Learning about my profession

[Adventure-time]

Hello, I am a podiatry student.

As a DPM, what can't I do in clinic, that all MD and DO physicians are able to?

Can I do a full physical? Can I assess a heart attack, etc.?

If someone asks me "What can every MD/DO do in a clinic that no DPM can do", what would you say?

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[bobtheweazel]

Nobody's gonna stop you from doing a full body H&P on every patient. I mean you'd probably go broke spending all that extra time on every patient, but you can do it.

For real though, if you just had a group of people watching various MDs/DOs/DPMs doing their daily routines in a clinical setting they wouldn't be able to tell you which one is which. I mean the patient comes in, you do H&P, ROS, and all the things the E&M code requires you to do (same E&M codes as for MDs/DOs, same requirements on your part), you order the tests (imaging, blood work, etc), prescribe the treatments (medications, PT, assistive devices, etc), refer out when necessary. Heck, you can even do surgery which probably most MDs/DOs can't do (since most aren't in a surgical specialty).

You might be limited in anatomy you can treat depending on state but that's a little different because within those anatomical limits you could still do pretty much whatever you want. There might also be a few other limitations on DPMs that might not be on MD/DO but those generally vary by state or insurance and are usually pretty minor in the grand scheme of things.

 

[Adventure-time]

Nobody's gonna stop you from doing a full body H&P on every patient. I mean you'd probably go broke spending all that extra time on every patient, but you can do it.

For real though, if you just had a group of people watching various MDs/DOs/DPMs doing their daily routines in a clinical setting they wouldn't be able to tell you which one is which. I mean the patient comes in, you do H&P, ROS, and all the things the E&M code requires you to do (same E&M codes as for MDs/DOs, same requirements on your part), you order the tests (imaging, blood work, etc), prescribe the treatments (medications, PT, assistive devices, etc), refer out when necessary. Heck, you can even do surgery which probably most MDs/DOs can't do (since most aren't in a surgical specialty).

You might be limited in anatomy you can treat depending on state but that's a little different because within those anatomical limits you could still do pretty much whatever you want. There might also be a few other limitations on DPMs that might not be on MD/DO but those generally vary by state or insurance and are usually pretty minor in the grand scheme of things.

I agree, when I shadowed a variety of physicians, I didn't notice much difference. Going through the preclinical years, I have a much better understanding than before I first entered podiatry school. As I'm getting closer to clinic, I just wanted to be sure I knew 100% where that line was drawn between what an MD and DO can do in a clinic that a DPM can't. I figured we can do just about everything an MD/DO can do because our physical diagnosis class didn't really have any limits.

Without the incusion of insurance, what can't we physical do in terms of patient care that every MD/DO can do? Do you know any specifics? stroke/heart attack assessment?

 

[Weirdy]

Without the incusion of insurance, what can't we physical do in terms of patient care that every MD/DO can do? Do you know any specifics? stroke/heart attack assessment?

Started clinic end of 1st year. Go in, see patient do SOAP note blah blah blah, then report back to attending. Attending goes in sees patient gives off list of things to do (or picks your brain and modifies your plan). They leave and you finish it up, finish the chart for them to sign off.

We only do full physicals (and even then, mostly residents doing it, not us) when patient is pre-op.

Why should I care about diagnosing their stroke/heart attack when they were referred to our department in the hospital for foot issues specifically?

Sure if they have a history of stroke or I see symptoms, make a note of it in HPI/PMH if it already isn't in their record and mention it to attending when presenting (only if it is pertinent to F&A or the attending likes having that info specifically when you present to them).

If they are a brand new patient and referred to our department specifically, do thorough HPI/PMH/SH/FH and pertinent ROS. I will document their unmanaged diabetes, hyperlipidemia, Schizophrenia, but I am not there to medically manage it.

When you go through clinic and residency, you will be going through other departments and they will expect you to do everything. Knock yourself out. But for now, and after you graduate residency, there should be no reason why you should be medically managing stroke/heart attack/ anything you were not trained for or explicitly spelled out in the state laws/hospital policies.

Be trained to recognize/diagnose/maybe manage a lot of things. But do realize you are a foot and ankle specialist. You gain nothing from taking on more responsibility that you are not specialized in.

 

[bobtheweazel]

I agree, when I shadowed a variety of physicians, I didn't notice much difference. Going through the preclinical years, I have a much better understanding than before I first entered podiatry school. As I'm getting closer to clinic, I just wanted to be sure I knew 100% where that line was drawn between what an MD and DO can do in a clinic that a DPM can't. I figured we can do just about everything an MD/DO can do because our physical diagnosis class didn't really have any limits.

Without the incusion of insurance, what can't we physical do in terms of patient care that every MD/DO can do? Do you know any specifics? stroke/heart attack assessment?

In terms of H&P and ROS and stuff like that you can do basically whatever you want, you just can't necessarily treat what you find depending on what you're looking at (but if an MD/DO found something outside of their specialty they wouldn't be treating it either, they would refer it to the appropriate specialist or back to PCP). I mean both CMS and JCAHO support podiatrists doing full body H&Ps for inpatient purposes and CMS also supports podiatrists doing it for outpatient services. Especially if you're talking something like cardiovascular risk assessment, that's definitely relevant to podiatry and it could hypothetically make sense to assess it if it's relevant to your treatment of that patient.

As far as limits I would use common sense, like you prob have no business doing prostate exams in your office but also would a foot/ankle MD be able to justify doing prostate exams in their office? Probably not. So that's kind of a ridiculous example but I'm sure you're safe examining systems relevant to your specialty, just as would be the case for any doctor in any other specialty.

But again, especially if you're working for someone else I'm not sure they would be down with you listening to heart and lungs sounds and doing all these extra tests all day instead of just looking at the things most relevant to the chief complaint and just working up and treating that issue, looking at the bare minimum extra body organ systems required by the E&M level you plan to bill. I guess you can do the extra exams (which is what your original question was) but in reality you probably won't (like most practicing podiatrists don't).

 

[NTT123]

Hello, I am a podiatry student.

As a DPM, what can't I do in clinic, that all MD and DO physicians are able to?

Can I do a full physical? Can I assess a heart attack, etc.?

If someone asks me "What can every MD/DO do in a clinic that no DPM can do", what would you say?

Not all MD/DO are the same. Not all DPMs are the same. Degree, license, and training are different things.

If you have an MD/DO degree and don’t have residency training, you cant do a single thing related to patient care. Maybe in 1 state acting as an assistant physician.

MD/DOs choose their speciality during school. DPMs choose their specialty before school.

They are bound by their residency training and practice what they train for.

A radiologist will not fix your fracture when they see it in the X ray.
A dermatologist will not try to manage your liver or kidney problems.
A pediatrician will not see your grandma’s heart problem.
A psychiatrist will not treat your pulmonary problem.
A vascular surgeon will not treat your mental health issues.
A Internist will not get a hospital privilege to perform bunions surgery.

In the real world, doctors want to do less, not do more.

MD/DOs stay in their specialty. Why would a DPM want to do something they are not train to do ?

 

[Adventure-time]

MD/DOs stay in their specialty. Why would a DPM want to do something they are not train to do ?

Its not about efficiency of taking medical tasks outside of ones specialty.

The conundrum rests between what we are able to do as DPM physicians, and if there is something we can't do that every DO/MD can.

So far, it appears that there is nothing that every MD or DO can do in a clinic that a DPM can't.

 

[NTT123]

Its not about efficiency of taking medical tasks outside of ones specialty.

The conundrum rests between what we are able to do as DPM physicians, and if there is something we can't do that every DO/MD can.

So far, it appears that there is nothing that every MD or DO can do in a clinic that a DPM can't.

There are many things that DPMs cannot do, but not every MD/DO can do.
- DPMs cannot take out a brain tumor, but not every MD/DO can do.
- DPMs cannot do a bypass surgery, but not every MD/DO can do.

There are many thing that DPMs can do, but not every MD/DO can do.
- DPM can perform reconstructive foot and ankle surgery, but not every MD/DO can do.
- DPM can treat gait and mechanical problems, but not every MD/DO can do.

Every physician performs the service that they are trained to do. Physicians consult and collaborate with each other all the time.
One of the best examples is the collaboration between vascular surgeon and podiatric surgeon.

DPMs have a scope of practice in the foot and ankle, but it doesn’t mean systems base care is missing.

DPMs are often the first one to diagnose someone with hypertension, uncontrolled diabetes, neuropathy, and PAD. When a DPM suspects patients with these diseases, they order the proper test and labs, and make a proper referral just like other physicians.

When an ophthalmologist diagnoses you with diabetic retinopathy, they refer you to PCP to manage your diabetes.

No one can do everything, unless you are Dr. House.

 

[de Ribas]

There are many things that DPMs cannot do, but not every MD/DO can do.
- DPMs cannot take out a brain tumor, but not every MD/DO can do.
- DPMs cannot do a bypass surgery, but not every MD/DO can do.

There are many thing that DPMs can do, but not every MD/DO can do.
- DPM can perform reconstructive foot and ankle surgery, but not every MD/DO can do.
- DPM can treat gait and mechanical problems, but not every MD/DO can do.

Every physician performs the service that they are trained to do. Physicians consult and collaborate with each other all the time.
One of the best examples is the collaboration between vascular surgeon and podiatric surgeon.

DPMs have a scope of practice in the foot and ankle, but it doesn’t mean systems base care is missing.

DPMs are often the first one to diagnose someone with hypertension, uncontrolled diabetes, neuropathy, and PAD. When a DPM suspects patients with these diseases, they order the proper test and labs, and make a proper referral just like other physicians.

When an ophthalmologist diagnoses you with diabetic retinopathy, they refer you to PCP to manage your diabetes.

No one can do everything, unless you are Dr. House.

That's why I don't really understand people who say that DPM has a limited scope. Any specialty has limited scope. Ophthalmologists are probably the most limited specialists. I have never shadowed any nor I know much about their work, but I guess their scope is even more narrowed than DPM's.

 

[GypsyHummus]

It’s because a ophthalmologist MD could eventually open up a medical spa, or a nutrition store as they have an unlimited medical liscence. There was a post on the pharmacy boards not too long ago that explained this: a pharmacist wouldn’t ask questions if a dermatologist MD prescribed ADHD medication to a patient, but if a DPM did the same thing, the pharmacist wouldn’t fill it.

That's why I don't really understand people who say that DPM has a limited scope. Any specialty has limited scope. Ophthalmologists are probably the most limited specialists. I have never shadowed any nor I know much about their work, but I guess their scope is even more narrowed than DPM's.

 

[de Ribas]

a pharmacist wouldn’t ask questions if a dermatologist MD prescribed ADHD medication to a patient, but if a DPM did the same thing, the pharmacist wouldn’t fill it.

Do you really think that any MD would just prescribe ADHD meds just because his license theoretically allows it? Do you really think this is that much more significant difference in our licenses? Why would I even want to prescribe ADHD meds as a podiatric physician? Why would orthopedic surgeon prescribe ADHD meds? Would like to see real numbers of what and how often MDs prescribe outside of their scope. This has been discussed in various threads and forums that even orthos would not adjust meds or even try to get involved with anything else unrelated to ortho work. They will simply write a note and send patient back to their PCP.


I am not saying that MD is not better than DO or DPM. It is better. But for the vast majority of MDs they will never really use MD beyond their specialty. Vast majority just work as hospital employees or in private practice utilizing their degrees only within the scope of their specialty.

Yes, potentially MD can be used much more broadly then other healthcare degrees, but most will never use that potential.

We all know the limits of DPM scope, but let's not say that it is worst degree you can have.

 

[Nowehjose]

In regards to reddit posts about DPM prescribing psychotic and other drugs on reddit. As mentioned above:

I don't think we should act like our friend's/family's personal GP. We live in a world where people fish for malpractice lawsuits... Simple thought process of "Something doesn't feel right, I probably shouldn't do it". Worst case you annoy a PT and ask them to bring it up with their GP.

 

[DexterMorganSK]

It’s because a ophthalmologist MD could eventually open up a medical spa, or a nutrition store as they have an unlimited medical liscence. There was a post on the pharmacy boards not too long ago that explained this: a pharmacist wouldn’t ask questions if a dermatologist MD prescribed ADHD medication to a patient, but if a DPM did the same thing, the pharmacist wouldn’t fill it.

That PharmD is being an idiot for not double checking the Derms Rx; just because an MD/DO can prescribe something doesn't mean they do it all the time or they don't know the consequences of being under their board's scanner...its a potential lawsuit just waiting to happen.

Everyone in their line of work has to work within their scope of practice and this doesn't make one field or profession better than another.

 

[dr.phoot]

That's why I don't really understand people who say that DPM has a limited scope. Any specialty has limited scope. Ophthalmologists are probably the most limited specialists. I have never shadowed any nor I know much about their work, but I guess their scope is even more narrowed than DPM's.

They average higher $$$$ than you do, big boy

 

[heybrother]

Become the kind of podiatrist who actually offers value to your patients and you won't have all these neurotic worries. Start asking yourself - what diagnoses will I nail that only a podiatrist or a f&a ortho could understand.

Or qualify every patient for nailcare so you have to spend the rest of your life seeing them 4 times a year for $29. Try and sell every patient custom orthotics. Set up a shoe carousel in your front office. Tell people that laser nail is the best solution. Perform crappy ineffective bunion surgeries with high recurrence rates (I've seen a person being signed up for their 3rd Reverdin and an Austin being revised with a second Austin, bravo!). Biopsy everything. Push b*ll**** compounded vitamins from a pharmacy you have stock in. When you see pathology you don't understand or don't have the tools for - just do whatever the minimum is/thing you know how to do even if its ineffective/will fail rather than referring them on.