Time for change in Podiatry/Combined DPM and MD program

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Would you be in favor of a combined DPM/MD degree


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DocHermes

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The current practice of podiatry is facing many hurdles, especially in states where podiatrist are not recognized as physicians. We have some of the worst application numbers to Podiatry schools ever seen. I have been a long believer in parity; the recent white paper which would have allowed podiatry students to sit for the USMLE was promptly shot down by the AMA. I have long believed the path forward would be to model OMFS and start hybrid programs, which would combine the DPM and MD degree together, this could even include decreasing a year off of podiatry school and increasing one year of residency (a 3+4 program which would help offset the increase two years that would be required for the MD degree) such as combined OMFS and MD programs do. This would put us on a level playing field with all other medical specialties and allow for a pathway forward, including board certification through the American College of surgeons like all other 14 surgical specialties (Instead of having two boards fighting each other -> dissolve ABPM and ABFAS and roll it into ACS). This would also require a name change to distinguish those with the new credentials such as “lower extremity surgeons” so their would be clear distinction from Podiatrists of different training. Previous Podiatrists can be grandfathered in. The goal would not necessarily be to change what Podiatrists do, but to eliminate state scope issues by allowing one to practice within their training, allow for use of physician extenders, allow for application to loan repayment programs only “physicians” qualify for (many states have programs that will reimburse some part of student loans for a time commitment, but Podiatrists don’t qualify), etc. Hoping to gain some traction with this thread.
 
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At this point in my career, the only way an MD degree would augment my practice of podiatry is:
  • harvest my own iliac crest graft/bmac
  • treat warts on peoples' hands
  • manage my own inpatient admissions which none of us want to do
  • moonlight in urgent care clinics (i.e. stop practicing podiatry)
And there it is. I think deep down, the only reason DPMs want to be rolled in with MDs is so they can stop practicing podiatry. If that's what you want to do, I'm not going to stop you from doing it, just don't expect the AMA to play along.

I have been a long believer in parody;
I hate to be the grammar police, but this malapropism is perfect for what you're asking for.
 
*parity (not parody)

Podiatry's issue is saturation and poor ROI, through and through.
Podiatry does nothing MD/DO can't... we simply do what they don't want (nail care, wounds, incfection surgery, etc).

OMFS has high demand (and therefore high pay) for a skill MD/DO surgeons don't have. They are an apples to oranges comparison.

Podiatry's best bet is better training and FAR fewer grads... but that won't happen, due to greed.
 
I agree in principle however only in principle. The reality is a lot of what holds podiatry down is PODIATRY. We can’t even standardize our residency programs which bleeds into we don’t even have one agreed upon surgical board.

Then we expect a notoriously pretentious organization like AMA to sit down and have meaningful discussion? Foolish.

Let’s look at it from THEIR perspective. Why would they want to be involved with a speciality that logistically right now is a nightmare which would give them additional headaches. Podiatry has a lot of work to do from within before we can honestly expect another medical organization to sit down and discuss a merger.
 
At this point in my career, the only way an MD degree would augment my practice of podiatry is:
  • harvest my own iliac crest graft/bmac

Depending on what state you're in, this should be an acceptable practice already. I know some, not.
 
Sounds like a good idea til someone asks you to read an EKG
True, but the AI (computer interpretation) is already so good. So you just have to know what to do with the result.

Also, IMO, it will be less than 5 years and AI will be fully reading XR, CT, MRI. But it will be knowing what to do with the information.
 
I have no business doing prostate exams. Head shoulders knees, just toes for me bros.

We have enough incompetent pods being grandfathered into surgery.
Yeah it’s funny how a lot of people pushing for md/do parity were also the same people who got grandfathered into ABFAS without a proper residency.

If you need to be “grandfathered” into something that only thing should be retirement
 
Depending on what state you're in, this should be an acceptable practice already. I know some, not.
Aren’t there still some states where podiatrists can’t amputate? I remember that being a thing on rotations back in the day
 
Work in a building shoulder to shoulder with IM/FM outpatient.

I have no business managing ESRD, hypertensive urgencies, chest pain, IUD insertions, critical labs, cancers on MRI.
They have no business managing foot wounds, doing minor procedures, clipping nails and doing ingrowns, doing amputations or soft tissue mass excisions or elective surgeries, sports med stuff.

Their license allows them to do quite a bit, especially with FM- but they don't want to, don't have the time to, or weren't trained enough to feel comfortable doing podiatry/foot and ankle specific stuff.

We talk all the time about how each of us would manage xyz given pathology and symptoms that pop up in our respective patients.
We curbside each other all the time and the stories are numerous. But we stick to what we're good at and trained in.

Even if I had the additional MD degree certificate/whatever, I still would not be managing their patients, and they would not be managing mine.

There's a mutual respect-but we both know what we like to do, what we're good at, and what keeps the lights on in the building.
 
“Name 10 lab results and how you would manage them”
 
OMFS has high demand (and therefore high pay) for a skill MD/DO surgeons don't have. They are an apples to oranges comparison.

To add, their DDS schooling/training doesn’t prepare them to perform the procedures that OMFS must be proficient in. So a DDS adding the MD and becoming a OMFS actually expands their scope/practice. Adding an MD to the DPM wouldn’t change what a podiatrist treats (as the OP even admits). Well, other than ortho and vascular letting us do BKAs and AKAs lol. Yay, more pus!
 
To add, their DDS schooling/training doesn’t prepare them to perform the procedures that OMFS must be proficient in. So a DDS adding the MD and becoming a OMFS actually expands their scope/practice. Adding an MD to the DPM wouldn’t change what a podiatrist treats (as the OP even admits). Well, other than ortho and vascular letting us do BKAs and AKAs lol. Yay, more pus!
I don’t know if bovie at 30/30 can manage the hemostasis for a bka and aka
 
Just as an orthopedic consultant is not managing things like ESRD or interpreting EKGs, the dual degree would not really change the management of “podiatry” patients. You would still have to “stay in your lane”
 
Becoming MD/DOs is what the PM News Survey crowd thinks is the solution for the profession. If only we were MDs we could debride lesions above the level of the ankle is the classic PM News sad tale.

I don't like engaging in fantasy ie. that someone outside the profession is going to save us or that we'll be fixed by something magical happening like grandfathering us as physicians. The profession has to fix itself from within at every level. It would be convenient if the country would also fix the healthcare system simultaneously.

Sadly, the profession fixing itself is such a vague statement that an SDNer and the APMA president could both say it and there would probably be an ocean of difference in what each person intends.
 
Just as an orthopedic consultant is not managing things like ESRD or interpreting EKGs, the dual degree would not really change the management of “podiatry” patients. You would still have to “stay in your lane”
Then what would the increased credentials bring besides prestige in naming rights only?
I still can't take general ortho or medicine call.
Soft tissue stuff above the ankle-, sure but do I now need an added derm credential? What's the foot guy doing blasting lesions on the hand, arms, or face?

What other services could I provide in my practice setting with the added MD credential?
Is the sports med ortho guy doing spinal fusions and hand surgery?
Sure they may field a call, do an I&D, triage- but if they aren't going out of what they were trained in fellowship- what other services will I be doing outside of podiatry/foot and ankle stuff with a now added MD credential?
 
Then what would the increased credentials bring besides prestige in naming rights only?
I still can't take general ortho or medicine call.
Soft tissue stuff above the ankle-, sure but do I now need an added derm credential? What's the foot guy doing blasting lesions on the hand, arms, or face?

What other services could I provide in my practice setting with the added MD credential?
Is the sports med ortho guy doing spinal fusions and hand surgery?
Sure they may field a call, do an I&D, triage- but if they aren't going out of what they were trained in fellowship- what other services will I be doing outside of podiatry/foot and ankle stuff with a now added MD credential?
Once you had a full scope license there would be nothing to stop you from running an obesity clinic where you dispense marked up tirezepatide or doing come sort of aesthetics cool sculpting with lip filler injections and sticking pellets in butts. It would probably be easier to write marijuana cards for people and to give people antibiotics for their colds.

That's the MD-Difference!
 
It would require significant restructuring of podiatry school education/training.

IMO, podiatry could fit in as an FM/IM interventional specialty; separate and distinct enough from F&A ortho in terms of treatment philosophy/training. I sense reluctance about engaging in patient care that FM/IM is more commonly involved in, but that is the inherent weakness of the current way podiatry specializes so soon as well as in our student recruitment efforts (surgery!!). There's room for podiatry to grow from a primary care background, and with demand for quality primary care in general, the field of podiatry with realigned expectations and schooling/training could potentially position itself to help fill that gap - and that would help position podiatry to where we can be an essential (or at least a more useful) service and not a luxury one that's one of the first to be cut when funds get tight.
 
sticking pellets in butts
Christian Bale Swag GIF
 
Once you had a full scope license there would be nothing to stop you from running an obesity clinic where you dispense marked up tirezepatide or doing come sort of aesthetics cool sculpting with lip filler injections and sticking pellets in butts. It would probably be easier to write marijuana cards for people and to give people antibiotics for their colds.

That's the MD-Difference!
Wait how do you make money sticking pellets in butts? I am not on tik Tok.
 
… allow for use of physician extenders…
Isn’t this already a thing for you guys? The hospital DPM at my last job had a couple NPs working under her.

Also, if the goal isn’t to change podiatric practice, but instead to get around regulatory/scope issues, wouldn’t it be more practical to lobby for this change at the legislative level? If the AMA shot down pod students taking USMLE, wouldn’t it be just as hard if not harder to make you guys MDs? I imagine the AMA would play a key role in starting this kind of thing.
 
Isn’t this already a thing for you guys? The hospital DPM at my last job had a couple NPs working under her.

Also, if the goal isn’t to change podiatric practice, but instead to get around regulatory/scope issues, wouldn’t it be more practical to lobby for this change at the legislative level? If the AMA shot down pod students taking USMLE, wouldn’t it be just as hard if not harder to make you guys MDs? I imagine the AMA would play a key role in starting this kind of thing.
The problem with podiatry is that there are too many. Not that much footcare to go around. No amount of usmle or grandfather MD means jack ****
 
The problem with podiatry is that there are too many. Not that much footcare to go around. No amount of usmle or grandfather MD means jack ****
Sorry, new schools opening doesn't fit that narrative. Moar schoolz
 
Isn’t this already a thing for you guys? The hospital DPM at my last job had a couple NPs working under her.

Also, if the goal isn’t to change podiatric practice, but instead to get around regulatory/scope issues, wouldn’t it be more practical to lobby for this change at the legislative level? If the AMA shot down pod students taking USMLE, wouldn’t it be just as hard if not harder to make you guys MDs? I imagine the AMA would play a key role in starting this kind of thing.
I remember when this was being debated at one of the -PMA meetings to see if we should try to lobby our state to allow to oversee NP/PA's. The consensus from the old guys in the room was who cares? A podiatrist is cheaper than an NP/PA.
 
I remember when this was being debated at one of the -PMA meetings to see if we should try to lobby our state to allow to oversee NP/PA's. The consensus from the old guys in the room was who cares? A podiatrist is cheaper than an NP/PA.
Nailed it
 
For everyone's information, NPs operate under their own license, so it's completely feasible for a dpm to hire one. I practice in a very NP-friendly state where they function completely autonomously in PCP roles.
 
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