Is it mere coincidence, clever manipulation by
the editor, or some Karmic influence that put the
posts about Podiatry's Secret Problem and 104
graduates not having residencies together in the
latest PM News?
I read Dr. Marks' retort to Dr. Moskowitz's
concern about billing for routine services, and
agree with Dr. Marks, the aging of America with
the resultant morbidities that age brings should
be a major focus of ours to broaden the
definition of "at risk" foot care.
This "routine" care will be needed more and more
as the population ages. And as DPM's see these
patients for "routine" care, we have the
opportunity to screen patients and pick up many
pathologies before they become advanced. We all
see this in our daily practices. And it is indeed
a very valuable service that we provide, not just
trimming nails and calluses, but using our
education training and experience to decide when
a patient who fits the Q8 qualifier should be
worked up with additional diagnostics, sent for
vascular referral, etc.
Next, I read the continuing thread about the
graduates without a residency. This is truly a
great problem for us. I have had the privilege of
being on the faculty of a high volume, highly
academic residency program, and it has been my
experience that the students coming out today are
far better educated and trained than I was. Our
residents' abilities far exceed my own. And there
in lies the problem. Yes, we need our young
podiatrists to continue to advance the
profession, to continue be the best trained foot
and ankle specialists in the community, but does
it have to be surgical advances only?
Society is presenting us with a need, (and
therefore an opportunity), as the population
ages, but we are not addressing the entirety of
that need. We are only addressing the surgical
aspect of it.
When our residents and students are on office
rotation, their lack of enthusiasm for "routine "
care is palpable. And I don't blame them. After
24 years , I'm not so happy about it either. But
this is part of our job, our duty to care for the
patients that present to us. And as the need for
this service increases, our opportunity to
provide these services increases also.
What I'm getting at is the need for our
profession to define what we really are.
Podiatry's dirty secret is not that podiatrists
are fraudulently billing services, it is that our
profession can't come to grips with the fact that
not all graduates are going to be the best
surgeons. Unfortunately, we don't provide the
adequate residency training for anything other
than surgeons.
Therefore, we should consider the following
model: 1st year is a general internship, 2nd and
3rd years will follow either a surgical or non-
surgical tract. By adding a non-surgical tract,
which would involve more exposure to podiatric
office practice, dermatology and rheumatology
and other medical experiences, we would be able
to expand the positions available in many of the
programs in existence now. And our profession
would be in a position to treat the great influx
of elderly that is on the horizon.
Richard M. Maleski, DPM, Pittsburgh, PA,
maleski@zoominternet.ne
