Residency Insight -- A PRESENT Podiatry eZine

Alan Sherman, DPM is the CEO and Co-founder of PRESENT e-Learning Systems. He has helped to make all of the PRESENT online resources become a reality and is the creative thought behind much of the technology. While Alan happily remains behind the scenes doing his work, he has great insight into what we do every day and what direction the profession of Podiatry is taking. I have invited Alan to share some thoughts with us today and I think you will enjoy his perspective. —John Steinberg, DPM, Editor

Alan Sherman, DPM, CCMEP
CEO, PRESENT e-Learning Systems

Podiatry – The Next 10 Years

My first introduction to podiatry was over 30 years ago, and since that time, the profession has been in the evolutionary fast lane. In fact, we've gotten so used to change in our honored profession, that change has become accepted as the norm. As befits any rising star, much continues to be written about our future. That writing tends to take two paths: predictions as to where we should be in 10 years, and predictions as to where we will be in 10 years...and as we live in an imperfect world where perfect justice is rarely achieved, the two predictions rarely match.

As a podiatry student in the late 70s, I fully expected that by the year 2000, Podiatry would have taken it's place as the universally accepted lower extremity specialty – just another medical specialty, like ENT or Urology. What I failed to appreciate then was the hotbed of competition, the turf battles that we would face from Plastic Surgeons, Vascular Surgeons, Dermatologists, and now, even PCPs, PAs and NPs. While we've become widely respected, as I expected, we've not been widely ceded the anatomical turf of the lower extremity, simply because it is too valuable.

So where do I see us in 10 years ? Being a practical guy, I prefer to answer the question from the point of view of where we will be, rather than where we should be. What we can achieve, rather than what we deserve. This time of year, a football analogy is most appropriate. You start the game against a new competitor with the sense that anything is possible, but by the end of the first quarter, that reality has been tested and a new, shall we say "evidence based" reality is now available. Let's say you have tried to run up the middle, and have been pushed back again and again. But the passing game is working and you've even made some yards on some screen plays and pitch outs. So do you continue to run up the middle ? Maybe you do it occasionally to keep the other team off balance defending against it, but you know that won't be how you're going to make the important yardage and get into the end zone to score.

The MD Degree

Following the same analogy, as much as I would like to see all of my colleagues and myself with MD degrees, I don't see that happening in the next 10 years and don't even see it as a way to hasten our achievement of the "golden chalice", the "holy grail"; parity with MDs. Degrees and titles are symbols that generally follow general acceptance that they are deserved, but as symbols, which deliver powerful messages, they are closely guarded. Do today's podiatry school graduates deserve an MD degree ? Of course they do, as much as MDs do. But in 2009, there are still many podiatrists whose knowledge of general medicine was never on par with medical school graduates. In fact, our admissions standards continue to be lower than general medical schools. I do want to acknowledge the many of us who have taken their livelong learning very seriously, and since graduation, have improved their medical knowledge to become the equals or betters of their MD friends. But I don’t think an MD degree will be tolerated for us by the general medical community until the podiatrist down the hall or in the building of the average MD is seen as their equal, and I think we have about a decade to go for that. Is it important for us to have an MD degree ? I think we have already gained what is most important, and that is our rightful place in the medical care systems and the respect of our medical colleagues. The symbols, the awards and decorations, will come eventually.

Why are We All Surgeons?

I think we are also reaching a crossroads as far as our scope of practice, and by this, I don’t mean what we are permitted to do by the scope of our license. I mean what work each of us should do. I trained at a time when a podiatrist did not have the respect of his/hers peers, and could not feel professional pride, unless he did surgery. It hasn't changed much since then. Surgery continues to define us, both qualitatively and quantitatively. Get together with a group of podiatry colleagues, and you can almost feel the need to line up in order of how many surgeries you do and how many are rearfoot cases. Yet, to get into podiatry school, we took no test in hand-eye coordination, no test in spatial relations (since we stopped using the dental boards for admission), or leadership and team building skills. These are all required skills for surgeons, and all were never assessed before we were offered admission. It’s a dirty little secret, but all of my classmates at CCPM in 1977 were never meant to be surgeons, but most have become great doctors. Medical students have vast career choices, from psychiatry to thoracic surgery, and they track into a specialty commensurate with their skills in their 4th year and residency. But we didn’t have that freedom in the 70s and I don’t believe that has changed much in the 30 years since. But in reality, so much of what we do is non-surgical, and highly regarded by the medical community and the public at large. I’ve never understood why we don’t track our own into a part of podiatry practice that is most suitable for their particular skill set ?

The Business Model for Medical Practice

I NEVER IMAGINED when I decided to go into podiatry/medicine how much time I would be spending figuring out :

How to get paid for what I do for patients?
How to maximize my take home from my practice?

I ENVY those of us that work for academic institutions and the VA, just for this reason: they can focus on what is best for patients. I know I am simplifying this to make the point, but I think the point is correct.

If physicians were simply paid a respectable salary for the work we do (and I know this is just a dream at this point) like the system employed at the VA, Mayo and I think Kaiser, we could spend 100% of our time figuring out what is best for our patients. AND if we were paid this way, over time, I think patients would regain the trust that they had in us back in the 50's, before insurance put that big firewall between us and our patients. And the trend that we now see, where more and more of the ART of medicine is being taken away from us, because patients have lost their trust in their entrepreneurial doctors, would start reversing. We know it needs to, because I firmly believe that allowing us to practice the ART along with the SCIENCE ( and a balance is needed here) is in the best interest of patient care.

*WHAT DO YOU THINK?*
What are your plans over the next decade to optimize patient care, along with your income? You can join in on any number of live ETalk discussions, at podiatry.com or create one of your own.