How about DPM as a PCP?

[RockFoot]

I'm pretty new around here, am still in the interview acceptance process, etc. I know my place and do not wish to start a massive flame war one way or another.

I was thinking about the PCP shortage. In discussing this with my brother-in-law who is in NP school we both agreed that it would not be a bad thing if a 1 year additional residency/fellowship in primary care/family medicine were available for DPMs after their 3 year surgical residency. He agreed with me that a DPM would be at least as qualified as he in basic sciences to perform primary care, top that with a 1 year internship of some sort and why not?

Just like a pa or np, or even a DO or MD, a DPM who found him/herself out of his/her depth could just refer on up the chain. I know there are only 15k dpms and so it would be a drop in the bucket of the PCP shortage, but all the same, it could be a start that was beneficial to everyone involved.

Now please tell me what you think, how right I am or how wrong I am, just be nice about it.

* as a note, I would be proud to be a DPM and don't see a need to make DPM--->MD(p). I do think that legal equality across the board with DOs and MDs is a good thing, the fact that DPMs are treated as less than a 'real' doctor in military medicine is an are that bothers me somewhat.

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[flyhi]

While DPM and MD/DO programs are similar in some ways, I think there would be too many gaps in the DPM education to overcome with only 1 year additional training. Not to mention, a PCP residency.

I wonder if you did a PA program (2 years) after DPM, what your scope of practice might entail and if you could successfully practice as a DPM and as a PCP (by law under MD/DO)? Interesting concept. Curious as to other's thoughts as well.

 

[RockFoot]

interesting idea, yes I'd like to hear from the others on the forum as well

 

[MaxillofacialMN]

I don't care that pods don't have full scope (with the exceptions when it hinders treatment, like diabetes, etc etc). If you want to be a PCP, go to med school. Podiatrists are foot and ankle specialists, not PCP backups. Pods not a type of MD/DO/NP/PA, we're foot and ankle specialists. Asking to be PCPs suggests you aren't satisfied with the scope of practice and you should look elsewhere for a career imo.

 

[flyhi]

Asking to be PCPs suggests you aren't satisfied with the scope of practice and you should look elsewhere for a career imo.

Negative.

It's trying to access multiple income streams, perhaps. It's possibly being interested in moving to a very rural and underserved area that does not have enough business to support solely a podiatry practice, yet needs a PCP and podiatrist in town. It's perhaps wanting to do both and learn both. It's perhaps planning for the future in the event surgery is no longer an option due to health reasons. There are MANY reasons I can think of that this would make sense. Think big picture, big.

 

[flyhi]

My overall point is that podiatry students are getting exposure to the basic physical exams that medical students are getting. I've been told that we will be held to same standards as the medical students when we are doing our ER and Medicine core rotations in downtown Chicago. The arguement is whether or not podiatry students are getting the same medical education. Our medicine class during our P2 year has been a major dissapointment in my eyes. I thought we would be learning out of Harrison's like every other medical student but instead we are getting watered down lectures. Right now we are in the neurology section of the class and it has more of an emphasis on the the lower extremity. This is obviously great from a podiatry perspective but from a parity perspective it doesn't cut it.

Interesting. Thanks for the input.

 

[MaxillofacialMN]

An MD PCP can do everything a pod does anyway... If your moving to a small town as a podiatrist PCP you would see the same patients if you were an MD PCP, do it wouldn't matter what you specialized in...

 

[tenaciousplus]

deleted

 

[flyhi]

An MD PCP can do everything a pod does anyway... If your moving to a small town as a podiatrist PCP you would see the same patients if you were an MD PCP, do it wouldn't matter what you specialized in...

LOL.Really, now? Last time I checked, a Family Medicine specialty and residency did not equal a Surgery residency. If that were the case, MD/DO students who wanted to be a PCP would just go to pod school if they couldn't get into MD/DO school.

 

[MaxillofacialMN]

LOL.Really, now? Last time I checked, a Family Medicine specialty and residency did not equal a Surgery residency. If that were the case, MD/DO students who wanted to be a PCP would just go to pod school if they couldn't get into MD/DO school.

You are suggesting you are in a small town. The reason you want a DPM PCP is because there isn't a MD PCP around. If that's the case, certainly the opposite would be true as well, you could be a MD PCP and there wouldn't be a DPM around. The patient pool is finite and under either situation you would see all the cases. One of them already exists, the other doesn't.

 

[MaxillofacialMN]

LOL.Really, now? Last time I checked, a Family Medicine specialty and residency did not equal a Surgery residency. If that were the case, MD/DO students who wanted to be a PCP would just go to pod school if they couldn't get into MD/DO school.

Also, this doesn't make sense. You are saying: If family med is equal to surgery, then any student who wants to go into PCP (family med) would just go to pod school. What?

Pod school isn't full scope surgery, nor is it family med/PCP. It is foot and ankle specialists. If you allow pods to become primary care providers you WOULD see a bunch of students who want to go into family medicine go to pod school because it's easier to get into. Then you lose the integrity of the career.

 

[MaxillofacialMN]

Negative.

It's trying to access multiple income streams, perhaps. It's possibly being interested in moving to a very rural and underserved area that does not have enough business to support solely a podiatry practice, yet needs a PCP and podiatrist in town. It's perhaps wanting to do both and learn both. It's perhaps planning for the future in the event surgery is no longer an option due to health reasons. There are MANY reasons I can think of that this would make sense. Think big picture, big.

But... if you want to do family medicine and foot surgery in a small town, go get a F&A fellowship after orthopaedic surgery and then move to a small town. This route already exists, I don't know why everyone is so gung-ho about allowing pods to become primary care physicians. Am I seriously the only one who sees a problem with this?

 

[347932]

We ARE primary care physicians...of the foot and ankle!!

 

[flyhi]

But... if you want to do family medicine and foot surgery in a small town, go get a F&A fellowship after orthopaedic surgery and then move to a small town.

It's real simple. I want to be a podiatrist not a F&A ortho. You only picked out one example, btw; there are other reasons to marry the two other than being a rural DPM/PCP. But, since you asked.....the scenario you suggested doesn't make sense and would be foolish to attempt if your goal was to be a F&A surgeon and PCP . First of all, you have to TRY and match into an ortho residency and then TRY and get a F&A fellowship. Secondly, you just don't go do family medicine after an ortho residency. Pretty sure you would have to do a FM residency as well. Obviously not only the much longer route, but ZERO guarantees you will match ortho in the first place. Plus, med school is generally quite a bit more expensive. There is more than one way to skin a cat. Big picture, remember?

 

[flyhi]

you could be a MD PCP and there wouldn't be a DPM around. The patient pool is finite and under either situation you would see all the cases. One of them already exists, the other doesn't.

That's fine, but as an MD PCP, you cannot do the surgery on the foot that a podiatrist is qualified to do, so what's your point? As a DPM/PCP, you would treat patients that needed foot/ankle surgeries AND be a PCP. Big difference.

 

[MaxillofacialMN]

That's fine, but as an MD PCP, you cannot do the surgery on the foot that a podiatrist is qualified to do, so what's your point? As a DPM/PCP, you would treat patients that needed foot/ankle surgeries AND be a PCP. Big difference.

MD PCPs can do foot surgeries. They can do whatever they want. Hence the full scope.

 

[Ferocity]

Sigh...

 

[RockFoot]

and that is exactly what I had hoped to avoid. Oh well it was just a thought no n need to kill each other over a hypothetical.

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[flyhi]

MD PCPs can do foot surgeries. They can do whatever they want. Hence the full scope.

Ok, good luck with that.


Hopefully others can contribute to the OPs initial question without getting the 'why on Earth would you EVER want to do that?' question again.

 

[flyhi]

and that is exactly what I had hoped to avoid. Oh well it was just a thought no n need to kill each other over a hypothetical.Sent from my SPH-D600 using SDN Mobile

In reality, it's more than a hypothetical, especially when more cuts come down the road and no one wants to go into FM. They will either move more towards mid-levels, or figure out a way make current physicians PCPs, imo. There is a reason at least one school provides a DPM to DO track.

 

[MaxillofacialMN]

Flyhi, you engaged me, so you were just as off topic as I was, lol.

Also, DPM to DO path? This is the first I've heard of this...?

 

[josebiwasabi]

Nova Southeastern University (NOVACOM) near Ft. Lauderdale, FL, has an accelerated DO track for people who have already earned a DPM.

 

[347932]

MD PCPs can do foot surgeries. They can do whatever they want. Hence the full scope.

Oy vey. No they can't.

They must function within the scope of their specialty. Not only that, but they are not covered for surgical procedures by their malpractice. Believe it or not, them doing nail avulsions in their office can lead to trouble malpractice wise.

Please give me an example of a IM/FP who is doing surgery (other than nail avulsions and lesional biopsies in their offices).

 

[MaxillofacialMN]

Nova Southeastern University (NOVACOM) near Ft. Lauderdale, FL, has an accelerated DO track for people who have already earned a DPM.

Well look at that. You learn a new thing everyday!

 

[MaxillofacialMN]

Oy vey. No they can't.

They must function within the scope of their specialty. Not only that, but they are not covered for surgical procedures by their malpractice. Believe it or not, them doing nail avulsions in their office can lead to trouble malpractice wise.

Please give me an example of a IM/FP who is doing surgery (other than nail avulsions and lesional biopsies in their offices).

Well, according to page five, in Michigan MDs can do whatever they want: "A physician is someone who is licensed under the state’s Public Health Code to practice medicine, including surgery, regardless of whether the practitioner is a generalist or specialist."

http://www.msms.org/Content/ContentFolders/Advocacy2/ScopeofPractice/ScopePracBook.pdf

And if you are a family doctor and want to do surgery, just get different malpractice insurance. It will probably cost way more, but it is certainly doable.

 

[flyhi]

Flyhi, you engaged me, so you were just as off topic as I was, lol.

True dat, but it's because I can't help it when you are so wrong

Yeah, NOVA has the bridge program. I think they only take like 1-3 a year and if you read the fine print, not sure it makes any sense to do it from a time/financial perspective. I think you only get one year shaved off of the 4 yr. curriculum, then you have to do a residency That's why I still feel the DPM/PA combo might be something worth investigating. Plus, you probably could get the 2yr PA program shaved down to 1yr since the basic sciences would surely be covered by Pod school. Then, you are basically just doing PA rotations.

And, we've come full circle

 

[347932]

Well, according to page five, in Michigan MDs can do whatever they want: "A physician is someone who is licensed under the state’s Public Health Code to practice medicine, including surgery, regardless of whether the practitioner is a generalist or specialist."

http://www.msms.org/Content/ContentFolders/Advocacy2/ScopeofPractice/ScopePracBook.pdf

And if you are a family doctor and want to do surgery, just get different malpractice insurance. It will probably cost way more, but it is certainly doable.

Did you happen to read the entirety of the document? You will find that your comment is a little off. Read it, please.

 

[RockFoot]

yes a pa/pod combo would be more in line with what I was thinking. a dpm/do combo would take to long and cost too much. of course being that we are pods and have more in depth training I would of course want autonomy to practice independently as a pcp a la NPs.

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[janV88]

Well, according to page five, in Michigan MDs can do whatever they want: "A physician is someone who is licensed under the state's Public Health Code to practice medicine, including surgery, regardless of whether the practitioner is a generalist or specialist."

http://www.msms.org/Content/ContentFolders/Advocacy2/ScopeofPractice/ScopePracBook.pdf

And if you are a family doctor and want to do surgery, just get different malpractice insurance. It will probably cost way more, but it is certainly doable.

I didn't read the document but I can tell you that in order to perform surgery at a hospital you will need hospital privileges...good luck getting that without the training. And if an MD/DO PCP were somehow able to get these privileges, what kind of patient would go to them instead of the Pod or Ortho next door? Even if they did find a patient to perform surgery on...how would they know what to do without the training? Even if they did somehow perform the surgery...what if the patient has a bad outcome...this situation would be a Lawyer's dream come true. Oh and "I am an MD so I can do whatever I want!" will not hold up in court. DPMs and MD/DO orthos would be lining up as expert testimony.

 

[MaxillofacialMN]

Did you happen to read the entirety of the document? You will find that your comment is a little off. Read it, please.

I did read it. Pages 13-14 say that because of a physicians training, education, etc etc they may "Perform surgery and other invasive and non-invasive procedure."

 

[MaxillofacialMN]

I didn't read the document but I can tell you that in order to perform surgery at a hospital you will need hospital privileges...good luck getting that without the training. And if an MD/DO PCP were somehow able to get these privileges, what kind of patient would go to them instead of the Pod or Ortho next door? Even if they did find a patient to perform surgery on...how would they know what to do without the training? Even if they did somehow perform the surgery...what if the patient has a bad outcome...this situation would be a Lawyer's dream come true. Oh and "I am an MD so I can do whatever I want!" will not hold up in court. DPMs and MD/DO orthos would be lining up as expert testimony.

The reason my point was brought up was because we were in a rural town that had a podiatrist but didn't have an MD... somehow

 

[janV88]

The reason my point was brought up was because we were in a rural town that had a podiatrist but didn't have an MD... somehow

Rural or not, federal law/state law is not the end all be all. Hospital bylaws must be met before a physician or any clinician can be granted privileges and these always boil down to training.

 

[flyhi]

yes a pa/pod combo would be more in line with what I was thinking. a dpm/do combo would take to long and cost too much. of course being that we are pods and have more in depth training I would of course want autonomy to practice independently as a pcp a la NPs.

I get the autonomy thing, but PA's actually can have quite a bit, in a lot of situations. As you may know, becoming an NP is a circuitous route - must get RN first and then NP. Plus, no offense to your brother whatsoever, but PA training is just that - modeled after medicine, whereas NP training is based off of the nursing model. Very different, imo.