The "profession" of Podiatry

Kevin

I don't expect my words to have much impact within this site (hey, the government writes the rules!), hence I spend a lot of my spare time on committees and writing policy papers on these very issues - without a pseudonym.

Having been 'burnt' rather badly by another online podiatry discussion forum in the past, I prefer to not publish my name. There are many other non-podiatrists (read 'competitive interests') who scan these pages and are happy to turn any critical or passionate views against you in real life. This, I have first hand experience in, and it wasn't pleasant.

Meanwhile, as you appear to do, I like to pass off some of the pearls I have gained over the years to the newer members of our learned profession. I have observed you have a tendency to stay out of 'politics' and focus on clinical matters. Perhaps a luxury or practicing in the US where many of the battles have been fought and won? I wish I could restrain from entering into discussions of this nature sometimes, but I believe strongly in the benefits that a skilled profession such as ours can have for the community - if only given the legislative freedom to do so.

I know you express displeasure at pseudonyms, however I assure you there can sometimes be sincere motivations behind doing so.

LL

 

LL:

I know who you are but thought others would like to know your prominent role in your country's efforts to improve podiatry education. I stay out of politics because I am, at heart, a scientist and as such avoid find political discussions quite boring and nonproductive.

As you stated, I am happy to let my colleagues here in the States who are much better at political issues than I am do the talking on politics. As a matter of fact, one of my classmates from the CCPM Class of 1983, Dr. Ross Taubman, will be inducted as President of the American Podiatric Medical Association this coming summer. Ross loves this political stuff....thank God for men like Dr. Taubman for those of us who are more interested in science than governmental policy and professional organizations.

 

A thoughtful posting by L.L.

However, there is a fundamental difference between the 'Commonwealth' countries and the USA which I touched upon in my previous posting on the subject. Full professional closure in the USA has allowed the development of the profession to the position it currently enjoys. As mentioned, the profession itself fully backs it's members at every turn. In the U.K. this is not the case and indicative closure only is enacted. This (perhaps deliberately) prevents the profession from becoming master of its own destiny in the same way as has been the case in the USA. I understna that in Australasia the professional bodies are much more pro-active in the legislature on behalf of their members.

However, unless recent changes have taken place, it cannot be ignored that in the USA some states do not permit the full surgical treatment of the foot by an independent podiatric practitioner and as a result the scope of practice is much the same as in the U.K. without the addition of podiatric surgeons.

I will be very interested to hear from members in Australasia and the USA (and anyone else) how they would see a solution to the present U.K. situation.

All the best

Bill Liggins

 

LL

At last year's FIP Conference there was a separate mini symposium focused on setting international competencies for podiatry which had representation from all member countries (not Australia or New Zealand because they do not affiliate). The intention of the steering committee as I understood it was to define an internationally agreed set of professional competencies which would eventually define podiatry across the globe. This would include job roles and scope of practice. A mammoth undertaking and if successful would determine the practice, administrations and education of podiatry, internationally. Presumably the movement is to establish international reciprocity. So whatever the situation is at present it is likely to change in the future. Since the FIP organisation appears to represent the critical mass then the impact upon non member countries will be interesting to document.

Usually the trend has been for Australian and New Zealand podiatry to follow global trends rather than set them. Now there are exceptions and one in setting professional competencies. New Zealand was arguably one of the first countries to do this with a needs analysis chaired by Greg Coyle at the CIT in the late 80s. About the same time, the Soc of Pods and Chiropodists in preparation for UK joining the EC directed a sub committee to investigate and Prof Robert Ashford invited a group of experts to define a set of clinical competencies. Using a delta technique he later validated these and the results are published in the UK journal (circa 1992). These have been more recently updated (The Quality Assurance Agency for Higher Education 2001) and to the best of my knowledge the UK remains the only country to do this. Australian Podiatry Association (1994) did an independent analysis of clinical competence for Australia. Somewhere in between a Canadian initiative (led by Brian Brody) did a similar exercise. The published results collectively have come to represent podiatry in the commonwealth. The concept of professional competencies which ironically came from the US was not immediately adopted by podiatry but has been subsequently.

When you compare the published competencies there are many similarities. Some parochial differences which may relate to bias do exist, for instance nowhere in the NZ competencies is there mention of patients - the skills relate only to scope of practice. However put them together and they collectively represent a bigger picture. When the 'commonwealth competencies' are compared to the North American competencies, there is no difference.

As a qualified instructional designer and curriculum writer I have had to study different educational systems (including US, UK and Russian systems) and would agree there is a significant difference in the way pods have been trained in the US. Most certainly in my opinion no system is better or worse there are just different. I agree it is perfectly natural to have people in one system enviously observing another hoping to pick the best to include it in their establishment, but as I am sure you are aware the 'pick and mix' approach to curriculum building is fraught with problems which are mainly due to cultural differences. Rather like a wine which does not travel well taking the better of one system and putting into another may not work so well in practice.

I am sure you are aware of the history of podiatric education so I will not expand other than to say once upon a time we were all trained. Then there was move to in UK and Australia to have all nursing and allied health professions educated at university level. This was a major initiative and politically driven to create non-medical faculties which could compete for research monies which previously had exclusively gone to medicine. Interestingly Australia led the way with podiatry and was first past the post with an undergraduate degree at a public university. The UK and South Africa followed and New Zealand were the last. Sadly Toronto never quite made it but not for the want of trying. Having sat on many diploma to degree university development committees and contributing to writing degree programs, if I had a dollar for every time I heard, "why do you want a degree for podiatry, surely, you are well trained for the job in the existing diploma program." I would be a very rich man.

The argument which won over the authorities time and time again was, as professionals responsible for the care of others it was necessary for all pods to have a science degree in order to understand the scientific literature concerning pharmacy and podiatric requisites which had direct bearing on client’s wellbeing. To do otherwise would be an abdication of care. Whatever else transpired after that basic academic accomplishment would prepare pod practitioners to be clinical scientists in the pursuit of their vocational calling. New entrants to pod programs were educated combined with an 'ill defined training,' loosely based on a set of clinical competencies. Ill defined in this sense refers to the absence of targeted instructional design and not to imply something derogatory. However there was evidence that after many degree programs were up and running the clinical training did not always match the academic approach. These comments are recorded in the published university review and there you can read chapter and verse. At one point I was a consultant who helped other university programs rewrite their courses as they were running to try to match theory and practice. One of the best kept secrets in Britain, until now . A decade later I went back to visit several UK universities and podiatry centres and had the privilege of speaking to staff and students at length. From my observations there was still a mismatch between theory and practice which led me to believe little had changed. These priblems were being grappled with. To be fare to all the pressures in the centres of podiatric education were much greater and the opportunity to innovate far more constrained.

Back to the US, until comparatively recently the centres for podiatry education were all private institutions not affiliated with public universities. Whilst eminently respectable the academic component was not open to outside scrutiny as would be standard at a public university and the DPM was a professional qualification with mjuch emphais on quality training. Entry criteria to the programs were pre-published but apparently not all entrants met this criteria. Whilst encouraged to complete their training not all graduates required to complete their studies to be able practice in their chosen States (because of the differences in State laws) and would leave the course before its completion. This has long been a concern to the professional bodies according to published reports.

Outside the states the DPM qualification would equate academically to an undergraduate Honours Degree and not a higher degree such as a Masters and PhD. More recently the pod centres of education in the US have gone towards a public university education and many pods will complete Masters and PhDs. On that level this would be no different to the 'Commonwealth.'

toeslayer

 

Bill

Podiatry is a closed profession in OZ and NZ.

toeslayer

 

Hello Toeslayer

Thanks for the info. and your highly literate analysis of the international pod. education scene. :good:

How did Australasia obtain functional closure without the government objecting on the grounds that seem to appertain in the U.K. ie. a marked reluctance to allow professional self determination? Did that have something to do with the different health systems and the NHS in the U.K. needing to control the professions?

All the best

Bill

 

Dear all,

I am sure Toeslayer/Cameron will love this post. It will add more information to his amazing knowledge about Podiatry worldwide. I think he is aware that Spain is not also affiliate to FIP; Spain is member from Association Européenne des Podologues (European Podiatrist Association), just another example of insight fights among the profession. Also, it is surprising how much from the above comments match with our own problems and challenges.

This info comes from the article "Podiatry in Spain" (Podiatry Now Sept-Oct 2006):

Podiatry is a well-known and established profession in Spain. Practitioners, as in the UK, were originally called Chiropodists or Chiropody surgeons (“cirujanos-callistas”). However, during the 1960’s the term chiropody was dropped in favour of “Podology” (the study of feet), and subsequently practitioners became known as Podologists. Currently, the Podology course is a three year University degree conferring the award of “Diplomado en Podologia” (similar to the Bachelor of Science in the United Kingdom).

The History of Regulation

The first attempt at professional regulation came in 1860. On June 26th the “art of chiropody” and its scope of practice was first recognised but Spanish practitioners had to wait almost a century for full regulation of the profession. On July 31st, 1962 new legislation was issued. This regulation allowed the newly renamed Podologist to treat a full range of foot conditions, without supervision from other health professionals. This mandate also included a range of surgical procedures (provided they were carried out under local anaesthesia). The only caveat to this was that all those applying were required to hold a degree in nursing, prior to commencing the two-year Podology course.

This changed again in 1988. In that year, a superior degree in Podology was approved and the course was extended to a full time 3 year format to achieve the “Diplomado en Podologia”. Practitioners who qualified under the two year system were required to pursue a conversion course to meet the new standards. Essentially, unlike the UK at this time, there was only one nationally available course in Podology. The most recent changes occurred in November, 1997. As a result of the Bologna Process (a strategy to harmonise University education across the European Union) changes to Spanish Universities meant a new, four year curriculum had to be developed. The official title of the course will change when it starts in around three years time.

Education

Currently there are eleven Spanish Universities that offer the Diploma de Podologia. Some of them are in the public sector, others private. The average of annual cohort being around 50 students from every University thus, there is currently no shortage of Podiatrists in Spain - for a country with a population of 40 million there are around 5000 Podiatrists.

The undergraduate course covers similar subjects as in the UK: general podiatry, biomechanics, orthotics, pharmacology, surgery, anatomy and biochemistry, etc. Like all health studies, Podology is mainly practical with a large amount of time devoted to practical and clinical skills. Under current legislation, all Podology Schools must have an in-house podiatric clinic for clinical training purposes. The misuse of the official title whilst studying Podology is a serious offence, that can carry a large fine and up to two years of imprisonment. Postgraduate training and opportunities are also available - surgery, biomechanics and diabetic foot management courses are popular being run by Universities and professional organizations.

Scope of practice

Like the UK, Podologists in Spain are allowed to treat all kind of foot conditions and to prescribe foot orthoses and other devices to correct foot alignment and biomechanical malalignments. Many practitioners make their own orthoses, but its manufacturing is strictly regulated by an Act based on Medical Device Directive (93/42/EEC). The main contrast between the UK and Spain is the scope of surgical practice. Podologists are permitted to perform any kind of surgical procedure - rearfoot and forefoot but curiously practitioners are not allowed to perform any type of foot amputation!

The other unusual anomaly is an incongruity about prescribing. Technically, Podologists are not allowed to prescribe oral drugs but neither are they forbidden to do so. This legal “grey area” has currently being fought for over two years in an attempt to achieve prescription rights. So far, the latest proposal was dismissed on the last poll in the congress but the legal battle continues. For most practitioners, the system currently relies on a Podologist recommending a specific drug to a patient but ultimately whether a patient receives them or not depends on the Pharmacist’s willingness to dispense them.

Practising in Spain

Podology is mainly based in private practice. Most Podologists work in their own offices, in nursing homes and or in group practices. Podology is not included on the Public Health Service. Although, two autonomous communities (Spain is divided in 17 autonomous communities, similar to US states), Andalucia and Asturias, have created Podiatry services for treating diabetic population through their own public health networks. Podiatry organizations however continue to fight to create more local and specialized podiatry services in the Public Health Service but as with most other countries funding remains the largest obstacle. There only a handful of hospitals (both public and private) that include specialist podiatry services for treating the growing diabetic population.

Private insurance usually covers routine foot care, but there are an increasing number of podiatric procedures covered by some insurance (mainly surgical procedures). Foot orthoses are not covered by public or private health networks, although some private plans offer some kind of reimbursement policies.

Regards,

 

Even though I am no politician, in my international travel to lectures in New Zealand, Australia, Canada, Spain, England and China over the past two decades, I have had the opportunity to speak with many podiatrists and foot-health care specialists regarding their professions and their professional difficulties. Here are my overall impressions of the US podiatry profession relative to the international podiatry/chiropody/podology scene.

1. Podiatry is primarily a surgical specialty only in the US, and in no other country. All podiatrists are trained to do osseous forefoot and rearfoot surgery currently in the US with many podiatrists also doing ankle surgery, including ORIF of fractures, and, in some states, doing surgery below the knee in the leg. The percentage of podiatrists who do bunion, hammertoe, and neuroma surgery here in the US is probably around 90%.

2. Podiatrists are granted the "Doctor of Podiatric Medicine" degree in the US, are allowed to be called Doctor before their name (i.e. I am Dr. Kirby to my patients), and are considered physicians. Since medical doctors (MD degree) are also called "Doctor" before their name (i.e. Dr. Roberts), then podiatrists and medical doctors have the same salutation and, in the public eye, are often perceived to have similar training and social standing because of this distinction.

3. All podiatrists are trained to perform and read plain film radiographs, and read bone scans, MRI scans, and CT scans in the US. Podiatrists in the US are given a limited radiographic and fluoroscopic licenses that allows me, for example, to not only take x-rays in my office but also to use a C-arm (i.e. fluoroscopic unit) during surgery to analyze the position of surgical reductions, etc.

4. All podiatrists in the US are trained and are licensed to write for prescription medications. We prescribe all types of oral, IV and IM narcotics, antiobiotics, muscle relaxers, sedatives, NSAIDS, cortisone, and other medicines.

5. All podiatrists in the US are trained and licensed to give injections of local anesthetic, cortisone, B-12, and other injectables from the ankle distally, and in the leg for tibial and peroneal nerve blocks. There is a grey area in the leg, from my understanding, in some states, regarding injections, but peroneal nerve blocks are not uncommonly done here in California by podiatrists.

6. Podiatry is a much more mature profession in the US than in other countries due to the longer training required. Here is the program that most US podiatrists do for their education from their first year of school as a child to their last year of post-graduate training of surgical residency:

Age 5: Kindergarten (1 yr)
Ages 6 - 12: Elementary School (6 years)
Ages 12 - 14: Middle School (2 years)
Ages 14-18: High School (4 years)
Ages 18-22: College/University (4 years, completing with a BS or BA degree)
Ages 22-26: Podiatric Medical School (4 years, completing with a DPM degree)
Age 26-28(29): Podiatric Surgical Residency (2-3 years of surgery/medicine/clinical post-graduate training that is hospital and clinic based)

Therefore, podiatrists in the US have generally spent 4 or more years in college/university studying non-medical degrees before they enter podiatric medical school. Podiatrists in the US come out of their final year of training and into private practice, at the youngest at about 27-28 years old, with some being closer to 29-30 years or older if they had another occupation or type of schooling before entering podiatric medical school. This, to me, makes the US podiatry profession much more mature than in other countries since there are no practicing podiatrists that are in their early 20s, with most of them starting in the later 20's. It is my understanding that in most other countries, podiatrists are, on average, coming out to practice at the age of 21-24.

7. Podiatric medical education in the US is a huge investment monetarily and is not state or government funded. Current students of podiatric medicine here in the US pay $25,000 - $27,000 (US dollars) per year for tuition, which does not include room, board, books and other miscellaneous fees. Therefore, the average podiatry student ends up with over $100,000 in students loans upon entering practice, with some having well over $150,000 in student loans to pay off. It is my understanding that podiatry education in nearly all other countries is paid for by the government.

Hopefully this provides some objective data for those of you who are not familiar with US podiatry system. From my viewpoint, we are all similar in many ways, whereas the US system is very different from other countries in other ways. I see positives and minuses in both the US and other country's training programs for podiatrists. Maybe some of the other US podiatrists following along can add their comments.

 

Thanks Javier that was very informative and I will certainly keep that background on file. The situation in other parts of Europe is complex and one day I will try to gather it all together.


Bill
>How did Australasia obtain functional closure without the government objecting on the grounds that seem to appertain in the U.K. ie. a marked reluctance to allow professional self determination?

This happened some time ago not entirely sure of the exact date but could be 20 years back. I am sure someone will quote chapter and verse. Not actually conversant with the politics but certainly there were enough ex-pats around to make the call for closure a priority. John Gallocher did a lot in NZ and there were a few active individuals in Australia who would see the closure of the profession as a major priority.

>Did that have something to do with the different health systems.
Probably leading to this event the health care systems were not that different from the UK. The remnants of a public based health care system still exist in Australia and NZ, albeit the provision of podiatry services vary from State to State. Conditions of service are not exactly uniform across the big brown land and the absence of a Whitley System is apparent by the wide variation in remuneration and other conditons of employment.

and the NHS in the U.K. needing to control the professions?
I think closure here was driven by the profession predating any QA issue. Now I could be wrong and again hopefully someone will fill in the gaps.

Although the situation remains fluid, the professional body has been very proactive in Australia and New Zealand over the last 25 years. Although membership varies from state to state a large percentage of pods would automatically join their professional association in each state which gave the federal council incredible influence. The significance of a national podiatry counsel made up of state representatives was the Federal Government which will only deal with national bodies. A common misconception among many pods however was the professional association had a mandate to speak for all podiarists, which of course they do not have. Not so many registered practitoners now affliliate but despite the drop in membership the association continues to be pre-emptive in many fronts on behalf of its membership.

Needing to control the Professions
There seems to be a move towards reorganising the current registration structure in Australia which may result in a national board for podiatry (similar to the State Registration Board in the UK). This is all work in progress but I would not be too surprised if down the track there were moves by the Federal Government to create a Health Professions Council in Australasia. So to that extent we are just catching up :dizzy:

toeslayer

 

Seems to be a world of difference between a US and UK based Podiatrists then!

I was a mature student (started at 26 and a half). Been working in the NHS for 18 months......I'm saying nowt (cos I'm NOT anonymous!).


To the OP

You got any further info on post grad surgical training? i.e. where it is and how much it costs?

 

found it

http://www.qmu.ac.uk/courses/PGCourse.cfm?c_id=213

 

Thank you to many people who have replied to my post, i now feel entirely out of my depth in terms of the historical political events which have occured in our profession, but i am glad people who are a lot more qualified to speak in relation to this have commented. My post wasn't about getting people to agree or disagree with my comments, it was about sparking a "professional" debate about the issue, rather than in my experience, having a moan around the coffee table. Thank you everyone for having a professional debate and not reducing to name calling which i have found on other sites. Personally i think we on podiatry arena are all biased in a way, the people we should be trying to debate with are the "professionals" who do not log onto sites like this and don't stay in tune with current professional issues.

dgroberts, if you want to know anymore about the surgical training, just send me a message. I don't confess to knowing everything, but i am making my way through the struggle at the moment so might be able to give you an insight.

 

Thank you Ray the 1st, for flagging up an interesting and topical debate. I think we can all draw something positive from the posts.

Best wishes for your surgical training.
Bel

 

I wrote a similar letter about 25 years ago and after a couple of years regretted it as I began to meet more of my own profession that I have huge respect for. You will go far if you let your energy that is making you cringe right now propell you to your dreams and goals. We have plenty of unusual characters in our profession, but as i have had the pleasure to mingle with our fellow doctors and para medical professions, so do they and they cringe too. Dont focus on what you dont want, focus on where you are going and you will be challenged and create change for the greater good. Hope to read about you in the years to come. As for Ms Chipper Clipper she probaly prevented 4 diabetic foot ulcers today. The public need you and her. I hope that we just have clearer distinctions between the levels in the years to come.

 

Hi Podiatry Arena,

I have been a lurker on this forum for a while & not long registered thus whenever I log on I am always reminded to make my first post by "saying hello" ... HI!

Reading this thread has sparked me to do so now; as I can understand to some degree Ray's feelings - yes, I can also understand why some found certain parts confronting & their subsequent reaction (although name calling is uncalled for). However, I found the following two posts specifically apt & balanced towards the underlying issues of the discussion.

As a profession (Podiatry) we need to continually question our purpose & direction.Dare I say, part (if not a big part) of the resolution of the misunderstanding of the scope of our profession lies with the various Podiatry Associations. The scope of Podiatry needs to be promoted/marketed to other health professionals (i.e. G.P's, orthopaedic surgeons, physio's etc.) as well as the general public. The following is just one example: a person with an ingrown nail needs to be aware that a podiatrist can resolve the problem & a G.P needs to know that we are qualified to do so. If it wasn't that I am a podiatrist, I (a member of the general public) would know very little about the scope of Podiatry - same as the G.P & physio friends of mine... as well as the vibe I get from orthopaedic specialists.

Subjective I know, but ... Podiatry (the 'Associations') needs to stop focusing promoting Podiatry to qualified podiatrists & start broadening their horizons to include others who know less about our profession than we do. I am sure this may be happening to some extent (small?) but it needs to be more i.e. not just 'Foot Health Week'. This may eliminate some of the frustration that Ray (& some of us) has experienced as well as the confusion his friend experienced - as well as help advance the future of our profession. I am writing from an Australian (NSW) perspective.

Kind regards,
BEN-HUR.

PS, I thought about posting my real name but due to the possibility of :butcher: & that it is my first post I'll refrain for now.

 

Ray has captured a few of the frustrations felt by the Podiatry professional. In his profiling of the 'type' he has somewhat naively isolated a particular cohort; perhaps this was his experience. This can be forgiven, it is but the impulse of youth and exuberance.

It is not an experience I share. Enrolling in 1987 as a 25 year old student , I too was categorized as a 'mature' student. Our class had several older students, aged 30-40, alongside the regular intake of 18 year olds. The academic achievements of those who graduated did not seem to me to follow a particular pattern based on social profiling. Perhaps some of the older student were a little more anal about suffering the consequences of failure, and at times more diligent in their studies - I was one. And some of the younger students also were fiercely competitive and successful. The graduate student is taught, and required to be a professional. This is my experience. And, I believe, as a rule this is so.

Commenting on the student's background, also in my student days, many looked at Podiatry, not as a first preferred option, as it was mine, but as a rescue option. The student who failed the grade to enter medical training, dental school or even physiotherapy.

It is my believe that in part this attitude has persisted because Podiatry in the UK is, in the main a part of the system of socialized healthcare, the National Health Service. In contrast in the US, the Podiatrist is, for the most part, thrust into a highly competitive open market environment from the get go. I believe this breeds an entirely different outlook and set of expectations. The US Podiatrist, after investing $120K in education, simply cannot afford to spend the working day nail and corn cutting, whilst neglecting the delivery of high quality care, CPD, and all those activities that promote professionalism. It is all tightly interwoven with a system of remuneration to further propel such high aspirations. There will be other important factors: not least the failure of government to sanction restrictive covenants to offer patients and Podiatrists apropriate protection in our work.

There are many exceptions to the broad sweep of this brush; to this day the element of very base practice persists, alongside much excellent work, performed every day by the highly motivated Podiatrist within a diverse range of clinical activities; biomechanics, Rheumatology, Diabetic clinics etc. In the end, the bottom line is the employing organisation has to decide what level of care is provided to the population. The drivers for this are varied and complex and beyond the scope of this response. Surely, if headed up by a lazy manager, the service is disadvantaged. But I depict an overly simplified scenario.

In the UK, I am not convinced that raising the entry qualifications will, in itself, alter this - Podiatry, as in many other countries, to this day in general still has a profiling / marketing problem. If Podiatry school should in this isolated way compete with other health professions, the student with the golden grades can take a look and make an easy choice - social standing, income potential, promotion prospects, professional kudos etc. Medicine, Dentistry, Veterinary Practice .... or Podiatry (?).

In my opinion Ray has touched on the problem, and hit some raw nerves, but the frustration needs to be more correctly focused on the system, not the individual. Nature abhors a vacuum - this truism extends to the work place. When there is room to accommodate the lazy (for want of a better descriptive) salaried Podiatrist, the vacuum is filled; it is a natural law.

Ray has some concerns about concealing his identity. For the most part I agree, the weblog poster on this professional forum should reveal his identity and stand by the courage of his convictions. In this case, and with the benefit of drawing on 18 years experience of organisations, he is wise to exercise discretion. Perhaps he can in time and with experience negotiate his way diplomatically and skilfully through the quagmire of what can be summarised loosely as 'office politics'. Or his outspokenness might instead attract disfavour; if unlucky it can take but one ill intentioned superior to inflict a crushing reprisal. This can take many forms, and it will have little to do with 'right' or 'wrong'; but this could inflict some permanent scars.:sinking:

 

Excellent posting and thanks.

I do disagree with one point, namely posting under one's own name. Even when dealing with a contentious issue, one should be able to use sufficiently diplomatic language to make the point without resulting punative measures. That is a part of professionalism. If the issue is so burning, and the view so controversial that punative measures are strongly suspected, then a choice exists. Don't post, or post and be dammned. I have taken the latter course in another area and suffered as a result. However, I have never regretted what I did; no one has ever questioned my integrity, but many have questioned the professionalism and integrity of those who took action against me. These people have been diminished as a result, and I have learned a great deal about the larger profession in the process.

It is for you, Ray to make your decision but can you aspire to that which you clearly do, without that element of professionaism?

Bill Liggins