Ralph

I do not like the philosophy that says we exempt medical students
(including podiatry) from course fees therefore we can restrict the
salaries in the marketplace thereafter. From the professions standpoint
that simply retards growth in earnings as there has to be a knock-on effect
even in private practice fees. I guess it comes back to the
perceived ‘value’ of the profession. If public sector salaries are kept
artificially low – perhaps justifiably so as part of a government's
monetary policy, then it is certain to impact on private sector incomes
too. This retards professional development and investment.  The problems
accrue where market forces come into play and unsatisfied demand drives
pricing upwards. There will be an increasing divide between public –v-
private earning capabilities and the state run sector will suffer as a
result. That may explain the thinking behind the ‘proposal’ of committed
service through a postgraduate scheme.

I’m not averse to such an idea. I proposed just that in the reform paper
last year. I believe that the profession and the state are in ‘partnership’
with each other – one provides clinical expertise that is deemed socially
desirable – the other provides assistance with training and employment.
This ‘contract’ will vary from time to time – what we are seeing with
student fees is simply another adjustment, as is changes to the employment
structures within the service – but essentially it can be viewed as a
commercial contract between the two. My own view is that the ‘terms’ of the
contract need to be readjusted to improve the delivery to patients and to
strengthen the professional base.

In the US we have a tried and tested residency/preceptorship scheme for new
graduates in podiatry. A similar scheme works here in the UK for medics and
dentists. The professions view this as an inclusive part of their training
and I think it would be desirable for podiatry if we adopted a similar
approach. True, some may see this as a ‘cheap labour’ option, but it would
depend on what the profession got from its side of the deal. As you rightly
say, it would depend on the proper structure for this supervised practice.
But it would also depend on what the end result would be in terms of
professional practice structure. It would be no good having a comprehensive
residency scheme for podiatry if the current practice structure remained
the same. There is simply not enough opportunity or flexibility in the
salaried model to reward and promote innovative and excellent practice.
Having a residency program tied into existing structures would not be
attractive as it would just amount to cheap labour. We need to change the
practice model to suit the investment in training.

Ann Marie

I fully agree with all that you say. I just wish that some of our political
representatives could be more socially conscious but as we’re in our twenty
sixth year of a right-wing capitalist administration in Britain, I don’t
see any hope of that for another few years!

The point about the regional centres of excellence is well made.
Logistically they would require much planning and integration. But there’s
always ways around that. They could tie in nicely with a residency program
for graduates – and could also offer placements to non podiatry students
orthotists, bio-engineers, orthopods – as well. How they are integrated
into the NHS is another matter – they could be viewed as strategic
authorities in their own right – or they could have affiliation to a
regional authority. I would prefer the autonomy of the former. Having
centres of excellence in podiatry might also resolve the problems that our
surgeons are facing with theatre and operating rights in the NHS, providing
new facilities were established along side those for gait and podiatric
medicine. Surely that would be the ultimate in cohesive integration within
the profession? Underpinning the whole ethos would be a desire to quantify
accurately the processes that are involved in human gait and the
consequences of abnormalities in later life. If we as a profession can say
that we can prevent (as opposed to cure or alleviate) skeletal
abnormalities such as O/A of the hip and knee as well as any number of
postural disorders, then we move the profession into a whole new arena.
That would be the attraction to politicians – cost benefits aside –  a
dynamic profession focussing on the preventable aspects of its care. A
different ball-game altogether don’t you think?

Best wishes

Mark Russell

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