Guest Editorial: For the past 30 years, Gary 'Dock' Dockery, DPM, FACFAS has specialized in pediatric and adult reconstructive foot & ankle surgery and dermatology of the lower extremity. He maintained an active practice until 2002 in Seattle. Dock is an internationally known lecturer and continues to travel extensively throughout the world to scientific seminars to present his diagnostic and surgical techniques and to speak on medical topics regarding the lower extremities. I have asked him to share some of his observations with us on the future of the profession and some challenges for us…
—John Steinberg, DPM, PRESENT Editor
Gary 'Dock' Dockery,
DPM, FACFAS
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A Challenge to Podiatry for the Next 10 Years:
A Perspective of an Educator
As I started to put my thoughts together for this article, several ideas and concepts came to mind. Many of them are overlapping and interconnected, but I sat down at my desk and tried to put them into some rhyme and reason. Then, I tried to place them in order of preference, but I found this task too difficult to do since they are all, by necessity, items that must be considered concurrent and ongoing. I did finally number my thoughts and suggestions, but they are not in any order of importance. So, in essence, this is just a list of one thing: goals for the future of our profession. I would like to challenge each one of you reading this to consider these items and try to make them happen during your career.
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Development of a National Scope of Practice. We, as a profession, are slowly working our way toward this goal, but, I think it should be a higher priority. A national scope of practice can’t be one in which the overall scope of practice is “dummied-down” to lowest scope. Rather, it should be lifted to the highest scope of practice for all. Scope of practice doesn’t mean that all practitioners can do anything within the scope within that state, but that scope allows those who can demonstrate education, training and experience to do anything within that scope.
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The Achievement of Parity of our Profession with other Medical Professions. The unified national scope of practice is a major step in obtaining parity within the allopathic medical model. When one state can’t touch a patient above the talus; another state can’t amputate; and another can work up to the knee, there is considerable confusion by our medical colleagues. A unified national scope of practice allows a clearer direction for uniform podiatric medical school training, residency training and continued medical education programs.
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The Assimilation of Podiatry into “Mainstream” Medicine. This is currently happening in many parts of the country, as our highly trained podiatric residents join multispecialty groups and large orthopedic groups. Again, the national scope of practice and parity of professions are intertwined.
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Avoiding the Loss of our Professional Identity. Unfortunately, as podiatry becomes a stronger surgical specialty and assimilates into mainstream medicine, some of the things that made us stand out from other physicians will be lost. We must strive to continue to understand and promote palliative care, biomechanics of the lower extremity and wound care, and combine this with increased surgical mastery. This means we would continue as a unique branch of medicine. We do not want to become foot and ankle orthopedists, but want to continue as foot and ankle physicians and surgeons.
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Become a Mentor. There are several ways to do this: become a trusted friend, counselor or teacher. The mentor is usually a more experienced person helping someone else. You could easily offer to work with the young foot & ankle surgeon in your town, sharing your experiences, advising them and serving as an example as they advance. Podiatric medical schools sometimes offer mentoring programs to new students, students having difficulties, or residents, and you could volunteer to get involved.
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Expanding our Knowledge of the Lower Extremity. It is not true that everything there is to know about the human lower extremity has already been discovered. Some of our most talented students, residents and clinicians of the future will be finding new information, new conditions, new equipment, new technology, and new treatments that were not even considered before. All of us must proceed forward with daily expansion of our minds. Nothing annoys me more than doctors that are still doing things the “old” way with no knowledge of the new ideas being taught. Now, just because something is new does not mean it is necessarily better. But, if you are still doing a Keller bunionectomy for every patient with a painful bunion, regardless of age or biomechanical problems, then I believe you are behind the times. Conversely, not every surgical treatment needs a laser or external fixation frames. Every single one of us needs to attend regular scientific symposia to keep up.
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Sharing our Knowledge through Continued Education, Teaching and Writing. Once we obtain new information, new skills, or techniques, it behooves us to share this information with our colleagues. That means being involved and participating in continuing education meetings; teaching in residency training programs; teaching students or externs; and publishing our findings and writing about the information we have obtained. By continually expanding and sharing this knowledge, all of us will improve and advance forward.
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Becoming More Involved in Hospital, State, and National Organizations. This is easier than it sounds. All we have to do is go to the meetings, participate in the managerial side of the group, volunteer to assist in planning and running the sessions, become involved in the decisions that have to be made regarding hospital policy, residency training, state leadership and national forums. I hear from colleagues regularly that they don’t want to get involved in “politics” but they want to have a say in the end-results of these decisions. Then, just call it something else like “management”, but at least attend and voice your opinions and help guide the decision makers and “politicians”.
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Improving and Expanding Research and Evidence Based Medicine Studies. This is something that should be considered a ‘must’. The quality of research must be improved and expanded with legitimate projects that have been well designed. We are currently light years ahead of research in podiatry from just a few years ago and this process must be continued. It will be imperative that our studies and scientific papers be founded upon evidence-based medicine. It will no longer be acceptable to do all treatments and procedures without evidence that it works. We should each be working toward providing this goal on a regular basis.
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Taking Time to Live and Enjoy Life. This might sound rather cliché, but I can cite a large number of stories from colleagues who, after many years of practice, are taking their first real vacation or attending their first resort seminar. They were always “too busy” to leave their practice; the children were “too young” to miss school; the patients would not know what to do without me; and, so on. All I have to say about this is, “Phooey”. What is the point of having a good career when you can’t enjoy the rewards? What is wrong with taking time to share wonderful places and adventures with your friends, family and loved ones? What is wrong with taking your children out of school to show them that there is a real world out there? What is wrong with really enjoying your life while you can? Too many of us think that we will wait for retirement to enjoy the sights, or wait until the children are out of school to take that trip, or wait until our practices can run by themselves to attend that meeting, or wait and wait for something. Don’t do it! Start now and do some careful thinking and planning to live.
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