Green Podiatry?

We've all heard the term "green" in the popular media and news. The debate continues to rage over global climate change and its potential impact on the world. We hear daily discussions about fuel efficiency for automobiles, emissions standards, etc. One place I have not heard much discussion, though, is in the medical field. The emphasis nationally when it comes to medicine is the argument over universal health care and decreasing medicine related costs to the country while increasing access to health care.

Jarrod Shapiro, DPM
Joined Mountain View Medical
& Surgical Associates of
Madras, Oregon July 2008

So where does podiatry sit with the “green” movement?

About where the rest of medicine sits – behind the 8 ball. Most experts agree climate change is a significant issue that does exist and is not cyclical – increasing human emissions are the cause. With that in mind how can we as podiatrists – and medicine as a whole – assist with decreasing harmful carbon emissions and move toward a conservationist frame of mind?

I think the healthcare industry will be one of the last to respond to this problem – not because we are careless, but rather due to the nature of healthcare resources. As it exists now many of our medical supplies are disposable (by necessity). Think of the amount of materials we dispose of in surgery – gloves, gowns, covers, blades, certain instruments, etc. Now extrapolate that to the entirety of medicine. It is by nature and necessity an expensive process.

I think a new line of “renewable” or recyclable materials will be required for this type of “necessary waste” to stop, but it’s not possible with our current technology. For those of you entrepreneurial types, here’s a new business idea. All you have to do is create a material from which you can effectively, safely, and cheaply remove human biohazardous waste. That’s it…easy. Until then we’ll have to keep doing things the current way.

So, what can we do in the real world with our current technology?
Here are a few thoughts: Write in with your ideas.

Install automatic lights in patient exam rooms. This will decrease energy usage (and save your electric bill).
Consider utilizing EMR programs to reduce paper use (also increases staff productivity).
Switch to digital radiography once it becomes affordable (decreasing harmful chemical use and disposal and supply costs).
Review your practice locations for building efficiency and utility usage (which will decrease energy costs).
Recycle your nonbiohazardous waste.

I find it interesting to note that of the five ideas I just listed four of them have direct cost savings to the doctor. Hmmm. Food for thought about green podiatry. Best wishes with your green practice!

Jarrod Shapiro, DPM
PRESENT New Docs Editor
[email protected]

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Letters to the Editor

***The Changing Face of Podiatry***

First of all, I would like to thank you for the time and effort that you put into this column. I always read it with interest. However, something that you recently wrote bothered me enough to respond. As a Residency Director at the Miami VA Healthcare System PM&S 36 program, I am acutely in tune with your comments about standardization of residency training. Many passionate and dedicated people in our profession have worked incredibly hard over the past years towards this effort.

Your comments "I think it's safe to say that any quality residency program is now three years long, and I wonder that any two year programs even exist anymore", however, insinuates that quantity equates with quality, and in my experience, this is simply not the case. Even with a standardization of 3 years, I think that we can all agree that residency experience must be well balanced between clinic and surgery, diverse in pathology seen and treatment options offered, and highly structured, organized, and academic to continue development of critical thinking skills. Furthermore, a simple review of the CPME website shows that of the 240 residency programs approved for the 2008/09 academic year, 52 are PM&S 24 – a 20% representation certainly proves existence of 2 year programs. While our program here in Miami is in fact 3 years, my residency director colleagues around the country running 2 year programs are no doubt working hard and unselfishly to provide quality education to their residents. With all this said, I remain optimistic about the future of our profession as our training continues to evolve towards quality standardization.

Sincerely,

—Gary M. Rothenberg, DPM, CDE, CWS
Director of Resident Training Attending Podiatrist
Miami VA Healthcare System

***Editor's Response***

Dr Rothenberg provides some very good points. My original statement about two year programs existing was somewhat tongue in cheek. However, Dr Rothenberg is correct about two year programs and those hard working doctors who take the time to thanklessly train us. I wouldn’t be where I am today if it weren’t for my residency director. I also agree that quantity does not equal quality. I have heard of three year programs that struggle to maintain their status due to lack of experiences for their residents.

Having said that, the standard is clearly a minimum of three years’ training. What other surgical specialty – much less any medical specialty – has less than three years of training? I can think of exactly ZERO. In a medical community where we continue to fight for parity, standardized training- starting with the length of that training and including those components Dr Rothenberg mentioned – is the one primary tool we need to achieve success. I would ask the directors of those 52 PM&S-24 programs to spend more of their unselfish time to move their residencies to the PM&S-36 model. I may be difficult, but the rest of our community should (I hope) be more than willing to help. Good luck with your efforts.

—Jarrod Shapiro, DPM

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Your posting about the future of the three year trained Podiatry Resident was very timely and deserves heeding from your young readers. I would like to add two other topics for consideration as they decide whether or not to put their futures totally into surgical Podiatry.

The first is the fact that surgical revenue has and will continue to reduce on a per case basis unless the insurance companies and the government lose their ability to dictate fees. In January, the new fee schedules will come out and once again, as in the last dozen or more years, surgical fees will go down. Businesses are supposed to grow in revenue, not shrink!

The second is the well capitalized and malicious agenda of the AMA and the Orthopedic Foot Society to denigrate Podiatrists as capable surgeons to the insurance companies and the public in order to reduce or eliminate our ability to share in the foot surgery pie. This program has had a level of success (Texas Scope of Practice Law) and will only escalate during hard times.

My opinion is that realistically, non covered services like foot orthotics are where the podiatry community will be left alone to market successfully to the foot suffering public in the future and will become the core practice of a large portion of our profession whether three year trained or not. My advice is for your audience to expand and upgrade their biomechanical skills and practice habits while "Ilizaroving".

Sincerely,

—Dennis Shavelson, DPM
[email protected]

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