It might be a complex issue, but I don't see it that way.
When I was a 3rd year student, a few of my colleagues and I were so upset at our lack of clinical training that we set up a meeting with the then Dean of Students. He was nice enough, but basically said that the reason we didn't have more clinical training (mostly in hospitals) was because of money and not all hospitals would welcome podiatry students as regular medical students. This really deflated me, to say the least. At that point I really began to feel like a second-class citizen. I kept thinking to myself, "if it's money, why do other med students who are paying the same tuition as me and sometimes less have the opportunity to rotate through hospitals during their final two years"? And, if it's because we're podiatry students, then are we really being trained to be doctors, or some peripheral health care provider"?
The money explanation made me angry. The school doesn't even pay the instructors the same kind of salaries that other med school professors get and they certainly didn't give the students a whole lot of perks. Some of the schools are located in the hinterlands, so the leasing cost can't be an issue. So, how is it that after all these years, they still haven't managed to pay to get us into hospitals? The only thing I could come up with was horrible mismanagement. I'm talking about CCPM and I'm sure many of you are aware of the checkered financial history of the school. Several past Presidents and CEO's etc. absconded with some funds, which damaged the school significantly. But, I don't know. I don't know if this is the reason.
The explanation that some hospitals were reluctant to have podiatry students as regular medical students REALLY ticked me off. I felt some serious indignation at this thought because I knew that our coursework in the first two years was at least 90% identical of what a medical student experienced. I started to think that part of the reason was that the doctors and administrators who ran the hospitals knew of the relatively low admission standards for podiatry school and felt that we would be more of a liability than an asset. They probably also didn't even know what our education entailed and likely equated it to something that a chiropractic student might go through.
So, I see it as maybe two or three broad issues. The money issue is pure bunk if you ask me. If we're paying 20+k every year for our education, then they certainly should have the funds to put us in hospitals. The other issue, which I believe is the main issue, is the low standards for admission to pod school. This, coupled with the ignorance of most MD's and DO's as to what pod students study keeps them thinking that we would make things more difficult for the hospital rather than adding another viewpoint. They persistently look at pod students and podiatry as some kind of ancillary branch of medicine, but not as medical students and physicians.
I still don't buy the argument that, as podiatry students, we need to spend so much time on podiatry related issues, which leaves less time to study general medicine and see gen med patients. Biomechanics training is total overkill. We spent so much time learning the same crap over and over, I was beginning to resent the very idea of biomechanics. I still have yet to meet a working podiatrist who uses all of those time consuming techniques to cast or strap a patient. And, what in the hell were we taking classes in Sports Medicine, Psychiatry (only a couple of weeks as I remember), Emergency Medicine, Pediatrics, Podiatric Trauma and Rehabilitation Medicine without even seeing any patients??!! I'm sorry, but that's just ridiculous. By that time, I was boiling mad. I resented this weak attempt to pacify us into thinking we were getting a medical education. As it is, I only saw a handful of biomechanics patients during that rotation. And my supposed junior surgery rotation? I scrubbed in on two cases and only observed. What's that all about??!! Bottom line is that it doesn't take a whole lot of training (didactic and clinical) to be reasonably skilled in debriding nails, calluses and wounds. And since very few podiatrists actually go through all of the B.S. biomechanic gesticulations and gait analyses in real life, the schools don't need to occupy two years of our education on this topic. If you want to pursue that then do a biomechanics fellowship. What else is there? Surgery? We can learn all we need to know in a residency program. God knows they don't give us enough real experience in school. I think it's all a front to hide the real reasons that pod students are not allowed access to hospital based rotations. Meaning, they fill your time in the 3rd and 4th years with inconsistent, often repetitive courses and some clinical exposure to save money and justify it by saying that this is specialized podiatry training. Let me ask you this. Why is it that every other specialty in medicine doesn't start training in their field until they are residents? All med students go through the same 4 years with only slight variations (when they pick their elective rotations) and don't even start to focus on their chosen field until AFTER they've graduated. Why should podiatry be any different? You'd think that the public and the health care system would recognize us as even MORE educated than MD's and DO's since we are continually focusing on our specialty. Unfortunately, this isn't true. And, I don't care if you already know that you're going to be a podiatrist when you graduate. You're also supposed to be a doctor. You'd think that it would be kind of important for students to actually SEE some patients before they graduate and have experiences with actual patients that have diseases that can manifest in the LE (which is almost every disease). And, aside from that, if we are supposed to be doctors, we should be seeing ALL KINDS OF SICK PEOPLE! Like I said, future dermatologists, brain surgeons, cardiologists, etc. do and see everything. They are completely trained to be physicians before they start their specialty training.
Focusing the education towards the lower extremity early on and continuing with superfluous classes and repetitive lectures is just a ruse to obscure the fact that pod students don't have the same opportunities as medical students in their education. There isn't any rationale behind it. This is where I think that chiropody and podiatry are still married at the hip. It's as if podiatry is trying to break out of its chiropody cocoon, but something's blocking its exit (mismanagement, lack of public awareness, the AMA, lack of money). Current podiatry education is a weird blend of chiropody and medicine. Chiropody isn't tough to master, but medicine is.
The way I see it, podiatry is either going to be a part of mainstream medicine or it isn't. As it stands today, I don't feel that it is a part of mainstream medicine. I think it's caught in a gray world between practitioner and doctor. How deeply should podiatry be allowed in to the world of medicine? With the current admission stats and educational standards, not very far. This haphazard education and inconsistent training isn't going to cut it. And the current admission standards are only pushing us further back into the Stone Age of medicine.
So, what needs to be addressed? Several things. First, I feel the education needs to be significantly expanded while concomitantly reducing the detritus that they call necessary courses. I think that this is the root of the problem. The schools are preparing us to be a chiropodist/doctor. Not enough doctor and, frankly, not enough chiropodist. Everyone's coming out half-baked. They need to do one or the other. Or, they need to streamline the chiropody education (like debridement, strapping, padding, orthotics) and adopt a traditional, all-inclusive medical education. If they're going to be charging us such obscene fees, they need to train us like physicians so we can integrate into the world of medicine like other doctors. Once this is done, the public and health care industry will eventually see us as equals just as they see DO's equal to MD's (in the vast majority of cases). If this doesn't change, podiatry will forever lurk in the backwaters of medicine. Next, they need to raise the admission standards at least to the level of a DO school and not a trade school. And, lastly, they need to create a standard residency, which trains all DPM's to be physicians and surgeons. It's beyond me why they haven't been able to achieve this as of yet.
I really don't see how this is so complicated. Hundreds of medical schools around the world are doing it and, many, charging students less fees than podiatry schools.
Aside from those main issues there are others. The APMA and the schools appear to be impotent when faced with the realities of the profession. Podiatrists tend to turn their backs on the profession once they get out. Why is this? Are they upset at the lack of job opportunities? Do they feel that the schools gave them little in return for their money? Do they feel that they were sold a bill of goods?? The schools aren't screening the applicants stringently enough. They're offering admission to people who have little promise of even finishing the first semester much less the entire 4 years. They aren't actively searching for people who might be able to contribute to podiatric research (there is a tremendous dearth of good material). The organizations fail to help the struggling DPM's in the country. The list goes on and on.
But, you've heard all of this before, huh?
