01/28/2016    Paul Fogel, DPM, PA

New Podiatric Medical School to Offer DPM-MD/DPM-PA Degrees

As a Vietnam War veteran medic in the 60s, a PA
since 1973, and a DPM since 1980, I have come to
a conclusion that may not make many here happy.
When I first worked as a PA before there were
very many in 1973, nobody knew what I was capable
of doing. I worked in almost every department in
the hospital and then was the only PA in the
hospital for 350 beds. Feeling it was basically a
dead end because nobody knew what to have me
doing, I became a podiatrist at the urging of
other DPMs with whom I scrubbed in surgery.

I had done every type of surgery except neuro and
cardiac by that time. As a PA, I was segregated
and as a podiatrist, worse. All my MD friends
thought I was a sellout. I knew I would be a
great doctor because I cared about patients. As a
podiatrist, I received nothing but disrespect. I
was considered an “O" doctor. When someone asks
"What kind of doctor are you?, I answered, a
podiatrist, to which the reply was "Oh." It
pretty much seemed that no matter what position I
held or what level my education was, it was just
never good enough because I was not an MD.

Now we are teased by the possibility of a medical
degree that gives us DPM/PA-C or DPM/MD. When I
left podiatry in 1992 after 12 years of
unsuccessful podiatry practice on my own, I
returned to being a PA in oncology. My general
med-surg education was a great help. My podiatric
education was also a wonderful help to further my
knowledge. But there I was with two degrees of
separation. If I told my oncology patients that I
was also a podiatrist because I was called
doctor, it shocked them. When I treated podiatry
patients, most had no idea what a PA was or what
we do, I was one of only 5 DPM, PAs in the
country, NO ONE CARED. In fact it almost got me
in serious trouble a few times. Enough that in my
hospital, one administrator told me I was NOT
ALLOWED to use the word DOCTOR in front of my
name as it is very confusing to the patients. The
head of the department spoke up for me and that
was dismissed as an issue.

What I see here is the institution that will be
giving a DPM/PA or DPM/MD degree being a problem
in itself. Unless it is a part of a large MD Med
school. DPM/PAs and DPM MDs will still have the
stigma of not being a good old fashioned graduate
of a known Med school and will sort of attain the
status of being like a graduate of a Mexican Med
school, as opposed to a mainstream med school. It
will again segregate the practitioner with those
titles to make them feel inadequate In the same
way DOs had to suffer for years, these newest
practitioners will have to prove to the world
that they are as good as everyone else who has
the degree. I believe it will take a long time.
I have been retired from practice for about 8
years now and I am very happy not to say doctor
before my name.

Paul Fogel, DPM, PA (ret) , Philadelphia, PA

Other messages in this thread:

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02/17/2016    Ira Baum, DPM

New Podiatric Medical School to Offer DPM-MD/DPM-PA Degrees (Joseph Borreggine, DPM)

Dr. Borreggine has suggested a solution of dual
degree that may mitigate podiatry's place in the
healthcare environment. Because we are a regional
specialty, it makes change complex. All aspects
of our profession are critical to the health of
the foot and ankle, vascular, trauma, surgical,
dermatological and biomechanics, but how do you
maintain all these specialties under one umbrella
called podiatry?

Independent (although in conjunction with the
APMA) specialty groups and boards have moved
podiatry in an evolution of improved education
and training that's undeniable. But podiatry does
not exist in a vacuum. So the improved education
in training has been focused on surgery,
impacting the profession in two profound
directions. A dichotomy in the profession to
surgical and non-surgical podiatrists (although
I'm sure the hybrid podiatrists still exists) and
a subset of podiatrists seeking employment in
orthopedic groups, or multi specialty groups.

But even in these environments there persists an
air of financial inequality. The financial
inequality has been mitigated by the "groups"
billing for the podiatrists, not the value of
podiatry in comprehensive health care. This is an
indirect and unsatisfying solution for the
profession.

Inertia requires energy and disruption of the
status quo. The specialty boards have made there
move and basically the APMA rationally
capitulated to the change. But the podiatric
institutions have not acted responsibly for the
profession. Efforts of the podiatric institutions
should be directed at a strategy to integrate the
profession into mainstream medicine.

A spirit of altruism is required by all the
podiatric institutions including the schools of
podiatric medicine may be the only foundation
that will enable physicians to benefit the
public's foot and ankle health and the
practitioners that chose that career.

Negotiations with respected medical schools will
require accommodations that may be met with
resistance, but from my perspective, if that
window of opportunity exists, it is the one that
should be explored. The end result may not be
recognizable to most of us, but to the future
foot and ankle specialists, it may mean a
satisfying career. A career not froth with issues
of identity and inequality.

Ira Baum, DPM, Miami, FL

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02/17/2016    Daniel Wu, BS, MS

New Podiatric Medical School to Offer DPM-MD/DPM-PA Degrees (Joseph Borreggine, DPM)

In response to Joseph Borreggine’s thoughts:

To give a voice for current students in podiatry
school, the long debate of parity has been
brought up to students by the APMA, APMSA,
podiatric state representatives, and current
practicing DPMs. The current problem I believe is
that students who are concerned about this issue
are compelled to help but are not given the tools
or platforms to contribute effectively at this
point in time. I agree with Dr. Borreggine that
some podiatrists who have responded to this
thread regarding parity have been in the
profession for years and at this point in their
career, may not see the urgency to change or push
for laws that may not necessarily affect them.

I agree that for the advancement of the podiatric
profession, we must strive to obtain an
unrestricted plenary license that current MDs and
DOs have under the law. An unrestricted plenary
license would not only give us the same legal
practicing license of an MD and DO, but moreover,
would help solve the issue of varying scopes of
podiatric practice by state. Some examples of
current state specific restrictions include
restricted ankle or leg privileges, amputations,
and anesthesia administration. With an
unrestricted plenary license, podiatrists across
the nation should be able to give the same
treatments without restrictions regardless of the
state they practice in.

To my knowledge, the 3 current ways that future
and current DPMs may obtain an unrestricted
plenary license are 1) change the law at the
federal level, 2) obtain an MD/DO degree, or 3)
pass the USMLE Step Boards. From my
understanding, it will be hard to change the law
at the federal level unless it is included in a
big omnibus bill that has a higher success rate
of passing. I think that is why podiatrists over
the years have rather pushed to obtain an MD/DO
degree or addition of it, seeing it to be a
potentially more feasible or obtainable option.
The third approach not talked about much is that
there is also a current push for podiatry
students to take the USMLE. Next year in 2017,
the class of 2019 podiatry students from the 2
current California podiatry schools, CSPM and
Western, will take an equivalent of the USMLE
Step 1, called the Comprehensive Basic Sciences
Exam (CBSE) on top of their APMLE Boards I Exam.

Results will be confidential and will help
determine if current podiatric medical education
is on par with current MD/DO medical education.
If results are poor, it will show where podiatric
medical education is weak and can be improved to
be on par to that of MD/DO medical education. If
results are good, there will be a push to then
take the USMLE. In my opinion, the prospects are
favorable given that current podiatry students at
Western take all the same basic science courses
as their DO counterparts, while CPSM offers a
basic sciences curriculum comparable to that of
current medical schools.

All in all, I believe that if current students or
younger podiatric physicians are given the tools
and platforms to help in this parity issue, more
would get involved given that it would directly
affect where and how they practice at this point
in time. Echoing Dr. Borreggine, unity is key to
establishing our identity as a profession.

Daniel L WU, BS, MS

PPMA Student Representative, 2nd Year student at TUSPM

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02/16/2016    Joseph Borreggine, DPM

New Podiatric Medical School to Offer DPM-MD/DPM-PA Degrees

I have been reading the responses posted in
response to the recent posting about the
establishment of a new podiatry school offering
the dual degrees of DPM-MD and DPM-PA. The
responses so far have been equal on both sides.
Those who are against and in favor are pretty
much equal. Most have valid arguments on either
side. The problem I see in this debate is that I
would assume the younger demographic may have not
weighed in on this discussion. Since the
responses do not indicate how long the
practitioner has been a podiatrist, I cannot
decipher that fact. I recognize some of the names
and know them as long-time podiatrists.

I would just wonder if the younger practitioners
and those just entering the profession even care
about this matter at all. They may care, but not
want to say or they are using some other sort of
social media or blog platform to voice their
opinion? It is true the knowledge that these
individuals have accumulated over their four
years of education has created a tremendous
school debt to achieve this DPM degree. Maybe
they are already working in well-paying positions
and just are glad they are able to make a steady
paycheck to support themselves and their
household. So, they are quiet to this dual degree
concern.

With the recent podiatric residency shortage and
some DPM graduates still floundering about to
find a post-graduate position somewhere or a job
in their chosen profession, they must have an
opinion on this subject, but maybe not? I would
assume that this population of post DPM grads has
a great concern that the educational system has
failed them in some way since they were not
provided what was promised upon graduation? I
honestly do not have an idea about the numbers of
recently graduated DPMs in this position? I can
only imagine the concern they have if they have
yet to find a required three year residency to
obtain a DPM license to allow them to make a
living in their chosen career.

This dual degree discussion has been on-going for
the last 40 years. I believe that there have been
resolutions through the years presented to the
APMA HOD which have failed to pass. Maybe the
delegation did not think a dual degree was
necessary and hence did not pass the resolution?
But, the opinions of those delegates regarding
the dual degree will probably always be in the
negative. Most delegates are past presidents of
state affiliate associations who are well-
established in the profession and have been able
to make a decent living and basically are
satisfied with the way things are at present. So,
there is no need to change anything.

Well, change is needed. To continue to hear the
warning signs and do nothing is like standing on
the deck of the Titanic knowing that it is slowly
slipping into the sea and believing that the ship
will never sink. This may sound like an
exaggeration, but there is some truth to this
comparison. The fact is that podiatrists have
struggled to obtain the respect in medical
profession and the acknowledgement and
identification that we rightfully deserve. Why
this has continued to plague us is beyond me.
Historically, we started out as palliative care
providers for the foot, but over time this
profession has evolved into a medical profession
that specializes in all facets of foot and ankle
care.

This evolution has splintered podiatry into many
sub-specialties from general foot care to
reconstructive foot and ankle surgery and all
that is in between regarding foot and ankle
health. This is good for the profession, but not
for public perception of what we actually do. I
bet if the APMA took a street poll in all
different parts of the country and asked the
person being polled: “If they knew what a
podiatrist does?” The results may be surprising.
I believe it would be the same as it always has
been; the majority of the public really does not
know who we are or what we do!

With the all the transitions in podiatric
education and training through the years, DPMs
have not had a consistent program to allow every
graduating DPM to have equal training in
podiatric medicine and surgery. Now, the DPM is
required to have a three year surgical residency
and very few have fellowships in foot and ankle
surgery afterward. Again, since I have been in
practice for over 25 years, I do not know the
extent and intricate details of the post-graduate
training that a DPM goes through and how well-
qualified they are in the field of foot and ankle
surgery. I do know that the podiatric residency
minus the fellowship is nowhere near the surgical
training of an orthopedic surgeon. This is a
problem.

The fact is that our allopathic and osteopathic
colleagues only understand what we do if they are
working in close conjunction with DPMs on a daily
basis or they are a part of a corporate or
hospital medical group. Orthopedists in the same
work environment have the same comprehension of
the surgical skills of a well-trained podiatrist.
This is becoming more the norm as podiatrists
become part of this medical arena and the number
of employed podiatrist increase as the years pass
by. However, most DPMs are limited to what they
are comfortable doing in their office and
surgical suite and have very little exposure to
their medical colleagues. This is another
problem.

The fight has always been in podiatry of our
actual necessity in healthcare. There are pockets
throughout this country where this is not true
because those DPMs have done their job either in
the past or into the present to provide proper
education and the necessary exposure the needed
skills of a podiatrist. But, our services are
being replaced by and performed other specialties
in healthcare. These include physician
assistants, nurses, chiropractors, physical
therapist and so on. Why? Because I opine that
insurance companies believe these other
healthcare professions can do it cheaper and
better. How did this happen? Did the APMA not do
its job? I do not know. But, this is a big
problem.

We need to solve these problems and it is not
done by ignoring it and just continuing doing the
same. We need to consider the dual degree as a
viable option to move this profession forward
into the future. We need to stop struggling and
doing the same thing over and over and expecting
a different result. This may be the answer to all
our problems, but maybe not. But silence on the
matter means approval of the way things are. The
DPMs who are doing just fine and are satisfied in
what they are doing utilizing all their skills.
To that, I say, "Good for you"! And there are
many DPMs who chosen to relegate themselves to
just making a living based on their skills of
palliative foot care regardless of their
training. And to them, I say," Good job"! But,
this is choice that a DPM must make either
because of their training has allow them to do so
or they are just comfortable doing what they do
best. It is a choice they have made.

This choice is something that has been in the
profession for years. Unfortunately, I believe
that there still more general podiatrists than
there are surgical podiatrists. Why is that true?
Or is not true? I have no idea. I would love to
see the APMA take a survey of their membership
and see how many of them are doing general versus
surgical podiatry. You would think that all the
recent podiatrists who have the required three
year residency program would become full-fledged
foot and ankle surgeons and do not practice
general podiatry. But, that may not be the case.

This is what causes an unnecessary schism in our
profession. Are foot surgeons or not? You would
think so especially with the numbers who of us
you are members of the American Board of Foot and
Ankle Surgery or the AMPA's version of the
American Society of Podiatric Surgeons. The
convention halls of these organizations are
filled at every meeting. So, is that DPMs are in
love with the idea of being a foot surgeon, but
would rather not do it for some reason? Wait a
minute!! Two surgical groups for podiatrists and
only one have the name "podiatry" in it. I find
that interesting, as well.

So, where do we go from here? Either we will
continue to be this divided profession in
healthcare and keep doing the same thing or we
all decide that the dual degree is a viable
option made available in just not one school, but
in all the schools. This way there is no
competition and possible loss of a potential
student population choosing one school over the
other? This will be a choice that the student
will have to make on their own. This may require
a change in the definition of what that degree
represents that is obtained, but in the long run
we are all still DPM's. I hope whatever becomes
of this situation and possible fruition of a dual
degree program in podiatry that everyone for or
against understands that this is for the future
of podiatry. Let us stop being the profession of
“the haves” and “have nots.”

Joseph Borreggine, DPM, Charleston, IL