08/13/2015    Jason Kraus

Pedorthists & Podiatrists Should Work Together:

The original post regarding podiatric and
pedorthic collaboration seems to have spun off
its tracks. Dr. McGuire made the point that
CPeds and DPMs can work together for the mutual
benefit of patients and practitioners. At OHI
we see that happening every day in the hundreds
of podiatric practices who utilize our Central
Casting pedorthic service program. In this
model, highly experienced pedorthists are
available to podiatric practices on an on-
demand basis, either as an "extra set of hands"
or to add to the skill-set of the practice. The
Cpeds work at the direction of the DPM.
Positive impact to these hundreds of practices
has been considerable.

These forward-thinking podiatrists understand
the value proposition represented by C.Ped
‘physician extenders’ and they consistently
express their excitement to us over the
improvements they see in both patient outcomes
and practice performance.

While some podiatrists possess the skills
necessary to single-handedly deliver
comprehensive care in an effective and
efficient manner, their colleagues who choose –
for whatever reason – to work in tandem with
highly skilled and experienced professionals
are hardly doing their patients or their
profession a disservice. Quite the opposite.

We live in an increasingly collaborative world
in which outcomes and efficiency will be the
touchstones of optimum healthcare delivery and
efforts to create a moat around "know how" will
simply not be given much credence. The reality
is that there has always been substantial
overlap between podiatry and other specialties.
What has kept this profession strong is a
commitment to education, innovation and
quality. To denigrate innovative, forward-
thinking podiatrists who have found ways to
enhance their practices with convenient and low
cost solutions, seems and short sighted. While
some pine for the "good old days", many others
can see an even better future and are taking
steps today to achieve success in that new
healthcare environment.

Jason Kraus, President, OHI

Other messages in this thread:

---

08/14/2015    Jeff Root

RE: Pedorthists & Podiatrists Should Work Together: PA Podiatrist

The role and relationship between podiatrists
and pedorthists is anything but clear and
simple. First, the difference in education,
training and licensing between podiatrists and
pedorthists is significant. A podiatrist cannot
practice without a degree in podiatry and a
license. To the best of my knowledge, both
certified and non-certified pedorthists are
able to practice without a license. With no
licensing requirement and authority, who
oversees their conduct to provide a layer of
protection for the public? The difference
between certification and licensure is an
important point of distinction between
podiatrists and pedorthists.

The national, state and local podiatry
associations should not just look at the role
of CPeds working under the direction of
podiatrists, but should consider the role and
function of all pedorthists and CPeds,
including those who function independently.
While having the oversight of a podiatrist
might be beneficial in a collaborative
environment, it is not a requirement to
practice. Although a collaborative effort might
be today’s intent, there is no guarantee of
collaboration now or in the future. Since CPeds
can function independently, this begs the
question as to whether CPeds are qualified to
independently examine the “patient/customer”
and diagnose and treat foot conditions with
orthoses and AFOs.

While some foot conditions are somewhat routine
to treat and can be treated with fairly
standard OTC or custom foot orthoses, other
foot conditions are not so simple and
straightforward. For example, adult acquired
flatfoot, Charcot arthropathy, Charcot Marie
Tooth Disease, tarsal coalitions, clubfoot,
dropfoot, diabetic foot ulcers and pre-ulcers,
etc. can be much more difficult to treat and
the treatment can have potentially harmful side
effects. In addition, these conditions may
require medications and diagnostic tests which
can only be ordered by a licensed medical
practitioner. Even plantar fasciitis may
require imaging, injection or other diagnostic
and treatment procedures that are beyond the
scope of pedorthists and others who sell or
dispense foot orthoses.

If CPeds are expected to examine, diagnose and
treat foot and leg conditions, then they need
the proper education, training and licensing.
If CPeds are to have a more limited scope, then
who defines and enforces their more limited
scope of practice? Just like podiatrists did
with orthopedists, CPeds are working to expand
their scope of practice. This became all the
more evident a few years ago when their
association changed their name from the
Pedorthic Footwear Association to the Pedorthic
Footcare Association (PFA). Since some in
podiatry have turned away from biomechanics and
foot orthotic therapy over the past few
decades, who can blame pedorthists and the PFA
for recognizing the need and opportunity.

While some companies and podiatrists might see
collaboration as an opportunity today, what are
the potential longterm ramifications for
podiatry? Will pedorthic education and training
be improved to support their expanding role? Is
there a need for licensing and regulation for
CPeds? If pedorthic education and training are
improved and their role expands, what might the
economic implications be for podiatry? These
are just a few of the many unanswered questions
that exist.

There are many talented pedorthists providing a
variety of important services to their clients
today. I hope my questions and concerns will
help stimulate much needed dialogue within the
fields of podiatry and pedorthics in the
interest of improving patient care in the
future.

Jeff Root, President, Root Laboratory, Inc.

---

08/10/2015    Rachel Eisenfeld, C.Ped

Pedorthists & Podiatrists Should Work Together: PA Podiatrist (Robert Scott Steinberg, DPM)

I am not a podiatrist. I have been a certified
pedorthist for 8 years, who tries to continually
educate myself by staying up to date with what is
happening in the foot world. I do subscribe to PM
News, but Dr. Steinberg’s response was sent to me
by a an open-minded podiatristwho I happen to
work with on a regular basis. I am not surprised
by Dr. Steinberg’s response to Dr. McGuire’s
comments. Most podiatrists feel the same way. Dr.
McGuire, as well as the podiatrist I work with,
are forward thinkers and do not pride themselves
on having to do it all.

I am not your “typical” certified pedorthist. I
am 29 years old, I run my own orthotics company
which does concierge mobile evaluations and I
have my own fabrication facility. I get to meet
all kinds of people and form a more unique bond
with my patients than many healthcare providers
wish they could achieve. I am a college graduate,
from a four-year University, where I studied
sports medicine and exercise science. I have 14
years of experience in gait analysis and shoe
componentry. I happened to be qualified enough to
win a government contract to work for the NIH as
their certified pedorthist. I see patients in
collaboration with world-renowned, published,
Physiatrists and physical therapists.

If Dr. Steinberg would like some examples of how
the Podiatric Profession could benefit from
pedorthic services, I think I am well qualified
to provide some assistance.

1. We are supposed to be the foot biomechanics
experts. As a certified pedorthist, I don’t know
how to do bunion surgery or take out ingrown
toenails, but I do know how the foot is supposed
to move. Podiatrists know the movement of the
foot as well, but most of your schooling is based
on different pathologies and treatments well
beyond orthotic correction pathologies. Why not
collaborate with someone whose expertise is only
in foot biomechanics? Having a specialist on
staff makes your office appear full service.
Adding a CPED, you can offer onsite orthotic full
service from fabrication to adjustment and shoe
fit.

2. I would like to think of myself as more of a
podiatric physician assistant than an orthotic
technician. I have thought, since getting into
the profession, that the certified pedorthist
should be in the clinical setting NOT in the shoe
store or fabrication lab. Think about this
scenario: someone comes in complaining of foot
pain, you narrow it down to being a
musculoskeletal issue that could be corrected
with orthotics. You can just hand them off to
your certified pedorthist to do the rest of the
work, leaving more time for seeing more patients
with more complicated issues.

3. When the patients ask you about their shoes,
do you know why that shoe isn’t good for them and
can you name at least 3 different brands and
versions that would be good for that patient?
What about 3 different brands/versions of dress
shoes? Sure, you can give the whole quick spiel
about heel counter, straight last, etc., but
wouldn’t it be outstanding customer service if
you had someone in your office that knows
everything about shoes, like the types, brands
and different functions? I read shoe catalogues
for pleasure! I enjoy being the Wikipedia of
shoes and your patients will greatly benefit from
it.

Dr. Steinberg is correct, though, the only way
these services provided by a certified pedorthist
would be lucrative is if there was time that
could be billed for our consultation services.
Unfortunately, there is not. If a certified
pedorthist wants to work in a clinical setting,
they are only going to get paid for half of their
work. That’s if they make the orthotics
themselves. Patients like the service, but are
not usually willing to pay for extra services not
covered by insurance.

I appreciate Dr. Steinberg’s comments, but I hope
that I changed his mind a little bit to see what
a certified pedorthist can do beyond the
orthotic.

Rachel Eisenfeld, C.Ped, Herndon, VA