DPM parity.. NO!

[prettypod]

Does anyone else out there NOT want to admit, NOT want "parity", JUST want to concentrate their efforts on podiatry? I get so tired of hearing people argue and complain, comparing themselves to their counterparts with different specialties. I for one LOVE that if one of my patients needs an admit to the hospital due to a life threatening issue that may require podiatry surgery/intervention they can be admitted and managed by a hospitalist, who specializes in managing patients while inpatient status in the hospital. We should abandon this idea of expanding our scope of practice, albeit I do practice where I have below knee privileges as far as surgery is concerned. Some negative comments available all over the web speak of being an allied health professional is a bad thing. I disagree, I embrace it and wouldn't have it any other way. If I did want it another way I would go back to school and get the proper training and credentials. As it stands, I do what I want to do and like things just the way they are. We did not just go to a regular medical school like most people do, we went to a specialty medical school that limits us in some ways, but in GOOD ways. Ways that let us run the busiest clinics in the hospital and still manage an inpatient load on a consultant type status. Ways that I like and that make sense with our training. I just got asked if I wanted to admit my own patients and I said NO!!! That's what god created hospitalists for. I do not want or have the time for it, I have 60 patients to see in clinic and I will consult like a champ after hours. Leave podiatry alone, the fight for more medical privileges can be fought and won by going back to school, a regular medical school which I'm sure it will be easy to get into after completing podiatry training from AtoZ. Or maybe even somewhere inbetween if you want to jump ship.

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[Greattoe]

I completely agree with you prettypod. We have a huge deficit in medical management training. There is no way going to podiatry school can prepare us for managing patients. Medical students do clinical rotations through IM and other medical specialties through out their 3rd and 4th year and then do an IM intern year. The only way we can have true parity is for podiatry to become a true medical specialty that you go into after RD medical school and after an intern year. Do we want to keep the specialty separate like Dentistry or try to cram in our square peg into the round hole of medicine? We have two paths we can go down, but to try to go cross country and combine the two will result in a mess.

 

[PMSIII]

I see your point and I agree that as DPM's we do not have the training to manage acute renal failure patients or Diabetic patients with ketoacidosis. The point of the parity initiative is to continue to elevate our profession and quality of care that we provide to our patients. I trained in a system where we had full admission privileges. As a surgically-trained podiatrist, I prefer to have the primary team handling what they're trained to do and leave me to do what I'm trained to do and that is to operate. I don't think egos become a factor when your patient's safety and health is on the line. We just need to continue doing what's best for the patient and that is providing him/her with the best care possible and utilize the services of the appropriate referrals. Other surgical specialists do this as well - in my three years of surgical training and one year of fellowship, I've seen other surgical specialists admit under hospitalists/primary care - why? Because, it's better care for the patient and they can concentrate on doing what they need to do for the patient from a surgical point of view.

As for the future of podiatry and our direction as a profession, I personally support the initiative to continue following the allopathic model. I think it is important for us as a profession to elevate our standards and level of care with our education and training. I don't think the point here it to obtain privileges to manage CHF patients but rather to train our students/residents/fellows in recognizing more and more about the medical comorbidity of those patients that present to our offices. I was fortunate to spend a fair amount of time in clinical rotations as a student and resident with other medical specialties but I don't feel that this is the standard of training across the board, when it should be. I believe that as a curriculum we don't spend enough time in our third and fourth years with medical specialties and subspecialties.

 

[ldsrmdude]

I see your point and I agree that as DPM's we do not have the training to manage acute renal failure patients or Diabetic patients with ketoacidosis. The point of the parity initiative is to continue to elevate our profession and quality of care that we provide to our patients. I trained in a system where we had full admission privileges. As a surgically-trained podiatrist, I prefer to have the primary team handling what they're trained to do and leave me to do what I'm trained to do and that is to operate. I don't think egos become a factor when your patient's safety and health is on the line. We just need to continue doing what's best for the patient and that is providing him/her with the best care possible and utilize the services of the appropriate referrals. Other surgical specialists do this as well - in my three years of surgical training and one year of fellowship, I've seen other surgical specialists admit under hospitalists/primary care - why? Because, it's better care for the patient and they can concentrate on doing what they need to do for the patient from a surgical point of view.

As for the future of podiatry and our direction as a profession, I personally support the initiative to continue following the allopathic model. I think it is important for us as a profession to elevate our standards and level of care with our education and training. I don't think the point here it to obtain privileges to manage CHF patients but rather to train our students/residents/fellows in recognizing more and more about the medical comorbidity of those patients that present to our offices. I was fortunate to spend a fair amount of time in clinical rotations as a student and resident with other medical specialties but I don't feel that this is the standard of training across the board, when it should be. I believe that as a curriculum we don't spend enough time in our third and fourth years with medical specialties and subspecialties.

Unfortunately, I agree with you that we don't spend enough time as students with medical specialties. And I agree with what you're saying about managing patients with multiple comorbidities. I don't want to do that. I'd much rather have the internal medicine folks do what they do. That all said, I don't see anything wrong with trying to get admitting privileges for those who want to manage their patients (within reason). We manage quite a few of our patients, but those are usually our trauma or status post elective surgery patients that are staying for pain control/monitoring. I think having admitting privileges for those cases is beneficial. Otherwise, I'll leave the management to the hospitalists.

 

[Zill]

Will podiatrists be considered by the Powers That Be (State/Federal/NPI/ACA) as 1. SPECIALISTS or PODIATRY SERVICE PROVIDERS? 2. IF DPMs are NOT considered specialists in language of the Affordable Care Act, and most state boards will they be able to earn a living? 3. What will these foot clubs do to help podiatry, podiatrists, students, and the rest of the DPM community? If the answer is NOTHING what is the solution? Would a population within the podiatry community be inclined toward additional training including but not limited to academic, and clinical rotations to achieve these goals? If not, why? If so what suggestions would you make to these ends?