We Are Podiatrists. Nothing More, Nothing Less.

Ladies and gentlemen, I have an earth shattering confession to make. Wait for it … I am extremely proud and honored to call myself a podiatrist.

As silly and simple as this revelation may seem, when I look around at what is going on in our profession today, that term that so eloquently describes what we do everyday seems to be whispered these days instead of proclaimed loudly and proudly. It is almost blasphemous to actually refer to ourselves as what exactly we are. We are podiatrists, the foot and ankle experts, nothing more and nothing less.

Let’s review what I do just about all day everyday. I cut toenails for the elderly who either can’t physically do it themselves or who present with comorbid factors that make it better for a trained professional to take care of this seemingly simple task. Should I then call myself an onychomycologist? I am not sure that really applies because my very next patient could be in need of an ingrown toenail removal and also may ask me to kill the nail root, using carbolic acid as a destruction agent. Maybe I should be known as a phenol and alcoholic. Hmm … that doesn’t sound very appealing to me.

I generally see patients with diabetes in the hospital almost every day. I field their medical issues relating to their feet, potentially order appropriate testing and possibly even take them to the operating room for an incision and drainage, or even an amputation. So am I known as a podiatric hospitalist or should I refer to myself as a foot amputation specialist? That is also not very appealing to the average person, wouldn’t you say?

I personally like to review the actual films when I send my patients for computed tomography (CT) or magnetic resonance imaging (MRI), so am I now a podiatric radiologist? Believe it or not, I went so far as to try to get malpractice insurance to practice strictly as a podiatric radiologist but my carrier turned me down, saying I was not licensed to read these films. I was “just” a podiatrist, you see. So now the MRI identifies a nerve issue and I think I could use injection therapy to relieve the symptoms. A podiatric acupuncturist sounds a little mystical, doesn’t it? If I happen to do the injection with ultrasound guidance, am I now a podiatric interventionalist?

By the end of my week, I have my surgery schedule so I head over the hospital and perform my cases for the week. A podiatric surgeon … hold the phone. Now that sounds sexy. I am actually a board certified podiatric surgeon. Whoa … now we are talking. Let’s try something else. If I am a foot and ankle expert, let’s put something else in there and see what happens. Oh, I am a board certified foot and ankle surgeon. That’s the ticket.

Hmm … the problem with that terminology is that it implies that all I do is foot and ankle surgery. I do not really like that because even though it may describe a small part of what I do as a podiatrist, it really does not accurately reflect how I help my patients in most situations. It is only maybe one-tenth (a half day a week of a six-day work week or so) of what I do most of the time. So why is it that I hear our colleagues refer to themselves as foot and ankle surgeons rather than what it is we truly do for our patients in most situations? This is especially true when we start putting things like “fellowship trained foot and ankle surgeon” in front of our names instead of DPM after our names.

I am not poking fun (well, maybe just a little) but I’m not a foot and ankle surgeon. It is part of what I do every week to help people feel better but it is not who I am as a professional. I am a podiatrist, plain and simple.

Has This Conversation Ever Happened To You?

Since I am such a fan of role-playing games (I played the massive multiplayer online role playing game World of Warcraft for years and now am a Star Wars: The Old Republic junkie), let’s role play through a scenario that, believe it or not, I encounter frequently.

A new doctor in town (let’s call him Dr. Nu Youngblood or “YB” for short) gets invited to a party with his new wife in the new town they just moved to where he is newly in practice. He meets another young professional (Brian, whom we’ll call “B”) at this party and their conversation goes something like this.

B: Hi, I’m Brian.
YB: Hi Brian, I’m Nu.
B: Hey Nu, so what do you do for a living?
YB: Well, I’m a foot and ankle surgeon.
B: Wow, that sounds great. Where did you go to medical school?
YB: I went to Temple but I didn’t go to medical school, I went to the podiatry school there.
B (looks a little confused): I thought you said you were a foot and ankle surgeon?
YB: I am.
B: My mom sees a podiatrist. She goes there every few months to have her nails cut. She is diabetic. So, do you do that?
YB: Some but I like being in the OR more.
B: Well, what’s the difference between you and the guy that cuts my mom’s nails?
YB: He might not be a surgeon.
B: Oh, he is a surgeon. He did a really great job when he fixed her bunions ten years ago, but on his business card, it says he is a podiatrist. What is the difference?
YB: Well … um … nothing really …
B: Huh? So you’re a podiatrist, too?
YB: Yes, I am.
B: Why didn’t you say that in the first place?!

I hear this kind of thing all the time. I chuckle every time but can’t seem to put a finger on why this scenario bothers me so much.

Here is the same scenario that plays out when I’ve been to the same types of parties over my career.

B: Hi, I’m Brian!
Ron: Pleasure to meet you, Brian. I am Ron.
B: So Ron, what do you do for a living?
Ron: I’m a podiatrist, Brian.
B: Ha … foot fetish?
Ron (laughs): Not so much. I stay pretty busy taking care of all kinds of foot stuff.
B: Oh?
Ron: Yeah, I see patients with diabetes in my office and prevent them from having problems with their feet from bad circulation or nerve problems. I can also see them in the hospitals and in a couple of wound care centers here locally. I also see all kinds of sports injuries and treat kids who have bad feet. I do perform surgery if people need it. I do everything from bunion surgery to fixing Achilles tendon tears. Most of my time is spent taking care of patients in the office and hospitals. I like to write and contribute to online magazines, and have been published too. Once in awhile, I lecture at national conferences about kids and surgery.
B: Wow! You stay pretty busy, don’t you? Here I thought all podiatrists do is wiggle toes (laughs). You know, come to think of it, my mom sees a podiatrist here locally to get her toenails cut. She is diabetic, you know. He did surgery on her ten years ago or so. She had really bad bunions but is really doing well with that now. My wife is always complaining about how much her feet hurt. Maybe you can help her. Anyway, it was really nice to meet you. Good luck to you. Do you have a card?

I have absolutely nothing against our push forward to more techniques and technologies in the surgical realm. What I do take issue with is not that we focus too much on surgery these days but that we only focus on surgery. There is so much more to what we do as professionals than the skills we practice in the operating room. If you take a hard look at strict finances, I think any practicing podiatrist will tell you that to certain degree, one can make more money doing simple office procedures than the time and money it takes each of us to make our way and spend our time in the operating room.

One other alarming trend I see now is that the aspiration is turning away from the more humble and “simple” aspects of our art, and more toward the “big” stuff. If that is what you want to do, go for it. More power to you. I personally find the “simple” stuff much more rewarding. I also find that patients tend to appreciate it more. Your personal and family life will appreciate it more too, I think. Mine does.

I am a podiatrist. Nothing more and nothing less. There. I said it.



Observersays: November 28, 2012 at 7:20 pm

The point of your essay can be distilled to this: The general public is largely confused as to what a podiatrist is, does, or how podiatrists are trained.

Podiatrists expend a lot of energy every day explaining what they are, what they do and the sort of training they have. Many podiatrists have to, if pressed by a confused or concerned person, have to explain why they chose podiatry. I imagine that can become tiresome, especially after many years of practicing.

Podiatry has a public relations and media presence problem that would probably serve the profession well to explore. The title, DPM, brings to mind many things: shaving a callus, treating a bunion, fungus nails, scraping dead skin, ... .

It must be draining and distracting having to explain yourself so often. When will the letters DPM be a household word?

Reply to this comment »
Ron Raducanu DPMsays: November 29, 2012 at 10:33 am

It is not draining or distracting at all. It's a matter of education. I see my role as a physician as an educator.

When we start thinking we are beyond educating everyone as to what it is we truly do, it is time to re-evaluate ourselves.

I have to admit "Observer", I have read this prose on another website. Eerily familiar writing style too. Hmmm...

Reply to this comment »
CP. Aka, Observer-Good eye.says: November 30, 2012 at 2:49 pm

Glad you recognized the style. Feel free to visit. Anyway, I see that "educating" as more of a distraction, energy drain, and there are better, and more useful things to educate patients about.

Do dentists need to "educate" their patients as often as a DPM?

No. DDS and DMD are well branded. Change the degree already.

So far it has been: DSC, DP, DPM ... Time for a change and rebrand the profession to mark its progress.

PMD would be a decent choice.

Reply to this comment »
Whatsawhatsasays: November 30, 2012 at 2:35 pm

The letters DPM have no value outside of clinical podiatry. If the degree was different and newer sounding, it would put a new face on an old profession. Ya think?

Reply to this comment »
Dr. Ron Raducanusays: December 2, 2012 at 9:47 pm

Not sure I agree with this.

I don't think if the degree was "different and newer sounding," it would make any difference at all. DPM is what I signed up for. Why do we constantly look to change things instead of finding ways to empower what we have and who we are?

Reply to this comment »
Amossays: December 3, 2012 at 7:20 pm

How do you empower old news? I signed up for parity. That was the promise. Now I have debt and nobody knows or cares what DPM is but know we are not real doctors. At least the new DNPS GET A CHANCE to start fresh. None of my classmates care to be associated with the podiatry of the last century. Where is all the great change? We want to break away from the mold of DPM.

Reply to this comment »
Ron Raducanu, DPMsays: December 5, 2012 at 4:50 pm

Sounding bitter again there.

Too bad your classmates don't want to be associated with those before them. That is shallow and shortsighted. We learn from the past to improve our future.

You need a history lesson. If it wasn't for "those guys," we wouldn't be in the hospitals, operating rooms, wound care centers and, for most of us, very happily in practice. Our residencies wouldn't be as advanced as they are. "Those guys" are the ones that are still teaching your generation (and mine) their skills and techniques in the office and the operating room.

Have some respect please. They've earned it.

Reply to this comment »
Christophersays: November 29, 2012 at 4:02 am

Ha ha! Love it! I am a student training to be a podiatrist in Ireland and that is what I deal with everyday from patients to my best friends! It brought a smile to my face reading this as I prepare for my podiatry exam! All the best! :)

Reply to this comment »
Ron Raducanu DPMsays: November 29, 2012 at 10:35 am

Best of luck to you as well Christopher!!! Thanks for your feedback. Come over stateside one day so we can swap patient stories!

Reply to this comment »
Wayne says: November 29, 2012 at 3:22 pm

Correction: Podiatrists are medical and surgical experts at foot, ankle and leg below the knee cap.

Reply to this comment »
Dr. Ron Raducanusays: December 2, 2012 at 9:49 pm

Sadly, we have not established a nationwide scope of practice, YET. Some of our colleagues can't practice above the tibial plafond and some struggle with their state scope of practice to even go that proximally.

It will happen but only when we stop trying to re-invent ourselves every few years and unify for a nationwide scope.

Reply to this comment »
Podstudentsays: November 30, 2012 at 11:37 pm

So podiatrists can DIAGNOSE head to toe, hence the H&P, but TREAT only below the knee cap medically and/or surgically?

Reply to this comment »
Ron Raducanu DPMsays: December 3, 2012 at 1:24 pm

No. You can examine head to toe, but you can only diagnose and treat within your state scope of practice.

Reply to this comment »
Wayne says: December 4, 2012 at 9:31 am

But isn't 'examine' also diagnose? The purpose of clinical examination to gather clinical signs is to DIAGNOSE.

Reply to this comment »
Ron Raducanu, DPMsays: December 5, 2012 at 4:45 pm

No, sorry. If I do an H&P (which I don't, but just for argument's sake) and suspect a lung disease, I will send that patient for a more thorough examination and refer back to their PCP. A clinical examination's purpose is to identify a potential issue. If the issue is foot and ankle-related, then as podiatrists, we are free to diagnose.

Sorry to tell you, but just about every MD specialist does the same thing. Ask orthopods to diagnose a heart murmur and they will laugh. If they suspect something going on with their patient's heart, they will send the patient either back to the patient's PCP or to their cardiologist friend.

Reply to this comment »
anonymoussays: November 30, 2012 at 11:41 pm

The point is the public is not educated and the DPM degree needs to be changed.

The following is a very typical office sign :

Dr. John Smith, D.P.M

Podiatrist and Foot Specialist
Foot Doctor and Surgeon Podiatrist

All 4 names says the same thing. This is ridiculous. Change the degree!

Reply to this comment »
Marksays: December 6, 2012 at 9:17 am

The lack of understanding of what a podiatrist is, does, training, education has not changed.

What are we? Who are we? Foot surgeon? Foot/ankle surgeon, podiatrist, podiatric specialists, podiatric foot (redundant) surgeon! If we don't know who we are, how are MDs and laypeople able to figure this out? Educating patients is a time waste and futile. Over-explaining credentials, training, etc., shows a raging inferiority complex. I am curious. Do dentists have to over-explain their training, education too?

There remains a lack of parity and as we embark on 2013, little has indeed changed.

In some hospitals or some states, podiatrists have more "physician-like" status. However, the fact remains that DPM is a tainted brand. Also, sock talk, boots and toenail lacquers do not help our plight on "physician" status either.

Reply to this comment »
csays: December 1, 2012 at 4:16 pm

The journal Practical Pain Management is a widely distributed and viewed publication that reaches the medical, MD/DO, physical therapy, dental, chiropractic and many other fields. Its articles are often specific to podiatry issues yet have been authored by some other specialist(s).

Occasionally, there is an article regarding foot and leg issues in this journal by podiatrists but not often.

Recently, there was an announcement by the journal's editor who said: "Many people are surprised that podiatrists in most states can prescribe narcotics and order tests."

In a media savvy world, IS THIS HOW PODIATRY EXISTS?

That's an example of how podiatry is portrayed in the media, considered and viewed. An afterthought or the brunt of some preconceived notions.

Time to disabuse those notions and focus on bringing podiatry into the 21st century and STOP having to continually explain itself, and its exclusion from so many "physician only" areas!

Reply to this comment »
IPsays: December 2, 2012 at 3:39 pm

As a dentist, it's an interesting read. I have gotten a few questions through the years about having to look inside people's mouths all day and all I can do is respond with "There are two ends to a long tube and compared to doctors who work at the other end, I think I make out pretty good." But as a specialist (periodontist), there are sometimes questions about what I do, more along the line of cutting and seeing blood all day.

I guess people are more familiar with DDS/DMD because everyone (most everyone) has a dentist while not everyone has a podiatrist. I don't think changing your degree to another acronym means anything. But at least you guys can settle on one degree. Look at us, we still graduate dentists with both the DDS and DMD. Ridiculous.

Reply to this comment »
Marksays: December 3, 2012 at 12:07 pm

The article in the November 2012 Practical Pain Management issue (read it) again reflects how health professionals view us. "Many people may be surprised that now podiatrists in most states can rx, order X-rrays, lab tests??!? We're in 2013 practically.

All the walkathons, talkathons and proclamations, and little has changed.

The PR for podiatry and DPMs is poor. Change the degree already and get universal scope.

PMD.

Reply to this comment »
Ron Raducanu DPMsays: December 3, 2012 at 1:35 pm

Hi Mark,

What will that achieve? We will still have to explain what a PMD is, won't we?

You're right. The PR for podiatry IS poor, but whose fault is that? It's ours! We need to persevere. The APMA does a brilliant job with it but not all DPMs are members.

Also, MUCH has changed within our profession. Saying nothing changed because people haven't caught up to us means we just have to educate more. That's all.

Reply to this comment »
Amossays: December 3, 2012 at 7:13 pm

Did we go to school and debt to educate patients about what we do? It gets old. The post about dentists hit it on the head. DPM has too much baggage. You might (enjoy) explaining yourself and how all the junk the old DPM these days is new and improved but I think it sucks. I would rather EDUCATE people about something new and improved. Look at the DNPS. They have a new start. Why can't we? $227,000 in debt for a degree that is out of the disco days. I have better things to educate patients about than my degree. Maybe you do not.

I agree on PMD. I would never pay APMA dues because they do not do squat for PR.

Reply to this comment »
Ron Raducanu, DPMsays: December 4, 2012 at 11:02 am

Amos,

You sound bitter about your career choice. That has everything to do with you.

I think that if you are not a dues paying member of the APMA, you are part of the problem in our profession, specifically if you are that embittered about your career choice. So what are YOU doing to make things better for the profession besides being very outspoken here?

Reply to this comment »
Amossays: December 4, 2012 at 11:53 am

I am bitter. The APMA is a joke. No pr, more promises, a lot of lies. Most of my classmates feel the same way. A clique of older podiatrists living in the past.

What am I doing?

I am NOT defaulting on my student loans. If I do, I will get sued. If I get sued, I will respond to the complaint with affirmative defenses. Somewhere along the way, podiatrists will be called to testify. This can go on for years. Many podiatrists will say all is well and many like me and my contemporaries who are in so much debt will not.

If it goes down that way, I will show the court all the documentation rejecting us from work.
I am preparing.

Reply to this comment »
Ron Raducanu, DPMsays: December 4, 2012 at 12:27 pm

I'm sorry Amos, but I believe it was you who decided to pursue the profession, so ultimately the responsibility falls on you for your choices.

I challenge you to become more involved with the APMA. It might change your mind on what exactly they do for us.

It sounds like you are protecting yourself, but that does little to help your colleagues.

I'm sure as a non-member, you take no advantage of the legislative strides your colleagues at the APMA have made for you. They are able to lobby and have done so successfully. This has helped members and non-members alike.

Reply to this comment »
Wayne says: December 4, 2012 at 10:48 am

DNPs (nurses with doctorate degree in nursing) will become the new PCPs soon, not the MD/DO internists and the MD/DO family practicioners. Funny thing is, DNPs cannot technically be addressed as "doctor" by personnel and patients in the health care setting, even though their degree is a doctorate degree. Still an active controversy not getting any better yet. Especially with the MD/DO internists and MD/DO family practitioners being the loudest complainers.

Reply to this comment »
Marksays: December 4, 2012 at 11:16 am

DNPs are the future and MD/DOs will be replaced in the primary care setting by these providers. In fact, the ACO language is quite clear, PAs and NPs are primary care providers.

Where does that leave DPMs and foot and ankle surgeons/podiatrists? Who knows. It is time that the degree be changed. As stated above, the DPM remains an enigma, tired of over explanations, glazed eyes by patients, and what is a DPM? (Also tired) of 2nd-tier/3rd-tier status by ignorant docs that cannot believe the podiatrists now can prescribe, order X-rays, lab tests in most states (Nov 2012 PPM). It podiatrists could be retrained, retooled to be primary care physicians with all the rights and privileges, then that could perhaps help with the PCP/GP shortage and offer a bridge into mainstream medicine.

Is it reasonable for practitioners to be PR professionals? It seems futile. Either the degree/profession IS or IS NOT moving forward or dying. There's no such thing as status quo. That equals dying.

Reply to this comment »
Wayne says: December 4, 2012 at 3:54 pm

I think podiatrists can and must stick with the following goals in their scope of practice:

1) Examine and diagnose head to toe for comprehensive and focused H&Ps just like the PA, NPs, and MD/DO PCPs (i.e. internists and family practictioners). General internal medicine and general family medicine should be universal for all these medical providers, especially podiatrists.

2) Treat medically and/or surgically below the knee.

Reply to this comment »
Doug Richie D.P.M.says: December 6, 2012 at 1:32 pm

I am astounded by the comments from Amos, Mark and others. Am I tired of explaining my degree? I hardly ever have to do so! Do I have to look into glazed eyes of patients? Never. Do I want or need to be "retooled" to become a primary care physician? Are you kidding?

I am going to devote my next blog in a few weeks to this sad state of affairs reported by some of my colleagues.

Reply to this comment »
Excitedsays: December 29, 2013 at 8:17 pm

I will be commencing my DPM soon in a country where this particular degree is relatively "new" and I just want to say your article has strengthened my resolve!

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