Jarrod Shapiro, DPM
Practice Perfect Editor
Mountain View
Medical &
Surgical Associates,
Madras, Oregon
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Podiatric Parity?
This past weekend, I completed my Advanced Cardiac Life Support (ACLS) certification. For my hospital, this was voluntary for me as a podiatrist, but going through the classes and workshops started me thinking. Should podiatrists be mandated to be ACLS certified? What about being able to read ECGs? H&Ps? How about admissions? What about treating other medical conditions and complications? In light of the APMA’s work on Vision 2015, as well as the hard efforts of podiatrists throughout the country for parity with MDs and DOs, I’m going to argue a strong YES to all of the above questions. This brings up the bigger question: are we, in 2009, on par with the rest of the physician community? That answer, I’ll argue, is NO.
I’d like to make the argument that we should be trained equivalently from two standpoints: podiatric parity and quality of patient care. Let’s start with parity with other specialties. Listed below is the overall mission and main objectives of Vision 2015 as quoted from the APMA.
Overall Mission: Podiatrists are universally accepted and recognized as physicians consistent with their education, training, and experience.
Objectives:
O1.
O2.
O3.
O4.
O5. |
Evaluate and ensure that podiatric medical education is comparable to that of allopathic and osteopathic physicians.
Demonstrate to the entire health care community that the education, training, and experience of a podiatric physician are comparable to that of allopathic and osteopathic physicians.
Obtain state and federal government recognition that podiatrists are physicians.
Market and promote podiatrists as physicians.
Attract high quality applicants to colleges of podiatric medicine and thereby to the profession. |
These goals are right on the mark and reflect exactly where we should be as podiatrists. Successfully completing the overall mission means podiatrists should be physicians (just like any other) that happen to treat the foot and ankle. Is this really where we are? Are we truly physicians who happen to treat the foot and ankle? I don’t think so. We’re closer today than ever, but we’re not there yet.
Disagree? For those who feel we are exactly the same as any physician, I’ll use my education as a counter argument. My first two years of medical school were essentially the same as any MD student, but it is in the clinical training that I deviated. The remainder of school and postgraduate training were quite different from MDs. A few of the rotations I did NOT perform during school or residency were as follows: obstetrics and gynecology, intensive care/nephrology, ACLS certification, ECG interpretation, oncology, and cardiology. Although the first year of my residency exposed me to much of medicine, it still was not the internship year of MDs and DOs. These are very few differences, I admit. However, they are differences nonetheless.
Now, I’m not arguing we should combine the DPM degree with the MD or DO, or that we should be treating entities that fall out of our scope of practice. I also understand that there’s plenty of work to do in our own field, and it’s not possible to learn everything. I am arguing that our medical colleagues do go through this training (whatever their eventual specialty), and if we want to be considered equal, then our training should be equal.
From a quality of patient care standpoint, this is a pretty obvious argument. Medicine (and podiatry) is a knowledge-based field The more you know about the human body, the better the patient care you can deliver. If you don’t understand rheumatology, how can you understand the contribution of diseases such as reactive arthritis or psoriatic arthritis to recalcitrant heel pain? If you don’t understand diabetes, can you effectively treat its lower extremity complications? If you don’t know ACLS – something all doctors learn to do – what will you do if a patient codes in your office or in your OR?
The authors of Vision 2015 have it right on the mark. We need to give them the support they need to succeed in creating true podiatric parity. Parity will include not only our young members receiving essentially the same training as our allopathic colleagues, but also creating opportunities for those in practice to expand their medical knowledge. It’s not just about the next surgical procedure; we need to incorporate more comprehensive medical updates into our conferences.
After I completed my ACLS testing, I was talking with one of my examiners, an old family practice MD known in my community as a medical leader. During our conversation, he relayed an interesting story. Many years ago, he was attending an ACLS certification course and came across a podiatrist who was also attending the course – the first podiatrist this doctor had ever seen at an ACLS course. He was so impressed by this podiatrist’s desire to better his education that he referred his wife to the podiatrist for her bunion surgery. Respect and parity are beneficial, but respect and parity must also be earned. Good luck on your next ACLS certification.
Keep writing in with your thoughts and comments or our eTalk discussion forum on PRESENT Podiatry and start or get in on the discussion. Best wishes.
Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]
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