Alan

>> I was waiting for a deluge of responses to your mailbase contribution.
In some ways I was not surprised by the zero result<<

Neither was I. The profession, especially in Old Blighty, has a tendency
to ignore the obvious and bury its head in the sand when it comes to
addressing professional and political issues that affect its future. In
the past some of our ‘leaders’ have responded – after a fashion – to
enquiries and criticism regarding professional direction when such topics
are aired through the mailbase. I suspect this was more out of
embarrassment than for any other reason. As was suggested to me earlier
this year, the profession in the UK could well do without all this public
airing of dirty laundry, especially on such a global forum as the
mailbase. That is a point of view of course, but one also has to remember
that the council of the Society, as well as the other representative
organs, refuse to enter into any dialogue concerning such matters on any
forum….so I guess we’ll just have to carry on without them! I would also
suggest that such a position is also terribly parochial – the problems
regarding structure and professional direction are not unique to the UK –
the healthcare systems might vary from country to country, but the
logistical issues regarding establishment, growth and funding are
remarkably similar no matter where you live and work. What really
surprises me is the willingness of many in the professional hierarchy, to
absolve themselves from any examination and communication with the rest of
the profession. Doesn’t the term Ivory Tower have some resonance here? I
guess we’ll just have to carry on without them, for the time being at
least.

Now that I’ve set the tone, let’s expand a little more on the subject of
professional direction and look at why we’re getting nowhere fast in
podiatry. Much has been written here about the general apathy that
afflicts the professional community today. Less than 2,000 votes were cast
at the last council elections for the Society – about 20% of the total
membership. If this were mainstream politics, there would be an outcry
followed by a rigorous examination to determine the cause of voter apathy.
In podiatry however, such lassitude is regarded as the norm. Why should
this be the case? It is not a new phenomenon; twenty years ago when I
graduated, the disinterest and disillusionment was just as prevalent.
Branch meetings were poorly attended and if it was not for the dedication
of a few (and they deserve a special mention) hard-working branch
secretaries, the Society would have become a complete nonentity for most
of the profession north of the midlands. I think the fact that there seems
to be no sense of belonging within the community – perhaps a contradiction
in terms – to the Society; it doesn’t represent the majority; it is a
source of indemnity insurance and a trade magazine. That is what it has
become. In terms of influencing and promoting the daily professional life,
it is an impotent force. I suggest this disengagement between the
organisation and the individual is a primary factor in fermenting the
culture of apathy. Two decades down the line and the profession still
hasn’t asked itself the question – What is preventing change?

As difficult as it so obviously is, it is incumbent on the profession to
examine the way it directs practice, if not all the time, certainly on a
regular basis. That includes the way we organise ourselves through the
representative organs in order to promote reform in our favour. That
applies to all countries and organisations. Maybe in the future we will
have a global governing council for the profession; whether that happens
in our lifetimes is another question, but if/when that occurs, they too
must examine the way practice is structured and run. That is essential if
the profession wishes to become proactive in managing its affairs rather
than reactive, as it is at the moment. In that spirit, let us examine the
case in the UK.

I would like to begin with an observation. There seems to be a general
crisis of identity within the profession. Like everyone else in Britain, I
graduated as a chiropodist; the name of my trade that is set in statute is
chiropody. The certificates that are issued by the regulatory body – the
HPC and its predecessor, the CPSM – have in bold type CHIROPODIST written
next to my name. Sure PODIATRIST has appeared alongside in the past couple
of years, but the ‘C’ word remains stubbornly in pole place. I, for one,
really couldn’t give a damn. I always thought that the best way to change
the public’s perception is by serving them better. In Britain, the public
associate the word ‘chiropodist’ with someone who specialises in treating
foot disorders. Our image and public persona isn’t going to be changed by
changing out title. It’s what we do that really matters. The public are
too intelligent to be fooled by a cheap marketing ploy like a name change.
Or have we become so arrogant as to suppose that they might?

I wonder why there seems to be a fixation with disassociating ourselves
from chiropody. A good practitioner in chiropody or podiatry assimilates
all the aspects of specialist practice in their management regime. There
are some excellent practitioners in general practice. Many of them have a
plaque with ‘Chiropodist’ on their front door and are rightly proud of
what care they give. Yet generally there is a drive, certainly within the
public sector, to disassociate oneself from that field. Maybe it’s because
of career pathways; if you want to ‘get on’ in podiatry, management was
the only option for a public service employee.

Now you have another option – podiatric surgery; with all the inherent
problems for the profession that accompanies its establishment. And I
suppose you could always go into academia – but with higher education
salaries as they are, I’m not sure that I would classify that as ‘getting
on’. In a financial sense, at least.

But what if you want to remain as a general practitioner? What career
prospects do you have? Are they any better now compared to what they were
twenty years ago? I would suggest not. Public practice is contracting
rather than expanding. The private market is poorly established and
underfunded, and the regulatory fiasco with the HPC will have far reaching
implications in terms of limiting sustainable growth in clinical and
fiscal performance in even the best of practices. Factor in student debt
and the profession faces a dangerous and uncertain future.

You would think this might concentrate minds throughout the community. At
the very least we could ask ourselves some honest questions for a change.
Like ‘why is the membership so switched off?’ or ‘how do we go about
reforming professional practice?’ It’s bad enough to see the apathy in the
membership at large – about 60% have ‘switched off’ permanently – but to
have the professional body adopt the same approach is quite simply
shocking. There has been no discussion about strategic direction or how we
can attain even the simplest of goals. Where are the proposals for
furthering the political agenda? How is that agenda being furthered at the
moment? How do we best develop the foot health market? How do we fund,
establish and protect our practice? There has been no examination of
current policy. Until that changes there will be no progress.

Following on from the last stream on podiatric surgery I offer this as a
topic for debate. It does not necessarily reflect my opinion.

Today, the BBC reported allegations from a leading Consultant Surgeon who
was observing the medical profession’s approach to reform. He believes
part of the medical profession is guilty of holding up progress on waiting
lists because of concerns about the impact on their private practices. The
government should also take some responsibility for failing to tackle
resistance from surgeons in the past, he said.
He went on: "The majority of consultant surgeons are thoroughly moral,
hard working individuals.
"But there is a small group who are exceptionally aggressive,
exceptionally ambitious, who are like pigs with their snouts in the trough
and it is they who are blocking change."
In podiatry, the issue is not over financial impropriety and greed.
Professional practice reforms are being hindered by a combination if
incompetence, undemocratic representation, a lack of strategic direction
and an unwillingness to communicate or examine alternative policies.
Could it be said of podiatry, that there is a small group who are
exceptionally arrogant, personally ambitious, who are resistant to change.

Is it not time to ask ourselves why?

Best wishes

Mark Russell

http://news.bbc.co.uk/1/hi/health/3775077.stm

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