09/12/2023    Allen Jacobs, DPM

The Increasing Podiatric Abandonment of “Routine Foot Care" (Ivar E. Roth, DPM, MPH)

Many podiatrists now work within orthopedic
groups. Many podiatrists are employed by medical
care groups. Many podiatrists are employed by
hospitals. Many podiatrists are fully engaged in
wound and diabetic foot care. There are many
podiatrists fully engaged in surgical management
of trauma, deformity correction, discretionary
surgery. Many podiatrists are employed by medical
colleges as faculty members. There are many
podiatrists employed in the VA system. Many, if
not most) podiatrists are on staff of hospitals,
on ED call, receive in-hospital patient
consultations.

There are many podiatrists paid hundreds of
thousand, and in some cases, one million or more
dollars as consultants to corporations. Many (not
all) podiatrists receive extraordinary residency
and fellowship training in surgery.
These individuals are capable and competent
surgeons. This was absolutely NOT the scenario
when I graduated PCPM in 1973. The expanded
participation of podiatry within medical care, and
the scope of pathology now treated by podiatrists,
is beyond anything that I would have envisioned or
hoped for when I completed my residency. A
podiatrist may absolutely lead a productive and
financially successful career without performing
much if any so called routine foot care.

Conversely, my generation did not face the
increasing hostility of the AAOS, the challenges
of managed Medicare, the demands of EMR, audits, a
rapidly ageing population, the diabetic pandemic,
corporate infiltration of medicine. Todays
graduate faces increasing performance of E and M
of foot pathology by PAs, NPs, foot care nurses,
DCs, PTs, even PCPs. That is reality.

This weekend, I presented several lectures at a
vascular surgery/interventional cardiology
meeting. The overwhelming majority of those
registered were PA’s. They were attending to learn
more about treating serious heart and peripheral
vascular disease. The speakers (other than I) were
all MDs. They were educating the “ competition “.

After the conference I was conversing to the
conference chairpeople regarding the large
presence of NPs and PAs. Was this a concern to
them ? Only to a minor extents. Then to my
surprise one of the conference chairpersons,
unsolicited, looked at me a said “ you know they
are doing more foot work. They could potentially
wipe out podiatry “.

Dr. James Ganley once asked me if I educate non
podiatrists on how to correct ingrown toenails or
care for “ routine “ foot care needs. At that
time, I said no I do not. He said “ I do “. He
explained that when he does, non- podiatrists
realize what they did not know, and that many
seemingly simple problems were more complex than
they imagined. Dr. Ganley explained to me that
when he educated non-podiatrists, the result was
more referrals and the referral to him of more
complex pathology.

As I have aged, I have increasingly returned to my
“ podiatry roots “. It has allowed me to continue
to provide care and comfort to people in need. The
problem discussed in PM news regarding the
abandonment of so called routine foot care is one
for which I personally have no definitive answer.

It has been my observation and considered opinion
that at least a part of this problem has been a
lack of growth of the non-surgical branch of our
profession, so called podiatric medicine. Like Dr.
Kesselman, I believe that a podiatrist can enjoy a
professionally and financially rewarding life in
primary care podiatry. Dr. Rogers, to my thought,
is attempting to do something that should have
been done years and years ago, make ACPM the
medical equivalent of ACFAS.

Strong education and leadership in this area has
been desperately lacking. Note I say medicine, not
surgery certification. Primary care podiatry
should, in my opinion, include some surgical care,
no doubt. The profession must determine where that
surgical care should be the province of a well
trained podiatric surgeon.

Family medicine residents spend a good deal of
time in primary care offices learning and
acquiring the skills necessary for their future
professional lives. Podiatry students are
recruited believing they will be “ surgeons “.
They spend their third and fourth years rotating
in hospitals. The spend their residencies in
surgery centers and hospitals. The majority of
fellowships are surgical. As noted earlier, many
will indeed proceed to a career in which surgery
represents a major portion of their professional
careers. However many do not receive comprehensive
surgical training.

Sadly, they have also failed to receive
comprehensive primary care training. The current “
PS and M “ 3 year residency model must begin to
take seriously medical education. This means
serious office rotation time, not an occasional
month or two. Not a one month medicine rotation.
Seminars and CME programs need to stop the
overwhelming presence of discussions on advanced
surgical topics which represent to practice of
some but not most podiatrists. YOU need to educate
non- podiatrists on foot pathology, so as to
generate an understanding by them of the multi
factorial nature of many foot and ankle problems.
YOU must devote time to patient education. YOU
must do a proper job of foot care that others
cannot provide.

Allen Jacobs, DPM, St. Louis, MO

Other messages in this thread:

---

09/12/2023    Allen Jacobs, DPM

The Increasing Podiatric Abandonment of “Routine Foot Care" (Ivar E. Roth, DPM, MPH)

Many podiatrists now work within orthopedic
groups. Many podiatrists are employed by medical
care groups. Many podiatrists are employed by
hospitals. Many podiatrists are fully engaged in
wound and diabetic foot care. There are many
podiatrists fully engaged in surgical management
of trauma, deformity correction, discretionary
surgery. Many podiatrists are employed by medical
colleges as faculty members. There are many
podiatrists employed in the VA system. Many, if
not most) podiatrists are on staff of hospitals,
on ED call, receive in-hospital patient
consultations. There are many podiatrists paid
hundreds of thousand and in some cases one million
or more dollars as consultants to corporations.
Many (not all) podiatrists receive extraordinary
residency and fellowship training in surgery.
These individuals are capable and competent
surgeons. This was absolutely NOT the scenario
when I graduated PCPM in 1973. The expanded
participation of podiatry within medical care, and
the scope of pathology now treated by podiatrists,
is beyond anything that I would have envisioned or
hoped for when I completed my residency. A
podiatrist may absolutely lead a productive and
financially successful career without performing
much if any so called routine foot care.

Conversely, my generation did not face the
increasing hostility of the AAOS, the challenges
of managed Medicare, the demands of EMR, audits, a
rapidly ageing population, the diabetic pandemic,
corporate infiltration of medicine. Todays
graduate faces increasing performance of E and M
of foot pathology by PAs, NPs, foot care nurses,
DCs, PTs, even PCPs. That is reality.

This weekend, I presented several lectures at a
vascular surgery/interventional cardiology
meeting. The overwhelming majority of those
registered were PA’s. They were attending to learn
more about treating serious heart and peripheral
vascular disease. The speakers (other than I) were
all MDs. They were educating the “ competition “.

After the conference I was conversing to the
conference chairpeople regarding the large
presence of NPs and PAs. Was this a concern to
them ? Only to a minor extents. Then to my
surprise one of the conference chairpersons,
unsolicited, looked at me a said “ you know they
are doing more foot work. They could potentially
wipe out podiatry “.

Dr. James Ganley once asked me if I educate non
podiatrists on how to correct ingrown toenails or
care for “ routine “ foot care needs. At that
time, I said no I do not. He said “ I do “. He
explained that when he does, non- podiatrists
realize what they did not know, and that many
seemingly simple problems were more complex than
they imagined. Dr. Ganley explained to me that
when he educated non-podiatrists, the result was
more referrals and the referral to him of more
complex pathology.

As I have aged, I have increasingly returned to my
“ podiatry roots “. It has allowed me to continue
to provide care and comfort to people in need. The
problem discussed in PM news regarding the
abandonment of so called routine foot care is one
for which I personally have no definitive answer.

It has been my observation and considered opinion
that at least a part of this problem has been a
lack of growth of the non-surgical branch of our
profession, so called podiatric medicine. Like Dr.
Kesselman, I believe that a podiatrist can enjoy a
professionally and financially rewarding life in
primary care podiatry. Dr. Rogers, to my thought,
is attempting to do something that should have
been done years and years ago, make ACPM the
medical equivalent of ACFAS.

Strong education and leadership in this area has
been desperately lacking. Note I say medicine, not
surgery certification. Primary care podiatry
should, in my opinion, include some surgical care,
no doubt. The profession must determine where that
surgical care should be the province of a well
trained podiatric surgeon.

Family medicine residents spend a good deal of
time in primary care offices learning and
acquiring the skills necessary for their future
professional lives. Podiatry students are
recruited believing they will be “ surgeons “.
They spend their third and fourth years rotating
in hospitals. The spend their residencies in
surgery centers and hospitals. The majority of
fellowships are surgical. As noted earlier, many
will indeed proceed to a career in which surgery
represents a major portion of their professional
careers. However many do not receive comprehensive
surgical training.

Sadly, they have also failed to receive
comprehensive primary care training. The current “
PS and M “ 3 year residency model must begin to
take seriously medical education. This means
serious office rotation time, not an occasional
month or two. Not a one month medicine rotation.
Seminars and CME programs need to stop the
overwhelming presence of discussions on advanced
surgical topics which represent to practice of
some but not most podiatrists. YOU need to educate
non- podiatrists on foot pathology, so as to
generate an understanding by them of the multi
factorial nature of many foot and ankle problems.
YOU must devote time to patient education. YOU
must do a proper job of foot care that others
cannot provide.

Allen Jacobs, DPM, St. Louis, MO