Addressing Continued Concerns Expressed About The Joint Task Force Resolution

The American Medical Association (AMA) House of Delegates (HOD), in their June meeting, did not hear Resolution 303. Therefore, the resolution or some modified version of it will now go to the November AMA HOD. At present, I am still observing the persistence of misunderstanding, confusion, uncertainty and misrepresentation of the facts on podiatric forums, social media and message boards. The response to The Joint Task Force's White Paper and the resolution to move podiatric medicine and surgery to a plenary license has majority support in a recent poll.¹

Resolution 303 stated, "That our American Medical Association study, with report back at the 2021 Interim House of Delegates Meeting, whether Council on Podiatric Medical Education (CPME) accreditation standards are comparable to Liaison Committee on Medical Education (LCME) standards and sufficient to meet requirements which would allow Doctors of Podiatric Medicine (DPMs) to take all parts of the USMLE." ² While there is no requirement the exact resolution will be put forth at the November AMA HOD, the potential steps of the process presuppose the forthcoming resolution will be at least similar in content. This means that if passed, the AMA will evaluate if CPME standards are comparable to LCME standards, the first step in this process.

If the resolution does not pass in the November HOD, the process returns to the Joint Task Force for reconsideration. If the resolution passes, the complexity of the full realization of a plenary license timeline is substantial.

Initially, the Council on Medical Education (CME) of the AMA would undertake its assigned task directed by the resolution. One of three potential outcomes exists. First, the accreditation standards of CPME meets LCME standards. In that case, the process will return to the AMA HOD for a resolution to encourage the National Board of Medical Examiners (NBME) to allow podiatric medical students to take the United States Medical Licensing Examination 

(USMLE). Second, if LCME finds the standards are not comparable (minor revisions are required, or significant modifications are necessary), the American Podiatric Medical Association (APMA) HOD could recommend to CPME to make the changes needed to meet LCME standards. Thirdly, If CPME approves the recommended changes, the process also returns to the Joint Task Force for a subsequent resolution to be submitted to the AMA HOD encouraging NBME to allow podiatric medical students to take the USMLE. Finally, if CPME does not support the changes, things go back to the Joint Task Force.

If the subsequent AMA resolution to allow podiatric medical students to take the USMLE did not pass, the process would return to the Joint Task Force. If the resolution passes, podiatric medical students and graduates of CPME approved medical schools would be able to sit for the USMLE. Podiatric medical schools would begin to prepare students to take Step 1 and Step 2 of the USMLE, like the changes Western University College of Podiatric Medicine in prepping their students to take the Comprehensive Basic Sciences Examination (CBSE). Residency programs would then have to make changes to prepare residents to take Step 3 of USMLE after the first year of residency.³ Podiatric medical students and residents would begin to take the USMLE if they so choose after necessary changes are made and implemented to both podiatric medical schools and residency program curriculum.

The last step in the process would be a change in physician licensure via state legislation to include graduates of CPME accredited schools with the passage of all three steps of the USMLE and completing a residency. Alternatively, modification of the American Podiatric Licensing Exam (APMLE) meets NBME approval leading to recognition as a physician with a plenary license.

The endpoint is MD=DO=DPM. The Doctor of Podiatric Medicine degree does not go away, just as the Doctor Osteopathic Medicine degree did not go away when our osteopathic colleagues went through a similar process towards equivalency with allopathic medicine. Ditto for podiatric medical schools and residency programs. Osteopathic residencies transition under the Accreditation Council for Graduate Medical Education (ACGME) umbrella. Most podiatric residencies are already part of their hospital's Graduate Medical Education (GME) department and indirectly follow ACGME common program requirements.⁴ As I mentioned in my last blog, podiatric board certification standards will be required to be comparable with standards as set forth by the American Board of Medical Specialties (ABMS), just like every other surgical specialty.^5,6

The Joint Task Force White Paper resulted from a series of negotiations between the four organizations involved – American Podiatric Medical Association (APMA), American College of Foot and Ankle Surgeons (ACFAS), American Academy of Orthopaedic Surgeons (AAOS), and American Orthopaedic Foot and Ankle Society (AOFAS) and supported AMA Resolution 303. Additionally, the White Paper serves as a reference for AMA Delegates to provide background information allowing for informed decision making on the topic.  Compromise is the basis of negotiations with neither party getting everything they want. Nevertheless, all four representative Boards signed off on the final product, not just Task Force members. The argument of who determines and what the definition of a physician is monumentally complicated and nuanced. When phrases are taken out of context from the White Paper without including the complete statement, this matter only serves to muddle the entire process and lack intellectual integrity.

The focus going forward must be focused on two key topics. First, are CPME's accreditation standards comparable to LCME's? Second, should DPMs take the USMLE? But, again, keep in mind no viable pathway to advance the podiatric profession to true parity exists. I believe in our profession, and I trust in the process. Change is a hallmark of growth and a prerequisite for evolution. The podiatric profession's advancement over my thirty-year career is remarkable, but it is just the tip of the iceberg. What awaits us is transformative and will enable podiatric physicians to truly practice to the extent of their education, training, and experience.

Dr. DeHeer is the Residency Director of the St. Vincent Hospital Podiatry Program in Indianapolis. He is a Fellow of the American College of Foot and Ankle Surgeons, a Fellow of the American Society of Podiatric Surgeons, a Fellow of the American College of Foot and Ankle Pediatrics, a Fellow of the Royal College of Physicians and Surgeons of Glasgow, and a Diplomate of the American Board of Podiatric Surgery.

References

1. PM News Poll. Podiatry Management. Available at: https://podiatrym.com/pmnewsissues.cfm?pubdate=05/17/2021 . Published May 17, 2021. Accessed July 8, 2021.
2. Improving the Standardization Process for Assessment of Podiatric Medical Students and Residents by Initiating a Process Enabling Them to Take the USMLE. American Medical Association. Available at: https://www.ama-assn.org/system/files/2021-05/J21-303.pdf . Accessed July 8, 2021.
3. Eligibility for USMLE Steps. USMLE Bulletin. Available at: https://www.usmle.org/bulletin/eligibility/ . Accessed July 8, 2021.
4. Common Program Requirements. ACGME website. Available at: https://www.acgme.org/what-we-do/accreditation/common-program-requirements/ . Accessed July 8, 2021.
5. DeHeer P. Addressing misconceptions about the recent joint task force white paper and resolution. Podiatry Today. Available at: https://www.hmpgloballearningnetwork.com/site/podiatry/blogged/addressing-misconceptions-about-recent-joint-task-force-white-paper-and-resolution . Published May 20, 2021. Accessed July 8, 2021.
6. Joint Task Force of Orthopaedic Surgeons and Podiatric Surgeons - White Paper. Improving the Standardization Process for Assessment of Podiatric Medical Students and Residents by Enabling Them to Take the USMLE . Available at: https://www.apma.org/files/Joint%20Task%20Force%20of%20Orthopaedic%20and%20Podiatric%20Surgeons%20-%20White%20Paper.pdf . Accessed July 8, 2021.