02/11/2019    Alan Sherman, DPM

Is podiatry a surgical specialty, or is surgery a sub-specialty of podiatry?

I must begin this message with an apology,
because what I’m about to say cuts to the core of
the very identity of many of our colleagues. But
my firm belief is that in 2019, our very identity
should be re-examined, for the long-term
sustainable reputation and credibility of
podiatry, and our service to the American
healthcare system and the public health. The
question I wish to pose is: Is podiatry a
surgical specialty, or is surgery a sub-specialty
of podiatry?

My son is a pediatric emergency specialist. He
did a 3 year fellowship after his 4 year
pediatric residency. While all pediatricians do
some emergency care, and general pediatricians
work beside him in the emergency department, he
is recognized asa pediatric sub-specialist in
emergency care. Last year, my understanding is
that the pass rate on the ABFAS Part II
Certification Exam and the case review process
was around 28%, and it’s long been below 50%.

My feeling about this is – it seems about right.
I am not outraged about that low passing rate. I
think it is really as it should be. Most
podiatrists are general practice podiatrists and
a subset of us are full qualify specialty
surgeons. I think about 20% of podiatrists, give
or take, are fully qualified, talented and
competent surgeons. Whatever surgery a patient
needs can be done competently by them, and better
than anyone else on the planet. The rest of us
are general practice podiatrists, and should not
be judged by how they do in the ABFAS
certification process. They should be judged,
officially, but how they do in the ABPM
certification process.

As far as our service to improving the public
health, which is our most important mission as a
medical specialty, we don’t need and shouldn’t
want all podiatrists to be specialty surgeons,
for a number of important reasons. First and
foremost, like general medical schools, we don’t
even try during the admission process to select
out candidates that have skills that would lead
to being the best surgeons. This makes sense for
medical doctors, and it makes sense for us,
because most of what needs to be done for
patients as medical doctors or podiatrists is not
surgical.

What doesn’t make sense is that we channel all
podiatrists into 3 year surgical intense training
programs. Why are we surprised that not all
become skilled specialty surgeons? The medical
doctors aren’t all predisposed with the skills to
be great surgeons, and many of them rise to the
top as medical specialists (internists,
cardiologists, dermatologists) and even cognitive
specialists ( psychiatrists). Why do we, in
2019, feel that we can or even should make all of
us that are admitted to podiatry schools into
specialty surgeons?

Yes, I know why this path was taken years ago and
I don’t fault our predecessors for doing this.
We felt we all needed to be surgeons to get on
the hospital staffs to get on the insurance
panels to be able to be paid for our services.
And I don’t fault our surgical forefathers, the
Earl Kaplans, the Harold Schoenhauses and Lowell
Weils, for pushing the training of podiatrists in
surgery. It did get us into hospitals and get us
recognized as capable of greatness and competency
as a profession. But now that we have a
recognized well run certifying board in podiatric
medicine, and now that certification in podiatric
medicine gets us on hospital staffs and insurance
panels, I think we are long overdue to recognize
that all podiatrists do not need to be surgical
specialists and shouldn’t be compelled to pretend
that they are surgical specialists.

And of course, all podiatrists do and should do
some surgery, in their offices, hospitals and
surgery centers, just as all dentists.
dermatologists, etc. do some surgery. I think we
need to distinguish, for our benefit and that of
the public, the difference between a general
practice podiatrist who does some surgery, and
our podiatric surgical subspecialists, who do all
foot and ankle surgery and are the best foot and
ankle surgeons on the planet. In general
medicine, this distinction is made by fellowship
training and subspecialty board certification. I
think it’s time for us to adopt the same model.

Alan Sherman, DPM, Boca Raton, FL

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02/18/2019    Joseph Borreggine, DPM

Is podiatry a surgical specialty, or is surgery a sub-specialty of podiatry? (Alan Sherman, DPM)

The fact is Dr. Sherman is right. The last time
I looked our degree is “Doctor of Podiatric
Medicine” which encompasses everything under the
sun when comes to podiatry. Yes, we perform
surgery, but for most; it’s not the mainstay of
the profession.

I would opine that most are surgeons in name
only because they have been “certified” and now
are considered a card-carrying member of a
surgical board or college that has allowed a
podiatrist to have such a distinction. I am one
of those dues paying members. All the precepts
required to bound over the necessary hoops to
gain such esteem along with paying the yearly
dues makes me a “podiatric surgeon”. Right?

Wrong!

Rather I am a podiatrist first and foremost who
has chosen to use surgery to include in my
treatment considerations for patients who
require it. But, am I comfortable doing
everything that we should be able to do as a
board certified foot and ankle surgeon? Um, that
answer is a resounding “No”! Just because I can
doesn’t mean I should.

This is the problem folks. Most DPMs who have
excelled to great surgical heights in this
profession have done so with great achievement,
skill, and training. Deservedly so these
individuals are probably better at doing foot
and ankle surgery than most orthopedic surgeons.

However, that does not mean that the entire
profession should aspire to do the same. This is
the quandary. A three surgical residency is now
required for all graduating DPMs to complete
whether they will do surgery or not. What was
the reason for this anyway. I hear it was the
APMA membership who wanted it. Was it more of
settling an identity crisis, resolving parity,
or eliminating previous podiatric residency
dichotomies? Who’s to say?

This PM News survey result is disparaging. The
answer should be 100% identify as a podiatrist
with the ancillary result of how many of
podiatrists routinely perform foot and ankle
surgery on a weekly basis. Because folks an
orthopedic surgeon who is duly trained to do so
during residency and fellowship are performing
surgery everyday of their practice life because
that is what they have chosen to do after
getting their MD.

So, we are all podiatrists and nothing more.
What you identify yourself after you graduate is
another story. And if you decided to go to
podiatry school to become an foot and ankle
surgeon because you did not think you could do
it through the much more rigorous and
competitive path of orthopedics is the real
question that needs to be answered.

Joseph Borreggine, DPM, Charleston, IL