Practice Perfect 761
Joint Task Force White Paper -
Equivalence as Physicians

On May 6, 2021, the Joint Task Force of Orthopedic and Podiatric Surgeons released an announcement and white paper regarding recognition of podiatric surgeons as physicians. The resolution was proposed by the American Association of Orthopaedic Surgeons (AAOS), American College of Foot and Ankle Surgeons (ACFAS), American Orthopaedic Foot & Ankle Society (AOFAS), and the American Podiatric Medical Association (APMA). 

The resolution stated that in order to be considered physicians, podiatrists should do the following:

  1. DPMs must pass all 3 parts of the USMLE.
  2. Accreditation of colleges of podiatric medicine should meet comparable standards to the Liaison Committee on Medical Education (LCME). We will accept the NBME’s determination on whether the CPME accreditation standards are comparable to LCME and sufficient to meet requirements which would allow DPMs to take all parts of the USMLE.
  3. CPME approval of podiatric residency programs should meet comparable standards to the Accreditation Council for Graduate Medical Education (ACGME).
  4. Board certification for DPMs should meet comparable standards as set forth by the American Board of Medical Specialties (ABMS).

Click here for the white paper and resolution as posted on the ACFAS website.

I found this paper thought-provoking on multiple levels, as I’m sure the rest of the podiatric community does. Clearly, there is a lot of potential controversy. What would it mean for podiatry as a profession if the AMA considered us “physicians”? Would the ramifications include scope of practice changes? Will our podiatric colleges have to change in some fundamental way? What about residency programs? These and other questions are brought to the fore by this Taskforce. Before making a judgment on those working on this project, I decided to do a little investigating on my own. Over the next few weeks, the Practice Perfect editorial plans to present interviews with individuals involved with or potentially affected by this movement to have podiatrists listed as physicians by the AMA. It is always better to hear from those with an educated perspective, and we hope to bring these perspectives to all of our readers. Keep on the lookout for those perspectives in future issues.

To start considering the proposal, I suggest a broad review of the four components of the white paper proposal listed above. It seems clear that these components look to examine the primary aspects of podiatric education: student education and the accreditation process for podiatric colleges, residencies, and board certification.

After reviewing documents pertinent to podiatric accreditation in comparison with that of MD’s, I would argue that podiatry is already satisfying almost all of these requirements.

After reviewing documents pertinent to podiatric accreditation in comparison with that of MD’s I would argue that podiatry is already satisfying almost all of these requirements. Let’s take a look at these criteria and see that our answer to the question “should the AMA review podiatric accreditation” is a firm yes.

  1. Pass all parts of the USMLE - Of the four components of the proposal, this aspect is likely to receive both the most attention and the most controversy. Will our podiatric students perform well enough on this examination? What is “well enough”? Obviously, sitting for this examination requires that our podiatry schools teach all of the material on the USMLE steps 1-3. But there are other factors to consider when determining the level of performance of our students that would be considered “comparable.” For example, podiatric students learn much of their chosen specialty in college, while MD and DO folks at many schools learn general medicine during medical school and hone their speciality education in residency.

    Remember, if the question is, “Are we comparable”, then our students should not be held to the same standard as the MD students, since we would then have to consider that “equal”, something no one is advocating. Another question concerns our students’ preparedness for this exam in terms of med school-entering GPA, MCAT scores, and size of the applicant pool. All three of these statistics generally favor MD and DO students, so we should expect a certain percentile higher score rate for those students. My suggestion when podiatric students do sit for the USMLE is to consider all of these factors and adjust the threshold for “comparable” accordingly. It should not be simply “do podiatric students score the same as MD students.” The standard should be, do podiatric students achive a passing score on the exam. As in all things, nuance is important.

  2. Accredit podiatric colleges to the standards of the LCME - What are those standards? The LCME has twelve standards as published in their Functions and Structure of a Medical School document. Reading through this document reveals that the podiatry colleges already do everything the LCME asks. If this is indeed true, then what does podiatry have to fear from the AMA reviewing our college accreditation process?
  3. CPME approval of residencies should be comparable to that of the ACGME - A review of the ACGME’s own document, ACGME Common Program Requirements (Residency) reveals that the podiatric residency review process is already on par with the ACGME. In fact, when I review their standards, I see areas where podiatric requirements exceed those of the ACGME. For example, ACGME-approved residency programs are assessed every 10 years, while podiatry programs have site reviews every 6 years for program renewals. Similarly, the ACGME requires their program directors to spend 0.2 FTE (1 full day/week) of time administering their programs. Now, although the CPME doesn’t have a specific requirement, I would bet any amount of money that almost all podiatric residency directors spend more than that per week on their programs. Simply put, the podiatric residency review and approval process is already comparable to that of the ACGME. Again, feel free to review it, AMA.
  4. Board certification should be comparable to the standards of the ABMS - The interested reader can peruse the ABMS’ standards on their website (https://www.abms.org/board-certification/board-certification-requirements/) which, not surprisingly, shows podiatric board certification is already comparable to the ABMS. The only difference between their standards and podiatric certification is the requirement of passage of the USMLE examinations, which brings us back to #1.

Residency Summit Online 2021

If, with the exception of taking the USMLE, the podiatric profession already satisfies their requirements to be “considered physicians” then we are, simply put, already physicians. I’m not saying podiatry is perfect, and we have no areas to improve. Of course there are. But if satisfying these four criteria make us “physicians” then, I say, give our students the USMLE, score it properly, and investigate our various accreditation processes. Over the next few weeks I hope to provide our readers with a thoughtful consideration of this important topic so our community can weigh in rationally rather than ignorantly to make decisions that benefit all of us and our patients.

Best wishes.

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
jarrod@podiatry.com

Major Sponsor