No DPMs vs. MDs

[AZPOD Rocks]

Yep! Now, I gotta couple of concerns to share with you. For one, I am a little worried about your mode of transportation.

?????

Is that another movie quote? I don't recognize it. Or is it just some random statement?

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[flypod]

Uncle Rico to Kip in the bowling alley.

 

[AlKlineDPM]

I missed some pretty interesting stuff here in this forum. I found this thread pretty interesting.

First, let me tell you that this ruling in PA is completely bogus and just goes to show the ignorance's still present in society about podiatry and the injustices in our legal system. Does anyone really think that a podiatrist cannot testify against an orthopedist? This is a good example of legal 'tricks' to debunk expert testimony. It's an old trick. You know, going after someone's credentialing. What I find interesting in this case, is that the defense lumped all of the podiatry profession into 'non experts against MD's'. How they pulled that one off, well, we all watched the OJ trial, right?

Now, let me tell you that both Podman and Flypod are correct in their assessment of the field of "podiatric medicine&surgery". Podiatry is now basically getting its act together and going to more consistent residency programs to deal with the disparity in training. Another thing to realize is that certain podiatrist train to do rear foot surgery and some just choose not too. It also depends on where you practice. If you go to any forum on podiatry, you will also see a lot of disgruntled podiatrists who are struggling with their decision to become a podiatrist and struggling with reasons why they got into the field.

Well, I have to say, from personal experience, that podiatry for me has been the best and most rewarding field. Is it for everyone, of course not. Just like in any field of medicine, some people will come to the forefront in their field and others will fail. In podiatry, just like orthopedics, there are miserable surgical failures that I've seen over the years, and it's not usually because of training. It's because of poor surgical technique or poor decision making on the part of the surgeon. You will see examples of this in every part of our society, not just in medicine. And, as any good doctor knows, even the best attempts at 'doing the right thing' will sometimes lead to disappointment on the part of the patient. You can't please everyone all of the time. However, most competent doctors do it more often than their counterparts.

I know to some in this forum that Flypod may look like he is instigating a negative attitude in podiatry, but I think he is good for this forum and I welcome his input. I've been practicing in private practice since 1994, and there is some truth to his observations.

Al Kline DPM
THE FOOT BLOG

 

[AlKlineDPM]

You are speaking from a very limited experience. Basically everywhere I have been, pods take a lot of ER call. The majority of the pods that don't take ER call don't do it because they don't have the training (or they are so rich that they don't care). But the majority of pods coming out today do have it. Believe me, SLC VA DOES NOT represent podiatric medicine!!! And I'd be willing to bet that there are a lot more than one or two pods in Phoenix that take call.

I'm not sure you understand how well podiatrists are trained (compared to orthos).

I will tell you from experience, ER call is not very glamarous, and most doctors, surgeons including podiatrist, will avoid ER call if at all possible. Who wants to get up at 3 in the morning and tend to an infection or fracture? Most ER's now have podiatrists on staff and utilize them daily. It also depends on where you practice. Many ER's will 'contract' out orthopedists, so that is why many of them get the ER call first. Being and MD, DO or DPM has nothing to do with ER involvement.

Al Kline DPM
THE FOOT BLOG

 

[capo]

Dr. Kline, could you elaborate for us some of the downsides of podiatry? We'd all appreciate some candid reviews of the field, as you've seen it evolve over the past decade or so. Thanks from everyone on here.

 

[dpmgrad]

I will tell you from experience, ER call is not very glamarous, and most doctors, surgeons including podiatrist, will avoid ER call if at all possible. Who wants to get up at 3 in the morning and tend to an infection or fracture? Most ER's now have podiatrists on staff and utilize them daily. It also depends on where you practice. Many ER's will 'contract' out orthopedists, so that is why many of them get the ER call first. Being and MD, DO or DPM has nothing to do with ER involvement.

Al Kline DPM
THE FOOT BLOG

Great post about DPMs taking primary ER call for foot and ankle issues. When I started residency training, many of my classmates and I were excited about doing as much as trauma as we can in residency so that we would be prepared for anything that will come in through the ER when we took primary call. However, I can tell you that the main reason why my group would even take primary call in the ER is that we have resident support. As you said, it is not fun to be called 3 am for some foot and ankle issue (whether it is a bad diabetic foot infection that requires surgical intervention or foot and ankle trauma) from the ER. In addition, if you have office hours and you get paged to the ER, it may put you very behind schedule in the office. Hence, resident support is very helpful when a DPM takes primary call for foot and ankle issues in the ER. Many of my classmates (majority of them completed three years residency training) do not take primary call in the ER because it is so disruptive to the family life and private practice. The few classmates that take primary call in the ER do it because they have resident support and can deal with the implications that ER call may have on family life and really enjoy trauma.

 

[Podman]

Great post about DPMs taking primary ER call for foot and ankle issues. When I started residency training, many of my classmates and I were excited about doing as much as trauma as we can in residency so that we would be prepared for anything that will come in through the ER when we took primary call. However, I can tell you that the main reason why my group would even take primary call in the ER is that we have resident support. As you said, it is not fun to be called 3 am for some foot and ankle issue (whether it is a bad diabetic foot infection that requires surgical intervention or foot and ankle trauma) from the ER. In addition, if you have office hours and you get paged to the ER, it may put you very behind schedule in the office. Hence, resident support is very helpful when a DPM takes primary call for foot and ankle issues in the ER. Many of my classmates (majority of them completed three years residency training) do not take primary call in the ER because it is so disruptive to the family life and private practice. The few classmates that take primary call in the ER do it because they have resident support and can deal with the implications that ER call may have on family life and really enjoy trauma.

Thanks for the feedback

 

[dpmgrad]

I should also clarify one more thing about the DPMs that do not take primary call for foot and ankle issues in the ER. Just because they do not take call in the ER, it does not mean that they will not see any trauma in their practice. Many of the foot fractures that do not need immediate surgical intervention(metatarsal, toes, etc...) and ankle sprains are often immobilized in a splint or cast by the ER physician and then sent to the private practice of DPM or Orthopedic Surgeon or PCP (if patient has HMO) for follow up depending on what arrangements the ER has with the DPM and Orthopedic Surgeon. The only trauma that a DPM that do not take call in the ER would miss would be the open fractures and rearfoot/ankle fractures that often require some sort of surgical intervention as soon as possible (depending on the condition of the injured limb). Of course, the DPM may also get foot and ankle trauma from patients that walk into the office or sent over by the PCP. You will be surprise how many patients would rather wait until the doctors office open the next day before going to the ER since many of those patients may end up waiting x amount hours in the ER before being seen.

 

[AlKlineDPM]

Dr. Kline, could you elaborate for us some of the downsides of podiatry? We'd all appreciate some candid reviews of the field, as you've seen it evolve over the past decade or so. Thanks from everyone on here.

Well, like any field there is a downside. Where do you start in medicine generally? Decreasing reimbursement, increased operational costs, etc. etc. The field of podiatry has made great strides in the 'acceptance' of the field as a legitimate, scientific specialty in medicine.

I guess the biggest downside that we still see in podiatry is the amount of ignorance in the general and even medical population. However, I think with the advent of better residency programs, this will improve. Another problem is: the schools are not selective enough. It is a known fact that it is still easier to get into podiatry school than medical school. I know this will probably open a can of worms, but it must be said. One solution is to have a standard set of acceptance criteria for all medical, dental and podiatry schools. Why this has not been thought of before, I don’t know, but I suspect it’s because podiatry schools rely on a certain number of students every year for their bottom line. I think enrollment in podiatry schools is probably lower than medical schools. I’m not really sure what is the real number of students trying to apply to podiatry school vs. medical school. I suspect the medical schools can be more selective due to the higher number of applicants. Also, who would apply to podiatry school if the acceptance standards were the same as medical school? Wouldn’t most people just apply to medical school first? I think this would make for a strong argument that podiatrists should be licensed under the auspice of MD/DPM.

I think podiatry is a great field of medicine, and I for one will admit, I tried medical school first and was not accepted right away. I applied to podiatry school and got accepted on the spot. For me, I turned a frustrating situation into a great opportunity. I am fortunate to have found this field, and my work ethic is just as strong in podiatry as it would have been if I were to have become a medical doctor.

And let’s face it, there are enough quacks out there with both an MD or DPM after their name, so it’s not really the schools or the education you get, but the person who takes that information and applies it in a useful, productive and helpful way.

Al Kline DPM
THE FOOT BLOG