Another look at DPM to MD

[krabmas]

Leaders take us from where we are to where we’ve never been.
Henry Kissinger

The greatest leaders are the ones with vision. The interesting thing about their
vision is that often only they are able to clearly see what is in front of them.
Others cannot, and many times are fearful or doubtful of their leaders’ decisions.
There is once again a push within the profession to change the DPM degree
to MD, or to designate a dual degree of DPM/MD. This is much like the
oralmaxillofacial surgeons who dual degree as DDS/MD and are clearly recognized
as the dental surgical subspecialists. I certainly can appreciate the desire for
this degree change. It would make our lives much simpler, recognition much
quicker, and appointments to hospital staffs less cumbersome.
Others argue that a loss of professional identity would occur. But I wonder
about that. Exactly what professional identity are we talking about? Surely it
cannot be chiropody; we wanted that moniker gone a long time ago. James Burke
said, ‘‘There are many institutions in history that have simply winked out of
existence because there was no need for them anymore. Where is the nearest
watermill?’’ I have heard the argument that if we, as a profession, do not continue
to perform all of the services that we have in the past, ‘‘someone else’’ will do it.
If those services were all that we did, then yes, that would be a problem. But
as we progress as a profession, as we understand the science and pathophysiology
0891-8422/04/$ – see front matter D 2004 Elsevier Inc. All rights reserved.
doi:10.1016/j.cpm.2004.04.005
Vincent J. Mandracchia, DPM, MS
Consulting Editor
Clin Podiatr Med Surg
21 (2004) xi– xiiof the conditions we treat, our sophistication should open new avenues of
treatment that may indeed put the old ways to rest or safely in the hands of
others. Hasn’t this happened with our allopathic and osteopathic comrades?
Hasn’t the role of the physician assistant increased, and at the request and
insistence of MD and DOs, freeing the doctor to do more, research more, and
exercise more diagnostic abilities?
I was at a recent meeting of our society when the topic of sterilization of nailcutting
instruments came up. Nurses who were caring for nonambulatory patients
in nursing homes in rural areas (where no podiatrist coverage is available) wanted
to know how to clean their nail instruments satisfactorily between patients. One
of the members of our group brought up the issue of whether nurses should be
cutting toenails at all. My answer is yes, they should. We as the podiatric
physicians should be diagnosing the pathologic nail, determining if the patient is
a candidate for antifungal treatment, recommending treatment options, and not
fixating on who is physically cutting the toenail.
The students at the Iowa College were upset because a physical therapist,
while lecturing on muscle testing and treatment, mentioned that the therapists
were debriding foot ulcers in their department. So what . . . do they understand
the science of wound healing, the role of growth factors? Do they understand
when exogenous growth factor therapy is warranted, who is a candidate for
surgical off-loading, the role of vascular perfusion in the healing process? Or are
they merely mechanically removing dead tissue because someone told them to or
showed them how.
We don’t need to hold onto the entire identity of our profession. We just need
to be recognized as the true foot and ankle specialists, and that is done by our
ability to diagnose and treat lower extremity problems with predictable outcomes.
That is accomplished by first being a physician in our approach to patient
concerns. Do we need an MD degree to do that? I doubt it. Would it be nice?
Absolutely! I support the efforts of our leaders who continue to push for better
recognition, better education at the colleges, better and longer residency training.
These are the visionaries who will lead us into a bright and secure future. The
question remains, Will we be ready to release the baggage of the profession and
‘‘step up to the plate’’?
One of the ways that we ‘‘grow up’’ as a profession is to look at our surgical
results with a critical eye, allowing us to confirm or alter our procedures as needed.
This issue of the Clinics is dedicated to the recognition and treatment of the lessthan-
desirable surgical outcome, and Dr. Wally Strash has done an excellent job
of coordinating authors and articles that will, hopefully, stimulate self-evaluation,
critical thinking, and discussion that will ultimately benefit our patients.

Vincent J. Mandracchia, DPM, MS
Broadlawns Medical Center
1801 Hickman Road
Des Moines, IA 50314, USA
E-mail address: [email protected]
xii V.J. Mandracchia / Clin Podiatr Med Surg 21 (2004) xi–xii

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[cool_vkb]

Leaders take us from where we are to where we've never been.
Henry Kissinger

The greatest leaders are the ones with vision. The interesting thing about their
vision is that often only they are able to clearly see what is in front of them.
Others cannot, and many times are fearful or doubtful of their leaders' decisions.
There is once again a push within the profession to change the DPM degree
to MD, or to designate a dual degree of DPM/MD. This is much like the
oralmaxillofacial surgeons who dual degree as DDS/MD and are clearly recognized
as the dental surgical subspecialists. I certainly can appreciate the desire for
this degree change. It would make our lives much simpler, recognition much
quicker, and appointments to hospital staffs less cumbersome.
Others argue that a loss of professional identity would occur. But I wonder
about that. Exactly what professional identity are we talking about? Surely it
cannot be chiropody; we wanted that moniker gone a long time ago. James Burke
said, ‘‘There are many institutions in history that have simply winked out of
existence because there was no need for them anymore. Where is the nearest
watermill?'' I have heard the argument that if we, as a profession, do not continue
to perform all of the services that we have in the past, ‘‘someone else'' will do it.
If those services were all that we did, then yes, that would be a problem. But
as we progress as a profession, as we understand the science and pathophysiology
0891-8422/04/$ – see front matter D 2004 Elsevier Inc. All rights reserved.
doi:10.1016/j.cpm.2004.04.005
Vincent J. Mandracchia, DPM, MS
Consulting Editor
Clin Podiatr Med Surg
21 (2004) xi– xiiof the conditions we treat, our sophistication should open new avenues of
treatment that may indeed put the old ways to rest or safely in the hands of
others. Hasn't this happened with our allopathic and osteopathic comrades?
Hasn't the role of the physician assistant increased, and at the request and
insistence of MD and DOs, freeing the doctor to do more, research more, and
exercise more diagnostic abilities?
I was at a recent meeting of our society when the topic of sterilization of nailcutting
instruments came up. Nurses who were caring for nonambulatory patients
in nursing homes in rural areas (where no podiatrist coverage is available) wanted
to know how to clean their nail instruments satisfactorily between patients. One
of the members of our group brought up the issue of whether nurses should be
cutting toenails at all. My answer is yes, they should. We as the podiatric
physicians should be diagnosing the pathologic nail, determining if the patient is
a candidate for antifungal treatment, recommending treatment options, and not
fixating on who is physically cutting the toenail.
The students at the Iowa College were upset because a physical therapist,
while lecturing on muscle testing and treatment, mentioned that the therapists
were debriding foot ulcers in their department. So what . . . do they understand
the science of wound healing, the role of growth factors? Do they understand
when exogenous growth factor therapy is warranted, who is a candidate for
surgical off-loading, the role of vascular perfusion in the healing process? Or are
they merely mechanically removing dead tissue because someone told them to or
showed them how.
We don't need to hold onto the entire identity of our profession. We just need
to be recognized as the true foot and ankle specialists, and that is done by our
ability to diagnose and treat lower extremity problems with predictable outcomes.
That is accomplished by first being a physician in our approach to patient
concerns. Do we need an MD degree to do that? I doubt it. Would it be nice?
Absolutely! I support the efforts of our leaders who continue to push for better
recognition, better education at the colleges, better and longer residency training.
These are the visionaries who will lead us into a bright and secure future. The
question remains, Will we be ready to release the baggage of the profession and
‘‘step up to the plate''?
One of the ways that we ‘‘grow up'' as a profession is to look at our surgical
results with a critical eye, allowing us to confirm or alter our procedures as needed.
This issue of the Clinics is dedicated to the recognition and treatment of the lessthan-
desirable surgical outcome, and Dr. Wally Strash has done an excellent job
of coordinating authors and articles that will, hopefully, stimulate self-evaluation,
critical thinking, and discussion that will ultimately benefit our patients.

Vincent J. Mandracchia, DPM, MS
Broadlawns Medical Center
1801 Hickman Road
Des Moines, IA 50314, USA
E-mail address: [email protected]
xii V.J. Mandracchia / Clin Podiatr Med Surg 21 (2004) xi–xii

i heard there are some schools in carribean who have advanced standing for DPM students. If one is really interested perhaps they could look at that option.

what is your opinion abt these MD programs.

 

[krabmas]

i heard there are some schools in carribean who have advanced standing for DPM students. If one is really interested perhaps they could look at that option.

what is your opinion abt these MD programs.

that is not what the passage was about. It mentioned a degree change, not an additional degree.

But since it was mentioned...

Let's just say that I decide to waste 4+ more years of my life to get the illustrius MD degree (I'd never do DO, I do not want 2 degrees that I have to explain why I did not do MD, 1 is enough).

back to the MD thing - in order to practice as an MD and a podiatric surgeon I would have to pass 2 sets of lisencing exams, and pay to be part of numerous medical associations. Being a member of the medical associations is not necessary to practice but it is to be a responsible part of the profession (IMO). I'm not sure about this but I might need 2 sets of malpractice insurance.

Would I still be a surgeon? by the DPM degree, yes, by the MD degree, no unless I wasted even more time doing a surgical residency. And if in a podiatry unfriendly state, who cares if you have a DPM/MD you still have not been trained as an orthopedic surgeon so the MDs will most likely still frown upon you and not refer because you are a pod by training not an orthopod.

In theory the DPM/MD degree looks good but in practice I think the legal implications would be too difficult.

Instead of looking for more letters after your name focus on becoming the best podiatric physician. This is enough of a responsibility.

 

[Podman]

i heard there are some schools in carribean who have advanced standing for DPM students. If one is really interested perhaps they could look at that option.

what is your opinion abt these MD programs.

i think the quality of these carribean programs are very suspect. The only reason they exist is to open an escape route for failing, disgruntled podiatrists to become "real doctors". These programs in specific do not improve the quality of our profession in any way or another - the DPMs who enroll there do so to escape from the profession completely not to come back and practice podiatric medicine.

The vision mentioned by Dr. Mandracchia is to improve the quality of our education, residency, and professional standing - i.e. contribute to the profession. The carribean programs thats you speak of do not carry that purpose.

 

[Podman]

Instead of looking for more letters after your name focus on becoming the best podiatric physician. This is enough of a responsibility.

absolutely.

 

[cool_vkb]

And if in a podiatry unfriendly state, who cares if you have a DPM/MD you still have not been trained as an orthopedic surgeon so the MDs will most likely still frown upon you and not refer because you are a pod by training not an orthopod.

When you say Podiatry unfriendly state. Do you mean states that have only foot as scope of practice. or are there some states which are unfriendly to us apart from that. and in what way are they unfriendly to us. Can you name some states please.

 

[jonwill]

i think the quality of these carribean programs are very suspect. The only reason they exist is to open an escape route for failing, disgruntled podiatrists to become "real doctors". These programs in specific do not improve the quality of our profession in any way or another - the DPMs who enroll there do so to escape from the profession completely not to come back and practice podiatric medicine.

The vision mentioned by Dr. Mandracchia is to improve the quality of our education, residency, and professional standing - i.e. contribute to the profession. The carribean programs thats you speak of do not carry that purpose.

 

[dawg44]

Leaders take us from where we are to where we’ve never been.
Henry Kissinger

The greatest leaders are the ones with vision. The interesting thing about their
vision is that often only they are able to clearly see what is in front of them.
Others cannot, and many times are fearful or doubtful of their leaders’ decisions.
There is once again a push within the profession to change the DPM degree
to MD, or to designate a dual degree of DPM/MD. This is much like the
oralmaxillofacial surgeons who dual degree as DDS/MD and are clearly recognized
as the dental surgical subspecialists. I certainly can appreciate the desire for
this degree change. It would make our lives much simpler, recognition much
quicker, and appointments to hospital staffs less cumbersome.
Others argue that a loss of professional identity would occur. But I wonder
about that. Exactly what professional identity are we talking about? Surely it
cannot be chiropody; we wanted that moniker gone a long time ago. James Burke
said, ‘‘There are many institutions in history that have simply winked out of
existence because there was no need for them anymore. Where is the nearest
watermill?’’ I have heard the argument that if we, as a profession, do not continue
to perform all of the services that we have in the past, ‘‘someone else’’ will do it.
If those services were all that we did, then yes, that would be a problem. But
as we progress as a profession, as we understand the science and pathophysiology
0891-8422/04/$ – see front matter D 2004 Elsevier Inc. All rights reserved.
doi:10.1016/j.cpm.2004.04.005
Vincent J. Mandracchia, DPM, MS
Consulting Editor
Clin Podiatr Med Surg
21 (2004) xi– xiiof the conditions we treat, our sophistication should open new avenues of
treatment that may indeed put the old ways to rest or safely in the hands of
others. Hasn’t this happened with our allopathic and osteopathic comrades?
Hasn’t the role of the physician assistant increased, and at the request and
insistence of MD and DOs, freeing the doctor to do more, research more, and
exercise more diagnostic abilities?
I was at a recent meeting of our society when the topic of sterilization of nailcutting
instruments came up. Nurses who were caring for nonambulatory patients
in nursing homes in rural areas (where no podiatrist coverage is available) wanted
to know how to clean their nail instruments satisfactorily between patients. One
of the members of our group brought up the issue of whether nurses should be
cutting toenails at all. My answer is yes, they should. We as the podiatric
physicians should be diagnosing the pathologic nail, determining if the patient is
a candidate for antifungal treatment, recommending treatment options, and not
fixating on who is physically cutting the toenail.
The students at the Iowa College were upset because a physical therapist,
while lecturing on muscle testing and treatment, mentioned that the therapists
were debriding foot ulcers in their department. So what . . . do they understand
the science of wound healing, the role of growth factors? Do they understand
when exogenous growth factor therapy is warranted, who is a candidate for
surgical off-loading, the role of vascular perfusion in the healing process? Or are
they merely mechanically removing dead tissue because someone told them to or
showed them how.
We don’t need to hold onto the entire identity of our profession. We just need
to be recognized as the true foot and ankle specialists, and that is done by our
ability to diagnose and treat lower extremity problems with predictable outcomes.
That is accomplished by first being a physician in our approach to patient
concerns. Do we need an MD degree to do that? I doubt it. Would it be nice?
Absolutely! I support the efforts of our leaders who continue to push for better
recognition, better education at the colleges, better and longer residency training.
These are the visionaries who will lead us into a bright and secure future. The
question remains, Will we be ready to release the baggage of the profession and
‘‘step up to the plate’’?
One of the ways that we ‘‘grow up’’ as a profession is to look at our surgical
results with a critical eye, allowing us to confirm or alter our procedures as needed.
This issue of the Clinics is dedicated to the recognition and treatment of the lessthan-
desirable surgical outcome, and Dr. Wally Strash has done an excellent job
of coordinating authors and articles that will, hopefully, stimulate self-evaluation,
critical thinking, and discussion that will ultimately benefit our patients.

Vincent J. Mandracchia, DPM, MS
Broadlawns Medical Center
1801 Hickman Road
Des Moines, IA 50314, USA
E-mail address: [email protected]
xii V.J. Mandracchia / Clin Podiatr Med Surg 21 (2004) xi–xii

If you are proud of your training and are the "true foot and ankle specialists" then DPM is all you need after your name. Stand by your training and initials rather than go out and get somebody elses that suit your cause. I've seen too many podiatrists that list their name on jackets and stationary as "Dr." and never mention their degree anywhere. Tricking patients and other physicians into thinking you are a MD or DO is basically what this is tactic is trying to accomplish. Making your training better and more uniform so DPM stands on its own should be your profession's mission.

 

[krabmas]

When you say Podiatry unfriendly state. Do you mean states that have only foot as scope of practice. or are there some states which are unfriendly to us apart from that. and in what way are they unfriendly to us. Can you name some states please.

no I will not list states. it has been mentioned on here before.

sometimes it is just the hospital sometimes the whole state. As what Dawg mentioned before about the Orthopod not wanting pods at the hospital in order to get him to work there.

there will always be people trying to stop our progression.

 

[krabmas]

If you are proud of your training and are the "true foot and ankle specialists" then DPM is all you need after your name. Stand by your training and initials rather than go out and get somebody elses that suit your cause. I've seen too many podiatrists that list their name on jackets and stationary as "Dr." and never mention their degree anywhere. Tricking patients and other physicians into thinking you are a MD or DO is basically what this is tactic is trying to accomplish. Making your training better and more uniform so DPM stands on its own should be your profession's mission.

I am confused as to what this has to do with what Mandracchia wrote?

 

[cool_vkb]

no I will not list states. it has been mentioned on here before.

sometimes it is just the hospital sometimes the whole state. As what Dawg mentioned before about the Orthopod not wanting pods at the hospital in order to get him to work there.

there will always be people trying to stop our progression.

Oh ok! got it boss! yep it was mentioned before. my bad!

i thought u were saying like some states themselves are unfriendly. If its hospital policy then i guess no one cant do anything, unless u wanna open ur own hospital lol!

 

[Celeripedean]

hey podman, or anyone else

are you saying that there are md,dpm programs in the carribean? or were you just talking of the md programs in general about people going down there to escape the "complexity" of med school rigor?

please explain?

 

[Podman]

hey podman, or anyone else

are you saying that there are md,dpm programs in the carribean? or were you just talking of the md programs in general about people going down there to escape the "complexity" of med school rigor?

please explain?

the purpose of my post was not to analyze the legitimacy of all carribean schools in general - I was referring to the carribean MD programs who offer an accelerated curriculum for DPMs to become MD's.

Krabmas posted an article about the vision of our profession in improving the quality of our training, degree, and profession as a whole - I am simply stating that the carribean "DPM to MD" programs do not fit that the purpose at all. On the contrary, in my humble opinion, I feel that they rather serve as an escape route for DPM's who couldn't cut it in our profession - proof for that is the mere fact that the graduates of these programs go on to other medical specialties and leave podiatry all together.

 

[AZPOD Rocks]

You know everyone... this article is terrific! I don't say this from MD envy or anything of the like but because I like seeing visionary people! Without goals, you slide back. With goals, you can improve.

What I would like to know is what is the history of oral and maxillofacial surgery? How did this profession come about? Is it at all synonymous in circumstance to modern podiatry or are they very different?

AZPOD Rocks

 

[krabmas]

You know everyone... this article is terrific! I don't say this from MD envy or anything of the like but because I like seeing visionary people! Without goals, you slide back. With goals, you can improve.

What I would like to know is what is the history of oral and maxillofacial surgery? How did this profession come about? Is it at all synonymous in circumstance to modern podiatry or are they very different?

AZPOD Rocks

from what I have heard (not evidenced based ) dentstry used to be MD - go thru med school to become a dentist. then they separated off to be their own thing. So now there are branches of dentist - those that become general dentists, periodontists (gum docs), orthodontists, oral maxillofacial surgeons.

periodontists go for further 3 years of school including the clerkship/residency.

oral maxillofacial surgeons do not have to do MD school but lots do. And they also do a residency.

Orthodontists I think go for further schooling and it is usually only the top of the class that gets in.

I'm sure our dental friends can tell us more info on the subject.

 

[Dr. Dai Phan]

from what I have heard (not evidenced based ) dentstry used to be MD - go thru med school to become a dentist. then they separated off to be their own thing. So now there are branches of dentist - those that become general dentists, periodontists (gum docs), orthodontists, oral maxillofacial surgeons.

periodontists go for further 3 years of school including the clerkship/residency.

oral maxillofacial surgeons do not have to do MD school but lots do. And they also do a residency.

Orthodontists I think go for further schooling and it is usually only the top of the class that gets in.

I'm sure our dental friends can tell us more info on the subject.

OK, here's goes...

There are nine different dental specialties of dentistry. Each does more than what I put here but this is what the public knows about them...

1. Orthodontics ( straighten teeth with braces).
2. Endodontists (root canals).
3. Prosthodontist (dental reconstruction with crowns, bridges, implants).
Maxillofacial Prosthodontics- a SUB-speciality of prosthodontics ( prosthetic reconstruction in the maxillofacial region).
4. Oral and Maxillofacial Radiology- interpreting x rays in the head and neck region.
5. Oral and Maxillofacial Pathology- diagnosis of pathology in the head and neck region.
6. Oral and Maxillofacial Surgery- Surgical management of the head and neck region.
7. Pedodontics- dentistry for children.
8. Public Health- managing dentally related issues (non-clinical).
9. Periodontics - surgical management of the gum.

Any other "specialties" not listed here are NOT specialties, i. e, there is no such thing as " TMD or Implant or Facial Pain Specialists". People who advertise themselves as such are deceiving the public. It is like advertising yourself as " Abortion Specialist".

To become a dental specialist requires addtional residency ranging from 2 to 6 years. Oral and Maxillofacial Surgery requires 4 w/o the MD or 6 with MD degree awarded. Maxillofacial Prosthodontics (this is what I do) require 4 years ( 3 years for the prosthodontics and one fellowship for the maxillofacial discipline).

Now you know what we do as dentists. DP

 

[IlizaRob]

Very informative. Thanks

 

[gustydoc]

I just thought since this topic of scope of practice change vs degree change continues to come up, I would post this article. The following is a resolution that has passed the OPMA house and was voted on and approved by the APMA as resolution 2015. Currently a task force has been put together and the resolution is in it's planning phase. I would encourage current students to inquire with their APMSA delegates and APMA reps as to the status of the resolution. Sorry it is so long ... enjoy!

The PM Forum
APMA Resolution 2-05
This proposed resolution sets the goal of an unlimited scope of practice for podiatric physicians.
By Gary L. Fetgatter
Mr. Fetgatter is Executive Director of the Ohio Podiatric Medical Association.
“Resolved: That the American Podiatric Medical Association prepare an all APMA membership referendum to have APMA members vote on the goal of becoming the third US medical profession (following the MD and most recently the DO professions) to achieve an ‘unlimited scope of practice’ by the year 2015.”
Purpose
The purpose of this guest editorial is to support APMA Resolution 2-05 “Unlimited Scope of Practice for Podiatric Physicians” which was adopted unanimously by the Ohio Podiatric Medical Association’s House of Delegates June 9, 2004. There are many reasons for supporting this resolution; this editorial will address these needs:
* Establish equivalency between podiatry and the MD/DO medical and surgical specialties.
* Achieve physician status and remove the risks to patients of mis-classifying podiatrists as an “optional service’ in public entitlement programs or a ‘supplemental benefit’ in private insurance coverage/fees.
* Advance the freedom to practice podiatric medicine and surgery within podiatrists’ surgical and clinical knowledge.
Introduction
How is it possible that eighty-four podiatrists unanimously voted to approve this vision as Delegates to the Ohio Podiatric Medical Association House of Delegates?
These eighty-four podiatrists included every aspect of the podiatric profession from retired podiatrists to students, from surgeons to primary care podiatrists, from urban to rural podiatrists, from private practice to the President and Dean of Academic Affairs at the Ohio College of Podiatric Medicine. While there was a full and free discussion of this resolution, once it became understood, it unified the entire profession; there was not a single negative.
Should this April’s APMA House of Delegates approve this resolution, then every member of the American Podiatric Medical Association would have the same opportunity to vote on the policy in an APMA referendum.
Background
In many ways the resolution represents an ‘organic evolutionary process’ in which the clinical, surgical, and medical abilities of the podiatric medical education and medical practices have become too effective in treating patients to remain limited in scope.
This growth of podiatric clinical and scientific knowledge may best be illustrated by the following research information on diabetic foot ulcer patients: The US Centers for Disease Control research data shows a dramatic increase in the ability of podiatrists to reduce amputation rates due to diabetic foot ulcers (From a 50% reduction in 1990 to an 85% reduction in 2000).
This data is significant to diabetic patients covered either by public Medicare and Medicaid or insurance programs provided by the private sector. Diabetes has increased across all patient demographics by an average of 49% in the last decade alone.
This data makes the mis-identification of podiatrists as an ‘optional service’ under the public Medicaid law a danger to diabetic patients, but the issue is even larger than just Medicaid. Equally at risk are the greater numbers of diabetic patients who are covered by private sector insurance and managed care companies which misclassify podiatrists as a “supplemental benefit.” Everything podiatrists do, every service, every surgical procedure performed are basic physician’s services. Podiatry is a medical specialty, not an optional service/supplemental benefit.
Anatomical Limitations Why should a podiatrist be able to save a diabetic patient’s foot from amputation, but not be able to treat the same diabetic ulcer if it is a half inch above some anatomical line drawn by lay legislators? This is exactly the problem we had with an Ohio Diabetic Wound Care Center whose podiatrists were actually getting a 90% diabetic ulcer amputation reduction rate.
How can a podiatrist be a “real doctor” if you crush your foot, but not a “real doctor” if you scrape your knee? Podiatry is so confusing to the general public, most of which have never been to a podiatrist, that television’s #1 rated Jerry Seinfeld Show did an entire program on whether a podiatrist was a real doctor or not?
Podiatry’s clinical, medical, and surgical abilities have become too important to patients to allow confusion by virtue of an illogical anatomically-triggered scope of practice to impede patients from accessing podiatric care. Podiatry’s scope of practice separates it from every other medical specialty in the U.S.
Historical Sketch and Summary
* Podiatry (formerly chiropody) may represent American Medicine’s first attempt to create a medical specialty. It is an historical artifact dating back to the birth of modern chiropody/podiatric medical education with the opening of the first U.S. podiatric medical college founded by Maurice J. Lewi, MD in New York in 1911.
* In 1911, the hands and feet were considered the most complicated aspects of the medical profession. The podiatric profession became American Medicine’s first attempt to experiment with specialization. A year later, the Carnegie Foundation funded a comprehensive study of all MD medical schools in the US and published what became knownas the Flexner Report which represented the birth of modern American allopathic MD medical education.
* The AMA used the Flexner Report over the next two decades to close MD diploma mills and pass state legislation that opened up public tax dollars to create standardized modern medical school curriculum.
* The Flexner Report was the basis for gaining the state legislators’ agreement that MD’s legally were recognized as physicians and granted an unlimited scope of practice.
* MD internships surfaced in the 1920’s and 1930’s, but medical specialty residency training did not occur until after World War II with the explosion of medical and surgical knowledge that WWII brought to medicine. Most current MD medical specialty societies were not founded until the 1950’s.
* In 1937, the Illinois Delegation to the American Medical Association House of Delegates introduced a resolution which called on the AMA to take a position that it “…would be unethical for any MD to associate with or teach at a podiatric medical school.” This AMA Resolution was referred to the AMA Council on Judicial and Ethical Affairs “for Study and to be Reported Back to the AMA House of Delegates in 1938.”
* One year later, the AMA Judicial and Ethical Council reported to the AMA House of Delegates, “…podiatrists do practice ‘real medicine’ and provide a needed service that MD’s are too busy to attend to with their patients, unlike other professional quackery professions, such as osteopaths….” Therefore, in 1938, the podiatric profession was deemed ethical and the osteopathic profession was deemed “quackery.” Until 1961, MD’s were told it was unethical for an MD to associate with any member of the DO profession.
* In June of 1961, the AMA’s Judicial Council took an official action…”that it was no longer unethical for doctors of medicine to associate professionally and on a voluntary basis with doctors of osteopathic medicine.”
Not only did the DO osteopathic profession become accepted by the AMA as not being ‘quacks’, they became the first profession other than MDs to achieve an unlimited scope of practice and have full physicians status. In the 1980’s, DO’s were AMA’s number one targeted group of physicians to be recruited into AMA membership.
One key factor in the success of the osteopaths overcoming the discrimination of the AMA occurred in the 1950’s with the emergence and integration of osteopathic and allopathic graduate medical education residency training programs. Medical knowledge exploded with the human carnage of World War II. This growth of medical knowledge necessitated creation of medical specialization to capture and fully utilize this knowledge.
This was accomplished in the 1950’s by the creation of graduate medical educational specialty residencies, medical specialty societies and voluntary medical specialty certifying boards. This proved to be a much more effective manner of managing the explosion of medical and surgical knowledge.
Podiatric Residency Programs Podiatry’s development of graduate medical education residency programs was linked to the medical education process only in recent generations of practitioners. Currently, podiatric residents, just like the osteopathic residents of the 1950’s, are clinically trained in full body systems.
Today’s podiatric accredited residencies require podiatric residents to be rotated through different medical specialty departments so they are trained as full scope physicians, just as MD and DO residents are trained regardless of their chosen medical specialty.
For example, psychiatric MD residents rotate through OBG-YN departments to deliver babies, surgery departments to do surgery, and internal medicine/family practice department to do clinical medicine before they specialize in psychiatric practice.
Podiatric residents have similar rotations through a number of these same medical specialty departments and are required to do a complete comprehensive history and physical examination as part of their accredited training program. (See Council on Podiatric Medical Education 320, Standards and Requirements for Approval of Residencies in Podiatric Medicine and Surgery, page 20, B Assess and Manage the Patient’s General Medical Status, Items 1 – 4)
The average layman or legislator does not understand how the Ohio podiatric scope of practice limits podiatric physicians to using their clinical and surgical skills to treating the foot or ankle by state law (ORC Sec. 4731.51), yet allows podiatric residents to train in full body systems with the need to have the ankle or foot disease or injury triggering their training?
This is because the state law grants podiatry residency training certificates (ORC Sec. 4731.573) which limit the podiatric residents training to the accredited hospital residency program under the supervision of the podiatric residency training director. The statute, however, cites the Council on Podiatric Education’s residency accreditation requirements as the basis for the training certificate.
This allows podiatric residents to be trained in all aspects of the human body, including the ability to perform a total physical examination of patients the same as any MD or DO medical specialties are trained.
Podiatry can be viewed as American medicine’s first attempt to specialize and its last medical specialty to bloom via clinical and surgical graduate residency training programs.
Interestingly enough, even the issue of dropping the DO degree and exchanging it for an MD degree was tried by California DO’s back in the 1960’s. After a few years, the osteopathic physicians reversed their earlier decision to accept an MD degree and returned to the DO degree, which gave them their unique professional identity. They found it was the freedom to practice osteopathic medicine that empowered their profession, not the MD degree.
If the podiatric profession should approve Resolution XX-05, then it would place into motion a 10 year program to adjust podiatric medical education’s system to follow the MD’s and DO’s pathway to an unlimited scope of practice.
Timetable for Implementation of Unlimited Scope of Practice
April, 2005 – Step 1 - “Unlimited Scope of Practice” Ohio House of Delegates’ Resolution will be debated by the APMA House of Delegates. If passed, it will become an APMA membership referendum.
Summer/Fall 2005 – Step 2 - If the APMA House approves Resolution 2-05, ballots will be provided to APMA members to vote on this issue. For it to become the goal of the APMA requires approval by a majority of APMA members.
Fall/Winter 2005 – Step 3 - If the APMA member referendum on creating an “unlimited scope of practice” succeeds, then the APMA will initiate formal communications with the American Medical Association and the American Osteopathic Association requesting help and assistance in achieving this goal. This will include a formal request for assistance from the AMA and the AOA for re-engineering the podiatric medical education system to produce an unlimited scope of practice to podiatrists over the next 10 years.
2006 to 2009 – Step 4 - Following a series of meetings between the APMA, AMA and AOA, a task force will be created to create an integrated medical school and residency training experience and to produce an unlimited scope of practice podiatrist.
2009-2012 - Step 5 - The APMA/AMA/AOA Task Force would work with the eight podiatric medical colleges and residency programs to implement the educational changes necessary to create an unlimited scope of practice podiatrist.
2012-2015 - Step 6 - the APMA/AMA/AOA Task Force would work to create model state legislation to allow for grandfathering in all current podiatric physicians and surgeons who wish to keep their current state podiatric scope of practice while repealing all anatomically limited foot/ankle scopes of practice for newly trained podiatrists.
Podiatrists who already are in practice and wish to move to an unlimited scope of practice would need to supplement their training and pass a licensure examination once the unlimited scope of practice became state law. Once again we can look to the osteopathic profession approach to phasing in the unlimited scope of practice with doctors who were trained and practiced under the osteopathic limited scope of practice laws.
Conclusion
Whatever vision you as members of the podiatric profession choose to follow, it is critically important that you do have some vision to guide your profession through the turbulent times our nation’s health care and insurance systems will surely be facing over the next ten years. Franklin Delano Roosevelt’s second inaugural address used a biblical quote “Without vision, the people perish.”
The podiatric profession is fast approaching the 100th year anniversary of the birth of “modern American podiatry”; like the ‘century plant’ that only blooms once in a 100 years, podiatry is blossoming.
As APMA President Dr. Lloyd Smith stated in his recent editorial, “The Golden Age of Podiatry is now...don’t miss out on being a part of it!”

 

[krabmas]

what a way to make a come back Gustydoc.

In your oppinion do you think this is a reality? Or just pipe dreams?

I hope that it is a reality but in some states like NY it will be a steep up hill battle.

 

[doclm]

I just thought since this topic of scope of practice change vs degree change continues to come up, I would post this article. The following is a resolution that has passed the OPMA house and was voted on and approved by the APMA as resolution 2015. Currently a task force has been put together and the resolution is in it's planning phase. I would encourage current students to inquire with their APMSA delegates and APMA reps as to the status of the resolution. Sorry it is so long ... enjoy!

The PM Forum
APMA Resolution 2-05
This proposed resolution sets the goal of an unlimited scope of practice for podiatric physicians.
By Gary L. Fetgatter
Mr. Fetgatter is Executive Director of the Ohio Podiatric Medical Association.
"Resolved: That the American Podiatric Medical Association prepare an all APMA membership referendum to have APMA members vote on the goal of becoming the third US medical profession (following the MD and most recently the DO professions) to achieve an ‘unlimited scope of practice' by the year 2015."
Purpose
The purpose of this guest editorial is to support APMA Resolution 2-05 "Unlimited Scope of Practice for Podiatric Physicians" which was adopted unanimously by the Ohio Podiatric Medical Association's House of Delegates June 9, 2004. There are many reasons for supporting this resolution; this editorial will address these needs:
* Establish equivalency between podiatry and the MD/DO medical and surgical specialties.
* Achieve physician status and remove the risks to patients of mis-classifying podiatrists as an "optional service' in public entitlement programs or a ‘supplemental benefit' in private insurance coverage/fees.
* Advance the freedom to practice podiatric medicine and surgery within podiatrists' surgical and clinical knowledge.
Introduction
How is it possible that eighty-four podiatrists unanimously voted to approve this vision as Delegates to the Ohio Podiatric Medical Association House of Delegates?
These eighty-four podiatrists included every aspect of the podiatric profession from retired podiatrists to students, from surgeons to primary care podiatrists, from urban to rural podiatrists, from private practice to the President and Dean of Academic Affairs at the Ohio College of Podiatric Medicine. While there was a full and free discussion of this resolution, once it became understood, it unified the entire profession; there was not a single negative.
Should this April's APMA House of Delegates approve this resolution, then every member of the American Podiatric Medical Association would have the same opportunity to vote on the policy in an APMA referendum.
Background
In many ways the resolution represents an ‘organic evolutionary process' in which the clinical, surgical, and medical abilities of the podiatric medical education and medical practices have become too effective in treating patients to remain limited in scope.
This growth of podiatric clinical and scientific knowledge may best be illustrated by the following research information on diabetic foot ulcer patients: The US Centers for Disease Control research data shows a dramatic increase in the ability of podiatrists to reduce amputation rates due to diabetic foot ulcers (From a 50% reduction in 1990 to an 85% reduction in 2000).
This data is significant to diabetic patients covered either by public Medicare and Medicaid or insurance programs provided by the private sector. Diabetes has increased across all patient demographics by an average of 49% in the last decade alone.
This data makes the mis-identification of podiatrists as an ‘optional service' under the public Medicaid law a danger to diabetic patients, but the issue is even larger than just Medicaid. Equally at risk are the greater numbers of diabetic patients who are covered by private sector insurance and managed care companies which misclassify podiatrists as a "supplemental benefit." Everything podiatrists do, every service, every surgical procedure performed are basic physician's services. Podiatry is a medical specialty, not an optional service/supplemental benefit.
Anatomical Limitations Why should a podiatrist be able to save a diabetic patient's foot from amputation, but not be able to treat the same diabetic ulcer if it is a half inch above some anatomical line drawn by lay legislators? This is exactly the problem we had with an Ohio Diabetic Wound Care Center whose podiatrists were actually getting a 90% diabetic ulcer amputation reduction rate.
How can a podiatrist be a "real doctor" if you crush your foot, but not a "real doctor" if you scrape your knee? Podiatry is so confusing to the general public, most of which have never been to a podiatrist, that television's #1 rated Jerry Seinfeld Show did an entire program on whether a podiatrist was a real doctor or not?
Podiatry's clinical, medical, and surgical abilities have become too important to patients to allow confusion by virtue of an illogical anatomically-triggered scope of practice to impede patients from accessing podiatric care. Podiatry's scope of practice separates it from every other medical specialty in the U.S.
Historical Sketch and Summary
* Podiatry (formerly chiropody) may represent American Medicine's first attempt to create a medical specialty. It is an historical artifact dating back to the birth of modern chiropody/podiatric medical education with the opening of the first U.S. podiatric medical college founded by Maurice J. Lewi, MD in New York in 1911.
* In 1911, the hands and feet were considered the most complicated aspects of the medical profession. The podiatric profession became American Medicine's first attempt to experiment with specialization. A year later, the Carnegie Foundation funded a comprehensive study of all MD medical schools in the US and published what became knownas the Flexner Report which represented the birth of modern American allopathic MD medical education.
* The AMA used the Flexner Report over the next two decades to close MD diploma mills and pass state legislation that opened up public tax dollars to create standardized modern medical school curriculum.
* The Flexner Report was the basis for gaining the state legislators' agreement that MD's legally were recognized as physicians and granted an unlimited scope of practice.
* MD internships surfaced in the 1920's and 1930's, but medical specialty residency training did not occur until after World War II with the explosion of medical and surgical knowledge that WWII brought to medicine. Most current MD medical specialty societies were not founded until the 1950's.
* In 1937, the Illinois Delegation to the American Medical Association House of Delegates introduced a resolution which called on the AMA to take a position that it "…would be unethical for any MD to associate with or teach at a podiatric medical school." This AMA Resolution was referred to the AMA Council on Judicial and Ethical Affairs "for Study and to be Reported Back to the AMA House of Delegates in 1938."
* One year later, the AMA Judicial and Ethical Council reported to the AMA House of Delegates, "…podiatrists do practice ‘real medicine' and provide a needed service that MD's are too busy to attend to with their patients, unlike other professional quackery professions, such as osteopaths…." Therefore, in 1938, the podiatric profession was deemed ethical and the osteopathic profession was deemed "quackery." Until 1961, MD's were told it was unethical for an MD to associate with any member of the DO profession.
* In June of 1961, the AMA's Judicial Council took an official action…"that it was no longer unethical for doctors of medicine to associate professionally and on a voluntary basis with doctors of osteopathic medicine."
Not only did the DO osteopathic profession become accepted by the AMA as not being ‘quacks', they became the first profession other than MDs to achieve an unlimited scope of practice and have full physicians status. In the 1980's, DO's were AMA's number one targeted group of physicians to be recruited into AMA membership.
One key factor in the success of the osteopaths overcoming the discrimination of the AMA occurred in the 1950's with the emergence and integration of osteopathic and allopathic graduate medical education residency training programs. Medical knowledge exploded with the human carnage of World War II. This growth of medical knowledge necessitated creation of medical specialization to capture and fully utilize this knowledge.
This was accomplished in the 1950's by the creation of graduate medical educational specialty residencies, medical specialty societies and voluntary medical specialty certifying boards. This proved to be a much more effective manner of managing the explosion of medical and surgical knowledge.
Podiatric Residency Programs Podiatry's development of graduate medical education residency programs was linked to the medical education process only in recent generations of practitioners. Currently, podiatric residents, just like the osteopathic residents of the 1950's, are clinically trained in full body systems.
Today's podiatric accredited residencies require podiatric residents to be rotated through different medical specialty departments so they are trained as full scope physicians, just as MD and DO residents are trained regardless of their chosen medical specialty.
For example, psychiatric MD residents rotate through OBG-YN departments to deliver babies, surgery departments to do surgery, and internal medicine/family practice department to do clinical medicine before they specialize in psychiatric practice.
Podiatric residents have similar rotations through a number of these same medical specialty departments and are required to do a complete comprehensive history and physical examination as part of their accredited training program. (See Council on Podiatric Medical Education 320, Standards and Requirements for Approval of Residencies in Podiatric Medicine and Surgery, page 20, B Assess and Manage the Patient's General Medical Status, Items 1 – 4)
The average layman or legislator does not understand how the Ohio podiatric scope of practice limits podiatric physicians to using their clinical and surgical skills to treating the foot or ankle by state law (ORC Sec. 4731.51), yet allows podiatric residents to train in full body systems with the need to have the ankle or foot disease or injury triggering their training?
This is because the state law grants podiatry residency training certificates (ORC Sec. 4731.573) which limit the podiatric residents training to the accredited hospital residency program under the supervision of the podiatric residency training director. The statute, however, cites the Council on Podiatric Education's residency accreditation requirements as the basis for the training certificate.
This allows podiatric residents to be trained in all aspects of the human body, including the ability to perform a total physical examination of patients the same as any MD or DO medical specialties are trained.
Podiatry can be viewed as American medicine's first attempt to specialize and its last medical specialty to bloom via clinical and surgical graduate residency training programs.
Interestingly enough, even the issue of dropping the DO degree and exchanging it for an MD degree was tried by California DO's back in the 1960's. After a few years, the osteopathic physicians reversed their earlier decision to accept an MD degree and returned to the DO degree, which gave them their unique professional identity. They found it was the freedom to practice osteopathic medicine that empowered their profession, not the MD degree.
If the podiatric profession should approve Resolution XX-05, then it would place into motion a 10 year program to adjust podiatric medical education's system to follow the MD's and DO's pathway to an unlimited scope of practice.
Timetable for Implementation of Unlimited Scope of Practice
April, 2005 – Step 1 - "Unlimited Scope of Practice" Ohio House of Delegates' Resolution will be debated by the APMA House of Delegates. If passed, it will become an APMA membership referendum.
Summer/Fall 2005 – Step 2 - If the APMA House approves Resolution 2-05, ballots will be provided to APMA members to vote on this issue. For it to become the goal of the APMA requires approval by a majority of APMA members.
Fall/Winter 2005 – Step 3 - If the APMA member referendum on creating an "unlimited scope of practice" succeeds, then the APMA will initiate formal communications with the American Medical Association and the American Osteopathic Association requesting help and assistance in achieving this goal. This will include a formal request for assistance from the AMA and the AOA for re-engineering the podiatric medical education system to produce an unlimited scope of practice to podiatrists over the next 10 years.
2006 to 2009 – Step 4 - Following a series of meetings between the APMA, AMA and AOA, a task force will be created to create an integrated medical school and residency training experience and to produce an unlimited scope of practice podiatrist.
2009-2012 - Step 5 - The APMA/AMA/AOA Task Force would work with the eight podiatric medical colleges and residency programs to implement the educational changes necessary to create an unlimited scope of practice podiatrist.
2012-2015 - Step 6 - the APMA/AMA/AOA Task Force would work to create model state legislation to allow for grandfathering in all current podiatric physicians and surgeons who wish to keep their current state podiatric scope of practice while repealing all anatomically limited foot/ankle scopes of practice for newly trained podiatrists.
Podiatrists who already are in practice and wish to move to an unlimited scope of practice would need to supplement their training and pass a licensure examination once the unlimited scope of practice became state law. Once again we can look to the osteopathic profession approach to phasing in the unlimited scope of practice with doctors who were trained and practiced under the osteopathic limited scope of practice laws.
Conclusion
Whatever vision you as members of the podiatric profession choose to follow, it is critically important that you do have some vision to guide your profession through the turbulent times our nation's health care and insurance systems will surely be facing over the next ten years. Franklin Delano Roosevelt's second inaugural address used a biblical quote "Without vision, the people perish."
The podiatric profession is fast approaching the 100th year anniversary of the birth of "modern American podiatry"; like the ‘century plant' that only blooms once in a 100 years, podiatry is blossoming.
As APMA President Dr. Lloyd Smith stated in his recent editorial, "The Golden Age of Podiatry is now...don't miss out on being a part of it!"

It is now fall 2006, what has been done?
Has it passed the APMA house of delegates yet?

Has anyone spoken with or heard from a APMA rep on this subject?

 

[gustydoc]

what a way to make a come back Gustydoc.

In your oppinion do you think this is a reality? Or just pipe dreams?

I hope that it is a reality but in some states like NY it will be a steep up hill battle.

Thanks Sam. I think the possibility is certainly there and I believe our profession is at a stepping off point. The APMA has voted and passed a resolution approving the formation the investigative committee. They have already begun talks with our allopathic and osteopathic colleagues and from what little info I could squeeze out of the APMA reps I spoke with things are going well. The big roadblock I see in the near future is at the level of the podiatric colleges themselves. In order for resolution 2015 to work the schools will have to work together to make the necessary changes to curriculum and as you know there are a lot of egos out there in the podiatric education system that are opposed to change. I hope that by educating students on issues like this one we can help encourage change from the bottom up, so to speak.

 

[doclm]

Thanks Sam. I think the possibility is certainly there and I believe our profession is at a stepping off point. The APMA has voted and passed a resolution approving the formation the investigative committee. They have already begun talks with our allopathic and osteopathic colleagues and from what little info I could squeeze out of the APMA reps I spoke with things are going well. The big roadblock I see in the near future is at the level of the podiatric colleges themselves. In order for resolution 2015 to work the schools will have to work together to make the necessary changes to curriculum and as you know there are a lot of egos out there in the podiatric education system that are opposed to change. I hope that by educating students on issues like this one we can help encourage change from the bottom up, so to speak.

Thanks for the feedback. This is the first time in over a year that I heard of anything going on with this resolution.

 

[bigdig712]

So is this basically saying that students that complete their residency before 2015 will have to go back for more training to get the full scope license and those completing residencies after 2015 will already have the full scope license?

Also, if this goes through, would we be basically the same thing as foot/ankle orthopedic surgeons?

 

[gustydoc]

So is this basically saying that students that complete their residency before 2015 will have to go back for more training to get the full scope license and those completing residencies after 2015 will already have the full scope license?

Also, if this goes through, would we be basically the same thing as foot/ankle orthopedic surgeons?

It's hard to say exactly what additional rotations practicing DPMs would have to go through until that time comes, but it certainly would not be someting they would be required to do. With osteopathic medicine there was a grandfathering of degrees and there would be a similar method for DPMs. We would not be the same thing as a foot and ankle ortho since they would still have the additional surgical training for the rest of the body. I beleive we already are the same as foot and ankle orthos in regards to what we can do within our scope. With unlimited scope you would be restricted by your training. If you can prove you are trained in a procedure you can perform it.

 

[Dr_Feelgood]

I think that the meaning of the resolution is not to become orthopods; DPMs will still be DPMs. The change is that their will be a universal scope. It does not matter if you practice in NY or IA, the scope is what it should be, whatever your training dictates.

If anyone expects to be doing prostate exams after the resolution, I think that you will be disappointed. It will decrease the confusion not increase our ability to practice (unless your state is extremely limited like the NE USA)

 

[Podman]

I think that the meaning of the resolution is not to become orthopods; DPMs will still be DPMs. The change is that their will be a universal scope. It does not matter if you practice in NY or IA, the scope is what it should be, whatever your training dictates.

If anyone expects to be doing prostate exams after the resolution, I think that you will be disappointed. It will decrease the confusion not increase our ability to practice (unless your state is extremely limited like the NE USA)

I couldn't have said it any better feelgood. I also believe that this resolution will help ease some of the obstacles faced by DPMs for hospital previlidges and perhaps some insurance companies. The idea is essentially to allow us future DPMs to practice what we were trained to do without politics.

 

[cool_vkb]

It's hard to say exactly what additional rotations practicing DPMs would have to go through until that time comes, but it certainly would not be someting they would be required to do. With osteopathic medicine there was a grandfathering of degrees and there would be a similar method for DPMs. We would not be the same thing as a foot and ankle ortho since they would still have the additional surgical training for the rest of the body. I beleive we already are the same as foot and ankle orthos in regards to what we can do within our scope. With unlimited scope you would be restricted by your training. If you can prove you are trained in a procedure you can perform it.

So is this something that is going to happen for sure. or its just a plan or proposal. If this can really happen then i think all pods and pod students should donate generously what ever the APMA needs from us. Its very good resolution.

And how are the relations between APMA and AMA/AOA. I mean whats the guarantee that they will help APMA in achieveing this goal.

 

[Podman]

So is this something that is going to happen for sure. or its just a plan or proposal. If this can really happen then i think all pods and pod students should donate generously what ever the APMA needs from us. Its very good resolution.

nothing is for sure in politics my friend. However, our profession and association is pursuing that direction.

 

[ucrs]

wow..sounds like some exciting news. but why is it that the info on resolution 2015 is kept on the low so much? Wouldn't it be good to get the news out to the public and get more support?

 

[krabmas]

wow..sounds like some exciting news. but why is it that the info on resolution 2015 is kept on the low so much? Wouldn't it be good to get the news out to the public and get more support?

Like most politics things are done behind the scenes. When the APMA is ready for outside support they will ask for it.

 

[OSUDDS]

so what will happen to all the people fresh out of school, who miss it by a year or so?

 

[Dr_Feelgood]

I don't think that it will hurt active DPMs. I'm sure they will be included in any change b/c as stated before a universal scope doesn't mean you can do anything outside of your training. Therefore, active DPMs will be as experienced as any in caring for foot and ankle pathologies and will be included in the expansion of the scope.

 

[cool_vkb]

I don't think that it will hurt active DPMs. I'm sure they will be included in any change b/c as stated before a universal scope doesn't mean you can do anything outside of your training. Therefore, active DPMs will be as experienced as any in caring for foot and ankle pathologies and will be included in the expansion of the scope.

hey feelgood, when you say that our scope of practice will remain the same after resolution 2015.Then isnt the APMA self sufficient to carry out this resolution on its own as APMA is responsible for Podiatry, and if we are just asking for Universal Podiatry Scope then why do we need AMA or AOA to interfere. We could just have a strong lobby in Congress forcing them to pass a law on universal Podiatry Scope of practice.

I thought that as gusty_doc said that they are trying to make DPM something like DO (i.e having full scope on human body). Thats why they are asking help of AMA or AOA.

Can you explain in detail. iam not understanding this.please!

 

[Dr_Feelgood]

The AMA is about 100 times bigger that is why they are involved. Also most state and federal governments submit to the AMA recommendations.

And yes the universal scope does include the whole body, but even a DO/MD cannot go outside their training. A urologist would be in a world of trouble if (s)he decided to manage a patients heart disease. A physician is limited by his/her training. The issue w/ podiatry is in some states we have more training than the state scope allows. By lifting the limited scope in these states a pod will be able to perform any procedure that they have been trained in. Some examples would be ankle surgery in a state that does not include ankles, harvesting a skin graft from the butt/thigh not the posterior leg, treating compartment syndrome in the leg.

The only major adds that may be a possibility is BK amputations but again this will be dictated by the amount of training future DPMs receive.

 

[gustydoc]

hey feelgood, when you say that our scope of practice will remain the same after resolution 2015.Then isnt the APMA self sufficient to carry out this resolution on its own as APMA is responsible for Podiatry, and if we are just asking for Universal Podiatry Scope then why do we need AMA or AOA to interfere. We could just have a strong lobby in Congress forcing them to pass a law on universal Podiatry Scope of practice.

I thought that as gusty_doc said that they are trying to make DPM something like DO (i.e having full scope on human body). Thats why they are asking help of AMA or AOA.

Can you explain in detail. iam not understanding this.please!

Just to clarify our scope of practice will not remain the same, but Feelgood is right in that what we do as podiatrists will not change. An unlimited scope would allow us as podiatric physicians to better manage our patients overall health. For example the patients with diabetes who come to us for ulcers or neuropathy still have to see another physician for the management of their diabetes. With an unlimited scope you could also manage their diabetes, hypertension and other co-morbidities. Not only would that be easier for the patient, but it would save money in healthcare costs for the government and insurance companies. The unlimited scope would not only clarify the extent of our training to those who are not familiar with podiatric medicine. It would also allow us to make full use of the education we have received. To steal some words from Dr Mandraccia, the only difference between us as podiatrists and our allopathic colleagues is that we have an unlimited license to diagnose and a limited license to treat. With the passage of vision 2015 that would no longer be the case.

 

[cool_vkb]

thank u feelgood and gustydoc to clear my doubts. may god bless u guys.

 

[krabmas]

Just to clarify our scope of practice will not remain the same, but Feelgood is right in that what we do as podiatrists will not change. An unlimited scope would allow us as podiatric physicians to better manage our patients overall health. For example the patients with diabetes who come to us for ulcers or neuropathy still have to see another physician for the management of their diabetes. With an unlimited scope you could also manage their diabetes, hypertension and other co-morbidities. Not only would that be easier for the patient, but it would save money in healthcare costs for the government and insurance companies. The unlimited scope would not only clarify the extent of our training to those who are not familiar with podiatric medicine. It would also allow us to make full use of the education we have received. To steal some words from Dr Mandraccia, the only difference between us as podiatrists and our allopathic colleagues is that we have an unlimited license to diagnose and a limited license to treat. With the passage of vision 2015 that would no longer be the case.

I do not know if I agree with you that we could treat their diabetes. This is still an endocrine specialty. And HTN as well is more internist/cardiology.

It more means that we would be able to do full H & Ps and charge for them (BP,auscultate the heart and lungs...)

I really do not think that it would change how we practice that much, just a better understanding to the patients and medical community.

There would not be an arbitrary line on the leg where we have to stop treatment.

We could give out own B12 injections for peripheral neuropathy if that was the cause (a deficiency).

 

[Dr_Feelgood]

I do not know if I agree with you that we could treat their diabetes. This is still an endocrine specialty. And HTN as well is more internist/cardiology.

It more means that we would be able to do full H & Ps and charge for them (BP,auscultate the heart and lungs...)

I really do not think that it would change how we practice that much, just a better understanding to the patients and medical community.

There would not be an arbitrary line on the leg where we have to stop treatment.

We could give out own B12 injections for peripheral neuropathy if that was the cause (a deficiency).

I agree w/ you Sam. Like I said the only major surgery I can see being added is BKA.

 

[krabmas]

I agree w/ you Sam. Like I said the only major surgery I can see being added is BKA.

I think if we start talking about that as an added plus we may be headed for a fight. The vascular, ortho, and plastics that do it already make money on it - I think. but then again some do not want to do it.

Some one pretty influential in the "game" and head of a residency program said that this 2015 will never happen.

I started to think about that a little and this is what I thought...

If the APMA is working with the AMA and AOA for this goal it has to be a priority of those organizations as well to get it done in only 3 years (the time line says 2012-2015). They have their own isssues to work out like health care insurance, reimbursement, what ever else are their concerns...

I do not think it is a priority of the AMA or AOA. I hope I am wrong.

What do you guys think?

 

[Dr_Feelgood]

Agreed. But it does not seem to be a complex issue like insurance, ect. But they only way I think that will stay on task is if they feel that they will get something out of it, such as PPAC support. PPAC is a very well support group and money talks.

 

[gustydoc]

I do not know if I agree with you that we could treat their diabetes. This is still an endocrine specialty. And HTN as well is more internist/cardiology.

It more means that we would be able to do full H & Ps and charge for them (BP,auscultate the heart and lungs...)

I really do not think that it would change how we practice that much, just a better understanding to the patients and medical community.

There would not be an arbitrary line on the leg where we have to stop treatment.

We could give out own B12 injections for peripheral neuropathy if that was the cause (a deficiency).

Well the way the resolution is currently worded you could easily manage a patients other co-morbidities that a family practice doc might otherwise take care of. I haven't had any diabetic patients in clinic that are seeing an endocrinologist to get their glucophage, they get it from their FP Dr. The same goes for anti-hypertensive meds. I just chose these examples because they are common in the podiatric patient base. If you don't think with proper training we should be allowed to perform these things, that's fine but that is one of the goals of resolution 2015. Even something as basic as a flu shot is not currently within our scope and I think that is ridiculous. As far as what a podiatrist could do surgically that would not change at all unless there was some kind of change in the residency model which I don't see happening. The purpose is not to turn podiatrists into orthopedic surgeons, but to clarify the fact that they are physicians with the ability to manage the patient as a whole and refer when necessary. Many of the opponents of the resolution fear that with the unlimited scope there would be nothing to stop someone from getting their DPM degree and the seeking residency training in an area outside podiatry. I really don't think that is an issue since the AMA and OMA would have to agree to accept podiatrists into their residency programs first and there would be no reason to change disciplines if you could practice and bill like a foot and ankle ortho. I guess the bottom line is that there are a lot of uncertainties with where the profession is headed and how this resolution could effect us all, but with that being said I personally would like to see us be proactive rather than reactive. Those who are proactive don't find themselves looking back saying we should have done something when we had a chance.

 

[dawg44]

Well the way the resolution is currently worded you could easily manage a patients other co-morbidities that a family practice doc might otherwise take care of. I haven't had any diabetic patients in clinic that are seeing an endocrinologist to get their glucophage, they get it from their FP Dr. The same goes for anti-hypertensive meds. I just chose these examples because they are common in the podiatric patient base. If you don't think with proper training we should be allowed to perform these things, that's fine but that is one of the goals of resolution 2015. Even something as basic as a flu shot is not currently within our scope and I think that is ridiculous. As far as what a podiatrist could do surgically that would not change at all unless there was some kind of change in the residency model which I don't see happening. The purpose is not to turn podiatrists into orthopedic surgeons, but to clarify the fact that they are physicians with the ability to manage the patient as a whole and refer when necessary. Many of the opponents of the resolution fear that with the unlimited scope there would be nothing to stop someone from getting their DPM degree and the seeking residency training in an area outside podiatry. I really don't think that is an issue since the AMA and OMA would have to agree to accept podiatrists into their residency programs first and there would be no reason to change disciplines if you could practice and bill like a foot and ankle ortho. I guess the bottom line is that there are a lot of uncertainties with where the profession is headed and how this resolution could effect us all, but with that being said I personally would like to see us be proactive rather than reactive. Those who are proactive don't find themselves looking back saying we should have done something when we had a chance.

The flu shot is not in your scope what the heck does that have to do with the foot.

 

[krabmas]

The flu shot is not in your scope what the heck does that have to do with the foot.

I think that is more for pods in rural settings.

Dawg - did you read 2015? Did you read the history of DPM, MD and DO? I think that is the most interesting part of the whole memo.

 

[WildcatDMD]

Dawg has a darn good point. What the heck does a flu shot have to do with the feet? Why would a podiatrist give a flue shot?? Would a dentist give a flue shot?

What I don't understand is why people don't chose a profession based on what they want to do for a living. And even more, I don't understand why they aren't proud of what they choose to do. You don't see physicians calling themselves dentists, or dentists calling themselves physicians, why do some podiatrists want to call themselves physicians? I know that some chiropractors call themselves physicians... Why don't you like feet? That's what you chose. I seriously don't get it. You want there to be DPM cardiologists??

P.S. That whole thing about podiatry being "American medicine's first attempt at a specialty" is almost hilarious. Have you ever heard of dentistry? Dentistry split off far earlier than podiatry. The first dental school in the US opened in Baltimore in 1840 by physicians. Yet, we still are proud of being dentists. And we have our own scope of practice, that even a physician with "unlimited scope" of practice would likely lose his or her license practicing.

P.S.S. I've been drinking, and I'm looking for a fight. Bring it.

 

[Dr_Feelgood]

Dawg has a darn good point. What the heck does a flu shot have to do with the feet? Why would a podiatrist give a flue shot?? Would a dentist give a flue shot?

What I don't understand is why people don't chose a profession based on what they want to do for a living. And even more, I don't understand why they aren't proud of what they choose to do. You don't see physicians calling themselves dentists, or dentists calling themselves physicians, why do some podiatrists want to call themselves physicians? I know that some chiropractors call themselves physicians... Why don't you like feet? That's what you chose. I seriously don't get it. You want there to be DPM cardiologists??

I think you make some good and valid points. I have no problem w/ what I am going to be but I feel the spirit of the Resolution is not to make DPMs into cardiologists. It is to make things less confusing. Honestly, if all pod schools go to a format similar to DMU and AZPOD, they go to DO school. So to have a confusing system of this state says this while this state says that does not make sense.

The simplest solution is unlimited scope, therefore a pod practices what he/she has been trained. Honestly it would be like if a dentist had to stop at the 3rd molar in some states and at the 2nd at others. Wisdom teeth could be removed if the break the gum line in Nebraska but Iowa says that no dentist can removed them. Texas says you can remove the wisdom teeth but the dentist cannot administer local anesthesia, it must be done by a anesthesiologist.

P.S. That whole thing about podiatry being "American medicine's first attempt at a specialty" is almost hilarious. Have you ever heard of dentistry? Dentistry split off far earlier than podiatry. The first dental school in the US opened in Baltimore in 1840 by physicians. Yet, we still are proud of being dentists. And we have our own scope of practice, that even a physician with "unlimited scope" of practice would likely lose his or her license practicing.

I don't think it is fair to compare practices and scopes. Most dentist don't work in a hospital or do surgery in the OR. If that was the case then we are comparing apples to apples. Think of this as a insuree or a tax payer, right now in most states a pod cannot harvest a skin graft from the thigh or buttocks even though they have been trained in residency to do it. And in some states they cannot harvest a graft from the lower leg. Instead a general surgeon comes in and usually watches, says good job and walks out. So we are paying another doctor to do nothing. If we are to control medical costs we need to find stupid things like this and change them.

P.S.S. I've been drinking, and I'm looking for a fight. Bring it.

This is my favorite part. Maybe tonight I'll have some beers and get frisky.

 

[IlizaRob]

Dawg has a darn good point. What the heck does a flu shot have to do with the feet? Why would a podiatrist give a flue shot?? Would a dentist give a flue shot?

What I don't understand is why people don't chose a profession based on what they want to do for a living. And even more, I don't understand why they aren't proud of what they choose to do. You don't see physicians calling themselves dentists, or dentists calling themselves physicians, why do some podiatrists want to call themselves physicians? I know that some chiropractors call themselves physicians... Why don't you like feet? That's what you chose. I seriously don't get it. You want there to be DPM cardiologists??

P.S. That whole thing about podiatry being "American medicine's first attempt at a specialty" is almost hilarious. Have you ever heard of dentistry? Dentistry split off far earlier than podiatry. The first dental school in the US opened in Baltimore in 1840 by physicians. Yet, we still are proud of being dentists. And we have our own scope of practice, that even a physician with "unlimited scope" of practice would likely lose his or her license practicing.

P.S.S. I've been drinking, and I'm looking for a fight. Bring it.

It can be very confusing if you do not fully understand the resolution. I would be upset too if I thought pods were trying to be cardiologists. And dont worry, no one is discrediting dentists for their achievments. As feelgood eluded to, its more of an effort to decrease the confusion of scope. Pods will be able to do what they are trained to do based on their residency training. I do not see nor do I advocate residency training to include competency requiremnets into the knee and above. I think that in order for 2015 to happen, there will need to be an understanding of this so that we dont upset the orthos any more than we have.

This brings me to another thought. I find it difficult to believe that the AMA will endorse this resolution when they are currently supporting orthopedic societies in some states (Texas, Florida, etc) to decrease the scope of a pod. Somehow we need to get the orthos on our side. I think that is the biggest milestone. Im not sure how Dawg feels about that. But this resolution will bring with it changes in the podiatric medical education that is consistent with the AAMC's standards. That can only be good for everyone. (Setting financial reasons aside).

 

[jonwill]

This brings me to another thought. I find it difficult to believe that the AMA will endorse this resolution when they are currently supporting orthopedic societies in some states (Texas, Florida, etc) to decrease the scope of a pod. Somehow we need to get the orthos on our side. I think that is the biggest milestone. Im not sure how Dawg feels about that. But this resolution will bring with it changes in the podiatric medical education that is consistent with the AAMC's standards. That can only be good for everyone. (Setting financial reasons aside).

I don't think they have a lot of orthopods on their side. That is why nothing is being passed. I'm willing to bet it is a few old, insecure orthopods that have no clue and don't care what our training consists of. After all, how much opposition was there in Des Moines last year when hospitals FINALLY began recognizing podiatrists as members of medical staff with full privileges (Ok, so Des Moines is a little behind the rest of the nation with this kind of stuff but nobody is angry)? I don't think this "opposition" is what people make it out to be. I've personally never seen it.

I was actually in Florida right after the resolution failed and spoke with the pod that wrote the law and testified before the state. I asked him if he thought that they would try to pass the law again. He stated, "That depends on whether they want to spend that much money and lose that bad again!" The Florida issue is actually quite complicated. The bottom line is that increasing a scope of practice of any specialist is extremely difficult. One physician trying to decrease another physicians scope of practice is even more difficult! Especially when there is really no substance behind it (the whole "they don't have the training" defense won't hold up in court when you don't even know what someones training consists of).

On the other hand, I've said many times that I would be for reducing the scope of practice in a few states if it means establishing a national scope.

 

[cool_vkb]

I was actually in Florida right after the resolution failed and spoke with the pod that wrote the law and testified before the state. I asked him if he thought that they would try to pass the law again. He stated, "That depends on whether they want to spend that much money and lose that bad again!" The Florida issue is actually quite complicated. The bottom line is that increasing a scope of practice of any specialist is extremely difficult. One physician trying to decrease another physicians scope of practice is even more difficult! Especially when there is really no substance behind it (the whole "they don't have the training" defense won't hold up in court when you don't even know what someones training consists of). .

Hey what happened in Florida, which resolution failed. Can someone give some more details. Please.

 

[Dr_Feelgood]

One thing that has been brought up in another thread is the issue of equal pay for equal work. I would guess that is Resolution 2015 went through it would be difficult to deny this. Similar to paying DOs and MDs the same, I would imagine that insurance companies would be forced to do the same w/ DPMs.

Just another reason to get behind the Resolution.

 

[dawg44]

It can be very confusing if you do not fully understand the resolution. I would be upset too if I thought pods were trying to be cardiologists. And dont worry, no one is discrediting dentists for their achievments. As feelgood eluded to, its more of an effort to decrease the confusion of scope. Pods will be able to do what they are trained to do based on their residency training. I do not see nor do I advocate residency training to include competency requiremnets into the knee and above. I think that in order for 2015 to happen, there will need to be an understanding of this so that we dont upset the orthos any more than we have.

This brings me to another thought. I find it difficult to believe that the AMA will endorse this resolution when they are currently supporting orthopedic societies in some states (Texas, Florida, etc) to decrease the scope of a pod. Somehow we need to get the orthos on our side. I think that is the biggest milestone. Im not sure how Dawg feels about that. But this resolution will bring with it changes in the podiatric medical education that is consistent with the AAMC's standards. That can only be good for everyone. (Setting financial reasons aside).

I think you can eventually get some orthos on your side. The AAOS is the workhorse for the orthopod not the AMA. Legislation battles can get very ugly. Its going to take alot of time though, and many of the things that many in here have posted many a time are going to be what it takes. You have to standardize your education and training. You have to make admission standards more rigid. You have to phase out and get rid of the old timers. Those that have been out there practicing with nothing more than an "apprenticeship", or spending one day watching an orthopod and calling it a "fellowship". Finally you have to let your work do the talking and work side by side with orthopods.