Two Degrees Are Not Always Better Than One

Camille P. Ryans

With the recent explosion of the dual degree concept, one must ponder both the advantages and disadvantages of obtaining such titles. I am opposed to the concept of the dual MD/DPM degree.
The field of podiatry is unique in that it offers the opportunity to specialize in a doctorate-level medical profession early in one’s education. Entering students are aware of what their specialty will be from day one. This provides a sense of security and devotion to a chosen profession.
Possibly the most significant difference between the training of podiatry students and allopathic students is the degree of training in anatomical sciences. Podiatry students complete a full year of gross anatomy courses whereas gross anatomy is only offered for one semester at some allopathic medical schools. Podiatry students have the advantage of spending twice as much time learning about the human body’s structure, which is essential to being a well qualified physician.
In addition, podiatric medical students are introduced to biomechanics, which is not a required class in medical school, and are even introduced to surgery courses at an earlier stage in their education than allopathic medical students. For example, podiatry students are enrolled in “Introduction to General Podiatric Surgery Principles,” “Operating Room Protocol” and “Digital and Metatarsal Surgery” during their second year. The curriculum of allopathic medical students consists primarily of classes that are tested on the U.S. Medical Licensing Examination (USMLE) Step 1.
The introduction of surgery classes pertaining to the foot and ankle results in the development of well trained specialists in every aspect of the lower extremity. By combining MD/DPM degrees, there will be less emphasis on such classes and workshops. Podiatric residencies may include fewer rotations pertaining specifically to the foot and ankle, and become more focused on other aspects of medicine. If this occurs, can the doctors who emerge from these residencies truly call themselves lower extremity experts? What differentiates podiatry from general medicine is its focus on gait analysis, shoe wear and pathomechanics. Podiatry is not only the art of surgery but of fabricating devices to improve bodily kinesthetics as well.
In the 1980s, Runner’s World published a monumental article which highlighted differences among orthopedic physicians and DPMs in the treatment of chondromalacia of the patella or “runner’s knee.” Orthopedic surgeons generally treated the condition via shaving of the patella and removing damaged articular cartilage. This approach was invasive and only provided temporary relief as the ultimate consequence was bone rubbing with bone.
In comparison, podiatrists treated their patients by fitting them for orthotics in order to counteract the hyperpronation. By utilizing the concepts of biomechanics, DPMs were able to provide permanent treatment of the runners’ ailments without subjecting these patients to painful surgery.
This positive press was extremely beneficial to the profession of podiatry and led to incredible innovations in footwear. Prior to the concept of treating pain and ailments by altering biomechanics, shoe wear for athletes included Converse All-Stars. Although these shoes are a fashion statement today, they do not provide much support or have significant shock absorbing ability. Fortunately, because of the impact of podiatry, shoe companies began manufacturing footwear designed to dissipate the shock endured from physical activities. In addition, a variety of shoe models have been created based on foot type, which podiatrists may evaluate.
Podiatrists are a small close-knit community. Minority populations do not gain strength by assimilating to the standards and norms of the majority. Strength is demolished when this occurs and the result is disunity among the minority.
Some may argue that adding a MD degree signifies increased education, which will lead to better patient care. However, the measure of an individual’s knowledge is not by how many degrees he or she holds. There is no law that prevents DPMs from seeking information about any topic they would like. We live in a time when information sources are so readily obtainable.
Professional podiatric organizations and journals would also be hindered due to the increased interest and enrollment in general medical associations.
The evolution of a profession is inevitable. However, if the proper conditions are not met for its preservation, extinction will occur. Podiatry has a strong heritage and many individuals have made a commitment to bolstering the image of this profession. I would hate to see this legacy fade away when we should embrace it.

Ms. Ryans is a student at the Temple University School of Podiatric Medicine and is in the class of 2010.

Dr. McCord is a Diplomate with the American Board of Podiatric Surgery. He practices at the Centralia Medical Center in Centralia, Wash.


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