What A Spanish Podiatrist Learned From Visiting With Podiatrists In The United States

Patrick DeHeer DPM FACFAS

Editor’s note: This entry’s guest author is Gabriel Aguirrezabal, a Spanish podiatrist. He is in private practice in Bilbao in Basque Country, Spain.

I am Gabriel Aguirrezabal, a Spanish podiatrist. I am very thankful to Dr. DeHeer and his colleagues for welcoming me into Indianapolis for two weeks in March.

During my journey, I wanted to develop new podiatric skills and discover how doctors practice podiatric medicine in the United States. I was able to rotate through a variety of podiatric settings such as surgery, clinical practice and even wound care.

I would like to describe some podiatric aspects that I found to be very interesting in the U.S.

Highlighting Differences In Podiatric Education

Spain does not offer residency programs like the one I visited in the U.S. To become a podiatrist in Spain, you must study at a four-year university. Upon graduation, you are qualified to diagnose, practice surgery and prescribe orthotics and drugs. If you continue studying, you can choose different postgraduate degrees (usually a one-year duration) either in surgery or orthoses.

I completed my postgraduate study in both orthoses and surgery in 2009 and 2008 respectively. I found these were theory-based programs rather than practice-based. Can you imagine a postgraduate program in podiatric medicine where you do not have the chance to apply your concepts on patients? We need programs in Spain that allow us hands-on experience with patients under the supervision of other podiatrists.

A Closer Look At Clinical Practice And Wound Care In Spain

The biggest problem in Spain is that our National Health System (NHS) does not view podiatrists as health physicians. Patients have to pay to visit the podiatrist. Private insurance will only cover nail trimming and shaving calluses. Insurance does not cover fungal culture, orthoses, blood work, X- rays, warts or surgery. Orthopedic physicians working under the NHS take care of such issues. Private offices and insurance companies send these patients to hospitals with the necessary machinery and supplies. This situation makes laypeople get the wrong impression of the podiatric qualification. It is our goal to demonstrate and teach people in Spain about the podiatric profession.

In Spain, the majority of podiatrists have their own private office. Usually, they work for themselves and employ other podiatrists to work for them. The type of work for a common podiatrist includes conservative treatment such as trimming nails, shaving calluses and orthotics. In rare cases, podiatrists also perform surgery. We study surgery programs but we are not confident enough to make surgery a part of our daily practice. The most common types of surgery are forefoot and rearfoot surgery. Podiatrists perform surgery either in a rented surgical room or in a surgery room that they have built in their own office.

Although the government is responsible for establishing wound care units in all Spanish cities, Spain only has a few units in large national hospitals. The results that professionals obtain from these units are often unpredictable because of biomechanics and low healing rates. Wound care units are also not part of the NHS.

Reassessing One’s Goals

This was my first time in Indianapolis, although traveling to the U.S. is always marvelous. I have learned important concepts that I had previously ignored. I have seen things I could not even imagine.

Most importantly, during my time in the U.S., I was regarded as health professional and as a person. Throughout my trip, I was most impressed by the people I encountered. I thank Dr. DeHeer for opening his office, program and family to me. (Also, thank you to Erika Jagger). I am also very thankful to the rest of podiatrists I met, including Anthony Jagger, DPM, Ronald Banta, DPM, Michael Miller, DPM, FACFAS, Michael Baker, DPM, Brian Elliott, DPM, Adam Perler, DPM, FACFAS and Dr. Nowsu. I appreciate them leading me through this incredible experience and having the patience to answer to my questions.

What are my personal goals after this experience?

1. I want to help educate people about the role podiatrists play in the Spanish society.
2. I’d like to apply my surgical concepts when treating my patients. I hope to try to heal the problems and not just give a palliative or aesthetic service.
3. I’d like to achieve a multidisciplinary approach in my treatments, keeping in mind that it is about the patients.

No one is perfect but by working together, we can all learn from our mistakes and give excellent treatment.

Thank you all for being so pleasant with me. I hope to do the same when you come to visit me here in Spain.

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