Richard Derner, DPM, FACFAS
ACFAS President
As 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 occur.
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.
Years 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.
Therefore, 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 exhausted.
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.
This 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.
Our surgical 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.