Licensure and Podiatric Medicine Our Expert Panel of Educators Discusses 83 This Hot Button Topic

PM’S ROUNDTABLE

David Armstrong, Jeffrey DeSantis, Lawrence Harkless, Allen Jacobs, Leonard Levy, Bryan Markinson, Kathleen Satterfield, Michael Trepal, DPM DPM DPM DPM DPM DPM DPM DPM Licensure and Podiatric Medicine Our expert panel of educators discusses 83 this hot button topic.

BY MARC HASPEL, DPM

he call for the increase in the scope of licensure for podiatric physicians is one that seems to surface year in and year out. In the past, that subject may have been a tad premature. With the uniform expansion of global three-year post-graduate podiatric residency training (the hallmark of clas- sic four-four-three medical training—four years undergraduate, four years Tmedical, and three years post-graduate), the call has never been louder. Today, podiatric physicians train alongside their allopathic counterparts of all disciplines, share similar clinical experiences, and participate in many of the same hospital rotations. Yet, limitations in licensure prevent many of these same podiatric physicians from practic- ing to the full extent of their abilities, experience, and training. Podiatry Management has invited a distinguished panel of podiatric educators and political leaders to discuss this critical topic. Their contributions to the field are already profound, and their input on this potential advancement could be the most significant of all. Joining this panel: David Armstrong, DPM is professor of surgery at Keck School of Medicine of Uni- versity of Southern California and the founding president of the American Limb Preser- vation Society (ALPS). He is an inductee into the PM Podiatry Hall of Fame. Jeffrey DeSantis, DPM is the current president of the APMA. He is board certified by ABFAS in Foot Surgery as well as Reconstructive Rearfoot & Ankle Surgery. His pas- sion throughout his tenure as a Trustee has been Vision 2015, with tangible advance- ments such as the standardized three-year PMSR moving our specialty into the 4-4-3 model. Lawrence Harkless, DPM is interim dean, University of Texas Rio Grande Valley (UTRGV) School of Podiatric Medicine and, professor in the Department of Surgery School of Medicine UTRGV. He is an inductee into the PM Podiatry Hall of Fame. Allen Jacobs, DPM is a Summa Cum Laude graduate of the Pennsylvania College of Podiatric Medicine. He completed his residency in surgery at Monsi- gnor Clement Kern Hospital for special surgery in Warren, MI. Dr. Jacobs is in Continued on page 84

podiatrym.com JUNE/JULY 2021 | PODIATRY MANAGEMENT PM’S ROUNDTABLE

Licensure (from page 83) be promoting two classes of podiatric As founding Dean of Western Uni- physicians? versity of Health Sciences CPM, I over- private practice in St. Louis, Missou- Assuming a workable pathway, saw that students take all pre-clinical ri. He is an inductee into the PM Podi- the gorilla in the room is the resolu- classes with the medical school in the atry Hall of Fame. tion of feasibility and desirability. I first two years, except for osteopathic Leonard Levy, DPM is professor dare to say that there is unanimity manipulative medicine. In the clinical emeritus and, up to June 30, 2016, among all podiatric physicians that the curriculum third year, three months of for seventeen years served as associ- goal is equal pay for equal work and medicine and three months of surgery ate dean for research and innovation elimination of any degree-based dis- were required. The fourth year clinical for the Dr. Kiran C. Patel College of crimination, which would pejoratively curriculum required four months as Osteopathic Medicine of Nova South- and arbitrarily interfere with our abil- a sub intern, two months medicine, eastern University (NSU COM) in ity to provide the services we are well and two months surgery. These ro- Fort Lauderdale, FL. qualified to perform. Any reasonable tations prepared students to be true Bryan Markinson, DPM is Chief mind will recognize the enormous ad- physicians and surgeons of the foot of podiatric medicine and surgery at vancements our profession has made and ankle. All the colleges of podiatric the Leni and Peter W. May Depart- ment of Orthopedic Surgery of the Mount Sinai School of Medicine. He is the 2021 inductee into the PM Po- “We are at a historic point in podiatric medical diatry Hall of Fame. education, and as a profession, we need to make Kathleen Satterfield, DPM is a graduate of Des Moines University a choice whether we continue to grow or if we go College of Podiatric Medicine, the backwards.”—Satterfield 84 first of the modern podiatric colleges that began to embed education into existing medical schools without abandoning podiatric principles. She towards achieving these goals under medicine should change their curricu- is now the dean of Western Universi- our current DPM licensure. The ques- lum to reflect equivalence by challeng- ty of Health Sciences, College of Po- tion before us now is what the most ing the same examinations CBSE and diatric Medicine, the newest college prudent path is to cross the finish line. USMLE Step 1and 2. which continues to pursue parity for podiatric medicine. DeSantis: Today’s podiatric phy- Satterfield: Yes, podiatric phy- Michael Trepal, DPM is vice pres- sicians and surgeons are exceptionally sicians should receive it if their ed- ident for Academic Affairs, and is dean well trained and those that have the ucation and training live up to what and professor in the Department of desire to help medically manage their is needed to achieve that privilege. Surgery at the New York College of patients, such as those with diabe- We are at a historic point in podiat- Podiatric Medicine. tes, peripheral vascular disease, etc., ric medical education, and as a pro- should be able to perform those ser- fession, we need to make a choice PM: Should podiatrists ob- vices. Their current educational train- whether we continue to grow or if tain a plenary medical li- ing and experience exceeds the scope we go backwards. cense? If so, why? If not, of practice that is available in any of For years, mainstream medical edu- why not? the fifty United States. cation and, in particular, the orthopedic Q leaders, have challenged podiatry. They Trepal: A plenary license in Harkless: I believe podiatric physi- didn’t give us a hard “no” about trying medicine is defined as one without cians should obtain a plenary medical to achieve parity, but they made it clear restriction as to what one can prac- license. We always say that we are that if we wanted to join their club, we tice in the jurisdiction which issues physicians and that thus we practice would have to standardize and broaden it. In its purest form, hypothetically, medicine. I believe we do; however, medical education and training. Cur- the holder could diagnose and treat, there are many things that we do not rently, there exists a piecework quilt of by any means, any and every possi- do. Hence, the only way to be the educational models across the schools ble human ailment. In practice, we same is to challenge the same classes of medicine. Some models treat the know there are checks and balances and examinations, including the clin- feet as disconnected pieces of anatomy which would mitigate that from oc- ical basic science exam (CBSE). Allo- and not as integral parts of the larger curring. Getting back to the question, pathic medical schools require passage picture. This profession has to provide it is not an easy answer. Would at- of CBSE prior to sitting for USMLE that standardization. taining such a license be feasible for Step1. There is an eighty percent con- all podiatric physicians, both current cordance of passing USMLE upon Markinson: An unfettered, un- and future? If yes, how do we bring passing CBSE. Successful completion limited medical license of course is all existing DPMs into educational of these examinations supports MD desirable as it may eliminate the past compliance to qualify? If no, will we equals DO equals DPM. Continued on page 86

JUNE/JULY 2021 | PODIATRY MANAGEMENT podiatrym.com PM’S ROUNDTABLE

Licensure (from page 84) the depth and breadth of the ocean, physicians with the exception of OB/ which makes this question moot. Ple- GYN, psychiatry, and a few other 40 years of podiatrists being objects nary licensure will not come from just areas which can be added very likely of curiosity and confusion when it the asking or wanting or thinking we in six months or less. I served for sev- comes to hospital staffing, legislative deserve it. enteen years as a senior member of the administration (Associate Dean for Research and Innovation) of the osteopathic medical school from which “There is an ocean between the DPM and the MD/DO I recently retired as well as on the cur- experience (starting from the application processes riculum committee of a new allopathic medical school, which is now part of to the colleges) which we must accept, define, the same academic health center. I can make these statements not only acknowledge, and fix.”—Markinson based on experience, but because of the many contacts that I had to make in the allopathic and osteopathic edu- issues, insurance coverage of podiatric Levy: Podiatric physicians should cational community. services, etc. Having DPM listed in the have the same license and degree as same paragraph as MD and DO would other physicians (i.e., MD or DO) and Armstrong: In my opinion, podi- be a huge benefit. However, there is yes, the DPM degree would be retired, atric physicians in the United States an ocean between the DPM and the and all in the profession would earn are either a) overtrained or b) under MD/DO experience (starting from the an MD or DO degree. They current- licensed. Almost all of the data sug- application processes to the colleges) ly function no differently than other gest that b) is probably the one that 86 which we must accept, define, ac- medical specialists, and the education is most likely, and therefore, should knowledge, and fix. My impression is and training that they now receive guide us toward the future. I believe that our profession has understated is virtually the same as that of other Continued on page 87

JUNE/JULY 2021 | PODIATRY MANAGEMENT podiatrym.com PM’S ROUNDTABLE

Licensure (from page 86) that either an unlimited license DPM, adding an MD, or just eliminating the DPM, would be the best way forward. This is a not a profession. This is a specialty. As the grateful son of a podiatrist and the father of a third-generation podiatric medical student, I am excited to see this specialty evolve to where it is now.

PM: What are the advantages or disadvantages of obtaining a plenary license?

Trepal: First, we need to distinguish be- Q tween a degree and license. In my opinion, and of course I could be wrong, receiving a plenary license without an MD or DO degree in the foreseeable future is a tall order. Perhaps someday medicine will evolve to a system of limited license MDs. In such an environment, we would conceivably see limited license psychiatrists, ENTs, etc. Podiatric Medicine would be a natural fit in such a rubric. Until such a time, that such a paradigm shift occurs,

“Let me be clear when it comes to competency in the diagnosis and treatment of lower extremity pathology, podiatric medical education is second to none.”—Trepal

DPMs, under the current system, would need to demonstrate to obtain a plenary license that the undergraduate and graduate education system is not simply equivalent, but more likely identical or nearly so to that obtained by their allopathic and osteopathic colleagues. Hence, the major disadvantage we would face is the need to funda- mentally change the content of our curriculum. Postings in various podiatric forums, where folks opine that all which is needed is simply to add a few hours in OB/GYN and psychiatry, and we are there, stem from some altered universe and are laughable. Let me be clear when it comes to competency in the diagnosis and treatment of lower extremity pathology, podiatric medical education is second to none. And that is no easy feat nor serendipitous, but rather the culmination of a well-designed continuum of undergraduate and graduate medical education. One of many examples might be where podiatric medical students spend an entire semester studying the anatomy and struc- ture of the lower extremity. Medical students spend very few hours on anatomy distal to the ankle. Podiatric medical students spend, on average, three clinical months studying podiatric surgery. Medical students do not spend three minutes. Podiatric medical students spend countless hours studying biomechanics, peripheral vascular disease, lower extremity dermatology, and much Continued on page 88 podiatrym.com JUNE/JULY 2021 | PODIATRY MANAGEMENT PM’S ROUNDTABLE

Licensure (from page 87) sicians since they were not accepted nary license, we must acquiesce as a by and graduated from an LCME MD profession to the demands of the MD/ more than time permits in the standard COCA DO accredited medical school. DO process, including undergraduate allopathic curriculum. Likewise, med- Thus, podiatric medicine needs more requirements, MCAT scores, all exams ical students spend three months on schools fully integrated within aca- and educational experiences, etc. In general surgical clerkships for which demic health centers. The most seg- my opinion, having achieved the abil- time would not allow in our podiatric medical curriculums. My point is that a potential disadvantage to obtaining a “The advantages are that podiatric physicians plenary license is that it might require a significant adjustment of the DPM would be considered equal to MDs in training with a curriculum to the extent that we po- tentially could lose our superiority in subspecialty in the foot and ankle.”—Harkless knowledge and skills of lower extremity medicine at the time of awarding of the first professional degree. regated aspect of healthcare for this ity to apply for training in any medical profession is the academic health cen- specialty, podiatric medicine by the Harkless: The advantages are that ter. Podiatric medicine is not there yet. DPM as we know it will be extinct. I podiatric physicians would be con- Currently, and unfortunately, there are know that many, if not most podia- sidered equal to MDs in training with two podiatric schools that are affiliated trists, including myself, are so satisfied a subspecialty in the foot and ankle. with allopathic medicine out of 155 with our wonderful profession that Obviously, it would be recognized in MD medical schools in America. they think podiatry will be a viable, that regard only if the education and even popular choice amongst students 88 training are the same. The disadvan- Markinson: At this point, I see trained to the point of ability to apply tages would be that podiatric doctors one major undesirable. I have often for any specialty. I strongly disagree. If would not be able to practice as phy- stated that to get to the point of a ple- Continued on page 89

JUNE/JULY 2021 | PODIATRY MANAGEMENT podiatrym.com PM’S ROUNDTABLE

Licensure (from page 88) we go this route, the best we can hope for is a very diluted podiatric specialty than the one we have now. There will be no one trained in lower extremity medicine anywhere near the depth we are trained now.

Levy: Having a plenary medical license would allow podiatrists to practice their specialty without having to endure what really are artificial and political roadblocks, which would create hours of wasted time. It also would provide professional and legal recognition to perform the duties of the profession, receive reimbursement from private and governmental agencies on the same basis as the rest of the medical community, and receive the same recognition from the community as other physicians do.

“Having a plenary medical license would allow podiatrists to practice their specialty without having to endure what really are artificial and political roadblocks, which would create hours of wasted time.”—Levy

Jacobs: I have long believed that to some extent, podiatry education is a truer model of what medical education should be, a curriculum constructed to the specific needs of a particular “specialist “. With that said, however, the awarding of a plenary degree is not a simple matter of adding a few additional courses. There is a difference in the degree of par- ticipation, patient responsibility, and involvement between podiatry students/ residents and medical students/residents. This would require changes to clinical experiences if the awarding of a plenary degree were the objective. I would strenuously argue that excellence in podiatric medicine does not, for example, require an obstetrics or ENT rotation. There is no dispute that a plenary degree would be helpful for certain political and licensing problems facing podiatrists.

Armstrong: This is the only specialty I know that tries to pre-credential itself. We have these silly Mason-Dixon lines at joints named after old French surgeons. Why? Like all other specialists, podiatrists should be credentialed based on training and experience. I am happy to see that this has started to happen.

DeSantis: A plenary license would allow podiatric physicians and surgeons to provide comprehensive treatment for their patients, equivalent to what an MD or DO could provide. Some believe a plenary license would create physician recognition for podiatric physicians and surgeons and ensure equal reimbursement. Continued on page 90 podiatrym.com JUNE/JULY 2021 | PODIATRY MANAGEMENT PM’S ROUNDTABLE

Licensure (from page 89) unified national voice and the sup- outcomes in a cost-effective manner. port of a concerted group of strong While common sense would dictate PM: Should podiatry have states behind it. I’m not the politician that equal pay should be the norm, a uniform scope of practice? here, but I do know that if the leaders the flower of reason does not grow in If so, how can that best be in states like California, New York, everyone’s garden; therefore, it most achieved? Pennsylvania, Texas, Ohio and other probably necessitates well-planned leg- Q thought leaders align their efforts, this islative and possible legal challenges. DeSantis: Until podiatric medi- could be achieved. Perhaps the Fed- cine is practiced with an unlimited eration of Medical Boards, the AOA, Satterfield: Simply put, if podiat- license, yes, in my opinion, there and the AMA would be logical start- ric physicians were granted the degree should be a uniform scope of practice ing points. As this profession inches of MD or DO and licensed as such, adopted by all states. APMA created closer to a model that looks more like it would be virtually automatic to be a uniform scope of practice template that of our proposed partners, through reimbursed as any other MD or DO. under the aegis of its Vision 21st ACGME standards and the like, podi- Century Committee. APMA defines atric medicine will get there. Harkless: This is an issue of de- podiatric medicine and surgery as gree, and the insurance companies. “the specialty that addresses the di- Harkless: Podiatrists should have Obtaining the plenary medical license agnosis and treatment of pathologies a uniform scope of practice. It will be should eliminate this problem. Every- and conditions of the lower leg, with special emphasis in the diagnosis and treatment of the foot, ankle, and their “In the medical lexicon, governing and related structures of the leg by any and all means with because of this separate degree, podiatric physicians 90 osseous surgical treatment limited to that part of the lower leg below the are something of an asterisk.”—Armstrong anterior tibial tubercle.” Achieving a uniform scope of practice likely would require buy-in difficult to achieve as scope of practice thing, however, is about the dollar bill. and support from our orthopedic col- is regulated by each state. Most state Insurance companies will do every- leagues. If they chose to support it, statutes include foot and ankle, and thing they can to save money. Because passing it through state legislatures soft tissue structures in the leg that the degree remains different, they pay should be much easier. APMA works govern the function of the foot. Fed- podiatric physicians less. The VA Pro- closely with national orthopedic and eral law does not supersede state law vider Equity Act passed by Congress medical societies to build and foster as it relates to regulation of the prac- is more ammunition in the arsenal in supportive relationships and to edu- tice of professions, hence this will be order to obtain financial parity. cate their leadership about our educa- difficult. During project 2015, APMA tion and training. evaluated the scope of practice in all Markinson: I am at a loss to states. Data demonstrates all but three explain this disparity in reimburse- Jacobs: Of course it should. How- states have an ankle law. A uniform ment. But this I know for sure: po- ever, the lack of uniformity of residen- law is difficult because each state diatrists in New York City in large cy experiences, the acceptance of a wants to have its own independence measure will accept and par with ridiculous number of “board certifica- and freedom, and not be regulated by any plan regardless of the poor reim- tions” results in an eclectic collection the federal government. bursement. Those that reject these of residency graduates and unreliabil- plans are in the large minority. Med- ity in credible assessment. What mat- Levy: Issues related to scope of ical directors and CEOs of insurance ters are the state legislators, as the practice would virtually disappear and companies are well aware of this. APMA has been unable to provide what podiatrists do would be based We have no one but ourselves to such uniformity from state to state. on education and training rather than blame. I am not even so sure that on political acumen. plenary licensure would change this, Satterfield: It would be my pref- as podiatric services are sometimes erence to have a uniform scope. I feel PM: What is the best way largely devalued, even eliminated by it would be wonderful to be able to to ensure equal reimburse- some carriers. practice to the fullest extent of one’s ment to podiatrists for per- license and training, without regard to forming the same services Armstrong: I have to agree. In the a statewide decision that limits one in Q as MDs and DOs? medical lexicon, because of this sep- one state or another. Imagine having arate degree, podiatric physicians are the freedom to move from one state Trepal: By continually making something of an asterisk. Realistically, to another, and not having to jump the case that podiatric physicians are there is not some sort of evil cabal out through hoops. not only competent to do what they there trying to eliminate podiatry. To make that happen will take a do and achieve similar if not better Continued on page 92

JUNE/JULY 2021 | PODIATRY MANAGEMENT podiatrym.com PM’S ROUNDTABLE

Licensure (from page 90) credited by the Council on Podiatric States that have a three-year program Medical Education (CPME). Such in- leading to the medical degree, and Jacobs: Good, credible outcome stitutions must be in compliance with there certainly is a possibility that studies demonstrating the cost effective- published standards comporting with other schools will do the same. Our ness of podiatric services when com- the podiatric medical curriculum. The current national board would be mod- pared to the same services performed CPME is not empowered to accred- ified to become our specialty board, by non-podiatrists. A plenary degree it any institution to award the MD and its examination would be given would likely be helpful, but at what or DO degrees. Institutions award- to become board certified in podiatric cost? Podiatrists should be reimbursed ing these degrees must receive their medicine. A difficult task could be at a higher rate than non-podiatrists for accreditation from the Liaison Com- a “buy in” by the current podiatric the same or similar services. 7-8 years mittee on Medical Education (LCME) medical schools, the American Podi- vs. a one-year orthopedic foot and fel- or Commission on Osteopathic Col- atric Medical Association, and likely lowship? How does knowledge of gastri- lege Accreditation (COCA). Therefore, a significant number of members of tis improve the treatment of a bunion? contrary to the opinions of some, it the profession, who may not be able is not simply a matter of “changing to make this transition. If this does DeSantis: The best way to accom- or converting” a DPM degree into not get accomplished first, allopathic plish equal reimbursement is to ensure an MD or DO degree, as the degree and/or osteopathic medical schools that every insurance provider pays the granting institution would need to be may be reluctant to engage in the same way Medicare does with a uni- accredited by either LCME or COCA. difficult and complex discussions that form fee schedule that is not based on Our Colleges of Podiatric Medicine likely would be necessary to make specialty or degree. Providers are re- would need to obtain their accredita- this major transition. imbursed based on the CPT code they tion from one of those agencies and submit, and the CPT code (except for CPME would be rendered irrelevant. Satterfield: The osteopathic phy- 92 some geographic adjustments) is paid We would then be MDs or DOs who sicians faced this in California and, the same to all providers. specialize in lower extremity medi- at first, it was a matter of sending in Again, this change might require cine. There are other questions that one’s license along with a fee and one state legislation regarding equal pay would need to be answered involv- would get an MD license in the re- for equal work. APMA has a model ing, for instance, who would approve turn mail, although there were clearly fee parity law for states to implement. our residency programs; whether the differences between the two. Many The purpose is to ensure that patients national organization of choice would osteopaths objected and appreciated have access to foot and ankle care ser- be APMA or AMA; determining their unique skills. Thus, after much vices from the healthcare providers of who would recognize the certifying work, laws were changed. It was so their choice, and that insurers do not boards. controversial that a book was written discriminate against Doctors of Podi- Other possibilities might include about it, The Merger: MDs and DOs in atric Medicine in terms of coverage or a United States Podiatry College California by Michael Seffinger, DO. I amount of reimbursement. partnering with a willing U.S. or off- certainly think it is a worthwhile read APMA also strongly recommends shore medical college to offer a joint to understand the complex history that podiatric physicians carefully DPM/MD degree. This would surely and appreciate the similarities. consider the details of their contracts entail more years of study and in- I agree with my osteopathic col- with third-party payers before agree- crease in student debt, and then a leagues who fought to maintain their ing to a fee schedule. Moreover, it decision as to what type of residency own identity. Those initials speak to is recommended that podiatric phy- program to enter. The logical out- why we are different. I’m comfortable sicians consult with their attorneys come would be that the individual in my skin and want to be identified and negotiate more favorable agree- holding such a joint degree would as a DPM. I want, however, to earn ments when appropriate. APMA has practice under the MD license. The the same pay as my DO and MD col- resources available to help members question would remain about what leagues doing similar work. demonstrate the value of podiatric would happen to those who do not education, training, and care. choose this pathway. Harkless: I am not in favor of a degree change. If podiatric physicians PM: Should podiatry seek Levy: I believe those in the spe- want a degree change, they should to maintain the DPM or cialty of podiatric medicine and sur- have to go to an LCME MD or COCA seek an MD or DO degree? gery should be granted the allopathic DO accredited medical school and If you are in favor of a de- or osteopathic medical degree and, obtain the MD/DO degree. Having Q gree change, what steps upon completion, if they choose to served on the admission committee would be necessary to achieve that be a specialist in podiatric medicine, at two allopathic medical schools, goal? take a residency of three years or four admission to medical school is diffi- years if additional specialization in cult, and most podiatric physicians Trepal: In the United States, the that specialty is desired. It should be would not qualify. Therefore, the ple- DPM degree may only be conferred noted that there are now sixteen allo- nary medical license is appropriate. I by Colleges of Podiatric Medicine ac- pathic medical schools in the United Continued on page 94

JUNE/JULY 2021 | PODIATRY MANAGEMENT podiatrym.com PM’S ROUNDTABLE

Licensure (from page 92) but we would risk stratification with Harkless: I believe podiatric med- attendant scrutiny of podiatric medical students should take the USMLE would not seek to change to a MD/ ical students against other cohorts to demonstrate that their knowledge DO degree. of students taking the exam. Hav- and skills are equivalent to those of ing podiatric medical students sit for medical students. Successful passage DeSantis: At this time, my vision the USMLE Step two (CK) exam is would provide evidence, and confirm is that podiatric medicine and surgery an entirely different story as content and validate it. retains the DPM degree and achieves matter in that exam does not par- recognition that MD=DO=DPM. allel as closely content material in Jacobs: Both the AMPLE and Podiatric medicine has come a long the APMLE Part two Exam, which USMLE should be taken by our stu- way by adopting a standardized three-year, hospital-based, postgrad- uate residency training program. “Part of achieving recognition that MD The PMSR gives us a four-four-three model (undergraduate, medical equals DO equals DPM is taking the same exams school, residency training) equivalent to allopathic and osteopathic med- as MD and DO students.”—DeSantis icine. As the profession progresses with the USMLE for licensure, the degree change will be the decision of is configured to assess competency dents. This would serve as anoth- its future leaders. in mastering the podiatric medical er attestation to the growing compe- curriculum. I would suspect that as tency of today’s podiatric student. It PM: Why should podiat- a group, medical or osteopathic stu- would serve as another “brick in the 94 ric medical students be al- dents would do poorly if they were wall” for consideration of a plenary lowed to take the USMLE required to sit for the APMLE part license or at least expanded scope of Q Exam? two Exam. practice for the DPM. Trepal: Step one USMLE like Part Satterfield: I do not see why not. DeSantis: Part of achieving rec- I APMLE tests subject matter in the I have to refer to the challenge that ognition that MD equals DO equals pre-clinical sciences. For the most orthopedists threw down decades DPM is taking the same exams as part, podiatric pre-clinical curricu- ago. They made it clear that to join MD and DO students. The indica- lums mirror those found in allopath- their club, podiatrists would have to tions received from some of the allopathic colleagues are that podiatric physicians need to take, and “Both the AMPLE and USMLE should be pass, the same exam they pass to demonstrate that the education is taken by our students. This would serve as another comparable. If this profession is to push for a plenary license, there is attestation to the growing competency of a strong case to be made that a po- today’s podiatric student.”—Jacobs diatric physician and surgeon who passes all three parts of the USMLE should be granted a plenary license. APMA has worked to achieve the ic and osteopathic medical colleges. play by their rules. I have rarely en- goal of gaining access to the USMLE Therefore, it could make sense for countered a profession where a por- for podiatric medical students. We podiatric medical students to sit for tion of the practitioners wanted to want the deans and the colleges of this exam. There are some notable grow, and another was equally intent podiatric medicine to believe in this differences, however, in the respec- on not progressing. I believe every- path for our future and to prepare tive exams, which would need rec- one wants to improve and challenge podiatric medical students to pass onciliation. For example, twenty-five themselves. I know the young podiat- the exam. PM percent of Part I APMLE is devoted ric physicians do. to lower extremity anatomy. There Dr. Haspel is senior are few if any lower extremity anat- Markinson: I believe that experi- editor of this magazine omy questions on the USMLE. The ment already took place. The silence and past-president of APMLE emphasizes questions in about it is deafening. An entire ret- the New Jersey Podi- pharmacological, physiological, and rofit of podiatric medical education atric Medical Society. pathological disciplines pertinent to would be required to make this a vi- He is a member of the lower extremity medicine. I am quite able effort. That means much more American Academy of confident that podiatric medical stu- than sitting next to an MD/DO stu- Podiatric Practice Man- agement. dents could pass Step One USMLE, dent for two years.

JUNE/JULY 2021 | PODIATRY MANAGEMENT podiatrym.com