By Sandra Basu

At Stand Down South Jersey, an annual event at the Cherry Hill Armory of the New Jersey National Guard, Karen Galli, DPM, examined the feet of Marine Corp. veteran Don Morton. Photo from the American Board of Podiatric Medicine website.

WASHINGTON — Who should be considered a physician at the VA?

That question was discussed by lawmakers and advocacy groups in response to introduction of a recent bill that would revise current VA law to include podiatrists in the physician and dentist pay category.

The bill, introduced by House Committee on Veterans’ Affairs Health Subcommittee Chairman Rep. Brad Wenstrup, DPM, (R-OH), a podiatrist, would include those healthcare providers within the VA definition of physician and would increase their pay grade to match the compensation of other VA physicians.

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Wenstrup said this is “not about expanding the realm of credentialing that a podiatrist has or has had.”

“It’s about access, access that is stymied by a classification, a limited career path for podiatrists and opposition that has come against the notion of moving podiatrists to the category of physicians and surgeons,” he noted.

Podiatric groups sought the change in prior years, but a legislative fix has not made it out of Congress.

During the hearing, advocates of the change pushed for moving podiatric surgeons and physicians into the physician pay category. Seth Rubenstein, DPM, a trustee for the American Podiatric Medical Association, told lawmakers “that simply changing the law to recognize podiatry, both for the advancements we have made to our profession and for the contributions we make in the delivery of lower extremity care for the veteran population, will resolve recruitment and retention problems for VA and for veterans.”

VA also is among the backers of the legislation.

“Our compensation system has fallen behind the times as the current pay authority is over 41 years old … As a result, it has been increasingly difficult in the past several years to recruit and to retain experienced providers,” VHA Chief of Podiatry Jeffrey Robbins, DPM, told lawmakers.

Robbins said that, in FY 2015 and FY 2016, VHA brought in 142 new hires for a net gain of 54 podiatrists.

“What this means is that 88 providers left the system or almost 62% of medical centers had to replace providers disrupting patient continuity,” he pointed out.

Robbins said that a pattern emerging in podiatry in VA over the past several years is of young providers coming into the system “gaining experience as well as cases for board certification, becoming board certified and then leaving for the private sector, where the average compensation is $30,000 higher than the highest compensation in VA.”

A VA white paper on podiatry pay explained that “the VA podiatrist compensation package has remained unchanged since 1976, except for those changes that include adjustments for basic pay and locality rates.”

“Meanwhile, clinical responsibilities of VA podiatrists have greatly expanded and podiatrists in the Veterans Health Administration (VHA) have assumed equivalent professional and administrative duties to other physician groups,” the paper explained.

Furthermore, the paper explained that there “is a growing healthcare demand for primary and specialty podiatric services, especially among veterans suffering from polytraumatic injuries, spinal cord injury, and limb amputation. This is in addition to the approximately 1.8 million veterans (up 21% from 2015) who are receiving VHA care and are at risk for major foot wounds, infection and amputations.”

Physician Classification

Objections to provisions in the bill were voiced by retired Col. James Ficke, MD, on behalf of the American Orthopaedic Foot & Ankle Society and the American Association of Orthopaedic Surgeons.

He acknowledged that the current statistics are “staggering” regarding the burden of injury and disability and agreed that musculoskeletal care for veterans is “imperative.”

Ficke suggested that the organizations agree that podiatric surgeons should be more equitably paid to support their recruitment and retention in VA. He emphasized, however, that the organizations he represents do not support the use of the term “physician” for podiatrists.

 

“While recent changes have improved podiatric education, it is not the same as a multisystem medical education required to become a DO or MD, nor is it the same accreditation process,” he explained. “Podiatry does not participate in the U.S. medical licensing examination, which is the standard for all advanced medical care and is essential for practice as a physician.”

“We believe the title of physician should be obtained through the accreditation process and not the legislative process,” he added.

Ficke said the definition by various dictionaries and several other organizations for “physician” is that they have passed the U.S. medical licensing examination.

He also maintained that the “public and our veterans need to understand there are differences in training” [b[between MDs and DPMs]/p>

Rep. Ralph Abraham, MD, (R-LA), however, said that he thought it was “tragic that we are arguing over semantics.” He said that patients and veterans know there are differences but do not make a distinction.

“These are all physicians in their mind and certainly in the mind of myself. They want to be healed. The definition of a physician is a healer,” Abraham stated.

Wenstrup said he hoped the groups can “get beyond this.”

“Some of the definitions I looked at [f[for physician]ave the example of MD, but it didn’t limit it to that. So for us to be hung up on this word at the expense of the veteran having a large pool of physicians able to take care of them, I think it is a shame,” he said.