What Does The Future Hold For Podiatric Surgeons?

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A Closer Look At The ASPS

Formed in late 2008, the American Society of Podiatric Surgeons (ASPS) is the surgical voice for the APMA and supports the association’s Vision 2015 project, according to the society’s Web site.

   The ASPS has available membership categories of Fellow, Associate, Affiliate, Resident, Student and Emeritus, according to bylaws posted on its Web site. It is not a credentialing organization.

   “The principal purpose of ASPS is to facilitate education and research activities in the area of podiatric surgery,” notes the ASPS site. “These activities are viewed to reinforce and support licensing and certification processes.” The society also notes it will offer educational programs and work with the American Board of Podiatric Surgery (ABPS).

   Michael Graham, DPM, is a Fellow of both the American College of Foot and Ankle Surgeons (ACFAS) and the ASPS. He joined the ASPS because he thinks it is important to have an organization associated with the APMA.

   “Even though I might not always agree with the decisions of the leadership of the APMA, we need a representative body for our profession,” notes Dr. Graham. “The higher the membership, the better political pressure we can have as a united front.”

   Bret Ribotsky, DPM, is a Fellow of the ASPS and notes that he opposed the schism between APMA and ACFAS. Dr. Ribotsky says it is up to the ASPS to provide value for its membership. He feels the ASPS needs to do a better job of sharing its goals and providing information on what it has accomplished. Officials from the ASPS did not respond to requests for comment for this article.

   Research is a critical goal for the ASPS, according to Dr. Graham. He notes that podiatric schools and residency programs must address the fact that podiatrists are not as well versed in research and publishing as orthopedic surgeons.
Stephen Barrett, DPM, is a Fellow of the American College of Foot and Ankle Surgeons and a Fellow of the ASPS. He plans to continue his association with both groups.

   In his conversations with colleagues, Dr. Barrett has gathered that many do not know how the situation with the ACFAS and APMA had occurred and some remain confused. He believes both organizations will grow.

   In Dr. Barrett’s opinion, if the profession continues with a collective and not divided effort, there will be “very positive change and patient outcomes will continue to improve for many things, which were considered untreatable a couple of decades ago.”

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Author(s): 
Brian McCurdy, Senior Editor

   “These changes will do nothing to improve the surgical expertise of podiatric residents and will significantly weaken their training compared to our allopathic counterparts,” argues Dr. Richie, an Adjunct Associate Professor in the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University.

   In addition, Dr. Richie believes the ACFAS “continues to ignore” the vital role that biomechanics plays in foot and ankle surgery. He notes that in the past five years, topics even remotely related to biomechanics have disappeared from the curriculum at ACFAS meetings while biomechanics is growing in importance at orthopedic surgery meetings.

   Reducing the biomechanics exposure for training podiatric residents “will doom our efforts to achieve parity in training with allopathic physicians and will certainly ensure that our podiatric surgeons will become inferior to their orthopedic counterparts,” states Dr. Richie.

   “Surgery and biomechanics go hand and hand,” notes Michael Graham, DPM. “We must first understand the biomechanics in order to understand the pathomechanics that lead to the need for surgery.”

   As Dr. Graham notes, this can be difficult because to prevent recurrence of the deformity, the surgical procedures must address or eliminate the underlying etiology. Given that the major underlying etiology for foot disorders is from the pathomechanical forces, he emphasizes that surgery is usually the required method to stabilize these excessive abnormal forces.

   Are the current medical and biomechanical CPME requirements enough? Dr. Lee advocates having more medical and biomechanical training as part of the CPME. As he says, biomechanics is more than custom orthotics and surgical planning and technique require sound biomechanical principles. Dr. Catanzariti concurs with the need for more medical and biomechanical training as part of CPME 320. Dr. Lee says the ACFAS sent comments to CPME in March on the 320 document that urged the current medical requirements be maintained.

   Although he says the CPME’s current requirements are adequate in terms of time exposure for medical and biomechanics training, Dr. Richie feels the requirements are inadequate in terms of content. He says the description of the biomechanics requirements is outdated as far as what is happening today in the biomechanics community. He supports giving residents access to a gait lab and biomechanics research, and emphasizes that biomechanics is not just foot orthotic therapy.

   Stephen Barrett, DPM, believes there cannot be too much emphasis on podiatric surgical training.

   “We largely are a surgical specialty and do extraordinary work, which will continue to be sought out by patients seeking the ultimate in foot surgery,” maintains Dr. Barrett, an Adjunct Associate Professor in the Arizona Podiatric Medical Program at the Midwestern University College of Health Sciences. “Many podiatric surgeries are biomechanical corrections in and of themselves so it is difficult to separate (biomechanics and surgery).”

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Anonymoussays: May 27, 2010 at 12:26 pm

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?

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legondownsays: June 18, 2010 at 4:39 pm

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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