California physicians, podiatrists pursue collaboration on education

In a rare collaboration, California podiatrists and physicians are sitting down together to evaluate podiatric training in the state. The goal: Make education offered at the state's two podiatric schools on par with medical schools.

The California Podiatric Medical Assn., California Medical Assn. and California Orthopaedic Assn. are forming a task force to review curricula at the two schools and identify any deficiencies compared with medical education.

The plan is to have the podiatric schools meet accreditation standards set by the Liaison Committee on Medical Education -- the same standards that medical schools must meet, said COA Executive Director Diane Przepiorski. If the effort is successful, the schools would be LCME-accredited, and one day California podiatrists could be licensed as physicians and surgeons.

"It's the biggest story to happen in podiatry in 50 years," said Barry Block, DPM, editor of Podiatry Management, a national business and practice management magazine for the profession.

The CMA is excited to be part of "this unprecedented partnership," said Dustin Corcoran, CEO of the medical association. "The licensure requirements of podiatrists have increased in California in recent years, and the time has come to evaluate their training programs in this context."

Such partnerships are unusual in scope-of-practice debates, which historically pit physicians against nonphysicians in courtrooms and state legislatures around the country. The California collaboration is an important first step that should be a model for other states, said Glenn Gastwirth, DPM, executive director and CEO of the American Podiatric Medical Assn.

"Our reaction is: It's about time," he said. "There is so much common ground, common interest and so many common concerns that we should be working together."

As licensed physicians and surgeons, podiatrists would have unrestricted medical licenses and be able to practice nationwide within their education and training, like any other physician specialty, said CPMA Executive Director Jon Hultman, DPM. For now, podiatrists' scope of practice is limited by varying rules in different states.

Outside the political arena, physicians and podiatrists routinely work together, said APMA President Michael King, DPM. Seventy percent of his referrals come from physicians. "We welcome the opportunity to have these discussions. We want people to look at us for our education, training and our credentials," he said.

The American Orthopaedic Foot & Ankle Society issued a statement about the effort from its president, Keith L. Wapner, MD, saying, "The AOFAS supports any initiative that can improve patient safety and the quality of care for patients."

The American Academy of Orthopaedic Surgeons declined to comment for this article.

Not always as congenial

Podiatrists and physicians in California haven't always had such a congenial relationship. They have been on opposing sides more than once. "We continually fought legislative battles with podiatrists when they wanted to expand their scope of practice," Przepiorski said.

Eight years ago, both sides were at odds after the CPMA backed a bill in the state Legislature asking that podiatrists be allowed to perform partial amputations of the foot. "We were in a bitter battle for about one year," Hultman said.

But when the CPMA decided to back the bill a second time, podiatric leaders invited the state's physician organizations to see podiatric training for themselves. The groups came to a common understanding, and the legislation ultimately passed in 2004, Hultman said.

"We decided that rather than doing this in a vacuum, we should be doing this in collaboration," he said.

It's appropriate that changing podiatrists' licensure is an issue that should be handled within the medical community by academics instead of by politicians, Gastwirth said.

"Rather than looking at anecdotal evidence and a lot of emotion, let's sit down and have an objective conversation," he said.

A question of education

A question for the task force is how closely podiatric education aligns with education offered at medical schools. Podiatrists say their training standards, which include four years of podiatric school and three years of clinical training, are close to those required of physicians.

"We deserve to be under the same umbrella," Block said. "The biggest problem is the medical community is not familiar with how educated we are and how well-trained podiatrists are today."

COA President Tye Ouzounian, MD, said the CPMA approached the COA six months ago about establishing the task force. The COA agreed to support the concept, but the outcome of the collaboration remains to be seen, he said.

"It's important to emphasize that there are no assumptions about this process," Dr. Ouzounian said. "It's not a foregone conclusion that this is going to be an accomplishable task. My personal belief is that they have a long road to go before they get there."

In a May 2009 position statement, the AOFAS said podiatrists provide a valuable service when they function within their education and training. To achieve parity in credentialing to other physician specialties, podiatric graduates should be required to pass the U.S. Medical Licensing Examination, podiatric residency programs should be accredited by the Accreditation Council for Graduate Medical Education, and podiatric residents should take a certification exam prepared by an American Board of Medical Specialties member board, the AOFAS said.

Block has advocated for 30 years that podiatry give up the doctor of podiatric medicine degree and transition to MD and DO degrees. "I believe it's inevitable that podiatrists will eventually be in the same tent as other allopathic specialties. We're currently discriminated against because of our degree," he said.

Though there is agreement within the profession that podiatrists should be on par with physicians, Gastwirth said there is debate about whether that requires a degree change.

"What we are looking for is to be recognized as physicians within the area of our education, training and experience," he said.