Another question about the profession.

[Hendooneh]

Anyone know why podiatry is not a post MD/DO specialty and instead it has its own school? I mean just looking in here it seems podiatrists can prescribe drugs do surgeries and a lot more things so then what's different about the feet to set it apart from the rest of the body?

I mean I can understand optometrists since they don't deal with any medical problems, just dx refer and prescribe glasses. But it seems podiatrists are just like MD/DO with a podiatry residency.

Is treating the feet that hard that you need to focus on it completely?

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[TomOD]

Hello Hendooneh,

I can't answer your question about podiatry (I am an Optometrist)but felt the need to help you understand the scope of practice of optometry. I do diagnose and treat ANY disease of the eye not requiring major surgery (ie. medically). This includes red eyes (from conjunctivitis, conjuntival/corneal abrasions) , anterior uveitis/iritis, lid infections, glaucoma and pre-and post-operative care for all eye surgeries (including cataract, diabetic-PRP and focal, strabismus surgeries).

I apologize for jumping into the podiatry forum. But I am sure I would see this person in the OD forum soon enough.

Why not ask why dentistry is not a part of allopathic medicine. There are no toothMD's!
I believe podiatry, like optometry, dentistry, chiropractic and other health professions evolved because people realized that knowledge is available everywhere...not just within a few schools that teach medicine.

 

[Toejam]

I'm a DPM and I'll tell you what I know.

I'm not 100% sure, but when I was in school the prevailing thought was simply that the foot and mouth were not adequately addressed in a typical medical school curriculum and separate schools eventually popped up. Podiatrists, originally, did not have the full-scope, medical priveleges that they have now. They didn't do any surgeries or have any drug licensing privileges. Eventually, they incorporated all of this into the profession and are still fighting for certain rights. I don't know about dentistry, but I've heard that it is a similar story.

And, just as an observation, when I was studying as a student and seeing patients as a resident, the MD's and DO's were NOT AT ALL interested in dealing with patient's foot and ankle problems. This led me to believe that the foot and mouth are just parts of the body that physicians have little interest in.

 

[amily]

If podiatry and dentistry were subspecialties available to MDs post graduation they would probably be very competitive. They are in some ways similar to dermatology and ophtalmology in that you concentrate on the medical and surgical treatment of one system. Also the lifestyle is good compared to many other medical subspecialties.

 

[efs]

To get a better understanding of how podiatry and dentistry came to be you ought to look into the history of medicine. It is certainly more complex than what I might post here. I really recommend you do some reading on your own.

Way back when, the "Medical Doctors" had a more limited scope than they take today. They considered themselves to be "educated" and many things were below what they would do. Medicine was cerebral rather than a "hands-on" type of thing. That would have been menial, and not for persons of their standing. They felt that surgery and such was beneath them. For a reference to this, I would point out that the Hippocratic oath states they will not take up the knife to cure kidney stones. That this is better left to those who do that sort of thing. Think about the "Barber-Surgeons". Treating ailments of the foot, (Corns, calluses, etc.); or pulling teeth was beneath them. People still needed these things done, so people other than the "Medical Doctors" did them. For many obvious reasons, what they could do was limited. For example, without anesthesia there is only so much that can be done.

To this day, there is still some rivalry between "Medical" Doctors and Surgeons. If you spend some time among both, you will notice some differences in temperament and personalities. There are jokes about it, and there is some truth to it. The Dentists and Podiatrists both fall outside of this as they are newer "specialties."

Things change with time. Podiatry came out of the roots of Chiropody in the past 100-200 years. With the advances made in antibiotics, anesthesia, surgical technique and so forth, Podiatry has become a more surgically oriented specialty than could have been envisioned by the chiropodists of 1900.

In addition to this, some podiatrists spent a great deal of effort putting together their theories on biomechanics. This is more recent, like early 1950's. Lots of stuff going on with biomechanics. This is one major focus of podiatry that sets it apart from the MD/DOs.

I think it is an interesting topic. Unfortunately there are few sources of podiatric historical literature. On the other hand, it is a young profession, so journals are available as far back as the profession began in this country. The big questions concern what happened before then.

Hope this helps a bit.

 

[efs]

On a more practical note. From my experiences in clinical rotations, most physicians still have little/no interest in the foot. It is incredible how many diabetic patients we see whose primary physicians have no idea what is happening with their feet. They don't even take the time to look during a routine appointment. Hey, that diabetic neuropathy and a small ulceration can lead to an amputation. If you don't look, you won't see it.

 

[Hendooneh]

To TomOD: Everything I said about optometrists came straight from lectures that we had from my optomologist classes (in fact we had questions on our tests asking us what optometrists could and couldn't do) so if its different in the real world I apologize.

EFS: I actually have had a history of medicine class where I learned all about the roles of medical doctors and surgeons and how they shifted into what they are today and there wasn't a single mention of podiatry. In fact I had never even heard of podiatry until I took the MCAT and was bombarded with brochures from podiatry schools telling me to consider podiatry. Dentistry in practise is just very different from anything else an MD does (my wife is a dentist so I see what she does) but podiatry just seems like it should follow md/do school.
I guess I feel its nice that you get to go to school and experience a few different fields before choosing what specialty you want to have. The only advantage I would see to having a separate school is if the time in training were to be cut drastically lower for people who want to get on with their lives.

 

[efs]

You are right on target. Time in training is reduced, with an earlier emphasis on specialty.

As fas as your history of medicine classes. Did they mention anything about Osteopathy and how that came about? Or its other off-shoot of chiropractics? Did they spend any time discussing homeopathy or naturopathy? I don't intend to put podiatry in a class with any of the above, I just want to know if the classes were really in depth or if they just focused on the major aspects of modern medicine. The history of medicine really is pretty amazing, and unfortunately I don't think most physicians get enough of it.

 

[ussdfiant]

•••quote:•••Originally posted by efs:
•You are right on target. Time in training is reduced, with an earlier emphasis on specialty.
•••••This is one of the biggest problems that I have with the way in which podiatrists are educated. In the fall I will be attending Temple School of Medicine and I am thinking about specializing in radiology. If I decide, after a radiology rotation in my 3rd year, that I never want to look at a CT scan again I can still do anything. I have made no comittment and have lost nothing. If I were to have gone to Temple School of Podiatric Medicine, gone to the wards during my 3rd year and decided that I never want to look at another foot again (even if, before enrolling, I shadowed podiatrists who did neat and interesting things and I was sure, at the time, that is what I wanted to do) I would be out of luck. If I changed my mind, which I think is totally reasonable if prematriculation clinical exposure is limited, I would have to start all over again beginning with retaking the MCAT (right Toejam?) I would never want to be obligated to a certain specialty (even radiology) from day one without being able to explore all specialties (from a medical student's point of view) and make an informed decision with the option of changing my mind 2 or 3 times without consequence. Just my opinion.

 

[Toejam]

So true, defiant.

This is one of the biggest obstacles when someone "decides" that they want to be a podiatrist. I know that there are a good number of podiatry students who wanted to be DOCTORS and were unable, for one reason or another, to gain admission to MD or DO school. Once they were in podiatry school they may realize that they still want to be a doctor but DO NOT want to be a podiatrist (me). I've experienced it, seen it with other students and have heard these kinds of stories time and again. I was ACUTELY aware that once I started the program, I was not going to be able to change tracks (like become an orthopod or dermatologist). I didn't like it at all, but I also was ACUTELY aware that I was unable to gain entry into any DO or MD schools. So, if I wanted to be a doctor, I had to stick it out. And, oddly enough, even though I no longer want to be a podiatrist, I know that all of this podiatry education and experience will most likely be my ticket into DO or MD school (however circuitous the route may have been).

DPM's are not in the same category as DO's and MD's. I'm not saying that DPM's are inferior, just that they aren't in the same medical category as DO's and MD's. They don't have the same didactic or clinical training. They don't have the same clout or overall respect in the real world. There are many pod students who begin to feel these inequities early on (me) and start to feel a little uncomfortable and naturally begin to question their decision to be a podiatrist. Our class went from about 140 to 80 when it was all said and done. There were at least 10 students that I knew of that were simply biding their time and waiting to get into a DO or MD school during our first year. The rest left for a whole host of reasons. I can tell you that I was SERIOUSLY envious of the students who went on to MD or DO school. Even if it was overseas.

I think the absolute worst mistake a prospective podiatry student can make is to accept admission only because they couldn't get into DO or MD school. Most will regret it. They will forever be suffering from DO/MD envy.