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, podiat- ric physicians train alongside their allopathic counterparts of all disciplines, share sim- ilar 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 os- teopathic 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.