Redefining the Role of Podiatric Medicine

[DexterMorganSK]

Following is from a dean's lecture at WesternU:


Podiatric physicians and surgeons are trained alongside their allopathic and osteopathic peers, have proven to be equal in their ability to care for patients, and should be licensed accordingly. That was the message from Franklin J. Medio, PhD, keynote speaker for the fourth annual Western University of Health Sciences College of Podiatric Medicine Dean’s Distinguished Lecture March 13, 2019. Medio, who is president of Consulting Services for the Health Professions, presented “The Recognition of Podiatric Medicine as a Medical-Surgical Specialty: Breaking Down Barriers through Education and Training.” Medio said he does not consider podiatry a separate profession from allopathic and osteopathic physicians. Dentistry, pharmacy, and optometry have unique qualities and are different professions, he said. But podiatrists perform a complete history and physical examination of patients. They order lab tests. If a patient has a medical problem that’s outside of their scope, they call for a consultation. “They manage patients just like any other physician. I don’t see the difference.”


(L-R) Drs. Franklin Medio and Lester Jones (Photo: Jeff Malet)

The main difference is that podiatric medical students do not take the United States Medical Licensing Examination (USMLE) or the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA). Podiatric medicine and surgery is not recognized by the LCME (Liaison Committee on Medical Education), by COCA (Commission on Osteopathic College Accreditation), or ACGME (Accreditation Council for Graduate Medical Education) as a clinical rotation, Medio said.

WesternU CPM is already taking steps toward having its students earn a Physicians and Surgeons Certificate, which will require approval from the Medical Board of California. CPM students will sit for the Comprehensive Basic Science Examination beginning this year and for the next two years. “Then we will assess and evaluate it. That will help us determine their readiness to sit for the USMLE. Once we are able to demonstrate proficiency at the initial level, then we will be able to take it further,” said CPM Interim Dean Lester J. Jones, DPM, MS. “The whole key is that the four-year academic environment here at WesternU sets the stage for our students to have the knowledge, skills, and attitudes necessary to be able to sit and be successful at each of those stages of that type of testing structure.”

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[DexterMorganSK]

Interesting stuff and waiting to see what happens next. I believe with the right prep and use of questions, Pod students can also do well on Step 1; though, our current curriculum is not tailored for this exam.

 

[wakaflocka88]

This is delusional and mis-leading. While it is a good idea in theory, it will not be beneficial. Sure, you can obtain the P&S certification, but as long as garbage residency programs exist, our training will never be standardized enough across the board to prove to the medical community we can all perform and be equivocally skilled. Passing the USMLE is one aspect, but passing it in addition to receiving a comprehensive education and residency training is another discussion.

 

[DexterMorganSK]

This is delusional and mis-leading. While it is a good idea in theory, it will not be beneficial. Sure, you can obtain the P&S certification, but as long as garbage residency programs exist, our training will never be standardized enough across the board to prove to the medical community we can all perform and be equivocally skilled. Passing the USMLE is one aspect, but passing it in addition to receiving a comprehensive education and residency training is another discussion.

Residency training will be better as time passes, just like what is happening to the AOA spots once ACGME took over, starting from this year.

 

[Podstar]

Seems the wording on the National Board of Physicians and Surgeons website says certification requires ABMS or AOA certification, which podiatrists cannot attain. I wonder how they plan to get their students certified?

 

[wakaflocka88]

Residency training will be better as time passes, just like what is happening to the AOA spots once ACGME took over, starting from this year.

Nope. A handful of programs have been around the block for too long and look at the quality. Look at the programs that scramble each year. How can these programs claim to provide RRA certification and/or as they describe on CASPR “comprehensive forefoot, rearfoot and trauma surgery....”

 

[de Ribas]

Residency training will be better as time passes, just like what is happening to the AOA spots once ACGME took over, starting from this year.

100% agree

 

[de Ribas]

My thoughts on DPMs taking USMLE.

I know that most would say that DPMs would not do well on USMLE. I heard somewhere on SDN that at one DPM school students took USMLE and didn't do so well. But we have to consider several things. Those students never took USMLE as if their life, career, specialty or income depended on it. Those students didn't spend 2 pre-clinical years knowing that they would have to take USMLE. They didn't have enough time and motivation to study for it. I am sure that given that DPMs are required to take USMLE, they can do well enough on it. Maybe not so well as MD average, but well enough to start. We have to consider this as well. Most of DPMs go to school with DOs or MDs. At my school for example, we take all the same classes presented on USMLE during first 2 years as do DOs. Maybe except Ob class. So, why given same preclinical years, we can accept that DOs can get decent scores on USMLE, but DPMs cannot?

Also, as we all know, it is not so much that preclinical years get someone ready for USMLE, but personal prep through B&B, Anki and all other resources available for everyone. On MD/DO forums, students often say how they see preclinical years completely useless and that they use outside resources to study for exams and boards. I personally know DOs at my school that they say they do not go to lectures and do not use school resources. They use board prep materials and do well on exams.

So, why wouldn't DPMs be able to do well on USMLE, given we are required to take it or as if our life depends on it.

How come FMGs coming from other developing countries can do very well on USMLE. I personally know an MD who took USMLE and scored in 240 range ~15 years after he graduated med school in another country. He was able to teach himself everything he needed in less than 1 year.

 

[Nowehjose]

We lack the rotations of DO and MD medical student as well as emergency medicine courses... Waste of money paying for usmle to say "looky looky me doctor too".

If we sacrifice pod rotation clinics for general ones, we would need more residency... might as well go to DO school and be a Ortho at that point.

 

[HarmonicConvergence]

I think this is a step moving in the right direction. Progress has to start somewhere. Residency quality is def also an issue that needs to get better but I think in time it will. I mean compared to other specialties we just got mandatory 3 yr residencies. Allo has had many decades to perfect their system. I think if the field keeps progressing COTH and CPME will be forced to follow suit and mandate a certain quality in training for accreditation.

 

[DexterMorganSK]

We lack the rotations of DO and MD medical student as well as emergency medicine courses... Waste of money paying for usmle to say "looky looky me doctor too".

If we sacrifice pod rotation clinics for general ones, we would need more residency... might as well go to DO school and be a Ortho at that point.

Yes, we do lack those rotations right now...but if at a point in the future DPM students are allowed to sit for the USMLE then everything else should also be upgraded to meet the LCME/CPME requirements. That will take time though..as we are seeing it with the MD/DO merger.

We'll know more as time goes on but this thought process is definitely in the right direction, imo.

 

[HarmonicConvergence]

We lack the rotations of DO and MD medical student as well as emergency medicine courses... Waste of money paying for usmle to say "looky looky me doctor too".

If we sacrifice pod rotation clinics for general ones, we would need more residency... might as well go to DO school and be a Ortho at that point.

I don't see what that has to do with the usmle which is taken before the clinical years. I think its less looky im a doctor too as is hire and pay me like I am a doctor. Medicaid still does not consider pods physicians and thus states have the right to not cover podiatric services.

Getting physician status is in the best interest of all our bank accounts IMO

 

[DexterMorganSK]

My thoughts on DPMs taking USMLE.

I know that most would say that DPMs would not do well on USMLE. I heard somewhere on SDN that at one DPM school students took USMLE and didn't do so well. But we have to consider several things. Those students never took USMLE as if their life, career, specialty or income depended on it. Those students didn't spend 2 pre-clinical years knowing that they would have to take USMLE. They didn't have enough time and motivation to study for it. I am sure that given that DPMs are required to take USMLE, they can do well enough on it. Maybe not so well as MD average, but well enough to start. We have to consider this as well. Most of DPMs go to school with DOs or MDs. At my school for example, we take all the same classes presented on USMLE during first 2 years as do DOs. Maybe except Ob class. So, why given same preclinical years, we can accept that DOs can get decent scores on USMLE, but DPMs cannot?

Also, as we all know, it is not so much that preclinical years get someone ready for USMLE, but personal prep through B&B, Anki and all other resources available for everyone. On MD/DO forums, students often say how they see preclinical years completely useless and that they use outside resources to study for exams and boards. I personally know DOs at my school that they say they do not go to lectures and do not use school resources. They use board prep materials and do well on exams.

So, why wouldn't DPMs be able to do well on USMLE, given we are required to take it or as if our life depends on it.

How come FMGs coming from other developing countries can do very well on USMLE. I personally know an MD who took USMLE and scored in 240 range ~15 years after he graduated med school in another country. He was able to teach himself everything he needed in less than 1 year.

Most students do just fine with the USMLE World Q-bank, First Aid for Step 1, and Pathoma for pathology....maybe sketchy micro...rest is up to the student to put in the time and study. If we have the time to use those resources, we can also do fine on that exam considering our curriculum is very similar to md/do.

 

[de Ribas]

I think this is a step moving in the right direction. Progress has to start somewhere. Residency quality is def also an issue that needs to get better but I think in time it will. I mean compared to other specialties we just got mandatory 3 yr residencies. Allo has had many decades to perfect their system. I think if the field keeps progressing COTH and CPME will be forced to follow suit and mandate a certain quality in training for accreditation.

Agree. Also I think DPMs that have been graduating for past 5-10 years and all those who train now at good 3-year residency programs will eventually become program directors and will also help improve residencies.

 

[Nowehjose]

An extra 4k for those pods... who will be required to take usmle… I don't see this happening within the next 10 years... Too much political bull****.

 

[de Ribas]

We lack the rotations of DO and MD medical student as well as emergency medicine courses... Waste of money paying for usmle to say "looky looky me doctor too".

If we sacrifice pod rotation clinics for general ones, we would need more residency... might as well go to DO school and be a Ortho at that point.

I look at this from slightly different perspective. For me it is not so much about saying that I am equal or not to other physicians, but rather to improve our education to respond to current requirements, standards and demands.

MD standards have been improving during the last century, as well as educational standards of DOs. I think it is fine if we understand today's demands and improve our education to be equally qualified.

 

[HarmonicConvergence]

An extra 4k for those pods... who will be required to take usmle… I don't see this happening within the next 10 years... Too much political bull****.

Thats very true it is a whole lot of political B.S. I can't see it happening in 5 years but i could see pods getting the option to sit in 7-10 years. I personally don't think usmle should be mandatory. I'd like us to have the option like DO's.

 

[Nowehjose]

I look at this from slightly different perspective. For me it is not so much about saying that I am equal or not to other physicians, but rather to improve our education to respond to current requirements, standards and demands.

MD standards have been improving during the last century, as well as educational standards of DOs. I think it is fine if we understand today's demands and improve our education to be equally qualified.

So, we will all be grandfathered in? Then those pods after us will face the same stigma for the next 20 years that we are facing for the non-surgical pods... You think the people who write our boards will give up on all that money from us, so we can pay another group?

Ask the class bottom 30% DO students how the merger went in 7 years. We are bright, but lets face it majority of us would be bottom dwellers in MD. Major reason a lot of us are here is our poor standardized test taking, for example the mcat… I want more money, I'm just being honest.

 

[DexterMorganSK]

Thats very true it is a whole lot of political B.S. I can't see it happening in 5 years but i could see pods getting the option to sit in 7-10 years. I personally don't think usmle should be mandatory. I'd like us to have the option like DO's.

So, we will all be grandfathered in? Then those pods after us will face the same stigma for the next 20 years that we are facing for the non-surgical pods... You think the people who write our boards will give up on all that money from us, so we can pay another group?

You guys are looking a bit much into the future. Let's see how the kids at CPM do on the CBSE (which is about 3 years from today)

 

[Stagg737]

Residency training will be better as time passes, just like what is happening to the AOA spots once ACGME took over, starting from this year.

That's not really what's happening with the merger. The AOA programs that got accredited likely could have gotten accredited at any time. Sure, some programs have had to up their game, but most programs will be largely unchanged after the merger and time likely won't change that.

Also, I have no idea why anyone would want to take USMLE. I get it for MDs/DOs and I think mid-levels who want to practice independently should have to do this if they're going to shoot for full autonomy. For podiatry though, which is a similar but more limited field in terms of geography of the body, I think large portions of the test(s) aren't really relevant.

 

[CutsWithFury]

Yes, we do lack those rotations right now...but if at a point in the future DPM students are allowed to sit for the USMLE then everything else should also be upgraded to meet the LCME/CPME requirements. That will take time though..as we are seeing it with the MD/DO merger.

We'll know more as time goes on but this thought process is definitely in the right direction, imo.

Merging with LCME/CPME is what podiatry has been REFUSING to do. You can thank the APMA for that. Podiatry is the only profession that has not progressed. The APMA is greedy. They want more privileges and fight things at the state level to only benefit podiatry.

But the one thing that could allow us to be "equal" they don't want to do. Why?

Because if the LCME/CPME takes over then the party is over for all these old greedy podiatrists who are now career politicians and take the APMA dues and pocket them. Then ABFAS would be dissected and destroyed by the LCME/CPME. The DPM who designed the crappy CBPS exam would be out of the job. Everything would change. Our profession would be at the mercy of the LCME/CPME. Ortho would definitely have a hand in re-defining podiatry and who knows what direction the profession would take.

 

[DexterMorganSK]

Merging with LCME/CPME is what podiatry has been REFUSING to do. You can thank the APMA for that. Podiatry is the only profession that has not progressed. The APMA is greedy. They want more privileges and fight things at the state level to only benefit podiatry.

But the one thing that could allow us to be "equal" they don't want to do. Why?

Because if the LCME/CPME takes over then the party is over for all these old greedy podiatrists who are now career politicians and take the APMA dues and pocket them. Then ABFAS would be dissected and destroyed by the LCME/CPME. The DPM who designed the crappy CBPS exam would be out of the job. Everything would change. Our profession would be at the mercy of the LCME/CPME. Ortho would definitely have a hand in re-defining podiatry and who knows what direction the profession would take.

I think all the issues you stated with this profession are the reasons why there should be a talk about changes in the future. And if it comes to these changes then either the APMA steps up/helps with the transition or give up and let someone else do it for them.

Ortho will for sure have a big say in any significant change to this profession, as they do their best downgrading Pods as much as possible.

 

[Weirdy]

I think all the issues you stated with this profession are the reasons why there should be a talk about changes in the future. And if it comes to these changes then either the APMA steps up/helps with the transition or give up and let someone else do it for them.

Ortho will for sure have a big say in any significant change to this profession, as they do their best downgrading Pods as much as possible.

I feel that you have too much faith in the apma to do the right thing.

 

[DexterMorganSK]

I feel that you have too much faith in the apma to do the right thing.

lol..its more like this :

 

[HarmonicConvergence]

Merging with LCME/CPME is what podiatry has been REFUSING to do. You can thank the APMA for that. Podiatry is the only profession that has not progressed. The APMA is greedy. They want more privileges and fight things at the state level to only benefit podiatry.

But the one thing that could allow us to be "equal" they don't want to do. Why?

Because if the LCME/CPME takes over then the party is over for all these old greedy podiatrists who are now career politicians and take the APMA dues and pocket them. Then ABFAS would be dissected and destroyed by the LCME/CPME. The DPM who designed the crappy CBPS exam would be out of the job. Everything would change. Our profession would be at the mercy of the LCME/CPME. Ortho would definitely have a hand in re-defining podiatry and who knows what direction the profession would take.

Wait isn't that a good thing that APMA fights for more podiatric privileges at the state level. And if podiatry merging with LCME/CPME would let ortho have their way with us isnt it a good thing APMA doesnt let us merge?

 

[CutsWithFury]

Wait isn't that a good thing that APMA fights for more podiatric privileges at the state level. And if podiatry merging with LCME/CPME would let ortho have their way with us isnt it a good thing APMA doesnt let us merge?

If you are looking for equality merging with LCME/CPME is the only way.

If you are looking for more of the same then the way things are is what you want.

You can't have both.

 

[wakaflocka88]

If you are looking for equality merging with LCME/CPME is the only way.

If you are looking for more of the same then the way things are is what you want.

You can't have both.

I think all the issues you stated with this profession are the reasons why there should be a talk about changes in the future. And if it comes to these changes then either the APMA steps up/helps with the transition or give up and let someone else do it for them.

CutsWithFury nails it. DexterMorganSK, once you start residency and enter the real world and not the BS school feeds you, you'll understand it better. As long as these old croons run the show higher-up, it will never progress. To them, greed trumps everything else. As long as they continue to reap the benefits, why fix it if it ain't broken?

 

[DexterMorganSK]

CutsWithFury nails it. DexterMorganSK, once you start residency and enter the real world and not the BS school feeds you, you'll understand it better. As long as these old croons run the show higher-up, it will never progress. To them, greed trumps everything else. As long as they continue to reap the benefits, why fix it if it ain't broken?

Sounds good. I can't wait to start dealing with the real world!