Why Is Podiatry Trying To Reinvent The Wheel?

I am honored to contribute a monthly blog for Podiatry Today and have given my first topic much consideration. What should I write about? Should I discuss an interesting case presentation? Should I offer pearls for a complex reconstructive surgery? As I contemplate these possibilities, I am drawn to a potentially “hot potato” political topic, which I feel is vitally important to discuss.

I had a recent conversation with an acquaintance, who is a periodontist. We were making small talk and he asked the all-too-familiar question, “Why do some podiatrists practice ‘traditional podiatry’ (his words, meaning office-based primary foot and ankle care, wound care) and others are ‘foot and ankle surgeons like an orthopedist?’” To the outside medical community, the change in training over the years and hence the scope of practice continues to be a source of confusion.

I explained the current state of podiatric medical education and the ongoing change to the residency training programs. “We are moving to all three-year surgical training programs and no longer have any primary care programs,” I told him. His next comment took me aback and forced me to think. He simply asked, “Why are you guys trying to reinvent the wheel?”

At first, I did not understand what he meant until I asked him to explain. He pointed out the amazing similarities between the dental and podiatric professions. There is a need for primary care foot and ankle and wound care, just like there is a need for general dentistry. This need is not going to fade but rather will likely grow.

He pointed out that not everyone wants to be a surgeon or is programmed for it. That is not a bad thing. It is just a fact. So after dental school, some go on to become general dentists and that satisfies a need of the public and the individual doctor. Others go onto additional residency training in one of nine specialties and become periodontists, endodontists, oral/maxillofacial surgeons, etc.

He concluded by asking me why we were moving away from filling an important community health need for primary foot care and at the same time trying to force everyone to become surgeons. Why reinvent the wheel? You need both: some become primary care practitioners (podiatrists/general dentists) and other gain additional specialized surgical training (foot and ankle surgeons/periodontists, oral-maxillofacial surgeons). In his view, this serves everyone well. The public has greater access to well-trained physicians and surgical specialists, and the practitioners are doing what they are meant to do and enjoy it wholeheartedly.

So why reinvent the wheel? I did not have a good answer for him actually. As a profession, we struggle with the external issue of “parity” and the internal politics of being a foot and ankle surgeon or a podiatrist. Perhaps we could look to our dental colleagues who seem to have figured out a pretty successful system that works for all parties involved.



Elbys Erasays: August 31, 2011 at 1:44 pm

Why did he ask the first question then? I don't get it!
The problem is not the distinction between a foot and ankle surgeon or a podiatrist. It is between the different types of foot and ankle surgeons. Those who do the rearfoot, the ankle, the leg, who can do external fixation, who can't, It is crazy!

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Juliet Burk, DPMsays: September 1, 2011 at 12:39 pm

I agree wholeheartedly with the caution in this article. When I enrolled in podiatry school in 1992, I had absolutely no desire to be a surgeon. Being a graduate with distinction in my graduating class at Des Moines University did not spur my ambitions to be a foot and ankle surgeon. My intellect and ego were well served without a scalpel.

When I graduated from my RPR in 1997, I declined my PSR-12. I obtained a license in Oklahoma without a surgical residency (no longer possible) and have thrived as a GP podiatrist with an emphasis on biomechanics and wound care. My lack of surgical ambition was mocked by some and I still have idiotic fellow podiatrists who suggest that I would be a better doctor if I performed surgery. Really? Using that logic, an internist is a worse doctor than an ENT doctor. I don't see the relevance.

I think the profession is crucifying itself on its own ambition/inferiority complex. If we don't resurrect the primary care podiatrist, our niche will not exist. Will the stupid people in charge please step down? The master plan is flawed.

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Steven D Epstein, DPMsays: September 1, 2011 at 1:10 pm

I am one of those "office-based, primary foot and and ankle care, wound care "traditional podiatrists." My problem is that our local podiatric foot and ankle surgeons do not see fit to limit themselves to sub-specialty care but also do "primary" foot and ankle care, thereby competing with me. Imagine how the local general dentists who refer to this periodontist would feel if he also did general dentistry, even if not on his referred patients. I suspect the reason for the way podiatry is less is that multi-year residency trained ABPS qualified/certified podiatrists enjoy "all phases" of practice but more that they must practice "all phases" in order to remain busy and viable. This situation is the result of decades of over-production of podiatric medical school graduates. It is as if by increasing our numbers, we might somehow overwhelm our adversarial situations. How many advanced foot and ankle surgical specialists do we really need? Is it really good use of their talents that they also grind toenail or even do primary non-surgical podiatric orthopedics and office-based minor surgeries, like P&A's and wart curettage?

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Dave Stevens, DPMsays: September 16, 2011 at 1:09 pm

Good points but there is something missing in the dental comparison. Dentists don't clean teeth. They have hygienists for their "routine" visits. It is not reasonable to go through 11 years of training (8 yrs college, 3 yrs of residency) to become a general podiatrist whose main task is to cut people's toenails. There's nothing wrong in doing this and it is a valuable service to people, but I don't think patients receiving this service would expect the provider to have such advanced training.

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Vladimir Gertsik DPMsays: December 27, 2011 at 6:04 am

Excellent article. Thank you.

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