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Can Podiatric Also Be Primary Care Providers? If not, why not?

By Leonard A. Levy, DPM, MPH

Note: The opinions expressed in internist for several weeks and not podiatric medical curriculum is equiv- this article are not necessarily those of self- their blood pressure, alent to that required by U.S. accred- Management Magazine. may make multiple visits to their po- ited medical schools, which should diatric , where at every visit include the ability to complete Part 1 Rationale their blood pressure is monitored. of the U.S. Medical Licensing Exam- 41 While members of the podiatric This determines the degree to which ination (i.e., USMLE). In addition, po- medical provide medical a ’s hypertension is being con- diatric clinical training now includes and surgical care to people for prob- trolled. Such information is an essen- didactic as well as -based ex- lems affecting their pedal extremity, tial component of primary care, so periences, requiring knowledge and is it not also true that because of the important in preventing such issues as skills in physical diagnosis as well as nature of podiatric medical practice, a cerebral vascular accident, cardio- several of the medical specialties (e.g., they are or can also provide primary vascular , or kidney problems. , , sur- care? Many physicians, because of the An obvious question is whether gery, , orthopedics, etc.). nature of their , focus on an organ of the body (e.g., ophthalmolo- gist, otorhinolaryngologist) and do not Over the past several decades, podiatric provide primary care. Other physicians provide a specific function support- medical and training has gone through ing the medical care process (e.g., ra- diologist, anesthesiologist). Typically, a major metamorphosis. primary care physicians such as those who practice , , , , and ob- podiatric physicians have the educa- All this is within the four-year stetrics and gynecology have a longitu- tion and training to be a major partic- of undergraduate podiatric medical dinal relationship with , seeing ipant in the provision of primary care. education and part of graduate podi- them several times yearly. Patients re- Not too many years ago, a justifiable atric , with a three- ceiving podiatric medical care are also response might have been no. But year, hospital-based . typically seen several times a year and over the past several decades, podiat- Exceptions to the clinical training part of such longitudinal services could ric medical education and training has podiatric medical students receive be considered primary care. gone through a major metamorphosis. during their four year pre-doctoral Because of the nature of problems Part of the basis of this has been the studies is the absence of medical affecting the pedal extremity, podiatric enrichment of the podiatric required /gynecol- physicians often also see patients for education and training experience. For ogy, pediatrics, and , ro- multiple years. This gives them an decades, this has included the same tations, typically totaling sixteen to opportunity to provide primary care pre-medical requirements required for eighteen weeks. With a current and for patients, monitoring many of the entrance into schools of medicine and growing shortage predicted for phy- medical indices associated with chron- osteopathic medicine, including taking sicians over the next several years, ic problems that may not orig- the Admissions Test including those who provide primary inate in the . Consider, for exam- (MCAT) as a requirement for admis- care, this deficit in podiatric medical ple, patients with a history of hyper- sion to podiatric medical school. Also, training should not be a major issue. tension, who while not visiting their the basic component of the Continued on page 42 www.podiatrym.com OCTOBER 2020 | PODIATRY MANAGEMENT THE FoRUM

Primary Care Provider (from page 41) the profession to consider expanding diatric medicine or after the its designation and become identified 3rd year of residency. Need as one of the small army of prima- The Association of American ry care providers. This designation Conclusion Medical Colleges states that by 2025 in no way is a device to modify the Podiatric medicine has grown ex- there will be a shortfall of between profession’s knowledge and skills in ponentially in the last 80 years. Today, 14,900 and 35,600 primary care phy- the diagnosis and medical and sur- there is minimal difference in the edu- sicians. This shortage is fueled by the gical treatment of problems affecting cation and training of allopathic phy- rapidly growing population, especial- the pedal extremity. What is being sicians and podiatric physicians. As a ly of people age 65 years and older, proposed is the inclusion of addition- result of changes in the demography of which is projected to account for 81 al responsibilities as a primary care the , the need for primary percent of the change in demand.1, 2 physician. Indeed, the special focus care is growing very rapidly and there These people are especially vulnera- of providing podiatric medical care still is much to do to meet this need. ble to a number of chronic . makes it logical for the profession to Combining the rapidly changing needs Also, successes in medical science have converted diseases that previ- ously were acute to become chronic Today, there is minimal difference disorders. Because a large percent of the population seen by podiatric in the education and training of allopathic physicians physicians are elderly, this same phe- nomenon has led to and will con- and podiatric physicians. tinue to make the need for podiatric physicians increase exponentially. 42 In addition, the increasing preva- accept the addition of primary care of healthcare with the major education lence of type two , which has responsibilities. Furthermore, such a and training advancements in podiatric as one of its major complications isch- modification makes a major contri- medicine provides an opportunity to emic and neurological conditions, re- bution by podiatric medicine, with make a significant contribution to the quires the providing of podiatric med- relatively little modification to its ed- primary care crisis. PM ical and surgical care. Such care is ucation and training, to the rapidly often required over the lifetime of the expanding primary care shortage. References diabetic patient. In addition, the pedal 1 HRSA Health Workforce, November extremity is frequently affected by os- Road Map 2013. Projecting the Supply and Demand for teoarthritis, which can be painful and The following road map is sug- Primary Care Practitioners Through 2020. 2 not infrequently debilitating, especial- gested: Journal of the American Medical As- sociation, 2018.320:1706-1707. New Assis- ly in but not limited to older people. • Require podiatric medical stu- tant Physician Program Raises Again, such problems often require dents to satisfactorily complete Part Concerns. https://m.facebook.com/story. a longitudinal relationship with the I of the USMLE at the end of the sec- php?story_fbid=10158320747842969&id= podiatric physician, including physical ond year of podiatric medical school. 710742968https://m.facebook.com/story. assessment that not only is essential • Require completion of the re- php?story_fbid=10158320747842969& to podiatric medical management, but quirements for a degree in podiatric id=710742968. also is part of the information one medicine. needs for the providing of primary • Add clinical and didactic ex- healthcare. These primary care func- periences in pediatrics, psychiatry, Dr. Levy, Professor tions that the podiatric physician pro- and obstetrics/gynecology (estimated Emeritus, completed 17 years as Associate Dean vides are not done so in isolation. The total of sixteen to eighteen weeks) for Research and Innova- completed during the course of the information obtain from tion at Nova Southeast- the examination of patients at each fourth year of podiatric medical ern (NSU) Dr. visit, as well as information regarding school and first year of residency. Kiran C. Patel College of the medical and surgical care they • Require podiatric medical stu- Osteopathic Medicine in provide, is often shared with other dents to satisfactorily complete Part Fort Lauderdale, FL. in physicians, both those designated as II of the USMLE at the end of the first 2016. He was also Dean primary care physicians as well as ap- year of residency. and later President of the California College of propriate medical and surgical special- • Require podiatric residents to Podiatric Medicine. For14 years he was Founding ists. In this way, podiatric physicians satisfactorily complete Part III of the Dean of the College of Podiatric Medicine and Surgery in and Vice Pres- may function as part of a team pro- USMLE at the end of the second year ident for Research. In 2009 he served as a Ful- of residency. viding comprehensive, coordinated, bright Scholar at Comenius University Faculty of collaborative, and continuous care. • Receive unrestricted license to Medicine in Bratislava, Slovakia. In 2017 and 2018 Because of these factors, it is sug- practice medicine upon completion of he served on the Curriculum Committee of the gested that the uniqueness of podiat- USMLE, Part I, II, III. new allopathic medical school at NSU. Currently ric medicine makes it appropriate for • Become board certified in po- he serves as a reviewer for Academic Medicine.

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