Spoken like a true first year, second semester, student.

[spooge]

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This is my leg skeleton. There are many like it, but this one is mine. My leg skeleton is my best friend. It is my life. I must master it as I must master my life.

My leg skeleton, without me, is useless. Without my leg skeleton, I am useless. I must study my LEA true. I must understand my leg skeleton better than the orthopaedist who is trying to steal my business. I must master it before they do. I will...

My leg skeleton and myself know that what counts in this war between becoming a doctor or becoming nothing is not the histology we drudge through, the study groups we form, the beer we drink or surving physiology. We know that it is the mastery of LEA. We will master it...

My leg skeleton is human, even as I, because it is my life. Thus, I will learn it as a brother. I will learn its weaknesses, its strengths, its parts, its accessories, its trochanters and its crests. I will ever guard it against the ravages of weather and damage as I will ever guard my legs, my arms, my eyes and my heart against damage. I will keep my leg skeleton clean and ready. We will become part of each other. We will...

Before God, I swear this creed. My leg skeleton and myself are the defenders of Podiatry. We are the masters of our enemy the orthopaedists. We are the saviors of my life.

So be it, until graduation and residency until ortho and Podiatry are at peace!


From a Navy guy trained by Marines ____ the Air Force

 

[MaseratiGT]

This is my leg skeleton. There are many like it, but this one is mine. My leg skeleton is my best friend. It is my life. I must master it as I must master my life.

My leg skeleton, without me, is useless. Without my leg skeleton, I am useless. I must study my LEA true. I must understand my leg skeleton better than the orthopaedist who is trying to steal my business. I must master it before they do. I will...

My leg skeleton and myself know that what counts in this war between becoming a doctor or becoming nothing is not the histology we drudge through, the study groups we form, the beer we drink or surving physiology. We know that it is the mastery of LEA. We will master it...

My leg skeleton is human, even as I, because it is my life. Thus, I will learn it as a brother. I will learn its weaknesses, its strengths, its parts, its accessories, its trochanters and its crests. I will ever guard it against the ravages of weather and damage as I will ever guard my legs, my arms, my eyes and my heart against damage. I will keep my leg skeleton clean and ready. We will become part of each other. We will...

Before God, I swear this creed. My leg skeleton and myself are the defenders of Podiatry. We are the masters of our enemy the orthopaedists. We are the saviors of my life.

So be it, until graduation and residency until ortho and Podiatry are at peace!


From a Navy guy trained by Marines ____ the Air Force

I'm going to get along with Ortho from day one. I'm giving this 👎

 

[spooge]

http://www.aaos.org/news/bulletin/jul07/reimbursement2.asp


Podiatry scope of practice
John S. Early, MD, chair of the Health Policy Committee for the American Orthopaedic Foot and Ankle Society (AOFAS) presented a national overview of efforts by podiatrists to expand their scope of practice. He discussed the structure of the organizations overseeing the practice of podiatry, as well as the curriculum, postgraduate training, and residency requirements for podiatrists.
According to Dr. Early, neither the public nor legislators are very knowledgeable about the limits of podiatric training. As a result, some podiatrists are effectively advocating for an expanded scope of practice to the ankle and beyond. Only four states—California, Montana, Tennessee, and Connecticut (pending)—follow the American Board of Podiatric Surgery (ABPS) guidelines of requiring training to match scope of practice.
“Although podiatrists provide a valuable service within the medical community,” said Dr. Early, “nationally recognized standards—widely accepted by the medical community—are important for safe, effective patient care and essential to maintain public trust. Privileges for ankle surgery should coincide with demonstrated training, using the ABPS status as the minimum standard.”

State experiences
In Texas, said David Teuscher, MD, past president of the Texas Orthopaedic Association (TOA), podiatrists have attempted to change the definition of the foot to include the ankle and leg. The resulting lawsuits—including a restraint of trade suit against both the state medical society and the TOA—were both costly and wearing.
“A state specialty society can carry a scope of practice fight only so far,” said Dr. Teuscher. “Scope of practice issues affect all physicians and all physicians must join together to address these issues.” To ensure patient safety and oppose unsafe scope of practice expansion, the Texas PatientsFIRST coalition was formed by 17 medical and specialty societies and the 10 largest county medical societies in the state. The coalition is working to educate legislators and the public; as a result, physicians have increased their effectiveness at writing and passing legislation.
Steven Ross, MD, former president of the California Orthopaedic Association and AOFAS president elect, discussed his state’s experience in this area. Dr. Ross stressed that formal education and training are the cornerstones of appropriate, quality care. “Educational standards are essential to ensure public safety and need to be monitored and accredited by a national organization recognized by the Federal government,” said Dr. Ross.



Finally, Alan S. Routman, MD, president of the Florida Orthopaedic Society (FOS), discussed a new strategy to introduce “Take Back” legislation in Florida. Under current statutes, podiatrists in Florida can perform surgery below the knee and can provide nonsurgical treatment up to the hip. Last year (2006), the FOS proactively proposed legislation to restrict all podiatry treatments to the foot and ankle. Although the bill had limited success, it did prompt the Florida Podiatric Medical Association to begin negotiations with the FOS. Rather than abandon foot and ankle treatment to podiatrists, advised Dr. Routman, “articulate a clear delineation of hospital privileges for members to use locally and be active on your hospital’s committees and carefully screen podiatrists’ applications and privileges.”


-You can go make bread and hold hands with the people who are "trying" so hard to get along with podiatrists. Since we are rating posts I will give yours a

 

[mrfeet]

I'm going to get along with Ortho from day one. I'm giving this 👎

Well, you better be prepared to become your local ortho's bitch, because that's just about what it will take to get along with them. My Dad has been a podiatrist for 28 years and has many "friends" who are orthopods. Yeah, then he finds out how much crap they talk about his profession to his patients behind his back who go there to have other things done like shoulder surgery. I have no problem with orthopods as long as they stay on their side of the hospital.

 

[jonwill]

This ortho vs podiatry issue is old news. I'm sure it still exists in some hospitals and I know that it used to be a HUGE issue but has since died down. You have to look at the facts. The fact of the matter is that the majority of orthopods receive little or no foot training. This is no big secret. Couple that with the training that pods now get and there is really nothing to argue. I'm more than willing to compare my training with ANY orthopod, general or F&A fellow.

Over half of of the ortho foot and ankle fellowships sit empty year after year. Pods even do some of them. Again, I'm not saying that it doesn't still exist in some venues but I've been to quite a few hospitals and have never really seen it. In fact, pod and ortho have worked very well together at every hospital that I have rotated or worked at.

You have to also realize that "hospital rivalries" are nothing new to medicine. Ortho spine vs neuro, medicine vs ID, general surgery vs plastics and vascular (there is a lot of overlap in these 3), etc. These fights are all usually driven by ego!

 

[Dr_Feelgood]

Also, DMUers don't take lower limb until 2nd year 2nd sesmeter. 😀

 

[Creflo]

from my viewpoint, the prejudice issue is getting better. i'm only a first year student, but it seems that the younger students (in our generation) won't discriminate because we are in the same classes with them (do students).

my brother married the daughter of an md surgeon who is near retirement age. when i told him i was doing podiatry, he replied "you'll never get on at a hospital." i'm not exactly sure what he meant by "get on," but obviously he has some pretty strong bias. his hospital still does not have any pods, but all of the other hospitals in the city do have pods with privileges.

this is in alabama, which has a pretty restrictive law for pods. other parts of the country are better in this regard. everything i've heard seems to point to a strong future for the profession.

i am curious what the chances are for a state like alabama to move past its forefoot only law, particularly since when i graduate all the residencies should be 3 years.

 

[jonwill]

when i told him i was doing podiatry, he replied "you'll never get on at a hospital." i'm not exactly sure what he meant by "get on," but obviously he has some pretty strong bias. his hospital still does not have any pods, but all of the other hospitals in the city do have pods with privileges.

That's awesome! You have to understand that he is comparing your training with the training that a podiatrist received in his era. And these types of people are really the only ones left that still knock podiatry. The majority of the medical field (ortho included) is now familiar with our training and as I said before, there is really nothing to argue.

I'm currently at one of the largest teaching hospitals in the country where 140 podiatrists have privileges.

 

[JEWmongous]

from my viewpoint, the prejudice issue is getting better. i'm only a first year student, but it seems that the younger students (in our generation) won't discriminate because we are in the same classes with them (do students).

my brother married the daughter of an md surgeon who is near retirement age. when i told him i was doing podiatry, he replied "you'll never get on at a hospital." i'm not exactly sure what he meant by "get on," but obviously he has some pretty strong bias. his hospital still does not have any pods, but all of the other hospitals in the city do have pods with privileges.

this is in alabama, which has a pretty restrictive law for pods. other parts of the country are better in this regard. everything i've heard seems to point to a strong future for the profession.

i am curious what the chances are for a state like alabama to move past its forefoot only law, particularly since when i graduate all the residencies should be 3 years.

I didn't think there were any states left that specified "forefoot" only. I thought Alabama allowed the whole foot but no ankle ????

 

[SportPOD]

I'm currently at one of the largest teaching hospitals in the country where 140 podiatrists have privileges.

You're actually at the largest allopathic teaching hosital. Up in Pontiac is the largest osteopathic teaching hospital (Pontiac Osteopathic Hospital).

 

[Stafocker]

I'm currently at one of the largest teaching hospitals in the country where 140 podiatrists have privileges.

140 is a lot, but should everyone of them be doing surgery?..... (not knocking on Jonwill's hospital at all, just pointing out a big problem in the DPM world)

it's great that hospitals give priveleges to DPM's, but we gotta be cautious about who is representing our degree at hospitals. There's a lot of DPM's in every major city, but it's still a smaller % that graduated from a 3 year (even 2 year in some cities) and are board certified to perform surgery. Some gain privileges and perform surgery, and may have resulted in major complications that some Ortho guy might have had to fix or deal with - maybe where the bias started, then leading to hospitals to ban privileges at a certain period in history. It's all changing, but we're still maybe 2 generations away until EVERYONE with a DPM has an equal education/training.

Those DPM's who gain respect usually have extensive experience and qualifications to do surgery (usually), but because most DPM's in their practice don't want/focus/and aren't trained, doesn't mean they should be doing surgery because they are a DPM. My rationale for this is that not all MD/DO's do surgery because not all of them are trained to do it. New DPM's with 3 year residencies are better trained, like Jonwill, Krabmas, myself, etc, but those bias that DPM still encounter are valid to a point. Because not everyone with a DPM is equal in training, it's hard to distinguish the "podiatric surgically" trained and focused from the "podiatric medically" focused.

I understand this is an old argument, just repeating another forum posting, but with each new year, we gotta keep the information flowing.

Disclaimer** I am not knocking any other resident or hospital or program or posting

 

[Dr_Feelgood]

140 is a lot, but should everyone of them be doing surgery?..... (not knocking on Jonwill's hospital at all, just pointing out a big problem in the DPM world)

it's great that hospitals give priveleges to DPM's, but we gotta be cautious about who is representing our degree at hospitals. There's a lot of DPM's in every major city, but it's still a smaller % that graduated from a 3 year (even 2 year in some cities) and are board certified to perform surgery. Some gain privileges and perform surgery, and may have resulted in major complications that some Ortho guy might have had to fix or deal with - maybe where the bias started, then leading to hospitals to ban privileges at a certain period in history. It's all changing, but we're still maybe 2 generations away until EVERYONE with a DPM has an equal education/training.

Those DPM's who gain respect usually have extensive experience and qualifications to do surgery (usually), but because most DPM's in their practice don't want/focus/and aren't trained, doesn't mean they should be doing surgery because they are a DPM. My rationale for this is that not all MD/DO's do surgery because not all of them are trained to do it. New DPM's with 3 year residencies are better trained, like Jonwill, Krabmas, myself, etc, but those bias that DPM still encounter are valid to a point. Because not everyone with a DPM is equal in training, it's hard to distinguish the "podiatric surgically" trained and focused from the "podiatric medically" focused.

I understand this is an old argument, just repeating another forum posting, but with each new year, we gotta keep the information flowing.

Disclaimer** I am not knocking any other resident or hospital or program or posting

I agree with the spirit but a TFP is great to learn what not to do. Also, scrubbing with a TFP means you'll probably get to do the whole procedure.

 

[jonwill]

140 is a lot, but should everyone of them be doing surgery?

Yea, most of them are really good. And most of them let us do the entire case. Why do you think our numbers are so high???!!! But Feelgood has a point. You can learn a lot from everyone, including TFP's. Sometimes you learn what NOT to do.

 

[Stafocker]

Yea, most of them are really good. And most of them let us do the entire case. Why do you think our numbers are so high???!!! But Feelgood has a point. You can learn a lot from everyone, including TFP's. Sometimes you learn what NOT to do.

yeah dude, you guys get great numbers, and again you got a great program, wasn't anything directed at you or your program.

That's probably the best point, you learn what NOT to do.

But in the wider world, outside of our residencies, what does that say about the quality of these DPM who aren't up to speed even compared to current residents? We still got a long way to go to truly make sure EVERYONE who graduates with a DPM and a DPM residency will have that universal recognition of "podiatric surgeon".

 

[krabmas]

yeah dude, you guys get great numbers, and again you got a great program, wasn't anything directed at you or your program.

That's probably the best point, you learn what NOT to do.

But in the wider world, outside of our residencies, what does that say about the quality of these DPM who aren't up to speed even compared to current residents? We still got a long way to go to truly make sure EVERYONE who graduates with a DPM and a DPM residency will have that universal recognition of "podiatric surgeon".

Even the best surgeons of any specialty have complications. And not all of their patients return to them to fix it. some seek advice elsewhere.

I'll say it again...

Medicine of all degrees is a minimal competency profession. This will most likely never change. There will always be the best, the good, the bad, and those that somehow that you can't figure out passed the test.

I agree that not all pods are trained equally, but neither are all surgeons (MDs). Trying to continuously bring up that point only continues the split of the profession. This does not strengthen anything.

 

[Dr_Feelgood]

Even the best surgeons of any specialty have complications. And not all of their patients return to them to fix it. some seek advice elsewhere.

I'll say it again...

Medicine of all degrees is a minimal competency profession. This will most likely never change. There will always be the best, the good, the bad, and those that somehow that you can't figure out passed the test.

I agree that not all pods are trained equally, but neither are all surgeons (MDs). Trying to continuously bring up that point only continues the split of the profession. This does not strengthen anything.

Well stated. That is one of my new things, I would like to see the profession work towards a united front. I have a feeling that most of the present leadership in the profession will need to go away before this occurs.

 

[Stafocker]

Even the best surgeons of any specialty have complications. And not all of their patients return to them to fix it. some seek advice elsewhere.

I'll say it again...

Medicine of all degrees is a minimal competency profession. This will most likely never change. There will always be the best, the good, the bad, and those that somehow that you can't figure out passed the test.

I agree that not all pods are trained equally, but neither are all surgeons (MDs). Trying to continuously bring up that point only continues the split of the profession. This does not strengthen anything.

There's a big difference in training for MD surgeons than DPM surgeons. Rotating through vas, gen, trauma, ortho, etc, the MD training is standardized, though some are lower quality than others, all surgical residency programs have to be recognized by the NMRP and ACGME with certain standards that have been in place for years. Of course there are changes every year, but the drastic changes we have seen in DPM residencies only means we still have some ways to go before we can say the profession is equal. Not all 3 year residencies are standarized yet, although we're close, it's still not all under one roof. (This may be a reason why it's still hard to compare residencies or even rank them)

There is a public trust we have to address and AMA has pointed out a very important issue. How can we knowingly support a DPM who hasn't been trained adequately for doing surgery on a patient? We can't forget there's someone connected to the foot who's a person. Ex. When a non-board certified plastic surgeon screws up a patient's life, board certified plastic sx jump this, attacking them them, maybe even trying to strip their license away. What these board-certified plastic sx are doing isn't to tear apart their profession, it's to PROTECT it. If anyone could call him/herself a plastic sx, how does that help the profession? to unify and bring them in, when knowingly they aren't trained/certified? this was only an hypothetical example.

DPM's have only began surgical training the last 30 years and yeah, there is an obvious split in the profession. There is even 2 different recognized Boards for certification. Not everyone with a DPM from early years wants to be a surgeon, but more and more that graduate are trained to be. Unless DPM's recognize this split, we can't move forward with our head in the dirt. There has to be something to help explain the difference between those DPM's who do surgery and those DPM's who do not, ABPS certification is a way, but there are still issues with the way they do things politically.

We can't just agree with any DPM doing surgery without some kind of proof of training. the degree and it's historic, traditional reference doesn't allow us the luxury of assuming "minimal surgical training". Once someone finds a political answer to it, we can finally address the AMA's bias against DPM's. To us, it doesnt' make sense because we're seeing it from a new generation's perspective, this bias and nonsense. But to the many before us, the training hasn't been up to par - even in the last 10 years. If we unify, we have to PROTECT our profession around QUALITY PATIENT CARE by trained/certfied/competent/etc DPM's who can best represent the patient/public's interest.

 

[Stafocker]

Well stated. That is one of my new things, I would like to see the profession work towards a united front. I have a feeling that most of the present leadership in the profession will need to go away before this occurs.

Anyone in APMA or APMSA or ACFAS board want to comment on current leadership?

 

[krabmas]

There's a big difference in training for MD surgeons than DPM surgeons. Rotating through vas, gen, trauma, ortho, etc, the MD training is standardized, though some are lower quality than others, all surgical residency programs have to be recognized by the NMRP and ACGME with certain standards that have been in place for years. Of course there are changes every year, but the drastic changes we have seen in DPM residencies only means we still have some ways to go before we can say the profession is equal. Not all 3 year residencies are standarized yet, although we're close, it's still not all under one roof. (This may be a reason why it's still hard to compare residencies or even rank them)

There is a public trust we have to address and AMA has pointed out a very important issue. How can we knowingly support a DPM who hasn't been trained adequately for doing surgery on a patient? We can't forget there's someone connected to the foot who's a person. Ex. When a non-board certified plastic surgeon screws up a patient's life, board certified plastic sx jump this, attacking them them, maybe even trying to strip their license away. What these board-certified plastic sx are doing isn't to tear apart their profession, it's to PROTECT it. If anyone could call him/herself a plastic sx, how does that help the profession? to unify and bring them in, when knowingly they aren't trained/certified? this was only an hypothetical example.

DPM's have only began surgical training the last 30 years and yeah, there is an obvious split in the profession. There is even 2 different recognized Boards for certification. Not everyone with a DPM from early years wants to be a surgeon, but more and more that graduate are trained to be. Unless DPM's recognize this split, we can't move forward with our head in the dirt. There has to be something to help explain the difference between those DPM's who do surgery and those DPM's who do not, ABPS certification is a way, but there are still issues with the way they do things politically.

We can't just agree with any DPM doing surgery without some kind of proof of training. the degree and it's historic, traditional reference doesn't allow us the luxury of assuming "minimal surgical training". Once someone finds a political answer to it, we can finally address the AMA's bias against DPM's. To us, it doesnt' make sense because we're seeing it from a new generation's perspective, this bias and nonsense. But to the many before us, the training hasn't been up to par - even in the last 10 years. If we unify, we have to PROTECT our profession around QUALITY PATIENT CARE by trained/certfied/competent/etc DPM's who can best represent the patient/public's interest.

I just cannot relate to your drastic way of thinking. The profession has made huge strides in the past few years and it does not look like it will revert backwards.

I do not understand why you want to put such a rift in the profession. For years the profession has been split into surgical and non-surgical and it has only confused the public. If there were a couple hundred thousand DPMs in the country it would be OK for there to be surgical and non-surgical but with only < 20,000 pods this confuses the public. And it fractionates the goals of the profession. Since all residencies are surgical now it does not make sense to revert back to the old way of thinking of them vs us between pods.

About the boards...

As much as I think there should be one board I do not want ABPS to be the only one until they act more like the MD borads when it comes to certification. Without the ABPOPPM we will most likely have trouble betting on staff/privileges at hospitals straight out of residency.

 

[Feli]

There's a big difference in training for MD surgeons than DPM surgeons. Rotating through vas, gen, trauma, ortho, etc, the MD training is standardized, though some are lower quality than others, all surgical residency programs have to be recognized by the NMRP and ACGME with certain standards that have been in place for years. Of course there are changes every year, but the drastic changes we have seen in DPM residencies only means we still have some ways to go before we can say the profession is equal. Not all 3 year residencies are standarized yet, although we're close, it's still not all under one roof. (This may be a reason why it's still hard to compare residencies or even rank them) ...

This is an interesting point, and it was brought up at the ACFAS meeting last month. There were various ideas on what the podiatric residency PGY-1 should entail... more medicine rotations? More surgical specialties (gen/vasc/ortho)?

In residency, I think it'd be most sensible for all surgical DPMs to do a PGY-1 similar to ortho... a bit of time in ER, anesthesia, and ICU to polish diagnosis and patient management, and then almost purely time spent with exposure to surgical specialties like plastics, general, ortho, and, of course, podiatry. You could toss in some private practice or researcg electives in the final year. I think the ideal PGY-1 for a pod surgery resident would be somthing like this:
2m ER, 1m ICU, 1m anes, 2m gen sx, 1m vasc sx, 1mo trauma sx, 2wk ped sx, 2wk path, 3m pod sx

Then again, I also think we should have non-surgical DPM residencies that train heavily in relavent medical specialties like IM, rheumatology, ID, rad, neuro, intensive care, etc during PGY-1. Something like this in PGY-1 for a non-surgical pod:
3m IM, 2m ER, 1m ID, 1m ICU, 2wk neuro, 2wk endocrinology, 1m rheum, 1m rad, 2wk PT/rehab, 2wk path, 1m pod

What do others think?
...Should our PGY-1 be like that of a MD going into internal med? Gen surg? Ortho? Other?
...What would your ideal PGY-1 look like?
...Should every DPM get and complete a surg residency, or should we have some designated primary care pods and some pods who are almost pure surgeons (similar to dentistry)?

 

[Dr_Feelgood]

I just cannot relate to your drastic way of thinking. The profession has made huge strides in the past few years and it does not look like it will revert backwards.

I do not understand why you want to put such a rift in the profession. For years the profession has been split into surgical and non-surgical and it has only confused the public. If there were a couple hundred thousand DPMs in the country it would be OK for there to be surgical and non-surgical but with only < 20,000 pods this confuses the public. And it fractionates the goals of the profession. Since all residencies are surgical now it does not make sense to revert back to the old way of thinking of them vs us between pods.

About the boards...

As much as I think there should be one board I do not want ABPS to be the only one until they act more like the MD borads when it comes to certification. Without the ABPOPPM we will most likely have trouble betting on staff/privileges at hospitals straight out of residency.

I again, completely agree with you (as if you need support ). I think that stafockers thinking is the old way, the way those who are in charge have created. I see this attitude in the ABPS and ACFAS.

Name another profession that acts the way we do. Do OB-GYNs separate those who can do C-sections and those who cannot? Or those who can only do pap smears? All ortho residencies are not equal. Do they say who can do joint replacements and who cannot? While I understand that DPMs are unique, in a way it is like the saying dress for the job you want not the job you have. Where are we going? I have to believe that any undertrained DPM will not his/her limit. If not, it will only take 1 or 2 losing their license to teach the others.

 

[Feli]

...The board can set the number of cases; this will increase the demand for strong residencies and fellowships. Students and directors will be mindful of what is being trained. Just my thought on a solution.

The numbers are a must since they are the common objective denominator between surgeons, but a competency is really the main thing. I could toss a football 1000 times a day, but I sure won't become Peyton in terms of blitz pickups or threading the needle in the 4th quarter.

Maybe some residents can do 3 Austins and 3 Scarf procedures skin to skin and be stellar at both because they know 3D anatomy, have read the lit, and practiced a few times in their residency's cadaver lab. Other people might have done dozens of each yet still fixate them improperly or fail to even fully understand the proper indications. I think that, regardless of the minimum numbers, an oral board exam with case workups has to remain the cornerstone of certification. It's not elitism as much as just good medicine.

Like I hinted above, I really don't think it'd be the end of the world if 65% of pods got a non-surgical residency (non-OR surg... still do basic office nail, derm, and toe procedures) and 35% got the surgical spots to do the real bone/joint work. The way we presently sit with most DPMs doing mainly clinic and just a day or two of surgery each week isn't really the most efficient. A surgical fraction of the specialists doing procedures every day is the way to go (like dent, neuro, cardio, etc). You get the most efficient surgeons that way; practice makes perfect. That sure wouldn't help the public understanding if some pods did surgery and others did not, but that's where we are at right now anyways. If not every pod school grad got a surgical residency, you would then have only the best and the brightest honing their skills in the OR and teaching while other DPMs got trained for diagnostics and medical podiatry. JMO, but that would probably be the best way to advance scope and respect in the long run.

If we keep pushing both surgerons and non-surgeons through surgical residencies, that will continue to produce board exam failure (evidenced by fairly high ABPS fail rates even among PM&S residency grads), or worse, lawsuits and detrimental news headlines down the line.

 

[Stafocker]

I just cannot relate to your drastic way of thinking. The profession has made huge strides in the past few years and it does not look like it will revert backwards.

I do not understand why you want to put such a rift in the profession. For years the profession has been split into surgical and non-surgical and it has only confused the public. If there were a couple hundred thousand DPMs in the country it would be OK for there to be surgical and non-surgical but with only < 20,000 pods this confuses the public. And it fractionates the goals of the profession. Since all residencies are surgical now it does not make sense to revert back to the old way of thinking of them vs us between pods.

About the boards...

As much as I think there should be one board I do not want ABPS to be the only one until they act more like the MD borads when it comes to certification. Without the ABPOPPM we will most likely have trouble betting on staff/privileges at hospitals straight out of residency.

I guess it's just the difference across the nation of what DPM means, especially with Scope of Practice laws. I realize you guys are very supportive of our profession, but even CASPR/CRIP and CPME admits not all residencies are surgical ones (not yet, again still some PRR, and one years still out there).... I understand you want to bring the profession together, but we're not there yet. We still got some ways to go. To think we're there already, is not admitting to the obvious.

because there is a confusion with the public about what we do, we have to make standards, that is my point. We have to protect our profession. Again, not all MD/DO are surgical, if DPM's are to be "only" surgical, we're going to leave out more than HALF of all current DPM's.

Dude, if there are close to 20,000 DPM's, how many of them graduated recently? from a surgical program? It's misleading to say, all DPM's have the same training and are certified surgeons, as much as it is misleading to say all MD's are surgically trained and certified.

 

[Stafocker]

Name another profession that acts the way we do. Do OB-GYNs separate those who can do C-sections and those who cannot? Or those who can only do pap smears? All ortho residencies are not equal. Do they say who can do joint replacements and who cannot? While I understand that DPMs are unique, in a way it is like the saying dress for the job you want not the job you have. Where are we going? I have to believe that any undertrained DPM will not his/her limit. If not, it will only take 1 or 2 losing their license to teach the others.

well, the MD/DO profession acts the way we do.

OB/GYN separate who can do c-sections? yes. Ob/gyn can do c-sections. No other MD, unless certified to do C-sections, can do it. There is no ORTHO guy doing C-sections, and if they do, you can be assured that the OB/GYN MD's will be riding him to lose his license. they'll make sure to fight anyone who tries without the proper training.

I believe we have 2 different perspectives on the matter. People think DPM and think DPM are all equal. That is not true, just like not all MD's are equal. Their residency determines their specialty. there is a difference between "profession" and "degree", and I think our fundamental arguments are based off separating the too. No MD/DO will ever say that because they have their degree, they are equal to all other specialties. We have been saying on these forums that people discriminate against all types of ppl in all different specialties. DPM do act like MD/DO's, but our internal battle should be to protect the public trust. Even 1 surgery outside someone's limitation is too much.

I realize DPM's have come a long way and we are going forward, but we can't keep the baggage that keeps us down. If we are truly moving forward, we have to realize what's best for the patient. If we truly believe 3 year residencies are better training for DPM's than 1 or 2 year residencies, then that's a start.

I just want to say, these are not personal attacks on anyone, just differences of opinion by really strong people. And I appreciate the great dialogue(sp)

 

[Stafocker]

Like I hinted above, I really don't think it'd be the end of the world if 65% of pods got a non-surgical residency (non-OR surg... still do basic office nail, derm, and toe procedures) and 35% got the surgical spots to do the real bone/joint work. The way we sit with most DPMs doing mostly clinic and a day or two of surgery each week isn't really the most efficient. A surgical fraction of the specialists doing procedures every day is the way to go (like dent, neuro, cardio, etc). You get the most efficient surgeons that way; practice makes perfect. That sure wouldn't help the public understanding if some pods did surgery and others did not, but that's where we are at right now anyways. If not everyone got a surgical residency, you would then have the best and the brightest honing their skills in the OR and teaching while other DPMs got trained for diagnostics and medical podiatry. JMO, but that would probably be the best way to advance scope and respect in the long run.

If we keep pushing both surgerons and non-surgeons through surgical residencies, that will continue to produce board exam failure (evidenced by fairly high ABPS fail rates even among PM&S residency completion), or worse, lawsuits and detrimental news headlines down the line.

👍 wish i could say something like that without offending ppl, ha. nice post.

 

[Dr_Feelgood]

well, the MD/DO profession acts the way we do.

OB/GYN separate who can do c-sections? yes. Ob/gyn can do c-sections. No other MD, unless certified to do C-sections, can do it. There is no ORTHO guy doing C-sections, and if they do, you can be assured that the OB/GYN MD's will be riding him to lose his license. they'll make sure to fight anyone who tries without the proper training.

I believe we have 2 different perspectives on the matter. People think DPM and think DPM are all equal. That is not true, just like not all MD's are equal. Their residency determines their specialty. there is a difference between "profession" and "degree", and I think our fundamental arguments are based off separating the too. No MD/DO will ever say that because they have their degree, they are equal to all other specialties. We have been saying on these forums that people discriminate against all types of ppl in all different specialties. DPM do act like MD/DO's, but our internal battle should be to protect the public trust. Even 1 surgery outside someone's limitation is too much.

I realize DPM's have come a long way and we are going forward, but we can't keep the baggage that keeps us down. If we are truly moving forward, we have to realize what's best for the patient. If we truly believe 3 year residencies are better training for DPM's than 1 or 2 year residencies, then that's a start.

I just want to say, these are not personal attacks on anyone, just differences of opinion by really strong people. And I appreciate the great dialogue(sp)

I think that you are looking at my points in the wrong way. Let me compare it another way that is closer to pods. Ortho residencies that are 5 years in duration instead of 6, don't get to do trauma, spines, or joint replacements. Does that make sense? Why do we do that then?

What you have illustrated is what I believe is important. I think that we could get rid of the limited scope by making the same arguement that you just did. A OB-GYN would lose their license and suffer a civil suit if they did brain surgery, but they have an unlimited scope. Instead, our scope should be what we are trained to do. This is what I took out of my last post (I thought it rambled on).

 

[Stafocker]

I think that you are looking at my points in the wrong way. Let me compare it another way that is closer to pods. Ortho residencies that are 5 years in duration instead of 6, don't get to do trauma, spines, or joint replacements. Does that make sense? Why do we do that then?

What you have illustrated is what I believe is important. I think that we could get rid of the limited scope by making the same arguement that you just did. A OB-GYN would lose their license and suffer a civil suit if they did brain surgery, but they have an unlimited scope. Instead, our scope should be what we are trained to do. This is what I took out of my last post (I thought it rambled on).

Yeah, thanks for the clarification. I understand your point and it's just slightly different from my point.

I agree ALL 3-year pod residencies are equal in the sense of "minimally competent". But 3 year (IMO) should be our minimal limit - Ortho is commonly our compared specialty, but i think we can be compared more closely to Opthomalogist. They do surgery in 4 years, the shortest span of the "MD/DO" world and they only focus on 1 area of the body as well (the eye). They are different from optimologists, who don't do surgery (but there is a lot of overlap). Being at my residency, i have a lot of exposure to my friends in all these different fields (Optho, Ortho, Cardio, CT, Neuro, Uro, Rehab, Emed etc). Granted, i made these friends at a local Chinese church, before they knew what i did for a living, but it really opened their eyes toward me and my eyes to the larger world of patient care. They commonly tell me what they've been told about the "old" podiatry, and I have to explain that my training is much different - hell, i'm at a top institution, their institution, haha. I joke and say, "I'm a new breed of Podiatrics, I can read. (chuckle, chuckle)". My training really opens their eyes, but i can't just welcome and say those other DPM's did what I currently do. It's just not true. It's a thin-line, i know its tough to dance around it, so we need great leaders to some how bring us all together..... for the better of the patient.

I'm hearing ya, Feelgood. I hope i got my point across, too.

 

[krabmas]

When you meet internal medicine residents and sit thru morning reports and one is a complete ***** do then think that all internal medicine residents are *****s? Or do you realize that the majority in the room are pretty damn smart?

I think if you put all of the truely old school podiatrist in a room you would find that most of them are pretty damn smart. They may not have the surgical trianing that we will have but they have been practicing for a long time and know their anatomy and have amassed surgical skills.

Most surgeons do not get to do every procedure in residency. The point of residency is to make you competent surgeon that can think on your feet and see a wide variety of pathology. But you will not see or do it all. But if you have decent skills and know your anatomy you should be able to do any procedure, even if it wasn't the procedure you were trained to do.

I know as well as anyone that there are some crappy pods out there. But there are also some pretty crappy orthos and same with general surgeons.

I think it benefits the profession more to be more cohesive and then when someone screws up just say that is them not the profession. (a bit idealistic- I know)

 

[krabmas]

well, the MD/DO profession acts the way we do.

OB/GYN separate who can do c-sections? yes. Ob/gyn can do c-sections. No other MD, unless certified to do C-sections, can do it. There is no ORTHO guy doing C-sections, and if they do, you can be assured that the OB/GYN MD's will be riding him to lose his license. they'll make sure to fight anyone who tries without the proper training.

I believe we have 2 different perspectives on the matter. People think DPM and think DPM are all equal. That is not true, just like not all MD's are equal. Their residency determines their specialty. there is a difference between "profession" and "degree", and I think our fundamental arguments are based off separating the too. No MD/DO will ever say that because they have their degree, they are equal to all other specialties. We have been saying on these forums that people discriminate against all types of ppl in all different specialties. DPM do act like MD/DO's, but our internal battle should be to protect the public trust. Even 1 surgery outside someone's limitation is too much.

I realize DPM's have come a long way and we are going forward, but we can't keep the baggage that keeps us down. If we are truly moving forward, we have to realize what's best for the patient. If we truly believe 3 year residencies are better training for DPM's than 1 or 2 year residencies, then that's a start.

I just want to say, these are not personal attacks on anyone, just differences of opinion by really strong people. And I appreciate the great dialogue(sp)

It is not that no other profession can do it. No one wants to. General surgeons do not want to touch that. They know the anatomy and could do it, but they have enough to do.

As for scope of practice, there was a case at my program last week for vascular surgery they were trying to angioplasty the splenic artery something happened and it did not work. They ended up doing a splenectomy. This is clearly something that general surgeons should do. I know that vascular surgeons train first as general surgeons but they become vascular surgeons. Total splenectomy is clearly not in the scope of vascular surgery. Many people have heard about the case and no one is going to sue for scope of practice.

When you are doing a surgery you do what is right for the patient and think about scope later.

I think far too often podiatrist tie their own hands and terrified of being sued. If you do your best and convey that to the patient there is less chance of being sued.

 

[Stafocker]

When you meet internal medicine residents and sit thru morning reports and one is a complete ***** do then think that all internal medicine residents are *****s? Or do you realize that the majority in the room are pretty damn smart?

I think if you put all of the truely old school podiatrist in a room you would find that most of them are pretty damn smart. They may not have the surgical trianing that we will have but they have been practicing for a long time and know their anatomy and have amassed surgical skills.

Most surgeons do not get to do every procedure in residency. The point of residency is to make you competent surgeon that can think on your feet and see a wide variety of pathology. But you will not see or do it all. But if you have decent skills and know your anatomy you should be able to do any procedure, even if it wasn't the procedure you were trained to do.

I know as well as anyone that there are some crappy pods out there. But there are also some pretty crappy orthos and same with general surgeons.

I think it benefits the profession more to be more cohesive and then when someone screws up just say that is them not the profession. (a bit idealistic- I know)

I understand your point. It's good to be idealistic, i wish i still was, too.

we talk "surgery" and "procedures" and "numbers" a lot in this profession. I think we leave out the Patient. Practicing for a long time on cadavers, saw bones, will never equate to a human being/person looking me in the eye before they go under the knife. Having seen people pass away during my internal medicine rotation, I'm learning more and more how important it is to be competent and how much these ppl trust us to do what's right for them. The patient trusts us. That means a lot.

With that, I can't knowingly allow "crappy" anyone treating ppl who might be my friends, family, or my patients. If there is something I can't do - like brain surgery, i'd refer my patients to the best I know, not just to brain surgeons who might be my friends or other surgeons out of the yellow-pages. I'd find them the best damn one, with the best training, etc. More and more, we try to educate patients on diabetes care and routine exams for preventative measures. We can't be silent about educating patients on what to do if their doctor hasn't the skills to treat their medical/surgical diagnosis. Sure there are "crappy" professionals everywhere, but our focus should be our profession and protecting the Patient. Remember, We took an Oath:

To practice and prescribe to the best of my ability for the good of my patients, and to try to avoid harming them.

Decent skill is good for butchers, mechanics, carpenters... artists. As Doctors, we need to return to rely on our belief that we are doing what is best for the patient. I say the rite of passage through training, experience, certification, and a judgement by our peers, would be best for our patients. Just being pretty damn smart is not what my profession is about. We, as podiatric physicians/surgeons, treat patients and focus on their foot & ankle. Our cohesiveness, IMO, should be around the patient. The patient should come first, because they are what the profession is all about.

Disclaimer**I'm not trying to misread Krabmas posting, and this is not directly at her. I just got on my soapbox a few postings ago, and i'm just riding it. This posting is not a direct response to the quoted previous post.

 

[Dr_Feelgood]

Yeah, thanks for the clarification. I understand your point and it's just slightly different from my point.

I agree ALL 3-year pod residencies are equal in the sense of "minimally competent". But 3 year (IMO) should be our minimal limit - Ortho is commonly our compared specialty, but i think we can be compared more closely to Opthomalogist. They do surgery in 4 years, the shortest span of the "MD/DO" world and they only focus on 1 area of the body as well (the eye). They are different from optimologists, who don't do surgery (but there is a lot of overlap). Being at my residency, i have a lot of exposure to my friends in all these different fields (Optho, Ortho, Cardio, CT, Neuro, Uro, Rehab, Emed etc). Granted, i made these friends at a local Chinese church, before they knew what i did for a living, but it really opened their eyes toward me and my eyes to the larger world of patient care. They commonly tell me what they've been told about the "old" podiatry, and I have to explain that my training is much different - hell, i'm at a top institution, their institution, haha. I joke and say, "I'm a new breed of Podiatrics, I can read. (chuckle, chuckle)". My training really opens their eyes, but i can't just welcome and say those other DPM's did what I currently do. It's just not true. It's a thin-line, i know its tough to dance around it, so we need great leaders to some how bring us all together..... for the better of the patient.

I'm hearing ya, Feelgood. I hope i got my point across, too.

I believe that all residencies should be PMS 36 and I do understand you point. I just cannot look down my nose at my colleages. I know podiatric surgeons that are not APBS rearfoot and ankle certified, and they are excellent surgeons. One of them maybe the best ankle surgeons in the Midwest. I have seen ankle fractures done under 30 minutes. How can we hold down a surgeon who's skills are obviously superior? Here is another thought, require a surgical inspection. A representative from the board watches the surgeon do 3 cases on a random day. That will tell them who has the skills to pay the bills.

 

[Feli]

...Here is another thought, require a surgical inspection. A representative from the board watches the surgeon do 3 cases on a random day. That will tell them who has the skills to pay the bills.

👍

 

[Stafocker]

When you are doing a surgery you do what is right for the patient and think about scope later.

Yeah I think we're getting to the same point. The patient should be first, what's right for them. we have Scope of Practice laws to protect the patient. I know there's a lot of politics involved, but i do believe ppl who try to limit DPM scope want to do what they think is best for the patient because there are too many who are not doing what is right for the patient. We as the "new generation" have to continue to produce good works and produce the best results. It'll take a few more years before there are plenty of us, graduating from these "minimally competent" 3 year residencies, before the entire country can confirm our quantity of highly qualified DPM surgeons. I think Conn is leading the way, they expanded the SOP laws recently with Ortho/AMA/AOFAS member surgeons that agreed there was a quality to the DPM degree that wasn't there initially. Specifically, those who attained a higher level of training (and some grandfathered in) received the trust of other professionals to entrust their patients to DPM's. Conn DPM's were demonstrating through consistent higher levels of training that they put the patient first.

But I think we can agree, we as a profession should do what's best for the patient. If that means, limiting (for example) a non-residency trained DPM from carving up a patient's foot, yes, we need to protect that patient.

 

[Stafocker]

I believe that all residencies should be PMS 36 and I do understand you point. I just cannot look down my nose at my colleages. I know podiatric surgeons that are not APBS rearfoot and ankle certified, and they are excellent surgeons. One of them maybe the best ankle surgeons in the Midwest. I have seen ankle fractures done under 30 minutes. How can we hold down a surgeon who's skills are obviously superior? Here is another thought, require a surgical inspection. A representative from the board watches the surgeon do 3 cases on a random day. That will tell them who has the skills to pay the bills.

yeah, the whole ABPS thing is a funny pickle... i really don't understand a lot of what they do cause at times they just do things for political reasons and not for the patient/profession.

I'd support the idea of a "representative", but who knows if that "representative" actually knows how to do surgery, ha.

btw, i can do an ankle fracture in less than 30mins, too. As long as it's "cast-able", ha 😉
(for the noobies out there, not all ankle frx need surgery, the majority can be casted)

 

[Dr_Feelgood]

yeah, the whole ABPS thing is a funny pickle... i really don't understand a lot of what they do cause at times they just do things for political reasons and not for the patient/profession.

I'd support the idea of a "representative", but who knows if that "representative" actually knows how to do surgery, ha.

btw, i can do an ankle fracture in less than 30mins, too. As long as it's "cast-able", ha 😉
(for the noobies out there, not all ankle frx need surgery, the majority can be casted)

I know what the research says but the ~50 ankle fxs I've seen have done much better with surgery than casting. Almost all of the casted patients went on to get surgery due to noncompliance, invagination of periosteum into the fracture, or just good all delayed union.

 

[Feli]

...I know what the research says but the ~50 ankle fxs I've seen have done much better with surgery than casting...

Careful, man. Charnley is sneakin up behind ya to put you in a sleeper hold. 😱

I fully agree that the few ankle fx I've seen had much better reduction and long term alignment with ORIF. The only real downside is that, if it's re-fractured, all that hardware is a giant headache. That may be one big reason even the best surgeons still a fair amount of close reduce + cast.

 

[Dr_Feelgood]

Careful, man. Charnley is sneakin up behind ya to put you in a sleeper hold. 😱

I fully agree that the few ankle fx I've seen had much better reduction and long term alignment with ORIF. The only real downside is that, if it's re-fractured, all that hardware is a giant headache. That may be one big reason even the best surgeons still a fair amount of close reduce + cast.

Maybe you can look at it this way you can get another procedure to remove the hardware, practice management.

Also, the bigger issue I have seen is wound dehiscence. It is not extremely common but can be a huge problem.

 

[krabmas]

I think we all agree that the patient should come first.

I think it is problematic when you start making rules to exclude people for fear of what if one of the DPMs decides to do what is unethical or out of their comfort zone. There has to be some level of trust of the profession as well. If we cannot trust each other as a profession, then why should the MDs trust us either. This is my point about the united front.

I understand that not all pods get the same training. That will not change. There will always be differences between residencies. Competencies and requirements of residencies are minimums. Each residency can add to the minimum or just meet the minimum.

I am obviously not at a program that just wants to meet the minimum. Nor do I follow just the minimum for myself. But when rules are made for the medical profession that is what they are based on - minimal competencies.

Even if we raise the minimium it is still the minimum and there will always be those that are at the top and those at the bottom.

 

[krabmas]

This is an interesting point, and it was brought up at the ACFAS meeting last month. There were various ideas on what the podiatric residency PGY-1 should entail... more medicine rotations? More surgical specialties (gen/vasc/ortho)?

In residency, I think it'd be most sensible for all surgical DPMs to do a PGY-1 similar to ortho... a bit of time in ER, anesthesia, and ICU to polish diagnosis and patient management, and then almost purely time spent with exposure to surgical specialties like plastics, general, ortho, and, of course, podiatry. You could toss in some private practice or researcg electives in the final year. I think the ideal PGY-1 for a pod surgery resident would be somthing like this:
2m ER, 1m ICU, 1m anes, 2m gen sx, 1m vasc sx, 1mo trauma sx, 2wk ped sx, 2wk path, 3m pod sx

Then again, I also think we should have non-surgical DPM residencies that train heavily in relavent medical specialties like IM, rheumatology, ID, rad, neuro, intensive care, etc during PGY-1. Something like this in PGY-1 for a non-surgical pod:
3m IM, 2m ER, 1m ID, 1m ICU, 2wk neuro, 2wk endocrinology, 1m rheum, 1m rad, 2wk PT/rehab, 2wk path, 1m pod

What do others think?
...Should our PGY-1 be like that of a MD going into internal med? Gen surg? Ortho? Other?
...What would your ideal PGY-1 look like?
...Should every DPM get and complete a surg residency, or should we have some designated primary care pods and some pods who are almost pure surgeons (similar to dentistry)?

I think this would work only at large teaching facilities. As long as there are programs at local hospitals or non-teaching institutions not all specialties have residents. If the specialty is not resident focused the experience typically turns out to be little more than a shaddowing experience.

IMO the learning experience starts when you are on call and have to make a decision in the middle of the night. Yes there is some one to call - but how many times do you want to call and say can I give the patient some tylenol for their fever?

I agree that some time in the ICU would be benificial. However I think orthopedic trauma is just fine and we do not need to spend time on the trauma service except for as an elective. I think if you do IM as a completely integrated program for 1-2 months at a teaching hospital then you do not need Endocrine, Rheum, and Neuro. If we increased the residency to 4 years like Presby then having almost 12 months away from pod is fine. But if only 3 years I think the first year with so much off service is too much.

I also think the dental model will not work for pods. There are too few pods. The pods model used to be like dentists but all pods were still called pods. Where as dentist have different names - orthodontist, periodontist...

If we go back to separating surgical and non-surgical pods what is considered surgery? What is considered a procedure? Does it matter what the complications are to the procedure for whether it is considered surgery?

I consider nail avulsions procedures until you think of the possible complications. Osteomylitis comes to mind - rare but possible. If the patient goes on to need an amputation of the hallux shouldn't that pod be able to handle the complication?

At what point does a hammertoe procedure become surgery? A flexor tendon release percutaneously can be done in the office in a procedure room.

Is LASERing warts surgery?

At some point you just have to trust that people are only going to do what they feel comfortable doing and will refer to someone when they reach their limit.

 

[Feli]

...If we go back to separating surgical and non-surgical pods what is considered surgery? What is considered a procedure? Does it matter what the complications are to the procedure for whether it is considered surgery?

I consider nail avulsions procedures until you think of the possible complications. Osteomylitis comes to mind - rare but possible. If the patient goes on to need an amputation of the hallux shouldn't that pod be able to handle the complication?

At what point does a hammertoe procedure become surgery? A flexor tendon release percutaneously can be done in the office in a procedure room.

Is LASERing warts surgery?

At some point you just have to trust that people are only going to do what they feel comfortable doing and will refer to someone when they reach their limit.

Well, for the grads who aren't going to get a residency this year, I think a "non-surgical" residency, even a 1yr PPMR or something, would suit them just fine. This year, it'll only be about a dozen who don't get PG training, but it might be 40 next year, and 100+ in the years after that. You can basically throw 2015 out the window if that happens.

The USA needs more foot and ankle specialists, but they don't all have to be surgeons (and not all pod school grads have the drive or skills to be surgeons). The biggest reason that podiatry supposedly needs to grow is diabetes. Primary care medical podiatrist can do wound care, nail care, orthoses, etc just fine (and probably even has more time to read about updates in those areas than a pod surgeon). If the patient needs deformity correction, amp, or Charcot reconstruct, the primary care pod can refer them to a surgically trained DPM colleague (who will then in turn refer back to the primary care pod for continued post-op wound care and nail care).

There's almost no way to create 100+ quality 2 and 3yr PMS residency spots in two years time. I think that going back to having surgical and non-surgical residencies is a viable option; PPMRs and RPR spots could be created (or resurrected) in a hurry as a stopgap for the current residency shortage. It might not be great for the proposed goal of having all pods being 3yr trained if the CPME reverts to 1 and 2yr non-surg PG training, but they really might not have any other choices with the amount of students. Some training is always better than none... at least those who don't get a PMS could still get a state license and practice what they are trained for.

 

[krabmas]

Well, for the grads who aren't going to get a residency this year, I think a "non-surgical" residency, even a 1yr PPMR or something, would suit them just fine. This year, it'll only be about a dozen who don't get PG training, but it might be 40 next year, and 100+ in the years after that. You can basically throw 2015 out the window if that happens.

The USA needs more foot and ankle specialists, but they don't all have to be surgeons (and not all pod school grads have the drive or skills to be surgeons). The biggest reason that podiatry supposedly needs to grow is diabetes. Primary care medical podiatrist can do wound care, nail care, orthoses, etc just fine (and probably even has more time to read about updates in those areas than a pod surgeon). If the patient needs deformity correction, amp, or Charcot reconstruct, the primary care pod can refer them to a surgically trained DPM colleague (who will then in turn refer back to the primary care pod for continued post-op wound care and nail care).

There's almost no way to create 100+ quality 2 and 3yr PMS residency spots in two years time. I think that going back to having surgical and non-surgical residencies is a viable option; PPMRs and RPR spots could be created (or resurrected) in a hurry as a stopgap for the current residency shortage. It might not be great for the proposed goal of having all pods being 3yr trained if the CPME reverts to 1 and 2yr non-surg PG training, but they really might not have any other choices with the amount of students. Some training is always better than none... at least those who don't get a PMS could still get a state license and practice what they are trained for.

If you are not trained to do surgery how do you know what is a surgical diagnosis vs. medical/conservative.

I've seen medicine and ID specialists treat abscesses w/IV abx. On more than one occasion.

I think it is better to be surgically trained but only practice if you are able to pass the boards. If you are only able to pass ABPOPPM then you should not be able to do surgery.

This would require ABPS to change and allow just graduated residents to sit for boards.

And...
again, what do we consider surgery? biopsy? P and A? Arthroplasty of 5th toe? I & D of simple MRSA abscess/furuncle? Who decides?

 

[MedWriter]

All the discussion seems to center on Pod Vs gen ortho....but really, the comparison should be with the F&A orthos. They have 5 years of surgical training and a year of f&A ONLY whereas pods have at most 3 years of surgery, and that is not just f&a. So when you talk about skills, don't years of training and specialization push the F&A orthos beyond the skills of the pod?

 

[Feli]

All the discussion seems to center on Pod Vs gen ortho....but really, the comparison should be with the F&A orthos. They have 5 years of surgical training and a year of f&A ONLY whereas pods have at most 3 years of surgery, and that is not just f&a. So when you talk about skills, don't years of training and specialization push the F&A orthos beyond the skills of the pod?

Depends entirely on the doc, and this has been debated ad nauseum. FYI, not all F&A ortho fellowships are 1yr... some are only 6mo (and the majority were 6mo years not too long ago).
http://www.aofas.org/files/public/Available_2008-09_FA_Fellowships_3-14-08.doc
Also, there are 4yr podiatric surgical residencies as well as numerous fellowships available today, so saying "pods have at most 3 years of surgery" is not always accurate.

A fellowship trained F&A ortho can surely do a shoulder or knee better since pods don't train in that, but when you compare surgical numbers and diversity coming out of training, it varies. For bunions, toe procedures, and even flatfoot surgeries, and it's generally not even close. Depending on the programs, ankle fractures and rearfoot procedures might be close... I have no idea and it probably really depends on the program.

 

[MedWriter]

Depends entirely on the doc, and this has been debated ad nauseum. FYI, not all F&A ortho fellowships are 1yr... some are only 6mo (and the majority were 6mo years not too long ago).
http://www.aofas.org/files/public/Available_2008-09_FA_Fellowships_3-14-08.doc
Also, there are 4yr podiatric surgical residencies as well as numerous fellowships available today, so saying "pods have at most 3 years of surgery" is not always accurate.

A fellowship trained F&A ortho can surely do a shoulder or knee better since pods don't train in that, but when you compare surgical numbers and diversity coming out of training, it varies. For bunions, toe procedures, and even flatfoot surgeries, and it's generally not even close. Depending on the programs, ankle fractures and rearfoot procedures might be close... I have no idea and it probably really depends on the program.

I agree, it totally depends on the program. However, currently there is only one F&A ortho fellowship that is 6 mo (Roger Mann) that I am aware of, so it is probably safe to assume that most f&a orthos have the full year. But just as there is a small variety of ortho fellowships, there appears to be quite a bit more variety in pod training, even within the surgically trained (2 vs 3 year etc) (As a side note, I am curious to know many months of f&a pods do in residency? I saw 3 mo quoted on another blog)

But here is a question for someone: Recently in an outpatient surgery center there was a case where 2 pods together took 5 hours for a triple arthrodesis. Is this standard of care in your community? If it is not, how are these 2 pods upholding the profession and are they providing high quality f&a care?

 

[MedWriter]

Depends entirely on the doc, and this has been debated ad nauseum. FYI, not all F&A ortho fellowships are 1yr... some are only 6mo (and the majority were 6mo years not too long ago).
http://www.aofas.org/files/public/Available_2008-09_FA_Fellowships_3-14-08.doc
Also, there are 4yr podiatric surgical residencies as well as numerous fellowships available today, so saying "pods have at most 3 years of surgery" is not always accurate.

A fellowship trained F&A ortho can surely do a shoulder or knee better since pods don't train in that, but when you compare surgical numbers and diversity coming out of training, it varies. For bunions, toe procedures, and even flatfoot surgeries, and it's generally not even close. Depending on the programs, ankle fractures and rearfoot procedures might be close... I have no idea and it probably really depends on the program.

Another question: based on what you said here, you think that pods do more bunion,s flatfoot and toes? How many do you do exactly within the residency?

 

[SportPOD]

Another question: based on what you said here, you think that pods do more bunion,s flatfoot and toes? How many do you do exactly within the residency?

It depends on the podiatrist. Some will just do only bunions and hammertoes. Some will do the whole gamut of the entire foot and ankle. It also depends on the location that one is practicing. In certain practices, the podiatrist is the go to guy for foot and ankle and the orthopedist for all other joints. Sometimes it can be that the orthopedists is there for the ankle and the podiatrist for the foot. This is becoming less and less the norm as group practices are realizing the training of podiatrists and how much "cheaper" they can be to the practice compared to the orthopedists. (and when I mean cheaper, I'm talking about costs to the practice, i.e. malpractice)

 

[Dr_Feelgood]

I agree, it totally depends on the program. However, currently there is only one F&A ortho fellowship that is 6 mo (Roger Mann) that I am aware of, so it is probably safe to assume that most f&a orthos have the full year. But just as there is a small variety of ortho fellowships, there appears to be quite a bit more variety in pod training, even within the surgically trained (2 vs 3 year etc) (As a side note, I am curious to know many months of f&a pods do in residency? I saw 3 mo quoted on another blog)

But here is a question for someone: Recently in an outpatient surgery center there was a case where 2 pods together took 5 hours for a triple arthrodesis. Is this standard of care in your community? If it is not, how are these 2 pods upholding the profession and are they providing high quality f&a care?

According to the CPME the minimum number of cases is as follows:

PMS-24
Total 350
Digital procedures 80
First Ray procedures 60
Other Soft Tissue Foot Surgery procedures 45
Other Osseous Foot Surgery procedures 40
Reconstructive Rearfoot and Ankle procedures 0

PMS 36
Total 525
Digital procedures 100
First Ray procedures 80
Other Soft Tissue Foot Surgery procedures 65
Other Osseous Foot Surgery procedures 60
Reconstructive Rearfoot and Ankle procedures 50

I don't know of any program in American that has only 3 months of podiatric surgery. That may be the amount of time in the first year. There is no requirement for how many months of podiatric surgery you need, but you'll never get 525 foot and ankle cases in 6 months. Also, many programs spend a lot of time doing cases with orthopaedic surgeons. So technically it is not a podiatric rotation but you are doing the same thing.

As for the 5 hour case, it took me 15 seconds to find poor surgical skills in foot and ankle orthopods (htp://www.projo.com/news/content/big_jury_award_11-29-07_OH82C4N_v17.261fb1c.html). You also do not know what complicating factors may have been present, if the OR staff had all of the equipment sterilized, or if anesthesia had problems. Even if it was poor surgical skills, every specialty has a sliding scale of skills, we are not all created equal.

I would suggest reading "Foot and Ankle Experience in Orthopaedic Residency" Foot and Ankle International July 2003. You can read it at http://forums.studentdoctor.net/showpost.php?p=4972019&postcount=11. It is very interesting to see the number of weeks and cases that are dedicated to the foot and ankle in orthopaedic residency programs.

 

[jonwill]

All the discussion seems to center on Pod Vs gen ortho....but really, the comparison should be with the F&A orthos. They have 5 years of surgical training and a year of f&A ONLY whereas pods have at most 3 years of surgery, and that is not just f&a. So when you talk about skills, don't years of training and specialization push the F&A orthos beyond the skills of the pod?

Without a doubt and of course, generally speaking, podiatrists receive more thorough training than F&A ortho. It is an issue of time (1 year vs 3 years). Sure, we spend some time off service but many will graduate with thousands of procedures. There are very few (if any) F&A ortho fellows that can say that. You'll also notice that every year, more than half of the foot and ankle fellowships sit empty. There are various reasons for this but the bottom line is that there aren't a whole lot of F&A orthopods left.

And the training is definitely different. In my experience, the F&A orthos that still do foot stuff largely limit it to the rearfoot trauma stuff. One of our residents recently tried to talk one into doing a bunion but he refused on the grounds that he had only done 20 bunions in his entire career and he sent it to a pod. I have seen this various times. So I think their is a different focus on training.

I have said it before but I believe that F&A ortho is a dying breed a podiatry has evolved into a surgical sub-specialty. Those poor ortho guys have enough to worry about!!! (ie the rest of the body)