02/18/2020    David E. Gurvis, DPM

E: What Kind of Podiatrist Do Today's Residents Want to Be? (Alan Jacobs, DPM)

There is room for all of us in all of our
capacities. Some will make it as surgeons. I
know several groups who will not do routine
care, or biomechanics, or dermatology, etc. and
some will morph into more generalists and still
earn a great living and be just as satisfied. I
do many surgical procedures and I do them well.
I am limited in my training and send the
complicated stuff out to the surgical groups.

My comments are regarding surgical vs.
conservative care. Maybe because of finances,
or training, it seems many of the surgeons no
longer offer any conservative option. My friend
saw the knee surgeon who suggested physical
therapy and a brace as a trial prior to
surgery. How many of our hotshot surgeons offer
any options? Why not? Is one treatment, being
permanent, better than another, being routine?
Take my word, after 45 years in practice, you
will realize the long=term results of your
surgery are not always something to crow about.

A gauntlet brace for STJ OA vs. a fusion?
Orthotics and shoe modifications as an option
for surgery? How many have said to a patient,
(this makes my blood boil), you need to do this
now while your young or you may be crippled
later in life) to book a surgery? How many have
said this might do well with routine
debridement vs. surgical? Yes, on is a “cure”
and one isn’t. But both relieve pain. I
personally feel not offing an option is beneath
the standard of care. There are plenty of
patients who will opt for the permanence of
surgery vs. the temporizing of conservative
care. And vice versa.

I know a lot of podiatrists who were well
trained in triple arthrodesis or complete
reconstruction who no longer do them as they
found them not necessary enough in a private
practice to continue their competence and who
gladly do many other things and send those out.
These is room for all of us. And we all do
damn good work.

As to how to change the training system away
from everything is a nail and my cold steel is
my only hammer back to offering options? That’s
beyond me.

David E. Gurvis, DPM, Avon, IN

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