Jarrod Shapiro, DPM Practice Perfect Editor Mountain View Medical & Surgical Associates, Madras, Oregon

I had the pleasure of reading both Stephen Freed’s article about podiatric advocacy and Dr Dockery’s views, which I found both enlightening and useful. While reading Mr Freed’s editorial two thoughts running through my mind. One, I appreciated his knowledge and acceptance of the podiatric community. Two, why does podiatry need someone to advocate for us?

Across the United States our podiatric community has many strong advocates. Take for example Congressman John Shadegg’s ridiculous comments about podiatry being one of the “esoteric” services. Kathleen Stone, DPM, President-elect of the APMA confronted this issue with admirable results. Not only did Representative Shadegg offer a formal reply, but he also signed on to legislation that may benefit podiatrists. Others are advocating strongly for podiatry as well. Whether it’s the Vision 2015 Parity drive or the local podiatrist fighting for equal privileging and treatment, our community has many advocates.

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In an interesting concordance of events I recently suffered an “advocacy” issue at my hospital. The ER department of the hospital that employs me referred out a trimalleolar ankle fracture patient to an orthopedist in another town instead of calling me. My first thought was, “How can this possibly happen now after I’ve worked daily with these doctors in this medical community?” I had two methods of response. Anger – a confrontation with one of our doctors may have made me feel better in the short term, but would have done nothing to advance the podiatric presence in my community. I chose an alternative response: advocacy. I took a multilevel approach, first discussing the matter with the involved ER physician, then extending my educational efforts to the other ER doctors and the nursing staff. The involved ER doc did not understand that my scope of practice and capabilities extended to various foot and ankle fractures. We agreed to a concrete plan, including the ER doctors calling me directly for any foot and ankle issues. Additionally, I’m planning a lecture to hospital staff on the emergent treatment of lower extremity injuries.

I bring up this issue to illustrate that although podiatric training has improved over the years, and we’ve made significant inroads into improving our situation in the medical community, there are still ongoing issues and, more often than not, those issues are evident at the local level rather than the national level. Until we manage to eliminate the remaining biases towards other specialties and away from podiatry we’ll never see true parity for podiatrists.

Towards that end I’ve listed a few thoughts below that I consider mandatory for us to become fully recognized as the true foot and ankle experts.

1. We need to remember who we are and just how important podiatry is to the medical community. We are NOT second class citizens to the orthopedists. Who has advanced wound care of the lower extremity? Orthopedists? No. Who spearheads lower extremity biomechanics? Orthopedists? Nope. Don’t think so. Who receives an average of SEVEN YEARS of foot and ankle training? Orthopedists? Sure, right (foot and ankle orthopods do a one year fellowship and receive on average less than 6 months of foot experience during residency per a study in Foot and Ankle International – an orthopedic journal). I think we all know the true answer to these questions: PODIATRISTS. That’s right. Be proud of your specialty. Why have we seen a surge in the number of orthopedic foot and ankle specialists? Because they’ve seen how successful we are and want to get in on the action.
2. We need to improve our research. We need high quality studies that prove WE are the experts. Our journals need to stop publishing large numbers of case studies, retrospective studies, and research with tiny numbers of participants. We need randomized controlled studies and quality Level 1 research that truly answers clinical questions. We need to collaborate together to form large, multicenter studies with rigid criteria. We need to stuff our journals with groundbreaking landmark studies with cool names like SIDESTEP. That’s our model. It’s been done. It’s possible.
3. ALL podiatrists should improve their skills. Every podiatrist should be as highly trained as possible to perform as many services as possible for their patients. Those of you with a broad scope of practice should be mentoring those whose training is less extenisve. Be a mentor. We should be offering more cadaver courses through the ACFAS and our national conferences (and make some of them free, ACFAS). Make a list of what you don’t know or aren’t trained to do and find someone who can do it. Those of you who can do it, train those who can’t. You biomechanics experts need to show the rest of us your secrets of success. We need to increase support to those organizations that promote podiatric improvement. The obvious examples are PRESENT, American Academy of Podiatric Practice Management, ACFAS, and APMA. Donate generously to APMA-PAC.
4. Establish a national scope of practice. Dr. Dockery stated it clearly in his article. Everyone needs to know what podiatrists can do. Every potentially referring doctor in the world should think Foot and Ankle = Podiatry. No thought. Just refer. To that end every resident should graduate from every residency trained to perform the MAXIMUM scope of podiatric practice. The training should be consistent and reproducible across the country.
5. Increase local and national advocacy support. Increase your political involvement. I know – you don’t have time. You’re busy making ends meet. You have to see more and more patients to stay in the black. You don’t have time to lobby your local politician or attend your local podiatry conference meeting. No excuses! Do it! How many more patients will you have to see when Medicare cuts 25% off your already low reimbursement? How happy will you be when your state laws change to exclude podiatrists as physicians, your scope of practice becomes limited, your malpractice rates skyrocket without tort reform, and your local hospital discontinues your admission privileges? How busy will you be then? How satisfying will your career be? The advances we’ve seen have been due to hard-fighting podiatrists who took the time to be present for the fight. We need to continue that fight.

THAT’s podiatric advocacy. Don’t be complacent with what you have. Strive for more. I know what you’re thinking: “Shapiro’s a young doctor. He hasn’t become jaded by the system yet. Give him time and he’ll learn to understand how it really is.” I hope I never learn that lesson. I don’t want “Podiatrists are the foot and ankle experts” to be empty words. My plan is to become more involved, fight harder, learn more skills, become a better doctor for my patients, and push the envelope. Join me.

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Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]

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