02/22/2016    Ira Baum, DPM

Podiatrists Joining Orthopedic Groups (Joe Agostinelli, DPM)

Dr. Agostinelli and others, that are involved
with orthopedic groups, have amplified my
concerns regarding "Does podiatry have a place in
the future of healthcare?" It was not my intent
to have podiatrists express their satisfaction as
part of an orthopedic group, but to illuminate
the possibility, that if podiatry is or becomes
solely a surgical specialty, then podiatry may be
on the path to extinction.

As I have stated previously, the residency
requirements have moved the profession in a
distinct surgical direction, and may be the spark
that ignited the focus of my concern: Is there a
future for podiatry in its current form (Not to
be confused, I believe improved postgraduate
training is a positive for any specialty).

The AOFAS in 2015, had 47 fellowship programs
participated in the AOFAS-sponsored Orthopaedic
Foot & Ankle Fellowship Match Program, and 75
positions were offered. That represents an influx
of new foot and ankle orthopedic surgeons that
will enter practice annually. It may not appear
to be a large number, but remember, that's
annually and there is a strong possibility it
will grow as these trained foot and ankle
orthopedic surgeons develop new post-graduate
programs.

It seems clear that a podiatric 3-yr surgical
training affords a podiatric surgeon excellent
training, and when compared with a foot and ankle
orthopedic fellowship program, may appear to be
superior, but that may or may not be the case.
Access to patients, facilities and funding may
not be equal and may level the playing field with
regards to training.

So let's play a game, "Back to the Future", if
the AOFAS persists (it started in 1969) and
evolves, what role will a podiatrist be in an
orthopedic group, if the group has the option of
a podiatric foot and ankle surgeon or an
orthopedic foot and ankle surgeon? I believe you
would agree, the foot and ankle orthopedic
surgeon most likely would be the choice.

Currently, there are podiatrists in orthopedic
groups that act as consultants specializing in
pediatric and geriatric conditions, diabetic foot
pathology, sports medicine, and arthritic
conditions of the foot and ankle. I have no
information whether or not their role is surgical
or non surgical, but it appears they may be non
surgical. Does that mean over time, podiatrists
working in orthopedic groups will be relegated to
those conditions?

To me, there is no issue with podiatrists joining
orthopedic groups regardless of their role, the
issue, again, is what does the future hold for
podiatry? The podiatrists working in orthopedic
groups have made their case why they are
satisfied being part of an orthopedic group, got
it, but that's not the main thrust of the
subject. The primary concern: Is the future clear
for a regional specialty that overlaps with many
other specialties? he purpose of this post is to
draw attention to the potential impact of the
current health care environment that is
struggling to get costs under control, and to
stimulate a conversation that describes a vision
of the future of podiatry.

"Podiatrist joining orthopedic groups" was only
one of many variables that may impact the future
of the profession. If you have thoughts in this
regard, what would you suggest as practical
method to alter the current course podiatry
appears to be on.

Ira Baum, DPM, Miami, FL

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