Optometrist to Opthomologist: Podiatrist to Orthopedic Surgeon

[cool_vkb]

Hey i have a quick question. I have no enimity to Optometrist nor this has to do anything with them.

During my Dinner, i was having a conversation with my friend who was having hard time understanding Podiatry. He was trying to convince me that we just as Optometrist are to Opthamologists, We Pods are to Orthopedic Surgeons. In terms of hirearchy , education, insurance fees and scope of practices, etc. like Optometrists cant do surgery, or other higher level tasks. basically they take over the patient from Opthamologist after the surgery (in a hospital setting i mean). i think he has seen Pods working in Orthopedic Practice who do after surgery management of Foot & Ankle cases. but iam not sure wat exactly he was referring.

As far as my research or during my shadowing, i never found anything like that about podiatry in the sense tat we are limited in Foot practice , but i want to ask from u guys also, AS PODIATRISTS , WE ARE THE MASTERS or EXPERTS OF FOOT Right? i mean As a PODIATRIST WE ARE HAVING THE LEGITIMATE POWER OF TREATING (BY SURGERY, PRESCRIPTION,) EVERY THING THAT IS CONCERNED WITH FOOT & ANKLE right ! Or are there some procedures that we still cant do and has to be done by Orthopedic Surgeons only or under their supervision.

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[Podman]

Hey i have a quick question. I have no enimity to Optometrist nor this has to do anything with them.

During my Dinner, i was having a conversation with my friend who was having hard time understanding Podiatry. He was trying to convince me that we just as Optometrist are to Opthamologists, We Pods are to Orthopedic Surgeons. In terms of hirearchy , education, insurance fees and scope of practices, etc. like Optometrists cant do surgery, or other higher level tasks. basically they take over the patient from Opthamologist after the surgery (in a hospital setting i mean). i think he has seen Pods working in Orthopedic Practice who do after surgery management of Foot & Ankle cases. but iam not sure wat exactly he was referring.

As far as my research or during my shadowing, i never found anything like that about podiatry in the sense tat we are limited in Foot practice , but i want to ask from u guys also, AS PODIATRISTS , WE ARE THE MASTERS or EXPERTS OF FOOT Right? i mean As a PODIATRIST WE ARE HAVING THE LEGITIMATE POWER OF TREATING (BY SURGERY, PRESCRIPTION,) EVERY THING THAT IS CONCERNED WITH FOOT & ANKLE right ! Or are there some procedures that we still cant do and has to be done by Orthopedic Surgeons only or under their supervision.

Ok, I think if I understood correctly, you're asking if we have complete procedural control over the foot and ankle right? If that is the case, then the answer is yes and no. Yes, in the sense that if you go through 4-years of podiatric medical school and 3-years of podiatric medicine and surgery residency then you are trained enough to handle any case pertaining to the foot and ankle. However, I also indicated "no", in the sense that the state's scope of practice will impose and guide what procedures you can and cannot do. As you already know, a state like New York prohibits a DPM from operating on the ankle, so eventhough you are trained to operate on the ankle, you cannot legally perform surgeries pertaining to that region in NY. In which case, you'd have to refer your case to an orthopoedic surgeon.

So, in summation, yes if you are well-trained - you should be able to perform foot and ankle surgeries - but that does not necessarily mean that you will in reality get to operate on every foot and ankle related deformity.

 

[cool_vkb]

Ok, I think if I understood correctly, you're asking if we have complete procedural control over the foot and ankle right? If that is the case, then the answer is yes and no. Yes, in the sense that if you go through 4-years of podiatric medical school and 3-years of podiatric medicine and surgery residency then you are trained enough to handle any case pertaining to the foot and ankle. However, I also indicated "no", in the sense that the state's scope of practice will impose and guide what procedures you can and cannot do. As you already know, a state like New York prohibits a DPM from operating on the ankle, so eventhough you are trained to operate on the ankle, you cannot legally perform surgeries pertaining to that region in NY. In which case, you'd have to refer your case to an orthopoedic surgeon.

So, in summation, yes if you are well-trained - you should be able to perform foot and ankle surgeries - but that does not necessarily mean that you will in reality get to operate on every foot and ankle related deformity.

Oh yes, i do know abt Ankle rules, like some states allow and some states dont and we cant do that.

My question was like, lets say if a state has FOOT & ANKLE included or lets just take the example of NY where there is only FOOT. Can a Podiatrist do all the procedures on the foot or there are some special procedures which he cant do and only a Foot and Ankle Ortho can do it.

For example, like an Optometrist, even though he is also having a Doctorate and can treat eye problems but he cant do major surgeries of EYE, they are reserved for Opthomologist or a CRNA does anesthesia but some procedures are strictly reserved for Anesthisiologist. So my question was , As a Podiatrist are there any special procedures or any treatments of foot and Ankle (if a state allows ankle), which are over-ruled for us and only an Ortho can perform it no matter we are licensed to practice on FOOT AND ANKLE in that state.

 

[Podman]

Oh yes, i do know abt Ankle rules, like some states allow and some states dont and we cant do that.

My question was like, lets say if a state has FOOT & ANKLE included or lets just take the example of NY where there is only FOOT. Can a Podiatrist do all the procedures on the foot or there are some procedures which he cant do.

For example, like an Optometrist, even though he is also having a Doctorate and can treat eye problems but he cant do major surgeries of EYE, they are reserved for Opthomologist or a CRNA does anesthesia but some procedures are strictly reserved for Anesthisiologist. So my question was , As a Podiatrist are there any special procedures or any treatments of foot and Ankle (if a state allows ankle), which are over-ruled for us and only an Ortho can perform it no matter we are licensed to practice on FOOT AND ANKLE in that state.

Again, it depends - quite a few of the foot and ankle cases are taken by foot and ankle orthopoedic surgeons, so you wouldn't necessarily get to operate on every foot and ankle case. Remember, podiatry is not just surgery - surgery is a part of it - a big part of it, but as a profession we do alot of non-surgical clinical treatments. However, assuming you are well-trained and are board certified then no there are no restrictions (although some hospitals will impose restrictions - i.e. policies to giving certain cases to orthopoedic surgeons), then you should be able to operate with no problems.

You have to take a broader perspective when looking at our profession - we are not foot and ankle orthopods - a podiatrist is a foot and ankle specialist in the sense that we treat everything and anything pertaining to the foot - which may not necessarily need surgical correction. An optemtrist is not "limited" to no surgeries - he or she is trained to be a primary eye care provider so to compare them to an opthamologist (eye surgeon) is like comparing apples to oranges. Similarily with us, we are foot and ankle specialists with surgical training - some of us can and will do alot of surgeries, some won't - it will all depend on many factors such as: training, certification, location, and the hospital that gives you surgical previlidges.

 

[cool_vkb]

Again, it depends - quite a few of the foot and ankle cases are taken by foot and ankle orthopoedic surgeons, so you wouldn't necessarily get to operate on every foot and ankle case. Remember, podiatry is not just surgery - surgery is a part of it - a big part of it, but as a profession we do alot of non-surgical clinical treatments. However, assuming you are well-trained and are board certified then no there are no restrictions (although some hospitals will impose restrictions - i.e. policies to giving certain cases to orthopoedic surgeons), then you should be able to operate with no problems.

You have to take a broader perspective when looking at our profession - we are not foot and ankle orthopods - a podiatrist is a foot and ankle specialist in the sense that we treat everything and anything pertaining to the foot - which may not necessarily need surgical correction. An optemtrist is not "limited" to no surgeries - he or she is trained to be a primary eye care provider so to compare them to an opthamologist (eye surgeon) is like comparing apples to oranges. Similarily with us, we are foot and ankle specialists with surgical training - some of us can and will do alot of surgeries, some won't - it will all depend on many factors such as: training, certification, location, and the hospital that gives you surgical previlidges.

Ok now i got it. Thank u very much. God bless u!

 

[AZPOD Rocks]

It is hard to argue with a guy who says, "God bless you," frequently and calls everyone, "Boss."

 

[whiskers]

Hey i have a quick question. I have no enimity to Optometrist nor this has to do anything with them.

During my Dinner, i was having a conversation with my friend who was having hard time understanding Podiatry. He was trying to convince me that we just as Optometrist are to Opthamologists, We Pods are to Orthopedic Surgeons. In terms of hirearchy , education, insurance fees and scope of practices, etc. like Optometrists cant do surgery, or other higher level tasks. basically they take over the patient from Opthamologist after the surgery (in a hospital setting i mean). i think he has seen Pods working in Orthopedic Practice who do after surgery management of Foot & Ankle cases. but iam not sure wat exactly he was referring.

As far as my research or during my shadowing, i never found anything like that about podiatry in the sense tat we are limited in Foot practice , but i want to ask from u guys also, AS PODIATRISTS , WE ARE THE MASTERS or EXPERTS OF FOOT Right? i mean As a PODIATRIST WE ARE HAVING THE LEGITIMATE POWER OF TREATING (BY SURGERY, PRESCRIPTION,) EVERY THING THAT IS CONCERNED WITH FOOT & ANKLE right ! Or are there some procedures that we still cant do and has to be done by Orthopedic Surgeons only or under their supervision.

Podiatrists are not "masters" of the lower extremity, ankle or even the esteemed foot.

There are many disease processes that manifest in the foot that we are not able to treat. For example, chronic gout. Sure, you may have a 1st mpj joint that's toast, but you'll send them to their primary care provider for treatment of the hyperuricemia. An orthopod would simply write a script and go from there. The fact is that many diseases are systemic in nature with the precarious involvement of the foot and it's up to the provider to differentiate between what they can treat and what they can't treat.

Things get real complicated when you have a differential diagnosis of one disease that favors systemic pathology and another that favors a pathology within your scope. If you plan to go ahead and treat for the thing within your scope, you'd better have some very good medical evidence, otherwise, err on the side of caution and send them to the specialist, who may or may not send them back to you... And you'd better have a good ruler to measure your anatomical boundries with, regardless of your surgical competence.

Many of us would like to be masters and ther eare probably many who pretend it, but the truth is we are a profession that is very dependant upon the MD's and DOs for even things within our self-proclaimed anatomic expertise.

My advice for you is not to get caught up in these mindless debates of who has the best degree/training etc. It's a complete waste of time because someone is always going to be wrong and it's always the other person, regardless of which side of the argument you reside. Instead, make a life for yourself and don't live to explain it to other people.

It's just another J-O-B.

 

[Podman]

Podiatrists are not "masters" of the lower extremity, ankle or even the esteemed foot.

There are many disease processes that manifest in the foot that we are not able to treat. For example, chronic gout. Sure, you may have a 1st mpj joint that's toast, but you'll send them to their primary care provider for treatment of the hyperuricemia. An orthopod would simply write a script and go from there. The fact is that many diseases are systemic in nature with the precarious involvement of the foot and it's up to the provider to differentiate between what they can treat and what they can't treat.

Things get real complicated when you have a differential diagnosis of one disease that favors systemic pathology and another that favors a pathology within your scope. If you plan to go ahead and treat for the thing within your scope, you'd better have some very good medical evidence, otherwise, err on the side of caution and send them to the specialist, who may or may not send them back to you... And you'd better have a good ruler to measure your anatomical boundries with, regardless of your surgical competence.

Many of us would like to be masters and ther eare probably many who pretend it, but the truth is we are a profession that is very dependant upon the MD's and DOs for even things within our self-proclaimed anatomic expertise.

My advice for you is not to get caught up in these mindless debates of who has the best degree/training etc. It's a complete waste of time because someone is always going to be wrong and it's always the other person, regardless of which side of the argument you reside. Instead, make a life for yourself and don't live to explain it to other people.

It's just another J-O-B.

Recognizing a manfiestation or systemic disease in the lower extremity is typically the first step to treatment - I agree however that treatment within our scope can be somewhat risky at times because you wouldn't want to manifest a larger systemic problem by treating a smaller one "within your scope". However, this is why we go through 4 years of podiatic MEDICAL education and why we spend more than a few years in residency right? To be well trained in treating and recognizing conditions in the lower extremity and knowing how to differentiate the mode of the treatment based on the condition of the patient.

To add to your point regarding our contingency upon the MD's and DO's - well that is a great thing in my opinion - any physician with morals would want the best for his and her patients, so typically you want to make sure that for whatever condition that your patient my have systemically manifesting, that it is taken care of and managed by other physicians as well. We work in networks - this is the reality of our health care system and each person has an important role. You may look at this as a mere "J-O-B". However, to me at least, I think it is a responsibility that I owe to my patients. If I am equiped and trained with knowledge and expertise in a specific branch of medicine, then it is my responsibililty that:

1) I treat the patient to the best of my knowledge/scope
2) offer the patient the best possible treatment by making the right referrals and providing his other physicians with concrete documentation pertaining to that patient's health.

Just my 2 cents

 

[IlizaRob]

Podiatrists are not "masters" of the lower extremity, ankle or even the esteemed foot.

There are many disease processes that manifest in the foot that we are not able to treat. For example, chronic gout. Sure, you may have a 1st mpj joint that's toast, but you'll send them to their primary care provider for treatment of the hyperuricemia. An orthopod would simply write a script and go from there. The fact is that many diseases are systemic in nature with the precarious involvement of the foot and it's up to the provider to differentiate between what they can treat and what they can't treat.

Things get real complicated when you have a differential diagnosis of one disease that favors systemic pathology and another that favors a pathology within your scope. If you plan to go ahead and treat for the thing within your scope, you'd better have some very good medical evidence, otherwise, err on the side of caution and send them to the specialist, who may or may not send them back to you... And you'd better have a good ruler to measure your anatomical boundries with, regardless of your surgical competence.

Many of us would like to be masters and ther eare probably many who pretend it, but the truth is we are a profession that is very dependant upon the MD's and DOs for even things within our self-proclaimed anatomic expertise.

My advice for you is not to get caught up in these mindless debates of who has the best degree/training etc. It's a complete waste of time because someone is always going to be wrong and it's always the other person, regardless of which side of the argument you reside. Instead, make a life for yourself and don't live to explain it to other people.

It's just another J-O-B.

The problem with you whiskers is that you assume too much. You are definately a "the grass is always greener on the other side" kind of guy. An orthopod is not going to want to bother with managing chronic systemic conditions. He will call the family doctor or internist of the patient and talk to them most likely after writing the script for hyperuricemia. Guess what? The pod does the same. Yes, a pod can write the script too. Dont think we are limited in writing scripts. But a good physician will consult other docs who are involved in the medical management of the patient when meds are changed/added, no matter the specialty. Gout is commonly seen in the pod office. If you were to say to a patient with acute gout, "sorry Sir, go make an appointment with your primary care provider for next week" without prescribing anything, be prepared to go to court.

 

[cool_vkb]

The problem with you whiskers is that you assume too much. You are definately a "the grass is always greener on the other side" kind of guy. An orthopod is not going to want to bother with managing chronic systemic conditions. He will call the family doctor or internist of the patient and talk to them most likely after writing the script for hyperuricemia. Guess what? The pod does the same. Yes, a pod can write the script too. Dont think we are limited in writing scripts. But a good physician will consult other docs who are involved in the medical management of the patient when meds are changed/added, no matter the specialty. Gout is commonly seen in the pod office. If you were to say to a patient with acute gout, "sorry Sir, go make an appointment with your primary care provider for next week" without prescribing anything, be prepared to go to court.

what does it mean by "SCRIPT". like u said "a pod can write the script too. Dont think we are limited in writing scripts".

 

[Dmayor22]

Prescription...Script is just short

 

[AlKlineDPM]

The problem with you whiskers is that you assume too much. You are definately a "the grass is always greener on the other side" kind of guy. An orthopod is not going to want to bother with managing chronic systemic conditions. He will call the family doctor or internist of the patient and talk to them most likely after writing the script for hyperuricemia. Guess what? The pod does the same. Yes, a pod can write the script too. Dont think we are limited in writing scripts. But a good physician will consult other docs who are involved in the medical management of the patient when meds are changed/added, no matter the specialty. Gout is commonly seen in the pod office. If you were to say to a patient with acute gout, "sorry Sir, go make an appointment with your primary care provider for next week" without prescribing anything, be prepared to go to court.

I agree, If it's in the foot, you can treat, surgerize, write system scripts (like systemic treatment of gout), etc. etc. We are not really dependant on MD's and DO's, we work together with the MD's and DO's. In fact, it's really the other way around; MD's and DO's don't work with podiatry enough. Then patients wonder why their foot is still hurting. It is a well known fact, that a good podiatrist is the foot specialist in most communities that have a qualified, knowledgeable podiatrist. Unless you are an orthopod and practice podiatry day-in and day-out, you'll never really get as much real-life experience in treating foot and ankle disorders. So the debate goes on, real life experience vs. education. Most orthopedists will argue that they have 4 years of 'real' medical school and 5 years of residency. What people fail to realize is, in their 4 years of medical school, they get virtually no education in podiatry and in their 5 years of residency they get very little foot and ankle experience. That is why they have 6 month to 1 year foot fellowships for orthopedists.

So back to the original question concerning pods working for ortho like optometrists do for ophthalmologist? I've never really heard the comparison and it is kind of a mute argument.

Al Kline DPM
THE FOOT BLOG

 

[cool_vkb]

So back to the original question concerning pods working for ortho like optometrists do for ophthalmologist? I've never really heard the comparison and it is kind of a mute argument.

Al Kline DPM
THE FOOT BLOG

Sir, i also heard this argument from my friend. he was just giving that example bcoz many people (general public) think Optometrist and Opthomologist are same and often confuse OD as a MD (Eye doctor). Yet their functions and scope of practice are very different and as an Opthomologist one can perform all the task of a Optometrist but an Optometrist cant do so many higher tasks (bcoz of his education, job description, scope of practice, they are just primiary care providers etc). Similar case applies to a CRNA and Anesthisiologist. General public doenst knows. they do anesthesia same as a MD yet they are nurse and have some limitations.

So he was making me believe that Podiatrists are also like a second in command position profession with not that many power or scope of practice within the feet itself. He was saying that many times we are basically limited to after surgery management of foot,etc and Orthopods (F & A) are needed for harder procedures. Which i didnt found during my shadowing with my DPM or when i searched on google. But i just wanted to know from others also. So i was asking the question about Pods being masters of foot.

But thanks to Podman, and other good people , i got my answer.

I hope you understand my question now. i know tat argument was kind of mute but i was just quoting from my friend. And thank you for ur valuable contributions. Its really a great resource to get first hand info from a practicing podiatrist. may god bless u.

 

[whiskers]

The problem with you whiskers is that you assume too much. You are definately a "the grass is always greener on the other side" kind of guy. An orthopod is not going to want to bother with managing chronic systemic conditions. He will call the family doctor or internist of the patient and talk to them most likely after writing the script for hyperuricemia. Guess what? The pod does the same. Yes, a pod can write the script too. Dont think we are limited in writing scripts. But a good physician will consult other docs who are involved in the medical management of the patient when meds are changed/added, no matter the specialty. Gout is commonly seen in the pod office. If you were to say to a patient with acute gout, "sorry Sir, go make an appointment with your primary care provider for next week" without prescribing anything, be prepared to go to court.

As clint eastwood once said, "A man's gotta know his limitations."

And I say so does a Podiatrist.

 

[AlKlineDPM]

Sir, i also heard this argument from my friend . . .
So he was making me believe that Podiatrists are also like a second in command position profession with not that many power or scope of practice within the feet itself. He was saying that many times we are basically limited to after surgery management of foot,etc and Orthopods (F & A) are needed for harder procedures. . . .

Your friend is just plain WRONG and is misguided. Some would even call it ignorant .

 

[AlKlineDPM]

As clint eastwood once said, "A man's gotta know his limitations."

And I say so does a Podiatrist.

You have it wrong my friend, in Podiatry, there are no limitations . . .

 

[cool_vkb]

Your friend is just plain WRONG and is misguided. Some would even call it ignorant .

I agree with you Sir!

 

[foraminal]

Prescription...Script is just short

rx=prescription

 

[jonwill]

He was saying that many times we are basically limited to after surgery management of foot,etc and Orthopods (F & A) are needed for harder procedures.

Over the past few months, I have participated in some of the most complex procedures possible in foot and ankle surgery so I'd have to say that "your friend" is way off.

It has been my experience that some of podiatry's harshest critics are those who actually know nothing about it. Your friend seems to be a very good example of that.

 

[cool_vkb]

Over the past few months, I have participated in some of the most complex procedures possible in foot and ankle surgery so I'd have to say that "your friend" is way off.

It has been my experience that some of podiatry's harshest critics are those who actually know nothing about it. Your friend seems to be a very good example of that.

he is not ignorant, but he is a kind of those hardcore Pre-med and u know how they are. dont wanna accept anything. I have seen many people like that , who even after knowing the facts dont wanna accept them. in fact they just dont want to accept it, even if u somehow download this podiatry concept in their brain but still they will treat it like that. i have seen a lot of fools like that, but hey wat can i do. he is my buddy also so cant argue with him too much.

 

[dawg44]

He was saying that many times we are basically limited to after surgery management of foot,etc and Orthopods (F & A) are needed for harder procedures.

Its easy for DPMs to dismiss this but I hear this first hand a minimum of 3-4 times a week from patients. Or if they aren't limiting themselves, they should. I've also heard it from multiple other physicians, not to mention two CEOs one in a 350 bed hospital and one in a 475 bed hospital. Those aren't exactly ignorant premeds and like it or not they are a part of the medical community. Maybe these 3 year residencies will improve DPM's image as they move away from going straight to practice or apprenticeships. It can't hurt, but you can't deny that there is a stigma in the medical community that's going to take a long time to wash away in some areas of the country.

 

[jonwill]

Its easy for DPMs to dismiss this but I hear this first hand a minimum of 3-4 times a week from patients. Or if they aren't limiting themselves, they should. I've also heard it from multiple other physicians, not to mention two CEOs one in a 350 bed hospital and one in a 475 bed hospital. Those aren't exactly ignorant premeds and like it or not they are a part of the medical community. Maybe these 3 year residencies will improve DPM's image as they move away from going straight to practice or apprenticeships. It can't hurt, but you can't deny that there is a stigma in the medical community that's going to take a long time to wash away in some areas of the country.

I can't figure out where you are practicing but I can tell you that this mentality is largely limited to that area (I'm betting northeast). I have been all over the nation and, infact, have not been to a hospital (Level one and two) where ortho touched below the knee. I will agree that there are pods out there that probably shouldn't be doing some of the things that they are doing. But that can be said about a lot of different docs.

F & A orthos get good training but in no way is it superior to the training that pods have been getting for the last 10 years. Generally speaking in reference to training, pods will perform more foot and ankle procedures in their residency as compared to orthos, F&A ortho included.

And I definitely agree that as the well trained pods continue to take over the field, the way podiatry is viewed will change. This is already being seen in many parts of the country as pods are now chief of medical staff, chief of surgery, etc. In the city that I am currently in, the major hospitals have just changed policy to include podiatrists as medical staff with full admitting privileges. So, slowly but surely, it is coming to pass.

 

[dawg44]

I can't figure out where you are practicing but I can tell you that this mentality is largely limited to that area (I'm betting northeast). I have been all over the nation and, infact, have not been to a hospital (Level one and two) where ortho touched below the knee. I will agree that there are pods out there that probably shouldn't be doing some of the things that they are doing. But that can be said about a lot of different docs.

F & A orthos get good training but in no way is it superior to the training that pods have been getting for the last 10 years. Generally speaking in reference to training, pods will perform more foot and ankle procedures in their residency as compared to orthos, F&A ortho included.

And I definitely agree that as the well trained pods continue to take over the field, the way podiatry is viewed will change. This is already being seen in many parts of the country as pods are now chief of medical staff, chief of surgery, etc. In the city that I am currently in, the major hospitals have just changed policy to include podiatrists as medical staff with full admitting privileges. So, slowly but surely, it is coming to pass.

I've been through 5 level one trauma centers during my training. In the midwest and south and I wonder if the ortho guys running the trauma are fellowship trained in trauma or if they are just covering call and would rather just give it to some one else so they don't mess up their office. I have never ever seen an orthopedic traumatologist that didn't jump all over a calcaneus or pilon. Heck an open tibia for an ortho trauma guy is like a carpel tunnel for a hand orthopod, so I have no experience with everything below the knee going to a DPM.
Orthopedic surgeons do wield alot of power in a hospital. With the shortage and call situation it's just going to get worse. A friend of mine that is a F&A orthopod moved to a new facility two years ago, but he stated to the medical staff he wouldn't come until the DPMs (3 in all) were kicked off of staff. There was a big enough shortage for general ortho call in the area and the hospital was in a pinch, it happened just like that. All he had to do was request it. The medical staff passed a bylaw that for musculoskeletal cases to performed in the hospital you have to complete a 4 year ACGME accredited residency and that was that.

 

[jonwill]

I've been through 5 level one trauma centers during my training. In the midwest and south and I wonder if the ortho guys running the trauma are fellowship trained in trauma or if they are just covering call and would rather just give it to some one else so they don't mess up their office. I have never ever seen an orthopedic traumatologist that didn't jump all over a calcaneus or pilon. Heck an open tibia for an ortho trauma guy is like a carpel tunnel for a hand orthopod, so I have no experience with everything below the knee going to a DPM.
Orthopedic surgeons do wield alot of power in a hospital. With the shortage and call situation it's just going to get worse. A friend of mine that is a F&A orthopod moved to a new facility two years ago, but he stated to the medical staff he wouldn't come until the DPMs (3 in all) were kicked off of staff. There was a big enough shortage for general ortho call in the area and the hospital was in a pinch, it happened just like that. All he had to do was request it. The medical staff passed a bylaw that for musculoskeletal cases to performed in the hospital you have to complete a 4 year ACGME accredited residency and that was that.

That is harsh! I have always had very positive experiences with ortho. In fact, at one program, I liked the ortho residents better than I liked the pod residents! As far as the shortage is concerned, it is only going to get worse.

 

[cool_vkb]

A friend of mine that is a F&A orthopod moved to a new facility two years ago, but he stated to the medical staff he wouldn't come until the DPMs (3 in all) were kicked off of staff.

Why wud that Ortho do such a thing. was he having some problem with Pods or any personal reason (like a Pod stole his GF ). It just sound some kind of discrimination. and tomorrow if tat ortho gets in an accident and is in need of some F & A help in a seculuded rural hospital where there is only a DPM stationed. Will he prefer to suffer or will he then get treatment from a DPM.

 

[dawg44]

Why wud that Ortho do such a thing. was he having some problem with Pods or any personal reason (like a Pod stole his GF ). It just sound some kind of discrimination. and tomorrow if tat ortho gets in an accident and is in need of some F & A help in a seculuded rural hospital where there is only a DPM stationed. Will he prefer to suffer or will he then get treatment from a DPM.

He wanted to be the end of the line as far a foot and ankle was concerned in that town and that was a relatively easy way to do it. Two of the DPMs closed up shop and left. One stayed and only does nonoperative stuff. To get him to come to that town that's what the medical staff and hospital had to do, otherwise they had to ship everything else out the door and could barely take care of a hip fracture.
I think he would say splint it and I will be on my way. Nowhere is secluded enough that a chopper can't get there.

 

[dawg44]

That is harsh! I have always had very positive experiences with ortho. In fact, at one program, I liked the ortho residents better than I liked the pod residents! As far as the shortage is concerned, it is only going to get worse.

Yeah it was pretty harsh. I'm still going to do lots of general ortho and sports, so I'm not that concerned with competition. I won't do toenails or windows. You've probably seen me post this before, there have been no DPMs on staff at any of the hospitals I've worked at, I just have no experience other than referrals with DPMs. I like to come in here and stir it up.

 

[cool_vkb]

He wanted to be the end of the line as far a foot and ankle was concerned in that town and that was a relatively easy way to do it. Two of the DPMs closed up shop and left. One stayed and only does nonoperative stuff. To get him to come to that town that's what the medical staff and hospital had to do, otherwise they had to ship everything else out the door and could barely take care of a hip fracture.
I think he would say splint it and I will be on my way.

Was there like only one hospital in the town.

 

[dawg44]

Was there like only one hospital in the town.

One major system in town.

 

[doclm]

I've been through 5 level one trauma centers during my training. In the midwest and south and I wonder if the ortho guys running the trauma are fellowship trained in trauma or if they are just covering call and would rather just give it to some one else so they don't mess up their office. I have never ever seen an orthopedic traumatologist that didn't jump all over a calcaneus or pilon. Heck an open tibia for an ortho trauma guy is like a carpel tunnel for a hand orthopod, so I have no experience with everything below the knee going to a DPM.
Orthopedic surgeons do wield alot of power in a hospital. With the shortage and call situation it's just going to get worse. A friend of mine that is a F&A orthopod moved to a new facility two years ago, but he stated to the medical staff he wouldn't come until the DPMs (3 in all) were kicked off of staff. There was a big enough shortage for general ortho call in the area and the hospital was in a pinch, it happened just like that. All he had to do was request it. The medical staff passed a bylaw that for musculoskeletal cases to performed in the hospital you have to complete a 4 year ACGME accredited residency and that was that.

Are you including level 1 trauma in MN? Mayo?

 

[cool_vkb]

Nowhere is secluded enough that a chopper can't get there.

Sir, this is kind of over confident statement. Its out of content, but we human beings think we are the most powerfull creature.

People who once lived in mansion and were proud of their beach houses near the beach in Indonesia, India were searching for food in garbage bins and sleeping in refugee camps after the Tsunami came. Sure, later they were rescued and got back their lives but they did had to suffer and neither their wealth, their status, their power came to rescue them. but for that time, they had no option. they cudnt order their servant to get them a roast turkey and gravy or ask their chopper to drop by and pick them.

Its not an attack on ur friend. but when disaster strucks everything goes wrong. i hope god protect him and bless him but in general iam saying, as u said "Nowhere is secluded enough that a chopper can't get there." Believe me, chances are he might be in the middle of a city and a chopper may not come to get him based on external factors like weather,fire, hail storm,etc. and if a DPM is there he has to show him unless he wanna wait for the rescue to come. what he did was too harsh and primal mamalian instinct to protect himself.

In a country where CRNAs practice in parallel to Anesthisiologists, a country where PAs can prescribe, Chiros can interpret MRIs. People gotta broaden their outlook. Its healthy for them as well as society. may be iam no pod student, may be i dont even know wat the scope of podiatry is. but i work in imaging industry and i know how succesfull they are. today the Podiatry lobby is not as strong as AMA but we all know its all about money. just as CRNAs were able to get wat they wanted. tomorrow when Pod lobby bcomes strong it wont be hard for POds to get wat they want. At the end of the day its all politics. and time changes, it changes everytime.

 

[dawg44]

Sir, this is kind of over confident statement. Its out of content, but we human beings think we are the most powerfull creature.

People who once lived in mansion and were proud of their beach houses near the beach in Indonesia, India were searching for food in garbage bins and sleeping in refugee camps after the Tsunami came. Sure, later they were rescued and got back their lives but they did had to suffer and neither their wealth, their status, their power came to rescue them. but for that time, they had no option. they cudnt order their servant to get them a roast turkey and gravy or ask their chopper to drop by and pick them.

Its not an attack on ur friend. but when disaster strucks everything goes wrong. i hope god protect him and bless him but in general iam saying, as u said "Nowhere is secluded enough that a chopper can't get there." Believe me, chances are he might be in the middle of a city and a chopper may not come to get him based on external factors like weather,fire, hail storm,etc. and if a DPM is there he has to show him unless he wanna wait for the rescue to come. what he did was too harsh and primal mamalian instinct to protect himself.

In a country where CRNAs practice in parallel to Anesthisiologists, a country where PAs can prescribe, Chiros can interpret MRIs. People gotta broaden their outlook. Its healthy for them as well as society. may be iam no pod student, may be i dont even know wat the scope of podiatry is. but i work in imaging industry and i know how succesfull they are. today the Podiatry lobby is not as strong as AMA but we all know its all about money. just as CRNAs were able to get wat they wanted. tomorrow when Pod lobby bcomes strong it wont be hard for POds to get wat they want. At the end of the day its all politics. and time changes, it changes everytime.

We went from discussing having a foot problem and going to a rural hospital with a DPM to a Tsunami and 100,000 people dead. Think there's a little bit of a leap there? Such always happens when talking about the hypothetical.

Who knows if it was harsh or wrong, apparently the hospital and medical staff didn't care. They went along with it and he got what he asked for. They didn't have to do it. If they thought it was wrong they could have said no and he could go elsewhere. One of the DPMs didn't want to leave town. He's actually employed by the group as a nonoperative podiatrist and sees toenails, ulcers and heel pain. If anything needs surgery it goes to the F&A guy. Politics can be huge part of the equation in any town. Hey I'm just telling how this scenario played out.

 

[cool_vkb]

We went from discussing having a foot problem and going to a rural hospital with a DPM to a Tsunami and 100,000 people dead. Think there's a little bit of a leap there? Such always happens when talking about the hypothetical.

he he he eh . thankgod there isnt life on Mars or europa. Or else that also i wud have brought in discussion.

No i was just saying all this bcoz u were saying very confidently tat a chopper can come anywhere and rescue. so i was just trying to give examples.

I dont think he was unfair but he was harsh. he is also a F & A and he also has to make sure his practice is secure.

 

[cool_vkb]

Hey I'm just telling how this scenario played out.

One more thing, plzz never ever take my post seriously. i have a tendency to write watever comes in my mind. So if iam going off the way, plzz do correct me. You are senior to me, i have to learn a lot from you. So keep me in your good books. ok!

 

[IlizaRob]

We went from discussing having a foot problem and going to a rural hospital with a DPM to a Tsunami and 100,000 people dead. Think there's a little bit of a leap there? Such always happens when talking about the hypothetical.

Who knows if it was harsh or wrong, apparently the hospital and medical staff didn't care. They went along with it and he got what he asked for. They didn't have to do it. If they thought it was wrong they could have said no and he could go elsewhere. One of the DPMs didn't want to leave town. He's actually employed by the group as a nonoperative podiatrist and sees toenails, ulcers and heel pain. If anything needs surgery it goes to the F&A guy. Politics can be huge part of the equation in any town. Hey I'm just telling how this scenario played out.

A CEO of a small hospital here in Iowa was telling me that a different hospital in Iowa salaried an ortho over a million a year because of how much he made the hospital. If these guys can bring in this much money no wonder why they are at the top of the political reign. If I were the CEO of that hospital I would probably do anything to keep him happy (Without breaking any antikickback laws of course). Our society lives on money and politics. Thats the way it is, and thats the way it will always be. hopefully, as the new generation of trained pods sweep the nation, we can gain a little more political power and respect where something like this would not happen. Podiatry and ortho can have a good relationship. There is enough out there for everyone.

 

[Dr_Feelgood]

Pods can make some good money for groups also. I talk to a pod Friday that billed 2.3 million last year for his multi-specialty group. He said that if he was private practice he would have made over $750K.

 

[cool_vkb]

See when things come about generating revenue or money. Its not abt what u studied or what u did. It is all abt Marketting. I know some Chiros in Chicago area who dont even prescribe tylenol yet their practices are overflowing and they are extraordinary rich. And i know a Internist in my family who is struggling and doing very bad.

If we know the right marketting skills and are able to convince the local population that v r the right choice. We will definetly make good money. Iam just giving an example, Iam an Indian. we indians generally operate in a close knit community. If i become a Pod and open my practice in my area. I will definetly get a good amount of patients. they are not going to care or do research whether iam a DPM or Ortho. The only thing they care is whether i will be able to treat them or not for their F & A probem. Now if i take their undue advantage and treat them wrong then ofcourse my practice is gonna suffer setbacks. I think the main factor is belief in the doctor. if u r having good social, communication and marketting skills u will succeed. So many external factors come into pay when things come on independent practice. Iam no Podiatrist, but basic business laws apply everywhere. after all healthcare itself is a very very very big business.

the problem comes usually when someone wants to start his business in already saturated area full of DPMS and Orthos. ofcourse he will suffer!