A New Direction in Podiatric Residency Training – Dual Track Third Year
Premise
In a subsequent poll, 1,034 respondents weighed in on the related Question: Is podiatry a surgical specialty or is surgery a sub-specialty of podiatry? Less than a third of podiatrists think of podiatry as a Surgical Specialty.
Barry Block recently wrote an editorial discussing these findings entitled, “Podiatry’s Continuing Identity Crisis”. I have been talking to Barry and many of my colleagues for years about this “identity” issue, and discuss it further in the paragraphs below. The reality revealed by the poll results is that most podiatrists engage in general podiatry practice, and identify themselves as a “Podiatrist” or “Foot and Ankle Specialist”, rather than a “Podiatric Surgeon” or a “Foot and Ankle Surgeon”. While we all do some surgery, we are all doing the same three year residency training programs in which training in surgical skills is highly weighted. The fact is, most of what most podiatrists need to do today and in the years ahead, is not advanced surgery. There are not enough patients needing advanced podiatric surgery to keep all the graduates of our residency programs busy doing surgery. There never has been. And the most highly skilled surgeons should to be doing advanced surgery daily, in high volume, to be the best surgeons they can possibly be.
There are not enough patients needing podiatric surgery to keep all the graduates of our residency programs busy doing surgery. The fact is, most of what most podiatrists need to do today and in the years ahead for our patients is not surgery.
The Reality
Less than 20% of podiatrists are primarily advanced foot and ankle surgeons, and that seems about right. The public doesn't need more than 20% of podiatrists to fill this role.
Why?
The volume of medical podiatry, the work we do as physicians, not as surgeons, far exceeds the volume of surgery needed by the public. Shouldn’t podiatric residency training reflect that?
Truth be told, is that I believe less than 20% of podiatrists ARE primarily surgeons, even though ALL podiatrists do at least some surgery among all the treatments that they do for their patients. And though surgery is an advanced calling, so too is the treatment of infection, preventative medicine, the non-surgical treatment of trauma (be that trauma acute and forceful, or small and repetitive), and all the other skills we possess and employ to cure disease and relieve suffering. Being a podiatrist, a Foot & Ankle Specialist is an advanced, sophisticated and appreciated calling, as advanced as are our Foot & Ankle Surgeons. One is not higher or lower in the podiatric hierarchy than the other. They are just both different paths. Medical doctors in medical specialties, your neurologists, cardiologists, pulmonologists, don’t feel inferior to surgeons because they don’t do surgery.
Truth be told, is that I believe less than 20% of podiatrists ARE primarily surgeons, even though ALL podiatrists do at least some surgery among all the treatments that they do for their patients.
Why do we have a hierarchy of esteem and self-esteem in podiatry based on how much surgery we do? It’s ridiculous, yet it persists. I believe strongly in the three-year model of residency training, but wouldn’t it be great if after two years, residents that show promise to be in the top 20% of podiatric surgeons continue on to focus their third year on advanced surgery to refine their skills, while the other 80% fill that third year with everything else that podiatrists do? They’d be spending their third year getting training that reflects that balance of work that they’ll be doing in practice. Our most talented surgeons would go on to do one or two-year fellowships in advanced surgery, limb salvage, and trauma care after they complete their third year of surgery focused residency education. And the 80% would complete their residency better prepared to be the best general podiatrists that they can be.
Why do we have a hierarchy of esteem and self-esteem in podiatry based on how much surgery we do?
Proposal
A New Direction for the Future to Best Train All Podiatrists
I've been gratified to learn that every single reasonable podiatrist whom I’ve discussed this with agrees. I can't help feeling that both the excellent surgeons and the general podiatrists will both feel vindicated once the clear distinction between them is made.
Alan Sherman, DPM
CEO, PRESENT e-Learning Systems
Comments
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I would welcome any of our podiatric colleagues to share their feelings and thoughts on the issues expressed in this article here. Let's have a good discussion and try to come to some consensus as to what is best for the profession and whether the dual track 3rd year of podiatric residency is desirable and is practical, and represents an improvement that will produce better trained podiatrists in the areas of practice they intend to pursue. Alan