APMA News - May 2011 - (Page 50)
Attaining Parity in California
By JON A. HULTMAN, DPM, MBA
odiatric physicians in California have recently been eliminated as providers under the Medi-Cal system (we are not considered physicians), despite the fact that the number of patients covered under the Medi-Cal program will soon be expanded by health-care reform legislation. Classifying podiatrists as non-physicians and the services we provide as optional is unacceptable. These are not only untenable classifications for the profession, but they are also not in the interest of public health. Our goal in California is to achieve parity with MDs and DOs with the blessing and assistance of organized medicine. To understand the rationale and logic that form the basis of the argument for this long overdue transition, let us trace the changes, accomplishments, and key milestones of the podiatric medical profession in California over the past 40 years.
1970 to 1984
In 1970, podiatric education and training consisted of a four-year post-baccalaureate program with an optional residency. Upon graduating and passing a state licensing exam, the new podiatric physician received a limited license, giving him or her the right to practice independently within the scope of the specialty. This scope included: the right to independently diagnose, treat, take X-rays, perform surgery, prescribe medications, and bill patients and third-party payers for foot-related services. Podiatric physicians were allowed to perform hospital consults and co-admit patients to hospitals for foot surgery and medical problems related to the foot. Even 40 years ago, the training and scope of a podiatric physician were closer to those of MDs and DOs than to any group of “non-physician” practitioners. During this 14-year time period, the depth of training and education of podiatric physicians became more broadly recognized within the medical community, resulting in access to “class A” hospitals and an expansion of physician referrals. By 1984, a one-year residency program was required for state licensure, and the podiatric surgical scope was expanded to include the ankle.
1985 to 2004
Between 1985 and 2004, the profession continued to make progress on multiple fronts, with a significant event occurring in 1993: The Medical Board of California elected to conduct a study of the state’s podiatric residency training. To ensure that this process would be objective and fair, the Medical Board of California appointed consultant Thomas L. Nelson, MD, and the California Board of Podiatric Medicine appointed consultant Franklin J. Medio, PhD, to conduct the study. Their find50 APMA News May 2011
ings were summarized in a report, referred to as The NelsonMedio Report, which was delivered to both boards on October 17, 1993. Significant findings and statements from this report included the following: 1) “Clearly the basic science instruction in podiatry colleges is very similar to that of a medical school in content and depth;” 2) “As might be expected, clinical instruction in obstetrics, gynecology, and urology is minimal in these colleges. Also, we believe that instruction in the behavioral sciences (psychiatry) is insufficient;” 3) “It is our impression that the level of knowledge of these first-year podiatric residents on beginning a service is that which is expected of a fourth-year medical student;” and 4) “Particularly in the large teaching hospitals, the first-year podiatric residents, rather quickly, after an initial orientation and experience on a general medical or surgical service, begin to function in a manner similar to first-year medical residents.” While the 1993 Nelson-Medio Report did not find the education of podiatric physicians to be exactly the same as that of MDs and DOs, it was clear to the consultants that it was quite similar and was, in fact, much more advanced than the Medical Board of California had realized. The Nelson-Medio Report provided evidence for DPMs in the quest for parity. The profession soon began working toward realizing the significant recommendations of this 1993 report. Goals included the following: 1) first-year podiatric residents should complete a significant portion of their general medical and surgical training in academic health centers and large teaching hospitals; 2) all first-year podiatric residents should complete an emergency room rotation; 3) training in the medical areas of pediatrics, neurology, and women’s health should be increased; 4) training in the behavioral sciences and certain aspects of psychiatry should be increased; 5) podiatric medical residents should be paid stipends commensurate with their duties and responsibilities for patient care; 6) the involvement of podiatric faculty and residents should be increased in research activities at training sites; and 7) both certifying boards should encourage the development of mechanisms to ensure reasonable comparability in content and quality of the podiatric residency programs in California. Since 1993 (with the exception of the challenges faced in increasing the number of programs at academic health centers), most of these recommendations have been implemented. Further, work aimed at standardizing programs is occurring at the national level through the efforts of APMA’s Vision 2015.
2004 to 2010
Another significant milestone occurred in 2004 when AB 932 was passed unanimously by the California State Assembly and Senate and signed into law by the governor. It is
Table of Contents for the Digital Edition of APMA News - May 2011
APMA News - May 2011
APMA Educational Foundation Annual Giving Campaign
91st House of Delegates: Focused on the Future
Roth: To Convert or Not to Convert?
Surgical Workshops at The National Offer Hands-on Instruction
Annual Scientific Meeting Preliminary Program
Annual Scientific Meeting Registration Form
Annual Scientific Meeting Sponsors
PICA and Podiatric Medicine: Family Ties Run Deep
Attaining Parity in California
Affordable Care Act, One Year Later: Part One
Members Who Know Media
Small Business 101
APMA Out and About
Worthy of Note
New and Deceased Members
2011 Call for Awards Nominations
Dates to Remember
APMA News - May 2011