Surgeons angry over lack of Medicare access

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Story on ABC News Victoria last night.

Podiatric surgeons are expressing frustration that Medicare only covers orthopaedic surgeons when it comes to foot and ankle procedures.
On line video available to view.

LL

 

Interesting comment by the head of the AOA:

"Orthopaedic surgeons are better equipped to manage complications, have a better understanding of post-operative protocol, and have a better knowledge of pharmacological management."

Says who? Unless I am mistaken the ACPS training program undertaken by podiatric surgical registrars is similar to that performed by orthopaedic surgical registrars. The main difference is that podiatric surgical registrars don't get paid for their training.

Good on the ACPS for pushing the point

------------

Nick Ryan

 

Same old same old arguments over and over and over again from the AOA, AMA, RACPS and any other body.....fact is they don't back this up with any statistics or real world examples.

If the AOA or any other organization want to have a fact for fact argument using real world statistics I am sure they will soon realize that all that glimmers is not gold.

 

Its funny, in any situation regarding healthcare we are quick to shoot people down who don't produce evidence when making a claim (refer to the snake oil thread for more info)

This scenario is no different. How can a statement be made like that without producing evidence to that effect? :craig:

 

Keep the faith. This is the same battle we fought in the U.S.A. for years. Podiatrist are now unquestionably the authority when it comes to medicine and surgery of the foot and ankle. Most of us have great working relationships with Orthopaedic surgeons most of whom do very little foot and ankle surgery with the exception of Foot and Ankle fellowship trained Orthopods. Wish I was there with you on the front lines.

 

Thanks for posting this LL. It is frustrating with orthopods running Podiatric surgery down.The AOA president in the video and also the health minister questions the surgical training as not be audited or accredited, hence their concern. Am sure LL would be abe to throw some light on this.

Regards

David

 

Dear Podiatry Arena Members,

I wish to retract my prior comments as they were made without the benefit of knowledge of both sides of this argument. Having now researched this issue I must agree with the health minister and AOA president. As a Podiatrist my heart still goes out to my fellow Podiatrist but unfortunately the burden of proof is your responsibility. If you want parity and respect of the Orthopedic community, you need to prove that parity exhists. Although it was a long road, this is exactly what we did in the USA. All Podiatrist are now all graduates of a 4 year school of Podiatric Medicine, complete a 2-4 year surgical residency and eventually become board certified by a nationally recognised board. I'm afraid that posting a video of yourself in a surgeons cap performing surgery will not help you achieve your goals. This is a recipe for disaster as the Australian population will eventually bear the brunt of serious mistakes. This will only set your cause back to square one and vindicate your retractors. My best advice would be to use the USA as an example as most of us here would be happy to guide you along your journey. Best wishes.

Dr. David Pizzano

 

David,

Maybe you need to have a longer look at the Australian model. I believe there is a growing base of evidence to support Podiatry, not only as a surgical specialty but also as a profession generally. The University education is second to none, they have S4 prescription rights and growing imaging rights.

You can't be tasked by the government on one hand to take care of serious lower limb disease and have it removed with the other by not allowing adequate rights.

Its simple logic - The government are happy for Podiatrists to save them millions a year on serious diabetic/vascular foot disease but are pressured by the AMA to reduce Podiatrists privileges in doing so. None of it makes any sense.

A GP can claim a medicare rebate for fixing an ingrown toenail but a Podiatrist cannot?

 

Paul,

I'm quite sure your universities are quite exceptional and would be great sponsors for Podiatric Medical and Surgical training. I'm thankfully too young to have experienced this struggle here in the USA but have heard the stories. You need (or may already have) a certifying body that assures quality and consistency of Podiatric Medical Education nationally. Here were have The Council on Podiatric Medical Education that oversees our colleges and residency programs:
http://www.apma.org/Members/Education/CPMEAccreditation.aspx

David

 

Hi David,

We have two regulating bodies:

The Australasian College of Podiatric Surgeons
http://www.acps.edu.au/

and

AHPRA
http://www.ahpra.gov.au/

 

Paul,

The ACPS list missed out Prof. Alan Bryant, Asso.Profs. Jennifer Bryant and Reza Neraghi from UWA.

I have trouble understanding how ACPS can govern training of podiatric surgery when ACPS surgical curriculum is under scrutiny by the AOA and AMA that ACPS in itself is not accredited.

ACPS cannot even guarantee a registrar status after passing the masters course. ACPS states that registrars of ACPS get trained in US. American Podiatric Medical Association states affiliate status means nothing. Podiatric Surgeons form ACPS openly stated that surgical work load is so poor that sometimes the time gap between surgical procedures can exceed months.

Its about time the top brass of podiatry let go off their ego and set up an accredited training programme with consultation from AOA/AMA. so far UWA is the only programme offered within the medical school by clinical professors of medicine. We cant expect to share the rights and previlidges of medical fraternity unless we are ready to sail in the same boat. We students have no hitch to take on further 8 yrs of study following Bachelors of Podiatry, if that further study leads to improved scope, recognition and rights by means of accredited training.

Good point Dr. Pizzano "I'm afraid that posting a video of yourself in a surgeons cap performing surgery will not help you achieve your goals".

 

its the same ol same ol your just not medical doctors the real doctors look down on you for getting in the back door route if you wont to be an orthopeadic consultant go to medical school or do it the usa way. otherwise you will always be the poor relative . think on podiatrists look down their noses at people who do correspondent courses. doctors look down on podiatists who practice bone surgery hey if we do enough cpd andpost grad training we could work our way up the leg and start treating piles.

 

To all posters including David S and Dr Pizzano, thanks for contributing to this discussion.

First off let me say that I am a current student of the UWA Podiatric Medicine program. I am also working as a podiatrist in private practice. I am NOT enrolled in the clinical doctorate at UWA that is designed to equip students with the surgical skills to become accredited podiatric surgeons. I will admit that as a prospective podiatric surgeon I am playing my cards close to my chest to see whether the UWA program becomes accredited, and how this will be incorporated into the current ACPS training model. At the moment the only program that has been accredited and recognised by AHPRA is the ACPS program, however it seems likely that the UWA course will be recognised in due course.

Make no mistake; the current landscape is a political dogfight. This thread highlights the problems underpinning the future of podiatric surgery in Australia. Instead of working together there is a lot of finger pointing going on, not only in the real world but also in this forum discussion.

To David S - you make the correct statement that the ACPS program is under scrutiny by the AOA/AMA. Do you honestly think that if the UWA surgery course is accredited by ANPAC the AOA and AMA will back down and stop making noise?

Furthermore I dont know which podiatric surgeons you are speaking to with regards to caseloads and the long time between procedures, but I attend theatre every week and watch at least 3-4 cases per week. That particular surgeon probably performs 10-12 operations per week, and another surgeon in my state is on par. A newly appointed Fellow of the ACPS that I also attend theatre with is currently building a case list and would perform ~ 4-8 cases per month.

With regards to Alan/Jenny Bryant not being listed as Pod Surgeons by the ACPS, my (limited) understanding is that Alan and Jenny are not financial members of the ACPS, hence why they are not on the list. I cannot comment on the reason why they are not members, however I know they are/were accredited Fellows.

To Dr Pizzano -
The ACPS training program underwent an audit and was compared to the equivalent orthopaedic training model. My understanding is that the programs were near enough to identical but in differing orders, and this certainly halted some of the rumblings at the time by the AOA (from what I have been told). Given that this audit was conducted and the programs were considered (by the auditor) to be very similar would this satisfy the burden of proof to establish parity?

Your tongue in cheek comment about "posting a video of yourself in a surgeon's cap" makes a good point, however I imagine the whole purpose of that news bulletin was to be part of a bigger push for lobbying for Medicare rights and increased scope of practice.

Podiatric Surgery has been recognised by AHPRA (the governing body for health professionals) as 1 of 3 specialty areas of medicine. 2 of those specialty areas have broad referral/prescription/Medicare rights, one does not.

It is now time for the profession to move forward and back podiatric surgery. The profession has been acknowledged and ratified by the government, the program has been shown to have parity, what is required now of the ACPS is to demonstrate efficacy and safety and gain a foothold (pardon the pun) in the medical community.

And for God's sake people, cut the finger pointing. It is not helpful in any way, shape or form. ANZPAC will make a decision on whether to accredit the UWA training program, and the ACPS will continue to lobby for increased scope of practice. See the the interview for what it really was: not a whinge-fest but a call to arms.

Nick Ryan

 

Furthermore Dr Pizzano you make the comment that without due diligence in the trianing programs the Australian public will bear the brunt of mistakes.

The current ACPS program is VERY difficult to get in to. I know because I am expecting to be a bridesmaid for ever!

The training model currently adopted by the ACPS is thus:
- 4 year undergraduate podiatry degree
- A minimum of 2 years clinical experience before beginning surgical training
- Masters' level education in a program approved by the ACPS (recognised programs found here: http://acps.edu.au//cms_files/ACPS Training - List of Masters degrees.pdf)
- A strict interview process and entrance examination
- a 3 stage training program that will likely take 6-7 years to complete (part-time). This training model is based on DPM modesl from the USA and includes preceptorships in the USA and UK.

This equates to 6 years of formal tertiary study and 7 years part time surgical training. This is somewhat similar to what you described, no?

To any current ACPS registrar - please comment if you come across this thread, we would love to hear your perspective.

 

Furthermore Fellows of the ACPS get affiliate status from ACFAS for US$175/year. It would appear that the national body of the USA recognises the surgical status of podiatric surgeons from the ACPS program

No more P.S. posts from me, I have vented enough and am off to bed :deadhorse:

 

Hi Nick, enjoyed ur DVT presentation.

Firstly Nick, i learned about the surgical training ACPS from a document on the web. A surgeons of ACPS, concerns of the training model.

If you read my post again i mentioned that UWA degree is the only one in australasia to run within the medical school and taught by clinical professors of medicine. This course has been setup with the assistance of medical professors. My point is, this is the way to go and why cannot ACPS do the same.

and Nick, the affiliate status: A document from AMerican Podiatric Medical Association to AOA defined affiliate status as an eligibility to attend workshops alone, and that APMA do not recognise ACPS training.

Ofcoz AMA/AOA wont clap their hands and invite pod surgeons on board even if UWA training gets accredited. atleast we have a say. AOA claims that Pod surgery has been allowed as a speciality by parlamentarians not by audit and creditation. thats a serious alligation. If APHRA has accredited ACPS training, then ACPS should hit back at AMA/AOA. why do we have wait till these guys throw a stone at us.

I agree, finger pointing is not constructive, criticism can be if taken in the right perspective.

Hope the exam went well and Good luck for second sem

 

I should make the point to anybody following this thread that I am not a spokesperson for the ACPS, and currently have no affiliation with the ACPS. I do not presume to speak for them, and any information I disclose is not based on opinion but rather freely available in the public domain.

David

You make a good point. It is a serious allegation. I think you will find that there will be some follow up in that regard.

You are also right about how the ACPS needs to hit back, however keep in mind the context of the opposing sides of the argument. It is a David and Goliath battle, one side with exceptional amounts of lobbying power and $$$. Therefore the ACPS will need to put forward any argument within the appropriate legal channels of the current political and bureaucratic system.

With respect to the UWA program being run in conjunction with medical support - I am not denying that this is an appropriate model. I would be surprised if ANZPAC did not end up accrediting this surgical program. It is clearly a sensible way of delivering the appropriate educational material to students of podiatric surgery. At no point have I stated otherwise. Alan and the other academic and clinical staff at UWA have put together a fantastic program that should be the model for future undergraduate and postgraduate training in Podiatry in Australia. Clearly I would not be enrolled in the UWA masters degree if I did not think it was a worthwhile program.

Furthermore I think you will find that the ACPS has no problem with the educational material presented in that degree, but rather is 100% behind it. On that matter I believe the College to be on the same page as the University.

On a different note, refer to this document regarding Medicare referral rights (which is what this discussion was originally about)
http://www.health.gov.au/internet/safety/publishing.nsf/Content/com-pubs_NSQF-Submissions-con/$File/28674-26.pdf

The ACPS has been and is active in its push for increasing scope of practice for its members, and that was the whole reason this thread started.

Also glad you enjoyed the DVT presentation, but that wasn't me! That was the other Melbourne student. I presented on nephropathy and ACE inhibitors. Was the audio ok? Sounded horrible on the recording. Cheers :drinks

Nick Ryan

 

Guys, What are we discussing here? Lets not fall into the trap of presenting untruths or evidence with no data.

ANZPAC and AHPRA are the accrediting bodies when it comes to Podiatry training. If the ACPS and UWA are approved training programs then I fail to see what anyone is criticizing here?

I am not standing up for either program, I am merely sticking to the point - they may both be accredited to train Podiatric Surgeons.

That's the end of the argument. No matter what you "personally" think of the program - the facts are the facts.

The facts are also much simpler than that - the evidence is unquestionable when it comes to lower limb medicine. Podiatrists are an integral part of the team - we are just as effective if not more so, we save much more money, we cut out the need for unnecessary visits on Medicare or PBS and we save limbs and/or lives.

I am sure there is no question that Dentistry is the specialist at that end of the body. Why are we constantly questioned or why do we constantly question ourselves?

This is an easy decision when it comes to Medicare item numbers and increased scope - the ACPS should not be having to do this on their own. Its an APodC issue. APodC should take this bull by the horns and run with it - last time I looked General Podiatrists still performed minor surgical procedures which should fall under the MBS item codes (i.e. ingrown toenail ablation) - we should all be fighting for this.

 

Thankyou Paul, you have said in a less round about way exactly what I have been trying to say.

NR

 

For the record it is worth noting that there is NO evidence that the ACPS is or has ever been accredited by ANZPAC, the PodBA, APodC, the Commonwealth Dept of Health and Aging.
The Commonwealth Dept of Health and Aging accredits individual pod surgeons so thay can obtain a provider number. The Commonwealth Dept of Health and Aging has never accredited the ACPS.
The ACPS is not affiliated with the ACFAS in the US.
Quote "...ACFAS recently created an "Internationale Affilate" status within the College: it allows like minded surgeons without a DPM and residing outside the US and Canada to submit an application and upon approval receive discounts on educational offerings, products and services and access to a members only content on the ACFAS website. Members of the Australasian College of Podiatric Surgeons have been invited to have Internationale Affilate" status with the College. Outside of this invitation, there is no offical affiliation between the two organisations...
Sincerely Michelle

Michelle D Brozell
Director Membership
American College of Foot and Ankle Surgeons"

 

Thank you Prof. Foley.

When the president of AOA publicly accused pod surgeons as incompetent and that they were allowed to practice surgery by parlamentarians, all ACPS can muster is 'very humbly is to do an audit with them. If ACPS is accredited let them bring it out to the public. We have to criticize ACPS training Paul because what AOA said is humiliating.