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Do Subspecialties Have A Place In Podiatry?

I recently read an online discussion about having limited podiatry specialty practices. The debate centered around why there is not specific training for, or specific practices devoted to, a subspecialty of podiatry, such as pediatrics, surgery, biomechanics or dermatology. In my opinion, there are many reasons to why this idea does not make sense.

Looking at my residency training, I can honestly say I am not sure how we could add further subspecialty training to the curriculum, let alone justify the time spent doing so. It is my belief that, at this time, residency is primarily for surgical training, but all residencies incorporate a well-rounded curriculum including dermatology, pediatrics, trauma, limb salvage and many other areas. To limit the curriculum to just one of those areas, in my opinion, would not result in a very comprehensive training program. Most programs spend a month on some of these special rotations and even that length of time can feel excessive. I think extending that time further would be more detrimental than beneficial.

Based on the patient population at the clinics in which I have rotated, to restrict that patient population down to subsets would greatly decrease the amount of patients that some of these subspecialists would see. If there is a specific podiatric specialty for surgery, for example, based off of the amount of surgeries we do, with pre-op and post-op visits, we would be limited to about five to 10 patients a day. With many of those being within the 90-day post-op global period, I do not feel like this would be a sustainable career for a private practitioner.

As far as pediatrics goes, it would be hard to delineate whether those pediatric patients go to dermatology for warts or surgery for flatfoot or biomechanics for orthotics. Would this also mean that if someone did make an appointment for warts and he or she did not go to the pediatric podiatric dermatologist but instead went to the pediatric surgeon, would that patient need to be rescheduled at a different office? This convolution would be very frustrating for patients.

Looking at board exams, in this scenario, I would assume there would have to be a board exam for each specialty. The current surgery board has such an abysmal pass rate. I don’t see how adding five or more additional specific board exams would be better or make the certification process more efficient. There are already issues as to which certifications are needed for hospital privileges with no consistency in the applicability of the American Board of Podiatric Medicine (ABPM) versus the American Board of Foot and Ankle Surgery (ABFAS) certification to these situations. Every hospital has its own bylaws with different requirements.

Now we would add an entire new level of discussion to this conundrum. Would a physician wishing to be classified as a pediatric podiatrist need to have a special board certification in order to practice as such? If not, then what is stopping us from doing this now? We already have some podiatrists that deem themselves “above” the standard podiatrist’s duties and attempt to only do surgery.

My last point is an example of a doctor-patient interaction a fellow resident witnessed at a podiatrist’s office. A patient presented for general foot care and at the end of the visit, the patient asked the physician for recommendations on shoes. The response from the podiatrist was “I don’t do shoes. I only do the surgery.”

In my opinion, this statement was ridiculous as well as detrimental to podiatry. Our profession is built on being the experts on the foot and ankle. The current trend in podiatry is this fight for relevance among the MD and DO communities. A podiatrist, a foot doctor, telling a patient that he or she does not “do” shoes makes us seem like we do not know the basics of our jobs.

I enjoy podiatry. In one day, I can treat plantar fasciitis, an ingrown toenail, perform wound care and do an elective bunion surgery. We can do it all without having to send our patients to four different offices. Further limiting our already limited scope of practice would be detrimental to our careers. We need to continue to be the experts in all things foot and ankle. Our comprehensive foot and ankle care is what our patients need and should expect.

Dr. Bishop is a third-year resident at Alliance Community Hospital in Alliance, OH.

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