Residency Insight -- A PRESENT Podiatry eZine

Jay Lieberman, DPM, FACFAS,
Director of Podiatric
Medical Education,
Northwest Medical Ctr.

The Orthopedists Think We've Gone Far Enough!

Imagine you are a veteran orthopedist. You look up on the Operating Room schedule and see “O.R.I.F. Pilon Fracture with application of External fixator." The circulating nurse tells you the case just ended. You search for your fellow orthopedist to find out why he didn’t turf it out to the local teaching hospital.


"Lead me, follow me, or get out of my way."
*—George S. Patton*

“Holy crap! It is a $%&# podiatrist”!

Fortunately, this guy is on a beta-blocker or he would have stroked out. Off to the medical staff office to find out what the hell is going on. He mutters a few select words, and then goes off to radiology to examine the postoperative x-rays personally. At that point, he finds out that this same podiatrist just got a calcaneal fracture from “his Emergency Room.” No words at all…..The son of a bitch keels over and drops dead.

I imagine many of you are from states without ankle privileges. I also imagine that those of you from states without ankle privileges are saying “so what”? But this concerns all of us.

Here is the problem. Residency programs all over the country have been training podiatrists in rearfoot and ankle surgery for more than twenty-five years. These graduate residents apply for hospital privileges and are denied simply because they are a “podiatrist” OR there is a hospital rule stating, “a podiatrist must be in practice two years after completing residency before he can apply for hospital privileges. OR they live 3.1 miles from the hospital and they must live less than 3 in order to respond to emergency call, which they are not allowed to have.

OR in some cases, they can get only limited privileges because the hospital surgical by-laws state that podiatrists may perform surgery from Lis francs joint distally. OR, within the delineation of hospital privileges it says a podiatrist may do wound care but may not under any circumstances perform a split thickness skin graft because harvesting would mean the podiatrist would be working above the knee.

OR in other cases, privileges get reduced or modified when a hospital decides to discontinue podiatry inclusive foot and ankle call because the local orthopedists have protested and refused to cover the ED unless it is done away with.

Now, LETS SAY this is a state, which allows surgery by a podiatrist below the tibial tubercle. LETS SAY this same podiatrist trained for three years and is quite proficient at skin grafts and Pilon Fractures, but he is denied privileges to perform the very procedures that he was trained to do and has every legal right to do. SO, what do we do with them now? SUE EM? Unless you have a trust fund, you don’t even mention the word SUE.

Here are some things that we CAN all do:

Support our fellow podiatrists if he/she has been wronged. Don’t sit on our thumbs because the issue doesn’t directly affect some of us.
Get in the ear of state officials. CONGRATULATIONS TO THE FLORIDA PODIATRIC MEDICAL ASSOCIATION FOR WARDING OFF TERRIBLE LEGISLATION to limit the scope of podiatry practice in the State of Florida. The following links provide documentation of the failed legislation in detail:
• SB 1016 - Relating to Podiatrists - Ankle Surgery
• HB 649 - Podiatric Medicine
Court newspaper and television reporters/editors.
Support medial equipment companies that support our profession.
The APMA and The American College of Foot Surgeons should get behind podiatrists who have been treated unfairly in a broken legal system.

Honestly, even I get a bit nervous when I see young Einstein podiatrists putting together large erector sets to repair complicated fractures, when I probably would have emergency transported the patient directly down to Jackson Memorial Medical Center. Your hospital should have some type of protocol in place when a physician is dealing with complex trauma or reconstructions of this type.

My insecurity in this arena should not prevent me from supporting my fellow podiatrists who have chosen to undertake these very difficult cases. Imagine what happens to most complex Charcot patients who never make it to a limb salvage center. Until the last few years, I did not think much of these folks. But today I have great respect for what they do, and patients get great benefit from their service. We must be PROACTIVE and not REACTIVE. Unless we as a profession take more definitive action, we are simply throwing in the towel.

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