Every day, I access a popular podiatric list serve and read numerous submissions from my colleagues who lament about their declining enthusiasm to continue practicing podiatric medicine. Many feel “helpless” as third party payors make regular cuts in reimbursement for services rendered. Others complain about the lack of ”parity” in training, scope of practice and acceptance in the community of podiatric physicians in comparison with our MD counterparts. Still others complain about the “disparity” within our profession when comparing post-graduate surgical training, scope of practice, hospital privileges and eligibility for board certification.
If any pre-medical undergraduate candidate were to read this doom and gloom dialogue on the Internet, he or she would certainly think twice about pursuing a career in podiatric medicine. Yet a golden opportunity exists for podiatric medicine, an opportunity that is almost ignored in the current training of our students and residents and is vanishing in the continuing education of practicing podiatric physicians.
This opportunity is the field of podiatric sports medicine. When I attended podiatric medical school in the late 1970s, podiatric sports medicine was the “darling” of our profession and was the first opportunity for us to be compared favorably with our MD counterparts. In fact, by the mid-1980s, podiatric physicians were the preferred choice of a doctor for the serious athlete who had any type of overuse injury in the lower extremity. And now we are fighting for “parity”?
In the 1990s, podiatric medical training emphasized surgery and began abandoning any serious study of biomechanics, which was the foundation of podiatric sports medicine in the previous two decades. Today, leaders in our profession are considering further elimination of biomechanics training in our post-graduate residency programs in favor of simply increasing the numbers of surgical cases. All of this is part of an effort to achieve “parity” with our MD counterparts.
Running Boom Creates Greater Need For Podiatric Services
Ironically, as our profession has abandoned the legacy that was the essence of our success in the 1970s, the very population that revered our services back then has grown significantly and is in need of our services more than ever. According to Running USA, participation in marathon distance running events has tripled since I graduated from podiatric medical school in 1980.1 In 2009, participation in marathon running races increased by 9 percent, which was the largest increase for any year this decade. Clearly, there is a “running boom” occurring right now in this country unlike any other time in history.
Even more spectacular has been the increase in participation in triathlon events. According to the United States Triathlon Association, participation in all events has grown by 30 percent in just the past two years.2 This has occurred despite the fact that the cost of participation with entry fees and equipment has almost doubled in the past decade.
In comparison to other major athletic events, running and triathlon events are leading the pack in terms of attracting major corporate sponsors simply because the demographics of the participants are extremely attractive. Participants in endurance fitness events generally have higher incomes and are willing to spend money on things that improve the quality of life.
So why wouldn’t a podiatric physician pursue the same patient population? The “sports medicine” segment of podiatric practice can be extremely satisfying and can eliminate any of the concerns voiced by current podiatric physicians about the future of their careers. I only have to look at my own practice to verify this assumption.
Other Key Benefits Of Having A Sports Medicine Practice
My active athletic patients have prioritized health and wellness in their lives and will spend almost any amount of money out of pocket to achieve their goals. Patients will pay for orthotic therapy, physical therapy and even surgery if the outcome will allow them to return to activity. Ironically, most of these patients have excellent private insurance that covers most podiatric services but when it does not, this segment of my population does not question the notion of “self pay.” So much for feeling “helpless” about a lack of reimbursement for hard work.
Podiatric sports medicine is not just focused on foot orthotic therapy. A significant number of my patients end up undergoing some type of surgical procedure over the many years that they are living an active lifestyle. In most cases, there is never any question about who will perform their surgery as the trust and respect these patients have for their “sports podiatrist” exceeds any relationship they may have with other medical specialists. No problems with “parity” here when athletic patients choose the best foot and ankle surgeon.
No matter what the treatment, active athletic patients are more likely to follow our instructions, be adherent with follow-up visits and consistently demonstrate a positive, appreciative attitude towards their doctor and the entire office staff. Furthermore, we are more likely to be paid a fair fee for our services to this type of patient.
The only problem is the fact that most current practicing podiatric physicians will have to supplement their training in order to compete with other specialties that have discovered the secrets of lower extremity biomechanics that we previously owned. Yes, there is a “disparity” today within our profession in terms of biomechanics and sports medicine training as younger graduates pale in comparison to older practitioners who benefited from the curriculum in the 1970s and 1980s, which emphasized podiatric biomechanics.
However, I still think there is opportunity for younger podiatric physicians to increase their skill in sports medicine and biomechanics with self-study and preceptor training. Furthermore, there are simple techniques to begin gaining referrals of quality athletic patients into the podiatric practice. I will share these techniques in my next blog.
1. Available at http://www.runningusa.org/node/57770#57771 
2. Available at http://www.usatriathlon.org/about-usat/demographics