What issues are important to you?

[gustydoc]

This is a thread for all you current pod students. I have noticed that some of the student leaders I have met don't really have a clear understanding of what issues are important to their peers. With the National APMSA meeting less than a month away, now would be a great time to suggest things that you would like to see addressed at the House of Delegates meeting. What things are important to you as a future DPM and what things you would like to see done differently?

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[IlizaRob]

This is a thread for all you current pod students. I have noticed that some of the student leaders I have met don't really have a clear understanding of what issues are important to their peers. With the National APMSA meeting less than a month away, now would be a great time to suggest things that you would like to see addressed at the House of Delegates meeting. What things are important to you as a future DPM and what things you would like to see done differently?

Are these only things that pertain to being a student? Or are they things about the profession in general that the APMSA can bring up to the APMA? Or both?

 

[gustydoc]

Are these only things that pertain to being a student? Or are they things about the profession in general that the APMSA can bring up to the APMA? Or both?

Definitely both. When we meet we will often times decide on what the APMSA's stance is on an issue and then present that information to the APMA. For example, last year we came to the decision that it would be the APMSA's stance that we would like to see only one certifying board in the future. As you know now there is the ABPS and ABPOPPM and others. It is confusing to hospitals and others in the medical profession, so we took our decision to the APMA so that they would now how the students feel. There is a lot more that goes into that specific example, but you get the idea. If it has to do with podiatry and you have an opinion aboutit, it's relavent. Keep in mind though that constructive criticism is appreciated.

 

[mrfeet]

I would really like to see the issue of "equal pay for equal work" resolved. To me, this is perhaps one, if not the biggest discriminatory problem in our profession. It is absolutely crazy that orthopods are receiving more pay for foot and ankle procedures than a podiatrist when they have far less experience in the area. I spoke with an orthopod a few weeks ago and I asked him how much foot and ankle education he received in residency. He told me "about 6 months." SIX MONTHS! That is ridiculous.

I hope that some of you who are going to the APMA meeting will address this issue with vigor. However, I am afraid that the only way we will ultimately resolve this with the insurance companies is to expand residency. In my opinion, I think that we should do away with all two year residency programs and go to three year exclusively. I believe that this will be the first step in assuring equal pay for equal work. None of us want to prolong our education any longer than it already is, but I'm afraid that it is a necessary evil.

 

[Podman]

first of all, great topic

second, i'd like to see our APMA get more active in promoting the profession amongst other healthcare providers and the general public. We are a small specialty and with our training we are probably creating more confusion to the general public since many still perceive us "toe nail clippers". We need a unified voice sending the message which entails who we are as professionals, and how we're qualified to help/treat the general public.

Lastly, I think we need to continue pushing for a unified scope amongst all the states.

 

[whiskers]

The most important issue for the advancement of our profession in my opinion is raising the academic integrity/standards of our schools.

Without that, we have no right to expect the rest of the world to respect our degree unconditionally.

I think that there is a reason that our education and training is perceived as inferior. It's not surprising to me, because I've experienced it and am uncertain about it myself.

 

[Catayst]

How about cadavers?

 

[Podman]

The most important issue for the advancement of our profession in my opinion is raising the academic integrity/standards of our schools.

Without that, we have no right to expect the rest of the world to respect our degree unconditionally.

I think that there is a reason that our education and training is perceived as inferior. It's not surprising to me, because I've experienced it and am uncertain about it myself.

I completely agree with that - we need to impose more strict and defined standards on all schools if we were to gain any strides in our profession

 

[Dr_Feelgood]

I am in agreement with increasing the standards, but I think hand in hand with that is decreasing class sizes at some schools. There is no need for a class of 100. I think that all schools should have a maximum of 75. This will increase the level at each school b/c you have eliminated 50-100 spots.

Also, I think that the APMA needs to stop wasting its money on the darn Medicaid wording. Dr. Yoho said it best, "You don't invite yourself to dinner." As a profession we need to promote ourselves to the public. If we make our profession irreplaceable, who cares if we are physicians in Medicaid's eyes, they need us. I feel that PPAC is beating its head against the wall on that issue.

Also, "equal pay for equal work" should go to the front of PPACs agenda.

If APMA starts promoting more and we get equal pay, we will all live high on the horse.

 

[IlizaRob]

Much confusion arrises from differences in scope among states. Someone who meets a pod in New York is going to think the same as in Georgia. We need a standard scope across the nation. I think that the insurance and pay problems will all come around easier when there is no question about what we can do.

 

[Dr_Feelgood]

Much confusion arises from differences in scope among states. Someone who meets a pod in New York is going to think the same as in Georgia. We need a standard scope across the nation. I think that the insurance and pay problems will all come around easier when there is no question about what we can do.

The difficulty in that is the differences in scope of practice. The issue is self defeating. Some states will have to give up rights for other states to gain them. There is the problem. As with everything else political, everyone wants to gain and no one wants to lose.

 

[IlizaRob]

The difficulty in that is the differences in scope of practice. The issue is self defeating. Some states will have to give up rights for other states to gain them. There is the problem. As with everything else political, everyone wants to gain and no one wants to lose.

They should get over their pride. I dont care if anyone has to lose a little for the better of the profession (although I do understand it). Or maybe we could setup the national scope identical to the state with the best. That would sove that right?

 

[mrfeet]

There have been many issues addressed on this thread about the future of podiatric medicine, and specifically what issues should be addressed at the upcoming meeting. Several students have voiced their frustration with podiatric medicine's treatment by those on the outside.

I think that we have to look at this from the perspective of osteopathic medicine in the 1960's. It was during this time that DO's gained great recognition when the California AMA offered them the MD degree and equal rights in practice. This began the American movement for unilateral acceptance of DO's with MD's in scope of practice and privilege. Now, please don't misinterpret me as saying that we should give up the DPM and become MD's, but I think that for us to receive equal pay and equal privilege, a few things have to happen:

(1) We must have a residency length that is comparable to orthopods. As much as none of us want to do a 5 year residency, it may very well become necessary.

(2) We must have a uniform scope of practice. Though I have mixed emotions on this one, it really is the truth. One of the many problems that podiatric medicine faces today is the lack of consistency in scope of practice. It is true that in order for us to gain this, some states such as Georgia, will probably have to give up their very generous scope of practice, however, if the profession as a whole gains, then it is a win-win situation.

(3) We must educate the public about our profession. Much like the osteopaths did in the 1960's by educating the public that they were not "quacks," we have to convince the public, medical community, and insurance companies that we are not glorified "toe nail clippers." We have to show them that we are highly-trained and very competent physicians and surgeons that specialize in foot and ankle.

(4) More consistency in education standards of our podiatric medical schools. Many compaints have been made on this forum that admission standards are too low. This problem was similarly faced by osteopathic schools several decades ago. Many of these schools were criticized by the medical community for their GPA and MCAT standards being lower than those of their allopathic counterparts. As we now see, their standards are equal and some of are even higher than MD schools. This is a result of uniform standards by the AOMA. However, lets not kid ourselves, as we are a specialty like dentistry, optometry, etc., our numbers will never be quite as high as MD or DO schools because of our limited scope of practice.

I think that if we address these issues, which I believe are at the core of our problems, then podiatric medicine will begin to receive the equality and dignity that it deserves as a profession.

 

[oncogene]

There have been many issues addressed on this thread about the future of podiatric medicine, and specifically what issues should be addressed at the upcoming meeting. Several students have voiced their frustration with podiatric medicine's treatment by those on the outside.

I think that we have to look at this from the perspective of osteopathic medicine in the 1960's. It was during this time that DO's gained great recognition when the California AMA offered them the MD degree and equal rights in practice. This began the American movement for unilateral acceptance of DO's with MD's in scope of practice and privilege. Now, please don't misinterpret me as saying that we should give up the DPM and become MD's, but I think that for us to receive equal pay and equal privilege, a few things have to happen:

(1) We must have a residency length that is comparable to orthopods. As much as none of us want to do a 5 year residency, it may very well become necessary.

(2) We must have a uniform scope of practice. Though I have mixed emotions on this one, it really is the truth. One of the many problems that podiatric medicine faces today is the lack of consistency in scope of practice. It is true that in order for us to gain this, some states such as Georgia, will probably have to give up their very generous scope of practice, however, if the profession as a whole gains, then it is a win-win situation.

(3) We must educate the public about our profession. Much like the osteopaths did in the 1960's by educating the public that they were not "quacks," we have to convince the public, medical community, and insurance companies that we are not glorified "toe nail clippers." We have to show them that we are highly-trained and very competent physicians and surgeons that specialize in foot and ankle.

(4) More consistency in education standards of our podiatric medical schools. Many compaints have been made on this forum that admission standards are too low. This problem was similarly faced by osteopathic schools several decades ago. Many of these schools were criticized by the medical community for their GPA and MCAT standards being lower than those of their allopathic counterparts. As we now see, their standards are equal and some of are even higher than MD schools. This is a result of uniform standards by the AOMA. However, lets not kid ourselves, as we are a specialty like dentistry, optometry, etc., our numbers will never be quite as high as MD or DO schools because of our limited scope of practice.

I think that if we address these issues, which I believe are at the core of our problems, then podiatric medicine will begin to receive the equality and dignity that it deserves as a profession.

Mr.Feet,

I am not sure why we would need to do a 5 year residency to prove that we are equal to the orthopods. They have 5 year programs because they are un limited scope physicians and must learn to treat the whole body. They spend maybe 6 months at most doing foot and ankle cases. We spend 3 years. I think that is more than enough. Why do you claim we need 5 years?

I agree with the rest of what you said. Very good post.

oncogene

 

[mrfeet]

Mr.Feet,

I am not sure why we would need to do a 5 year residency to prove that we are equal to the orthopods. They have 5 year programs because they are un limited scope physicians and must learn to treat the whole body. They spend maybe 6 months at most doing foot and ankle cases. We spend 3 years. I think that is more than enough. Why do you claim we need 5 years?

I agree with the rest of what you said. Very good post.

oncogene

You do have a point. I guess that the point I was trying to make is that insurance companies often use the fact that we have a shorter residency as a reason to not pay us as much for the same surgical procedures as that of our orthopod counterparts. I agree, we don't need to do a 5 year residency, but I do think that all residency programs need to be uniform and all be 3 years. There is too much confusion with the current system. As with scope of practice, if we had a consistent length for residency, it would alleviate much of the confusion that exists out there.

 

[capo]

Residencies should (and probably will soon) be a standard minimum of 3 years. Maybe a 4th year could be added later. There also should be alot more fellowships offered, to really hone in and specialize like ortho's can. This would upgrade training and give the medical and lay community, alot more respect for pods in general.

 

[Podman]

Residencies should (and probably will soon) be a standard minimum of 3 years. Maybe a 4th year could be added later. There also should be alot more fellowships offered, to really hone in and specialize like ortho's can. This would upgrade training and give the medical and lay community, alot more respect for pods in general.

i dont know about making every residency shift to a 3 year model - afterall, not every podiatrist out there wants to do rear-foot fractures procedures or reconstructive foot surgeries - some actually do want to specialize in wound care only with minimal surgery - granted that is abit "old school" but we are a profession with options.

The 2 and 3 year model I think is ideal. Especially with the 3 year one giving us the opportunity to do Full medical rotations like MD/DO students during our first PGY-1 year. This is when we really get the previlidge of working with vascular surgeons, orthopoedic surgeons, and internists to learn from their craft. In my opinion, 2 years of foot and ankle sugery is fine and we already have fellowships offered that include diabetes, sports medicine, and even further foot surgeries.

Regarding the concept of specializing - This is a good idea and you already see many top podiatrists around the country known for either surgeries, diabetic wound care, amputations, etc. However, you should also keep in mind that as a small specialty, you don't want to specialize yourself out of it too early - meaning, as a young practictioner you will want to work with many different patients first to establish yourself then eventually, with success you would probably look into focussing on your "specialty". I know a guy who is on call for all the diabetic amputations etc. and he made this his specialty after the 3-year residency and 1-year fellowship - so its definately something to look into down the road - but the important thing is to be first of all well trained and competent enough to handle all the cases.

 

[Dr_Feelgood]

Residencies should (and probably will soon) be a standard minimum of 3 years. Maybe a 4th year could be added later. There also should be alot more fellowships offered, to really hone in and specialize like ortho's can. This would upgrade training and give the medical and lay community, alot more respect for pods in general.

I agree with the increase in fellowships, but as for the minimum. I think that ACFAS and the Board of Podiatric Surgeons have addressed that issue well. If you want to do any surgery besides bunions and hammertoes, you must have 3 years of surgical residency. I would also like to see a fourth year fellowship/head resident position.

 

[Podman]

I agree with the increase in fellowships, but as for the minimum. I think that ACFAS and the Board of Podiatric Surgeons have addressed that issue well. If you want to do any surgery besides bunions and hammertoes, you must have 3 years of surgical residency. I would also like to see a fourth year fellowship/head resident position.

I think I would also like to see some more research-fellowships. I haven't heard of very many podiatry ones and these can be very good for our profession if we want to continue integrate into a full surgical subspecialty

 

[Dr_Feelgood]

I could see that, but some of the top programs require research already. If a few of the hospitals that were associated w/ universities offered a payed fellowship with the ability to get a Masters then I can see that becoming more impressive.

 

[gustydoc]

I noticed that there is a lot of talk about the residency model structure so I thought I would throw a few things out there for you guys from the mid-winter meeting with the AACPM. First of all a poll was done last year of all podiatric medical students by their schools APMSA rep and the results showed that 95% of us desire a three year residency. Apparently AACPM was not aware that students felt this way and they are now encouraging residencies to seek conversion to the three year model.

Here are some interesting stats I thought you all might be interested in from the AACPM liaison to the APMSA.

"For the 2006 CASPR Cycle, applicants applied to 9.84 programs, generating 3593 total applications. 346 applicants contended for 444 positions at 213 residency programs. 272 successfully matched. 172 positions remained unfilled a 92 programs. The majority of these programs are PM&S 24’s.
By 2008-2009 there is expected to be 523 entry level positions of which 140 will be PM&S24 and 393 will be 36’s. This number might change depending on where the residents decide to go. If a program remains unmatched for 4 years it can be shut down.
The AACPM is trying to pursue full funding for the PM&S 36’s because there is a strong trend that this is the preferred program model."

Keep the dialogue coming. I appreciate the insight into what you guys think is important.

 

[krabmas]

I noticed that there is a lot of talk about the residency model structure so I thought I would throw a few things out there for you guys from the mid-winter meeting with the AACPM. First of all a poll was done last year of all podiatric medical students by their schools APMSA rep and the results showed that 95% of us desire a three year residency. Apparently AACPM was not aware that students felt this way and they are now encouraging residencies to seek conversion to the three year model.

Here are some interesting stats I thought you all might be interested in from the AACPM liaison to the APMSA.

"For the 2006 CASPR Cycle, applicants applied to 9.84 programs, generating 3593 total applications. 346 applicants contended for 444 positions at 213 residency programs. 272 successfully matched. 172 positions remained unfilled a 92 programs. The majority of these programs are PM&S 24’s.
By 2008-2009 there is expected to be 523 entry level positions of which 140 will be PM&S24 and 393 will be 36’s. This number might change depending on where the residents decide to go. If a program remains unmatched for 4 years it can be shut down.
The AACPM is trying to pursue full funding for the PM&S 36’s because there is a strong trend that this is the preferred program model."

Keep the dialogue coming. I appreciate the insight into what you guys think is important.

we should talk and maybe co-author (produce) resolutions for the house.

I have 3 very rough drafts I can email you. PM me your email address?

 

[Dr_Feelgood]

we should talk and maybe co-author (produce) resolutions for the house.

I have 3 very rough drafts I can email you. PM me your email address?

I would like to see a resolution for MORE COWBELL.

 

[mrfeet]

I agree that there should be more fellowships offered. As is the case with subspecialties of surgery, such as cardiothoracic, neuro, etc., MD/DO surgeons all do a standard 6 year residency and then do a fellowship in their specific area of interest.

Podiatry should go to a standard 3 year residency (as a 6 year residency is standard with MD/DO surgeons) and then if one wants to sub-specialize in ortho or diabetic wound care, they should do a 1-2 year fellowship.

I think it is impressive that 95% of the students want to do a 3 year residency. I think this speaks highly of our profession. Our students are not taking the easy way out, but are dedicated to being more educated and becoming better physicians.

 

[whiskers]

Residencies should (and probably will soon) be a standard minimum of 3 years. Maybe a 4th year could be added later. There also should be alot more fellowships offered, to really hone in and specialize like ortho's can. This would upgrade training and give the medical and lay community, alot more respect for pods in general.

I agree completely. All programs should be 3 years in length to demonstrate to the states that a podiatrist is a podiatrist. It's almost like we're waiting for the states to tell us we're podiatrists and what we can do.

Having higher standards is the key all the way around for our our profession's advancement.

More standards please.