Raising Questions On Training And Double Standards For Hospital Privileges

The controversy rages on. Patrick DeHeer, DPM, reminded us of this in his recent blog, “An Open Letter To Foot And Ankle Orthopedic Surgeons,” in which he discusses how we need to take charge of the constant uphill battle we are faced with when dealing with our orthopedic colleagues (see https://bit.ly/eaTMrN ). Even though we have made great strides in our exposure and training, there are still questions as to our expertise.
 
The most recent glaring example of this is in the most recent issue of Foot and Ankle Specialist, which has a roundtable discussion on pediatric flatfoot and the various diagnoses and treatments pertaining to this complex issue.1 There were four participants in this roundtable, two podiatrists and two orthopedists. One of the two podiatrists is Harold Schoenhaus, DPM, one of the true pioneers in our profession as a whole but also in the realm of podopediatrics. I have been lucky enough to share the podium with him at various conferences and always enjoy hearing him speak.
 
If you happen to read this exchange presented, I am hoping you will quickly realize that our orthopedic colleagues are not as versed as we are in the biomechanics of the foot, the various ways to properly identify pathology and the various treatment modalities available for these small feet.
 
One of the most striking things in the roundtable article is that one of the orthopedists, when asked if surgery was warranted on seemingly asymptomatic flat feet, responded, “Never!”1 However, later in the discussion, one of the orthopedists on the panel recommends fusing the subtalar joint in a young patient with a certain level of arthritis noted on the magnetic resonance image (MRI) and a rigid flatfoot secondary to a tarsal coalition.
 
Really? So rather than evaluate this patient clinically, we check MRI and recommend fusion? I am always at a loss when faced with these scenarios and constantly wonder where exactly I was when our colleagues presented the lecture about that topic when I was a student.
 
I am now facing another issue, which many of us do when trying to secure hospital privileges at new facilities. I know for a fact that when an orthopedist applies for privileges, the medical executive committee does not ask the orthopedist for proficiency reports. I am trying to get privileges at a new hospital and the hospital is asking me for proficiency reports, even though I am board certified by the American Board of Podiatric Surgery and have been out of residency almost 10 years now. The hospital is asking for Quality Improvement(QI) data on my performance based on peer review by hospital administration.
 
I was shocked. I have never been sued (knock on wood) and have no disciplinary action in my record. I promise I am a good boy. Strange that some get a free ride and others have to continually prove their mettle to get what they need — not what they want, but what they need.
 
Is this double standard self perpetuated? I just do not know. I hope not. If it is self perpetuated, we need to stamp it out and make things smoother for the next generation. If it is not, the fight continues.
 
Reference
 
1. Kelikian A, Mosca V, Schoenhaus HD, Winson I, Weil Jr. L. When to operate on pediatric flatfoot. Foot Ankle Spec. 2011; 4(2):112-119.