Alan Borthwick and Olivia Dowd raise a number of important questions
regarding the relationship between podiatric and orthopaedic surgeons in
their excellent paper – Medical Dominance or Collaborative Partnership?
Orthopaedic Views on Podiatric Surgery – published in the May issue of the
BJPM. In many ways, the issues highlighted go to the heart of the
difficulties facing the profession today – that of leadership and cohesive
planning. I would like to explore and expand on the challenging points
they raise in their summary discussion.

The views collated from orthopaedic surgeons during their study will come
as no surprise to many within the podiatry community. Podiatrists and
chiropodists throughout the country have enjoyed close working
relationships with our colleagues in orthopaedics for many years and with
the emergence of podiatric surgery a couple of decades ago, we have been
privy to many considered opinions from the established surgical
fraternity. Whilst I agree with the authors that some opinions are clouded
by ignorance, much of what the orthopods have to say has validity. It has
always struck me as duplicitous that some within our profession view the
ascendancy of the unregistered sector with disdain and hostility, yet at
the same time, they regard the position of the British Orthopaedic
Association as intransigent and protectionist. There is widespread horror
that a part-time, distance learned ‘chiropodist’ should attain the same
legal status as a BSc/Diploma graduate through the legislative process of
the HPC grand-parenting scheme, but at the same time, we seek to impose
precisely the same set of values to the surgical practice of which the
Royal College of Surgeons are the established guardians. Is it surprising
there is such opposition?

One of the principal areas of opposition concerns the use of the
term ‘consultant’. When you consider the hurdles that have to be overcome
by medics before they achieve consultant grade, why are we shocked by
their reticence of accepting podiatrists using the same title after
undertaking part-time, unregulated training which offers them the same
platform as themselves? Podiatric surgeons are looking for parity with
their orthopaedic colleagues, yet they achieve ‘consultant’ grading after
a fraction of the time in study and training. That cannot be right.

The Chair-elect of the Society of Chiropodists and Podiatrists, Ralph
Graham, regularly uses the term ‘Consultant Podiatric Surgeon’ on these
pages. Some years back, Ralph wrote an article describing the
establishment of podiatric surgery through the Croydon Post-Graduate
Group, in which he notes they operated at the margins of the law and took
advantage of the prevailing political climate (apologies Ralph if I use my
own terminology here - I’m recalling the article from memory- but I think
the thrust is accurate). The argument was that unless the medical hegemony
could be circumvented, the aspirations of a few within the profession, to
further the cause of surgical practice in podiatry along the lines of our
American colleagues, could not be attained. I think that argument had some
merit. The medical professions are notorious for their protectionist
stance – a position that has much dubiety. But the argument of introducing
invasive surgical practice for podiatry, through the backdoor, was also
dubious. If we seek parity in surgical practice, should we not be prepared
to undertake the same rigorous training and study as the medics in order
to compete evenly on the same platform? Perhaps we should have proposed a
comprehensive grand-parenting scheme to facilitate integration without
conflict. Dental surgeons who wish to practise oral surgery have to
undertake FRCS examination and scrutiny and regulation. Should we, in
podiatry, not be prepared to do the same?

On the whole I agree with many of the comments made by orthopaedic
surgeons in the Borthwick-Dowd paper. I suspect many of my colleagues in
the podiatric/chiropodial community feel the same way too. I would go as
far as to say that the development of this profession has been hindered by
the actions of a few ambitious individuals, who, in the pursuit of
personal ambition, have endangered and blighted the career prospects of
many others by their reckless and selfish actions. In the history of
British podiatry, it could be said that seldom has much harm been done to
so many, by so few. The primary reason that many chiropodists and
podiatrists recognise the comments made by the orthopaedic surgeons is
that they are the same comments they would apply themselves if they were
asked. That is highly regrettable.

I would like to open this discussion further.

For the past three years I have tried to engage the podiatric hierarchy in
discussion about professional development and direction. In many ways I
have taken advantage of the opportunities afforded by communications via
the Internet; a medium not enjoyed by our predecessors. I have to confess
that I have not been entirely successful in that field. The Society has
resisted all attempts at open dialogue. They have restricted participation
in their own online forums; refused to contribute in non-affiliated sites
such as the mailbase and thatfootsite.com. In many ways they have
simply ‘closed ranks’ and buried their heads to the issues that face us.
Even in their own forum, many questions from membership go unanswered.
Yet, time and time again, council members and others in the Society’s
executive insist they will only answer queries from their own membership
and refuse dialogue with others on the profession. If the Society had any
real ambition of attaining the status as the ‘premier podiatry
organisation’ it must subject itself to close scrutiny by the whole
profession. Current policy is a farce; it does no-one any favours and is
doomed to failure. There are however, two prevailing forces in the
Society, and if we recognise them, it may go someway in explaining the
presenting hypocritical stance.

The Society is governed predominately by podiatric surgeons and podiatry
managers. Witness the two established Faculties – that of Management and
Surgery.  They represent around 9% of the total membership, yet their
influence exceeds the numbers they speak for. Often we are reminded of the
apathy that reigns supreme in the podiatric community. I suggest that is
because the vast bulk of membership believes their interests are not being
well-served; that the Society has become a vehicle for progressing the
interests of a few at the expense of the many. Where are the proposals for
progressing the profession?  The Strategic Plan published by the Society
last December was a disappointment to say the least. Should the Faculty of
Management not concentrate their minds on producing comprehensive
proposals for furthering the profession? The only paper on reforming the
profession has been my own – yet I have received no comments from the
Society’s council on its relevance or validity. Why not? Could it be they
are against any reform? Could it be the status quo suits them just fine?
Ralph has made comment about the ‘sleepers’ in the profession. John Mason
and Bill Liggins (podiatric surgeons not affiliated to the Society) lament
the apathy of the grass roots – only if they mobilise will the profession
progress. Gentlemen, in all humility, I suggest to you that they will not
awaken unless you offer them the same terms as you desire yourself.
General Podiatric Practice is the engine room of this profession. Without
it you go nowhere. The orthopaedic community will shun you; as will your
own – eventually.

The podiatric community in Britain is crying out for leadership and
direction. I attended the debate in the Scottish Parliament last month – a
debate that should have been instigated by the Society, not by an angry
and focussed individual. The podiatry manager in Lothian – a colleague
that I have great respect for – lambasted the Society for their
indifference in matters north of the border. It was a historic occasion –
the first time podiatry had been debated in any UK Parliament – yet the
chair, chair-elect and Chief Executive chose to attend a conference in the
USA instead, leaving representation to a podiatry manager and a policy
officer (with 2 months experience of the profession). I had to correct
her; the Society has no real meaning for clinicians’ out-with the M25
circle; they provide insurance and a monthly circular; that is all. There
is no vision or leadership. There is no direction. There is no hope. That
simply must change.

If the Society refuses to reform, should the profession not consider
forming a new body? One that represents the interests of the many, over
the ambitions of a few.

Sincerely

Mark Russell

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