Why Is Podiatry not a post-medicine Speciality

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It has always bugged me and still I have no clarity. Why is podiatry a stand alone discipline and not a post medicine speciality (e.g. dermatology, pathology, surgery etc.)?

Is it because it followed on from our fore-bearers in chiropody?
If so then are we truly the same profession?
Have we not advanced so much that, although we do chiropody work, it accounts for a mere percentage of our scope of practice?

Why has it been a struggle - and a multiple decade struggle at that - for prescription rights, surgery rights, advancing scope of practice recognition etc, for those that have gotten it right - for the most part (US, UK, AUS), and for those that continue the struggle (SA, FRA, Greece, Italy etc.). How and why did the US get it so right?

In truth we should all have as much scope to practice our profession as our US counterparts. We should have access to proper and comprehensive training in all aspects of what we do or how we choose to focus our practices (sub-specialities in podopaed's, sports, general etc.).

Instead we have had to 'fight' for what we now do have or still need in order to offer our patients a comprehensive and competent podiatric physician.

Are we up against the old guard to whom we take up this 'fight' who consider us still glorified chiropodists? How do we change (after all this time) this misconception, on masse!

Would it not be better to position podiatry as a post-medicine speciality then?

Perplexing.

Brandon

 

Simply in the US the profession was fully organized post WW1, before there were many drugs, and got in on the ground floor similar to Dentistry everywhere else. In the UK, Aus etc. The professions didn't properly grow until the 30s and 40s, by which time medical dominance had taken place, so it was always an uphill battle.

 

The UK profession in particular suffered from the exclusion of chiropody from the National Health Service when it was set up.

At that time my father was training to be a chiropodist, and certainly that particular cohort training at the Glasgow Foot Hospital were given to believe that chiropody may be included as a "free" NHS service.

Alas it was not to be, and in the UK chiropody, and latterly podiatry, have mostly either been paid for by the patient (and therefore directly subject to market forces), or included in the NHS but funded and streamed by each NHS Trust.

The government of the time realised the power they were bestowing on those professions who were allowed autonomy to practice within the NHS as they saw fit, and they made sure they limited the power to dentistry and medicine. The odd ancilliary service (eye tests for example) were also included.

 

Hello Brandon

Both Stephen and David are absolutely right, and the history of the profession is a fascinating subject. Basically, we got it wrong. There have been a lamentably few far sighted practitioners who have seen the way forward just Franklin Charlesworth in the UK, and no doubt you could name a number of like cases elsewhere. However, prophets are never heard in their own country, particularly if they - as they inevitably do - upset the establishment (this is probably particularly relevant to the U.K.) In the USA the lack of a formal health service and the utilisation of anti-trust laws to access medical insurance schemes allowed the profession to develop faster than elsewhere and to promote forward thinking ideas by forward thinking people.

My own view is that in order to save the profession (in the U.K. at least), we should be endowing a seat of medicine at a 'new' university and promoting existing podiatric practitioners as amongst the first students, thus creating a dual qualification. One of my former assistants was put on 'fast track' by an existing medical school but of course, he is now lost to the profession. We really need to follow the example of the Maxillo-Facial surgeons but maintain an element of independence such that we do not lose 60% of our people to medicine (as is the case with max-fax). Of course, this is far too advanced thinking for the profession in the UK, since it would mean that the current establishment would be seen as lesser mortals to the dually qualified, and that is as unthinkable now as it was when the Podiatry Association established podiatric surgery. Personally, I am too old, too tired and probably the bonce no longer works quickly enough to gain a medical degree but I do hope that I lack that element of hubris to deny my profession and its practitioners a future.

I trust you will forgive me detailing my thoughts, but I think it far more likely that this could become a reality in Anzac land or SA than the U.K.

All the best

Bill

 

Bill,

Growing old may be mandatory; growing up is optional and growing wiser is to form part of a very exclusive and rare club - the latter rarely applicable to some of our senior grandees. Your good self excluded, of course! I would agree with all you write, however I think podiatric medicine should be structured similar to dentistry and retain some of its professonal independence and identity. I would like to see some greater integration with the medical student at undergraduate level - but I feel there is sufficient scope of practice and potential scope of practice in years to come to build upon as we are.

Kindest

Mark

 

Thanks Steven, David, Bill and Mark.

I can certainly understand the need for autonomy and independence within our profession and agree with following the dentistry route as apposed to the out and out medical route in this regard, offering post-qualification specialization's such as the max-fax's.

I agree Bill that we got it wrong. But not just in the UK as you refer, but it seems in the rest of the world too. Why and how did we all get it wrong (in reference to the struggle for acceptance, recognition and placement)?

My thoughts in thinking ahead for our profession are centered around, podiatry rotation at undergraduate level at every medical school, lengthening the course to masters level exit with the final year being a specialty year, encourage further formal research to PhD/ DSc or similar for new graduates (especially if entering private practice/ NHS) and finally publish publish publish.

Brandon

 

I am glad it is not post - medicine speciality.I am not academic struggle with all the studying I undertake but feel thru podiatry have found a vocation that I find worthwhile, and in which I can earn a living and make a positive contribution to society.If podiatry was a post- medicine speciality when I joined it would have been closed to me
Tim

 

I don't actually disagree with any of the above comments. I just feel that each step forward is a huge battle; currently I do know something of the prescription only medicine struggles and I salute those who started the ball rolling (from physiotherapy) and those of our colleagues who are doing the grinding hard work to bring the pleasant ideas which we all spout with abandon, into reality. It seems to me that we could sidestep all these issues by simply having a dual qualification. I would not see it as mandatory, at least at the inception; the difficulty being, as Mark states, to maintain independence. I don't think that practitioners such as Tim would need to worry as he would not be disbarred (and neither would I); however, I would welcome any other constructive ideas to kick around.

All the best

Bill

 

Of course, if the medical fraternity welcomed and encouraged the development of the other professions, rather than undertaking an inhibitory and controlling influence - especially in areas that appear to threaten their own scope of practice, then we might not be having this discussion today.

 

Doctors can, and do, practice on the feet without any specialised training and without specific professional indemnity insurance cover.

 

It seems that the majority of patients would rather go to the person who is best able to manage their complaint. In foot-care it is the podiatrists domain, entirely, the primary care of the feet (excluding podiatric surgery).
Is it not therefore incumbent upon this profession to actively promote ourselves and our scope of practice to the Joe public?
In so doing we can ensure happy patients report back to their GP's and sing the praises of podiatry.

 

I agree. I am a chiropodist pure and simple. I would be happy to see the profession split into two strands. The 'podiatrist' doing their surgery and advanced biomechanics and us 'chiropodists' tending to the general population with their verrucae and dodgy nails. But now there's the FHP's into the mix and it all gets complicated again and the public don't know what we do!!

 

This quote cannot pass unchallenged
In Australia there is National Accreditation (APHRA)
You cannot practice medicine in Australia without paying your insurance.

No training eh?
Currently there are over 1500 Graduates who cannot get into GP training. without this you cannot prqctice medicine
Lovely day in Australia
Regards
PauL Conneely
Got a rough idea. Been paying medical insurance for 40 years.