Freeeedom!

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The following is a thread started by some "militant" physical therapists and their comments on a PT chat board.
www.rehabedge.com






"This is inspired by the current DC crossing the line thread. I thought a questionnaire would be interesting. Please answer with your profession and where you practice. Please forgive my bias towards orthopaedics. Try to post under another name if you wish to be anonymous. You could also email the answers to me(or someone you trust) and I'll post them anonymously. Feel free to only answer the questions you want to.
1)Do you think PTs should have direct access?

2)Do you think that PTs can diagnose?

3)Do you think that PTs need more training before having direct access?

4)Do you think that doctors should be able to write PT scripts (dictate treatment)?

5)Do you think the knowledge and expertise in physiotherapy justifies a DPT (along the lines of chiro, dpharm, od, not a medical degree)?

6)Are you for or against the move to a DPT and is this a strong or weak opinion?

7)Do you think that increased imaging and pharmacology is needed for a DPT?

8)Do you think that the knowledge and expertise in physiotherapy justifies a medical doctorate?

9)Do you think that the current move to a DPT is ill timed?

10)Do you believe that current DPT programs are adequate?

11)Do you think that PTs would benefit from the ability to order imaging studies?

12)Do you think that patients would benefit if PTs could order imaging studies?

13)Do you think that health care would benefit if PTs could order imaging studies?

14)Do you think that PTs would benefit from limited prescription rights?

15)Do you think that patients would benefit from PTs having limited prescription rights?

16)Do you think that health care would benefit from PTs having limited prescription rights?

17)Do you think that a PT is more knowledgeable than a physiatrist in a) rehabilitation and b) non-surgical orthopaedic assessment and diagnosis?

18)Do you think that a PT is more knowledgeable than an orthopod in a) rehabilitation and b) non-surgical orthopaedic assessment and diagnosis?

19)Do yo believe that the initials behind your name or others mean something?

20) Who is more deserving of the title doctor of rehabilitation: physiatrist or dpt

[This message has been edited by Bournephysio (edited May 12, 2003).]
"
 

PACtoDOC

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Whats up Freedom? Long time no hear or see! How was the intern year? Where are you again?

I hate the idea of another allied health professional trying to use the Dr. title. They can get seven doctorates, but they still aren't going to be physicians. You can speak for that I believe Freedom.
 
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Well what do you know? Another group of allied health care workers trying to take a crack at the MD/DO mountain.

Hell, if this crap continues for another 20 years, they will be able to do everything an MD/DO can do, including surgery.

I'm sick of hearing about how everybody and his brother is just as good at medicine as doctors are.

If they want to practice general medicine and keep increasing their scope, they have a definitive route for that and its called medical school.
 

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Do I even WANNA know what these guys think of the PM&R specialty ????

Seriously, I wanted to be a pt before med school.. then i found out about the above mentioned specialty, and decided, hey, I can be a physician and do what I love, and be able to help my patients better...hmmm... I think Ill go to med school.... yea THATS a good idea!


Just a thought, and nothing against PT's or DC's... but what the bleeep--- physical medicine is starting to become "popular" and everyone and their brother wants to do manipulation type stuff AND prescribe....
I wonder if medical coders will want to code separately for their services too...

Yea, back to neuro....
Brooklyn,
nycom 2006
 

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Direct access... one of the bigger topics going on in the physical therapy world...

My fiancee' is a physical therapist, and I usually try to read the journals that come along with being a PT... (The Journal of the APTA, Advance for PT, etc)... it appears that the drive to push for direct access to care is undergoing HUGE criticism even amongst many PTs. Most of the PTs I know (I almost always get to know the PTs at the hospitals I rotate at because of my fiancee') do not agree with direct access to care. It is but a few that support it. Off the top of my head, I do not even believe the APTA is supporting the push for legislation.

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It's a story as old as time: Everyone wants "increased access" and "scope of practice" without undergoing the rigors of actually attending medical school. Psychologists want to prescribe psychotropics, podiatrists want to do total knee replacements, optometrists want to do surgery, CRNA's want to pass gas unsupervised, PA and NPs want to everything, chiropractors want to be primary care physicians, etc. Yet, none of these groups really want the LIABILITY of what they do. There is only one way to secure a full-scope medical license and that's to attend medical school---you even have a choice---you can attend a DO school or a MD school. Which ever you prefer or can get into is fine with me. Physicians need to stand up, stand together, and say that our training matters. There's a reason why we attend 4 years of college, 4 years of medical school, and 3-7 years of residency and/or fellowship. It's because when it comes to other's lives rigor matters and when it comes to professional responsibility the buck stops with us. Guess who gets sued if the PA screws up, if the CRNA can't wake the patient up, if the NP prescribes the wrong med? It's us.
 

Freeeedom!

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You hit the nail on the head, go to rehabedge and tell them how you feel!
It is a complete cop-out on their part to LEGISLATE greater practice rights as apposed to using the avenue that is already open to them...medical school.
 

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Ditto what drusso said and I would like to add that even physicians don't have full practice rights even in prescribing. Some meds are off limits unless you are a certain specialist. Also, you wouldn't want a psychiatrist to do your triple bypass, and you wouldn't want a proctologist to talk about your feelings. I always tell people who say that they want to be an NP that they should go to med school if they want to be a doctor. Their answer always supports the assumption that they don't want to go through the rigors of med school.
 

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Maybe the allied health folks can do 99.9% of what MD/DO's do. As an analogy, I know that EMT-basics and paramedics have about the same outcomes for their patients. This is despite the huge difference in training and treatment capabilities. From what I have read, CRNA's and NPs do about as well as MD/DO's in many enviroments.

This debate will rage on stronger and stronger, and we have to be careful how we frame the debate. Justifying the higher-level provider based on better outcomes may not be the most effective tactic.

(Just for the record, when I am hurt, I want a medic in the rig, a doctor in the ED, and an anesthesiologist in the OR!)
 
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It's not about outcomes per se. Yes, I'm sure that a lesser trained individual could produce comparable health care outcomes most of the time. But, that's not how the airline industry approaches training airline pilots. Do you want an airline pilot, who is literally responsible for hudreds of lives at a time, to have the MINIMUM training or be overtrained as hell so as to pretty much be able to land safely a 747 with one engine, one eye, and one hand tied behind his (or her) back? So, why would you trust your loved one to someone with only minimal qualifications in medicine?

Overtraining is a real psychological phenomenon with decades of scientific research to substantiate it. As physicians we're -overtrained to generate not only positive health outcomes 99% of the time, but also to be as vigilant as hell for the 1% of things that are not so easily recognized. The only way to achieve this vigilance is through training intensity and duration. It's difficult to recognize what you've not personally seen or experienced. If a CRNA has never seen an allergic reaction to halothane during their training will they recognize it in their practice? If a PT has not worked up cancer patients who present with back pain caused by metastatic lesions to the spine, will they recognize it in their practices? If a psychologist has not been trained to recognize and manage medically complicated psychiatric patients, how will they recognize the myriad drug combinations that can mimic psychiatric symptoms?

Why doesn't there exist "pilot assistants" or "flight-attendant aviators" in the airline industry? Imagine if you got on board a "routine" commuter flight and the following voice came over the PA, "Good morning and welcome aboard xxx airlines. Your flight today will be piloted by Shiela, a certified flight attendant-avaitor. In addition to having 8 years of experience in the airline industry as a flight attendant, Shiela has completed an accelerated 14 month course in aviation and looks forward to serving you today." Would you stay on the plane?
 

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Originally posted by drusso
Imagine if you got on board a "routine" commuter flight and the following voice came over the PA, "Good morning and welcome aboard xxx airlines. Your flight today will be piloted by Shiela, a certified flight attendant-avaitor. In addition to having 8 years of experience in the airline industry as a flight attendant, Shiela has completed an accelerated 14 month course in aviation and looks forward to serving you today." Would you stay on the plane?
:laugh: HELL NO!!!! :laugh:
 

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drusso , I have to respectfully disagree with you(only profession I can speak for is podiatry),we do go through 4 years of Podiatry school then 2-4 yrs of residency. We dont want to do total knees or even do sx on knees. We want to practice what our training enables us to do not what our pocket books want us to do.
Not only do we have general medicine course taught by Med school faculty and rotate right along side MDs in school and residency, we also take added lower extremity anatomy and orthopedic/biomechanics classes and a ton of other LE related classes(just go to any pod school web site and look at our curriculum).
The reason our scope of practice is not uniform all through out the country is because the orthopods lobby is so strong(money talks). If this was a perfect world our scope would be from the tibial tuberosity and down(which it is in most states except NY). Training has nothing to do with it when it come to Podiatry because we are the best trained LE specialist around when it come to LE total care.
Our national organization has never endorsed total knee or hip sx because our residency training is not geared toward that so I dont know where you get your info from.
By the way the argument your making about others, it wasnt to long ago when DOs were seen as medical imposters, but now with proper training you guys have arrived. Please tell me why if other professions have the knowlege and know how why should they not be able to practice up to their education level? Do you guy think they only teach "medicine" in med school. I am always up for a friendly debate so lets begin.
CG
 
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Originally posted by paramed2premed
Maybe the allied health folks can do 99.9% of what MD/DO's do. As an analogy, I know that EMT-basics and paramedics have about the same outcomes for their patients. This is despite the huge difference in training and treatment capabilities. From what I have read, CRNA's and NPs do about as well as MD/DO's in many enviroments.

Are you high? Really... sniffing glue is not healthy.

Where do you get that EMT-basics and EMT-P's have the same outcomes? Where? If you are talking about the lack of benefit from having a doc on a flight or truck...that is one thing...scoop and run is what an EMT should do. I know you aren't talking procedures, the latest Academic EM has an article regarding the prehospital aspiration rate with EMT intubation....that is a singular example. Do you think you can do my job? Or are we simply talking about starting IV's, putting in NG's/OG's, and c-collars.
I am a huge defender of the EMT's I work with...but when they show cavalier judgement (attempting intubation and delaying transport for definitive care when the airway is clear) they find out really quick. I have never run across a para that thought they could do my job...we respect each other greatly.

When I was a PT, I thought I was pretty smart...med school taught me that I had a WHOLE LOT MORE TO LEARN...as an allied health provider I was arrogant to think my 2 years of professional training (post BS) was enough. The rigors of med school provided discipline and a huge differential diagnosis that could only be attained by "over training".
 
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Originally posted by cg2a93

By the way the argument your making about others, it wasnt to long ago when DOs were seen as medical imposters, but now with proper training you guys have arrived. Please tell me why if other professions have the knowlege and know how why should they not be able to practice up to their education level? Do you guy think they only teach "medicine" in med school. I am always up for a friendly debate so lets begin.
CG

The California Podiatric Association has indeed been trying to lobby to extend podiatric scope of practice to the knee---crawling up the lower extremity so to speak.

As for osteopathic physicians, osteopathic training as ALWAYS encompassed all of medicine, not just part of it. It's part of the holistic approach to patient care that has been a tradition in osteopathic medicine. The first DO school in Kirksville was originally charted (and still is by the way) to award MD degrees. The rivalry between MDs and DOs has never been about scope of practice as it has been about philosophical differences toward patient care. Today, these philosophical differences have all but disappeared (in principle) and the only remaining difference is that DO's learn how to manipulate the spine and axial skeleton and MD's do not.

DPMs, DDSs, ODs, CRNAs, DCs, psychologists, etc were once granted a specific role in patient care and have since tried to keep expanding that role indefinitely. Again, coming back to the airline analogy, you could say that DO's have always been "pilots" who took a different approach to learning to fly to a plane. DPMs, CRNAs, ODs, etc insist that their limited training in one specific thing generalizes to other things...a very different argument indeed.
 

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Again drusso, I am well aware of the legislation going on in cali and you are wrong. The legislation in cali encompases the same scope that Fl enjoys and that is the soft tissue from the hip down and not bony structure. We have no legislation asking for knee sx privledges. I stay abreast of legislation in Ca because that is a place that I plan to practice.
Anyway why cant we increase our scope if training allows it. Where is it written that MDs and DOs have a monopoly on health care. Podiatry evolved from chirpody. If we didnt evolve we would still be only allowed to clip nails and shave callouses. we did not have a role in health care until recently. We bring something to the table that no other practioners do and that is we commit the majority of our study to the proper function and surgical,medical correction of the LE. We provide alternatives to sx and when sx is needed we strive to give the best possible options to the patient. We are not putting the patient at risk from lack of proper training.
Do you know what the training of a DPM encompasses? You throw around phrases like limited training please elaborate.
 

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CG2 Pod Man,

I am sorry to have to have this conversation with you, but you jumped into this forum. You should have this argument on the Pod forum. But since you brought it up, podiatry is nowhere near the rigor of medical school. Pods are way undertrained to provide any real medical care. Their residency training is so piss poor (assuming you get one that even pays, or get one at all), that many are forced to clip toenails in nursing homes if they aren't the lucky bast**rd who got a surgical residency. And even the surgical residencies are a freaking joke with there being very few accreditation checks and balances for them. As a PA, I used to share an office with our practice Pod. He was literally one of my best friends. He graduated from Berkley, and then at the top of his class in Pod school. Yet he always asked me about common medical problems that I always found myself amazed that he did not know. I am serious when I say that he lacked info that any 3rd year med student would know 6 months into rotations. Their pharm knowledge is a freaking joke as well. Yes, he was stellar with ankles, but I found him overly willing to operate when patients could go without it. I saw what his curriculum in Pod school included, and it was not a complete medical education. I can say as a PA that I rotated through with medical students and sat in class with them. But now that I have been in real medical school, I see the many extra courses that I now have that I never touched as a PA. Pods do not complete the same required rotations, and their anatomy is more like a dental school (focusing more on one part than others). I freaking guarantee you that Pods don't get the same NeuroAnantomy as med school, or even CV anatomy. Something has to give to focus that much time on 18" of the lower body. And everyone knows there is a subtle difference in entrance stats from DO to MD, and DDS, but when you look at Pod schools, they are now accepting people without the MCAT at all, and are literally recruiting just to fill their slots at all. If you look at the schools that require the MCAT, they seem to average about 7's on the subsections across the board (just look it up for yourself in the text "Medical and Dental School Admission guide"). And before you say that Pod school must be medical school based on the title of this reference, the book includes all doctorate level professionals, even chiros. You hardly ever see a Pod do a real intern year after med school, which everyone knows is the real "maker" of a true doc (MD/DO). You can talk out your bu** all day long, but the truth is known far and wide. Pods serve a purpose, but they should never have gained the title "physician". Somehow that crap went overlooked by the AMA, but anyone who is a real physician knows that Pods are no more physicians than dentists, optometrists, soon to be DPT's, or chiro's etc.. In fact, in some states, even chiro's have legislated the title physician successfully, but we all know that the 7-11 store clerk is as much of a physician. And you ask why MD/DO types have the monopoly on medicine, it is because it is the way the law is written. Most states clearly outline in their laws that "physicians" are the only entities that can practice medicine. All others are allied health providers. And since Pods have a restricted license, they are allied health providers. Any dermatologist can practice manip, treat hypertension, flush your sinuses, do a PAP smear, and why??? Because they are physicians first, and specialists second. Pods are specialists second, skipping the requisite physician part. Its obviously true or they would be allowed unrestricted licenses. All I can tell you is that Pods will never be unrestricted physicians as long as there is one orthopedic foot fellow alive and breathing.

And if you can show that your Pod program compares equally to a medical school education, then I will eat the boots I am wearing. Show me where you did in your third year the following rotations:

Internal Medicine-2-3 months
General and subspec surgery-3 months
OB/GYN-2 months
Peds-2 months
Family Med- 2 months

These are just a minimum, and I know for sure there is not a Pod school in the country that provides this. if they did, there would be no Pod education. Something has to give, and you know it. Your 4th year is even more of a joke. I mean please, the Pod forum is full of Pods who try to others not to walk, but run from this profession. Have you seen this on the MD/DO forums? There are weekly debated on Pod forum about how piss poor the Pod training is and how inconsistent it is nationwide. I only have one thing to say to you if you try to say that you are qualified to practice medicine. USLME baby!!! Get permission to take it, and pass it, and you will be credible. But everyone knows that you guys would have as good a chance of passing it as the FMG's do. Some do, but more don't!! Any true physician has to pass a licensing exam that tests on all body systems equally. And the only professions to do this are the DO/MD's. DO's routinely pass the USMLE and get into specialty MD residencies. When was the last time a Pod went into an MD residency? They haven't because they are not true physicians. Pods are true experts of the lower extremity, and I would send my patients even now to one if they had a complaint that I thought was within the Pod scope of practice, ie...plantar warts refractory to cryo and chem treatment, callouses on diabetics, bunions, hammer toes, some ankle sprains, and even distal tib/fib fractures. But truth be told, I would rather the vet treat my kid for OM than a Pod, because at least the canine TM resembles humans', and vets get a diverse education. Sorry if you are offended by this, but this is reality and you know it.
 

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cg2a93,

the bottom line is that there is no good reason to extend DPM scope to anythign other than the foot.

if you want to do more than that, go to med school
 

cg2a93

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PA, what are you talking about? Pods dont want to do MD residencies we are already specialized. We are not Dermatologist or fam prac docs ect. That is why you do a MD residency. Your missing the entire point. You make such generalizations PA. Just because your bestfriend is weak when it come to education doesnt mean pod school is a joke, its outrageous that you can equate one pod to all pods around the country (there are over 14,000 of us) and I can assure I am not weak in pharm or general med. Are trying to tell me there are not any weak med students or MDs out there? Are you trying to tell me as a PA you are qualified to do what a Pod does or are you saying a Pod couldnt do what a PA does? who cares if we are consider physicians or not. What does that mean anyway, seems like another title to me?(legally we are classified as physicians by most states, but who cares)
You have never sat in a neuro or anatomy class given by a pod school so how are you a expert? Are you telling me I learned a different brachial plexus and physio than my wife(who is my study partner) who is in md school. How can you compare our classes to dentistry classes, are you a dentist? You make sweeping generalization and have no evidence to back what you say up. I will concede that our pathology course was not as thourough as MD school and our neuroanatomy didnt put as much emphasis on certain subjects, but we did learn those subjects and if I need to know more about those subjects I have the knowledge and know how to find out about those problems. Our anatomy and pharm classes were tough and thorough and our LE anatomy was brutal(some would say it was too detailed). One of the posters on the podiatry forum who attends DMU did a comparison of Pod and DO curriculum and they were not too different. You mention our residencies are a joke and arent reviewed by accredidation agencies on a regular basis. That is a blantant lie. You obviously dont have a clue about what your talking about. BTW in order for a program to become a surgical residency it must start out on probation and then if it can show it has a specific number of certain types of procedures then it become legitimate and they are inspected routinely just like MD residencies. All program are inspect on a regular basis. In order for a resident to get a certificate of completion you have to complete a certain amount of procedures(logs). The residency I am entering is rigorous and the training is great(80hrs+/wk). The average salary for a podiatric resident is between 30-35grand a year(Your quoting internet nonsense again).
We clip toenails and we do pretty complex sx procedures as well. Clipping toenails may seem menial and degrading to you, but as a person who has seen what elongated fungal nail or improperly debrided nail can do to a person with DM I gladly and proudly clip toenails. A uncut toenail on a DM pt today, can lead to a BKA or AKA tommorow. Not to mention the pain it can cause. You would be suprised on how such a little thing could make your pt very happy. One of the things I love about podiatry is that you can come to me in pain and leave pain free in many cases.
I am here for MATURE friendly debate not some IMMATURE pissing contest. If you want me to respond to you then dont write nonsense.
I want to state that pod dont want to be primary care docs or treat systemic disease. We are LE specialist. We have the training to do what is in our scope of practice. We give pts alternatives. A foot and ankle orthopedist is a surgical specialist. the avg foot and ankle orthopod doesnt have training in biomechanics and alternatives to sx that pods have so there is an need for us. The majority of the procedures the avg pod does are not surgical.
Yes, MDs and DOs have the "full scope" license, but what does that really mean. Yes, a dermatologist can legally manage HTN and DM ect., but would a ethical one do it. Is a orthopod or psyc, derm ect. qualified to manage endocrinological or renal manifestation ect. and would you take your mother to them? The MD give one the flexibilty if you want to change specialties you can. It also gives you a more recognizeable degree and many other perks that a DPM cant, but it isnt the only degree that teaches medicine.
I wont argue that the entrance requirements for MDs are higher than pods, but just because you get in pod school doesnt mean you will get out. you still have to pass 4yrs of extremely difficult classes, boards I,II,III(state written and oral exams depending on the state)2-4 yrs of residency and not to mention get board certified.
The mcat is not required for some pod schools, but I took the mcat and I can tell you it is only a way for competitive MD schools to weed out applicants because it predicts nothing about the success one will have or not have in school. Are you trying to tell me that those DO students who got into DO school with a 3.2 and 23-26 on the mcat arent going to be as good a doctor as the students with higher GPAs and mcats? Please eloborate. (BTW the avg gpa for pods is 3.1 with a 23 on mcat).

MD is the gold standard when it comes to medical education, it give one the flexibility to switch specialties and have the most complete medical education availible. I never disputed that, but I take exception when you tell me they are the only ones qualified to treat he human body.
The DO scope or education did not always encompass all facets of medicine. DOs did not use medicines as part of their armentum until later on because the meds used at the time they considered barbaric. And older MDs did consider DOs as 2nd rate inadequately trained doctors their are some who still practice today(my undergrad advisor told me dont go the DO route because I could do better, needless to say she flipped when I decided on pod school, but thats another conversation). The DO profession and education has evolved throughout the years to what it is today.(I was once interested in going the DO route until I found podiatry so I read "The DOs" , I also was a student member of MAOP).
All am trying to say is Podiatry the profession and the education is evolving and so will our scope of practice. 20yrs from now you proably will see some pods doing knee sx, but that will be only if they are properly trained(hopefully). All I can speak for is now and I can assure you we are well train for our current scope of practice.
drusso you are wrong pods in cali have not applied for knee sx privileges, the only legislative bills up are the parity bill , the 1st assist bill and some other insurance stuff.
Macgyver we already treat more than the foot we also treat the lower leg and trust me there is a need for us to treat more, you obviously have never been to one of our clinic before and seen some of pt we treat.
PA your right MD students do more medicine rotations than us, but that because you guys will be treating those problems I wont and dont care too. I did only(4th yr) 1 month of internal med, 1 month of emergency med, 1 month of gensurg, 3 months of podiatric sx, 1 month in a Dm clinic, no ob/gyn(thank god) 1 month of podiatric peds with and elelctive that no one does in general peds. Third year is dedicated to podiatric rotations with short rotations in derm, internal med, family prac. Of course in residency I will do more medicine and sx rotations, but in school that is what we get. BTW my school just added a ob rotation to its new 3rd year curriculum(I dont know the duration though), dont ask me why I think its a complete waste of time for a pod.

My main objective here is to clear up any misconception you guys have about podiatry because hopefully one day you will have some of your pt with LE problems to one of us. I am not here to say Pod are better than MDs or that our general medical education is equal because it is not nor am I going to debate the reasons why someone would chose their particular field because we all have our reasons for what we do. the bottom line is medicine is a only a job. It doesnt make you better or worse than anyone else.(my true aspiration is to be a college wrestling coach, but it doesnt pay enough and not to many jobs out there) .

We are as specialty and when we see something that is not within our scope we have the training to know who to refer to.
Respectfully
CG
 

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Originally posted by DocWagner
Are you high? Really... sniffing glue is not healthy.

That is a bit of an attitude. Relax, man.

I cannot cite the studies, but I have read many reports finding equivalent outcomes between doctors and mid-level providers in many different clinical settings. This is not too suprising, as most work is fairly routine. I would be truly suprised if, on the whole, basics and medics had drastically differnt outcomes. And I am an experienced paramedic in a strong system.

To use Drusso's example (whichI almost used) the skill that experienced pilots possess may be used only rarely. But, as a society, we value that experience and skill in our pilots. That is the tactic we might be better off using in justifying paying for higher-level providers. The outcomes-based argument might bite us in the butts!
 

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CG,

Have you even been on your own forum in the last year? Why is it that all the Pod grads are coming back and giving reports of few jobs, 10K paying residencies, waiting tables to pay the bills during residency, and inferior training? And please don't try to say that my opinion on Pods came from the one experience with one Pod. As a PA, I dealt with probably 10-15 Pods in my area on a regular basis. Hec, I played many a round of golf with them and the Lamisil Novartis reps. They are all great people, and I have no personal problem with any of them. I just get pissed off when they refer to themselves as a physician, because they just aren't. I get pissed off when they talk about doing knee surgery when they aren't even trained well enough to do ankle surgery most of the time. Many Pods settle for a non-surgical residency because there aren't enough to go around. How can you promote a profession to be a surgical one when you don't even have enough surgical residencies for all grads. If you go to any surgical residency as in general, ENT, plastics, ortho, urology, etc..., you will find a structured program with many faculty physicians supervising. Where I practiced, our Pod routinely had a resident from the area hanging around with him and going to the OR, but it wasn't structured. This resident followed certain Pods on certain days, and seemed to float under the radarin the hospital. Why? Because none of the MD's/DO's paid him any attention, because he served no real purpose except tp assist the Pod docs. So, he missed out on learning the art of real medicine, which even for surgery residents includes doing mnay non-surgical tasks....trips to radiology, path lab, grand rounds, MMWR, admissions and discharges daily. This resident only had to do a total of 2 years, and he did no real intern year. Anyone that should be able to carry the privilege of running an OR should be a fully trained physician, because when **** goes wrong in the OR, you can't expect that the anesthesiologist is going to save you. Just because you took ACLS does not mean you can help a crashing patient. People die under anesthesia, and if you aren't trained to understand all the body systems equally, you can be dangerous.

If Pods ever want true credibility, they should be integrated into medical schools, and choose the option of doing a Pod residency for 3-4 years. It is doubtful if anyone would really want to go this route though, and likely it would never work.

You just don't seem to get it. I already use and respect Pods, but I just think the profession needs to fully explain to its prospective students that they are not going to make the kind of money they think they will, and that they may have a very hard time finding a job in lots of places. Most insurance companies only need one Pod on their plan, and if you aren't this lucky guys, you are SOL for that area!

I hope you find satisfaction in your profession, and if you truly have, then congratulations. I hope I didn't completely piss you off; I was just trying to show you what you are up against. I realize that DO's went through a similar situation, but what was different about that was that DO education is truly the same education that MD's get. No one can argue this in any way. We all take the same basic required courses, pass shelf exams, boards to include USMLE or COMLEX, and even do the same residencies. Pods on the other hand could gain much more if they simply adopted a curriculum that was stronger in the basic sciences, as well as the Pod stuff. It can be done. Look at the DO programs. DO programs are actually tougher in the first two years because we have all the same basic sciences, in addition to the 2 years of a manip course some 3-4 hours per week extra. You guys could do this too I am sure, because it is not that much that you guys are missing. But someone is going to have to make a command decision in your profession to enhance training to warrant such expansion of privileges, otherwise the ortho docs will never give you what you feel you deserve. They are way more powerful a lobby than your profession can ever conquer, but I can see them relaxing a bit on the issues if you get your medical training on a scale similar to theirs.

On a side note, do Pods learn any foot manip? There are some pretty useful techniques that we learn that help quite a bit from the knee down. I am curious?

Later
 
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Originally posted by cg2a93
The DO scope or education did not always encompass all facets of medicine. DOs did not use medicines as part of their armentum until later on because the meds used at the time they considered barbaric. And older MDs did consider DOs as 2nd rate inadequately trained doctors their are some who still practice today.

Wrong. DO's have always been trained to practice the full scope of medicine, surgery, and obstetrics. In the earliest days of the profession, A.T. Still was antagonistic toward drug practices of his day, but even toward the end of his life osteopathic graduates were using the latest, greatest "wonder drug"---sulfa. Materia Medica, as pharmacology used to be called, has always been a part of the osteopathic curriculum if for no other reason than to discourage early DO's from using it in the early days---we're talking the 1800's here people. Osteopathic surgeons embraced anesthesia just like MD surgeons.

But, the real discussion revolves around what DPMs can and cannot do competently. There are DPMs and DPM residents at my hospital. They're good at diabetic foot management, soft tissue debridement, biomechanical/orthotic interventions, toe amputations and are the provider of choice for these problems. From time to time, when ortho is completely overwhelmed, they'll get to do a malleolar fx. They jump all over these cases because they get to do so precious few in their training.

I'll tell you that, from what I see, in the ankle or hindfoot their training begins to wane. If I had a patient with a real bad calcaneal osteomyelitis, I'd rather have the orthopod on the case. After doing an ortho rotation and working with ortho trained ankle-foot specialists, these guys were able to point out to me the subtle differences in hardware placement, operative technique, perioperative management and patient selection between the ortho ankle-foot approach and DPM approach. These ortho ankle-foot guys are not inherently brighter, inherently better surgeons, or magical healers---they're just better trained. They learned more about the surgical management of the entire lower extremity and then did fellowship training in ankle-foot. Four years medical school, plus five years general ortho residency, plus 1-2 years foot-ankle fellowship makes you a damn good doctor!

I actually think that DPMs can learn to repair and manage malleolar fxs just as well as orthopods with adequate post-graduate training. I think that the DPM profession is having a very difficult time ensuring that their graduates get adequate surgical training and usually end-up "piggy-backing" DPM residencies onto pre-existing ortho residencies where the DPMs end-up with sloppy seconds from the ortho guys. I've more than once seen ortho residents "throw the pods a bone" by punting some nasty foot or an ankle that they don't have time for on the surgery schedule.

Bottom line: I value DPMs. I like you guys. I play golf with you guys. You make a significant contribution to health care---especially since diabetic foot complication are raging out of control. I just hesitate at extending your scope of practice beyond the ankle and I'd like to see your surigcal caseload expand during residency training. Some programs actually DICTATE that every third ankle fx that comes through the ER goes to the pod service or that pods do half of the ankle/foot traumas. I've also seen that ER attendings sometimes will not follow these rules because they fear medico-legal repercussions---you can hear the prosecutor now---"So, Dr. So-and-so, you consulted the patient to the podiatry service for repair of a comminuted calcaneal fracture when your hospital also has on staff Dr. X who is a fellowship trained orthopedic ankle-foot specialist?" I know that some ankle-foot orthopod attending in residency programs will not operate with DPM residents. You guys need to change this.
 

MacGyver

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russo,

just remember that once DPMs get expanded scope, its never going to be revoked. And 20 years down the line, they will use that previously expanded scope to argue that their scope should be increased AGAIN to include the whole leg.

some MD/DOs are naive, they think "well if it goes badly, we can always restrict their scope again"

Wrong. Once they get a widened scope it will never get taken away unless they are just killing people left and right
 

cg2a93

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PA, I really cant rebutt your experiences with pods, but again the avg salary for a pod resident is 30-35. You are repeating info you read off a Internet forum and it is untrue period. I am in the field, and have recently gone through the residency process. The AACPM puts out a cd with the pay of every podiatric residency in the country and avg salaries and I can attest to this. I dont get info in regards to my profession from a internet forum, I go to the source. According to those gut podiatry is a dying profession which absolutey on true. By the way how do you know the experiences of your pod resident, how do you know he did learn "real medicine". You sure know alot about podiatry and not even be in the profession.
I cannot dispute your interactions with the handful of pods,that still doesnt mean they were not taught it in school because our curriculum speaks for itself. just go to our website and look at what is being taught. Alot of schools have there sylibi on line. I am sorry that you were exposed to substandard docs, but that is not the norm The docs I interact with are very knowledgable and medically savvy.
You are entitled to your opinion on what you think podiatric medical educatiion should do, but I disagree I think our training is evolving and will continue to do so. Their are some proponets who think our schools should be integrated in allopathic schools, but I am one of those who vehmently disagrees. Our roots are from chiropody and have evolved and will continue to evolve. As far as I know our residencies are structured and are modeled after other surgical residencies(I know the one I am going to be attending is). Your experiences are not consistant with what I have been exposed to. Again your on the outside looking in. The fact is the majority of the student today get sx residencies.
drusso, as for the residents in your hospital I dont know what type of residency they are involved in there are programs that deal mainly with forefoot sx and little rearfoot sx and there are programs that deal with mainly rearfoot and ankle reconstructive sx to be labeled as either one you have to complete a certain amount of ankle an lower leg procedures.
Regardless if they get scraps from the orthopods there are a certain amount of procedures you must complete in order to be considered a rearfoot and ankle residency and that is standared across the country(BTW most podiatry residents rotate at differrent hospitals in order to get the ankle and lower leg #s). I dont dispute that we compete with orthopods for ankle cases and in many cases they will get preference after all they are more of a part of organized medicine than we are. We are relatively new to hospitals and we are slowly becoming more accepted. The ER doc you mention might be hesitant to refer ankle case, but that is their own personal bias. The fact is we are held to the same level of standard of care as any other doc including orthopods. Under the law if a ER doc made a referral to a pod who is train in ankle fx instead of a foot and ankle orthopod he fufilled his obligation their are not medi-legal ramifications as long as he followed proper protocol and standard of care. Again a foot and ankle orthopod did 5-6yrs of residency, but it was not entirely dedicated to the LE. A pod not only did 4 years of medical education devoted mainly to the LE, on top of that a 2-4yr residency devotely to mostly LE care surgically and medically. Im not saying Pods are be better surgeons, but Im not say foot ankle orthopods are better either. The competence of a surgeon is a individual thing and should be evaluated on a case to case basis.
BTW in my hospital we routinely manage calcaneal OM, and my attendings are outstanding on all surgical and medical procedures pertaining to the LE. Just because you completed a long residency does not make you a damn good doctor. If your ortho residents dont have time for foot and ankle sx, dont you think thats a problem? I know our residents have plenty of time for them. Again, we are not trying to extent our scope beyond our training. I will be the first to admit our profession has its problems, but within the past year the whole structure of our residency programs has been updated and more uniform. I am extremly pleased with the direction my profession has gone and if I had to do it all over again I would be right where I am.
respectfully
CG

BTW if some orthopods wont operate with us that is their perogative, but there are plenty of orthopods that do let us in their or. People are always going to have their own biases whether it be degree, color, sexual orientation whatever. but that is not our problem that theirs.
 

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CG,

I don't mean to be critical, but reading your posts is like running uphill in an ice storm wearing glass slippers. Feel free to interject with a comma or a period now and then. Your ideas run into each other like a Maryland traffic pileup, and it makes getting your point less easy. Its time to stop this argument before it gets out of hand. Freedom deserves to have this thread continue in the direction he started it heading. So, on that note, how about them PT's trying to become DPT's? The only DPT I will be using in my practice will be the correctly ordered DTP, the immunization for children!
 

cg2a93

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PA, I apologize for my typing. I know it sucks, but I was not arguing I thought we were have a conversation.
CG
 
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The limited scope of PT makes it what it is. PTs are very creative because they have to be and the results speak for themselves (See the impact factor scores on the top 20 journals in orthopedics).

No PT really wants to take over a physician's role as the center of a patient's health care. Plain and simple. Direct access is what it is. I often read on this site "well if you only knew what we as physiciansknew..." Well as PTs, we have an exceedingly unique knowledge base and skill set. There is no other profession that practices physical therapy. That is the beauty that NO ONE on this site understands.


I went to a top flight PT school. A lot of our professors were MDs (great MDs) and they have a high respect for what we do because they learn it from the PT professors, they give us the medical viewpoint, they refer to PT and they get great results. No surprise that thesephysicians are some of the most respected and successful in the field.

Also, if you have a PT-->MD or PT-->DO name please do not respond. You aren't currently practicing PT, hence your viewpoints on the profession are not as valid as anyone practicing physical therapy or in school for physical therapy. Also, I find it offensive that you creep around in PT forums discouraging the future of the profession based on your own personal experiences.
 

THH

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The limited scope of PT makes it what it is. PTs are very creative because they have to be and the results speak for themselves (See the impact factor scores on the top 20 journals in orthopedics).

No PT really wants to take over a physician's role as the center of a patient's health care. Plain and simple. Direct access is what it is. I often read on this site "well if you only knew what we as physiciansknew..." Well as PTs, we have an exceedingly unique knowledge base and skill set. There is no other profession that practices physical therapy. That is the beauty that NO ONE on this site understands.


I went to a top flight PT school. A lot of our professors were MDs (great MDs) and they have a high respect for what we do because they learn it from the PT professors, they give us the medical viewpoint, they refer to PT and they get great results. No surprise that thesephysicians are some of the most respected and successful in the field.

Also, if you have a PT-->MD or PT-->DO name please do not respond. You aren't currently practicing PT, hence your viewpoints on the profession are not as valid as anyone practicing physical therapy or in school for physical therapy. Also, I find it offensive that you creep around in PT forums discouraging the future of the profession based on your own personal experiences.

You do realize how old this thread is, right? :confused:
 
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