podiatry is medical school

[347932]

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Here is a blurb about Tramadol:
http://www.drugs.com/sfx/tramadol-side-effects.html

I avoid it like the plague to be honest. Not a great suggestion sorry.

Of all the searches I did of Darvocet, it seems that is a "Bad" drug due to abuse which I can't really control unfortunately. Breathing depression is also something I mention specifically to all of my patients when prescribing any narcotic. Your assumption that I only see kids and don't do surgery on adults is a bad one. I don't prescribe Darvocet to my pediatric population. Children tend to prefer elixirs so they get Tylonel #3 or #2 in elixir form if they are old enough.

I'm not arguing with you ma'am. Condescending or not, I can't see your point of view the way you put it out there and I disagree with your demeanor, student or not.

Interesting how you fall back and play the student vs real life card.

 

[All4MyDaughter]

Did you read the document I linked above about propoxyphene? It's from the FDA website. If you want to PM me, I can probably figure out a way to send you the pdf detail document from The Pharmacist's/Prescriber's letter. If you use propoxyphene a lot in your practice, you should read it.

The document you linked lists standard side effects of tramadol, which are similar but not identical to most opioid medications. Your comment before seemed to imply that you knew of or had access to head to head studies comparing propoxyphene to tramadol (or other pain medications). I'd be interested in reading them if you do, but drugs.com doesn't address that particular issue.

Do you mind to share your reasoning for avoiding tramadol like the plague?

The issues with propoxyphene, which are UNIQUE to propoxyphene include:

- Narrow therapeutic index (toxic dose is not much higher than effective dose)
- Similar efficacy to APAP alone - in other words, you aren't getting any additional benefit from the propoxyphene but you add toxicities
- Cardiotoxic metabolite
- High overdose potential
- Not easily reversed by naloxone (unlike many other opioids)
- Listed on the Beers Criteria for toxicity, overdose potential and increased risk of falls

Demeanor is impossible to determine on the internet. I said you came off as condescending, and I also said I'd apologize if I was wrong. Perhaps I'm no more or less skilled at determining demeanor and intent than you are. So I will apologize for accusing you of being condescending but reiterate that you can't tell a thing about my demeanor from words typed on a screen.

 

[All4MyDaughter]

Your assumption that I only see kids and don't do surgery on adults is a bad one. I don't prescribe Darvocet to my pediatric population. Children tend to prefer elixirs so they get Tylonel #3 or #2 in elixir form if they are old enough.

I didn't make any assumptions, only asked if you used Darvocet in children. Can you explain the difference between a Tylenol #3 elixir and a Tylenol #2 elixir? Do you mean you just prescribe a higher dose for an older child? I don't think there are different concentrations available on the market in the United States.

Tylenol #3 tablets are 300 mg APAP and 30 mg codeine. Tylenol #2 is 300 mg APAP with 15 mg codeine. The codeine/APAP solution is 120 mg of APAP with 12 mg of codeine (per 5 mL of solution). The oral solution contains alcohol and the oral suspension is alcohol free. Most pediatric practitioners in my area prefer the alcohol free formulation for very young children.

 

[Xforward22]

My main argument aligns closely with many of these comments ... that pods are great at what they do and achieve respect from their work and not the letters after their name. However, the feelings of inferiority to MDs will always be an issue despite the giant strides made. I'm more perplexed as to if there is a DO vs. DPM status discrepancy. For all those who say "podiatric" should be placed before "medical school," then shouldn't "osteopathic" also be? It was not too long ago that osteopaths were referred to as glorified chiropractors.

This should be made very easy ... if you have to take the MCAT (medical college admission test with emphasis on the word medical) and are licensed to prescribe medicine with no restrictions, then you are a doctor. Go ahead and put "podiatric" and "osteopathic" in front of the words "medical school" when telling people where you go for the sake of clarity, and let the egotistical MDs (not all, but some) say what they want, but I don't want to ever hear it from a DO. All 3 types of docs should be in this together with a mutual understanding that medicine is too diverse nowadays to give all the credit to the MDs.

 

[BlueMerlin]

Pay me the same as an orthopod for the same operation and I won't care what you call me. No one should object to this except insurance companies, and if we have to get the MD degree to achieve financial fairness, so be it. If not, great, I'll stay a DPM.

 

[ItsGavinC]

This should be made very easy ... if you have to take the MCAT (medical college admission test with emphasis on the word medical) and are licensed to prescribe medicine with no restrictions, then you are a doctor. Go ahead and put "podiatric" and "osteopathic" in front of the words "medical school" when telling people where you go for the sake of clarity, and let the egotistical MDs (not all, but some) say what they want, but I don't want to ever hear it from a DO. All 3 types of docs should be in this together with a mutual understanding that medicine is too diverse nowadays to give all the credit to the MDs.

🙄

Why don't you guys worry about doing something you love instead of trying to manipulate or rationalize your profession to fit what others ought to think, or what you think others will love.

Nobody cares if you think you went to medical school, or if you really did, or if you might have. You are all in a pissing match with yourselves. Changing what you call yourself or your education isn't going to make you happy. Better come to grips with that before it's too late.

 

[347932]

My main argument aligns closely with many of these comments ... that pods are great at what they do and achieve respect from their work and not the letters after their name. However, the feelings of inferiority to MDs will always be an issue despite the giant strides made. I'm more perplexed as to if there is a DO vs. DPM status discrepancy. For all those who say "podiatric" should be placed before "medical school," then shouldn't "osteopathic" also be? It was not too long ago that osteopaths were referred to as glorified chiropractors.

This should be made very easy ... if you have to take the MCAT (medical college admission test with emphasis on the word medical) and are licensed to prescribe medicine with no restrictions, then you are a doctor. Go ahead and put "podiatric" and "osteopathic" in front of the words "medical school" when telling people where you go for the sake of clarity, and let the egotistical MDs (not all, but some) say what they want, but I don't want to ever hear it from a DO. All 3 types of docs should be in this together with a mutual understanding that medicine is too diverse nowadays to give all the credit to the MDs.

I never have and never will feel inferior to anyone professionally, except for those that came before me and paved the way for me to succeed. I don't necesarrily feel inferior to them. I am in awe of them.

A "feeling" is a personal matter. Those who "feel" inferior do because of some stigma they place on themselves. If you let someone else make you feel inferior, again that is something for you to deal with within yourself.

Do your best and know you are the best and all else will fall into place in this regard. Be humble about it as well. That really helps matters😀.

 

[347932]

🙄

Why don't you guys worry about doing something you love instead of trying to manipulate or rationalize your profession to fit what others ought to think, or what you think others will love.

Nobody cares if you think you went to medical school, or if you really did, or if you might have. You are all in a pissing match with yourselves. Changing what you call yourself or your education isn't going to make you happy. Better come to grips with that before it's too late.

I really like this person.

 

[UNVME2]

Changing what you call yourself or your education isn't going to make you happy. Better come to grips with that before it's too late.

Maybe you should tell that to one of the top DPM researchers at one of the well respected residency programs in the North East.

By his profile, you can see why the lay patient and pre-podiatry students are confused as to if/what we should refer to our education as.

He also happens to be the editor of the JFAS. Inferiority complex or typo?

http://www.pennmedicine.org/wagform/MainPage.aspx?config=provider&P=PP&ID=9153

 

[347932]

Maybe you should tell that to one of the top DPM researchers at one of the well respected residency programs in the North East.

By his profile, you can see why the lay patient and pre-podiatry students are confused as to if/what we should refer to our education as.

He also happens to be the editor of the JFAS. Inferiority complex or typo?

http://www.pennmedicine.org/wagform/MainPage.aspx?config=provider&P=PP&ID=9153

If you're referring to the fact the Dr. Malay's profile suggests he went to the Temple School of Medicine, I assure you it is a typo.

He is one of the pillars of our profession and is proud of his professional heritage, I promise. If memory serves he trained at one of the most prestigious residencies of his and many other generations.

Why does everyone read into these things with such disdain? Hospital/Residency profiles are wrong all the time. Where I am one of the well respected General Surgeons was profiled as a DDS by mistake. No one cares.

 

[UNVME2]

Why does everyone read into these things with such disdain?

Well you're agreeing with the person who said we should all get a grip and come to terms with who we are, so I pointed out an instance where one of our own has an education listing that is relevant to the discussion.

To be accurate, he graduated when it was PCPM, not TUSPM. With all the "you're medical students and going to be the greatest foot and ankle surgeons around" going around TUSPM from the faulty you wouldn't be surprised why the lines are blurred for the students.

I know, because I was at the white coat ceremony this year, that there is definitely an aversion to the "P" word, especially from those who perform more surgery.

I was recently at a hospital where DPM's had "MD" on their credentials, other's just went by Dr. X. Do I care, no, and if I didn't know he was a DPM I wouldn't have even noticed. However, to a current podiatry student, these are relevant issues regardless of how little you may care.

To make a comparison do a google search of St. Georges or any of the carribean schools and see how many of their doc's have "X school of medicine, New York, NY" listed (which is their schools US office, not where they went to school, of course).

Where I am one of the well respected General Surgeons was profiled as a DDS by mistake. No one cares

Again, do inferiorities exist in this profession, yes. Is this a case, maybe..but either way if I were a pre-pod reading his profile and not someone knows Dr. Malay personally you could see why students bring up threads like this.

 

[347932]

Interestingly these posts are never originated by those of us out in practice.

One thing that will become very evident to all of the students and residents who have issues with Podiatry vs. Allopathic medicine vs. DOs will quickly realise that once you get out into practice, no one cares about these types of things.

As to your experience with the "white coat" ceremony, I hate to hear that the "p" word was avoided. We need to embrace our heritage and be proud of who we are and what we do. We are Podiatrists. We are also Surgeons. Some states don't allow Podiatrists to do ankle surgery. Therefore we can't use the blanket "Foot and Ankle Surgeons". We are Podiatrists. Embrace it and be the best you can be at it. All else will fall into place.

 

[ladpm]

I can't help, but to put my two cents on this topic and hopefully this thread can disappear…for the time being.

Overall, I agree to what was said above from those who believe with conviction that podiatry is their true calling as a career. In fact, I have more respect and admiration for them because they are wiser than I was when I went through podiatry. The letters at the end of your name DOES NOT matter as long as you put forth your best effort to a make a difference as a physician. Instead of spending energy on posturing about what to be called, make better use of your time and take pride in what you do. And the reason I can say this is that I was (or maybe still am) that arrogant fool who thought your degree mattered. I'm finishing medical school right now and it is a very, very, very expensive lesson learned. For those wishing for a degree name change or the belief that you should omit the word "podiatric" in your introductions or there's a typo on a website, do the right thing and speak up if it bothers you. (As an aside, I did get a badge during residency with the MD on it so I went back to the security office to change it) If it still bothers you, maybe consider leaving the profession to get what you really want.

Here is where the argument of perception is a fallacy. A good portion of the general public where I'm from does view podiatrists as doctors that went to medical school. Even my friends were confused why I had to go to school again after I earned my degree. In addition, my classmates were shocked that I graduated from podiatry school and finished a residency. A few thought that you had to go to a medical school to receive training. But most thought that it was similar to medical school and it was unfair because I already knew the material. (I still hear it from classmates as recently as two days ago) On rotations, some of my attendings knew I went to podiatry school and were surprised I switched. What I found out was that perception works in both ways. A handful of IM/FM/Peds docs were envious of podiatrists because they made good money (if not more than them) and worked less than they did (basically not being on call). Even during my interviews for residency now, the attendings were intrigued and looked at it as a major asset. There was one hospital where the transitional years shared office space with the podiatry residents and they all get along just fine. For the most part, there is a mutual respect within the health profession regardless of the degree (DPM/DDS/MD/DO). Believe it or not, there still are those that discriminate between US MD vs. foreign MD vs. DO but it's rare. (Another aside, there is one attending I know that is a DO and his white coat has MD on it. I didn't care cuz he's an awesome doc)

Now for the LEAST important part of this issue is the technicality by which this thread was based on: the format of podiatric medical school is SIMILAR to medical school, but definitely NOT the same. I graduated at the top of pod school and had enough time to enjoy life after class. On the other hand, med school took way more than three times the effort and several near break ups with my now current wife. The format of pre-clinicals during the 1st year are similar, but the depth of memorization was intense. Was it easier because I recognized the components of the Kreb cycle and what not? Maybe, but I didn't felt like it was much of an advantage except for lower extremity anatomy where we spent like maybe 2 weeks on it at best. And of course, the 2nd year, clinical rotations, and boards are vastly different. Though, I did felt more prepared for surgery rotations. And no, you are not allowed to transfer credits so I had to take all the courses over again and good thing cuz it was vital for USMLE I. Would I recommend people to do it? Absolutely not! In fact, I discourage anyone who wants to go through this hardship unless you're 100% sure that this is what you want. The grass is always greener on the other side of the fence regardless which yard you're standing in.

Now please lets drop this silly thread.

 

[air bud]

AWESOME post.

 

[ItsGavinC]

Maybe you should tell that to one of the top DPM researchers at one of the well respected residency programs in the North East.

By his profile, you can see why the lay patient and pre-podiatry students are confused as to if/what we should refer to our education as.

He also happens to be the editor of the JFAS. Inferiority complex or typo?

http://www.pennmedicine.org/wagform/MainPage.aspx?config=provider&P=PP&ID=9153

He could have an inferiority complex, or it could be a form that the website uses and it's too much of a hassle to change it. I can't tell you how many insurance papers I've filled out where it asks where I went to medical school. I didn't, of course, but I still answer the question because we all know they want to know where I did my primary professional training.

Patients don't have any confusion about this. Either they are seeing a podiatrist that can provide them with service, won't hurt them, treats them kindly, and takes their insurance...or they are seeing someone else.

Pre-podiatry students should refer to the education as podiatry school. That's what it is. Physicians go to medical school. Dentists go to dental school. Podiatrists go to pod school. Grads with an MBA attended business school. It's not a difficult concept.

If this is really that big of an issue for you then you probably aren't going to be happy in this profession.

 

[UNVME2]

I can't tell you how many insurance papers I've filled out where it asks where I went to medical school.

Exactly, so would you say "Temple School of Medicine" or "Temple School of Dentistry"? I think that's obvious. Furthermore, there are several other colleagues on the same website with accurate credentials.

Patients don't have any confusion about this.

Actually, they do and it's supported by recent published research. Although they are more likely to associate "DPM" and "podiatrist" with foot care, a majority of people still think podiatrists went to allopathic medical school, which is not true.

If this is really that big of an issue for you then you probably aren't going to be happy in this profession.

The issue is with misrepresentation, which may or may not be occuring in the instance I provided. However, as podiatry evolves into a more surgical specialty the reality of "identity phobia" facing our podiatry students is often downplayed or downright misrepresented by practicing pods (and even dental students, evidently.)

Perhaps your "just get over it" attitude is due to the fact that your education and scope is not going anywhere, much like those podiatrists already out in practice, but don't criticize students for being confused about the terms "medical school" and "podiatry school" when the very same podiatrists who are teaching them are using the same vocabulary, and sometimes the same initials as allopathic physicians.

Oh, and thanks for your career advice, but my gripes are with misrepresentation, not what I do for a living.

 

[ItsGavinC]

Exactly, so would you say "Temple School of Medicine" or "Temple School of Dentistry"? I think that's obvious. Furthermore, there are several other colleagues on the same website with accurate credentials.

So blame it on the webmaster. I highly doubt that doctor in question looks at his own bio. Are you trying to say that because one podiatrist has that on university webpage that podiatrists should say they went to medical school? Quite the backwards argument.

Actually, they do and it's supported by recent published research. Although they are more likely to associate "DPM" and "podiatrist" with foot care, a majority of people still think podiatrists went to allopathic medical school, which is not true.

You are still missing the point. The point is that it doesn't matter what the patient thinks, UNLESS this in some way limits your ability to provide proper treatment to the patient. If that is the case, then there is something wrong with the profession, not with what you call your training. Who does it hurt if the patient thinks you went to med school? Is that a daily discourse you have with your patients?

Oh, and thanks for your career advice, but my gripes are with misrepresentation, not what I do for a living.

Once again, the misrepresentation being stated doesn't really affect anything. If you are telling people you have an MD, then you are lying. If you are telling people you went to med school and didn't then you probably are embarrassed by your professional training and trying to bolster your ego.

 

[347932]

 

[UNVME2]

So blame it on the webmaster. I highly doubt that doctor in question looks at his own bio. Are you trying to say that because one podiatrist has that on university webpage that podiatrists should say they went to medical school? Quite the backwards argument.

Ok, so not that it's obvious who really missed the point, let me summarize my posts in an "easy to follow" outline for you:

1. There is is a trend of podiatry students calling themselves medical students...check

2. I think the trend in #1 is embarrassing to our profession, though I can see why they are using this term being as though they are being taught by podiatrist who call them "medical students"...check

3. Although both of us know in reality podiatry students are not medical students and DPMs are not MDs, there are DPMs who say they went to medical school and students who are following suit...check

4. Why does it matter? Lying is bad.

The point is that it doesn't matter what the patient thinks, UNLESS this in some way limits your ability to provide proper treatment to the patient.

It doesn't matter what the patient thinks about my credentials? It does affect my ability to provide proper treatment and more importantly ANY TREATMENT if the patient doesn't even know what I'm allowed to treat. Again, look at the research and then reply rather than spout this nonsense.

If that is the case, then there is something wrong with the profession, not with what you call your training.

Just about every podiatrist/podiatry student would agree with this, and it's been this way for some time now. Organizing podiatrists to is like herding cats.

Who does it hurt if the patient thinks you went to med school?....If you are telling people you went to med school and didn't then you probably are embarrassed by your professional training and trying to bolster your ego

You answered your own questions, funny what a little logic can do and I agree with it! Now apply this to the DPM advertising he went to medical school.

Once again, the misrepresentation being stated doesn't really affect anything....If you are telling people you have an MD, then you are lying.

So, you mean it's not OK to tell a patient that I'm a MD because that's "lying" but it's not lying to say I graduated from medical school and not podiatry school just because you don't think there are consequences to the latter?

Hmm, that's funny because last time I checked if you went to medical school you graduated with an MD and if you graduated from podiatry school you got a DPM.

To sum this up, I'm not really sure what you're advocating because you're arguments are scattered, but it's never OK to lie and if you don't know the difference between an MD and DPM and how that affects patient care then you need more information than I can give you here.

Lying is bad sir dentist, in any sense (especially to the patient). I have no recourse for the argument that it's OK to lie as long as there are no consequences, that might be what they teach in dental school, but I think I learned somewhere back in middle school that this is wrong.

With that in mind, lets not lie to our patients podiatry students. Despite what the DPM's tell you, by law and by common sense we're podiatry students so don't embarrass yourself by telling anyone anything different.

 

[UNVME2]

Oh, no sir.

This horse is quite alive.

Just this week we had a well known podiatrist (who I'm sure you know if you went to TUSPM) tell our students that it's now "below us, as physicians" to cut toenails.

Yes, this is what we are being taught.

 

[347932]

Oh, no sir.

This horse is quite alive.

Just this week we had a well known podiatrist (who I'm sure you know if you went to TUSPM) tell our students that it's now "below us, as physicians" to cut toenails.

Yes, this is what we are being taught.

The horse is still dead. Beat away I guess.

Bah, ok I'll bite. How does this have anything to do with whether we say we go to Medical School or not???

Cutting toenails is an essential part of what our profession does. How does one professor's opinion of our scope of practice have to do with the discussion? Perhaps this professor is only in academic medicine and has students/residents cutting all the nails. I cut toenails everyday. I must be missing something.

 

[konkan]

I dont care what all other "haters" think but podiatry is medical school. I am all for changing DPM to PMD. Trust me this is coming and the profession is on the rise.

I don't know much about podiatry, nor how it is compared to traditional medicine, but from psychological point of view, your statement only shows that deep down you feel inferior.

 

[FarscapeGirl]

I'm surprised you made such an error in your post, because you are completely wrong. A podiatrist is also legally allowed to prescribe any medication. They must prescribe that medication for some reason that is in their scope of practice, but they can prescribe any CII-V substance. Like calcium channel blockers (for Raynaud's phenomenon, not hypertension). You as the pharmacist may not know the reason the Rx is written or the condition being treated. It is also not the pharmacists right to determine scope of practice for any practitioner, OD, DPM, DDS. If it is a validly written Rx and there are no safety issues, you fill it.

The state board of podiatry/optometry/dentistry is the only entity that can make judgements if a practice is in or out of scope.

Hmm... as a pharmacy student, I don't agree. I'd give the benefit of doubt for scope of practice, but here in Washington state, everything but MD/DO has to be in scope of practice. It's my duty (or will be) when I question a prescription to call and find out what's going on. Honestly, a straight-forward Rx from an ARNP, DPM, or PA will most likely get filled. I don't want to spend forever verifying if someone should be treating a UTI or not, and if it's a reasonable dosage, I really don't care. But it's for my patient's safety if I choose not to fill something if whoever's prescribing it doesn't have the specialty to write the Rx. If I get a complicated chemo prescription from an ARNP that specializes in mental health, or heck, even a psychiatrist, you expect me to fill it with no questions asked??

 

[FarscapeGirl]

Okay, I have a question for the podiatry students and practicing podiatrists after reading this thread. It sounds as if there is some push to make podiatry a specialty of medicine. How much would this add to the years of schooling? What would be sacrificed if podiatry was moved to medicine?

For one thing, possibly there'd be even more outcry that podiatrists shouldn't cut toe nails. Frankly, that is the one thing I knew before entering the medical field that podiatrists do and was very glad of. I'm young and can certainly deal with that part of personal hygiene, but my grandmother, with her damaged feet from hose and some high-heel wearing, definitely benefitted from visiting a podiatrist.

I'm not trying to troll, seriously. I'm just curious why podiatry developed the way it did and would appreciate learning more.

 

[malleolusman]

Okay, I have a question for the podiatry students and practicing podiatrists after reading this thread. It sounds as if there is some push to make podiatry a specialty of medicine. How much would this add to the years of schooling? What would be sacrificed if podiatry was moved to medicine?

For one thing, possibly there'd be even more outcry that podiatrists shouldn't cut toe nails. Frankly, that is the one thing I knew before entering the medical field that podiatrists do and was very glad of. I'm young and can certainly deal with that part of personal hygiene, but my grandmother, with her damaged feet from hose and some high-heel wearing, definitely benefitted from visiting a podiatrist.

I'm not trying to troll, seriously. I'm just curious why podiatry developed the way it did and would appreciate learning more.

Podiatry school in the US was actually developed by an MD who saw the need for a specialty devoted to the foot & ankle. I think he was the doctor who founded NYCPM . . . For more exactly on the history of podiatry, US podiatrists and their training, please see:

http://en.wikipedia.org/wiki/Podiatry

Scroll to Podiatry in the US.

There is an internal debate about how the profession is going to move forward.

Podiatry school as it is now is 4 years. That is followed now by a mandatory 3 year pm&s (podiatric medicine and surgery) residency. Some programs have a heavier focus on diabetic limb salvage or trauma than others.

If, and this a big big if, the specialty was to be moved to an allopathic medical specialty - the most significant change would be podiatric medical students taking the USMLE, and having an unlimited license but still just treating only the foot & ankle. If it did happen, it would effectively be sacrificing our niche in health care for the MD diploma.

To make things clearer, a neurologist may be trained in neurology, but he still has an unlimited license in medicine. For an MD, once you are in a given specialty - you don't treat outside your scope, because it opens you up legally, even though it is LEGAL. For a podiatrist, it is ILLEGAL to treat any condition that is out of our scope.

Right now, there are older podiatrists - some who do only routine palliative care (nail cutting like you describe) since they never received surgical training back when the profession was in formative stages for surgical training. The profession has evolved and come a long way since then. Often times now, nail cutting is not an insurance covered service, so this is the reason a lot of podiatrists are moving away from it, even if it may be medically warranted. What is point in performing a service that isn't covered, and the patient doesn't plan on paying you for? Patients often will fight with the doctors if they are told they have to pay for their nails to be cut if it isn't a covered service. The podiatrists who do bill for nails often find creative, yet legal, ways to bill for it. The bottom line is, it is becoming more and more a technician's work according to some - that of a medical assistant.

It varies how much routine care a podiatrist is getting. I know of several successful practitioners in all 4 quadrants of the US that just don't get any nails, simply because the populations they serve don't have diabetes. Instead, they are seeing sports injuries, bunions, congenital foot deformities, and the wide host of problems found in the LE.

Hope that answers your questions.

 

[ckjets]

what an embarrassment, I can't believe I am going to say this but I agree with airbud 100%. Some podiatry students have succeeded in belittling our profession more than any orthopedist has ever dreamed of. One suggestion to you all, get the f--- off SDN and hit the books.

 

[Aznfarmerboi]

I'm surprised you made such an error in your post, because you are completely wrong. A podiatrist is also legally allowed to prescribe any medication. They must prescribe that medication for some reason that is in their scope of practice, but they can prescribe any CII-V substance. Like calcium channel blockers (for Raynaud's phenomenon, not hypertension). You as the pharmacist may not know the reason the Rx is written or the condition being treated. It is also not the pharmacists right to determine scope of practice for any practitioner, OD, DPM, DDS. If it is a validly written Rx and there are no safety issues, you fill it.

The state board of podiatry/optometry/dentistry is the only entity that can make judgements if a practice is in or out of scope.

http://www.op.nysed.gov/opd/jun10.htm

Neil Subes, Forest Hills, NY

Profession: Pharmacist; Lic. No. 032018; Cal. No. 24839

Regents Action Date: June 22, 2010

Action: Application for consent order granted; Penalty agreed upon: 1 year stayed suspension, 1 year probation, $5,000 fine.

Summary: Licensee did not contest charges of dispensing a prescription-required drug on 2 occasions pursuant to 2 prescriptions written by a dentist that licensee knew were prescribed for non-dental-related purposes.
While states have different legal rules, How would you respond to the above pharmacist being sanction by the NY state Board of Professions? Also, while I agree that only respective boards can decide what is the scope of practice for their fields, if the pharmacist does not know the scope of practice for a field, how can they fill a prescription safetly? For example, if I am not aware that an opt. specializes only in the eyes, how do I know not to fill a prescription for digoxin?

And yes, while viagra is approved for PAD, the script should be written for Revatio.

Kidsfeet, I can not believe a pharmacist did not fill your prescription for Neurontin or refused Darvocet based on age... While I am not a big fan of Darvocet (thank god it is finally off the market), this is the first time I have heard of it. Maybe there was miscommunication?

A lot of times, there are rejection codes from "insurances" where they would have different tiers requiring step therapy. Sometimes a rejection code is an insurance telling the pharmacist, hey there is an interaction or precaution! The pharmacist or technician could have intepreted that as the insurance rejecting the claim since they look all the same. (Happens once in a while with new pharmacists who have no experience with insurances or pharmacists who fail to supervise their technicians).

 

[DrGonz]

...

 

[VVMed1]

you people are idiots for even discussing this! This is so ******ed!

Best post made in this entire thread! 👍

 

[doc1107]

No.

Just a big fat no.

Just like Dental school isn't medical school. And Pharmacy school isn't medical school.

My cousin is a dentist and went to school with a medical school attached. He said no.

I say no after I have sat in on a few medical school classes.

and just no.

Also, who cares? As long as you learn what you need for this profession, who cares?

 

[DrGonz]

Also, who cares? As long as you learn what you need for this profession, who cares?

Who cares?

No.

Just a big fat no.

Just like Dental school isn't medical school. And Pharmacy school isn't medical school.

My cousin is a dentist and went to school with a medical school attached. He said no.

I say no after I have sat in on a few medical school classes.

and just no.

..obviously you

 

[doc1107]

Who cares?






..obviously you

Uhhhhh way to take it out of context. Just because I am trying to correct a mis-conception doesn't mean I care. Just like if someone is for Gay rights, does that make them gay?

 

[FreshPodStudent]

I also agree that this forum isnt of much value, but I will point out one thing...

Saying that podiatry school isn't medical school based on the fact that dental school and pharmacy school isnt medical school isnt a very good arguement. Pharmacy curriculum doesn't include gross anatomy, and dental school does not teach you how to even listen to heart and lungs or bowel sounds. (Nor do they need to do those things.)

It kinda bugs me when people make characterizations by implying that we have the same general medicine knowledge and clinical skill as dentists and pharmacists do.

Neither of those professions study for their boards with USMLE prep books, nor are hospital rotations through many specialties or even residencies are typically required (to my knowledge).

Our education in podiatry school prepares us for 3 year residencies in which a significant portion will be spent in internal medicine and other specialties of medicine and surgery, with the same responsibilities as any other PGY's. That, I think, is a main reason many argue that we are basically in med school, and I think... yes, we "basically" are.... It is important to accurately portray the distinctions when necessary.

Again, it bugs me when people make the argument that we aren't in medical school because "optometrists, dentists, and pharmacists dont say they are in medical school".

I am aware of some key differences between our education and traditional medical school, and so I don't usually say im in medical school, because I think its important to point out to people our specific education and expertise, while also keeping in mind that we do have a very good knowledge of systemic pathology and medicine.

Podiatry is a near-perfect hybrid of specialization and vast general knowledge.

I am in podiatry school/podiatric med school/podiatry med school... to be an expert in foot and ankle medicine and surgery.

 

[air bud]

you make a good argument, bring up points I haven't thought about before. thanks.

 

[G0dFather]

"Podiatry is a near-perfect hybrid of specialization and vast general knowledge."


Im loving this sentence lol

 

[PeaJay]

"Podiatry is a near-perfect hybrid of specialization and vast general knowledge."

👍👍👍 Couldn't have said it better👍👍👍

 

[emericana]

I like to think of podiatry school (which I will not be starting until the fall) as what medical school would be like if everyone had to pick their specialization from day one....

for example a school just for derm, a school just for rad, a school just for ortho etc...

From my research this seems to be true. It is the only specialty (correct me if I am wrong) that will allow you to do surgery with a 3 year residency... the MD surgery programs are 5-7 years. This could be because we specialize earlier?

 

[shenanigans327]

I like to think of podiatry school (which I will not be starting until the fall) as what medical school would be like if everyone had to pick their specialization from day one....

for example a school just for derm, a school just for rad, a school just for ortho etc...

From my research this seems to be true. It is the only specialty (correct me if I am wrong) that will allow you to do surgery with a 3 year residency... the MD surgery programs are 5-7 years. This could be because we specialize earlier?[/QUOTE]


or because we're just that bad@$$!! 😀

 

[karizma098]

I like to think of podiatry school (which I will not be starting until the fall) as what medical school would be like if everyone had to pick their specialization from day one....

for example a school just for derm, a school just for rad, a school just for ortho etc...

From my research this seems to be true. It is the only specialty (correct me if I am wrong) that will allow you to do surgery with a 3 year residency... the MD surgery programs are 5-7 years. This could be because we specialize earlier?

No. because MD surgery programs require you to train on how to operate on everything from an anal fistula to a ex lap to a hernia repair to a broken bone to trauma. Not just below the knee/ankle. Even the most specialized surgeons such as ophtho and spinal ortho take greater than 5 years of training. I wouldn't take pride in the fact that your training is half as long.

 

[karizma098]

I also agree that this forum isnt of much value, but I will point out one thing...

Saying that podiatry school isn't medical school based on the fact that dental school and pharmacy school isnt medical school isnt a very good arguement. Pharmacy curriculum doesn't include gross anatomy, and dental school does not teach you how to even listen to heart and lungs or bowel sounds. (Nor do they need to do those things.)

It kinda bugs me when people make characterizations by implying that we have the same general medicine knowledge and clinical skill as dentists and pharmacists do.

Neither of those professions study for their boards with USMLE prep books, nor are hospital rotations through many specialties or even residencies are typically required (to my knowledge).

Our education in podiatry school prepares us for 3 year residencies in which a significant portion will be spent in internal medicine and other specialties of medicine and surgery, with the same responsibilities as any other PGY's. That, I think, is a main reason many argue that we are basically in med school, and I think... yes, we "basically" are.... It is important to accurately portray the distinctions when necessary.

Again, it bugs me when people make the argument that we aren't in medical school because "optometrists, dentists, and pharmacists dont say they are in medical school".

I am aware of some key differences between our education and traditional medical school, and so I don't usually say im in medical school, because I think its important to point out to people our specific education and expertise, while also keeping in mind that we do have a very good knowledge of systemic pathology and medicine.

Podiatry is a near-perfect hybrid of specialization and vast general knowledge.

I am in podiatry school/podiatric med school/podiatry med school... to be an expert in foot and ankle medicine and surgery.

Chiropractors take anatomy. so Do Nurse practitioners. Pharmacists learn about physiology, therapeutics, and patient management - they do bone scans and immunizations. Chirorpactors in chicago are even learning how to do a pap smear. Are they in medical school? No.

a Podiatrist is not a physician, period. He/She has a doctorate, but is not a physician. If podiatry school was medical school, they would call it that - and would offer students who wanted to 'specialize' in podiatry the option to do so during medical school on rotation, followed by a 3-6 year residency; as they do for any other field. I'm pursuing a residency in anesthesia. hence, 2 years medical school, 1.5 years general rotations, 6 months anesthesia rotations, then 4 years residency. if Podiatry school was medical school, it would be the same thing - you would earn your MD and then do a residency in podiatry - but that's not the case. it's a completely seperate entity. Does the AMA recognize pod's as physicians? no. Does the government? no. Medical school is a term exclusive to physicians. Do you really think a patient will take you seriously if you tell them you went to medical school, then when you explain you have a DPM how confused they will be? it makes 0 sense.

At the end of the day, we are all health professionals who will make a great living and are an equally important part of health care. The sooner we realize that blurring the lines between what a physician is, and isn't, the better it will be. I don't tell people i'm as qualified as a PhD or was trained to do research, nor do i tell pharmacists i know as much about drugs as they do, or dentists that i know as much about teeth - just because i learned about the whole mouth, it's nerves, blood supply, pathology and treatment, doesn't make me a dentist. Taking some classes with medical students and being able to prescibe some medications doesn't make anyone a physician.

I'm sorry, this may be worth of argument on SDN, but in the real world, in a hospital, and on the floors, a DPM is a DPM, not a physician.

 

[347932]

No. because MD surgery programs require you to train on how to operate on everything from an anal fistula to a ex lap to a hernia repair to a broken bone to trauma. Not just below the knee/ankle. Even the most specialized surgeons such as ophtho and spinal ortho take greater than 5 years of training. I wouldn't take pride in the fact that your training is half as long.

I'm not sure I understand your point. General surgeons do not learn how to fix broken bones I don't think, do they? So once you've finished your internship, you then continue as an ortho surgeon in your residency, and spend 5 years doing general ortho residency. Then you spend 6 months in a foot and ankle fellowship (being trained by a podaitric surgeon according to the AMA no less), but because you've been in ortho residency for 7 years now, you're a better trained foot and ankle surgeon? Even though allopathic medical school does no training on biomechanics and pathomechanics of the foot and ankle?

I take pride in the fact that my training in podiatry school and residency taught me to be THE expert in foot and ankle care. Be it clipping toenails, treating skin disorders, healing ulcers, general foot ailments, simple forefoot reconstructive surgery all the way to the most complex rearfoot reconstruction and limb salvage. From the youngest child to the elderly.

 

[karizma098]

I'm not sure I understand your point. General surgeons do not learn how to fix broken bones I don't think, do they? So once you've finished your internship, you then continue as an ortho surgeon in your residency, and spend 5 years doing general ortho residency. Then you spend 6 months in a foot and ankle fellowship (being trained by a podaitric surgeon according to the AMA no less), but because you've been in ortho residency for 7 years now, you're a better trained foot and ankle surgeon? Even though allopathic medical school does no training on biomechanics and pathomechanics of the foot and ankle?

I take pride in the fact that my training in podiatry school and residency taught me to be THE expert in foot and ankle care. Be it clipping toenails, treating skin disorders, healing ulcers, general foot ailments, simple forefoot reconstructive surgery all the way to the most complex rearfoot reconstruction and limb salvage. From the youngest child to the elderly.

Absolutely not - podiatric surgeons that spend 3 years of training in foot and ankle surgery are surely specialized very well in their field of training. Remember, and orthopedic surgeon , even with a foot and ankle fellowship, has to learn to do a few dozen other procedures, foot and ankle is just a fellowship to learn a few more things. As far as 'who is better' - isn't that an individual thing? there are good orthos and bad ones, and good podiatrists and bad ones, i'd say for the large part that is a individual thing.


Most surgeons ( except ophtho, maybe ) have to do an intern year specializing in all kinds of general stuff, and throughout residency rotate in various specialties to learn things. Even orthopods at our program spend time on gen surg, ob/gyn, trauma surg, etc during their first few years. A competent surgeon, be it a general surgeon or otherwise, should be able to treat a gunshot wound, a hernia repair, a broken bone, etc.

I agree with you 100%. Pod's are the foot specialist. I'm not going to an ortho for a foot ulcer or other foot problem, i'm going to my podiatrist. If i burn half my foot off though, i'll go to a trauma surgeon - and if that ulcer is malignant, i'm going to an ortho onc specialist. right?

 

[karizma098]

This a silly statement. I wouldn't doubt it takes 5 years to do an ortho residency if they learning to do surgical procedures on all areas of the body. How many years do you suggest Pods train to master the foot and ankle? Three years is a lot. Compare our three years of surgical training to the foot and ankle training a typical ortho does and you would know there is no comparison. Even if the ortho did an F/A fellowship after completing their 5 year program their total F/A surgical training would be almost half as long as our 3 year surgical training residency programs.

Why are you comparing yourself to an ortho though? They have to do hip replacements, knee replacements, all types of broken bones and other procedures. Foot and ankle is only a small portion of their scope of practice. An ortho surgeon spends much less time learning these things than a general surgeon, obviously - but they have to be proficient in various types of surgeries during their intern year and rotating year. Throughout, they are obviously learning ortho as well.

I think 3 years for foot and ankle surgery is probably proficient...since you aren't required to learn to do a lot of other stuff. i just don't see the point of thinking MD's waste their time spending 5-7 years. it's proven that this is a necessary amount of time; in fact, they are thinking of extending residency's by a year.

 

[karizma098]

I also agree that this forum isnt of much value, but I will point out one thing...

Saying that podiatry school isn't medical school based on the fact that dental school and pharmacy school isnt medical school isnt a very good arguement. Pharmacy curriculum doesn't include gross anatomy, and dental school does not teach you how to even listen to heart and lungs or bowel sounds. (Nor do they need to do those things.)

It kinda bugs me when people make characterizations by implying that we have the same general medicine knowledge and clinical skill as dentists and pharmacists do.

Neither of those professions study for their boards with USMLE prep books, nor are hospital rotations through many specialties or even residencies are typically required (to my knowledge).

Our education in podiatry school prepares us for 3 year residencies in which a significant portion will be spent in internal medicine and other specialties of medicine and surgery, with the same responsibilities as any other PGY's. That, I think, is a main reason many argue that we are basically in med school, and I think... yes, we "basically" are.... It is important to accurately portray the distinctions when necessary.

Again, it bugs me when people make the argument that we aren't in medical school because "optometrists, dentists, and pharmacists dont say they are in medical school".

I am aware of some key differences between our education and traditional medical school, and so I don't usually say im in medical school, because I think its important to point out to people our specific education and expertise, while also keeping in mind that we do have a very good knowledge of systemic pathology and medicine.

Podiatry is a near-perfect hybrid of specialization and vast general knowledge.

I am in podiatry school/podiatric med school/podiatry med school... to be an expert in foot and ankle medicine and surgery.

Your post makes a lot of sense, except for what i've bolded. That's a really really strong statement to say, one a lot of resident physicians don't even make until completing residency. Here is a list of my 3 years so far:


Year 1

Psychiatry 1
Psychiatry 2
Psychiatry 3
Biochemistry 1
Biochemistry 2
Biochemistry Lab 1 and 2
Patient/Physician Dialogue
Physiology 1
Physiology 2
Neuroscience 1
Neuroscience 2
Histology
Gross Anatomy 1 & 2
Gross Anatomy Lab 1 and 2
Embryology
History of Medicine
Health Care Issues

- in class roughly 8-4 monday through friday. study from 430 to 11ish every day.
- Every month , twice-thrice a month, shadow doctors, see patients, learn clinical skills

Year 2

Clinical Topics in Medicine 1, 2, 3 - year long course
Practice of Clinical Medicine 1, 2, 3 - year long course
Immunology 1 and 2
Infectious Disease and Etiology
Pathology 1
Pathology 2
Pathology 3
Pharmacology 1
Pharmacology 2
Psychiatry 4
Psychiatry 5
Patients, Physicians, Society
Pathology 3
Integrated Physiology ( 3 )
Step 1 Board Review Course ( optional )

in class 9-4, study till 11 weekdays, study much more in spring for boards. continue to shadow in the ER, clinics, etc, sharpen clinical skills 2-3X a month

Year 3

Psychiatry - 1 month, ~ 40 hours a week
Surgery 1 and 2 , general surgery, colorectal surgery/ 2 months / 75 hrs/wk
Pediatrics 1 - 50 hours a week / 2 months
Family Medicine - 55 hours a week / 2 months
Ob/Gyn- 75 hours a week / 2 months
Internal Medicine 1 - 60-75 hours a week, 1 month
Gastroenterology - 1 month, 65 hours a week
Anesthesiology - 1 month, ~50 hours a week

That is with 4th year remaining, followed by 4 years of residency. I am nowhere near stating that i have a 'good' handle on general medicine and pathology. I'd say that's a pretty irresponsible statement for a podiatrist to make , regarding something out of his area of expertise altogether. And before anyone brings up the argument; 'radiologists / anesthesia / ophtho are specialists, what do they know abut general medicine, etc' - yes they are, but they all also went through 4 years of med school and 1-2 years of intern training in general med, followed by their specialty.

 

[densmore22]

Why are you comparing yourself to an ortho though? They have to do hip replacements, knee replacements, all types of broken bones and other procedures. Foot and ankle is only a small portion of their scope of practice. An ortho surgeon spends much less time learning these things than a general surgeon, obviously - but they have to be proficient in various types of surgeries during their intern year and rotating year. Throughout, they are obviously learning ortho as well.

I think 3 years for foot and ankle surgery is probably proficient...since you aren't required to learn to do a lot of other stuff. i just don't see the point of thinking MD's waste their time spending 5-7 years. it's proven that this is a necessary amount of time; in fact, they are thinking of extending residency's by a year.

First, I am of the same opinion as you regarding "owning your profession," etc. However, during the course of my 3 year residency, I do inpatient Family medicine, vascular surgery, pathology, radiology, anesthesiology, pain medicine, general surgery, burns/plastics, emergency room, infectious disease, Ortho/Trauma, General ortho, peds ortho, various private practice rotations, most of which are a month long (except for the more office based rotations which are usually like 2 weeks). Does this make me competent in doing a hip nailing or an appy? Hell no, but I do those rotations, most of the time right along side other residents from other specialties and medical students. Treated the same as any other resident on that service. If we aren't able to function at the same level and capacity as a family med resident or Gen surg resident, the we run the risk of failing that rotation. So, the intern year that >90% of allopathic residents go through THEN they go onto to spend 3+ years (depending on the specialty of course) doing specifically what they're training to become is interspersed throughout our 3 years of residency instead of doing a concentrated 1 year of "scut" work that most interns are doing in order to get the surgical or medical management skills necessary for them to be competent throughout their respective residency.

I will not and do not ever say I'm a physician or went to medical school, but don't dumb down our profession unless you know the specifics of our training and what we go through. Just like I don't know what you will/have gone through as an allopathic student/resident or whatever capacity your are fulfilling at this point.

I appreciate your insight and comments.

 

[347932]

Your post makes a lot of sense, except for what i've bolded. That's a really really strong statement to say, one a lot of resident physicians don't even make until completing residency. Here is a list of my 3 years so far:


Year 1

Psychiatry 1
Psychiatry 2
Psychiatry 3
Biochemistry 1
Biochemistry 2
Biochemistry Lab 1 and 2
Patient/Physician Dialogue
Physiology 1
Physiology 2
Neuroscience 1
Neuroscience 2
Histology
Gross Anatomy 1 & 2
Gross Anatomy Lab 1 and 2
Embryology
History of Medicine
Health Care Issues

- in class roughly 8-4 monday through friday. study from 430 to 11ish every day.
- Every month , twice-thrice a month, shadow doctors, see patients, learn clinical skills

Year 2

Clinical Topics in Medicine 1, 2, 3 - year long course
Practice of Clinical Medicine 1, 2, 3 - year long course
Immunology 1 and 2
Infectious Disease and Etiology
Pathology 1
Pathology 2
Pathology 3
Pharmacology 1
Pharmacology 2
Psychiatry 4
Psychiatry 5
Patients, Physicians, Society
Pathology 3
Integrated Physiology ( 3 )
Step 1 Board Review Course ( optional )

in class 9-4, study till 11 weekdays, study much more in spring for boards. continue to shadow in the ER, clinics, etc, sharpen clinical skills 2-3X a month

Year 3

Psychiatry - 1 month, ~ 40 hours a week
Surgery 1 and 2 , general surgery, colorectal surgery/ 2 months / 75 hrs/wk
Pediatrics 1 - 50 hours a week / 2 months
Family Medicine - 55 hours a week / 2 months
Ob/Gyn- 75 hours a week / 2 months
Internal Medicine 1 - 60-75 hours a week, 1 month
Gastroenterology - 1 month, 65 hours a week
Anesthesiology - 1 month, ~50 hours a week

That is with 4th year remaining, followed by 4 years of residency. I am nowhere near stating that i have a 'good' handle on general medicine and pathology. I'd say that's a pretty irresponsible statement for a podiatrist to make , regarding something out of his area of expertise altogether. And before anyone brings up the argument; 'radiologists / anesthesia / ophtho are specialists, what do they know abut general medicine, etc' - yes they are, but they all also went through 4 years of med school and 1-2 years of intern training in general med, followed by their specialty.

The only differences in the curriculum in the first two years you posted and what I went through was that I did not get as much Psych and did not have a course in OB/GYN.

In my internship I was expected to have the same expertise as any other medical intern at the facility I did my 1st year in.

 

[dyk343]

Can we just let this argument die out and have both sides agree that we are in podiatric medical school? Not medical school... Podiatric medical school.

Temple university school of podiatric medicine
new york college of podiatric medicine
california school of podiatric medicine
Barry university school of podiatric medicine
college of podiatric medicine and surgery at DMU
etc, etc

american podiatric medical association
etc etc...


Podiatrists will be specialists in the foot/ankle and will know enough about the rest of the body that if a patient is showing complications not specific to the foot/ankle they will then be able to make the correct referral.

End of argument?

 

[janV88]

No. because MD surgery programs require you to train on how to operate on everything from an anal fistula to a ex lap to a hernia repair to a broken bone to trauma. Not just below the knee/ankle. Even the most specialized surgeons such as ophtho and spinal ortho take greater than 5 years of training. I wouldn't take pride in the fact that your training is half as long.

An ophtho surgeon and a spine surgeon do not learn general surgery. I really don't think a month or two makes you proficient in fistulas or appys. Heck...Podiatry Residents spend a few months in gen surg.

It takes these other specialized surgeons 5 years because they didn't start specializing until residency. Podiatry residents start residency already knowing their anatomy and the theory behind surgery (indications/contraindications for certain procedures). They have also spent several months of Podiatry rotations so they have already spent a lot of time in the OR.

You are right that Podiatrists do not know enough General Medicine to call themselves experts but Podiatrists know a lot more than you think. We are trained to recognize when something is not a foot and ankle problem Many Podiatrists also have admitting privileges. Do you really think a hospital will give a Podiatrist admitting privileges if they weren't confident in their medical knowledge? We learn a lot more general medicine than you think, but I agree with you...we are not experts in it.

 

[Torovador]

Podiatry School = Medical school with a major

Who cares what they'll call us? I'm thrilled to be a podiatrist after graduation and I'm thrilled to be a podiatry student now. I do believe that a podiatrist is a physician, but in the end, all I care about is the work I'll be able to do, the relationships I'll garner and the excellent pay that will satisfy my family.

My own father is an internist (M.D.), and I have never heard any of his colleagues or patients refer to him as "Physician." It's a term you'll hear a lot in school, legal or financial matters or as an embelished reference. The rest of the time, it's just plain 'ol "Doctor."

If anything, there should be more talks about "the possibility that MD/DO schools may one day shape arcane curricular forms to make for the best respective specialists." The more I think of it, the more I remember how undergraduate school (and high school before that) function; curriculums that are structured towards higher learning school applications or technical positions at best (at least state-side).

I chose podiatry because I found it to be Medicine's best kept "secret." I wanted to be a specialized surgeon, so it was a clear decision for me; a doctorate in specialized medicine and surgery that sets a trajectory from the start. I've seen the curriculum at my school. I'm satisfied with it. I have no foot fetish, but I have no problem with feet either. It's medicine and I get to specialize and perform surgery. So I'll be the best foot & ankle surgeon and medical doctor I can be. And if anyone ever feels like pointing out to me: "why feet? they're smelly and disgusting", I'll answer: "no more so than a proctologist's routine care, or the infectious dicease specialist holding the fecal sample he sent her.😉 In the end, being a great Doctor and the best you can be at what you do is what really matters."

 

[AttackNME]

Lots of good points in this thread, and I notice it comes down to respect that we deserve as pods, respect from colleagues, and respect from the general public. I'll leave the politics up to APMA and my classmates who want to get into that sort of thing but what I'm gonna focus on is being a good doctor and researcher. I hope you all have at least considered doing some research, it's sad how few research done on the foot are actually done by DPMs, which is part of the reason why some MD/DOs look at podiatry as the black sheep of the family.