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.