03/25/2019 John Trench, III, DPM
Should All Podiatrists Be Primarily Surgeons? (Jarrod Shapiro, DPM)
During the last effort to separate our profession
into a minority segment who would perform all of
the podiatric surgery, forefoot as well as
reconstructive rearfoot and ankle, with the
majority consigned - there is no other word for
it - to completely non-surgical podiatric
practice, there was widespread outrage among the
students who would be affected by the changes,
and aggressive resistance to the changes by both
students and a significant number of established
practitioners.
The elimination of the alphabet soup of past
residency options in favor of the current
structure did not happen in a vacuum. It happened
in large part because there was no broad support
for, nor any desire for, the forced segregation
of our profession into non-surgical and surgical.
The "excellent point that some number of
potential applicants to podiatric medical
colleges may be dissuaded from applying because
all of our marketing is toward the surgical side"
is unfounded. There is no significant data to
even suggest, let alone support, that opinion.
Indeed, the reaction to the efforts of the late
1980s and the early 1990s would argue forcefully
against that opinion.
The pay differential at Kaiser mentioned by Dr.
Shapiro is also telling, and reflects the value
potential employers are likely to assign to non-
surgical podiatrists. In the absence of a valid,
independently conducted survey showing a
significant level of interest in a purely non-
surgical residency opportunity, or one including
only minor surgical procedures such as toenail
and verruca procedures, no change segregated
surgical and non- surgical residencies is
warranted, and no such change should be imposed.
As I pointed out in a previous post, the most
common conditions seen in every day podiatric
practice continue to be HAV, hammertoes, toenail
conditions, calluses/corns, and heel pain.
Surgery continues to be a significant part of the
array of treatment options for these conditions,
and should be part of the training of every new
podiatrist, and not just an "elite" few.
I agree that surgery has been over- emphasized,
both in marketing our profession and in our
residency programs. The answer is not, however,
to tear us apart into surgical and non-surgical
turf. The answer is to accurately present our
profession as a whole to potential applicants,
emphasizing the non-surgical as well as the
surgical work we do, in our marketing, and to
ramp up the podiatric medical training in our
residency programs in addition to, not in place
of, the surgical training.
The reality for the majority of us is that we
practice a mixture of both medicine and surgery,
not either-or. It is also the reality that the
majority of us want to practice both podiatric
medicine and podiatric surgery, and not just non-
surgical podiatric medicine. There is, after all,
absolutely nothing preventing practitioners from
engaging in purely non-surgical practice if that
was what they really wanted to do. And yet,
almost no one does.
With all due respect to both Dr. Shapiro and Dr.
Alan Sherman--and I DO respect them--I offer an
alternative proposal: I propose that the current
residency structure be retained, retaining the
surgical training component and revamped the
programs to put much greater emphasis upon
podiatric medicine in addition to podiatric
surgery, bringing the two into balance.
The graduates of this type of program would be
skilled and qualified in comprehensive podiatric
medicine and surgery, with the surgery component
concentrating on reconstructive forefoot and non-
reconstructive rearfoot surgery. This would be
the majority of podiatrists, and reflect what we
truly see and do in daily practice. A small
number of alternate third year tracks would be
developed and offered, providing advanced
podiatric surgical training in reconstructive
rearfoot and ankle surgery, as well as advanced
trauma care.
This alternate track would de-emphasize podiatric
medicine in favor of producing the 15% of pure
"advanced" podiatric surgeons advocated by Dr.
Sherman. As I stated in my previous post, every
podiatrist should be trained in the medical and
surgical care necessary to treat what we all
commonly see in daily practice, which of
necessity includes HAV procedures, lesser
metatarsal procedures, hammertoe repair
procedures, and most soft tissue procedures, both
major and minor, of the forefoot, as well as many
soft tissue procedures of the rearfoot and
governing structures of the leg.
Most of us, however, have little call for major
reconstructive rearfoot and ankle surgery in
daily practice, and few of us will have the
opportunity or the interest to be trauma
surgeons. These areas would be the province of
the "pure" podiatric surgeons, of whom we need
very few. Every residency program would develop
and offer an elective non-surgical podiatric
medicine track. Students entering residency who
do not want to be surgeons would have the option
to elect that track--at THEIR discretion.
I firmly believe that very, very few residents
will elect the non-surgical podiatric medicine
track. I believe we will find nearly all of them
will go wanting due to a lack of interest. I ask
that students reading this please chime in, and
state if they would prefer to have non-surgical
residencies. If there truly is such a huge demand
for non-surgical residencies among students, it
should be no problem to flood the letters to the
editor section with "That's exactly what I really
want!" responses from students.
This proposal of Dr. Shapiro's will in no way
affect me or my practice. I oppose it because I
believe it will be detrimental to the lives and
futures of students both now and in years to
come. I also believe it will result in a
precipitous decline in applications from college
students who, as was the case in the late
80s/early 90s, will have little to no interest in
being confined to non-surgical podiatry.
I have the same concern for the well- being and
future of our profession and our students as do
Dr. Sherman and Dr. Shapiro. I respectfully but
strongly disagree with them, Dr. Shapiro more
than Dr. Sherman, with regard to what is in the
best interest of our profession in the years to
come.
John Trench, III, DPM, Terra Haute, IN
