huge part in catching a systemic illness early in the game, but it is not their job to treat it. i realize your heart is in the right place, but it is *still* not our responsibility, and just because someone is tight on money doesn't mean they can't ask for a simple prescription from there FP which does not take long or usually cost if just a regular refill. as an example, the podiatrist i got my LOR from needed a refill on his BP medicine. i remember the day very well as he called up another doctor to refill it. i asked him why he couldnt just do it himself and he said that he could but it still was best to call it up. whether the med was for him or a friend he would had called up his FP.

    as i mentioned earlier, there are so many doctors being sued and malpractice rising it is scary. lets say i did help that person with the small cut on their stomach with some bandaging and antibiotics. and lets say that patient doesnt take the antibiotics but instead goes home and picks at their wound causing the infection to worsen and spread. if he goes to court who do you think they are gonna hold responsible? and second they are going to ask you why as a podiatrist are you practicing on something other than the feet.
    i personally choose to play it safe when it deals with situations like these. i trust no one these days except family.
  10. cool_vkb

    cool_vkb Member

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    I know the argument is between you and feelgood so sorry for interferring but i dont freakin f..kin understand why the heck wud DPM bandage an abdmonen wound:eek: . I dont know if you are regular to this forum or not but you are taking feelgood's comment out of context.

    We were talking here about foot ailments and systemic diseases involved or associated with them and what kind of medications can we prescibe.

    Why the f...k wud we DPMs bother to see injuries or infections on shoulder or anus:( . from last two posts you are stressing abdomen injuries or wounds when the essecnce of the question or feelgood's post is related with FOOT AILMENTS & their systemic involvements. NOT EVERY CONDITION ON THE BODY.
  11. spo01

    spo01 Member

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    i first want to say i don't mean any disrespect to dr feelgood and appreciate all the advice he has given, i am just trying to clarify some things =)

    perhaps i am stressing the abdominal wound too much, but my argument still pertains to a similar scenario: treating a condition that is not the responsibility of the podiatrist. i have reread his post a few times and this is how i am interpreting it (and correct me if i'm wrong): a person comes in to the podiatrist for a foot problem, and the podiatrist notices the patient also is hypertensive as well and decides to treat that by prescribing medication (and the pod can continue managing it as well if they like). as NatCh pointed out, the second you prescribe that HTN medication you have taken on a big responsibility and are held to that higher standard level of care.

    my argument is that is even though the hypertension is obviously related to the foot and its problems, it is still primarily the responsibility of that patients FP, IM, or cardiologist. and with todays litigious society, why would the pod want the extra risk of doing such a thing?
  12. cool_vkb

    cool_vkb Member

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    Now your argument is perfectly in the scope of podiatry:) and now i guess we all can have a fair argument. from that time it was gettin confusing as to why would someone treat abdominal injuries etc. Yeah as NATCH said that a DPM will not treat it. however there are some DPMs outthere who for some reason do treat the early stages. iam 100% with you as to why take a big risk.

    Thanks for clarifying the post. it makes perfect sense now.
  13. NatCh

    NatCh Senior Moment

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    I think they're sticking their necks out. I personally don't do it. There's not much to gain but plenty to lose. Since we can prescribe most meds without anyone immediately overseeing us, who's to know what we're using the drug for? But if the patient has a bad turn of events, that's when someone will look at the chart and ask, "Why were you doing that? Were you qualified to be doing that?"

    Gout is one example of a disease that has fuzzy boundaries. It often first presents in the foot and the DPM is the first to make the diagnosis. It's also easy to treat acutely with an NSAID or Colchicine, but it's really a disease of the internal organs that presents in the foot rather than a foot problem per se. It's tempting to prescribe an NSAID then tell the patient "see ya later" but I always tell them, "I'd like you to see your PCP or a Rheumatologist for long-term medical management, as this is a disease of your internal organs."

    Nat
  14. Aznfarmerboi

    Aznfarmerboi Senior Member

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    Even though it is true Podiatrists are allow to prescribe most medications, it does not mean that they can. For most pharmacists, they would fill out narcs, HTN, DM, and so on. However for a script like Ambien or birth controls, that is generally out of scope. I hope this helps.
    I have clinicians (podiatrists, dentists, etc) argue that they are doctors and hence they can prescribe anything they want, Ambien and birth controls included. That is not true. Lets say that even if it was true for arguement's sake. When an insurance company audits the pharmacy; the insurance company will generally reject reembursements because of this reason. This means that even if it were true, a pharmacy will not fill it because they are losing money.
  15. spooge

    spooge

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    I heard Podiatrists can only prescribe medicines that will make your nuts fall off. Is this true?
  16. krabmas

    krabmas Senior Member Moderator Emeritus

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    Finally someone who knows the truth and is willing to tell it.

    I also heard that Podiatrists will only prescribe a medicine after the drug rep has taken them to dinner.:laugh: ;):boom:
  17. spo01

    spo01 Member

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    spooge, do you know Dee?
  18. SportPOD

    SportPOD Arizona Sports Pod Lifetime Donor

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    What? You get dinner to prescribe a drug?? I only get pens (that work half the time) and pads!!:p
  19. All4MyDaughter

    All4MyDaughter SDN Mommystrator Staff Member Administrator SDN Senior Moderator Lifetime Donor Partner Organization

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    In my state all prescribers are limited to prescribing within their scope:

    MD/DO - humans
    DDS/DDM - the oral cavity
    DPM - foot (not sure about ankles)
    DVM - animals

    So basically an MD/DO can write for whatever they want but we still sometimes have questions. Case in point:

    I was working in a community pharmacy and got a called in prescription for a sildenafil suspension (compounded) for an infant. Doc on the phone is a pediatric resident at the local university indigent clinic. I pulled up the infants profile and notice that the concentration and directions she's asking for would equal a 50% reduction in the infant's dose. I question the resident about this and am told, "look the parents just brought in the bottle and I want to refill it with those directions." I asked what the date on the bottle was. OOPS! 3 months ago. They brought in an old bottle. The child's dose had been increasing every month but the peds resident didn't know that because she wasn't managing the child's treatment for that condition. I told her that I would not be able to accept that RX from her and I suggested that she might instruct the parents to call the infant's cardiologist. She gets short with me so I ask to speak with the attending.

    *long wait*

    I explain that the resident 1) wanted to call in a refill on a medication that was prescribed by a specialist in another office and used old directions to call in the script and 2) I felt that the cardiologist needed to be consulted rather than just trying to refill the RX even with the most recent month's directions since the child was very, very ill and had needed a dose increase every month since birth. The attending agreed, thanked me and offered to call the cardiologist herself. Whew!
  20. spo01

    spo01 Member

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    interesting situation. a lot of doctors from our area are moving away from our local hospital in west virginia. i know 4 personally who just couldnt take the rising malpractice (then again WV is one of the worst places to practice medicine). my father comes home everynight and we have our father/son talks before heading to bed and it's the same thing every day: "dr so and so messed up again and made an absolutely stupid mistake that you shouldnt be making as a doctor. now i gotta take care of his patient so i'll be up really late son. the hospital is so desperate for doctors though they can't get rid of this guy (or that guy, or that person either, etc)"
    docs are ordering more and more tests to protect themselves, and the first day i went into work on the floor the nurse told me all about PYA which meant "protect your a*s".

    recently when i needed a REFILL on my ambien my dad wouldnt do it and his friend wouldnt do it who is a gastro doc. this is just an example of how those with an MD won't prescribe something outside their speciality because they are really cracking down around here.

    this is one of the main reasons i like podiatry so much: specialization. we're no 'jack of all trades', instead, we're the best at what we do. i think the health field is going to become more and more specialized as a result because you have so many doctors who have such a 'broad, jack of all trades' knowledge that can really pinpoint them in a lawsuit because where do they draw the line in their scope of practice? it's gonna be a professional referral service just so you can save your own a**.
  21. NatCh

    NatCh Senior Moment

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    Good catch! Nice job. Thank goodness for knowledgeable Pharmacists.

    Are there any medications that are specific to the foot and nothing else? I can't think of any.

    Some medications are not specific to podiatry but have podiatric applications (e.g., Neurontin, Lyrica, Phenergan, Compazine). Hopefully the Pharmacist who is filling the script is current on podiatric treatments, including those that are off-label.

    There's one local grumpy OLD pharmacist who thinks podiatrists only cut toenails and shouldn't get to prescribe meds when he himself can't. He gets huffy if he gets a script from a podiatrist.

    Nat
  22. Aznfarmerboi

    Aznfarmerboi Senior Member

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    The general pharmacist including retail should have an idea of medications that you can prescribe even if it is not specific to you. I got to admit that there are a lot of us out there that dont stay current specific since our access to journals and a lot of other literatures are limited. (I stay current via medscapes and pharmacology journals).
    Worst comes to come, you can explain the mechanism of action to us on something current that we didnt see yet, and give us the references on where you got it from. We have the professional training to understand this, and we can also document it.
  23. krabmas

    krabmas Senior Member Moderator Emeritus

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    Last time I checked

    NSAIDS
    Antibiotics
    Oral Antifungals
    Narcotics
    Gabapentin/Pregabalin
    Local Anesthetics

    do not act directly on the foot.
  24. spo01

    spo01 Member

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    spooooooooge! have you seen Dee?
  25. PharmD/DPM

    PharmD/DPM PGY-2

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    DPM's can prescribe Ambien or any type of sleep-aid. Here's an example: Pt is in so much pain post-op that he or she cannot sleep. Need Ambien. Orthopods do it all the time to there post-op pts that can't sleep and so will I. It it part of the total therapy that I give to the pt's post-procedure, to make them as comfortable as possible. I'm not saying go and prescribe it to friends or family when they complain to you about sleep, but if something you did (Sx) caused sleeping disturbances, then it is your responsibility to ammend those as a physician (DPM).
  26. NatCh

    NatCh Senior Moment

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    I do routinely with each surgical patient and have not once been questioned.

    On a slight tangent (i.e., this isn't directed at you PharmD/DPM), here's a good place for a couple of issues for anyone who might still be listening to my blathering. I knew a doctor who was on a State Board and he said that the single most common cause for professional discipline was doctors prescribing to friends, family, and colleagues without a legitimate doctor-patient relationship. If it's medically justified then it's okay to write for friends, family, colleagues as long as you have a legitimate doc-pt. relationship. In other words, start a chart. You don't have to bill them if you don't want to, but have a chart.

    As far as "if something you did...then it is your responsibility to amend those as a physician" goes, it is our responsibility to do something but don't feel you have to do it all alone. If surgery resulted in a DVT, then by all means call the PCP and the Coagulation Clinic. If the patient you put on antibiotics developed ulcerative colitis, then call the PCP and see if they want to call GI. If someone looks at all like they might be developing RSD (CRPS), then get them to Physiatry ASAP! Even if you think you can handle it by yourself, try to remember that saying, "many hands make a coffin lighter." It's so easy to be in denial that your patient is having a complication, but the last thing you want is for them to feel as if you're not concerned and then they seek a second opinion from a non-friendly competitor.

    Third point is about pain control. My brother-in-law (Orthopod) got named in a suit for not providing adequate pain control. I'm struck by our reluctance to prescribe strong enough medications. It's as if we feel it's a blow to the ego or something. "My patients almost never need anything stronger than Vicodin!" Sure. Don't make them writhe in agony all night because their pain meds aren't strong enough. If you do surgery on Friday, send her home with only Vicodin and her Marcaine wears off at 9pm after the pharmacies have closed, if that Vicodin isn't potent enough then your patient is out of luck unless she wants to go to the ER for pain control. That makes you look real good. If there happens to be a pharmacy that is open at night, stronger schedule II drugs (e.g., Oxycodone) need a written prescription; you can't phone it in. Have a nice drive! Don't be shy with the scripts.

    The State of Oregon now even mandates pain management training for all practitioners.

    Jeez, how'd I get up on this soapbox? Stepping down now...

    Nat
  27. NatCh

    NatCh Senior Moment

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    I might explain the application (e.g., "Aldara can be used to treat plantar warts too.") but the Pharmacist should know the mechanism of action of the drug itself. In all honesty though, I see myself more likely to tell the patient to go to a different retail pharmacy before I would discuss pharmacokinetics and give literature citations.

    Nat
  28. Aznfarmerboi

    Aznfarmerboi Senior Member

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    Sorry, I meant the application of the drug itself. I think if you said that, I would have documented it and filled it. For the most part, we do all the work since we call you before giving the script back to the patient. A lot of times, telling the patient to go to a different retail pharmacy will works but except that the insurance companies, medicaid and medicare have been cracking down. Finding prescriptions where drugs and prescribers mistmached are one of the easier things to do. In NYS, it is required that we scan the prescription w/ NYS serial and send the data electronically to them. That means that in the future, that option of sending patients elsewhere will not work as much. Whenever a pharmacy gets auditted (I have been in two so far in my district since I float around a lot), prescribers practicing out of scope are up there among the reasons why the insurance company fines us since that data is readily available to them.

    If you prescribed Ambien, the pharmacy would politely call you and ask the reason. They would then document it on the back of RX if it is resonable (post op sleep aid). On the other hand, if the Ambien has been prescribed for more than 30 days continously, I would probably stop filling it and address the issue.

    There are a lot of time that a pharmacy will fill scripts without asking because they do not know what kind of a doctor you are, or might have missed it. I personally have filled a few scripts for a dentist for Ambien (personal use) because he did not tell us he was a dentist since he always called it in. Recently CVS gave us the resources to double check the prescribers. I found out and politely told him he cannot do that. He then got another dentist to fill it out for him. Under NYS laws and talking with a few of my colleagues that did the same for him, we had to report him to NYS board since they are really strict with controls.
  29. NatCh

    NatCh Senior Moment

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    All good reasons for people to stick to their area of expertise.
  30. SportPOD

    SportPOD Arizona Sports Pod Lifetime Donor

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    Taking away your soapbox....................permanently.

    No, seriously, Nat you have brought some good points to this discussion. I think it's important for people to understand that you have to use common sense when prescribing medications for our specialty.

    I just find it great that a simple answer regarding our DEA license morphed into a huge discussion regarding laws and prescribing habits. :thumbup:
  31. NatCh

    NatCh Senior Moment

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    Given enough time I'll find something to spout off about. Is there a treatment for this affliction?

    I still don't know what Level 5 is...
  32. SportPOD

    SportPOD Arizona Sports Pod Lifetime Donor

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    Level 5 <ding> - special shoes, orthotics, cam-boots, post-op shoes.......:laugh:
  33. Toohotinvegas33

    Toohotinvegas33 Currently Glasgow 3

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    Here is a complete list of meds footies can prescribe. :smuggrin:

    [​IMG][​IMG][​IMG][​IMG]
  34. OSUDDS

    OSUDDS Senior Member

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    unfunny post is unfunny
  35. IlizaRob

    IlizaRob IlizaRob-erator Moderator Emeritus

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    Here is a complete list of meds that glorified chiros..err...osteopaths can provide. :smuggrin:

    [​IMG]
  36. MaseratiGT

    MaseratiGT Legilimens!

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    :laugh:

    If I had the skills to draw you a ROFLcopter, I would.
  37. 165007

    165007

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    Thats OMM at its best!
  38. dpmPOD

    dpmPOD

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    :laugh:
  39. j0ez0r

    j0ez0r

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  40. Boner

    Boner I just blue myself

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    Even if that were the actual case, we're still able to treat the whole body. Just remember, medicolegally and practically:
    DO = physician
    DPM = not a physician

    Healthcare Truth and Transparency Act can't come soon enough

    :smuggrin:
  41. SubRosa

    SubRosa

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    Burn?! WTH...
  42. OSUDDS

    OSUDDS Senior Member

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    in some states DPMs are considered physicians
  43. IlizaRob

    IlizaRob IlizaRob-erator Moderator Emeritus

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    A little sensitive there? Dont bring it if you cant take it.

    FYI, Every doctor (MD or DO) has a limited scope. A cardiologist is not going to do knee surgery.
  44. Boner

    Boner I just blue myself

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    Keep in mind that the limit to their scope is by choice, not by law. A cardiologist is also trained in internal med, and is permitted to medically manage medical conditions of the knee (and whole body). You'd be hard pressed to find a medical specialty that doesn't have a year of general medicine/surgery incorporated into their PGY-1, which allows them to hang a shingle as a general practitioner. You'd also be hard pressed to find a DPM who can hang a shingle as a GP since it is against the law, and rightfully so.
  45. dpmPOD

    dpmPOD

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    Mere semantics. They have limited scope, even if not "by law." Find me a cardiologist who is going to manage a knee problem without referring out.....seriously, get off your soap box and take a joke.
  46. IlizaRob

    IlizaRob IlizaRob-erator Moderator Emeritus

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    Dear 1st year DO student,

    DPM students and residents rotate through general medicine/surgery as well. No DPM/DO/MD would want to hang a shingle as a GP to only make 70K/yr anyway.

    Dont be mad just because a DPM scored higher than you on your last exam.

    Little bit of trivia for you. The DPMs at DMU have scored higher on average than the DO class in Pharmacology in the current and past years. The entrance stats (GPA, MCAT scores) have also been neck and neck. I know you are proud to be a DO but dont forget your heritage.
  47. IlizaRob

    IlizaRob IlizaRob-erator Moderator Emeritus

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    :thumbup:
  48. jonwill

    jonwill SDN Senior Moderator Moderator Emeritus

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    To be exact: 2 months IM, 1 month gen surg, 1 month ID, 1 month vasc surg, all in my first year. Whoever said it is spot on. It is all theoretical. I know and work with tons of docs with an extremely limited scope of practice. There is little choice involved. They were only trained to do certain things and can only perform certain treatments/procedures. Many different specialists will be consulted on any given patient.

    Any doctor that has unlimited rx power, is a member of medical staff (including chief) at a hospital, has admitting and OR privileges, and performs complex surgeries is a physician (podiatric physician in this case). Most laws and insurance companies agree!

    Settle down and take a joke. Plus, the only reason Ilizarob has that picture is because it is hanging on his bedroom wall!

    Good luck with your first year.
  49. Boner

    Boner I just blue myself

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    Let's just get the facts straight before you go making sweeping generalizations.

    CPMS:Academic performance: The class of 2011 has an average cumulative GPA of 3.39. The average science GPA is 3.25. The average MCAT score is 23.

    DO:The class of 2011 has a 3.64 average overall GPA and a 3.59 average science GPA. MCAT:The average MCAT score is 26.63, with a median writing sample of O.

    Those entrance stats aren't "neck and neck" as you say.

    Furthermore, should the "trivia" bit be true, realize that DO students are going through their systems courses concurrently with pharm, while the DPMs go through their watered down version of systems concurrently.

    Also, DPM class averages for the class of 2011 are not surpassing the DO class averages (just a little "trivia" for you).

    You may "rotate" through general medicine, but you do not have the depth of exposure to safely practice general medicine (i.e. education in systems based medicine + sum of 3rd/4th year rotations + PGY-1 year in general med and beyond).

    Lastly, a physician may not want to hang a shingle as a GP, but should the need arise, a physician is permitted to respond to any medical situation. Same can't be said for a podiatrist, and with the way recent scope of practice confrontations are panning out for DPMs, won't be long before all you're doing is digging out ingrowns :laugh:

    Being the mod that you are, you should probably just go ahead and close this thread and save yourself further embarrassment.
  50. IlizaRob

    IlizaRob IlizaRob-erator Moderator Emeritus

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    Stop being so insecure Boner. Calm down. It was one of your classmates that started this joke. You take things too seriously.

    Anyway, Ill dig out ingrowns all day. If you knew how much they paid, you would be too.

    You should be listening to Dr. Finnerty's lecture rather than screwing around on SDN anyway. :laugh:

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