President's Perspective Early December 2015
“That'll be the day.” —John Wayne, The Searchers
Richard Derner, DPM, FACFAS
an experienced practitioner, I have given a great deal of thought as to
where our profession is and where it should be going. Some may say,
“this is a dream,” or “that’ll be the day,” but I am hoping it will soon
be a reality.
I believe a conversation has to start in order
for our profession to continue to grow and move to the next level of
maturation. Before saying this is impossible or it should never happen,
look inside yourself, as I have, and I think you will agree this must
What is the future of our profession? It is becoming
more obvious there is going to be a separation between the surgical and
nonsurgical foot and ankle surgeon. Similar to the dentists and oral
surgeons, there is a need for the surgical and non-surgical podiatrist.
ago, surgery was performed by almost all podiatrists regardless of
training. The rationale was related to reimbursement; there was a
significant difference in the reimbursement for surgical vs.
non-surgical procedures. Today, most podiatrists still perform surgery,
however, the difference is that the reimbursement of surgery is greatly
reduced. One can be quite productive/successful in treating conditions
within the office rather than performing surgery.
in order for our profession to move forward, we need to realize some in
our profession may elect not to perform surgery. Once we realize this
fact, our profession will become stronger. This doesn’t mean we should
change the education model of our profession; in fact, it is even more
critical to continue to improve the quality of our medical school
education. Every student must graduate with the same skills and
knowledge in order to diagnose and treat every condition involving the
foot and ankle, which includes maintaining the three-year residency
model. However, not all will be performing surgery; there is no harm in
referring patients to skilled surgeons once conservative measures are
Every medical school graduate should have the right to
be educated to the best of his or her ability. As in allopathic
medicine, not every orthopaedic physician completing their residency
becomes a surgeon. They realize, either by choice or circumstance, that
surgery is not for them. However, they are still able to treat patients
successfully and are integral parts of the healthcare system. Is there
anything wrong with the idea of both surgical and non-surgical
podiatrists? I don’t think so, and I’ll give you a simple example: A
patient comes into the office with heel pain. We realize most cases are
treated successfully without the need for surgery. Treating the
symptomatic patient with injections, orthotics, night splints, physical
therapy, etc. is a productive process. But when this treatment fails,
the patient is then referred to one of your partners who routinely
performs surgery for treatment. The reality is the procedure itself pays
minimally in relation to all the conservative modalities performed.
is a maturation process of our profession. It won’t be palatable for
some, but I believe it is necessary. I feel we need to head toward this
direction in order for our specialty to move forward and be completely
integrated into the healthcare system.
Please understand this
is not a concept in which those who do not perform surgery are
second-class citizens, and it is not about each of us individually and
our egos. It is about what’s best for our profession.
decision-making is often times judged in our greater medical community,
and the results that are produced. We need to look inside our own home
in order to move forward—our profession will be that much stronger once
we have completed this significant journey.