What Does The Future Hold For Podiatric Surgeons?

Brian McCurdy, Senior Editor

   The APMA Web site notes a mission statement that it “advances and advocates for the profession of podiatric medicine and surgery for the benefit of its members and the public” and “influence(es) public and private policy affecting the future of podiatric medicine and surgery.”

   Dr. Richie, a Fellow of the American College of Foot and Ankle Surgeons, says the APMA should consider binding mediation to resolve continuing differences with the ACFAS. He cites the importance of any effort to get both parties back to the negotiating table.

   In four instances between July 2008 and July 2009, the ACFAS offered to discuss a new relationship with the APMA, according to Dr. Lee. “In each instance, the APMA did not respond or declined our invitation,” he says. “Instead, APMA decided to start an in-house surgical organization that may sap its own resources to, in effect, reinvent the wheel.”

Working In Tandem With Orthopedic And Surgical Organizations

Dr. Lee says the ACFAS will continue its interaction with the American Academy of Orthopedic Surgeons (AAOS) and American Orthopedic Foot and Ankle Society (AOFAS). He notes that two ACFAS members served on an AAOS Clinical Practice Guidelines panel last summer and the college conducts most of its surgical skills courses at the Orthopedic Learning Center in Rosemont, Ill. Since the college’s office is less than a mile from the AAOS, he says their staffs have frequent interaction.

   Alan Catanzariti, DPM, believes there will be “not much of an issue” with the ACFAS dealing with orthopedic organizations without APMA backing.

   “I think the ACFAS is equipped to deal with this better than anybody,” says Dr. Catanzariti, a Fellow of the American College of Foot and Ankle Surgeons. “I think ACFAS will continue to be quite effective.”

   In addition, Dr. Lee emphasizes that the members of ACFAS interact with MDs and DOs in hospitals, surgical centers and, in his practice, are partners with AAOS and/or AOFAS members.

   “These relationships should never be discounted and this is the future for podiatric surgeons,” says Dr. Lee, who is a partner and in private practice at Capital Orthopaedics & Sports Medicine, P.C. in Des Moines, Iowa.

   “Let us remember that AAOS does not require members of AOFAS to also be AAOS members yet they work together harmoniously so our similar membership policies have not surprised or concerned them,” points out Dr. Lee.

Addressing Scope Of Practice Issues

In regard to efforts by some organizations to curtail state podiatric scopes of practice, Dr. Lee says these “battles must be fought every day in the hospitals where board-certified surgeons are proving their competency to hospital medical staffs.” Dr. Lee notes the ACFAS frequently receives calls from board-certified surgeons who are facing privileging problems in hospitals. He says the college’s health policy staff works one on one with each member to overcome the roadblocks and the ACFAS Web site has more than 20 documents dedicated to this issue.

   Dr. Lee also notes that the ACFAS was the first organization to propose a model state scope of practice act, which is also available on the site.

   Dr. Lee maintains that scope of practice battles are also fought in the “halls of state legislatures, where ACFAS spokespeople work side by side with APMA leaders and, to the best of my knowledge, have not lost a battle in many years.”

   When it comes to scope of practice legislation, Dr. Lee says the college primarily works with state podiatric medical associations. He notes this is helpful because state leaders know the local players and politics best. As Dr. Lee notes, multiple voices are more effective in politics than lone voices so state leaders call upon the ACFAS, APMA and other groups to help. He says the college provides board-certified spokespeople to address surgical issues, noting that these issues are always the crux of battles over scope of practice.


Very interesting article.

I am one of the generations stuck in the middle of a choice between the ACFAS and the APSP. I was also somewhat abreast of the issues facing both the APMA and the ACFAS. I am aware that to be an APMA affiliate, your organization must require its members to be APMA members in good standings. My question is: Why would you not want to be part of the APMA? It has the legislative ear to help us advance our profession. That should be enough to want to be part of it I would think.

As far as residency training goes, I help train residents. Surgery is an integral part of what our profession is in this day and age and requires excellent training to be proficient at. I'm not sure what exactly it means to have "too much surgical" training. It is up to the attendings at each residency to help tie in conservative treatment, as well as the biomechanics behind the procedure they select. You can't do surgery without a firm understanding of the biomechanics behind what you are in my estimation. We are not robots, who see an IM of 12 degrees and decide to do a Chevron. You MUST be able to answer WHY?

To believe that there is an advantage of one certifying board over another in podiatry is at best wishful thinking and at its worst another divisive wedge that has continued to diminish the profession itself. A three year residency? What purpose does it serve if the emphasis is not to broaden the exposure to all facets of medicine akin to that of the DDS/DMD-MD oral surgeon?
Truly those individuals with advanced technical skill will enter a world of - what appears politically - lower paying opportunities and demeaning servitude to state scope of practice laws. Despite the efforts of the APMA there is still very little understanding in the general public of what a DPM is or does. For the most part - after several decades - podiatry is not advancing toward the goal of integration into mainstream medicine, it is moving laterally. Consider this, the 3 year graduate will be well equipped in the OR and his/her level of expectations will be met - in some locales - with a not-so-hardy reception. I understand the need for an APMA and the component societies, but; do not believe there will ever be enough funds for lobbyists capable of taking podiatry to the next level - integration into mainstream medicine.

3 year residency, extreme student loan debt and a lack of jobs for the few DPMs will not change very much in a profession with less than fifteen thousand practitioners of diverse backgrounds. My suggestion is to do what very few so-called leaders have failed to accomplish - integrate and advance a profession which has failed to progress much in thirty years.

Thirty years have passed and the consensus of the American public is that podiatrists cut toenails. That's it.

Why doesn't the APMA invest in media spots like the dentists or plastic surgeons?
Why? Maybe they are too busy patting themselves on the back and enjoying some golf outings and meals at the expense of the profession.

Until some REAL changes are made podiatry will be to mainstream medicine what professional wrestling is to the NFL.

I can't in good conscience be PROUD to be a podiatrist - Podiatry and the incongruity of the profession has done more harm to well intentioned young people aspiring to do well, as physicians (hell podiatry can't even decide if they want to be physicians or not) healers, and socially responsible adults.

Podiatry has failed podiatrists.

My advice to young people is that if they want to commit to an extra year or two, go to medical school and COMMIT all the way. The 3 year residency is superfluous in contemporary society.

For evidence in real-world parameters check with your life-insurance and disability carriers.
Actuaries know just how much of a risk podiatrists are to insure.
Better yet try to borrow money to start a podiatry practice.

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