How can podiatry obtain equal footing (no pun intended) amongst the various other disciplines in medicine?   State advocacy is one way, and not to take anything from that, but I feel more can be done.  Parity is defined in Webster's Dictionary as, "equality; likeness; like state or degree; analogy".  In my opinion, there is no better place to prove your worth or better yet, obtain acceptance than at the residency level.  Residency is most likely  the only time in our lives when we are able to inter-mingle with all of the various other specialties on an almost daily basis.  It is in these interactions that lasting impressions are made.  If you are currently in residency right now and you are not seizing every opportunity to prove your importance and maximise your training experience, it is already being noticed by the other specialties. The current residents in other specialties will become future attendings, some of whom will be involved in major decision making in regards to health care.


As current podiatric surgery residents and fellows we have the opportunity to enlighten a new breed of medical practitioners about the importance of our specialty and exactly what it is we are trained to do.  For those podiatric surgery residents who are doing the bare minimum and not: 1. going the extra mile to obtain as much knowledge as they can while on different rotations, 2. staying later even when you are not on call, 3. assisting in as many surgical procedures a possible, or 4. taking the time to have meaningful discussions with other medical colleagues, then you really aren't doing your part to  further advance our profession. 


In essence, we should all regard our respective residencies as "home", and as a place where we have the most influence and can really make the greatest impact on physicians in other specialties/disciplines.  As one of my attendings used to always say in regards to the choices and/or decisions one makes while in residency, "it's your education". So why not use this platform to showcase/ improve your skill set and broaden your knowledge base.  Others will take notice, and it will pay off in the end. 


-Justin

  • Comments (7)
  • Problems in NYS:

    In NYS podiatrists that are board certified in podiatric medicine lack parity compared to podiatrists with ankle permits:

    3 year residency training programs fragmented podiatry.  2 unequal classes of podiatrists were created in states such a NY. One class of podiatrists with generally 2 or less years of residency training lack the parity of being able to take a punch biopsy of an ankle lesion.

    We first must advocate to abolish minimum screening criteria of 3 years residency training (or any amount of residency training)  for any licensed experienced board certified podiatrist being granted a license to medically treat the foot or the ankle. It is more important for every licensed board certified podiatrist to

    1. have a uniform scope of practice to the full anatomic scope of their board certification

    2. full parity with other podiatrists before attempting to gain parity with MD's and DO's. 

    3. full parity with respect to being able to become licensed in every state even without any residency training ( board certification is supposed to be the highest level of achievement in any specialty)

    Achievements in Conn: 

    Connecticut has recognized the need for board certified podiatrists without residency training to be worthy of the parity of being licensed to treat the foot (surgically and medically) and also to give medical and nonsurgical care to the ankle. 

    Perhaps other states will follow Connecticut's fine example of recognizing the value in being board certified in podiatric medicine and not mandating any residency training whatsoever to get that ankle permit to medically treat the ankle as well as to practice podiatry. 

  • All good points.

    Justin, I agree that it's important to start educating our MD and DO colleagues at the point where a significant amount of interaction is occuring which is, in fact, at the residency level. It's also similarly at the student level. My students do all of their medical and surgical rotations (minus podiatry) with MD and DO students from various universities, Western U and UCLA to name just 2. There's no way the rest of the medical community will know what we actually do if we don't interact with them. Also, if you don't do the same rotations how can you A) say we have similar training and B) show them how hard working and competent we are?

    Brandon, I agree whole-heartedly with your argument that we need to take the same boards as the DOs and MDs. Of course, keep in mind the MDs and DOs use 2 different boards for examinations (USMLE for the MDs and COMLEX for the DO's). Interesting, huh? I see one major problem when it comes to podiatrists taking the same boards as MDs or DOs: ourselves. It's not the undergraduate training or the fact that some of our schools are still not associated with MD or DO universities. It's the fact that our residencies accept only the APMLE exams and NOT the USMLE. I know that in fact Drs Harkless and Jones (my bosses at Western University) want our students to take the USMLE. They've already taken their first APMLE with a 100% pass rate. Of course, if I were a Western U student I would ask, "Why should I take an exam that won't count for anything?" Simply put, if our residencies accepted the USMLE then our students actually could take this board exam just like the MD's and have it count for something.

    There's also been the thought floating around that our undergrad universities should have our students go through the EXACT same curriculum as the MD's and then learn podiatric medicine and surgery in residency, which is, of course, exactly how the orthopedists do it. I think this is probably too heretical an idea to actually happen, but it's food for thought.

  • Quote:

    One thing that I still don't understand is how there are still members of the medical community who are still unclear as to what our role is in medicine.  I feel that interaction with colleagues is where we can make the most impact. 


    Justin--

     

    It is a combination of things.  Our degree isn't the same.  Medical school isn't the same--the 4 years are spents with similar basic sciences, but ours is a specialized training thereafter.  Not that its not good enough or shouldn't be good enough to be seen as equal, but to a lot of other specialties just don't PERCEIVE it as such.  Then you have the image that we're largely in the business of cutting toenails and trimming calluses; surgically we're the "same" as orthopedic surgeons; there are plenty of dermatologists around so a lot of what we do is duplicated elsewhere.  That's just it--we're generalists of a specific body area.  Or at least, pretty much everything we do can be done by another doctor or another paraprofessional.  They don't see how our knowledge of biomechanics makes our orthotics any different than those made by a chiropractor, pedorthist, physical therapist or infomercial product.

     

    We are indeed the best FOOT specialists overall, but there isn't a whole lot of respect out there for foot problems save for the world of diabetics.  We have indeed made a lot of inroads in that direction to be sure.

     

    What makes us so special?  As a profession that has to be defined and explained.  Making the schools the same, taking the same board exams and having a different set of letters after our name are the outward steps.  Establishing our value in the medical world is the meat and potatoes.  That and a lot of time.  Those DO hospitals which used to be the only ones whic would allow podiatrsits on staff for a long time used to be referred to by some patients as "dog and cat hospitals" because DOs weren't thought of as real doctors for the longest time. 40-50 years later, it isn't a problem.

     


    Brandon Macy



  • We state we use biomechanical principles when making surgical decisions as if we are FLEB experts. 

    At the same time, we seem to also state that our biomechanical education has been reduced in school and residency because of the need to be surgeons, pass tests and get a good residency program in order to be on the modern track.

    So when faced with a painful insertional plantar fasciitis and taking biomechanics into consideration in making your surgical decision, how could you opt for an endoscopic (or other) plantar fasciotomy?

    This procedure permanently weakens the truss-flexible tie beam architecture of the foot by collapsing its proximal pillar (the rearfoot).  Whether or not it eliminates the insertional pain, this procedure is biomechanically unsound as it gifts the patient with permanent functional disability.

    Dennis

     

  • Your points are well taken Dr. Kass and Dr. Shavelson.  I agree that we should be allowed to sit for the national medical exams, its just a matter of when, if ever, this will happen. However, I do think that some of our residencies are very much on par with other training programs in regards to foot and ankle, especially now with the new 3 year standardization. 
    In regards to biomechanics I absolutely agree that as podiatrists we should at least have a fundamental knowledge of its general principles, I can't imagine treating a painful joint or recommending a surgical procedure without it.  I also agree that this is what sets us apart from others in medicine.
    One thing that I still don't understand is how there are still members of the medical community who are still unclear as to what our role is in medicine.  I feel that interaction with colleagues is where we can make the most impact. 
    In my opinion, I still feel that podiatric medicine and surgery is still too young for any of us to be complacent, and I feel that all too often some of our residents are not taking advantage of all of the opportunities that their institutions afford them.  

  • Quote:

    How can podiatry obtain equal footing (no pun intended) amongst the various other disciplines in medicine?   State advocacy is one way, and not to take anything from that, but I feel more can be done.  Parity is defined in Webster's Dictionary as, "equality; likeness; like state or degree; analogy".  In my opinion, there is no better place to prove your worth or better yet, obtain acceptance than at the residency level.  Residency is most likely  the only time in our lives when we are able to inter-mingle with all of the various other specialties on an almost daily basis.  It is in these interactions that lasting impressions are made.  If you are currently in residency right now and you are not seizing every opportunity to prove your importance and maximise your training experience, it is already being noticed by the other specialties. The current residents in other specialties will become future attendings, some of whom will be involved in major decision making in regards to health care.


    As current podiatric surgery residents and fellows we have the opportunity to enlighten a new breed of medical practitioners about the importance of our specialty and exactly what it is we are trained to do.  For those podiatric surgery residents who are doing the bare minimum and not:

    1. going the extra mile to obtain as much knowledge as they can while on different rotations,

    2. staying later even when you are not on call,

    3. assisting in as many surgical procedures a possible, or 

    4. taking the time to have meaningful discussions with other medical colleagues,

    then you really aren't doing your part to  further advance our profession.


    In essence, we should all regard our respective residencies as "home", and as a place where we have the most influence and can really make the greatest impact on physicians in other specialties/disciplines.  As one of my attendings used to always say in regards to the choices and/or decisions one makes while in residency, "it's your education". So why not use this platform to showcase/ improve your skill set and broaden your knowledge base.  Others will take notice, and it will pay off in the end. 


    -Justin

    In adding oneself to a group in order to gain parity, especially in these times where MD's that used to refer patients with warts to me call and ask "Dennis, how do you treat warts?", a group must bring something to the table that isn't already there.  It is simply not enough to work hard and go the extra mile as Justin would lead us to believe in my opinion. 

    Summarily, imitating a group doesn't get you an invitation to join it.  You must add to the pie beyond your own needs.

     

    There's already seats at the table doing bunion surgery and Ilizerov, treating wounds, inflammed joints, peripheral neuropathy and PAD.  There are ancillary Nurses, P.A's. and Nail Techs performing routine foot care and lining up to treat ingrown toenails and there is an entire cosmetology industry interested in reconstructing toenails with their own resins and debriding corns and callus that our patients rely on more and more.

     

    Does the Orthopedic Foot Surgeon want Justin to have a seat with a vote at their table? The Physiatry and Neurology community?  Do M.D.'s want me providing services they can perform even if I perform them better?  Do they want Justin to have the same privilegdes and a seat on The Boards of their Hospitals?  Do they want the APMA involved when discussing economics or politics with the government or insurance companies?

     

    There are certainly DPM friendly members in all places of the medical community but the great majority feel about us economically and politically as we feel about the pedorthist, nail tech, chiropractor, physical therapist and nail salon, don't they?

     

    My point here is that although it is hard to argue against Justin's desire for our profession to have parity with M.D.'s, trying harder and acting like an M.D. (basically your points 1-4) does not develop enough of a following to effect change.  We need to offer something expansive into the mix.  Something wonderful yet foreign.

     

    Something that podiatry has been performing and developing for generations away from status quo medicine.  Something we teach in our schools that does not exist in Medicine.  Something that we practice, as a profession, that is poorly referenced and difficult to understand even amongst the brilliant, well educated physicians.  Something that can change lives for the better in ways that M.D.'s just cannot.  Something that adds prevention, quality of life, performance enhancement and other Integrative aspects into the mix.  Something where we are still considered "expert".

     

    Diabetes, for me, is a two pillared monster that needs to be overcome.  One is diet and sugar control and the other is exercise and body functioning.  I sit at the bottom of the exercise and function pillar.  I offer foundational props, education, treatment and care for every diabetic and upon extrapolation for every functioning human.  I offer that into Medicine in exchange for parity or I will remain proud to be a D.P.M.  I will not sell out what brought me to the table.

     

    Can you guess what that one thing is?

    It's a dirty word these days in podiatry and it starts  with a "B".  Dr. Marvin Steinberg so aptly called it "Closed Chain Medicine" starting in the sixties and I am proud to have had him as a Mentor.

     

    Dennis

  • Justin - that is a small part of it. If you want parity, your training has to be on par.
    It seems with the advent of 3 year programs etc we are at least on the right course. I think it would be prudent to take the same national exams.
    "Going the extra mile" is nice in theory, but bottom line if you don't go thru the same training, you don't deserve parity. Just my opinoin.