AAPPM preceptorship

[txlioness]

For those graduates that are participating in the AAPPM preceptorship, give us your feedback on your experience for future graduates that may be interested or need to participate in this program.

Although this is the first year of the program it would be great to hear how things are going. I know some of the questions can't be answered now but if updates are posted that would be great (if possible 🙂)

1. What were the pros/cons of the preceptorship?
2. Any advice that would be helpful to future applicants?
3. Did the program help your chances for residency placement?
4. Any updates of your experience as you go along or complete the preceptorship.

I am sure future graduates/students would appreciate any information anyone is willing to share. 👍

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[PADPM]

For those graduates that are participating in the AAPPM preceptorship, give us your feedback on your experience for future graduates that may be interested or need to participate in this program.

Although this is the first year of the program it would be great to hear how things are going. I know some of the questions can't be answered now but if updates are posted that would be great (if possible 🙂)

1. What were the pros/cons of the preceptorship?
2. Any advice that would be helpful to future applicants?
3. Did the program help your chances for residency placement?
4. Any updates of your experience as you go along or complete the preceptorship.

I am sure future graduates/students would appreciate any information anyone is willing to share. 👍

These are great questions, but remember that these preceptorships were created for those who unfortunately did not obtain residencies.

Therefore, in reality, I can't really see any "con". Yes, you can end up working with/for a jerk who pays little and treats you poorly, but if you are smart and have a positive attitude, you should be able to walk away from every experience with knowledge.

When I was a resident many years ago, I always felt I learned as much from the "bad" doctors/surgeons as I did from the excellent docs. I took the way the bad docs practiced and looked at their skills and ethics and KNEW that's how I DIDN'T want to practice!

So, I completely understand your questions which are valid, but even if someone lands a preceptorship with a less than ideal doc, it's imperative to still walk away attempting to learn what to do and what NOT to do, which is important for your future success.

 

[doctazero]

If you did not get a podiatric residency why not explore the possiblities of staying in school, getting an MD degree and proceeding toward licensure. You can still be a podiatrist but you will increase your marketable skills and pursue foot and ankle anomalies through another route where scope of practice issues will NOT be a hinderance. It is not likely that you will be doing complex foot surgery unless you proceed into a surgical resisdency. If you spent four years in podiatry school paid tuition the least you could expect is adequate training to pursue your desired field of endeavor. Unfortunately this was not the case for you and preceptorships are not going to lead to licensure as a podiatrist in many states, especially those with expansive scopes of practice. This is just a suggestion NOT any criticism of podiatry or its training so kindly refrain from the usual knee-jerk insults, badgering, knit picking and other name-calling practices often statements such as the above evoke.

 

[sorham]

If you did not get a podiatric residency why not explore the possiblities of staying in school, getting an MD degree and proceeding toward licensure. You can still be a podiatrist but you will increase your marketable skills and pursue foot and ankle anomalies through another route where scope of practice issues will NOT be a hinderance. It is not likely that you will be doing complex foot surgery unless you proceed into a surgical resisdency. If you spent four years in podiatry school paid tuition the least you could expect is adequate training to pursue your desired field of endeavor. Unfortunately this was not the case for you and preceptorships are not going to lead to licensure as a podiatrist in many states, especially those with expansive scopes of practice. This is just a suggestion NOT any criticism of podiatry or its training so kindly refrain from the usual knee-jerk insults, badgering, knit picking and other name-calling practices often statements such as the above evoke.

In theory it would be great, however how many people have the money or want to put in the time to do this? There is a max to the amount of stafford loans you can take out, plus you would be looking at four more years of school plus residency all over again. If I were ever in this position I don't believe this would be an option... jmo.

 

[347932]

If you did not get a podiatric residency why not explore the possiblities of staying in school, getting an MD degree and proceeding toward licensure. You can still be a podiatrist but you will increase your marketable skills and pursue foot and ankle anomalies through another route where scope of practice issues will NOT be a hinderance. It is not likely that you will be doing complex foot surgery unless you proceed into a surgical resisdency. If you spent four years in podiatry school paid tuition the least you could expect is adequate training to pursue your desired field of endeavor. Unfortunately this was not the case for you and preceptorships are not going to lead to licensure as a podiatrist in many states, especially those with expansive scopes of practice. This is just a suggestion NOT any criticism of podiatry or its training so kindly refrain from the usual knee-jerk insults, badgering, knit picking and other name-calling practices often statements such as the above evoke.

I'm curious about a few things. Won't you still need a podiatric medicine and surgery to practice as a podiatrist at your local hospital? If you go to school and earn an MD, does that preclude you from needing the appropriate credentials to practice as such? Will you still need to do an internship to get a license to practice as an MD, and suppose you do this but decide to practice as a podiatrist whose jurisdiction do you fall under? Do you fall under the medical board or the podiatry board in those states?

 

[doctazero]

I'm curious about a few things. Won't you still need a podiatric medicine and surgery to practice as a podiatrist at your local hospital? If you go to school and earn an MD, does that preclude you from needing the appropriate credentials to practice as such? Will you still need to do an internship to get a license to practice as an MD, and suppose you do this but decide to practice as a podiatrist whose jurisdiction do you fall under? Do you fall under the medical board or the podiatry board in those states?

Please read and familarize yourself with state scope of practice laws and guidelnes regarding podiatry and medical boards for details regarding the individual states.

I do not know about your local hospital in your particular state but in the United States generally a licensed Medical Doctor does indeed need to finish a PGY-1 inernship/residency afterwhich he/she can practice medicine in all its branches (general MDs generally are frowned upon for doing thoracic surgery in their offices, but by law, under the MD license it is within their scope to treat the foot and ankle including but not limited to surgery of such (in office). Your local hospital(s) would likely have specifications and/or requirements to perform certain procedures which the practitioner must demonstrate via training or experience and competency. I am not at all suggesting that a general MD can garner any and all privelages to perform any and all procedures as specificied by ACGME and ABMS guidelines are closely adhered to in most major metropolitan hospitals. An MD graduate who is licensed in the state in which they practice falls under the jurisdiction and disciplinary boards of their respective State Board of Medicine. The Podiatry licensing bodies have NO jurisdiction over medical doctors who are practicing foot medicine. Please review the rules, regulations laws and guidelines as well as the scopes of practice for podiatry and medicine in the state you have chosen to practice. If you are going to ask if the MD license will help the individual seeking a podiatric residency so they can become podiatric surgeons I do not know. If, after a general medical internship/residency and licensure as an MD, the individual desires to become a podiatric surgeon they will likely have to continue along the lines set out by podiatrists and podiatric surgery for which a residency in that area is required. With respect to the individual who did not obtain a first year slot, going to medical school is NOT a substitute for a podiatric program, it is another career path.

 

[txlioness]

These are great questions, but remember that these preceptorships were created for those who unfortunately did not obtain residencies.

Therefore, in reality, I can't really see any "con". Yes, you can end up working with/for a jerk who pays little and treats you poorly, but if you are smart and have a positive attitude, you should be able to walk away from every experience with knowledge.

When I was a resident many years ago, I always felt I learned as much from the "bad" doctors/surgeons as I did from the excellent docs. I took the way the bad docs practiced and looked at their skills and ethics and KNEW that's how I DIDN'T want to practice!

So, I completely understand your questions which are valid, but even if someone lands a preceptorship with a less than ideal doc, it's imperative to still walk away attempting to learn what to do and what NOT to do, which is important for your future success.

Right the preceptorship is created for those without a residency. I was just trying to open communication with those that are willing to talk about their experience, if any directors of programs took notice at interviews, etc. Or any information that preceptees would be willing to share. 👍

I would have to agree that technically there is no "con" to the preceptorship. But yes, working for a jerk would make life a little miserable. Yes, you can always learn something from everyone anywhere that you go if you keep that perspective in mind. 👍

 

[txlioness]

If you did not get a podiatric residency why not explore the possiblities of staying in school, getting an MD degree and proceeding toward licensure. You can still be a podiatrist but you will increase your marketable skills and pursue foot and ankle anomalies through another route where scope of practice issues will NOT be a hinderance. It is not likely that you will be doing complex foot surgery unless you proceed into a surgical resisdency. If you spent four years in podiatry school paid tuition the least you could expect is adequate training to pursue your desired field of endeavor. Unfortunately this was not the case for you and preceptorships are not going to lead to licensure as a podiatrist in many states, especially those with expansive scopes of practice. This is just a suggestion NOT any criticism of podiatry or its training so kindly refrain from the usual knee-jerk insults, badgering, knit picking and other name-calling practices often statements such as the above evoke.

doctazero:

I would have to agree with sorham. It would be tough to return for a MD degree or any degree with loans maxed out after 4 yrs of podiatry school.

I am sure there are some graduates that may be rethinking their individual courses of action. Stay in the field, leave the field, return to school for another degree, return to prior career, etc. But I am sure finances will definitely drive many graduates' decisions.

Please do not assume because someone begins a thread that they are going through the experience. Remember what they say about assuming. As I said, and as with many threads, I am trying start a positive dialogue for a tough situation that some graduates are going through and discuss an option that has been kindly started by AAPPM.

 

[Podfather]

doctazero:

I would have to agree with sorham. It would be tough to return for a MD degree or any degree with loans maxed out after 4 yrs of podiatry school.

I am sure there are some graduates that may be rethinking their individual courses of action. Stay in the field, leave the field, return to school for another degree, return to prior career, etc. But I am sure finances will definitely drive many graduates' decisions.

Please do not assume because someone begins a thread that they are going through the experience. Remember what they say about assuming. As I said, and as with many threads, I am trying start a positive dialogue for a tough situation that some graduates are going through and discuss an option that has been kindly started by AAPPM.

Those who did not match (not all but I would suspect many) did not for a reason. Poor academic performance, failure of national boards, or poor interview skills. This would make it difficult to be accepted and perhaps even do well in medical school. Another alternative might be a MHA, MBA, or a JD. This way their podiatric background may actually open more doors with the additional degree.

 

[DrMushroomFoot]

Those who did not match (not all but I would suspect many) did not for a reason. Poor academic performance, failure of national boards, or poor interview skills. This would make it difficult to be accepted and perhaps even do well in medical school. Another alternative might be a MHA, MBA, or a JD. This way their podiatric background may actually open more doors with the additional degree.

+1 👍

 

[questiondoc]

Wouldn't that person also have to take the mcat and apply, which would burn up at least a year, during which you would be in repayment. There is also no guarantee you would get in anywhere. I would think that just having gotten out of school and not gotten a residency may also raise some eyebrows with the adcoms.

 

[DPMer]

If you did not get a podiatric residency why not explore the possiblities of staying in school, getting an MD degree and proceeding toward licensure. You can still be a podiatrist but you will increase your marketable skills and pursue foot and ankle anomalies through another route where scope of practice issues will NOT be a hinderance. It is not likely that you will be doing complex foot surgery unless you proceed into a surgical resisdency. If you spent four years in podiatry school paid tuition the least you could expect is adequate training to pursue your desired field of endeavor. Unfortunately this was not the case for you and preceptorships are not going to lead to licensure as a podiatrist in many states, especially those with expansive scopes of practice. This is just a suggestion NOT any criticism of podiatry or its training so kindly refrain from the usual knee-jerk insults, badgering, knit picking and other name-calling practices often statements such as the above evoke.

It is cool that after getting an MD or DO diploma, and completing a minimum of PGY-1, that MD or DO can treat the foot and ankle in their clinic practice (to the best of their knowledge and skill, which I think is smaller compared to podiatrists). Yes, MDs and DOs can perform general medical care from head to toe, but the question is how competent is the MD or DO in tackling a medically complex foot case that was not covered in that MDs or DOs medical training in school and in internship? That MD or DO would have to refer such complex medical cases of the foot and ankle to a podiatrist. It is inevitable. The beauty of podiatry is that after podiatry school and after a 3 or 4 year podiatry residency, the podiatrist can handle the complex foot and ankle medical cases that MDs and DOs must refer because these foot and ankle medical cases are beyond the scope of knowledge and skill of the MD or DO with PGY-1 training only to diagnose and treat. Heck, even a DPM with only PGY-1 training under the Podiatry Service of a teaching hospital has more medical/surgical knowledge and skill to handle foot and ankle medical cases compared to the MD or DO with only PGY-1 training.

 

[347932]

It is cool that after getting an MD or DO diploma, and completing a minimum of PGY-1, that MD or DO can treat the foot and ankle in their clinic practice (to the best of their knowledge and skill, which I think is smaller compared to podiatrists). Yes, MDs and DOs can perform general medical care from head to toe, but the question is how competent is the MD or DO in tackling a medically complex foot case that was not covered in that MDs or DOs medical training in school and in internship? That MD or DO would have to refer such complex medical cases of the foot and ankle to a podiatrist. It is inevitable. The beauty of podiatry is that after podiatry school and after a 3 or 4 year podiatry residency, the podiatrist can handle the complex foot and ankle medical cases that MDs and DOs must refer because these foot and ankle medical cases are beyond the scope of knowledge and skill of the MD or DO with PGY-1 training only to diagnose and treat. Heck, even a DPM with only PGY-1 training under the Podiatry Service of a teaching hospital has more medical/surgical knowledge and skill to handle foot and ankle medical cases compared to the MD or DO with only PGY-1 training.

This is my fundamental problem with what Doctazero recommends. So you have a DPM degree and then get yourself an MD degree. Then you practice as a podiatrist, but since you don't have residency training by a CPME approved podiatry residency, you are limiting your scope as a podiatrist. Also, as an MD, if you only do an internship, you are also limiting your scope as an MD, are you not? If you don't complete a full IM/FP residency by an ACGME approved residency, what is your scope as an MD? If you don't complete a PM&S-36 residency approved by the CPME what is your scope as a DPM/MD. YEs you can get a license to practice medicine in a state after having that internship, but what exactly are you going to practice as? You're still going to have to turf the more complex AND surgical podiatry cases to a podiatrist with the training, so what's really the point?

 

[doctazero]

This is my fundamental problem with what Doctazero recommends. So you have a DPM degree and then get yourself an MD degree. Then you practice as a podiatrist, but since you don't have residency training by a CPME approved podiatry residency, you are limiting your scope as a podiatrist. Also, as an MD, if you only do an internship, you are also limiting your scope as an MD, are you not?

…aren't you? Yes. But as a general MD you can practice medicine and the choice is available to proceed toward either an ACGME, ABMS residency and/or area of specialization. To those ends, I hope this answers your qeustion. If you elect NOT to proceed in residency for an MD specialty, there is a world of opportunities available including but not limited to those in an array of industries that recogize that designation. There is not a shortage of MDs. More people in the US without healthcare coverage often elect to have their general medical anomalies addressed prior to complex, often elective podiatric surgery or, dentistry.

I am getting the drift from these threads that the be all and end all for podiatrists is to become foot surgeons. IF that's the case, my suggestion is superfluous and we can just leave it at that. The podiatric three year residency is certainly the most direct route toward those ends.


If you don't complete a full IM/FP residency by an ACGME approved residency, what is your scope as an MD?

Unlimited. However many health insurance plans recquire board certification and most hospitals require ACGME approved residencies for privelages. Each state granting an unlimted scope of practice varies in its enforcement based upon several factors. For instance, it would be less-than ethical and subject to scrutiny for a general MD without ACGME, ABMS credentials to perform the intricate and complex prcedures of - for the sake of this post - thoracic surgery in his or her office. However there is NO law - to the best of my knowledge - outright forbidding this, if the MD is duly licensed in their respective state. This would not be practicing medicne witout a license and would likely garner some scrutiny from the licensing board (and of course the patient if things went south). However if the licensed MD wanted to perform any procedures in his/her office of an intricate and complex nature, as in podiatric surgery, and they've acquired some degree of competence vis-a-vis a preceptorship, or other such apprenticing they would unlikely be sanctioned by the medical board for practicing podiatry wiithout a license. Many podiatrists who did NO residency whatsoever perform surgery of an intricate and complex nature on feet and sometimes ankles (not defined) throughout the country every day. In fact some states with generous podiatry scopes that allow surgery up to the the knee and injections to the hip open up doors for podiatrists interested and desirous of those things other than feet.


If you don't complete a PM&S-36 residency approved by the CPME what is your scope as a DPM/MD. YEs you can get a license to practice medicine in a state after having that internship, but what exactly are you going to practice as? You're still going to have to turf the more complex AND surgical podiatry cases to a podiatrist with the training, so what's really the point?

Again, if you do not have a PM & S 36 residency approved by the CPME, your scope as a DPM MD is the same as it would be if you dropped the DPM entirely and practiced within the scope of an MD. Foot and ankle surgery to the best of your ability can be done in your own office and the consequences would be remote if you functioned with a modicum of skill sans any complaints arising from a procedure gone awry. Civil litigation might ensue, but; as a licensed MD ingrown nails, hammertoes, neuromas and such would just be a portion of your practice. There are an abundance - this page and time constraints preclude me from listing them - of procedures you are called upon to perform which deal with the body as a whole.

My point. Actually there is no POINT. This is not a tit for tat squabble, nor an argument or proclamation of one field of endavor being better than another, it is merely bringing to light the FACT that in the United States there are fifty states with fifty scopes of practice for podiatrists. Despite your training you are restricted be each of the state scope of practice laws to function within those parameters. If a DPM transgresses and practices outside of their scope, they will face CRIMINAL consequences. If an MD does podiatric surgical things at most severe, the consequences would be CIVIL. So, in these dire economic times, people generally tend to prioritize their elective healthcare needs and a one stop for several conditions makes more sense than several visits to several practitioners, with the exception being dentistry, makes economic sense. THAT, is the point, if there is one to be made. Financial trends favor those most maleable. Orthopedic groups which many of you suggest aspire to working for would trend toward adding another specialist even moreso if that specialist could fill in doing other procedures/follow ups and such than the restrictions of the DPM scope.

Like I've said, this isn't for all podiatrists. I am just reflecting on the economic conditions and opportunites to utilze your education and/or continuation thereof. With respect to the cost of tuition, you've already got student loans…and to the MCAT question posted by someone earlier, I thought all pod schools required that test. If there is a year without a podiatric residency, an unlicensed DPM would be served well by visiting as many podiatrists as possible, ranging from the most `succesful' to the least, garnering insight into ALL of the things available and possible in podiatry and chatting with people who own medical centers, clinics and out-patient surgical centers to find out what other people whov'e been out and about are looking for in new hirees. It can be very easy to fall into the haze of believing one thing or another based upon your frames of reference. There really is not much work available for an unlicensed DPM, so it might behoove the young pod to do some exploring, and listen to what the people you've been advised to stear clear of have to say. Maybe there are reasons podiatry students are discouraged to chat with those shunned by the mainstream of podiatry. It's a big world, hopefully you'll have a long, healthy and productive life. Take the time during these years of study and training to learn about things you'd ordinarily dismiss, disregard and disparge.

 

[347932]

If an MD does podiatric surgical things...

Like what?

 

[doctazero]

Like what?

Like what….what? What kind of procedures? You want a breakdown of the podiatry procedures - your question isn't clear.

 

[347932]

Like what….what? What kind of procedures? You want a breakdown of the podiatry procedures - your question isn't clear.

I would like to know what "podiatric surgical things" an IM/FP MD does.

 

[doctazero]

I would like to know what "podiatric surgical things" an IM/FP MD does.

If the IM/FP graduated podiatry school he/she would be doing most of the `podiatry things' that are/were taught in podiatry schools or gleaned from a preceptorship. These would include but not be limited to: Matricectomies, Nail avulsions, tenotomies, rasping or burring for HD-5's, enucleating an IPK. Does rasping or burring an HD5 get any more definitive as a `podiatry surgical thing'? Maybe you'd like to refer to these as intricate and complex podiatric surgical procedures requiring hospital privelages and board certifiaction as a podiatric surgeon to perform these procedures in your office.

After 4 years a dental student graduates to utilize a basic skill set as a dentist. Along those lines, what basic skill set does the `new' podiatry graduate have that requires years of additonal training to perform the above mentioned sample of `podiatric surgical things'?

 

[questiondoc]

Yes. Pod schools require the Mcat....as do the Md/DO schools. But they require an Mcat that is within three years. So yes you would have to take it again and apply all over again. The thought of four more years (five after reapplyiing and taking the Mcat again) would make the argument for going back for an MD really moot for most people in that posistion.

 

[347932]

If the IM/FP graduated podiatry school he/she would be doing most of the `podiatry things' that are/were taught in podiatry schools or gleaned from a preceptorship. These would include but not be limited to: Matricectomies, Nail avulsions, tenotomies, rasping or burring for HD-5's, enucleating an IPK. Does rasping or burring an HD5 get any more definitive as a `podiatry surgical thing'? Maybe you'd like to refer to these as intricate and complex podiatric surgical procedures requiring hospital privelages and board certifiaction as a podiatric surgeon to perform these procedures in your office.

Interesting how you are not taking the whole malpractice picture into account. Try doing these procedures with a basic IM/FP malpractice plan and see what happens if you have a claim for messing up these procedure. I am 100% sure that your malpractice carrier will hang you out to dry. I have NEVER heard of a IM/FP doc performing any of these procedures in their office. A temporary partial nail avulsion MAYBE.

As a matter of fact the standard of care in many communities is that if bone is exposed (like rasping an exostosis) it should be performed in a sterile environment, in an operating room. I would hesitate to think that even if an FP did graduate from podiatry school first, they would be current on what procedures should likely not be performed in the office setting.

And before you slam me or laugh that "OMFG you CAN do an exostosis in the office!", I won't argue with that, BUT again, the standard of care paradigm is shifting and if you aren't sensitive to that, you WILL get burned when it hits the fan.

 

[Podfather]

If the IM/FP graduated podiatry school he/she would be doing most of the `podiatry things' that are/were taught in podiatry schools or gleaned from a preceptorship. These would include but not be limited to: Matricectomies, Nail avulsions, tenotomies, rasping or burring for HD-5's, enucleating an IPK. Does rasping or burring an HD5 get any more definitive as a `podiatry surgical thing'? Maybe you'd like to refer to these as intricate and complex podiatric surgical procedures requiring hospital privelages and board certifiaction as a podiatric surgeon to perform these procedures in your office.

After 4 years a dental student graduates to utilize a basic skill set as a dentist. Along those lines, what basic skill set does the `new' podiatry graduate have that requires years of additonal training to perform the above mentioned sample of `podiatric surgical things'?

Sorry but schools state for the record (and I can verify it from training post graduates) that students ARE NOT trained to enter practice. They are prepared to enter residency. Hence why most state laws require residency training for licensure.

 

[DPMer]

Interesting how you are not taking the whole malpractice picture into account. Try doing these procedures with a basic IM/FP malpractice plan and see what happens if you have a claim for messing up these procedure. I am 100% sure that your malpractice carrier will hang you out to dry. I have NEVER heard of a IM/FP doc performing any of these procedures in their office. A temporary partial nail avulsion MAYBE.

As a matter of fact the standard of care in many communities is that if bone is exposed (like rasping an exostosis) it should be performed in a sterile environment, in an operating room. I would hesitate to think that even if an FP did graduate from podiatry school first, they would be current on what procedures should likely not be performed in the office setting.

And before you slam me or laugh that "OMFG you CAN do an exostosis in the office!", I won't argue with that, BUT again, the standard of care paradigm is shifting and if you aren't sensitive to that, you WILL get burned when it hits the fan.

I just can't fathom how an MD or DO internist or family practicioner or even a generalist (with only PGY-1 training) could perform an ingrown toenail procedure, or perform a digital block or sinus tarsi block, or perform a biomechanical exam of the lower extremity, or perform wound care below the knee! Not unless the teaching hospital has no podiatry service, not even a foot and ankle MD or DO orthopod. In that case, if there are only MD or DO hospitalists, internists, or family practicioners as the attendings with their residents and interns, then I do not think their BELOW THE KNEE medical services would be at a par level with the podiatry service. Allopathic and osteopathic medical schools in America, Canada, and the Caribbean put minimal emphasis on basic science and clinical science BELOW THE KNEE! This is also true in the intern and resident years of postgrad training in teaching hospitals in America and Canada. I think BELOW THE KNEE urgent and emergent medical care in hospital wards is best for the podiatrist to handle, not the allopath or osteopath, with the exception of emergent vascular issues and emergent infectious disease issues.

 

[doctazero]

I just can't fathom how an MD or DO internist or family practicioner or even a generalist (with only PGY-1 training) could perform an ingrown toenail procedure, or perform a digital block or sinus tarsi block, or perform a biomechanical exam of the lower extremity, or perform wound care below the knee!

Maybe, if you shadowed an MD internist/FP/generalist or DO (the REALLY do it all) - you did mention that your podiatric education did these things….right? Maybe you'd have a greater grasp of the plethora of procedures generalists, especially those in rural locales perform. We're in the realm of epidurals, shoulder, knee, paraspinal injections as well as the sort of wound issues of ostomy sites that pass through the generalists offices. A digital block? How about repairing facial lacs? I think that somewhere you may have been misinformed as to the duties of a well rounded rural family general medical practice. Kindly rethink these things AFTER you've done those rotations. I think there are some life threatening conditions which transcend suturing up a torn fingtip, removing the nail….I could go on, but really, think about all the things that turn up at any time of the day or night…..There isn't always a podiatrist around to do that critical sinus tarsi injection or digital block…sorry.
Must be a shortage of podiatrists.

Not unless the teaching hospital has no podiatry service, not even a foot and ankle MD or DO orthopod.

Hospital settings run the from rural to university teaching centers and resources are designated accordingly. Usually if the state has DPM scope and privelages and an inury to the ED shows up the ED doc deals with it and is referred to the ortho or podiatrist. If there's a serious trauma involving the foot podiatry might be called but all other systems need to be evaluated and I do not know if podiatry service is called to evaluate knees, shoulders and hips as well as ruling out and stabilizing the post trauma patient.

In that case, if there are only MD or DO hospitalists, internists, or family practicioners as the attendings with their residents and interns, then I do not think their BELOW THE KNEE medical services would be at a par level with the podiatry service.

OK, if that's what they teach you.

Allopathic and osteopathic medical schools in America, Canada, and the Caribbean put minimal emphasis on basic science and clinical science BELOW THE KNEE!

How would you know these things? Do they teach that at podiatry school? This is patently false.

This is also true in the intern and resident years of postgrad training in teaching hospitals in America and Canada. I think BELOW THE KNEE urgent and emergent medical care in hospital wards is best for the podiatrist to handle, not the allopath or osteopath,

I think you might come upon some resistance to this notion and suggest shadowing a hopitalist, infectious disease specialist as well as vascular and orthopedic surgons and Generalists both MD and DO.

with the exception of emergent vascular issues and emergent infectious disease issues.

The problem with this statement is that emergent vascular issues are often unpredictable and, correct me if I'm wrong, podiatry schools and podiatry residencies do not prepare the practitioner for running a code in the event things go south...quick. I may be entirely off base here. If so, just disregard this post

If what you're saying is true then I am completey misguided in my perceptions. Thank you very much.

 

[doctazero]

Sorry but schools state for the record (and I can verify it from training post graduates) that students ARE NOT trained to enter practice. They are prepared to enter residency. Hence why most state laws require residency training for licensure.

Judging by your logo and title you demand respect and I shall do the best I can to accomodate to those ends. I was under the impression that after podiatry school, podiatrists could perform a bare minimum of podiatric procedures including but not limited to ingrowing toenails, avulsions, fungal nail treatment, digital block injections, nerve block injections and other procedures. I am aware of several podiatrists who have done no training outside of podiatry school in some states (stictly ancdotal observations) - And, as you mentioned these things leading to licensure are state dependent - Those DPMs (non-residency trained) have done very well. I admit that my knowledge of modern podiatry is minimal and was unaware that the DPM graduate was unable to perform these tasks. Thank you for your reply.

 

[doctazero]

Interesting how you are not taking the whole malpractice picture into account. Try doing these procedures with a basic IM/FP malpractice plan and see what happens if you have a claim for messing up these procedure. I am 100% sure that your malpractice carrier will hang you out to dry. I have NEVER heard of a IM/FP doc performing any of these procedures in their office. A temporary partial nail avulsion MAYBE.

As a matter of fact the standard of care in many communities is that if bone is exposed (like rasping an exostosis) it should be performed in a sterile environment, in an operating room. I would hesitate to think that even if an FP did graduate from podiatry school first, they would be current on what procedures should likely not be performed in the office setting.

And before you slam me or laugh that "OMFG you CAN do an exostosis in the office!", I won't argue with that, BUT again, the standard of care paradigm is shifting and if you aren't sensitive to that, you WILL get burned when it hits the fan.

Before we proceed in an academic debate, find a willing generalist, either DO or MD and shadow them for a few weeks. Observe the things that show up and just how things like facial lacs, epidurals, broken bones, intubation, spirometry, Incisions and Drainages from the anus to the zygomatic and then ask the DO or MD generalist about their medical malpractice exposure. Perhaps a week with a rural generalist DO who does a lot of A-Z medicine icluding some pretty interesting injection therapy will share with you the nuts and bolts of the medicolegal aspects of some of the life and death conditions that appear in these settings. This, SDN threadline isn't really the place to bicker until AFTER you've done those things. If but for nothing else you'll get a better picture of what goes on in a GPs office. Really rural DOs are a lot sharper than you'd think. I think giving a digital block isn't that difficult, but that's just me. I think you'd also be surprised how inexpensive malpractice insurance is too. But stop, don't believe what I say, go out and make friends with some flesh and blood MDs and DOs and ask them if you can observe. You will benefit from this.

 

[Podfather]

Judging by your logo and title you demand respect and I shall do the best I can to accomodate to those ends. I was under the impression that after podiatry school, podiatrists could perform a bare minimum of podiatric procedures including but not limited to ingrowing toenails, avulsions, fungal nail treatment, digital block injections, nerve block injections and other procedures. I am aware of several podiatrists who have done no training outside of podiatry school in some states (stictly ancdotal observations) - And, as you mentioned these things leading to licensure are state dependent - Those DPMs (non-residency trained) have done very well. I admit that my knowledge of modern podiatry is minimal and was unaware that the DPM graduate was unable to perform these tasks. Thank you for your reply.

Yes in the past Podiatry school prepared graduates to practice. This was important since in my era only 50% obtained a residency. Many in those days even logged several osseus cases such as hammertoes and simple bunions while in school. Today that is not true. Since almost everyone does a 2-3 and soon a 3 year residency the schools now educate the graduates so they will be prepared for residency. Perhaps the graduates can give a heel injection and perform palliative nail and callus care but most can not suture or even perform an ingrown toenail. They have been prepared didactically and clinically to enter residency where they will learn techniques and diagnosis.

Even if Podiatry schools trained as they did in the past, only a few states will still grant a non-residency trained DPM a licenses so it's a moot point. Just like an MD who to get a license needs at least a one year internship and most hospitals require a residency.

 

[347932]

Before we proceed in an academic debate, find a willing generalist, either DO or MD and shadow them for a few weeks. Observe the things that show up and just how things like facial lacs, epidurals, broken bones, intubation, spirometry, Incisions and Drainages from the anus to the zygomatic and then ask the DO or MD generalist about their medical malpractice exposure. Perhaps a week with a rural generalist DO who does a lot of A-Z medicine icluding some pretty interesting injection therapy will share with you the nuts and bolts of the medicolegal aspects of some of the life and death conditions that appear in these settings. This, SDN threadline isn't really the place to bicker until AFTER you've done those things. If but for nothing else you'll get a better picture of what goes on in a GPs office. Really rural DOs are a lot sharper than you'd think. I think giving a digital block isn't that difficult, but that's just me. I think you'd also be surprised how inexpensive malpractice insurance is too. But stop, don't believe what I say, go out and make friends with some flesh and blood MDs and DOs and ask them if you can observe. You will benefit from this.

I worked side by side with Generalists almost daily at the medical school where I am on faculty. Furthermore in my PPMR residency I spent a month on FP where I WAS the FP for that month. I then spent another month as an IM resident half in the hospital, half in the office. The procedures you mentioned WERE NOT done by the FP/IM docs. But you're free not to believe me if you like. It's ok.

 

[fivescrew]

I wonder if any of those do-it-all, A to Z, rural MD\DO's do any dentistry? I mean the mouth is part of the body too, right?

 

[doctazero]

I wonder if any of those do-it-all, A to Z, rural MD\DO's do any dentistry? I mean the mouth is part of the body too, right?

Actually they do. Dental abscess I & D isn't uncommon. But there's no substitute for a dentist. Many medicaid pts. can't afford this and see their GPs or go to the ED….you can follow this up in the literature. There is a thread along these lines on another site for physicians. I am not permitted to name sites here. So if you want the details you can email at caddypod at yahoo.com

 

[doctazero]

I worked side by side with Generalists almost daily at the medical school where I am on faculty. Furthermore in my PPMR residency I spent a month on FP where I WAS the FP for that month. I then spent another month as an IM resident half in the hospital, half in the office. The procedures you mentioned WERE NOT done by the FP/IM docs. But you're free not to believe me if you like. It's ok.

I disagree with you and will gladly provide you references to the statements I've made, despite your experiences at the academic medical center there are many many places in the United States and Canada where the things I described are documented and detailed clearly not only in the literature but at a few other sites for physicians - I am not permitted to mention these sites but two manistream medicine sites have chat rooms where physicians chat amongst themselves and there are several threads substantiating the many things FPs/IMs do. The topic just happened to be concurrent with your assertions. Nonetheless I suggest visiting for some time with a rural MD or DO in his or her late forties or fifties and observe the LPs, CVPs, I & Ds and other procedures done by GM/IM/FPs as well as those done by NPs and PAs. Since you've brought your own experience to this thread, do you verily believe that being an FP for one month and then spending another few months at a specific location qualifies you a degree of expertise? For your sake, I am going to again refer you to the literature and the experiences of a DPM MD and all the things that can be done and covered by their malpractice carrier - IF they chose to carry malpractice insurance. Whether I believe you is moot.

What you should be concerned with is the gradual elimination of podiatry services from ACOs - this tit for tattery is silly and you can elect to believe what you want.

After all is bickered back and forth when funding is cut off for podiatry none of these things will matter. NPs PAs and RNs will step up and do the things that will be reimbursed. So whatever your position is, taking a long look at what's happening in the US economy re: budgetary constraints and podiatry services might rank higher in prioritizing your issues and agendas.

 

[dyk343]

:troll:

 

[Traum]

ACO and no PO. Rhea ipsa loquitor. Very predictable. Very professional and becoming of a future provider of the foot and sometimes ankle care that is excluded from some courts, and medicaid, and now ACO.

No responses other than personal attacks, get a life comments, must be a doctonada respondent, and forensic amateur analysis by "attendings".

Again, why cannot a student, offer some intellectual insight? or is flip flop fiascos, sock talks, clam chowdah fests at that foot club clouding judgements/reality of where podiatry is and is going?

Anecdotal examples as stated by the doctorzero are true. You cannot use that as a cogent argument. Stating that some pods are on staff at a ivy, or some pods are friends with orthos, or some are teaching orthos--so what??? That is not universal--tell that to PA courts, or TX, or MA, or SC?


My grandamother has testicles, so she is my grandfather type of argument--- Does not hold water.

 

[MaxillofacialMN]

But there's no substitute for a dentist... So if you want the details you can email at caddypod at yahoo.com

No substitute for a pod either.

Also, you just admitted to being Caddypod.....?

I think you should just get auto-banned. Hoaxbuster got banned, so Doctazero is the same person and therefore should get banned too...

 

[Feli]

For those graduates that are participating in the AAPPM preceptorship, give us your feedback on your experience for future graduates that may be interested or need to participate in this program.

Although this is the first year of the program it would be great to hear how things are going. I know some of the questions can't be answered now but if updates are posted that would be great (if possible 🙂)

1. What were the pros/cons of the preceptorship?
2. Any advice that would be helpful to future applicants?
3. Did the program help your chances for residency placement?
4. Any updates of your experience as you go along or complete the preceptorship.

I am sure future graduates/students would appreciate any information anyone is willing to share. 👍

1) *Pro = done in a year (if you don't like surg anyways, that's great!), learn how to bill... some AAPPM fellowship guys are conscientious and most are at least financially successful if you glean practice pearls off em (but after the fellowship, always remember what the Medicare billing/coding laws are)
*Con = no board cert (ABPS is rly only one that matters), fairly limited state licensure options with 1yr post grad training, underpaid assocaite year where you will probably doing a TON of nail/derm stuff in exchange for your billing education

2) Application for AAPPM fellowship thing... You must be joking? Those are basically low/min paid associateships in primary care pod and billing. It will be 99% unsuccessful scramble students going for these, so couldn't really forsee any significant 'app' process or competition to speak of.

3) As was wisely mentioned above, people who scramble usually - but not always - scramble for a reason. People who are then also unsuccessful in scramble usually found no spot for a reason. Could the AAPPM fellowship then help those same ppl get a residency the following year? Maybe... but do the AAPPM thing more as a last resort and in hopes that you can then get a pod med license, and make a modest living with routine care and wound care (in some states).

4) No comment.

...fyi, sugar-coating things was never my specialty. I hope this helps, tho? 😉