New Podiatry School?

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BootsnCats

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Just skimmed through PM news and saw a job opening for a new podiatry school. Anyone know anything about this?
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BootsnCats said:
Just skimmed through PM news and saw a job opening for a new podiatry school. Anyone know anything about this?
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We certainly don't need another podiatry school, especially in a state that already has one.
 
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There has been talk of this for a few months and it really hasn't progressed much. The PM news comment section exploded with backlash.

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As far as I can tell, it's just talk right now. If you read the article linked a few posts up, at that time (a few months ago) they hadn't decided if it was going to be a dual DPM/MD or DPM/PA degree. As @SLCpod said, this has been talked about for several months with mixed reviews. I would personally consider this a pointless step in the wrong direction, but there are obviously some who would disagree.
 
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A DPM/PA degree does not sound appealing...

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Yeah, that's one of the things that I didn't understand is why a DPM/PA degree would supposedly be better in increasing our autonomy and granting us parity with other physicians. It would seem to do about the opposite and making us dependent on an overseeing physician in most cases, I would think. Since the topic has come up, I don't really see what a dual-degree is supposed to do for us. It would add to the confusion that we already have in our profession. If MD is what we need to change our degree to (I don't think it is, but just for this argument), then change it, but this half-measure dual-degree isn't even a step in the right direction.
 
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Fusing DPM/MD or DPM/PA only makes it worse to gain parity.

They'd be better spending that time increasing DPM prominence instead of hiding behind a dual degree that equates DPM to a sub-specialty with less autonomy.

Why the hell should I go to school for 4 years and do a 3 year residency only to be given the same operating freedom as a PA?

“We cannot move forward in the new healthcare era as podiatrists with a limited license to practice”.........“To be a part of the integrated healthcare team, podiatry needs full licensure either through an MD Degree or PA Degree,” stated Dr. Stan Blondek, Medical Director of the Physician Assistant Program

Wut.......... $$$$$$$$$$$$$$$$$
 
The guy opened an MD school in Mexico too...not sure how I should feel about that...

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bobtheweazel said:
A DPM/PA degree does not sound appealing...
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ldsrmdude said:
Yeah, that's one of the things that I didn't understand is why a DPM/PA degree would supposedly be better in increasing our autonomy and granting us parity with other physicians. It would seem to do about the opposite and making us dependent on an overseeing physician in most cases, I would think. Since the topic has come up, I don't really see what a dual-degree is supposed to do for us. It would add to the confusion that we already have in our profession. If MD is what we need to change our degree to (I don't think it is, but just for this argument), then change it, but this half-measure dual-degree isn't even a step in the right direction.
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Agreed - I think the idea is an insult to our profession.
 
I agree. DPM/PA and this new school are both terrible ideas.

I would like to see DPM's be eligible to sit for the USMLE exam similar to IMG and other foreign medical school graduates. Those who pass, can get the Physician and Surgeons certificate and continue to practice as podiatrist. While those who do not take it, or fail, can continue to practice as podiatrist--like they do now.
 
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hematosis said:
I agree. DPM/PA and this new school are both terrible ideas.

I would like to see DPM's be eligible to sit for the USMLE exam similar to IMG and other foreign medical school graduates. Those who pass, can get the Physician and Surgeons certificate and continue to practice as podiatrist. While those who do not take it, or fail, can continue to practice as podiatrist--like they do now.
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The only issue I see with this is that the Physician and Surgeons certificate is something unique to California (if I'm not mistaken), so it doesn't really make sense to apply that to the entire country. I agree about sitting for the USMLE, I think it makes sense to sit for that or some hybrid of it specifically for us that is designed and run by the USMLE.
 
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ldsrmdude said:
The only issue I see with this is that the Physician and Surgeons certificate is something unique to California (if I'm not mistaken), so it doesn't really make sense to apply that to the entire country. I agree about sitting for the USMLE, I think it makes sense to sit for that or some hybrid of it specifically for us that is designed and run by the USMLE.
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At least being able to take the USMLE would be nice to demonstrate educational parity.
 
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Regardless of whether this proposed school can get accredited or not, there are other issues at hand. I agree that obtaining a DPM/MD degree will not in any way, shape or form change the way we are perceived by the allopathic medical community. However, obtaining a DPM/MD or DPM/PA degree will simply offer one significant advantage. It will allow the profession to practice with a full scope by theory. A PA can not perform surgical procedures or work independently at this time (as far as I know). However, a PA CAN clear a patient for surgery and in many areas a DPM can not do the same. A PA can treat any area of the body, and a DPM can not at this time. An ENT doctor realistically only treats ENT problems, but has the license to do whatever the doctor wants, without breaking the law. At present, a DPM can not treat anything outside the particular state's guidelines. So although a PA can't do surgery, a DPM in most states can't do the surgery without medical clearance, which CAN be done by the PA. So while most DPM's who would obtain a PA or MD degree would still focus on the foot and ankle, it would not be out of scope to treat other problems when indicated. It basically takes the limits off the present limited license.
 
ExperiencedDPM said:
At present, a DPM can not treat anything outside the particular state's guidelines. So although a PA can't do surgery, a DPM in most states can't do the surgery without medical clearance, which CAN be done by the PA.
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I think we need to define "clearance" in order to have this discussion. It probably varies from one institution to another, state to state, and certainly has different meaning if you are talking about the inpatient vs outpatient setting.

To me, there are only 2 situations in which a physician actually "clears" the patient for surgery:

1) inpatient setting when ICU or Trauma/Surgery team are primary and you are managing FA trauma or limb salvage. In that case, the primary team has the authority to tell you the patient is not stable to go to surgery with you. However, it should be noted that in the case of isolated FA trauma where you, as a podiatrist, have admitting privileges and are primary on the patient, it is entirely up to you whether or not the patient can go to the OR. You do not need a medicine or hospitalist consult to "clear" anything. Of course, if the patient has heart disease then you should have medicine on board to do the appropriate pre-op work-up...but in that case you shouldn't be primary anyways.

2) outpatient surgery when your patient has cardiac disease. In that case, a cardiologist will evaluate the patient and tell you whether or not their heart can handle surgery, type of anesthesia, etc. I would consider that "clearing" the patient.

If you are talking about an elective bunion in a patient with comorbidites that you send to their PCP prior to outpatient surgery, you are misunderstanding (IMO) what the PCP is actually doing. In that case they do not "clear" the patient, they simply perform a risk assessment. This does not allow you to or prevent you from taking the patient to the OR, it simply tells you how risky it is for you to put that patient under anesthesia and fix something. It also provides you with recommendations regarding any other specialists that the patient should see prior to any procedure (ie Cardio, nephro, rheum, etc.).

All that being said, while a PA or MD degree may allow you to perform "clearance" in the scenarios in which I believe are actual "clearance" (which is certainly up for debate), my question is and will always be, why on earth would you do that? Ortho doesn't do that. Vascular surgeons don't do that. But you want a group of docs who probably already have too many people practicing outside of their abilities/training (I will go into local DPM fubars, that we have to fix, if you'd like) to have that ability? No thanks. That is where we would have to agree to disagree.
 
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Your definition of clearance and mine are not the same. And in the real world, some hospitals will not allow the DPM to "clear" a patient or sign off on the H&P. The H&P must be signed by an MD, DO or PA.

I am not stating or suggesting I support the dual degree. I am stating that one advantage of eliminating the limited scope of practice would be to utilize that additional degree when needed.

Correct. Orthopods, etc., don't do their own H&Ps but since their license isn't limited, if push came to shove they COULD. In many states we can't.
 
dtrack22 said:
[…] All that being said, while a PA or MD degree may allow you to perform "clearance" in the scenarios in which I believe are actual "clearance" (which is certainly up for debate), my question is and will always be, why on earth would you do that? Ortho doesn't do that. Vascular surgeons don't do that. But you want a group of docs who probably already have too many people practicing outside of their abilities/training (I will go into local DPM fubars, that we have to fix, if you'd like) to have that ability? No thanks. That is where we would have to agree to disagree.
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ExperiencedDPM said:
[…] Correct. Orthopods, etc., don't do their own H&Ps but since their license isn't limited, if push came to shove they COULD. In many states we can't.
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I think that what @ExperiencedDPM noted is the main point, since having an unlimited license does carry with it a greater measure of security than a limited one. I disagree in the PA degree being a valid options as, although likely affording a practical solution in many cases, it would forever relegate podiatrists to needing other physicians' signing off on work deemed outside of our perceived scope.
 
Ready for the kicker? I've ran into tons of PA-C's at these hospitals conducting full physical exams, practicing medicine on the entire human body, prescribing medicine with just a 2-year associate's degree. Think I'm kidding?

http://mdc.edu/medical/AHT/PA/default.asp
 
ExperiencedDPM said:
Your definition of clearance and mine are not the same. And in the real world, some hospitals will not allow the DPM to "clear" a patient or sign off on the H&P. The H&P must be signed by an MD, DO or PA.
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Yup, which is exactly say we needed to define it because I think the point you brought up regarding some sort of dual degree is a good one. Also, while it sounds like we both agree that this theoretical new school is not the way to do it, that's been the same reasoning/argument that the folks in CA have been using to justify the push for their certificate of surgery proposal.

My question is, because I don't know the answer, how many states actually have legislation or scope that forbids DPMs from getting admitting privileges (what you're talking about when you bring up "clearance," ie pre-op H&P)? I thought it was mostly a hospital bylaws and credentialing issue as opposed to an actual license/scope of practice issue?
 
We've had a similar and silly pathway like this before. That Nova DO school used to offer a way to go back and get a DO degree. It never made sense. 4 years of podiatry school, 3 years of podiatry residency, and then ..1-2 (whatever) more years of DO. But having another degree doesn't do anything for you. You would at minimum need a medicine internship and having spoken to a bunch of MDs recently - people with MD degrees and only 1 year of residency training don't really serve a purpose.

We're already in school forever and maybe its just me, but a lot of my training seemed like a waste. Skip the loopholes and schemes - if the goal is for us to be full scope medicine then the training is no where close to what it needs to be. Its a nice vision/goal, but there has never been enough gas in the tank to get there and everybody knew it from the start.
 
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pod18 said:
???
Yes, that is what PA's do...
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My innuendo went completely over your head but it's ok I'll break it down simple for you: it's ridiculous that a 3-year residency trained DPM has to ask a PA-C with an Associate's Degree, or any PA-C for that matter, to clear a patient for surgery. I'm all for primary care doing what they do best but a DPM should at least, by law, be able to clear the patient if push came to shove as any other surgical speciality would be able to do.
 
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Nanocure said:
My innuendo went completely over your head but it's ok I'll break it down simple for you: it's ridiculous that a 3-year residency trained DPM has to ask a PA-C with an Associate's Degree, or any PA-C for that matter, to clear a patient for surgery. I'm all for primary care doing what they do best but a DPM should at least, by law, be able to clear the patient if push came to shove as any other surgical speciality would be able to do.
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No, nothing went over my head. I don't think you understood my response actually so I'll reword it: Everyone on here knows what a PA does and what their training entails (or should). It's not some secret you uncovered. So to answer your question in your original post, nobody thinks you're kidding. We all know what PAs do.
 
heybrother said:
We've had a similar and silly pathway like this before. That Nova DO school used to offer a way to go back and get a DO degree. It never made sense. 4 years of podiatry school, 3 years of podiatry residency, and then ..1-2 (whatever) more years of DO. But having another degree doesn't do anything for you. You would at minimum need a medicine internship and having spoken to a bunch of MDs recently - people with MD degrees and only 1 year of residency training don't really serve a purpose.

We're already in school forever and maybe its just me, but a lot of my training seemed like a waste. Skip the loopholes and schemes - if the goal is for us to be full scope medicine then the training is no where close to what it needs to be. Its a nice vision/goal, but there has never been enough gas in the tank to get there and everybody knew it from the start.
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I don't think the Nova pathway really made much sense either. I think it was (I have no idea if the program is still available) actually almost 3 years including rotations and DPMs were then only allowed to apply for internal medicine residencies. When I was a student, I talked to our Dean about a dual-degree DPM/DO. There has always been some talk about it, but I naively thought it would be neat to see it actually happen. The thought was that maybe you could better serve a very rural community that would be too small to support a full-time DPM, but my views have changed considerably on this subject.
 
heybrother said:
We've had a similar and silly pathway like this before. That Nova DO school used to offer a way to go back and get a DO degree. It never made sense. 4 years of podiatry school, 3 years of podiatry residency, and then ..1-2 (whatever) more years of DO. But having another degree doesn't do anything for you. You would at minimum need a medicine internship and having spoken to a bunch of MDs recently - people with MD degrees and only 1 year of residency training don't really serve a purpose.

We're already in school forever and maybe its just me, but a lot of my training seemed like a waste. Skip the loopholes and schemes - if the goal is for us to be full scope medicine then the training is no where close to what it needs to be. Its a nice vision/goal, but there has never been enough gas in the tank to get there and everybody knew it from the start.
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This. If we are going to keep whining for parity, then there have to be some major changes. Our training is not on par with MDs/DOs. We have 9 different schools with 9 different curriculums and some of which don't require any rotations outside of podiatry.
 
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dtrack22 said:
My question is, because I don't know the answer, how many states actually have legislation or scope that forbids DPMs from getting admitting privileges (what you're talking about when you bring up "clearance," ie pre-op H&P)? I thought it was mostly a hospital bylaws and credentialing issue as opposed to an actual license/scope of practice issue?
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I would be surprised if there was actually legislation that prohibited a DPM from getting admitting privileges in a specific state, but I admit I don't know for sure. My privileges at all of the hospital systems I am currently associated with require that my patients be admitted to the hospitalist service. It's also required for my patients to get "clearance" from their PCP or hospitalist (MD or DO) for me to do surgery, inpatient or outpatient.
 
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Nanocure said:
My innuendo went completely over your head but it's ok I'll break it down simple for you: it's ridiculous that a 3-year residency trained DPM has to ask a PA-C with an Associate's Degree, or any PA-C for that matter, to clear a patient for surgery. I'm all for primary care doing what they do best but a DPM should at least, by law, be able to clear the patient if push came to shove as any other surgical speciality would be able to do.
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Associate's degree? I'm confused.

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pod18 said:
This. If we are going to keep whining for parity, then there have to be some major changes. Our training is not on par with MDs/DOs. We have 9 different schools with 9 different curriculums and some of which don't require any rotations outside of podiatry.
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Some attempts are being made at standardizing the curriculum, or at least being aware of the differences that do exist.

http://www.aacpm.org/wp-content/uploads/2014CurriculumGuide.pdf

Also, every school requires rotations outside of podiatry. At the very least every school currently requires general medicine (internal medicine or family medicine) rotations. Most of them have general surgery rotations as well. Each school also has additional non-pod rotations, some of which are unique to that particular school. For instance, 7 of the schools have an emergency medicine rotation that is required or optional, but only Western has rheumatology, cardiology, and pulmonology rotations available. Temple and CSPM have neurology rotations. DMU has a pediatric rotation available. NYCPM and Temple have physical medicine and rehabilitation rotations. Barry has a vascular disease rotation. Scholl, and a number of other schools, have infectious disease rotations. Et cetera.

There seems to be a decent breadth of non-podiatric medical education in every school's curriculum as well as an effort to place students into non-podiatric medical and surgical rotations in the third and fourth years. Plus the re-exposure to outside rotations during residency where, at least according to the CPME residency requirements, rotations in general surgery, internal medicine/family medicine, medical imaging, anesthesiology, emergency medicine, infectious disease, and behavioral science are now required.

The question then, I suppose, isn't whether there is general medical education and training—there obviously is—the question is whether there is sufficient general medical education and training to justify being able to admit a patient or clear a patient or what have you.

Not saying I have an answer or anything. Y'all know more about a lot of this than I do. I was just chiming in because parts of your post seemed outdated.
 
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bobtheweazel said:
Some attempts are being made at standardizing the curriculum, or at least being aware of the differences that do exist.

http://www.aacpm.org/wp-content/uploads/2014CurriculumGuide.pdf

Also, every school requires rotations outside of podiatry. At the very least every school currently requires general medicine (internal medicine or family medicine) rotations. Most of them have general surgery rotations as well. Each school also has additional non-pod rotations, some of which are unique to that particular school. For instance, 7 of the schools have an emergency medicine rotation that is required or optional, but only Western has rheumatology, cardiology, and pulmonology rotations available. Temple and CSPM have neurology rotations. DMU has a pediatric rotation available. NYCPM and Temple have physical medicine and rehabilitation rotations. Barry has a vascular disease rotation. Scholl, and a number of other schools, have infectious disease rotations. Et cetera.

There seems to be a decent breadth of non-podiatric medical education in every schools curriculum as well as an effort to place students into non-podiatric medical and surgical rotations in the third and fourth years. Plus the re-exposure to outside rotations during residency where, at least according to the CPME residency requirements, rotations in general surgery, internal medicine/family medicine, medical imaging, anesthesiology, emergency medicine, infectious disease, and behavioral science are now required.

The question then, I suppose, isn't whether there is general medical education and training—there obviously is—the question is whether there is sufficient general medical education and training to justify being able to admit a patient or clear a patient or what have you.

Not saying I have an answer or anything. Y'all know more about a lot of this than I do. I was just chiming in because parts of your post seemed outdated.
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That's great that they are trying to standardize the curriculum. But your post kind of proves my point. There still isn't even a standardized curriculum across the podiatry schools yet we are saying we are equal to MD/DO. Some have rotations in ID, some have vascular, some have PM&R. ALL MD/DO students are required to complete rotations in general surgery, internal medicine, ob/gyn, peds, neuro, psych and whatever else I'm missing. Point is - no, our training does not even scratch the surface of MD/DO.


I'll be graduating from Scholl in a week and half. We definitely don't have an infectious disease rotation. Also my general medicine exposure was terrible. And depending on what tract you get at scholl you could do your required medicine rotation at University of Chicago where you work with a podiatrist the whole month. So coming from Scholl, no, our medicine exposure is definitely not sufficient. I'm sure the same can be said for a lot of the other schools.
 
pod18 said:
This. If we are going to keep whining for parity, then there have to be some major changes. Our training is not on par with MDs/DOs. We have 9 different schools with 9 different curriculums and some of which don't require any rotations outside of podiatry.
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The only way in which I felt my education was not on par with MDs/DOs was with clinical experiences in obstetrics and gynecology and psychiatry, which I would say are some of the least relevant fields to our end-goal. That said, I still felt comfortable enough with OB/GYN problems during my general surgery rotation to recognize when they were in the differential and could recognize mood and personality disorders when presenting classically. Overall, I actually felt better prepared than quite a few DO students on clinical rotations (I did not feel better prepared than MD students - the ones I worked with were all pretty solid).

bobtheweazel said:
[…] but only Western has rheumatology, cardiology, and pulmonology rotations available. […]
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MWU also has rheumatology available - it's a great rotation.
 
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I'm sorry, but can we please stop quoting PR off school websites. Those of us who have done the rotations know their worth.

Unless I receive stellar medicine training in residency, my medicine rotations were minimal with low expectations. Good for F&A above if he feels reasonably solid. I doubt anyone I know could establish an insulin regimen for a diabetic. A MWU student I spent time with couldn't explain azotemia so unfortunately mileage varies.
 
pod18 said:
I'll be graduating from Scholl in a week and half. We definitely don't have an infectious disease rotation.
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Good to know. Like I said, it was just what I could find online so I suppose it's not up to date.

"Our students begin making a difference in the lives of patients long before they graduate, through rotations at world-class hospitals and clinics in the areas of ER, infectious diseases, internal medicine and surgery."
https://rosalindfranklin.edu/academics/dr-william-m-scholl-college-of-podiatric-medicine/

"This puts Scholl students in multiple rotations, including ER, infectious diseases, internal medicine and surgery, at the nationally renowned John H. Stroger, Jr., Hospital of Cook County and other leading Chicago teaching hospitals."
http://50.63.85.172/Portals/0/Documents/SchollCatalog.pdf
 
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heybrother said:
[...] A MWU student I spent time with couldn't explain azotemia so unfortunately mileage varies.
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This is also true for general medical students, however - there's quite a bit of variation (and family practice isn't always a choice!). Not intending polemics, just food for thought.
 
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heybrother said:
I doubt anyone I know could establish an insulin regimen for a diabetic.
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meh, after 4-5 years of residency neither can most ortho residents.

ldsrmdude said:
I would be surprised if there was actually legislation that prohibited a DPM from getting admitting privileges in a specific state, but I admit I don't know for sure. My privileges at all of the hospital systems I am currently associated with require that my patients be admitted to the hospitalist service. It's also required for my patients to get "clearance" from their PCP or hospitalist (MD or DO) for me to do surgery, inpatient or outpatient.
Click to expand...

That was my thought, which means getting additional initials behind your name isn't a state-wide legislative issue as much as it is a hospital specific bureaucratic issue. Don't get me wrong, I understand it would be a sure-fire way to get admitting privileges but its a longer and more complicated road if you ask me. It would be nice if everyone in that situation could simply take cases elsewhere, take call elsewhere, etc. which (at least where I'm at) has led to lost $$ and some poor outcomes on family members of prominent local folks due to non-pods working on them...and pressure the hospital into changing bylaws. I wouldn't think it would be difficult for a hospital to justify changing those bylaws either, with CMS defining DPMs as physicians.
 
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This obviously can't happen. It reminds me of that time the loud real estate mogul from NY ran for president......


I find it frustrating that we continue to bother with "increasing our scope" or changing the degree. Maybe I am too green to comment, but we should be thankful for where we are at, even if every school continues to pump out a class of 30-50% TFP. Go take a visit to the optometry or pharmacy forums. These are highly trained individuals with lower income potential, higher saturation, and far more limited scope than we enjoy. We should focus on producing residents that are medically literate and excellent at what we do. There are a lot of great training programs out there for great students, we are very lucky, but we need more. Increasing quality of training and the quality of the graduating student is all we can do to control our own destiny as a profession. We have done pretty well over the last 20 years.
 
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HeySister said:
This obviously can't happen. It reminds me of that time the loud real estate mogul from NY ran for president......

I find it frustrating that we continue to bother with "increasing our scope" or changing the degree. Maybe I am too green to comment, but we should be thankful for where we are at, even if every school continues to pump out a class of 30-50% TFP. Go take a visit to the optometry or pharmacy forums. These are highly trained individuals with lower income potential, higher saturation, and far more limited scope than we enjoy. We should focus on producing residents that are medically literate and excellent at what we do. There are a lot of great training programs out there for great students, we are very lucky, but we need more. Increasing quality of training and the quality of the graduating student is all we can do to control our own destiny as a profession. We have done pretty well over the last 20 years.
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Not that i disagree with any of this, but i don't think those professions are good comparisons considering their length of training. Many are satisfied at the chance of making near 6 figure salary (or ~120k+ in case of Pharmacists) despite all those negatives.
 
dtrack22 said:
That was my thought, which means getting additional initials behind your name isn't a state-wide legislative issue as much as it is a hospital specific bureaucratic issue. Don't get me wrong, I understand it would be a sure-fire way to get admitting privileges but its a longer and more complicated road if you ask me. It would be nice if everyone in that situation could simply take cases elsewhere, take call elsewhere, etc. which (at least where I'm at) has led to lost $$ and some poor outcomes on family members of prominent local folks due to non-pods working on them...and pressure the hospital into changing bylaws. I wouldn't think it would be difficult for a hospital to justify changing those bylaws either, with CMS defining DPMs as physicians.
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I agree, and I think things will continue to evolve and change as more and more podiatrists press for extended privileges. Like you said, it would be nice if things were as easy as simply taking cases elsewhere and having things change, but that's unfortunately not the case for me and for a lot of other podiatrists I assume. Places where podiatry has a strong presence could probably make it work, but the main hospital I am probably wouldn't blink an eye if I told them I wasn't going to take call or bring my cases to the hospital unless I got extended privileges. I may write more about this if I get a chance later today
 
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ldsrmdude said:
I agree, and I think things will continue to evolve and change as more and more podiatrists press for extended privileges. Like you said, it would be nice if things were as easy as simply taking cases elsewhere and having things change, but that's unfortunately not the case for me and for a lot of other podiatrists I assume. Places where podiatry has a strong presence could probably make it work, but the main hospital I am probably wouldn't blink an eye if I told them I wasn't going to take call or bring my cases to the hospital unless I got extended privileges. I may write more about this if I get a chance later today
Click to expand...

Would like to hear about it when you get a chance. At your leisure.
 
ldsrmdude said:
I agree, and I think things will continue to evolve and change as more and more podiatrists press for extended privileges. Like you said, it would be nice if things were as easy as simply taking cases elsewhere and having things change, but that's unfortunately not the case for me and for a lot of other podiatrists I assume. Places where podiatry has a strong presence could probably make it work, but the main hospital I am probably wouldn't blink an eye if I told them I wasn't going to take call or bring my cases to the hospital unless I got extended privileges. I may write more about this if I get a chance later today
Click to expand...
So I may need to walk back my statement a little that the hospital wouldn't bat an eye if I took case elsewhere. Every hospital/surgery center wants more cases. But I do far fewer cases than the other specialists who would likely oppose additional privileges for me. As far as call is concerned, I found out this week that the hospital doesn't officially recognize me (or my group) as taking "call." Apparently, the consults we have been getting have been happening just from some of the hospitalists going out of their way to consult me. Until I came and started trying to see some of the inpatients here, all diabetic wounds were general surgery or rarely ortho. General surgery still gets the majority of infections/wounds/etc. Trauma is one place that I haven't made much progress at all. I do get a few follow-ups from the ED, but have yet to be asked to see someone in the ED for a foot and ankle trauma. Some of that may be due to the aforementioned call issue, but the majority of it is related to the strong ortho presence. If I stopped taking "call", things would simply revert back to where they were 10 months ago. As far as the negative outcomes affecting things, well someone has to educate the community that calc fractures can be fixed surgically with good outcomes, not all calcaneal osteomyelitis cases need a BKA, or that not every digital amputation needs to remain open and heal through secondary intention (although this may be hyperbole, there is truth in each of these statements). If that's been the status quo, it takes time to educate folks. For the record, I work in a rural, under-served community.

I guess my point is that parity a complicated situation and there isn't a one size fits all approach that will work
 
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I don't know why everyone is hating on the PA: it is the only degree (outside of the NP which in my eyes is essentially equivalent) where the scope of practice has continued to increase, but the training has remained the same. They have flat out schooled our political representatives. We should be taking notes on how they have advanced their profession to include a full scope, and we have been left in the dust on the same level as a chiropractor. By attempting to get a piece of their degree, we are basically using them as a backdoor to a full license. It's genius really. How do you get a full scope license without improving your training or without making any costly legal reform by relying on our very ineffective political representatives? Piggy-back on someone else's success. Use the door that is already open.
 
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ldsrmdude said:
So I may need to walk back my statement a little that the hospital wouldn't bat an eye if I took case elsewhere. Every hospital/surgery center wants more cases. But I do far fewer cases than the other specialists who would likely oppose additional privileges for me. As far as call is concerned, I found out this week that the hospital doesn't officially recognize me (or my group) as taking "call." Apparently, the consults we have been getting have been happening just from some of the hospitalists going out of their way to consult me. Until I came and started trying to see some of the inpatients here, all diabetic wounds were general surgery or rarely ortho. General surgery still gets the majority of infections/wounds/etc. Trauma is one place that I haven't made much progress at all. I do get a few follow-ups from the ED, but have yet to be asked to see someone in the ED for a foot and ankle trauma. Some of that may be due to the aforementioned call issue, but the majority of it is related to the strong ortho presence. If I stopped taking "call", things would simply revert back to where they were 10 months ago. As far as the negative outcomes affecting things, well someone has to educate the community that calc fractures can be fixed surgically with good outcomes, not all calcaneal osteomyelitis cases need a BKA, or that not every digital amputation needs to remain open and heal through secondary intention (although this may be hyperbole, there is truth in each of these statements). If that's been the status quo, it takes time to educate folks. For the record, I work in a rural, under-served community.

I guess my point is that parity a complicated situation and there isn't a one size fits all approach that will work
Click to expand...

Regarding call, and getting ED referrals: I feel your pain on getting a lack of trauma. I have tried and tried at several hospitals to make it known that I love fixing ankle fractures and taking care of F/A trauma, and I can count on one hand how many patients I have been sent, public aid or otherwise. I've tried to meet ER MDs, PAs, and NPs, and I've basically given up expecting anything traumatic. Now they have no problem calling me on that infected, diabetic, public aid, foot infection, but trauma goes to their ER buddies. It is partly due to a strong ortho presence and politics, and partly because Podiatry has not taken these cases in the past (we're 20 years behind the curve in my area). You also have to think that that ER doctor who has been working there for years, already has someone they rely on for F/A trauma (or all trauma for that matter), someone that they probably know and like personally. And you're trying to convince them that you, as a fresh new graduate, as a PODIATRIST, can treat that bimall ANKLE fracture better than the guy/gal they've been sending people to, well that can come off as almost offensive.
 
g squared 23 said:
I don't know why everyone is hating on the PA: it is the only degree (outside of the NP which in my eyes is essentially equivalent) where the scope of practice has continued to increase, but the training has remained the same. They have flat out schooled our political representatives. We should be taking notes on how they have advanced their profession to include a full scope, and we have been left in the dust on the same level as a chiropractor. By attempting to get a piece of their degree, we are basically using them as a backdoor to a full license. It's genius really. How do you get a full scope license without improving your training or without making any costly legal reform by relying on our very ineffective political representatives? Piggy-back on someone else's success. Use the door that is already open.
Click to expand...
A PA degree isn't a full, unrestricted scope - their orders are always under the auspices of a physician and signed off by their authority (unless this differs in other states, which would be unfortunate).
 
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