Orthopaedic & Podiatric Surgeons Joint Task Force 2021

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DexterMorganSK

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The attached PDF is for your reading. We will wait and see what happens, but definitely the way to move forward, IMO.

Screen Shot 2021-05-06 at 11.30.48 AM.png


Not related to this but also important is the re-introduction of HR 2972 in Congress. Check it out if you don't what it is and its impact on our field.
 

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heybrother

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What a beautiful trap.

There's a lot of nitty gritty you could look at in the above:

"There is a lack of consensus among the four organizations as to whether DPMs should currently be considered to be physicians." That line is fabulous.

"Comparable standard". Call me crazy but when the DO residencies changed accreditation there ultimately became only one standard. In the end, their standard will be the standard.

"Accreditation of colleges of podiatric medicine should meet comparable standards to the Liaison Committee on Medical Education (LCME). We will accept the NBME’s determination on whether the CPME accreditation standards are comparable to LCME and sufficient to meet requirements which would allow DPMs to take all parts of the USMLE." - Indeed. They already know what the curriculum is to meet a sufficient requirement to take the USMLE. Its the curriculum of an MD or DO school. At the lowest level you could say - ok, podiatry schools at MD/DO schools will simply take an identical path to their classmates + their podiatry courses (ugh). But MD/DO students already have mandatory rotations 3rd year in all the core medicine disciplines - ie. family medicine, internal medicine, obgyn, psych, neurology, radiology etc. If NBME says no part 2 without the above - 3rd year is spoken for. I wonder would shelf exams be required?

Keep in mind that as of a few years ago. Ohio was still graduating students who had NOT passed part 2. They literally couldn't practice, couldn't get a residency, but the school was graduating them because it technically wasn't a requirement that you had to pass part 2 to graduate. Will podiatry students be required to pass Step 1 of the USMLE to move onto 3rd year? Will they be required to to pass Part 2 to get a residency? Will they be required to pass Part 3 to continue their residency?

There's an anecdote over in the ED forum about how a few years ago a group of experienced NPs were given the chance to pass a modified step 3 (which is theoretically the easiest Step) and the pass rate was like 40ish%. My understanding is MD/DOs mostly take that 1st year of residency.

Would you want to try and take USMLE steps having received your education from a podiatry school where students regularly post that the teachers are trying to flunk you out? Podiatry schools that aren't part of MD/DO schools essentially have no path foward to meeting the curriculum requirement unless they merge with MD/DO schools.

I'm not bothered by more education, but the MDs just drew the line. Will we keep talking about parity? I don't know. But they know and we should know we're no where close. Meanwhile, nurse practitioners are completing online degrees and staffing ICUs/EDs.

Additionally, by putting this out there - by acknowledging the line - essentially, when you fail to meet it they can hammer you with it like a cudgel. We're physicians you say? Didn't we all agree what it takes to be a physician?

I didn't even say a word about our residencies. I wonder what percentage of DO residencies closed when they merged accreditation. Many pod residencies are garbage.

And since I didn't respond to the last person who said this to me - I don't give a crap what orthos think. I do believe we need to improve this profession. The schools suck. The boards sucks. Most of the residencies suck. Maybe there's something to be said for putting the MDs in the drivers seat because it will expose the empty hollow BS garbage profiteers who lead this profession. The shills and trash who run the schools. The $900 a test empty doofs who write our boards. I think a lot of the people who run our profession, run our schools, etc think they are doing a good job. They are not. Hopefully many of them will be out a job. What do we need a podiatry step 1 for if we're going to take USMLE Step 1. Perhaps we can pay $900 more to answer 50 lower limb questions.
 
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DexterMorganSK

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And since I didn't respond to the last person who said this to me - I don't give a crap what orthos think. I do believe we need to improve this profession. The schools suck. The boards sucks. Most of the residencies suck. Maybe there's something to be said for putting the MDs in the drivers seat because it will expose the empty hollow BS garbage profiteers who lead this profession. The shills and trash who run the schools. The $900 a test empty doofs who write our boards. I think a lot of the people who run our profession, run our schools, etc think they are doing a good job. They are not. Hopefully many of them will be out a job. What do we need a podiatry step 1 for if we're going to take USMLE Step 1. Perhaps we can pay $900 more to answer 50 lower limb questions.

That paragraph above is gold. And, I agree, there are too many "if" and "buts" for this proposal to get a green signal. However, I will gladly take the Step exams IF the LCME approves the current Podiatry curriculum. But it won't be easy because even within the 9 schools, there are major differences between the curriculum. Also, there would be a need to add additional courses (both in preclinical and clinical) years tested on the USMLEs and not on the APMLEs.

Whatever ends up happening in the coming months, it's a very unique and welcoming development.
 
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heybrother

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Inexperienced prepods will read this and think "the podiatry schools are going to change their curriculum, NBME is going to approve of it, and pods are going to start taking USMLE".

It isn't going to happen. Its fascinating that they "created a pathway", but its a pathway no one will walk.

Apart from what I said above - I'm concerned that in fact the pursuit of this might take away from more straight forward achievable goals that could benefit the profession or our education. For example, to achieve this everyone would have to do like 8 weeks(?) of OBGYN. I'm not saying OBGYN isn't relevant/great, but my school struggled to provide me an internal medicine rotation - a core discipline of much higher relevance to a podiatrist. I was literally sent on my IM rotation to a VA where a FM doc who clearly hated his life told me I could only be around him when he had a patient. So I sat with a nurse for 7 out of 8 hours in a day. The guy saw like 8-10 patients in a day and spent 5 minutes with them where he essentially refilled their medications, cut off their hydrocodone and then kicked them and me out of the room.

Consider the following - one of the schools somehow races ahead and gets NBME to approve of their curriculum and allow their students to take the USMLE. Maybe one of the DO schools that tries to do the true mirrored curiculum. It probably won't happen, but imagine it does. I think the other schools work together to sabotage it. No one can move forward unless all of us move foward. They can't create a situation where one school has an advantage. Also, what the hell would the MDs say about that. Here's some DPMs who passed and here's most who didn't. They probably would say - no DPMs take this exam until either all schools are up to par or the schools that can't pass muster shut down.

Ifs and buts like you said. Its jokingly like handing a stone age culture a book that says "everything you need to know to get to the moon" and then president of the stone age announces the next day that we're so grateful for the opportunity to start building rockets.
 
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air bud

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That paragraph above is gold. And, I agree, there are too many "if" and "buts" for this proposal to get a green signal. However, I will gladly take the Step exams IF the LCME approves the current Podiatry curriculum. But it won't be easy because even within the 9 schools, there are major differences between the curriculum. Also, there would be a need to add additional courses (both in preclinical and clinical) years tested on the USMLEs and not on the APMLEs.

Whatever ends up happening in the coming months, it's a very unique and welcoming development.

fixed it for you.
 
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The Last Reclaimer

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Every time I visit these forums I feel like its an endless stream of bad news/feedback.
 
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Podstar

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So say this happens and podiatry students start passing the USMLE. Will they be considered physician podiatrists and the rest of us non-physician podiatrists? Does anyone really think that us passing the USMLE will really change any ortho’s mind about us being “equal”. Some of them will like us and most will still not like us. I don’t think our schooling is as good, but I definitely think that those going to the good residency programs, getting well rounded training, and logging thousands of cases are proficient and capable of managing patients clinically and surgically with all foot and ankle pathology. They know us standardizing our education to meet LCME requirements and passing the USMLE won’t happen, at least not anytime soon if at all. I probably have an unpopular view here, but I am perfectly happy being a podiatrist. Us passing the USMLE will not change our compensation, hospital dynamic and politics, or whether or not ER docs consult us for foot and ankle trauma. If you wanted all of these things to go in your favor, well, you should have gone to medical school, matched ortho, and done your foot and ankle fellowship.
 
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I feel like we're about to be screwed. but I admittedly don't know much. Just sounds like we have to trust a few select leaders/organizations to really look out for us here. This would be a big change. And like mentioned in this thread, the curriculum at our schools need to change to be able to pass the USMLE. I really do think we have smart enough students, it's just the curriculum is not built for this lol. like at all. Even most med students though ignore their schools curriculum and just no life Anki all day. They go in focused on the USMLE on day 1 (may change now since it's becoming pass/fail not scored).

in summary... I think this whole thing sets up for a "GOTCHA" when our students do really bad on the USMLE, when in reality the game would be pretty much rigged at this point.
 
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heybrother

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I feel like we're about to be screwed. but I admittedly don't know much. Just sounds like we have to trust a few select leaders/organizations to really look out for us here. This would be a big change. And like mentioned in this thread, the curriculum at our schools need to change to be able to pass the USMLE. I really do think we have smart enough students, it's just the curriculum is not built for this lol. like at all. Even most med students though ignore their schools curriculum and just no life Anki all day. They go in focused on the USMLE on day 1 (may change now since it's becoming pass/fail not scored).

in summary... I think this whole thing sets up for a "GOTCHA" when our students do really bad on the USMLE, when in reality the game would be pretty much rigged at this point.
I feel like a few people have said something like this and I want to set your mind at ease.

Podiatry students are not going to take the USMLE.

So you don't need to worry about that.

"Accreditation of colleges of podiatric medicine should meet comparable standards to the Liaison Committee on Medical Education (LCME). We will accept the NBME’s determination on whether the CPME accreditation standards are comparable to LCME and sufficient to meet requirements which would allow DPMs to take all parts of the USMLE."

The NBME - an MD organization - gets to assess whether CPMEs accreditation is sufficient to meet LCMEs requirements. Only then will podiatry students take the USMLE. Since LCME does not equal CPME - our schools will not be found to meet the accreditation standard and therefore USMLE is not going to happen.

Actually read the white paper, look up the organizations, and then chill. NBME is not NBPME. They get to decide when/if we take USMLE and they are going to kick the crap out of our schools before that happens. Except it will never happen because our schools will never (or at least not for a long time) be able to meet the curriculum requirements.
 

de Ribas

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I feel like a few people have said something like this and I want to set your mind at ease.

Podiatry students are not going to take the USMLE.

So you don't need to worry about that.

"Accreditation of colleges of podiatric medicine should meet comparable standards to the Liaison Committee on Medical Education (LCME). We will accept the NBME’s determination on whether the CPME accreditation standards are comparable to LCME and sufficient to meet requirements which would allow DPMs to take all parts of the USMLE."

The NBME - an MD organization - gets to assess whether CPMEs accreditation is sufficient to meet LCMEs requirements. Only then will podiatry students take the USMLE. Since LCME does not equal CPME - our schools will not be found to meet the accreditation standard and therefore USMLE is not going to happen.

Actually read the white paper, look up the organizations, and then chill. NBME is not NBPME. They get to decide when/if we take USMLE and they are going to kick the crap out of our schools before that happens. Except it will never happen because our schools will never (or at least not for a long time) be able to meet the curriculum requirements.
I agree that it is not happening within a year or even maybe 3-5 years. But if our profession decides to go that route and works on curriculum and improves our education I don't think it is impossible.
 
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heybrother

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I agree that it is not happening within a year or even maybe 3-5 years. But if our profession decides to go that route and work on curriculum and improve our education I don't think it is impossible.
Its substantially more than 3-5 years. I don't claim to know the time table, but what I'm trying to impart to people is that anyone who is sitting here thinking that next year they will show up to school and find out they are taking the USMLE is probably worrying about nothing.

There will be no shortage of adjustments/road blocks/new hurdles to make this happen. Let's pretend for a second that NBME reviews Western or Arizona who supposedly mirrored the DO curriculum and say - oh hey, 1st-2nd are the same and ya'll actually take enough medicine rotations 3rd year (I don't know if they do - I don't know how their podiatry students would know any podiatry if they did a TRUE medical core curriculum ie. Pediatrics, Psych, OBGYN, etc. There is still going to be someone who says - yeah well, pass USMLE 123 but your residency is still not a real residency. Its not enough to just graduate, to just pass the steps because real doctors do real residencies and there's plenty of hay for them to make of our training.

Its a long road ahead. As I indicated previously, I think DMU would very possibly struggle to find 3rd year core rotations.

I spoke about this elsewhere but no one else has really touched it - if you really did a "podiatry" curriculum that qualified as a medical curriculum - and you passed USMLE Steps - would you really want to be a podiatrist when all was said and done? If LCME says your curriculum is identical and you've done the steps - do you really have to go into podiatry afterwards?

Sometimes an organization changes itself so much that it doesn't serve its original function when all is said and done.
 
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DYK343

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Every time I visit these forums I feel like its an endless stream of bad news/feedback.
I feel that way too when I log on here.
But then I go to work every day and I am pretty happy with the whole situation
For me at least, podiatry has been good. I have zero complaints and would absolutely do it again.

Dont get too bogged down in certain users negative posts. Its not that bad.

As for the current topic on hand. Who knows. I doubt anything changes. Its more of a proposal now.
 
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DexterMorganSK

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in summary... I think this whole thing sets up for a "GOTCHA" when our students do really bad on the USMLE, when in reality the game would be pretty much rigged at this point.

Besides the following topics, everything else is tested on part 1: Biostats/Epi, Psychiatry (need to know the pharm though), and Ob/GYN stuff (need to know pharm and path). Every other course is tested on Part 1 with more emphasis on General anatomy and lower extremity anatomy.

Biostats/Epi is on APMLE Part 2 exam.

That said, with the addition of the above subjects, a review course of some kind, and a subscription to a bank (other than board vital) should be enough to pass the USMLE Step 1, IMO. It's fine to think and say that this 'proposal' may not happen, but it is incorrect to state that "our students will do really bad" if they don't even take the exam first.

There are resources like Boards and Beyond, Sketchy medical/Pathoma, and of course, First aid, which, if used correctly with the Uworld questions, passing the step won't be difficult. And I say all this based on the CBSE exam score in the Cali schools and the overall numbers of FMGs/IMGs using the same resources and getting competitive scores on Step 1.

Finally, if anyone here is looking for parity and the same scope of practice (same compensation) as an MD FA-trained physician, then taking the STEPs is the best way to do it, IMO.
 
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de Ribas

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Besides the following topics, everything else is tested on part 1: Biostats/Epi, Psychiatry (need to know the pharm though), and Ob/GYN stuff (need to know pharm and path). Every other course is tested on Part 1 with more emphasis on General anatomy and lower extremity anatomy.

Biostats/Epi is on APMLE Part 2 exam.

That said, with the addition of the above subjects, a review course of some kind, and a subscription to a bank (other than board vital) should be enough to pass the USMLE Step 1, IMO. It's fine to think and say that this 'proposal' may not happen, but it is incorrect to state that "our students will do really bad" if they don't even take the exam first.

There are resources like Boards and Beyond, Sketchy medical/Pathoma, and of course, First aid, which, if used correctly with the Uworld questions, passing the step won't be difficult. And I say all this based on the CBSE exam score in the Cali schools and the overall numbers of FMGs/IMGs using the same resources and getting competitive scores on Step 1.

Finally, if anyone here is looking for parity and the same scope of practice (same compensation) as an MD FA-trained physician, then taking the STEPs is the best way to do it, IMO.
I think passing STEP 1 is the least worry pods would have, especially at schools which cover sciences and systems well. But Step 2 and Step 3 would be problematic. After 2 years, we focus primarily on pod material and pretty much no medicine, neuro, etc. Plus we don't rotate through as much medicine rotations to comfortably answer general medicine clinical questions.

I don't think it would require a large overhaul to our education, it's just I dont think most schools would be willing or able to find enough medicine rotations.

Also, I don't think that adjusting or adding medicine rotations or systems courses damages our uniqueness or somehow makes us less qualified in f/a. What pod students do during third year? Rotate at their school's clinic mostly seeing 1-4 patients per day clipping nails? Our 3rd year clinical experience can be changed so we still get similar exposure to podiatry and still do medicine rotations. Schools' 3rd year local rotations look good only on paper. Having ~10 students in half day clinics every other day can be condensed into less months, less students per day while other students go through medicine rotations. 3rd year rotations can easily be condensed into 6 months without significantly impacting pod education leaving another 6 months for medicine rotations. 4th year can stay pretty much as-is since DO/MD students mostly do their away rotations of choice.
 
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heybrother

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I don't disagree that most of third year at podiatry schools is worthless but I don't think it can be reduced down to 6 months because it would have to be reduced down to way less than that. Look up third year core rotations for medical schools online and while the numbers and variety are different at each school I'm pretty sure that to meet the rotational requirement for an MD or DO student essentially takes almost the entirety of the year. There's a reason that third year sucks for medical students.

The above is just an example. Count up the weeks on each service and without counting the elective I was at 44 weeks. 48 with the elective. Most of those are hospital-based electives. Where do you include 6 months of podiatry. Can you fit it somewhere? Maybe. But not in third year...
 
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de Ribas

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I don't disagree that most of third year at podiatry schools is worthless but I don't think it can be reduced down to 6 months because it would have to be reduced down to way less than that. Look up third year core rotations for medical schools online and while the numbers and variety are different at each school I'm pretty sure that to meet the rotational requirement for an MD or DO student essentially takes almost the entirety of the year. There's a reason that third year sucks for medical students.

The above is just an example. Count up the weeks on each service and without counting the elective I was at 44 weeks. 48 with the elective. Most of those are hospital-based electives. Where do you include 6 months of podiatry. Can you fit it somewhere? Maybe. But not in third year...
Looks like there is some variation how schools do 3rd year rotations, because at DMU, DOs only do 40 weeks of clinical rotations. 28 weeks (~6mos) of required rotations, 8 weeks of subspecialties (which can include pod I think) and 1 month of electives. Even that clinical curriculum can probably incorporate about 4-5mos of pod rotations at best. During 4th year, DOs are only required to do 3 mos of general med and everything else is electives. So 4th year shouldn't be a problem. I think that about 4 months of pod rotations is enough for 3rd year if they consist of busy schedule. I'd rather do 4 months of busy schedule than like 10 months of 3-4 half-days per week.

I agree that this will probably be one of the most challenging things to adjust. It depends what are minimal LCME rearequirements for clinical rotations. Our focused pod rotations can come mainly from 4th year rotations to preserve our "uniqueness" some people talk about.
 

de Ribas

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From Author's Statement of Priority:

" The AOFAS and AAOS have agreed with two national podiatric organizations on a process
by which only podiatrists who meet M.D./D.O. standards for undergraduate and residency
accreditation, board certification, and examination requirements would be considered
physicians within their scope of practice."

Only those? What will happen to already practicing pods?
 

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DexterMorganSK

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From Author's Statement of Priority:

" The AOFAS and AAOS have agreed with two national podiatric organizations on a process
by which only podiatrists who meet M.D./D.O. standards for undergraduate and residency
accreditation, board certification, and examination requirements would be considered
physicians within their scope of practice."

Only those? What will happen to already practicing pods?

It should be DPM students and graduates. However, taking the Steps (if we ever get to this point) should be 'optional', similar to the post above and what happened with the DO field and the COMLEX exams.
 
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de Ribas

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It should be DPM students and graduates. However, taking the Steps (if we ever get to this point) should be 'optional', similar to the post above and what happened with the DO field and the COMLEX exams.
What will be the difference between DPMs who took/passed USMLE and between those that didn't take it or didn't pass? Difference in pay? Scope of practice? Or just "physician" acknowledgement by MD/DOs.

DOs don't have to take or pass USMLE to become physicians. They have COMLEX to fall back onto, DPMs don't. So there should be an incentive for schools to initiate such an overhaul in curriculum and for DPMs to study and pass USMLE steps. Otherwise why even bother.
 
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de Ribas

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I didn't even say a word about our residencies. I wonder what percentage of DO residencies closed when they merged accreditation. Many pod residencies are garbage.
What if after all of what they stated is acceptable and agreed upon (USMLE, curriculum, CPME) they decide that 3 years of pod residency is not enough to be on par of other F/A orthos or that we need extra year or like an internship year where you cover most medicine rotations. Before they agree to USMLE thing, they need to talk through all possible future scenarios.
 

DexterMorganSK

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What will be the difference between DPMs who took/passed USMLE and between those that didn't take it or didn't pass? Difference in pay? Scope of practice? Or just "physician" acknowledgement by MD/DOs.

DOs don't have to take or pass USMLE to become physicians. They have COMLEX to fall back onto, DPMs don't. So there should be an incentive for schools to initiate such an overhaul in curriculum and for DPMs to study and pass USMLE steps. Otherwise why even bother.

The people I spoke to so far are 'predicting' that, like the DO field/COMLEX, we will have an option to either take the USMLE or stick with the APMLEs.
It is too early to know anything else at this point; we'll have to wait until this HOD meet next month.

The AMA seems to be pushing the 'physician' tag pretty hard. But I get it though, the NP/PA field has been encroaching their scope limit and playing the physician tag more every year. This is a thread of its own, but it's pretty ridiculous to get online training and calling yourself physicians, lol.

As others have mentioned in this thread, most likely, all these collaborations and joint force topics will blow up, and nothing will happen. Still, if something were to happen in terms of parity between our field and that of an MD (scope of practice, compensations, etc.), then IMO this is way to do it though, i.e., mirror our curriculum and training to that of an MD school and have us take the USMLEs.

It's easier said than done, so yeah, it probably won't happen.
 

de Ribas

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The people I spoke to so far are 'predicting' that, like the DO field/COMLEX, we will have an option to either take the USMLE or stick with the APMLEs.
It is too early to know anything else at this point; we'll have to wait until this HOD meet next month.

The AMA seems to be pushing the 'physician' tag pretty hard. But I get it though, the NP/PA field has been encroaching their scope limit and playing the physician tag more every year. This is a thread of its own, but it's pretty ridiculous to get online training and calling yourself physicians, lol.

As others have mentioned in this thread, most likely, all these collaborations and joint force topics will blow up, and nothing will happen. Still, if something were to happen in terms of parity between our field and that of an MD (scope of practice, compensations, etc.), then IMO this is way to do it though, i.e., mirror our curriculum and training to that of an MD school and have us take the USMLEs.

It's easier said than done, so yeah, it probably won't happen.
AMA and LCME will not do anything for us. It's not their job. All they can do is say, hey, we are the main medical organization and these our educational and training standards.
It is up to the leadership of podiatry organizations to make a move and work to improve our educational and training standards across all schools and residency programs. It's not that AMA/LCME standards are kept somewhere in a secure place. They are available. Why pod organizations don't improve our education/training standards even without waiting for AMA/LCME to say so.
Even if this time around AMA/LCME say no, our education and training must be improved to meet objective standards that are there for all physicians. If they are objective and improve patient care, pods must be trained better. USMLE does test competency in medical and clinical knowledge. APMLE doesn't. I don't think we need AMA/LCME to gather a committee to conduct an analysis on our education and training because it's obvious - at its current state, our education and training is not 100% on par with MDs to make us pass all 3 ateps of USMLE. Not that we are not able to. I belive, that with proper education, time, resources and incentive, most pods will pass USMLE. If thousands of FMG/IMGs do it every year, pods can too.
I belive pods must receive similar education and training to all physicians if not for parity, financial incentives, but mostly for best patient care. We take care of patients often with complicated health problems. We are calling ourselves physicians, patients call us that, federal government, hospitals, then we must objectively meet those physician standards.
I just don't get why we need AMA/LCME tell us that or them leading the way. Our leadership needs to acknowledge that and lead the way independently.
 
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DOs only have to take COMLEX because technically it is equal to the USMLE (though this isn't true in reality, based on percentile scores and how Program directors view the COMLEX, particularly for more competitive specialties)
 
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OblivionDPM

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It should be DPM students and graduates. However, taking the Steps (if we ever get to this point) should be 'optional', similar to the post above and what happened with the DO field and the COMLEX exams.


I truly hope this would be the case and there are no insidious loop-holes or malicious intentions behind this move because this would royally screw all current practicing podiatrists. Given the discussion on the other thread in the "Podiatric Residents & Physicians" fourm about the subject, the hatred is still there.

I agree that we should definitely have a pathway similar to DO for us, but my gut feeling is that this is unlikely.
 
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DexterMorganSK

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Can we paste that over here. I'm curious if it might disappear in the future. A lot of old APMA material tends to disappear through time. Also would let us know it'll it evolves through time.

AMA FAQs​

How and when was this initiated and what was the process?
In 2018 a task force was created consisting of leaders from the American Academy of Orthopaedic Surgeons (AAOS), the American College of Foot and Ankle Surgeons (ACFAS), the American Orthopaedic Foot & Ankle Society (AOFAS), and the American Podiatric Medical Association (APMA) to find common ground on the many clinical and policy initiatives that mutually benefit both groups and most importantly our patients. Additionally in 2019, Resolution 4-19 established that the national joint task force will endeavor to enlist the American Medical Association (AMA) to facilitate discussions with the National Board of Medical Examiners (NBME) on allowing DPMs to sit for the United States Medical Licensing Exam (USMLE), which unanimously passed the APMA House of Delegates. It was endorsed by the American Board of Podiatric Medicine (ABPM), the American Board of Foot and Ankle Surgery (ABFAS) ACFAS, and was cosponsored by the APMA Board of Trustees, the American Podiatric Medical Students' Association (APMSA) and 25 state component societies.

Since 2019, the Joint Task Force of Orthopaedic Surgeons and Podiatric Surgeons, comprised of two members from each of organizations’ leadership from AAOS, ACFAS, AOFAS and APMA, began drafts of both the White Paper and the AMA resolution. Over the course of two years, and extensive review and edits, the Joint Task Force Members and their organizations Board’s approved the documents released May 6, 2021.

Will access to the USMLE restrict DPMs scope of practice? No. As the White Paper states, “…DPMs, similar to MDs, and DOs, should not be restricted in their ability to appropriately take care of patients within their respective scope of practice, nor in their access to patients based upon type of insurance.”

What happens if the Resolution passes at the June 2021 AMA House of Delegates (HOD)?
For you and your practice, nothing will happen. This is a very long process that will take years to complete. The June 2021 AMA HOD is somewhat unique because it is virtual meeting. This makes the number of resolutions for consideration more restrictive. The AMA 2021 “Prioritization Matrix” ascribes resolutions as either Top, High, Middle, Low or Not a Priority. Therefore, not every resolution submitted will be heard. The first hurdle is that the resolution gets prioritized to be heard at this HOD. If it is accepted and placed on the priority list, it will be read on the floor of the HOD, options will be heard from AMA members (it could possibly go back to the AMA Council on Medial Education) and/or a vote will proceed. If all of this occurs and the resolution is ultimately approved at the June 2021 HOD, it simply requires AMA to conduct a study with the results presented at the November 2021 HOD. This is not LCME nor NBME reviewing the accreditation standards. This does not guarantee NBME would accept a recommendation that podiatric students and graduates have access to the USMLE.

What happens if the Resolution does NOT pass at the June 2021 AMA House of Delegates (HOD)?

If it is not considered at the June 2021 HOD, it may be considered at the November 2021 Interim AMA HOD. Depending on whether the meeting is virtual, additional challenges could occur. If the resolution is introduced and does not pass, it is the end of the resolution. A different resolution could potentially be introduced at a future AMA HOD being modified to satisfy the concerns that caused it not to pass.

Why was this kept confidential and why did it exclude other stakeholders?
The Resolution and White Paper took more than two years to gain approval by AAOS, AOFAS, ACFAS and APMA, and required that all organizations would have to agree to any statement before being released. Meticulous review and vetting were conducted by Joint Task Force Members and Boards from all four organizations, including professional staff and legal review. Because of extensive opinions and perspectives on this topic, the Joint Task Force decided it was necessary to keep conversations confidential in order to gain consensus. Other stakeholders will and are being included now that the joint announcement has been published.

How is this going to impact podiatric schools and curriculums needed to pass the USMLE?
In the short term, there is no impact. This process will be a long one. If AMA approves the Resolution, conversations and strategies will need to be developed and will require input from a larger group of stakeholders (Deans, Schools, etc.). Comparability of residency training standards and board certification are far in the future. It is certainly possible some curriculum changes may be required to sufficiently prepare graduates to pass the USMLE. This may also result in a change in testing and preparation.

Is this White Paper about defining the term physician?
No. The purpose of this white paper is not to address the different uses of the term physician within both state and federal laws and should not be construed as supporting the removal of any rights currently held by DPMs, nor supporting any effort to prevent DPMs from practicing under their title, status, or scope of practice as currently recognized by state and federal law and non- governmental entities.” If we get access to the USMLE, we will then be able to use those results to further confirm our physician definition. This is similar to what the osteopathic physicians did many years ago.

Are DPMs admitting our education and training is deficient?

No. DPMs education and training is solid. If DPMs were perceived as being deficient by MDs and DOs, AAOS and AOFAS would not have supported efforts underway to get access to the USMLE; nor would APMA and ACFAS have agreed with this pathway going forward. Further in 2011, the Physician and Surgeons Joint Task Force was initiated by the California Medical Association, the California Orthopedic Association, the Osteopathic Physicians and Surgeons of California, and the California Podiatric Medical Association. Its goal was to evaluate podiatric training and education, compare it to that of MDs and DOs. After site visits were complete at both podiatric schools in California and at four residency programs, the team of MDs, DOs, and PhDs concluded that by the end of DPM training and education, the practicing “end product” produced by podiatric training and education was indistinguishable from practitioners of other regional specialties of medicine (such as ophthalmology and ENT).

Does the option to take the USLME down the road make our Licensing Boards obsolete?
No. Speculating about taking the USMLE and how that might affect licensing boards is so far into the future that no one has the answers. For now, podiatry licensing boards will be the only entities licensing podiatrists for practice, and any change to the exam used (APMLE from the NBPME) would have to go through every state legislature. APMA and ACFAS will always protect our current licensees and their ability to practice.
 
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air bud

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I truly hope this would be the case and there are no insidious loop-holes or malicious intentions behind this move because this would royally screw all current practicing podiatrists. Given the discussion on the other thread in the "Podiatric Residents & Physicians" fourm about the subject, the hatred is still there.

I agree that we should definitely have a pathway similar to DO for us, but my gut feeling is that this is unlikely.
Your understanding of this profession changes profoundly if this happens. As has been stated, this is a desirable field if open to MDs. Chill out and enjoy. Suck up the occasional ego check and enjoy the benefits of the profession.
 
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DexterMorganSK

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Do you guys agree with Dr. Richie?

 

de Ribas

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Do you guys agree with Dr. Richie?

I agree with and I said the same thing that Steps 1 and 2 won't require much change in curriculum. MD/DO students start using USMLE prep materials during their first year and concentrate on that rather than on schools lectures and material. Therefore, I agree that podiatry students can do well enough on Steps 1 and 2 if they start using USMLE materials to study in their first year or so. Its not that 1st or even 2nd class will do well, but with time it will get there. I agree that pod students are at a disadvantage for USMLE step 3, because mostly this is covered during clinical. But again, there are materials to study for it. How come thousands of FMGs come to US and are able to do well on USMLE only using prep materials. Some of them come from poor countries with poor education standards, poor technology, etc. They often have different pharmacology material and clinical standards and protocols. They basically have to relearn a lot of medicine studying for USMLE and they are able to do it often with basic English.

Its just that 3rd and maybe 4th year will need to be changed to fit in medicine rotations. That's even if these don't help for USMLE step 3. AMA/LCME will require pod students to rotate through main/core medicine rotations.

I don't agree with him or with anyone saying that possible changes will eliminate "essential" podiatry courses. He mentioned biomechenics courses. What biomechanics courses is he talking about? At my school we took only one biomechanics course which was only 2-credit hour course. And there is no reason any school should have courses during third year. None. If MD/DO schools have more courses that they are able to fit into 2 years, there is no reason pod schools need to spread out lighter curriculum into a third year.
At my school, our first year is with DO students and during 2nd year it is almost the same. They have some additional courses. Our coursework is somewhat lighter especially during second semester of 2nd year. There is a space to put in several courses easily. Plus DO curriculum incorporates OMM lectures, practice, training and exam and physicianship, ethics, and other courses. So. Why they are able to fit heavier coursework into 2 years and start clinicals at the beginning of 3rd year and pods can't?

During 4th year, mostly, MD/DOs rotate through their specialties of choice Hopefully to land a residency in those specialties. We don't need to do that. As DPMs we can have 4th year primarily to rotate at pod externships and cover pod material.
I am not sure of all pod schools, but some pod schools make their students rotate through their school clinic or local pod practices seeing only couple students per day or maybe only every other day. They don't take courses all 3rd year or prep for shelve exams or something like that. I would rather spend 2 months with full schedules every day than 8 months seeing 2 patients per day going like 3-4 times per week and saying that we rotate through podiatry for 8 months.

I don't think making pods take USMLE and changing 3rd/4th year rotations to incorporate medicine rotations will make pods less distinctive, less knowledgeable in pod material or require eliminating any pod courses or time of podiatry exposure.
 
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PTPuser

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At the very end of the resolution the AMA said that they are going to actively start lobbying to the Joint Commission to establish a standard across all hospitals that anyone who is not an MD/DO in the hospital environment will have to immediately identify themselves as a non-physician and describe the nature of their doctorate for each and every patient encounter.

So now when you, as a Podiatrist, are doing a surgical consult in the ED you‘ll have to say “Hi, I’m Dr. Jones. I am a non-physician Doctor of Podiatric Medicine“. Isn’t that gonna get a little exhausting and awkward for both you and the patient? Especially if you’re hospital employed?

Also get ready to turn in your “DOCTOR” or “PHYSICIAN“ badge tags as they are going to lobby the Joint Commission to exclusively restrict that for AMA defined physicians also.

IMHO, and this is not directed towards you or anyone in this thread, their battle should be taken up with their PA and NPs / CRNA. Like, we're not the enemy here.
 
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heybrother

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Resolution 303, Improving the Standardization Process for Assessment of Podiatric Medical Students and Residents by Initiating a Process Enabling Them to Take the USMLE Original author’s rank: 1 out of 1 Extracted by: Michael Aronow, MD, Delegate, American Orthopaedic Foot and Ankle Society Extraction statement: AMA policy maintains that the term physician should be reserved for MDs and DOs. However, other health care providers including podiatrists, optometrists, chiropractors, and dentists have been designated as physicians by Medicare and a majority of States. We believe that any podiatrist who wants to be called a physician should pass all three parts of the USMLE, and receive education, residency training, and board certification that meets standards comparable to those of the LCME, ACGME, and the AMBS. If podiatry is willing to attempt to meet these standards, we believe that they 11 should be given the opportunity to succeed or fail, and demand that other non-physician health care providers do the same. If our AMA feels that the study requested in this resolution study is not the best path towards deciding whether or not to support this process, our AMA should make it a priority to find another way. Resolution Committee score: 1.92 (1 = not a priority at this time)

From their appendix:

Appendix – Extraction Statements and Resolution Committee Assessments The Resolution Committee evaluated each resolution using the following scale based on the prioritization matrix, with higher scores meaning higher priority:
5 - Top Priority Resolution: One of the very most important resolutions
4 - High Priority Resolution: Important Issue but not a top priority
3 - Medium Priority Resolution: Somewhat important issue, medium priority
2 - Low Priority Resolution: Lower priority issue, there is likely little impact
1 - Not a Priority Resolution: This is not a priority at this time

Each extracted resolution is listed below along with the original author's rank (i.e. its rank among the number of resolutions submitted by that same delegate, delegation or section), the extraction statement from the delegate that requested the extraction, followed by the Resolution Committee’s average priority score and any comments from AMA staff. Note: Extraction statements and comments were limited to 150 words.
 

DexterMorganSK

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Resolution 303, Improving the Standardization Process for Assessment of Podiatric Medical Students and Residents by Initiating a Process Enabling Them to Take the USMLE Original author’s rank: 1 out of 1 Extracted by: Michael Aronow, MD, Delegate, American Orthopaedic Foot and Ankle Society Extraction statement: AMA policy maintains that the term physician should be reserved for MDs and DOs. However, other health care providers including podiatrists, optometrists, chiropractors, and dentists have been designated as physicians by Medicare and a majority of States. We believe that any podiatrist who wants to be called a physician should pass all three parts of the USMLE, and receive education, residency training, and board certification that meets standards comparable to those of the LCME, ACGME, and the AMBS. If podiatry is willing to attempt to meet these standards, we believe that they 11 should be given the opportunity to succeed or fail, and demand that other non-physician health care providers do the same. If our AMA feels that the study requested in this resolution study is not the best path towards deciding whether or not to support this process, our AMA should make it a priority to find another way. Resolution Committee score: 1.92 (1 = not a priority at this time)

From their appendix:

Appendix – Extraction Statements and Resolution Committee Assessments The Resolution Committee evaluated each resolution using the following scale based on the prioritization matrix, with higher scores meaning higher priority:
5 - Top Priority Resolution: One of the very most important resolutions
4 - High Priority Resolution: Important Issue but not a top priority
3 - Medium Priority Resolution: Somewhat important issue, medium priority
2 - Low Priority Resolution: Lower priority issue, there is likely little impact
1 - Not a Priority Resolution: This is not a priority at this time

Each extracted resolution is listed below along with the original author's rank (i.e. its rank among the number of resolutions submitted by that same delegate, delegation or section), the extraction statement from the delegate that requested the extraction, followed by the Resolution Committee’s average priority score and any comments from AMA staff. Note: Extraction statements and comments were limited to 150 words.

If I read it correctly, it's extracted but will still be presented? It's fun to see words like "our AMA" lol
 
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None of the language in that summarized resolution seems like it is in favor or complimentary to podiatry. It reads more like "we should let them attempt and fail like we expected at doing the standards we set out."

With how much territory the (his) AMA is losing to NPs and PAs as a whole you'd think the language would be a little different.
 
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