What Do I Need To Do To Get `Parity` With My MD/DO Colleagues?

It has been recently suggested on a popular podiatry online newsletter that current podiatric curriculum should be expanded to include courses and rotations in pediatrics, OB/GYN and psychiatry. Upon completion, podiatric medical students would be qualified to sit for the United States Medical Licensing Exam (USMLE) and/or the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA). In order to make way for this expansion of the podiatric curriculum, it has been suggested that we eliminate biomechanics coursework.

What does this “expansion” accomplish? Now podiatric medical students can boast that their training is equivalent to the MD or DO, and they finally have “parity.” At the same time, they have sacrificed the essential ingredient of their training, which makes them superior to the MD in the evaluation and treatment of foot and ankle pathologies.

One podiatrist actually suggested that biomechanics is simply a course in orthotic prescription writing and this training could be provided by foot orthotic labs.¹ The notion that podiatric biomechanics is limited to foot orthotic therapy and that orthotic labs could teach the science to practitioners may be the most ludicrous proposal I have seen in 37 years of teaching and clinical practice.

During the past ten years, I have served as an attending for an MD family medicine residency program as well as an attending for a post-graduate MD sports medicine fellowship program. Many of my podiatric colleagues have similar appointments and actively teach MD residents. In our roles, we have not only achieved “parity” with our MD colleagues, we are recognized as experts with knowledge worthy of sharing with all allopathic disciplines.

Before starting a rotation with me, the MD Sports Medicine Fellow is requested to submit a list of clinical conditions that he or she hopes to gain further knowledge and expertise in. This list often includes ankle sprains, Achilles tendinopathy, peroneal tendinopathy, midfoot sprains, turf toe and plantar plate injuries.  This list is submitted by a licensed MD, who has already completed a 3-year family medicine residency. Why do they turn to me to learn about these pathologies? Maybe because instead of taking classes in pediatrics, OB/GYN and psychiatry, I took courses in biomechanics!

The problem for today’s podiatric medical student is the fact that Project 2015 attempted to achieve parity between the DPM degree and the MD degree by changing podiatric curriculum to mirror the traditional allopathic medical school curriculum.² I have previously written a blog on this subject.³ Biomechanics has been the sacrificial lamb for “upgrading” podiatric curriculum to achieve parity with our MD colleagues. In short, a total of five courses in biomechanics taught in 1980 have now been trimmed to two courses at the California School of Podiatric Medicine in 2015. Still, four years after Project 2015, my colleagues and recent graduates of podiatric medical schools are still begging for parity.

Is the solution to eliminate all biomechanics courses in favor of pediatrics, OB/GYN and psychiatry? What then? Enter into a podiatric surgical residency program with no understanding about the function of the human foot? Well, I suppose you could brag that you passed the USMLE exam. Then again, so can your MD colleagues. Are you still the expert in the evaluation and treatment of foot and ankle pathologies with no training in biomechanics? Hardly.

I must ask: What price “parity”?

References

1. https://www.podiatrym.com/search3.cfm?id=119480

2. Vision 2015: Mapping podiatric medicine’s path to parity. APMA News. February 2014:10-13. https://www.nxtbook.com/nxtbooks/apma/news_201402/#/10

3. Richie D. Are we still ‘uniquely qualified to treat sports injuries? Podiatry Today. 2015. Available at: https://www.podiatrytoday.com/blogged/are-we-still-%E2%80%98uniquely-qualified%E2%80%99-treat-sports-injuries . Accessed April 19, 2019.