Podiatry Parity

[teambringit]

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I know that there is a big push for parity in our profession. I get it. I'm happy we are making a push to do so. But a major problem I see so far as a 4th year student are the schools. The standards are way too low. Therefore they allow unqualified students into their program and even though most of them fail out, some do make it through. Some students simply aren't smart enough for this profession. I'm not saying we should be as competitive as MD or DO schools, but we should definitely have higher standards. Nobody that has less than a 3.0 should even be considered for acceptance. If we want parity we must improve our standards!

 

[ExperiencedDPM]

You're post is spot on. If you put crap in, you get crap out. Schools are tuition driven, and that's the problem. If we want parity we need to change the game. If the new DPM/MD degree school takes crap, it'll be simple.......the MD part of the degree will be useless if they can't pass the USLME exam. Read some questions on this site written by some students or pre students. These questions are scary and certainly don't reflect high intellect. But that's just my opinion.

 

[teambringit]

You're post is spot on. If you put crap in, you get crap out. Schools are tuition driven, and that's the problem. If we want parity we need to change the game. If the new DPM/MD degree school takes crap, it'll be simple.......the MD part of the degree will be useless if they can't pass the USLME exam. Read some questions on this site written by some students or pre students. These questions are scary and certainly don't reflect high intellect. But that's just my opinion.

Why are they even opening up a DPM/MD school in the first place?

 

[ExperiencedDPM]

For parity!!

 

[teambringit]

For parity!!

Haha. I mean don't podiatrists make enough money and contribute enough to healthcare?

 

[ExperiencedDPM]

What's the definition of "enough money"? Didn't Michael Jordan make "enough money" playing basketball without having to do underwear commercials?

It's not always about money. Podiatry has a limited license. and there are many who are concerned that equals no parity. NPs and PAs can treat the entire body, DPMs can't. Many fear those professions will (if not already) encroach on what we do, including palliative care, wound care and so on. Let's be brutally honest. There is little we do that isn't or can't be reproduced by other providers. NPs, PAs, dermatologists, orthopedic surgeons, physiatrists, physical therapists....... We can't sit back and say "we do it better". Maybe we do, but do we do it cheaper or THAT much better?

I'm not saying I support these ideas or the DPM/MD degree. But the feeling is that the profession is limited and the added MD degree will open doors.

I'll sit back and watch.

 

[teambringit]

What's the definition of "enough money"? Didn't Michael Jordan make "enough money" playing basketball without having to do underwear commercials?

It's not always about money. Podiatry has a limited license. and there are many who are concerned that equals no parity. NPs and PAs can treat the entire body, DPMs can't. Many fear those professions will (if not already) encroach on what we do, including palliative care, wound care and so on. Let's be brutally honest. There is little we do that isn't or can't be reproduced by other providers. NPs, PAs, dermatologists, orthopedic surgeons, physiatrists, physical therapists....... We can't sit back and say "we do it better". Maybe we do, but do we do it cheaper or THAT much better?

I'm not saying I support these ideas or the DPM/MD degree. But the feeling is that the profession is limited and the added MD degree will open doors.

I'll sit back and watch.

With all of that being said, are you worried about the future of podiatry? Are all young podiatrist screwed?

 

[ExperiencedDPM]

Yes I'm worried. No, not all young podiatrists are screwed.

 

[teambringit]

Then what exactly are you worried about?

I will be honest. I am most concerned about the money. As a 4th year student that is about to enter the field, will I still be able to have have a 6 figure salary in the future?

 

[ExperiencedDPM]

I'm worried about medicine in general, not just podiatry. I'm worried that many new DPMs believe that the majority of their practices will be surgical, when in fact that may not be the case. A significant amount of foot and ankle surgery is elective. With the new model of medicine, who knows if these elective procedures will be covered by insurance in the near future. Hospitals or multi specialty groups may prefer to hire orthopedic surgeons vs podiatrists since they may get more bang for their buck. The DPM can perform foot/ankle surgery. The orthopod can do that and the rest of the body, even foot and ankle orthopods of course are qualified to perform procedures on the entire musculoskeletal system.

Wound care? They can be performed by wound care nurses and the needed I&Ds, debridements, amputations, etc., can be performed by general or vascular surgeons (as it is done in many hospitals that don't have DPMs on staff), palliative care can be performed by NPs or PAs, etc.

Is this doom and gloom and am I being a pessimist? Not at all, I'm being a realist. Podiatry and podiatrists need to realize these hard facts in the new medical climate. As I've said in past posts, save your money listening to the total BS and load of crap being preached by the practice management groups. Their advice is obsolete. It's no longer going to be "the more you do the more you make" and their mantra to sell, sell, sell is what will cause the demise of those who follow that thought process.

Instead of trying to figure out how much you can do for that patient (I mean financially) and how much you can sell the patient, you will need to figure out how to treat the patient efficiently with great outcomes, without breaking the bank.

The profession has to rethink how they do business and be ready to reinvent itself according to market need. And then they have to figure out how to do it smarter, better and more economically than anyone else.

 

[AttackNME]

Then what exactly are you worried about?

I will be honest. I am most concerned about the money. As a 4th year student that is about to enter the field, will I still be able to have have a 6 figure salary in the future?

Absolutely, most newgrads, start at 6 figures, or close to it. Keep an open mind, the less picky you are the more opportunities will appear. Keep in mind that it is not uncommon for people to work somewhere for several years and then find a better opportunity elsewhere.

 

[dr.phoot]

I know that there is a big push for parity in our profession. I get it. I'm happy we are making a push to do so. But a major problem I see so far as a 4th year student are the schools. The standards are way too low. Therefore they allow unqualified students into their program and even though most of them fail out, some do make it through. Some students simply aren't smart enough for this profession. I'm not saying we should be as competitive as MD or DO schools, but we should definitely have higher standards. Nobody that has less than a 3.0 should even be considered for acceptance. If we want parity we must improve our standards!

I think schools are always going to be schools - a business! You can't really blame them for taking in students with less than 3.0s (mind you some mature later). And I think statistically, pod schools get less applicants than traditional Med school, so you'll just have to work with what you have.

Ultimately podiatry is podiatry. Why can't we just accept that as it is? Is there a need for this MD attachment to the DPM title? A dentist is a dentist and a vet is a vet. Podiatry should just be podiatry.

 

[dr.phoot]

What's the definition of "enough money"? Didn't Michael Jordan make "enough money" playing basketball without having to do underwear commercials?

It's not always about money. Podiatry has a limited license. and there are many who are concerned that equals no parity. NPs and PAs can treat the entire body, DPMs can't. Many fear those professions will (if not already) encroach on what we do, including palliative care, wound care and so on. Let's be brutally honest. There is little we do that isn't or can't be reproduced by other providers. NPs, PAs, dermatologists, orthopedic surgeons, physiatrists, physical therapists....... We can't sit back and say "we do it better". Maybe we do, but do we do it cheaper or THAT much better?

I'm not saying I support these ideas or the DPM/MD degree. But the feeling is that the profession is limited and the added MD degree will open doors.

I'll sit back and watch.

I'm curious about the doors it can potentially open. Will people start going to podiatrist for flu shots and check-ups just because of the MD title?

And why don't they just spend money on an advertising and marketing campaign to better inform the general public of podiatry?

You often bring up this concern about the field being limited. So are they aiming to expand the field in the long-term? So that the DPM can practice over more than just the foot? The makes the field lose its spark / identity, don't you think?


It's a foot and ankle speciality. Why can't we just do that? While they're at it, they might as well just push to have podiatry school integrated with traditional medical school, get rid of podiatry school, and just award DPMs the MD title.

 

[ExperiencedDPM]

I think schools are always going to be schools - a business! You can't really blame them for taking in students with less than 3.0s (mind you some mature later). And I think statistically, pod schools get less applicants than traditional Med school, so you'll just have to work with what you have.

Ultimately podiatry is podiatry. Why can't we just accept that as it is? Is there a need for this MD attachment to the DPM title? A dentist is a dentist and a vet is a vet. Podiatry should just be podiatry.

The fundamental difference is that no one else performs the services of a dentist. And no one else performs the services of a veterinarian.

Can you say that's true of podiatry? There is significant overlap and redundancy with other professions.

Podiatry can't just be podiatry due to the changing healthcare environment. If you're a one trick pony, your skills and services better be unique. You can't keep preaching that podiatry does foot/ankle services better than anyone else. You have to prove those comments.

 

[ExperiencedDPM]

I'm curious about the doors it can potentially open. Will people start going to podiatrist for flu shots and check-ups just because of the MD title?

And why don't they just spend money on an advertising and marketing campaign to better inform the general public of podiatry?

You often bring up this concern about the field being limited. So are they aiming to expand the field in the long-term? So that the DPM can practice over more than just the foot? The makes the field lose its spark / identity, don't you think?


It's a foot and ankle speciality. Why can't we just do that? While they're at it, they might as well just push to have podiatry school integrated with traditional medical school, get rid of podiatry school, and just award DPMs the MD title.

They are pushing for integration. I have no idea where the DPM/MD will lead. I don't know if the doc will give flu shots, I know orthopods don't. But I guess it will give them the option.

 

[NatCh]

Will people start going to podiatrist for flu shots and check-ups just because of the MD title?

I can't imagine anyone making an appointment with his or her podiatrist specifically for a flu shot any more than someone would schedule with the dermatologist, urologist, plastic surgeon, ophthalmologist etc. currently for a flu shot.

 

[dr.phoot]

I can't imagine anyone making an appointment with his or her podiatrist specifically for a flu shot any more than someone would schedule with the dermatologist, urologist, plastic surgeon, ophthalmologist etc. currently for a flu shot.

right, so I'm just curious what this will really improve since they're fighting to expand the scope of practice. Will people now start going to their podiatrists for check ups? Probably not. So being allowed / permitted to do something doesn't necessarily mean you'll actually do it.

Shadowed a pod last Friday and he said orthos recommend him cases all the time. But I understand that goes back go ExperiencedDPM's point that we can't keep saying we do it better.

All I'm saying with this whole thing is that the MD attachment isn't really necessary and they should continue pushing for parity but drop the MD attachment or just get rid of podiatry school and have it included with traditional medical schools.

 

[dr.phoot]

Podiatry can't just be podiatry due to the changing healthcare environment. If you're a one trick pony, your skills and services better be unique. You can't keep preaching that podiatry does foot/ankle services better than anyone else. You have to prove those comments.

Point well taken. Then I guess the profession is screwed? If they push this MD attachment and it expands the scope, woukdnt students still be foot and ankle specialists? Only exception being that now they can work as an internist too?

From the points you made about vet and dentistry, they would have to get rid of foot and ankle ortho specialty, not let PAs and NPs do anything with the foot and just have only pods doing that, I'm I right?

I recently got my foot operated on by a podiatrist. I saw an internist first who gave me a referall. I saw a NP who did my pre-op review, etc., but it was a podiatrist that did my surgery. The internist and the NP--based on what you've said--could have all performed it, is that right?

 

[ExperiencedDPM]

Point well taken. Then I guess the profession is screwed? If they push this MD attachment and it expands the scope, woukdnt students still be foot and ankle specialists? Only exception being that now they can work as an internist too?

From the points you made about vet and dentistry, they would have to get rid of foot and ankle ortho specialty, not let PAs and NPs do anything with the foot and just have only pods doing that, I'm I right?

I recently got my foot operated on by a podiatrist. I saw an internist first who gave me a referall. I saw a NP who did my pre-op review, etc., but it was a podiatrist that did my surgery. The internist and the NP--based on what you've said--could have all performed it, is that right?

WTF???? How did you spin what you just wrote from my comments? The NP did your pre op interview and that's why some believe we need the MD degree. So we don't have to have an NP clear our patient.

I have NO IDEA how your logic ended up that based on what I said an internist or NP could have performed your surgery. Where did I say anything even remotely like that??

Let me spell it out for you again.

Podiatrists treat skin and nail disorders. So do dermatologists.

Podiatrists treat aches, pains, strains, etc. So do physical therapists, physiatrists and orthopedists.

Podiatrists treat arthritic conditions and so do orthopedists, internists, rheumatologist, physiatrists.

Podiatrists perform wound care and so do primary care docs, dermatologists, general surgeons, vascular surgeons and wound care nurses.

Podiatrists treat many ailments that are also treated by NPs, PAs, PCPs

Podiatrists perform foot and ankle surgery and so do orthopods.

That does NOT equate with NPs and internists performing surgery, so your comments baffle me.

I did say that podiatrists have to stop saying how great they are and start proving it because there is a lot of duplicity between what we do and others can do. We aren't the only people capable of treating the foot and ankle.

'Ain't no one out there doing what dentists or vets do daily.

No, the profession isn't screwed. They just have to wake up.

 

[ldsrmdude]

This brings up the real issue. We, as a profession, don't really have a clear idea of what parity means and how to achieve it. It's also one of the big issues I have with the MD/DPM nonsense. Nobody has been able to explain to me what the goal of it is. I just hear people say "parity" but, again, we don't have a clear vision of what that means in practice. If I were to get a DPM/MD, would it be so I could do my own pre-op evaluations? Treat conditions outside my podiatry scope of practice? Impress people? Gain respect?

 

[AttackNME]

I agree with many of the comments posted above... I remember Vision 2015 was a big topic of discussion during podiatry school and I was really exited about whatever "it" is, and then I completely forgot about it and it's already 2016... Here's my thoughts on the topics of parity and our limited profession. Podiatry is by definition limited if having the ability to practice in other body parts is something you want to have. Dentists are well respected, it is clear what they do. There are lots of teeth problems and patients for them to be busy, and they are trained well and appear consistent across the country. We came from chiropody and have started medically and surgically treating feet because there are so many feet pathology and not enough orthopedist a to go around so naturally chiropodists stepped up to the plate and expanded their practice to cover a clear need. We are now podiatrists whom are still new and evolving.. I have to explain to residents from other specialties what we do.. How severely inconsistent is the training and our new generation of abilities are not public knowledge. But remembering where we came from... it's not a surprise. I believe that once we become consistent in our training and our boundaries, public knowledge of what we do and how well we do it will follow, and only at that point will "parity" be achieved.

 

[dr.phoot]

WTF???? How did you spin what you just wrote from my comments? The NP did your pre op interview and that's why some believe we need the MD degree. So we don't have to have an NP clear our patient.

I have NO IDEA how your logic ended up that based on what I said an internist or NP could have performed your surgery. Where did I say anything even remotely like that??

Let me spell it out for you again.

Podiatrists treat skin and nail disorders. So do dermatologists.

Podiatrists treat aches, pains, strains, etc. So do physical therapists, physiatrists and orthopedists.

Podiatrists treat arthritic conditions and so do orthopedists, internists, rheumatologist, physiatrists.

Podiatrists perform wound care and so do primary care docs, dermatologists, general surgeons, vascular surgeons and wound care nurses.

Podiatrists treat many ailments that are also treated by NPs, PAs, PCPs

Podiatrists perform foot and ankle surgery and so do orthopods.

That does NOT equate with NPs and internists performing surgery, so your comments baffle me.

I did say that podiatrists have to stop saying how great they are and start proving it because there is a lot of duplicity between what we do and others can do. We aren't the only people capable of treating the foot and ankle.

'Ain't no one out there doing what dentists or vets do daily.

No, the profession isn't screwed. They just have to wake up.

misread you then. Sorry, Ace.

But going back to your breakdown, that's the part that scares me. You list somethings that are done by DPMs and go on to list other professions that are able to also perform those tasks, and I just find that part scary and worrisome. Isn't that where most of the problem is coming from? We do things that can be done by other people whereas dentists and vets are the only ones that operate on teeth and animals respectively.

But what I wanted to point out was that, a lot of these people don't really seem to be interested (and I'm only speaking from my limited personal experienc). The NP I saw wasn't into feet. Seemed like she preferred internal medicine, asking quetsions. That's the point I wanted to get across. You're right that the "we do it better" argument isn't enough and won't cut it. But it seems a lot of these people that are capable and allowed to operate on the foot and ankle aren't interested in doing it though; even if they're allowed to.

 

[Weirdy]

Will higher quantifiable performance and consistent education increase parity? Namely board rates/residency performance, even admission standards?

 

[ldsrmdude]

Will higher quantifiable performance and consistent education increase parity? Namely board rates/residency performance, even admission standards?

It will help I think. But again, it depends on what you mean by parity. It will help some with respect from our physician colleagues, but that is a slow process. Gaining parity, however you define it, will be a long process

 

[dtrack22]

our fearless moderator is right, you have to define "parity" and what the end game looks like once "parity" has been achieved. I honestly have no idea what it means, mostly because I am in a state where what I do on a daily basis is indistinguishable from any other specialist/subspecialist. Unless you look at my name badge and see the DPM initials I guess.

If you want true "parity," the only solution is for all of the podiatry schools to shut down, and create residencies that the ACGME will acredit. No more sub-20 MCAT scores (yes MD/DO lurkers, I'm embarrassed), no more advancing through school while failing boards multiple times, no more grand canyon-like divide between great residency programs and really bad ones. That wouldn't be the worst thing in the world, and it is the only way to solve all of these problems with the profession that are somehow unique to podiatry and don't affect nearly every other physician that practices medicine in the United States.

If you ask me, we don't need to reinvent the wheel. As a profession we dug in to this niche that current medical doctors are more than happy to give up. We simply need to improve consistency in education and training so that every geographical location affords podiatrists the same level of respect (and subsequently privileges, scope, practice opportunities) that many of us already enjoy. Of course, that's just my opinion based on what I think most people complaining about lack of parity would define it as...and its easier said than done

 

[ExperiencedDPM]

misread you then. Sorry, Ace.

But going back to your breakdown, that's the part that scares me. You list somethings that are done by DPMs and go on to list other professions that are able to also perform those tasks, and I just find that part scary and worrisome. Isn't that where most of the problem is coming from? We do things that can be done by other people whereas dentists and vets are the only ones that operate on teeth and animals respectively.

But what I wanted to point out was that, a lot of these people don't really seem to be interested (and I'm only speaking from my limited personal experienc). The NP I saw wasn't into feet. Seemed like she preferred internal medicine, asking quetsions. That's the point I wanted to get across. You're right that the "we do it better" argument isn't enough and won't cut it. But it seems a lot of these people that are capable and allowed to operate on the foot and ankle aren't interested in doing it though; even if they're allowed to.

First of all, please don't ever refer to me as "Ace".

So you spoke with one NP and she doesn't want to do feet and that means NPs aren't "into feet"? Wow, that's a census of ONE. I assure you there are NPs and PAs who are happy to treat feet. Lots of them.

And you write that "a lot of these people that are capable (it should actually say "who" are capable) and allowed to operate on the foot and ankle aren't intersted in doing it though, even if they're allowed". Are you serious? Let me dissect that statement. First of all who are "a lot of these people"? Understand that every MD and DO who is licensed has a degree to practice medicine and surgery. They are all capable by degree to perform surgery, but not by training. No sane MD or DO without surgical training is going to perform foot and ankle surgery unless they live in a remote area or are stranded on a desert island.

So that leaves general surgeons, vascular surgeons, plastic surgeons and orthopedic surgeons realistically, who are "capable and allowed" to perform foot and ankle surgery. Most general, plastic and vascular surgeons don't perform foot and ankle surgery because they are too busy performing other cases. Although if you visit any hospital without a DPM on staff, you will routinely see general and vascular surgeons performing amputations, incision and drainage procedures, debridements and trauma cases on the foot and ankle. Plastics performs their fair share, especially for skin grafts, flaps, etc. And of course every orthopedic surgeon is capable of performing foot and ankle surgery, whether or not it's their preference. And of course there is a larger group of foot and ankle orthopods who do almost exclusively foot and ankle surgery.

So tell me exactly what statistic or study or proof do you have to make the unbelievably inaccurate statement that the people who are capable of operating on the foot and ankle aren't interested?

Believe me, DPMs don't own the foot and ankle, and there are plenty of people working on the foot and ankle daily without the DPM degree.

Your generalizations and blanket statements are really something you should evaluate as you move forward in your career.

I'd also prefer not to be called "dude", "bro", "buddy", etc. Studmeister though, is perfectly acceptable.

 

[ExperiencedDPM]

our fearless moderator is right, you have to define "parity" and what the end game looks like once "parity" has been achieved. I honestly have no idea what it means, mostly because I am in a state where what I do on a daily basis is indistinguishable from any other specialist/subspecialist. Unless you look at my name badge and see the DPM initials I guess.

If you want true "parity," the only solution is for all of the podiatry schools to shut down, and create residencies that the ACGME will acredit. No more sub-20 MCAT scores (yes MD/DO lurkers, I'm embarrassed), no more advancing through school while failing boards multiple times, no more grand canyon-like divide between great residency programs and really bad ones. That wouldn't be the worst thing in the world, and it is the only way to solve all of these problems with the profession that are somehow unique to podiatry and don't affect nearly every other physician that practices medicine in the United States.

If you ask me, we don't need to reinvent the wheel. As a profession we dug in to this niche that current medical doctors are more than happy to give up. We simply need to improve consistency in education and training so that every geographical location affords podiatrists the same level of respect (and subsequently privileges, scope, practice opportunities) that many of us already enjoy. Of course, that's just my opinion based on what I think most people complaining about lack of parity would define it as...and its easier said than done

Exactly.

 

[croak]

Experienced DPM, your posts are compelling, well written, and informative. My limited knowledge of podiatry prior to reading your posts suggest a mindfulness of the current milieu. I occasionally post on the allo site, and your posts were suggested as an interesting read. I am a retired surgeon (MD), and have seen the absurd changes in healthcare. My neighbor is a podiatrist and pointed this out. I will likely be called a 'troll' or something along those lines, but admire your no-nonsense explanations. Best to all, we're living in curious times, sometimes it is refreshing to read things that are informative, helpful, and wise.

 

[dr.phoot]

First of all, please don't ever refer to me as "Ace".

So you spoke with one NP and she doesn't want to do feet and that means NPs aren't "into feet"? Wow, that's a census of ONE. I assure you there are NPs and PAs who are happy to treat feet. Lots of them.

And you write that "a lot of these people that are capable (it should actually say "who" are capable) and allowed to operate on the foot and ankle aren't intersted in doing it though, even if they're allowed". Are you serious? Let me dissect that statement. First of all who are "a lot of these people"? Understand that every MD and DO who is licensed has a degree to practice medicine and surgery. They are all capable by degree to perform surgery, but not by training. No sane MD or DO without surgical training is going to perform foot and ankle surgery unless they live in a remote area or are stranded on a desert island.

So that leaves general surgeons, vascular surgeons, plastic surgeons and orthopedic surgeons realistically, who are "capable and allowed" to perform foot and ankle surgery. Most general, plastic and vascular surgeons don't perform foot and ankle surgery because they are too busy performing other cases. Although if you visit any hospital without a DPM on staff, you will routinely see general and vascular surgeons performing amputations, incision and drainage procedures, debridements and trauma cases on the foot and ankle. Plastics performs their fair share, especially for skin grafts, flaps, etc. And of course every orthopedic surgeon is capable of performing foot and ankle surgery, whether or not it's their preference. And of course there is a larger group of foot and ankle orthopods who do almost exclusively foot and ankle surgery.

So tell me exactly what statistic or study or proof do you have to make the unbelievably inaccurate statement that the people who are capable of operating on the foot and ankle aren't interested?

Believe me, DPMs don't own the foot and ankle, and there are plenty of people working on the foot and ankle daily without the DPM degree.

Your generalizations and blanket statements are really something you should evaluate as you move forward in your career.

I'd also prefer not to be called "dude", "bro", "buddy", etc. Studmeister though, is perfectly acceptable.

Sorry, Studmeister. And well said! I've got nothing else to add on the matter.

 

[ExperiencedDPM]

Experienced DPM, your posts are compelling, well written, and informative. My limited knowledge of podiatry prior to reading your posts suggest a mindfulness of the current milieu. I occasionally post on the allo site, and your posts were suggested as an interesting read. I am a retired surgeon (MD), and have seen the absurd changes in healthcare. My neighbor is a podiatrist and pointed this out. I will likely be called a 'troll' or something along those lines, but admire your no-nonsense explanations. Best to all, we're living in curious times, sometimes it is refreshing to read things that are informative, helpful, and wise.

Thank you.

 

[croak]

You're welcome.