What Do Podiatry Residents Aspire To Be In The Future?

I recently read a short article discussing the results of a survey of podiatry residents and which type of podiatrist they want to be after graduation.¹ The survey asked residents whether they aspired to be a general practitioner or an advanced foot and ankle surgeon. I would prefer not to limit our profession to these narrow choices.

We are podiatrists. We treat the foot and ankle, surgically and non-surgically. I take significant issue with the idea that we have to be further segregated based on an arbitrary definition of “advanced” foot and ankle surgery. Many attendings share that the Lapidus is one of the most difficult procedures they perform. Does that mean that it is “advanced?” Subsequently, is a “lowly” general practice podiatrist advanced enough to perform a similar procedure? I find this inquiry absurd. 

In my very short career, I see our specialty creating difficult board certification standards and separating ourselves based on which surgical procedures we perform. When will we understand that we have an amazing profession that offers patients something truly unique? We can treat an ingrown toenail, an ankle sprain and perform a flatfoot surgical reconstruction all on the same patient. Patients do not need to go to three different doctors for that. That is what makes us what we are: foot and ankle specialists.

In this survey, 34 percent of residents stated they want to practice as a general practitioner and 66 percent stated they want to be an advanced foot and ankle surgeon.1 These results suggest that this dichotomy exists and shines light on the reality that there is a stigma, namely if you don’t do “big cases,” you are not as good as those that do. This also begs the question of what is considered “advanced.” As I mentioned before, the Lapidus bunionectomy can be difficult. There are also rearfoot cases that we as residents consider to be fairly routine and these cases may include lateral ankle stabilizations, Haglund’s resection with detachment/reattachment of the Achilles, and a gastrocnemius recession. I would personally not consider these procedures to be advanced. I would agree that Charcot reconstruction, complex limb salvage reconstruction, an ankle fusion or total ankle replacement are advanced procedures that not every practitioner feels comfortable performing. However, I do not feel that this warrants a distinction as an “advanced foot and ankle surgeon.” 

When I graduate residency, I want to be a podiatrist. I don’t feel the need to describe myself in any other way. I will treat the foot and ankle pathology as it comes, whether a patient requires conservative or surgical treatment, “basic” or “advanced” care, sports medicine or diabetic wound care, etc. We should not over glorify ourselves to the point where we only pick and choose certain procedures, and ignore the rest of our specialty’s skills. That does not do justice to our title and degree. We owe it to our patients to be the specialist of the foot and ankle in all aspects.

I have two big concerns with this discussion. One is that there is yet again an attempt to divide our profession. Secondly, it seems to render the practice of conservative care, the bulk of what our profession performs, as being somehow inferior to the practice of one’s surgical skills. My issue with this is the same as I have stated in my previous blogs. We are podiatrists, not strictly surgeons. As great as our surgical skills have become and as we continue to progress with our scope of practice and surgical abilities, we cannot abandon our standard podiatric skills. We have come a long way as a profession in recent years. I hope we do not allow these advancements to split our profession apart. 

Reference

1. Sherman A. What kind of podiatrist do today’s residents want to be? Podiatry Management. 2020. Available at: https://www.podiatrym.com/pdf/2019/12/Sherman120web.pdf . Accessed February 25, 2020.