Residency Insight -- A PRESENT Podiatry eZine

Volume 6 - Issue 6

Somewhere along the line, we podiatrists have lost our identity.

Podiatry is not just a surgical sub-specialty, although many of our greatest surgeons set that as our primary goal during our professionalization evolution of the last 30 years. But podiatry is much more than surgery, and in my opinion, our public image and self-image should be refocused at this time in our history.

Podiatry is much more than just a surgical sub-specialty. Podiatry is an entire profession. We are not like ENT surgeons, we are not like thoracic surgeons. We are not surgeons first. We are more than that. We are both the primary care provider and the surgical care provider for an entire area of the body. As a profession, we don’t just operate, although our collective talent as surgeons is vast and very impressive. As a profession, our institutions uphold standards from first encounter with patients to issue resolution. We treat so many human conditions, and relieve so much human suffering, that to consider ALL of us PRIMARILY SURGEONS, is not only disingenuous, it is not good for our profession.

We are podiatrists. We are the profession that is most often sought out to treat a foot problem. If patients with new foot problems have no idea where to go, they may go to their PCP or to a walk in center or to a hospital ED. But many go directly to a podiatrist and that’s what makes us different, bigger and better than a surgical sub-specialty.

I am not particularly concerned that our current standards in residency training prepare us to be that surgical sub-specialist of the lower extremity. Our surgical training may not be 100% uniform in quality, but most of it is excellent. That we have evolved into the world’s most well trained foot surgeons is not in question. But since we are an office-based medical profession, and 60% of our patient encounters are for, in this order, Heel Pain, Onychomycosis and Onychocryptosis – I still want to have confirmed for me that our residency training program are preparing all podiatrists to be the very best we can possibly be in caring for patients who present with these most common foot pathologies. And, although I know that our surgeons must have 3 years of training to be as good, as foot surgeons, as ENTs and thoracic surgeons are at their craft – I also know that most of us go through this training, and then go on to devote most of our time to being office based podiatrists, spending more than half our time on non-surgical areas of practice. And I know how positive an impact we podiatrists make to the standard of American public health.

Looking back at the last 30 years of progress in podiatric education, I can’t help feeling that we have lost our way in creating a 3 year single track surgery focused education for all podiatrists . If we, as a profession, agree with this assessment, and are willing to reconsider this education plan we’ve adopted, I’d like to propose that a discussion begin on this alternative.

Proposed Modification to the 3 Year PMSR Residency Model

There are a number of ways that we could diversify podiatric residency education, but let me propose just one for the purpose of getting this discussion started. There will undoubtedly be many problems in making a change in podiatric residency structure at this point, but I think it’s worth the pain to get our training programs back on the right track.

Every podiatric residency program would continue to be 3 years, with the 3rd year involving a choice of Focus that the resident would make. Year 1 would consist of a rotating general medical internship. Year 2 would be general podiatric medicine and surgery. In Year 3, residents would select a Focus from among the following choices, for example:

Advanced Foot Surgery – Forefoot
Advanced Foot Surgery – Ankle and Rearfoot
Wound Care, Limb Salvage and Diabetic LE Care
Office Based Podiatry
Sports Medicine

Each year 1 and 2, and each Focus year, would include their own unique competencies that residents would have to prove by demonstration to their Director. I am tempted to call the Focus years Fellowships, but that implies something done electively after Residency training, while in this model, doing a 3rd year is mandatory and a part of the 3 year model. The addition here is giving residents a choice of Focus in the 3rd year. I’m imagining that Fellowships for additional more advance training in a Focus area would be made available for those few podiatrists wishing to go on to further improve themselves professionally. It is likely that each program would not offer all options. If a resident was interested in a Focus area that was not offered at his program, s/he would apply to change programs.

Yes, I too regret complicating what became a simpler 1 track solution for podiatric residency education. But after observing the consequences of that 1 track solution, I think we, as a profession, were naive to think that it made sense for all students applying to podiatry school should be or even want to be primarily surgeons. It’s not too late to reconsider that mistake and take corrective action.