The Recruitment Hurdle: Selling Wound Care

  Many wound care professionals feel a unique bond with others in their chosen profession. They identify with one another and draw from each other for strength during difficult hours. After all, the specialty of wound care is hardly the most glamorous area in medicine. Wound care is not a discipline for those who disdain unpleasant sights, foul smelling odors, or the harsh reality of caring for many who are considered by some ‘no longer useful’.

The Common Thread

  What makes wound care providers a truly special breed among our respective colleagues, regardless of the discipline? Perhaps the common thread is the excitement that one feels at the prospect of taking down a dressing and seeing the progress in a patient who may have previously met nothing but pain, frustration, failed treatment, or lack of hope.   Wound care providers constantly deal with less than optimal conditions; yet remain optimistic and eager to beat the odds. Nothing can describe the satisfaction of rescuing a patient who is scheduled for an amputation of a leg, and seeing them ambulating years later, without a prosthesis.

Putting the Patient First

  Yet for the moments of satisfaction, every professional has moments where they may feel as if they are doing it alone, giving their best under trying circumstances, encompassed in sheer frustration, and sometimes feeling that they care more about their patients than their patients may care about themselves. Despite a constant uphill battle in the clinician’s work, there is always an air of excitement during any major wound conference. Wound conferences have become not only venues for the dissemination of information, but a time where providers come to share experiences, commiserate, and reinforce what motivates them to forge ahead and continue in the pursuit of excellence for their patients.

Selling the Sizzle

  It has been said that honor, is doing the right thing when no one else is looking.   The efforts of wound care providers both past and present has allowed the birth of a specialty that is unique on multiple levels, including the concept of the multi-disciplinary team approach to problem solving. What other specialty in medicine includes members from diverse professions as is found in wound care?   With the emergence of our specialty, comes an ever-increasing demand for individual services. Baby-boomers are aging and the number of diabetics continues to increase. Implicit within each group is the increasing problem of wounds. Inherent as a result, the demand for wound care providers will continue to grow exponentially in the upcoming months and years.   How will the demands of an increasing wound population be met? How can the community attract the best and brightest from the various disciplines to a career in wound care? The issue will affect both patients and providers. A dearth of future wound care providers means fewer services available to patients as well as a lack of manpower to directly assist existing providers.   We have much reason to remain optimistic as our honorable specialty evolves and expands. The future of wound care is truly in the hands of each of us. Doing the right thing when no one is looking not only benefits our patients, but also grows our specialty, and will further attract some of the best and brightest. Desmond Bell is the CEO of First Coast Diabetic Foot and Wound Management Center and Wound Care on Wheels, Jacksonville, Florida. He is also the founder and director of Wound Summit Outreach, Inc., the Southeastern Interactive Wound Summit, the Wound Care Consortium of Jacksonville and the "Save A Leg, Save A Life" Foundation. Dr. Bell may be reached at drbell@wounddr.com or at info@savealegsavealife.com.

SIDEBAR

Expert Round Table   To examine this critical issue from a variety of perspectives, the question was posed: How do we attract new medical professionals to the specialty of wound care? All participants have varying degrees of wound care experience. All have a common bond that includes a passion for limb salvage and improved wound healing, based on experiences reinforced by an understanding of the need for evidence-based advanced wound care.   Interestingly, all interviewed share the opinion that for wound care to attract the providers necessary, the place to begin the search is at the professional or undergraduate school level.   James McGuire, DPM, PT, Cped, CWs, FAPWCA is the clinical director at the Leonard S. Abrams Center for Advanced Wound Healing and Associate Professor at the Temple University School of Podiatric Medicine in Philadelphia.    “I believe a strong wound program at Podiatric and Allopathic/Osteopathic Medical schools is a place to start,” he said. “Next, a series of Fellowships in Wound Care, open to all Physicians (MD, DO, DPM) at major medical institutions would be helpful. Funding for these programs is a must, and a government or foundation grant would be helpful.”   Jinal Mehta, is a student at the RFUSM Dr. Scholl College of Podiatric Medicine in Chicago. Student Dr. Mehta is the Founder of the Scholl College Student Chapter of the ‘Save A Leg, Save A Life’ Foundation. Her exposure to wound care came when she volunteered at a wound care center. There she not only was introduced to the importance of wound care, but also saw firsthand the team approach of the healthcare workers when treating patients.    “Rarely if ever did a patient (in her center) receive care from a sole provider,” she said.   The team approach is a reason why she believes an introduction to limb salvage at pre-medical clubs at the undergraduate level and at medical schools would help familiarize students with the challenges of wound care.   Stephanie Wu, DPM, MSC is an Assistant Professor of Surgery at the Dr. Scholl College of Podiatric Medicine and the Rosalind Franklin University School of Medicine. She is the Clinical Director of the Limb Preservation Center and CLEAR (Center for Lower Extremity Research). She also serves on the Editorial Advisory Board of JAPMA. Dr. Wu praised the efforts of Dr. Mehta in the formation of the ‘Save A Leg, Save a Life”’student Chapter at Scholl.    “I think what Jinal did, namely start a limb salvage club at a multidisciplinary school, is a great start,” she said. “By forming a limb salvage club, we are informing and educating future doctors, and thereby transforming the future.”   Dr. Wu adds that unlike Podiatric medical students, allopathic and osteopathic students have yet to chosen their specialties.    “Some of these students may eventually become key members of the limb salvage team while others may not,” she said. “However, because they are aware of the concept of limb preservation and the benefit it offers, they can refer patients appropriately.”   Dr. Mehta also emphasizes the introduction of students into research in wound care as a most important step towards getting future Doctors directed toward a career in our specialty. “Thanks to researchers like Dr. Wu, we have greater treatment options to offer our patients,” he said.   De Anna Bell, MSN, ARNP-BC, CWS, FACCWS, DAPWCA, is the founder of Wound Care on Wheels, LLC of Jacksonville, Florida, and is the co-founder of the ‘Save A Leg, Save A Life’ Foundation.    “Advanced and evidence-based wound care is still not being taught in the nursing school programs. The big problem I see is that the nurses who are already treating patients with wounds have likely learned only of wet-to dry dressings during their training,” she said. “The concept of ‘Save A Leg, Save A Life’ was born out of frustration with what we observed in our community, regarding wound care. ‘Save A Leg, Save A Life’ is an educational outreach program designed to teach established providers, students and laypersons, among others, the essentials of evidence based wound care and limb salvage. We are a grass-roots organization trying to improve outcomes in communities and cities, while seeing the big picture of our potential to impact wound care.”   Channa Williams, DPM is a third year Podiatric Resident at Providence Hospital in Southfield, Michigan.    “One of the most important ways to attract students and future healthcare providers to wound care is to dispel common myths about the field. This must be done through education and understanding that all wounds are not the same,” said Williams. “The etiologies of various wounds must be taught. Students being involved in the long-term treatment and success (or failure) of these patients will demonstrate and emphasize the importance and impact of the specialty.”   David Swain, DPM, is a third year Podiatric Resident at the Central Alabama Veterans Administration Health Center Montgomery, Alabama. Dr. Swain agrees that exposure to wound care is key.    “As a student, I wasn’t exposed to much wound care. It wasn’t until I went through rotations and interacted with Doctors who were performing state-of the-art wound care did I become interested,” Swain said. “Rotations at wound care centers would make students of all areas of medicine more interested in limb salvage. Consequently, more student doctors would pursue careers involving wound care if they were exposed to the patient benefits and the various challenges associated with advanced limb salvage and wound care techniques.”   Yazan Khatib, MD, FACC, FABVM is the Director of Limb Salvage and Endovascular Interventions for the First Coast Cardiology Institute in Jacksonville, FL. Dr, Khatib echoes the sentiments of the panel regarding early exposure to wound care during the academic years.    “Unfortunately, wound care is still very fragmented in the MD or DO schools, between General Surgery, Orthopedics, and Vascular Surgery, to name a few,” he said. “We may need to start a call for the establishment of a new specialty within the Allopathic and Osteopathic programs. At this time, however, I am more optimistic about affecting changes in wound care at the level of the Podiatry schools than the MD/DO schools.”   He also adds the observation that wound care has been regarded with much less respect than it should.    “Many in this patient population are elderly and many healthcare professionals have adapted an accepting, matter of fact attitude regarding these patients. We need to increase the appeal of the fields of wound care and limb salvage by emphasizing 2 points: a) the devastating effects of amputations at all ages and b), the extreme usefulness of foot ulcers as markers of a deadly disease, atherosclerosis. The concept of ‘Save A Leg, Save A Life’ parallels the breast lump-early detection scenario. We have treated numerous patients whose primary symptoms were a sore toe but ultimately received intervention that addressed critical coronary artery or carotid disease, and thus may have been saved from death, heart attack, stroke or congestive heart failure.”