Future of Podiatry might be changing vastly

[PharmDr.]

Well, I found this article online that is at a site that requires membership, so I felt the need to share this with you pre-pod and DPM's. Sorry for the long post, but it is pretty intriguing. I wonder how the rest of the medical community is going to respond to this though. I edited some pod history and background to fit the post.


"Resolved: That the APMA prepare a membership referendum to vote on the goal of becoming the third US medical profession (following the MD's and most recently the DO's professions) to achieve an 'unlimited scope of practice' by the year 2015."

Purpose

The purpose of this commentary is to support APMA Resolution 2-05 "Unlimited Scope of Practice for Podiatric Physicians" which was adopted unanimously by the Ohio Podiatric Medical Association's House of Delegates June 9, 2004. There are many reasons for supporting this resolution; this commentary will address these needs:

* Establish equivalency between podiatry and the MD/DO medical and surgical specialties.

* Achieve physician status and remove the risks to patients of misclassifying podiatrists as an "optional service' in public entitlement programs or a 'supplemental benefit' in private insurance coverage/fees.

* Advance the freedom to practice podiatric medicine and surgery within podiatrists' surgical and clinical knowledge.

Introduction

How is it possible that eighty-four podiatrists unanimously voted to approve this vision as Delegates to the Ohio Podiatric Medical Association House of Delegates?

These eighty-four podiatrists included every aspect of the podiatric profession from retired podiatrists to students, from surgeons to primary care podiatrists, from urban to rural podiatrists, from private practice to the President and Dean of Academic Affairs at the Ohio College of Podiatric Medicine. While there was a full and free discussion of this resolution, once it became understood, it unified the entire profession; there was not a single negative.

Should this April's APMA House of Delegates approve this resolution, then every member of the American Podiatric Medical Association would have the same opportunity to vote on the policy in an APMA referendum.

Background

In many ways the resolution represents an 'organic evolutionary process' in which the clinical, surgical, and medical abilities of the podiatric medical education and medical practices have become too effective in treating patients to remain limited in scope.


Anatomical Limitations

Why should a podiatrist be able to save a diabetic patient's foot from amputation, but not be able to treat the same diabetic ulcer if it is a half inch above some anatomical line drawn by lay legislators? This is exactly the problem we had with an Ohio Diabetic Wound Care Center whose podiatrists were actually getting a 90% diabetic ulcer amputation reduction rate.

How can a podiatrist be a "real doctor" if you crush your foot, but not a "real doctor" if you scrape your knee? Podiatry is so confusing to the general public, most of which have never been to a podiatrist, that television's #1 rated Jerry Seinfeld Show did an entire program on whether a podiatrist was a real doctor or not?

Podiatry's clinical, medical, and surgical abilities have become too important to patients to allow confusion by virtue of an illogical anatomically-triggered scope of practice to impede patients from accessing podiatric care. Podiatry's scope of practice separates it from every other medical specialty in the U.S.


Podiatric Residency Programs

Podiatry's development of graduate medical education residency programs was linked to the medical education process only in recent generations of practitioners. Currently, podiatric residents, just like the osteopathic residents of the 1950's, are clinically trained in full body systems.

Today's podiatric accredited residencies require podiatric residents to be rotated through different medical specialty departments so they are trained as full scope physicians, just as MD and DO residents are trained regardless of their chosen medical specialty.

For example, psychiatric MD residents rotate through OBG-YN departments to deliver babies, surgery departments to do surgery, and internal medicine/family practice department to do clinical medicine before they specialize in psychiatric practice.

Podiatric residents have similar rotations through a number of these same medical specialty departments and are required to do a complete comprehensive history and physical examination as part of their accredited training program. (See Council on Podiatric Medical Education 320, Standards and Requirements for Approval of Residencies in Podiatric Medicine and Surgery, page 20, B Assess and Manage the Patient's General Medical Status, Items 1-4)

The average layman or legislator does not understand how the Ohio podiatric scope of practice limits podiatric physicians to using their clinical and surgical skills to treating the foot or ankle by state law (ORC Sec. 4731.51), yet allows podiatric residents to train in full body systems with the need to have the ankle or foot disease or injury triggering their training?

This is because the state law grants podiatry residency training certificates (ORC Sec. 4731.573) which limit the podiatric residents training to the accredited hospital residency program under the supervision of the podiatric residency training director. The statute, however, cites the Council on Podiatric Education's residency accreditation requirements as the basis for the training certificate.

This allows podiatric residents to be trained in all aspects of the human body, including the ability to perform a total physical examination of patients the same as any MD or DO medical specialties are trained.

Podiatry can be viewed as American medicine's first attempt to specialize and its last medical specialty to bloom via clinical and surgical graduate residency training programs.

Interestingly enough, even the issue of dropping the DO degree and exchanging it for an MD degree was tried by California DO's back in the 1960's. After a few years, the osteopathic physicians reversed their earlier decision to accept an MD degree and returned to the DO degree, which gave them their unique professional identity. They found it was the freedom to practice osteopathic medicine that empowered their profession, not the MD degree.

If the podiatric profession should approve Resolution 2-05, then it would place into motion a 10 year program to adjust podiatric medical education's system to follow the MD's and DO's pathway to an unlimited scope of practice.

Timetable for Implementation of Unlimited Scope of Practice

April, 2005 -- Step 1 -- "Unlimited Scope of Practice" Ohio House of Delegates' Resolution will be debated by the APMA House of Delegates. If passed, it will become an APMA membership referendum.

Summer/Fall 2005 -- Step 2 -- If the APMA House approves Resolution 2-05, ballots will be provided to APMA members to vote on this issue. For it to become the goal of the APMA requires approval by a majority of APMA members.

Fall/Winter 2005 -- Step 3 -- If the APMA member referendum on creating an "unlimited scope of practice" succeeds, then the APMA will initiate formal communications with the American Medical Association and the American Osteopathic Association requesting help and assistance in achieving this goal. This will include a formal request for assistance from the AMA and the AOA for re-engineering the podiatric medical education system to produce an unlimited scope of practice to podiatrists over the next 10 years.

2006 to 2009 -- Step 4 -- Following a series of meetings between the APMA, AMA and AOA, a task force will be created to create an integrated medical school and residency training experience and to produce an unlimited scope of practice podiatrist.

2009-2012 -- Step 5 -- The APMA/AMA/AOA Task Force would work with the eight podiatric medical colleges and residency programs to implement the educational changes necessary to create an unlimited scope of practice podiatrist.

2012-2015 -- Step 6 -- the APMA/AMA/AOA Task Force would work to create model state legislation to allow for grandfathering in all current podiatric physicians and surgeons who wish to keep their current state podiatric scope of practice while repealing all anatomically limited foot/ankle scopes of practice for newly trained podiatrists.

Podiatrists who already are in practice and wish to move to an unlimited scope of practice would need to supplement their training and pass a licensure examination once the unlimited scope of practice became state law. Once again we can look to the osteopathic profession approach to phasing in the unlimited scope of practice with doctors who were trained and practiced under the osteopathic limited scope of practice laws.

Conclusion

Whatever vision you as members of the podiatric profession choose to follow, it is critically important that you do have some vision to guide your profession through the turbulent times our nation's health care and insurance systems will surely be facing over the next ten years. Franklin Delano Roosevelt's second inaugural address used a biblical quote: "Without vision, the people perish."

The podiatric profession is fast approaching the 100th year anniversary of the birth of "modern American podiatry"; like the 'century plant' that only blooms once in a 100 years, podiatry is blossoming.

As APMA President Dr. Lloyd Smith stated in his recent editorial, "The Golden Age of Podiatry is now ... don't miss out on being a part of it!"

Mr. Fetgatter is Executive Director of the Ohio Podiatric Medical Association.

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[truckibear]

That is really interesting. It's so funny that you post this because recently started reading the DOs: Osteopathic Medicine in America by Norman Gevitz (widely recommended) and I had just reached the part about the amalgamation of MDs and DOs in California that you mention (which ended up negatively affecting the DOs in a number of ways). However, while I was reading this it also sort of got me thinking about where podiatry is going and I see definite parallels between the two professions. I think in some ways podiatry is following the same road that osteopathy went through years ago... there's a similar struggle there to assert itself as the respected profession it is and when you look at the curriculum at podiatry medical schools and allopathic/osteopathic medical schools, I would say that it is just as challenging and comprehensive (if not more) than any of the med schools out there. It'll be interesting to see how this turns out.

 

[Anasazi23]

For example, psychiatric MD residents rotate through OBG-YN departments to deliver babies, surgery departments to do surgery, and internal medicine/family practice department to do clinical medicine before they specialize in psychiatric practice.

Not to nitpick, but psych residents don't necessarily rotate through OB/GYN, surgery or family practice. That's only if they choose to do so in certain circumstances, or if they decide on psychiatry after completing a traditional rotating internship. Thank the good Lord I didn't have to do any OB/GYN in my psych residency.

The article is interesting though. I always sort of considered podiatrists sort of like physicins already. Our podiatry dept. is great at my hospital, and very competent. Granting someone full physician status, however, assumes that one has received competent training in all clinical fields, including OB/GYN, pediatrics, surgery, medicine, radiology, ER, etc at least as a medical student. How would that fit into podiatry? I'm sure they wouldn't want to lengthen the training process...nor should they.

 

[PM2]

Granting someone full physician status, however, assumes that one has received competent training in all clinical fields, including OB/GYN, pediatrics, surgery, medicine, radiology, ER, etc at least as a medical student. How would that fit into podiatry? I'm sure they wouldn't want to lengthen the training process...nor should they.

Anasazi23,

Congrats wrt Psych.

I Cannot speak for podiatry schools that haven’t merged with medical schools; I can partially speak for schools that have merged with medical school (partially because I am just starting my 2nd year.)

In our program, podiatry students take several classes with medical students and the first two years is almost identical to medical students. One of those classes is clinical, and podiatry students take the same test as medical students. I have met a director of an east coast pediatrics department, a couple of other pediatricians, EM physicians and several family practice physicians who have stated something very similar to the following: The first 2 years of podiatry is almost exactly the same as medical school. The have gone on to comment about the proficiency of podiatric residents. As far as radiology, podiatrist are already considered specialist in techniques of the lower extremity. Appropriate angles of different anatomical locations... etc. Our program has a great radiology department. From what I have heard, 1-3 podiatry students are chosen each year to rotate through the University of Chicago's radiology program. Therefore,it would make since that our prof's are on good standing with UofC's profs.

As for the training in all fields of medicine, I think we both know that a class or even a rotation does not make one proficient in an area such as emergency medicine. Graduating internal medicine residents don't have the knowledge of a graduating EM resident. This is the reason, a practicing IM doc is required to complete a residency in EM if they want to cross over.

Even though a class or rotation will not provide podiatry and medical students with knowledge to become proficient, it does allow the student to gain some understanding of the various responsibilities.

In current podiatric residencies, podiatric students do rotate through general surgery, EM, IM, etc....

Podiatric physicians are the most qualified to perform foot and ankle surgery. Our knowledge of lower extremity anatomy (Hip down) far exceeds the knowledge obtained by medical students. I realize this alone does not make one more qualified but it is a good start for one who is interested in rearfoot reconstructive surgery and becomes board certified.

Although I have great respect for psychiatrist, I think we can both agree that psychiatrist are not competent enough to perform any surgeries. Furthermore, I will also suggest that a psychiatrist would not be competent in performing the normal duties of an EM physician while in an EM department. Yet, rightfully so, the psychiatrist is still called an MD. I am not asking that DPMs be called MDs; I am asking that the medical establishment realize the advances that have occurred in podiatric education, recognize podiatric medicine as the specialty that it is and assist podiatric physicians with creating a “scope of practice” that truly fits the profession of podiatric medicine. In the age of interprofessional healthcare, we need the best medicine available to help patients heal while saving money. Instead of wasting the knowledge that a podiatric physician obtains during per’s education, allow the podiatric physician to practice medicine in a scope that is practical and deserving.

Have a nice day!

 

[AFVET]

I don't know...I really like the idea of podiatry just as it is. Do you think this is neccessary to keep the field going? I mean most of us could probably get into some DO/MD school if we really wanted to (even if it means carib.)...so whats the point.

 

[PM2]

I don't know...I really like the idea of podiatry just as it is. Do you think this is neccessary to keep the field going? I mean most of us could probably get into some DO/MD school if we really wanted to (even if it means carib.)...so whats the point.

Although there are many podiatrist who are board certified in foot and ankle reconstructive surgery, many hospitals don’t utilize the podiatrist for this skill. Instead, the hospitals refer the pathology and trauma to orthopaedist. Does this make sense?

From what I have heard, the orthopaedist use the excuse that podiatrist cannot relax their on-call hours since podiatrist can only do the foot and ankle. Although I am not interested in “on-call”, I am interested in rearfoot reconstructive surgery if I have the opportunity. Therefore, “on-call” will probably be necessary. There is more than enough trauma in a EM department to keep a podiatric surgeon busy. EM physicians have told me that they would rather call a podiatrist instead of a orthopaedist anyhow. Especially in severe cases where the orthopaedist comes in, looks at the case, and suggests that a podiatric surgeon be called. Isn’t this a waste of time? Shouldn’t they just have called the podiatrist anyhow?

If a practicing podiatrist is in an area where the orthopaedist use politics to diminish his/her abilities, what is the need for that podiatrist to become board certified in a particular area? Why should the podiatrist have to seek out another area to practice? Why can’t a podiatrist practice what they have learned in their home town or place they that they would like to live?

Podiatrist are small in number, while orthopaedist are part of a much larger group. Therefore, there is a need to work together and respect the abilities of each field of medicine.

 

[Anasazi23]

Although I have great respect for psychiatrist, I think we can both agree that psychiatrist are not competent enough to perform any surgeries. Furthermore, I will also suggest that a psychiatrist would not be competent in performing the normal duties of an EM physician while in an EM department. Yet, rightfully so, the psychiatrist is still called an MD. I am not asking that DPMs be called MDs; I am asking that the medical establishment realize the advances that have occurred in podiatric education, recognize podiatric medicine as the specialty that it is and assist podiatric physicians with creating a “scope of practice” that truly fits the profession of podiatric medicine. In the age of interprofessional healthcare, we need the best medicine available to help patients heal while saving money. Instead of wasting the knowledge that a podiatric physician obtains during per’s education, allow the podiatric physician to practice medicine in a scope that is practical and deserving.

Have a nice day!

It's interesting to hear your arguments...the topic of introducing another official "physician" is intruiguing. I'll make a couple of other points to address the ones you mentioned.

Psychiatrists, although they are psychiatrists, are general medical doctors with specialization in psychiatry. In fact, with a few exceptions, that's what all medical doctors (MD and DO) are. To prove this, they take steps I, II, IICS, and both parts of step III in general medicine, surgery, ob/gyn, peds, radiology, pharmacology, psychiatry, neurology, and more. That's what's common to all of us regardless of specialty. When we graduate, we are given a diploma and although the words are antique now, that diploma states that we can practice medicine and surgery...even psychiatrists.

Podiatric students take similar yet very different (much more focused) licensing exams. In order to be called a physician, should one demonstrate competence in all fields of medicine, which is what regulary occurs now?


The scenarios you describe in which the podiatrist is called so that they can call the orthopedist, or vice versa, certainly occur. However, is this problem so overwhelming that we should blur the lines of "physicianhood" to alleviate this relatively minor problem? I guess my question is, what would this add to healthcare? Is it a reimbursement issue? An access-to-patients issue? What would this allow you to do that you can't do now?

I think podiatry is in sort of a unique position...akin almost to dentistry. There are a lot of "para medical professionals" i.e. social workers, psychologists, etc, clammoring for increased scope of practice rights. Podiatry is not a para medical professional, they are competent highl level experts in foot and ankle issues. They have adequate training and, as you know, perform surgery and many ways practice medicine as it relates to that important portion of the body. Podiatrists have already proven to be extremely valuable members of the medical team and often considered the premeire doctor/expert in that portion of the body. But, the term "physician" implies, whether specialist or not, a rudimentary competence in medicine - in general disease states and health. Dentistry seems to get along fine without being called "physician." What benefits will this bring you?

Take care...

 

[diabeticfootdr]

But, the term "physician" implies, whether specialist or not, a rudimentary competence in medicine - in general disease states and health. Dentistry seems to get along fine without being called "physician."

Doctors of Podiatric Medicine and dentists are already both physicians. They are specialists, but physicians in the purest definition of the word. They are independent practitioners of medicine and surgery, albeit limited to their respective anatomical areas.

Physician - one who is skilled in the art of healing (Webster's online dictionary)

Although, I think an unlimited scope of practice should be the goal of the profession (in the future), presently there are too many DPMs who wouldn't be competent to practice with unlimited scope.

LCR

 

[PM2]

In order to be called a physician, should one demonstrate competence in all fields of medicine, which is what regulary occurs now?

Anasazi23,

Podiatrist are already defined as physicians legally and by private insurance, medicare, and ~46 states in medicaid. A bill was introduced to define podiatrist as "physicians" in medicaid on a federal level. Since Medicaid is a political football, this may not happen for awhile.

I appreciate your points but they don't accurately tell the story. You completely dodged my discussion about residency requirements. Yes, psychiatrist are "physicians", just as podiatrist are defined as "physicians", and your license does say you can perform surgery; would a sane psychiatrist actually perform any surgical procedures? How do you think it would hold up in a malpractice suit if something went wrong?

As for disease states, podiatrist take pathology, pharmacology, microbiology, immunology, and more. We also do rotations, complete H&P, and physicals. I am sure you know that MDs rely heavily on published info during residency to become proficient in diseases. They DO NOT walk out of medical school with a complete knowledge of diseases. Many practicing doctors would make an inaccurate diagnosis of Marfan syndrome until they have experience with it.

 

[krabmas]

websters dictionary definition of physician will not hold up in a court of law.
I like your way of thinking but by physician it means that a pod that is considered a physician can do and sign off an a full physical which is posible in some states like NJ. The pod still has a limited scope in NJ but can do full physicals. They can't treat anything they find in that physical that is not in their scope.

 

[diabeticfootdr]

websters dictionary definition of physician will not hold up in a court of law.
I like your way of thinking but by physician it means that a pod that is considered a physician can do and sign off an a full physical which is posible in some states like NJ. The pod still has a limited scope in NJ but can do full physicals. They can't treat anything they find in that physical that is not in their scope.

Then what definition of physician will hold up in a court of law?? How about the legal definition, which as stated in an above post -- 46 states define DPMs as physicians.

DPMs have an unlimited license to diagnose. If you do an H&P, CXR, EKG, lab work to pre-op a patient for surgery and notice a 2nd degree AVB on the cardiogram -- you make the diagnosis and refer to a cardiologist. The same thing an orthopedic surgeon would do.

LCR

 

[krabmas]

Then what definition of physician will hold up in a court of law?? How about the legal definition, which as stated in an above post -- 46 states define DPMs as physicians.

DPMs have an unlimited license to diagnose. If you do an H&P, CXR, EKG, lab work to pre-op a patient for surgery and notice a 2nd degree AVB on the cardiogram -- you make the diagnosis and refer to a cardiologist. The same thing an orthopedic surgeon would do.

LCR

Are you aware that the state you are doing your residency in does not define you as a physician? That means that you might be able to do a physical exam and all that ather good stuff while you ae in residency but just wait until you try to practice in the same state. Try to fill out a physical form for a child going to summer camp and sign it with you DPM. You can't you are not a physician. Cross the river and you can.

From your other posts I read your were interested in wound care, most of those patients will have diabetes. If you were a physician those patients would be able to come to you for wound healing and to control the other systemic effects of the diabetes. Do you prescribe insulin? Do you prescribe oral hypoglycemics? I don't think so....

From reading your post I get the impression that you think you know everything. I know I don't know everything. Unless you want the rest of the profession to think you are arrogant you might want to change the way you respond to people. Oh, and be sure that other professions look at this site to see what we talk about and how many people are actually chatting here. If you want other professions to respect us don't act like an arrogant know it all. You put your name on your posts and are representing this profession.

I am happy that I am going to be a podiatrist and that is all I will be. I plan to be the best i can be at it but I can deal with the fact that it is all I will be. Can the rest of you?

If you are joining tis profession because you want to by a total body physician and are going to be bitter for the rest of your life that you did not get into med school or didn't try, go join a different profession - we (I) don't want you in mine.

 

[diabeticfootdr]

You put your name on your posts and are representing this profession.

I am happy that I am going to be a podiatrist and that is all I will be. I plan to be the best i can be at it but I can deal with the fact that it is all I will be. Can the rest of you?

I sign my posts with my name because I am not embarrassed by my comments, nor am I embarrassed to be a podiatric physician. Where is your name, Mr or Ms. Anonymous??

If you read my earlier post, I stated I don't think DPMs should have unlimited scope, as the current education stands.

Furthermore, NY state has a law that a podiatric resident can operate under the scope of their supervising physician, MD, DO, or DPM. So my scope mirrors my attending - yes I do perform H&Ps and sign my name, D.P.M. Yes I do admit patients to podiatry service and write for insulins and antihypertensives.

I graduated from a school which left me well educated in general medicine (as it should be) and I feel completely comfortable managing patients on my service.

As to your comment that you don't want someone like me in "your profession" . . . I have already published 2 scientific articles, I have 3 more accepted for publication, and I have 4 more submitted. I have spent time with and personally know most of the world leaders in diabetic foot disorders (MD and DPM). In the near future I intend to be a leader in this profession and reknown for expertise in diabetic foot disorders. What do you intend to be?

The profession is good, but not yet great. It is my intention to help elevate DPMs to the level of specialist (currently, many DPMs are primary care nail cutters). From the language in your posts, it sounds like you're still in pod school -- good luck w/ your education and you will see what I'm talking about when you finally are exposed to the rest of the profession.

LCR

 

[PM2]

If you are joining tis profession because you want to by a total body physician and are going to be bitter for the rest of your life that you did not get into med school or didn't try, go join a different profession - we (I) don't want you in mine.

Quite a comment. I assume the "Can the rest of you?" remark also included me.

Personally, I do not think your comment is accurate. I, for one, do not think "Lee" comes off as thinking that he/she knows everything.

Now, you can make a blanket statement that podiatrist become podiatrist only because they didn't matriculate into medical school but I don't think this is an accurate statement either, and very damaging to THE profession of podiatry.

Personally, I decided on podiatry because it incorporates many different aspects of medicine with a comfortable and healthy lifestyle. One aspect that has appealed to me is foot and ankle reconstructive surgery. If I do well in school, get accepted to a good residency and become board certified in foot and ankle reconstructive surgery, I want to actually perform some reconstructive surgery.

People are entitled to their own opinions. Do other people think podiatry is changing? I think so. Are they attempting to accelerate the change? I think so. Why? Because politicians are fighting for podiatry, podiatric medical schools are asking more students to enter research and podiatrist are accomplishing feats where other university doctors are failing. Furthermore, podiatric programs are merging with medical schools, and residencies are being restructured. MDs, patients and others are noticing these accomplishments.

krabmas, you have the option to take a two year residency if you like. That would be your decision. Some podiatrist make a living at reading EKGs for insurance companies. Some podiatrist do not want to do surgery and some podiatrist want to do wound care and diabetic limb salvage (which is a common fellowship). As for prescribing medicine, podiatrist have that ability in most, if not all, states.

In the above post, Anasazi23 stated that podiatrist are not "physicians" which is incorrect. Since podiatry is also my profession, I have the right to correct her with factual data.

You are correct....people are reading. Some people have huge ego's and like to demean others. Currently, I do not include Anasazi23 as one of these people. Still, I ask that we do not do this to each other.

Do I think podiatrist should do the job of an internal medicine doctor, family practice doctor or any other doctor? No! There are specialties because specialties are required as knowledge and information is developed. Podiatry is a specialty of the foot and ankle (ankle includes tibia/fibula with extrinsic muscles of the foot) but podiatrist are now taught to think of the patient as a whole. If we are to be proficient, we need to practice the medicine that we are taught. N minds are better than n minds. From what I experienced, podiatric medical students are taught more about the lower extremity than MDs. Should this information be wasted? I am not saying orthopaedist can not learn the info. I am saying that it is an intrinsic part of our curriculum.

I hope I didn't offend you. I have always tried to be respectful with my posts.

 

[krabmas]

I sign my posts with my name because I am not embarrassed by my comments, nor am I embarrassed to be a podiatric physician. Where is your name, Mr or Ms. Anonymous??

If you read my earlier post, I stated I don't think DPMs should have unlimited scope, as the current education stands.

Furthermore, NY state has a law that a podiatric resident can operate under the scope of their supervising physician, MD, DO, or DPM. So my scope mirrors my attending - yes I do perform H&Ps and sign my name, D.P.M. Yes I do admit patients to podiatry service and write for insulins and antihypertensives.

I graduated from a school which left me well educated in general medicine (as it should be) and I feel completely comfortable managing patients on my service.


LCR

Nice that you take the words you want to read. I am well aware of the law in NY that is sitting on the governer's desk waiting for enactment. Yes it has passed but it has not been enacted yet. You have actually been practicing illegally for however many years you have been a resident in NYC.

Did you go to Lobby Day in Albany? The Residency parody bill was one of the bills we were fighting for. Before this bill passed THIS YEAR podiatrists were only under the care of a pod and if anything went wrong - that would have been a mess.

And once you are not a resident anymore.... re-read. When you are NOT a resident and still in NY, you will not be a physician even if Webster says so.

I think this is a great profession and I would love for other people to join. However, not if it means that I have to lie to them or sugar coat the profession.

If you respond to me... please read this twice so you don't miss entire thoughts like you did last time!

 

[Anasazi23]

In the above post, Anasazi23 stated that podiatrist are not "physicians" which is incorrect. Since podiatry is also my profession, I have the right to correct her with factual data.

You are correct....people are reading. Some people have huge ego's and like to demean others. Currently, I do not include Anasazi23 as one of these people. Still, I ask that we do not do this to each other.

I'm definately not your enemy. I love our podiatrists, and refer to them all the time. I was just engaging in a discussion about the possible restructuring of a small part of healthcare with you.

In my stating that podiatrists are not physicians, I am obviously referring to the discussion at hand, which is to include that term, as you stated, on a federal level, not local, where it is not universal.

Anyway, I didn't dodge the discussion about surgery, I didn't address it because it's a misrepresentative extreme example. I'll address it now. No physician can practice general surgery (generalization...I know of office procedures) without having a difficult time in court should something happen. That includes internal medicine doctors, radiologists, dermatologists, AND psychiatrists. In some rural areas of the US, the psychiatrist is the only physician some patients have. They take care of them from a whole body standpoint. This extreme example begs another point. The only two federally recognized physicins at this juncture are MD and DO. Conversely, the scope of practice of the podiatrist is much more limited by the very definition of the profession. This is not a bad thing, just a highly specialized branch of medicine. The reason for this is, like I stated, that they are capable of (on paper at least) demonstrating competence in all major fields of medicine. Again I'll ask. Should podiatrists take step I, II, IICS, and III to become federally recognized as physicians? Personally, it doesn't matter to me either way. If you feel that it would greatly help your profession and allow access to care that people are currently not getting, I support you wholeheartedly. I was just engaging in discussion to hear the viewpoints, and playing devil's advocate, so to speak.

Good luck,
Anasazi
P.S. I'm a man (I think)

 

[diabeticfootdr]

I am well aware of the law in NY that is sitting on the governer's desk waiting for enactment. Yes it has passed but it has not been enacted yet. You have actually been practicing illegally for however many years you have been a resident in NYC.

Did you go to Lobby Day in Albany? The Residency parody bill was one of the bills we were fighting for. And once you are not a resident anymore.... re-read. When you are NOT a resident and still in NY, you will not be a physician even if Webster says so.

I think this is a great profession and I would love for other people to join. However, not if it means that I have to lie to them or sugar coat the profession.

I am well aware of the legislative activities (though few) of the NYSPMA. New York has THE WORST scope of practice of any state in the Union.

I am originally a Midwesterner, and do not plan on practicing in NY after residency - unless the scope changes. Because I could not offer patients the full scope of my abilities.

It seems like you have the NY DPM mentality. That of "not a physician". That's fine, you'll fit in well in NY as you cower to the MD and bow to incorrect (not evidence-based) decisions of ID specialists who treat OM x 6 weeks based on bone scan, as you get "vascular clearance" (a NY phenomenon) on all your patients before surgery.

The future DPM is a true specialist whose opinion of foot and ankle treatments is as strong as the cardiologists opinion of MVP.

To be a physician you must treat the full patient. And as a DPM, with the current scope of practice you can do this, but many choose not to.

- You must ask about nicotine dependence in patients and offer assistance . . .
- You can consider the patients psychological well-being and ask about depression, and understand depression is occurs commonly w/ diabetes, and it affects the way the patient complies with your treatment plan. . .
- You can ask about and screen for nephropathy, understanding it's correlation with diabetic neuropathy, similarly asking about retinopathy and erectile dysfunction and knowing their relationship to peripheral neuropathy . .
- You must ask about statin therapy in patients with PAD, and prescribe them or refer a patient who is not on them

I could name many more things that separate a podiatric physician from a podiatrist. If you do none of these things . . . you will still be a rich NY DPM, going on your house calls and trimming nails . . .

but if you want to be a physician ---------------- then BE A PHYSICIAN

 

[PM2]

In my stating that podiatrists are not physicians, I am obviously referring to the discussion at hand, which is to include that term, as you stated, on a federal level, not local, where it is not universal.

Anasazi23,

Thanks for discussing the topic with me. By my previous definition, podiatrist are recognized on a "federal" level in medicare (federal program.) There was a bill introduced asking that podiatry be recognized as other than optional in state (medicaid) programs. As I stated before, ~46 states, local, legally recognize podiatrist as physicians yet the Federal government legally recognizes podiatrist as physicians through Medicare. This is the nature of the argument. Therefore, by the obvious legal definition, podiatrist are considered physicians on a federal level. I didn't know you were referring to the federal level. Where did you define the legal definition of physicians? Still, it doesn't matter. Podiatrist are legally considered physicians on the federal level and at the state level in ~ 46 states currently. More to follow.

Why should we be concerned? Because patients deserve the best medical care available. I am sure you know that medicaid reimbursement can be a total pain. If there are cutbacks in STATE medicaid programs and podiatrist are not used because of the "optional" term, is this fair to diabetics or others? Should they cut out psychiatrist and tell patients to see the psychologist and family practice doctor? The family practice or IM doctor can write the necessary prescriptions and provide psychiatric care. Personally, I don't think this would be a good idea.

Anasazi23, I have the good fortune to know many doctors. Mostly MDs but I am meeting more DPMs also. I personally know and occasionally talk to urologist, general surgeons, pediatricians, family practice, emergency medicine and several others who practice other forms of medicine. In every case, none of these doctors have suggested that they could adequately treat patients in any environment other than their practice. Most surgeons would agree that they would probably shatter a patients incisors if trying to intubate, while a EM physician is quite capable of such a procedure.. I only mentioned surgery previously because you gave an example of the wording on your license. To me, it is not extreme. Especially since podiatrist practice surgery. Who is more qualified at foot and ankle surgery? A podiatrist or a MD? I think a podiatrist is more qualified. For this reason, it doesn't make sense to exclude patients from the best medical care available.

I hope you now realize that podiatrist are considered "physicians" on a federal level. Especially since you utilize their services so frequently.

Thanks for playing the “devil’s advocate” in this discussion. You asked about importance. Should MDs be the only people concerned with autonomic neuropathy? Although it affects the autonomic system, the major concerns are the internal organs. Should a podiatrist not be concerned? I think the podiatrist should be concerned because autonomic neuropathy can lead to server foot deformities like charcot foot. The tarsometatarsal joint is the most common site, but another site is the sub-talar joint (chopart charcot). The bones in the foot can become a ball of fused mass, collapse, and require amputation if severe. Currently, the DPMs and MDs who work in this field feel that most initial charcot pathology is incorrectly diagnosed as arthritis or gout. This can be detrimental. Maybe less detrimental for the people w/o diabetes, but very detrimental for diabetic patients. Did you know that the life expectancy of a diabetic decreases dramatically after amputation? The patient requires more energy to get around, greater probability of a 2nd amputation due to force imbalances, and greater probability of death over-all. Furthermore, other autonomic problems may be monitored more effectively once the problem is recognized. Simple situations like lack of hair on the feet and toes, decreased blood flow, and leg edema can suggest autonomic neuropathy. This is just one small reason why podiatrist are important. Personally, I believe it is also a reason for podiatrist to understand the entire body. As another example, what if the patient is on a medication that may limit the efficacy of another medication. I think the podiatrist should be aware of the patients medicine and potential cross-reactions. This could increase healing time, reduce treatment cost, and reduce the possibility of other infections.

Once again, thanks for the discussion. Good luck in psych; PA(s)can also treat patients in some areas that don’t have doctors.

By the way, I didn't consider you my enemy, and thanks for the support. If you really want to support our quest, please go to http://www.govtrack.us , monitor bills for podiatric medicine and take some time to write your senator and rep. This will be very helpful.

 

[PM2]

My wife sent this to me. Not to accurate scientifically but fun. I still want more podiatry legislation

Berkeley just announced the discovery of the heaviest element yet known to science. The new element has been named "Governmentium."

Governmentium has one neutrom, 12 assistiant neutrons, 75 deputy neutrons, and 224 assistant deputy neutrons, giving it an atomic mass of 312. These 312 particles are held together by forces called *****s, which are surrounded by vast quantities of lepton-like particles called peons.

When catalyzed with money, Governmentium becomes Administratium, an element which radiates just as much energy, since it has half as many peons, but twice as many *****s.

Since Governmentium has no electrons, it is inert. It can be detected; however, as it impedes every reaction with which it comes into contact. A reaction that would normally take one minute or less will require a week or more if contaminated by any Governmentium.

The half-life of Governmentium is 4 years. It does not, however, decay, but instead undergoes a reorganization in which a portion of the assistant neutrons and deputy neutrons exchange places. In fact, Governmentium's mass will actually increase over time, since each reorganization will cause more *****s to become neutrons, forming isodopes. The characteristic of *****-promotion leads some scientists to believe that Governmentium is formed whenever *****s reach a certain theorectical quantity in concentation.

This theoretical quantity is called "Critical Morass."

 

[krabmas]

I am well aware of the legislative activities (though few) of the NYSPMA. New York has THE WORST scope of practice of any state in the Union.

I am originally a Midwesterner, and do not plan on practicing in NY after residency - unless the scope changes. Because I could not offer patients the full scope of my abilities.

It seems like you have the NY DPM mentality. That of "not a physician". That's fine, you'll fit in well in NY as you cower to the MD and bow to incorrect (not evidence-based) decisions of ID specialists who treat OM x 6 weeks based on bone scan, as you get "vascular clearance" (a NY phenomenon) on all your patients before surgery.

The future DPM is a true specialist whose opinion of foot and ankle treatments is as strong as the cardiologists opinion of MVP.

To be a physician you must treat the full patient. And as a DPM, with the current scope of practice you can do this, but many choose not to.

- You must ask about nicotine dependence in patients and offer assistance . . .
- You can consider the patients psychological well-being and ask about depression, and understand depression is occurs commonly w/ diabetes, and it affects the way the patient complies with your treatment plan. . .
- You can ask about and screen for nephropathy, understanding it's correlation with diabetic neuropathy, similarly asking about retinopathy and erectile dysfunction and knowing their relationship to peripheral neuropathy . .
- You must ask about statin therapy in patients with PAD, and prescribe them or refer a patient who is not on them

I could name many more things that separate a podiatric physician from a podiatrist. If you do none of these things . . . you will still be a rich NY DPM, going on your house calls and trimming nails . . .

but if you want to be a physician ---------------- then BE A PHYSICIAN

You don't know me or anything about me. I didn't post my publications or how many I have (5) because I didn't see the need. I feel it is insecure people that have to preach to others how good they are and how much more they deserve.

I will not be practicing in NY. I am not from NY nor will I stay here even for a residency. If you think that the NYSPMA is not doing a good job why don't you join and help from within? Or are you just out for yourself... seems that way to me.

And I don't pln to treat the whole patient because you are right I can be RRRRRRRRRRRiCH just doing fot facials and minor procedures on rich people who will pay cash. there was a little sarcasm there.

I wish you all the luck back in the Midwest.

 

[ER-ER-Oh]

Anasazi23,

Congrats wrt Psych.

I Cannot speak for podiatry schools that haven’t merged with medical schools; I can partially speak for schools that have merged with medical school (partially because I am just starting my 2nd year.)

In our program, podiatry students take several classes with medical students and the first two years is almost identical to medical students. One of those classes is clinical, and podiatry students take the same test as medical students. I have met a director of an east coast pediatrics department, a couple of other pediatricians, EM physicians and several family practice physicians who have stated something very similar to the following: The first 2 years of podiatry is almost exactly the same as medical school. The have gone on to comment about the proficiency of podiatric residents. As far as radiology, podiatrist are already considered specialist in techniques of the lower extremity. Appropriate angles of different anatomical locations... etc. Our program has a great radiology department. From what I have heard, 1-3 podiatry students are chosen each year to rotate through the University of Chicago's radiology program. Therefore,it would make since that our prof's are on good standing with UofC's profs.

As for the training in all fields of medicine, I think we both know that a class or even a rotation does not make one proficient in an area such as emergency medicine. Graduating internal medicine residents don't have the knowledge of a graduating EM resident. This is the reason, a practicing IM doc is required to complete a residency in EM if they want to cross over.

Even though a class or rotation will not provide podiatry and medical students with knowledge to become proficient, it does allow the student to gain some understanding of the various responsibilities.

In current podiatric residencies, podiatric students do rotate through general surgery, EM, IM, etc....

Podiatric physicians are the most qualified to perform foot and ankle surgery. Our knowledge of lower extremity anatomy (Hip down) far exceeds the knowledge obtained by medical students. I realize this alone does not make one more qualified but it is a good start for one who is interested in rearfoot reconstructive surgery and becomes board certified.

Although I have great respect for psychiatrist, I think we can both agree that psychiatrist are not competent enough to perform any surgeries. Furthermore, I will also suggest that a psychiatrist would not be competent in performing the normal duties of an EM physician while in an EM department. Yet, rightfully so, the psychiatrist is still called an MD. I am not asking that DPMs be called MDs; I am asking that the medical establishment realize the advances that have occurred in podiatric education, recognize podiatric medicine as the specialty that it is and assist podiatric physicians with creating a “scope of practice” that truly fits the profession of podiatric medicine. In the age of interprofessional healthcare, we need the best medicine available to help patients heal while saving money. Instead of wasting the knowledge that a podiatric physician obtains during per’s education, allow the podiatric physician to practice medicine in a scope that is practical and deserving.

Have a nice day!

I think I have to agree with you on this one. I'm an MD, training now in EM. The hospital I did my 3rd and 4th year rotations at had some sort of podiatry internship. I didn't really understand it though. The podiatry residents were under the surgery residency, but I think they were only there for one year and then moved on to another rotation.

Either way, as I rotated through surgery and then infectious disease in 4th year, the podiatry residents were there also. I found them to be indistinguishable from the other residents. It seems to me that there should be some sort of scope of practice, just like a family practicioner, or an EM doc. I'm totally limited by my residency training in my future. I don't have the ability to admit and follow patients in the hospital, and the ICU makes my head spin in frustration. It's either the ED or the highway for me. In this day of highly specialized work, and the need of such because of the vastness of the knowledge required for each specialty, I don't see any reason a podiatrist should be considered any differently as a specialist. I mean, really, what's the problem in adding another colleague to the roster for christ's sake? I simply don't see the problem, other than professional arrogance and downright irritation to the established hierarchy of the old boy's club attitude that still seems to pervade medicine. Good riddance to that ****.

 

[Anasazi23]

Good luck folks. I know you work hard and are often underappreciated.

We'll see how it pans out.

 

[PM2]

Anasazi23,

Thanks for the intriquing conversation. Please remember to monitor the activity and write your Rep/Sen.

ER-ER-oh,

Thanks for your very friendly input. I would like to ask you for a favor also. Podiatrist are important to the overall well being of many patients. Will you please do us all a favor and write to your Senator/Rep. and tell them that you support podiatric medicine?

Thanks

 

[ItsGavinC]

I think podiatry is in sort of a unique position...akin almost to dentistry.

Other than the fact that DPMs cover services that are also provided by MDs and DOs, whereas no other profession provides the services that dentists offer. There is no medical profession (MD/DO) that provides clinical care to the oral cavity. There are medical specialties that deal solely with the foot and ankle.

 

[diabeticfootdr]

Other than the fact that DPMs cover services that are also provided by MDs and DOs, whereas no other profession provides the services that dentists offer. There is no medical profession (MD/DO) that provides clinical care to the oral cavity. There are medical specialties that deal solely with the foot and ankle.

However, DPMs have the only board certification in foot and ankle surgery -- and technically an MD/DO can provide services in the oral cavity -- they just don't want to.

 

[cg2a93]

The legislation for the title physician has nothing to do with scope of practice. If legislation were to passes in NY it would not change the scope of practice a bit. It is more for insurance and reimbursements issues than anything else.

 

[diabeticfootdr]

The legislation for the title physician has nothing to do with scope of practice. If legislation were to passes in NY it would not change the scope of practice a bit. It is more for insurance and reimbursements issues than anything else.

you're exactly right . . .

the irony is that "just a simple country foot doc" understands this but the big city docs don't --- ha ha.

Lee

 

[PM2]

One step at a time.

 

[Jawfixer]

However, DPMs have the only board certification in foot and ankle surgery -- and technically an MD/DO can provide services in the oral cavity -- they just don't want to.

Correct, they may provide limited palliative measures and CERTAIN surgeons may also share in trauma call with say MaxSurg, but MD/DO are TECHNICALLY not allowed to do the general things a dentist legally may do as GavinC was atempting to say; your facts are incorrect. There is no medical speacialty that is allowed to practice dentistry in any state, period; one must have a dental license to do this and the law is very clear. One exception, if teeth need to be removed as part of a H&N recon case or truama case, then ENT or plastic is allowed to do it; however, they normally call OMFS as a consult.


It always amazes me how the DPMs want to expand their scope when medicine already has the entire foot/ankle covered. Stick to what you do and be proud of what you chose...you guys entered podiatry school knowing waht podiatrist do and if you do not like it now then go to medschool.

 

[diabeticfootdr]

It always amazes me how the DPMs want to expand their scope when medicine already has the entire foot/ankle covered. Stick to what you do and be proud of what you chose...you guys entered podiatry school knowing waht podiatrist do and if you do not like it now then go to medschool.

MD's have a "LICENSE TO TREAT HUMANS", I believe the mouth is part of a human.

It amazes me how the SDN dentists feel so inferior on the medical totem pole, that they feel like trolling in the DPM forums to bash a profession they "think" they are superior to, to make them feel better.

Furthermore, dentists all over the country are attempting to change their scope of practice to allow them to do facial plastics --- I could pose the same question to you . . . aren't you satisfied just being a dentist?

My best friend at my hospital is PGY-2 OMFS. He does most of the anesthesia for my cases (moonlighting), I have the utmost respect for them, but not the trollers.

Go to your own forum, I don't troll in the dental forums.

 

[diabeticfootdr]

As a response you PM2's supposed but unconfirmed PM - (the content of which will not be disclosed);

Podiatric physicians are Doctors of Podiatric Medicine (D.P.M.), so if PM2 refers to himself as Podiatric Medical Student, he is more than accurate.

My school issued ID from Des Moines University (a school integrated with other medical students) said DPM Medical Student.

Jawfixer, your insults, closed-mindedness, and ignorance is not welcome here. I can tell you're a new member with 0+ posts, so please return to your forum and comment on something on which you are qualified.

LCR

 

[aphistis]

MD's have a "LICENSE TO TREAT HUMANS", I believe the mouth is part of a human.

To quote myself some time ago in an optometry thread dealing with this same subject--show me a physician who thinks s/he's even minimally competent placing fillings, cutting crown preparations, or performing root canals, and I'll show you a physician about to have a career-ending day in malpractice court.

It amazes me how the SDN dentists feel so inferior on the medical totem pole, that they feel like trolling in the DPM forums to bash a profession they "think" they are superior to, to make them feel better.

Funny, it looked to me like Gavin was responding to a comment somebody else made. Your response that podiatry has the only foot & ankle reconstruction board is great, but doesn't do much to support the profession becoming an MD/DO equivalent.

Furthermore, dentists all over the country are attempting to change their scope of practice to allow them to do facial plastics --- I could pose the same question to you . . . aren't you satisfied just being a dentist?

You could, but you'd look pretty ignorant. Next time you try attacking somebody with news from their own profession, you might do at least a *little* research first. I'd love to hear on what grounds you object to a genioplasty being performed by a specialty named "oral & maxillofacial surgery," whose practice involves cracking people's skulls in half as a matter of routine.

As for "inferior on the medical totem pole," our profession isn't the one completely abandoning its perfectly viable traditional identity in order to be "real" doctors. Do you think physicians need your help or something?

My best friend at my hospital is PGY-2 OMFS. He does most of the anesthesia for my cases (moonlighting), I have the utmost respect for them, but not the trollers.

You should let your best friend know what you think of his profession. Give me his e-mail address and I'll gladly send him a link to this thread. I bet he could use the laugh after being around you.

Go to your own forum, I don't troll in the dental forums.

I'm still trying to figure out where anybody's been trolling. Does "trolling" mean "disagreeing with Lee Rogers"?

 

[krabmas]

It always amazes me how the DPMs want to expand their scope when medicine already has the entire foot/ankle covered. Stick to what you do and be proud of what you chose...you guys entered podiatry school knowing waht podiatrist do and if you do not like it now then go to medschool.

I agree. There is nothing wrong with research and advancing your profession but trying to become something your not... Just go to school to become what you want to be.

One thing I'd like to say though, MDs and DOs unless specifically trained to be foot and ankle specialists are not. Just like an OBGYN and Neurosurgeon are trained in different aspects of surgery so are pods and orthos.

 

[krabmas]

MD's have a "LICENSE TO TREAT HUMANS", I believe the mouth is part of a human.

It amazes me how the SDN dentists feel so inferior on the medical totem pole, that they feel like trolling in the DPM forums to bash a profession they "think" they are superior to, to make them feel better.

Furthermore, dentists all over the country are attempting to change their scope of practice to allow them to do facial plastics --- I could pose the same question to you . . . aren't you satisfied just being a dentist?

.

Does it make you feel better and more superior to make fun of others?

 

[aphistis]

Medicine has the foot and ankle covered eh? I find this remark interesting. You must be dental.

As I have said in my previous post, medical students do not cover the foot and ankle like Podiatric medical students. I know this is factual since I took clinical anatomy with medical students. In addition, orthopaedist don't know the anatomy nearly as well as podiatrist. Especially podiatrist who are certified foot and ankle specialist.

If you do not agree, I suggest you read MD and DO replys to my past posts.

In addition, I suggest you read the above post by an EM resident. Podiatry is changing for the better and the scope of practice will change to match the changes. Just as the scope of practice in general denistry is changing and swallowing up specialty areas.

You must not do your homework when posting since you ordered me (via private msg) to quit saying I was a "medical student". As in my reply to u, I have not referred to myself as a "medical student".

Here is the PM for all to see:

...

Way to flagrantly violate the TOS by publically reposting a private message. You might consider doing something about that while you still have an SDN account.

 

[tkim]

The reposting of PM's is considered rude and violates SDN's Terms of Service unless permission from the sender is granted. Please edit any posts which contain such private converstations, or I or another mod will edit them.

If someone sends you a PM which you deem offensive, respond by asking them not to send you any further PMs, or report the PM to any mod.

 

[aphistis]

Here is the PM for all to see:

{PM omitted by aphistis}

Podiatric physicians are Doctors of Podiatric Medicine (D.P.M.), so if PM2 refers to himself as Podiatric Medical Student, he is more than accurate.

My school issued ID from Des Moines University (a school integrated with other medical students) said DPM Medical Student.

Jawfixer, your insults, closed-mindedness, and ignorance is not welcome here. I can tell you're a new member with 0+ posts, so please return to your forum and comment on something on which you are qualified.

LCR

Don't worry, Jaw, you can come back when you aren't such a newbie, and you have the wisdom & enlightment that only comes from extensive histories of 88 posts.

And, Lee, don't forget that you posted part of that PM too. You might want to do something about that, before somebody misconstrues it as trolling.

 

[krabmas]

Does "trolling" mean "disagreeing with Lee Rogers"?

I hate to go against some one in my profession but I agree completely. Anytime I post anything I just wait a couple minutes at the most a day and I get a response about how I am not completely right and a correction.

I could post 2+2=5 and I would get some one saying "well not always"

If this person is going to be a leader in the profession shouldn't they be spending more time practicing it?

 

[efs]

Looks like people have managed to drag this thread well away from the original topic. Who is called what, or what the definitions of various practitioners are doesn't really matter a whole lot. Who is better than someone else also really doesn't make much difference. There are some excellent ortho surgeons out there. There are also a few I wouldn't want to treat me for anything. Same is true for podiatric surgeons. And I would venture the same is true for every other specialty out there as well. Same goes for training. There are also so highly capable folks out there who didn't have much formal training. Also some with years of formal training, but still can't cut their way out of a paper bag. Most of this really isn't germane to the issues.

Look at a couple situations.

Podiatrists treat warts on the feet, many are plantar warts but not all. They can use any treatment modalities available. If a patient comes in and has a wart removed, and they also have one on their hand - the podiatrist cannot treat that one. (Unless of course they are in one of the 5 states that have the hand included in the scope of practice.)

Podiatrists treat many wounds. Often the patients have multiple comorbidities. These wounds may have any number of etiologies. Lets consider a venous stasis ulcer. If it is on the ankle it is in the scope of practice. If it is on the calf, it might not be (depending on which state they are located in.)

Do these things make any kind of logical sense? What is the best for the patient? That they may need to return to their primary care physician for a referal to a different specialist? This process and the approvals needed can take time, and may be denied by insurance companies. Meanwhile the patient is the one who suffers.

Fortunately I don't have to deal with insurance companies much. In some places there are different rates paid for surgeries depending on whether it was done by an orthopod vs a podiatrist. Does this make any sense?

Modification of the scope of practice is intended to address these types of issues. It will not suddenly mean podiatrists are going to be working shifts in the ER. It would not mean that suddenly podiatrists are sending in applications for general surgery residency positions. Podiatrists are not suddenly going to start delivering babies, or doing ACL reconstructions. It just doesn't work that way.

What they will be able to do in the OR will still fall under the hospital's privledging. Those who have not been trained in rearfoot reconstruction, will still not have privledges to do those procedures.

Modification of the scope of practice is intended to allow us to use our training to the patients' benefit. I don't see huge problems coming up with the changes they are proposing.

I would be interested to hear what other people's opinions are. I really am not interested to see a huge number of posts arguing about what the definition of a physician is. That's been done before, and won't come to any kind of resolution on a forum like this.

 

[PM2]

"Harassment and Flaming

The Student Doctor Network members are not permitted to harass or "flame" other members. Please do not post or transmit any unlawful, harmful, threatening, abusive, harassing, defamatory, vulgar, obscene, profane, hateful, racially, ethnically or otherwise objectionable material of any kind, including, but not limited to, any material which encourages conduct that would constitute a criminal offense, violate the rights of others, or otherwise violate any applicable local, state, national or international law. Please note that this also includes the posting of taunts on a forum solely for the purpose of deriding that forum's topic and/or members."

 

[krabmas]

Looks like people have managed to drag this thread well away from the original topic. Who is called what, or what the definitions of various practitioners are doesn't really matter a whole lot. Who is better than someone else also really doesn't make much difference. There are some excellent ortho surgeons out there. There are also a few I wouldn't want to treat me for anything. Same is true for podiatric surgeons. And I would venture the same is true for every other specialty out there as well. Same goes for training. There are also so highly capable folks out there who didn't have much formal training. Also some with years of formal training, but still can't cut their way out of a paper bag. Most of this really isn't germane to the issues.

Look at a couple situations.

Podiatrists treat warts on the feet, many are plantar warts but not all. They can use any treatment modalities available. If a patient comes in and has a wart removed, and they also have one on their hand - the podiatrist cannot treat that one. (Unless of course they are in one of the 5 states that have the hand included in the scope of practice.)

Podiatrists treat many wounds. Often the patients have multiple comorbidities. These wounds may have any number of etiologies. Lets consider a venous stasis ulcer. If it is on the ankle it is in the scope of practice. If it is on the calf, it might not be (depending on which state they are located in.)

Do these things make any kind of logical sense? What is the best for the patient? That they may need to return to their primary care physician for a referal to a different specialist? This process and the approvals needed can take time, and may be denied by insurance companies. Meanwhile the patient is the one who suffers.

Fortunately I don't have to deal with insurance companies much. In some places there are different rates paid for surgeries depending on whether it was done by an orthopod vs a podiatrist. Does this make any sense?

Modification of the scope of practice is intended to address these types of issues. It will not suddenly mean podiatrists are going to be working shifts in the ER. It would not mean that suddenly podiatrists are sending in applications for general surgery residency positions. Podiatrists are not suddenly going to start delivering babies, or doing ACL reconstructions. It just doesn't work that way.

What they will be able to do in the OR will still fall under the hospital's privledging. Those who have not been trained in rearfoot reconstruction, will still not have privledges to do those procedures.

Modification of the scope of practice is intended to allow us to use our training to the patients' benefit. I don't see huge problems coming up with the changes they are proposing.

I would be interested to hear what other people's opinions are. I really am not interested to see a huge number of posts arguing about what the definition of a physician is. That's been done before, and won't come to any kind of resolution on a forum like this.

Well said!

 

[aphistis]

Looks like people have managed to drag this thread well away from the original topic. Who is called what, or what the definitions of various practitioners are doesn't really matter a whole lot. Who is better than someone else also really doesn't make much difference. There are some excellent ortho surgeons out there. There are also a few I wouldn't want to treat me for anything. Same is true for podiatric surgeons. And I would venture the same is true for every other specialty out there as well. Same goes for training. There are also so highly capable folks out there who didn't have much formal training. Also some with years of formal training, but still can't cut their way out of a paper bag. Most of this really isn't germane to the issues.

Look at a couple situations.

Podiatrists treat warts on the feet, many are plantar warts but not all. They can use any treatment modalities available. If a patient comes in and has a wart removed, and they also have one on their hand - the podiatrist cannot treat that one. (Unless of course they are in one of the 5 states that have the hand included in the scope of practice.)

Podiatrists treat many wounds. Often the patients have multiple comorbidities. These wounds may have any number of etiologies. Lets consider a venous stasis ulcer. If it is on the ankle it is in the scope of practice. If it is on the calf, it might not be (depending on which state they are located in.)

Do these things make any kind of logical sense? What is the best for the patient? That they may need to return to their primary care physician for a referal to a different specialist? This process and the approvals needed can take time, and may be denied by insurance companies. Meanwhile the patient is the one who suffers.

Fortunately I don't have to deal with insurance companies much. In some places there are different rates paid for surgeries depending on whether it was done by an orthopod vs a podiatrist. Does this make any sense?

Modification of the scope of practice is intended to address these types of issues. It will not suddenly mean podiatrists are going to be working shifts in the ER. It would not mean that suddenly podiatrists are sending in applications for general surgery residency positions. Podiatrists are not suddenly going to start delivering babies, or doing ACL reconstructions. It just doesn't work that way.

What they will be able to do in the OR will still fall under the hospital's privledging. Those who have not been trained in rearfoot reconstruction, will still not have privledges to do those procedures.

Modification of the scope of practice is intended to allow us to use our training to the patients' benefit. I don't see huge problems coming up with the changes they are proposing.

I would be interested to hear what other people's opinions are. I really am not interested to see a huge number of posts arguing about what the definition of a physician is. That's been done before, and won't come to any kind of resolution on a forum like this.

I don't want to put words in anyone's mouth, but to an outsider, the (very elegantly presented) logic of this post seems to progress as follows:

1. Podiatrists are currently recognized as foot & ankle surgeons.
2. The foot & ankle contain bone, muscle, tendons & ligaments, soft tissue, nerves, vasculature, etc.
3. These same tissues are found all over the body, not just the foot & ankle.
4. Therefore, podiatrists are adequately trained to operate all over the body, & should be so recognized by the medical community.

 

[PM2]

aphistis,

I can see why you are not a lawyer

I don't think efs is suggesting that we "operate all over the body". That is pretty extreme.

As far as scope, some people are begining to agree that podiatrist should have an unlimited scope. "unlimited" does not mean the DPM will take over the jobs of other MDs. Instead it will allow the podiatrist to use their full scope of knowledge to properly manage the patient. This truly makes sense in the case of diabetics.

The above post by an MD, EM Resident, verifies that podiatric residents are "indistiquishable" from the other residents in their knowledge.

You really should read some of the posts.

 

[aphistis]

aphistis,

I can see why you are not a lawyer

Dispense with the cutesy passive-aggressive crap, please. If you're going to accuse me of faulty logic, then do it, and let's see some supporting evidence. Otherwise, stow it.

I don't think efs is suggesting that we "operate all over the body". That is pretty extreme.

It *is* pretty extreme, which is why I don't imagine he is either; thus the explicit disclaimer at the beginning. In your own words, "you really should read the post."

As far as scope, some people are begining to agree that podiatrist should have an unlimited scope. "unlimited" does not mean the DPM will take over the jobs of other MDs. Instead it will allow the podiatrist to use their full scope of knowledge to properly manage the patient. This truly makes sense in the case of diabetics.

I'd like to meet some of these people. Failing that, I'd like to see some citations. I'm sure an assortment of nephrologists, endocrinologists, ophthalmologists, and others would all be quite interested in your thoughts on diabetes management.

The above post by an MD, EM Resident, verifies that podiatric residents are "indistiquishable" from the other residents in their knowledge.

Personal anecdotes with an n of 1 verify nothing.


Eric, this digression aside, I'm interested to hear your response to my response.

 

[Foot Surgeon]

Dispense with the cutesy passive-aggressive crap, please. If you're going to accuse me of faulty logic, then do it, and let's see some supporting evidence. Otherwise, stow it.


It *is* pretty extreme, which is why I don't imagine he is either; thus the explicit disclaimer at the beginning. In your own words, "you really should read the post."


I'd like to meet some of these people. Failing that, I'd like to see some citations. I'm sure an assortment of nephrologists, endocrinologists, ophthalmologists, and others would all be quite interested in your thoughts on diabetes management.


Personal anecdotes with an n of 1 verify nothing.


There is nothing really being contributed from you in this forum. It is clear that as a dentist you obviously have contempt for podiatrists who are surgically trained physicians with hospital privelages and access to medical rotations beyond your reach as a dentist, except of course if you were entering the maxo-facial route. You said all the same garbage in the last podiatry forum that is now defunct. Move on dentist, the DMD pages await you!

 

[aphistis]

There is nothing really being contributed from you in this forum. It is clear that as a dentist you obviously have contempt for podiatrists who are surgically trained physicians with hospital privelages and access to medical rotations beyond your reach as a dentist, except of course if you were entering the maxo-facial route. You said all the same garbage in the last podiatry forum that is now defunct. Move on dentist, the DMD pages await you!

You could've saved some time by just typing "you wish you were me."

What's interesting here is that for all the flames I'm getting tossed my way, I haven't seen a single line of earnest rebuttal.

 

[PM2]

I'd like to meet some of these people. Failing that, I'd like to see some citations. I'm sure an assortment of nephrologists, endocrinologists, ophthalmologists, and others would all be quite interested in your thoughts on diabetes management.

Personal anecdotes with an n of 1 verify nothing.

You should really evaluate your own logic.

Although I do not have efs' experience in podiatric medicine, I have stated most of the same points in my previous posts.

As for statistical verification, the smallest number that can be analyzed is three due to the formula for standard deviation. Therefore, I will give you three examples:

NIH: http://www.guideline.gov/summary/summary.aspx?doc_id=2892

NIH did not ask nephrologists, endocrinologists, ophthalmologists, and others to write this guide.

http://www.guideline.gov/summary/summary.aspx?doc_id=6500&nbr=4073&string=DPM

Look closely at the composition of the group that wrote this guideline for Vermont. There is a DPM on there with numerous MDs.
I wonder why all these MDs ant "others" felt they needed the input of a DPM. Maybe you should write them and ask.

http://www.guideline.gov/summary/summary.aspx?doc_id=3722&nbr=2948&string=DPM

Look closely again. Another DPM on a group that created another guideline for management of diabetes.

I could find more, but I think these provide you with an adequate number of MDs and "others" to contact if you wish. Pretty good statistical sampling of individuals actually.

Now, who knows the foot and ankle the best? How about some opinions other than mine, which are obviousl statistically biased, and yours.

http://www.bpm.ca.gov/pubs/fsconsum.htm

Make sure you read the first paragraph.

Now for the real kicker:

What MDs, especially orthopaedist, would work with and listen to podiatrist?

http://www.footandanklecongress.com/faculty.html

As for scope, I am sure you could ask any of these people.

Make a special note of Dr. Armstrong, DPM, who is considered one of the best chronic wound care specialist is diabetic management. He has saved feet where other university doctors have suggested amputation.

 

[Foot Surgeon]

What's interesting here is that for all the flames I'm getting tossed my way, I haven't seen a single line of earnest rebuttal.[/QUOTE]

Maybe because there is no validity in the original argument you presented to our forum.

 

[aphistis]

You should really evaluate your own logic.

Although I do not have efs' experience in podiatric medicine, I have stated most of the same points in my previous posts.

As for statistical verification, the smallest number that can be analyzed is three due to the formula for standard deviation. Therefore, I will give you three examples:

NIH: http://www.guideline.gov/summary/summary.aspx?doc_id=2892

NIH did not ask nephrologists, endocrinologists, ophthalmologists, and others to write this guide.

http://www.guideline.gov/summary/summary.aspx?doc_id=6500&nbr=4073&string=DPM

Look closely at the composition of the group that wrote this guideline for Vermont. There is a DPM on there with numerous MDs.
I wonder why all these MDs ant "others" felt they needed the input of a DPM. Maybe you should write them and ask.

http://www.guideline.gov/summary/summary.aspx?doc_id=3722&nbr=2948&string=DPM

Look closely again. Another DPM on a group that created another guideline for management of diabetes.

I could find more, but I think these provide you with an adequate number of MDs and "others" to contact if you wish. Pretty good statistical sampling of individuals actually.

Now, who knows the foot and ankle the best? How about some opinions other than mine, which are obviousl statistically biased, and yours.

http://www.bpm.ca.gov/pubs/fsconsum.htm

Make sure you read the first paragraph.

Now for the real kicker:

What MDs, especially orthopaedist, would work with and listen to podiatrist?

http://www.footandanklecongress.com/faculty.html

As for scope, I am sure you could ask any of these people.

Make a special note of Dr. Armstrong, DPM, who is considered one of the best chronic wound care specialist is diabetic management. He has saved feet where other university doctors have suggested amputation.

This entire post, and all its links, are focused completely on podiatry's expertise in managing foot & ankle problems in the diabetic, which is something I never disputed in the first place. Once again, instead of trying to bait me into defending a position I never took, how about somebody actually responds to my original posts?

 

[aphistis]

Maybe because there is no validity in the original argument you presented to our forum.

Yeah, that must be it.

Of course, as long as everyone here stays too afraid to engage it, there'll be no way to know.