Is Podiatry a Surgical Specialty or is Surgery a Sub-Specialty of Podiatry?

The question of whether podiatry is a surgical specialty, or whether surgery is a sub-specialty of podiatry frames the next important milestone that podiatry must reach to secure our place as a vital medical specialty in the healthcare delivery system.

I must begin this message with an apology, because what I’m about to say cuts to the core of the very identity of many of our colleagues. But my firm belief is that in 2019, our very identity should be re-examined, for the long term sustainable reputation and credibility of podiatry, and our service to the American healthcare system and the public health. The question I wish to pose is: Is podiatry a surgical specialty, or is surgery a sub-specialty of podiatry?

My son is a pediatric emergency specialist. He did a 3-year fellowship after his 4-year pediatric residency. While all pediatricians do some emergency care, and general pediatricians work beside him in the emergency department, he is recognized as a pediatric sub-specialist in emergency care. Last year, my understanding is that the pass rate on the American Board of Foot and Ankle Surgery (ABFAS) Part II Certification Exam and the case review process was around 28%, and it’s long been below 50%. My feeling about this is – it seems about right. I am not outraged about that low passing rate. I think it is really as it should be.

Most podiatrists are general practice podiatrists and a subset of us are fully qualified specialty surgeons. I think about 20% of podiatrists, give or take, are fully qualified, talented and competent surgeons. Whatever surgery a patient needs can be done competently by them, and better than anyone else on the planet.The rest of us are general practice podiatrists, and should not be judged by how they do in the ABFAS certification process. They should be judged, officially, by how they do in the American Board of Podiatric Medicine (ABPM) certification process.

As far as our service to improving the public health, which is our most important mission as a medical specialty, we don’t need and shouldn’t want all podiatrists to be specialty surgeons, for a number of important reasons. First and foremost, like general medical schools, we don’t even try during the admission process to select out candidates that have skills that would lead to being the best surgeons. This makes sense for medical doctors, and it makes sense for us, because most of what needs to be done for patients as medical doctors or podiatrists is not surgical.  What doesn’t make sense is that we channel all podiatrists into 3 year surgical intense training programs. Why are we surprised that not all become skilled specialty surgeons? The medical doctors aren’t all predisposed with the skills to be great surgeons, and many of them rise to the top as medical specialists (Internists, cardiologists, dermatologists) and even cognitive specialists (psychiatrists). Why do we, in 2019, feel that we can or even should make all of us that are admitted to podiatry schools into specialty surgeons?

Yes, I know why this path was taken years ago and I don’t fault our predecessors for doing this. We felt we all needed to be surgeons to get on the hospital staffs, to get on the insurance panels, and to be able to be paid for our services. And I don’t fault our surgical forefathers, the Earl Kaplans, the Harold Schoenhauses and Lowell Weils, for pushing the training of podiatrists in surgery. It did get us into hospitals and get us recognized as capable of greatness and competency as a profession. But now that we have a recognized well-run certifying board in podiatric medicine, and now that certification in podiatric medicine gets us on hospital staffs and insurance panels, I think we are long overdue to recognize that all podiatrists do not need to be surgical specialists and shouldn’t be compelled to pretend that they are surgical specialists. And of course, all podiatrists do and should do some surgery, in their offices, hospitals and surgery centers, just as all dentists do some surgery. I think we need to distinguish, for our benefit and that of the public, the difference between a general practice podiatrists who does some surgery, with podiatric surgical subspecialists, who do all foot and ankle surgery and are the best foot and ankle surgeons on the planet. I can't help feeling that both the excellent foot and ankle surgeons and the general podiatrists will both feel vindicated once the clear distinction between them is made.