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Podiatrists as 'doctors' row

Discussion in 'United Kingdom' started by admin, Aug 20, 2004.

  1. admin

    admin Administrator Staff Member

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    Podiatrists as 'doctors' row

    [font=Arial, Helvetica, sans-serif]A group of podiatrists calling themselves 'physicians' has re-ignited the debate about whether non-medically qualified health professionals are misleading the public.

    On their website, Yorkshire Podiatry Services describe a range of foot problems with the claim that 'podiatric surgeons are the physicians most thoroughly trained' to manage them.

    Using the title 'physician' without GMC registration is illegal. A GMC spokesman said it had no power to act on people not on its register.

    Podiatrist Antony Wilkin- son, who is part of Yorkshire Podiatry Services, said the term 'physician' was an oversight and undertook to amend the website. But he insisted podiatric surgeons were best placed to manage foot problems. 'I carry out over 1,000 foot operations per year,' he said.

    Mr Angus Robertson, president of the British Orthopae- dic Trainees Association (BOTA), said: 'A clear deception is taking place.' He argued only orthopaedic surgeons should perform complex operations.

    Orthopaedic surgeons have objected for years to podiatrists describing themselves as 'consultant podiatric surgeons', arguing this could mislead patients.

    A recent survey of 350 members of the public by BOTA found 95 per cent thought consultant podiatric surgeons had attended medical school.

    The British Orthopaedic Association and the British Orthopaedic Foot Society say they think podiatrists should only operate in orthopaedic departments.

    From: http://www.hospitaldoctor.net/hd_news/hd_news_article.asp?ID=15402&Section=News

  2. davidh

    davidh Podiatry Arena Veteran


    Its a tricky one.
    Orthopaedic surgeons who have 1st-hand experience of podiatric surgeons are usually happy to work alongside, or refer foot cases into the domain of the podiatric surgeon.
    My personal experience (I'm not a surgeon) is that orthopods are very happy to have a podiatrist to refer their foot and knee cases onto. Most surgeons understand basic biomech theory, and don't dictate what I do with the patient.

    Unfortunately, in the UK we have very limited prescribing rights, so that, for example, we can't access antibiosis therapy directly. This is one of the factors which dictate that we can't be fully autonomous. One of the other problems we have is that (some) militant orthopaedic trainees are actively campaigning against autonomous podiatric surgery (as reported in the previous post). This is being done under the guise of "protecting the public", although the more cynical amongst us might think the motivation behind this type of campaign may be a little less altruistic?
    David H
  3. footmedic

    footmedic Active Member

    We are Doctor

    Podiatrists are Doctor on there ownright, if Dentise are Doctor so are we.

    Somuz Miah
  4. davidh

    davidh Podiatry Arena Veteran

    I think I'm correct in stating that the term "doctor" is honorific, except in those cases where the doctorate is a PhD. Doctor in the medical sense reflects a status obtained from years of study, rather than one undergraduate degree.
    So, for example a USA-based DPM (who has a medical doctorate) has studied for much longer, and at greater depth, than a UK-based BSc (or BScHons) in pod med.
    In the UK dentists are now allowed to use the honorific term "doctor", but again, their depth and length of training is greater than that of a podiatrist.
    Those with more academic experience than myself may like to step in here?
  5. Dieter Fellner

    Dieter Fellner Well-Known Member



    The American DPM does not have a medical degree but is a Doctor of Podiatric Medicine. Big difference. Often I hear DPM's in the US bitterly complain they are not regarded as Doctors, either by the public or the MD's

    I would also argue your comment the DPM "has studied for much longer, and at greater depth". The DPM course run 4 years instead of the customary 3 years in the UK. I think it is fair to say the UK Podiatric Surgeon makes up for the extra year, and then some! For personal reasons I have studied the US curriculum in some depth, and I can tell you the UK surgical curriculum can easily match this.

    In the US, professionals first obtain their Batchelor's degree before embarking on professional DPM studies. US Education is delivered differently to the UK but if you put the pieces in a bag, shake it hard, pour it out and assemble it thoughtfully, the jigsaw puzzle reveals a pretty similar picture.

    In the US, the post-graduate surgical residence extending over 1-4 years is becoming more common, if not compulsory, but certainly a requirment for competitive work placement. Those who follow the US discussion forums will know there are problems with this.

    One of the greatest strengths the US system has over the UK is that it is simply illegal, a fellony , to practice Podiatry unless you have DPM registration. It is the activity that is protected, not the title. Ignore the rules and you can expect a visit from the cops. :eek: Not a token twenty quid fine or whatever other punitive measures the HPC measures out.

    So the Orthopods have a rod up their backside... nothing new here guys. The title "Consultant" and "Surgeon" can be used in the NHS. There are now Nurse Consultants and Consultant Physiotherapists also. The title "Surgeon" may also be used legitimately. Thankfully there are also a growing number of pro-active Orthopaedic Surgeons. The honest ones will tell you, over a pint or two, this has more to do with Private Practice competition than altruistic concerns. Podiatric surgery has proven itself time and again - since the surgery is safe, the antagonists now bicker over professional titles. Gimme a break! I believe this to be misplaced frustration over recent government initiatives, wich seem to hurt many health care professionals.

    I use the title Consultant Podiatric Surgeon. Heck, I am so keen that my patients understand my professional background it is spelt out clearly in the patient advice literature! I don't wish to be confused with an Orthopaedic surgeon or other type of doctor..... :D

    I am a Fellow of the Surgical Faculty and I have a Consultant contract with my NHS Trust. In my Trust Podiatric Surgery is the preferred referral route.

    Moreover, the Orthopaedic Directorate i.e. the Orthopaedic Managers work with the service to have patients awaiting foot surgery transferred from the Orthopaedic waiting list for Podiatric Foot Surgery.
    Last edited: Oct 12, 2004
  6. Cameron

    Cameron Well-Known Member

    Your are not realy a doctor ?


    As I understand the North American podiatrists, have a professional doctorate which would equate academically in Australia, to an undergraduate honours degree. You can argue the toss about training versus education but graduates of both sytems seem to work competently and professionally.

    Some US podiatrists will have an academic doctorate which would equate to the about the same percentage of chiropodists/podiatrists/podolgists world wide with a similar qualification. As a global community (aprox. 35k peeps) we remain vulnerable when it comes to an academic foundation for podology (anthropology/sociology study of the human foot in health and disease), as the academic basis for the practice of foot care (podiatry/chiropody). Instead it has been easier to lean (heaviliy) on other disciplines. Hopefully as the importance of foot morbidity becomes apparent in preventative medicine and the health of a nation, then this will change.

    Personally I have always preferred the phrases "surgical podiatry" or "surgical chiropody" to podiatric surgeon because of its meaning.

    Podiatry is 'treatment of the foot " , surgical treatment of the foot makes sense, whereas "treatment of the foot surgeon" is rather fuzzy.

    I do not trust 'doctors' of any type, but have been grateful to a few when I needed them.

    What say you?

  7. davidh

    davidh Podiatry Arena Veteran

    Dieter and others,
    My last remarks were specific to the previous posting. I appreciate that the level of training in the UK of a podiatric surgeon is high :) .
    What I wanted to do was draw a clear distinction between an undergraduate podiatry degree, and an undergraduate degree + post-grad training leading to a further qualification. Clearly the first is in no way equivilent to the second.
    Thanks for putting me right re- the DPM tho :eek:

    Incidentally, according to the HPC the term Consultant can be legitimately used outside of the NHS too, provided it is not used to mislead the public. I use it myself (on account of my post-grad quals + practicing rights as a consultant at three private hospitals.
    Of course, it's entirely possible the HPC will catch up with me and tell me they were mistaken in their advice:eek:
  8. Hello Syd

    I'm not that happy with the term 'surgical chiropodist' or 'podiatric surgeon' for a number of reasons. The former is used primarily by practitioners of dubious training (in the UK at least) and the public rightly view it with some scepticism. The latter, although it has more validity, is detested by the medical/surgical community for good reasons, most of them based in the phrase 'territorial encroachment'.

    Podiatry or chiropody has always had an identity crisis – as long as I can remember. We are not doctors and we should not even think about calling ourselves that. There is no need and it just pisses other people off. Personally I don’t have a problem calling myself a chiropodist – in fact I take great pride in calling myself just that. I think it’s an honourable term and I know that the care that I provide through my practice is held in high regard to those whom I serve. My grateful thanks to people like you for that. I don’t consider it a demeaning term in any way whatsoever for my professional reputation is gained from what I do – not from what I call myself. That, in my mind, is the key to successful ‘marketing’.

    As far as surgical development in chiropody concerned, there is no doubt that our profession make good bone cutters where a concise knowledge of foot mechanics is applied to surgical practice. The problem stems from training and titles – something we are going to address in the UK over the coming year. As far as training is concerned there is much work still to be done – but with regards to title, I suggest a new name – Foot and Ankle Surgeon.

    What say you??

    Kind regards

  9. W J Liggins

    W J Liggins Well-Known Member

    W J Liggins

    Good morning.

    In order to approach this subject, it is necessary to deal with facts:

    1) it is not in any way illegal to describe yourself as a physician

    2) There is no deception in describing yourself as a Consultant Podiatric Surgeon if that is what your contract states. Further, as Dieter Fellner has pointed out, all the Podiatric Surgeons that I know in the U.K. explicitly state in writing to each and every patient, that they are not doctors of medicine

    3) The Kings Fund, amongst other bodies, including individual and formal orthopaedic groups have published on the subject of the benefits of podiatric, as opposed to orthopaedic surgery

    4) the survey mentioned by Mr Robertson was biased, unrepresentative, and non-scientific

    5) Mr Robertson is (or was at the time) a trainee, not a consultant

    6) The British Orthopaedic Association, in the minutes of the Annual General Meeting held 25th September 1991 under the heading 'podiatry' stated ".....Podiatry was here to stay. It was acknowledged that the problem (sic) was caused by the low level of interest shown by many orthopaedic surgeons in foot surgery and that in certain circumstances a well-trained podiatrist could produce better results than a not fully trained or uninterested orthopaedic surgeon. Council had resolved that podiatry was established........"

    Given these facts, it seems that Mr Robertson is condemned by his superiors as 'a not fully trained.....orthopaedic surgeon' who could not produce such good results as a well trained podiatrist. Unless he is misquoted - which is his fault for running to the press - then it also seems that he was lying. He is, of course, welcome to challenge that statement, and I am at his disposal.

    As far as changing my title is concerned, why? It adequately describes my activities; it is a title I have used for many years and I see no reason for changing now. If it usets the BOA, well they had ample opportunity to change things in 1993 when tri-partite talks with the Royal College of Surgeons (Eng) took place and an agreed report was produced which was subsequently scuppered by the BOA.

    What is happening is simply more wriggling in the area of medical imperialism and the message to all elements of the British profession is clear. Remain independent, support each other, and attempt to emulate the situation in the USA where the control of the profession is vested in the profession, not outside agencies.

    All the best

    Bill Liggins
  10. Dieter Fellner

    Dieter Fellner Well-Known Member


    I do not understand why the title "doctor" should upset (ah hem...) other people, or to put it differently, why this should concern us. As Bill Higgins has pointed out, this is merely a reaction to professional territorialism. As a professional group we could do much worse than aim for this professional title.

    Do you get upset about the Dr. Dentist? Is it not fair that society should recognize the efforts of the dedicated health professional and attribute a title correspondingly? Consider the workload of the average dentist and contrast with that of the Podiatric Surgeon. Why is it that Podiatrists should not rightly stake their claim in the health hierarchy? It's ok for the nurse to be a Consultant, but not the Podiatrist?

    Foot & Ankle Surgeon is a better alternative to Podiatric Surgeon ? Now you have totally lost me....

    Health insurance providers also place a premium on the registrants requirement for a substantive NHS Consultant contract. This is an economic reality. At some point I may wish to work in the private sector. Patients requiring surgical /specialist intervention should be able to make their health insurance work for them, if they want to see the foot specialist.
  11. Graeme Franklin

    Graeme Franklin Active Member


    As an aside I never understood why dental surgeons wanted to be addressed as "Dr" as the UK convention for surgeons is "Mr". It is not as if dentists struggle to get business. It seems they want to be both a doctor and a surgeon; they want their cake and eat it. Whenever I see the dentist I always insist on calling him Mr which hasn't been well received by the reception staff. The dentist doesn't seem to mind.

    As a further aside; I thought anyone can use the title of Dr as long as they do not represent themselves as a medical doctor? One of my friends (without a PhD, DSc, DPhil etc) always uses the title of Dr whenever he checks in for a airline flight in the hope of an upgrade to 1st class. He has had some success in this endeavour. Therefore I look forward to the day when all pods can call themselves Dr! :D

    Best regards,
  12. HJM41

    HJM41 Member

  13. Dieter Fellner

    Dieter Fellner Well-Known Member

    Hjmr41 .... ?

    It is not as bad as bad as you might be led to believe. All surgeons in the UK use the title of Mr in preference to Dr and take great pride in this. It is a kind of inverted professional 'snobbishness' and some of those surgeons would be horribly offended to be referred to as a mere Dr. Equally those highly skilled professionals would not take kindly to be called 'butchers'.

    Though you would be right to say the professions 'can't get their act together' but this is not for a lack of perserverance.

    Meanwhile I am not sure if I would really want the title of Dr.

    Doctors sometimes kill patients (well on House etc at the very least ) and I would not want to be confused with one of those fictional doctors :D
  14. John Spina

    John Spina Active Member

    Seems here like there is a cultural thing going on.In the UK it seems to be the norm to refer to doctors as Mr./Ms.In the USA,that is not done.I have patients refer to me as Mr.I do prefer Dr. and I tell them this.They will at times keep calling me Mr.Then what can I do?
    We pods are doctors and we have a lot to be proud of.
  15. Snowstorm

    Snowstorm Active Member

    Since the title of Doctor is not protected by law it is a matter for preference it seems.
    Case in point:
    A local plumber fitting out bathrooms has a van with an advertisement "Mike Trower
    Bath Doctor” strangely enough he has plenty of work.

    Dr. Mark :p

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