Mark,
Perhaps I should start by declaring my colours, I was elected as Chair
of the SCP 2 weeks ago, however my responses are mine and can not be
assumed to be endorsed by the Council of the SCP.
My conversations with the facial maxillary surgeons who gave in to RCS
pressure for the need to double qualify have shown that many of them
believe they were betrayed by those who gave away acceptance that they
were already appropriately qualified to carry out oral surgery without
an additional medical qualification.
How has that turned out? We now have new oral surgeons ironically
calling themselves surgical dentists who now carry out such surgery
without 2nd qualification in medicine.
A member of the RCS once said to me don't allow people to say that you
don't have a medical qualification, you do in an allied medical
profession what you don't have is a medical degree registerable with the
GMC.
If we agreed to your suggestions in a decade podiatry would disappear,
medics with no podiatric training would dominate and all our expertise
in foot function would be lost to surgical practice.
The joint training in Scotland is a world first and could be a model for
elsewhere. Of course you are right it is enlightened self interest to
try and control podiatric practice but the mutual benefits are a two way
street. Pressure will grow in England for some co-operation of a similar
kind. Sensible medics (and there are many) know that the Consultant
debate is lost, the DOH have endorsed many consultants and the title has
lost its exclusive position. In over 20 years of discussions with the
BOA and the RCS I have always had the highest regard for reasonable
individuals and reason will prevail.
You and others who favour the damage analysis underestimate the depth of
knowledge in podiatric training and the acquired dexterity. The gaps
(which exist) can be (and are) filled by postgraduate training.
As to the wider debate about training. We have shown by results that
narrow training can work. The same questions are being asked in medical
circles, if you are to practise hip surgery do you need to have hand
experience? If you are to be a dermatologist do you need a
gastro-intestinal rotation? Medical training will change and we will see
physician assistants in the UK within 3 years. The RCS and RCP no longer
controls post graduate medical education.
The model for education we have jointly established in Scotland was
suggested to the RCS England by their own enquiry into education but
they rejected it as they did not wish to give up theoretical education
to the universities. Scotland may well take a different view. We take 7
years to produce a podiatric surgeon at the shortest and we can hold up
such a person to any scrutiny and we have.
Your thesis is that this development has damaged the profession, not at
all. We have resisted the US model whereby 10,000 can dabble and do 2
procedures a week if they are lucky. We have established the case for
high volume, experience and quality, recognised by the DOH's own
evaluation system. As a result non surgical specialists can establish
the same standards and be recognised as experts with all that follows.
By providing a clinical career pathway which rewards knowledge,
experience and skill we can change the need to enter management in order
to raise salary.
We can support that progress with levels of skill and experience which
recognise assistant practitioners and support staff and underpin the
development of the graduate podiatrist.
In the US they are debating the change from DPM to MD degree, the
opponents wherein I count myself, counsel that the profession can not
survive as a subset of medicine, too many well paid specialisms will
steal the best and podiatry will suffer.
Here in the UK we must have faith in our knowledge base and our quality
of results to stay with a podiatric qualification at under and post
graduate level. The dental route was a mistake and should only be
contemplated in return for exclusive access to the foot as dentistry has
to the teeth. I am safe in this position with the certain knowledge that
no UK govt will make the exclusive mistake a second time.
The average medical student has two 3 hour lectures on the foot and
dissection of the foot is an option most do not take. The body of
knowledge of the foot rests with podiatrists and a small number of
enthusiasts in the rheumatoid foot and orthopaedic foot societies. We
can co-operate and produce high quality foot health.
How we started using the vagueness of legislation is no longer
important, what is important is the quality of training now and we have
nothing to embarrassed about. I know that we can always improve in the
universities and post grad level and we will.
If you want to see things get better then stop seeing the negative and
build from where we are.
I believe we can see a quality employed and self-employed profession
over the next decade taking advantage of the political opportunities
that are offered and preventing the otherwise inevitable disappearance
of the profession.
I intend to make that process the central plank of my time in the Chair.
That plank does not rest on the furtherance of podiatric surgery ( I
have other able colleagues who can see to that) but the development of
podiatric medicine from general practice to specialisms.
Finally, I have a suggestion for you; instead of worrying what
orthopaedics thinks worry about what GPs, rheumatologists and
diabetologists think. When they oppose us we are doing something
seriously wrong.
Kind Regards
Ralph Graham
Consultant Podiatrist
Witham, Essex, U.K.
-----Original Message-----
From: A group for the academic discussion of current issues in podiatry
[mailto:[log in to unmask]] On Behalf Of Mark Russell
Sent: 07 June 2004 17:35
To: [log in to unmask]
Subject: Re: Professional Representation; Podiatric Surgery et al.
Ralph
We seem to have a different interpretation of the word 'meaningful'. And
yes I was asking you to be specific to the Society as opposed to the
BChA or Unison or the Institute. The four examples you cite are nothing
more than proficient housekeeping for any representative organisation. I
was thinking about something else altogether. Perhaps I will give it
some thought and post what I consider the professional objectives might
be.
I admire the way the subject has been sidetracked into indemnity
insurance and I'm sure you mean to return to the primary topic -
podiatric surgery - before too long. I wonder if I can prompt you?
There was a lot of questions raised by Borthwick and Dowd at the
conclusion of their paper, in particular the difficulties facing the
profession in the establishment of this speciality and the continuing
hostility from the RCS and BOA. I've tried to expand on these points
from the point of view of the profession asking whether the continuing
dispute with the medical establishment might be harming the prospects
for the wider profession of podiatry. As chair-elect of the Society and
a prominent podiatric surgeon yourself, I guess you are in an
influential position when it comes to deciding future strategy on this
issue - a strategy that will undoubtedly affect us all. Would you care
to share your views and perhaps listen to some of ours?
I wonder also if I may be able to tempt you with a little hypothetical
conundrum? What, do you suppose, would be the reaction of the Royal
College of Surgeons, the British Orthopaedic Association and the wider
medical community, if the following were suggested to them?
For podiatrists who wished to practice as foot and ankle surgeons they
would be able to access a guaranteed assisted placement through a
medical degree providing they held a BSc in Podiatric Medicine and had
completed three years post-graduate employment within the NHS. The
candidate would receive a Band 5 salary for the duration of the course
and would be exempt from tuition and course fees (if they are applicable
for medicine). On completion of their medical course they would
undertake the usual residency rotations with one final year with a foot
and ankle team. The training and regulation would be the responsibility
of the Royal College of Surgeons.
These students would bring with them the knowledge of the foot from a
podiatric perspective; most likely a greater understanding of gait and
propulsive mechanics. From the medical school's perspective, they would
make the ideal candidate. I realise that many of the podiatric surgeons
are highly regarded and respected and have made many positive
contributions in improving patient care. They are technically proficient
and bring a different dimension to established surgical practice in the
foot. But I wonder if that contribution might not have been greater if
they had undertaken the same the same study as our medical colleagues?
Surely you must agree that, in most cases, the potential would be far
greater? The most likely barrier to that appears to be the cost and time
involved with such a route. We shouldn't compromise on the time - but if
assisted place schemes were introduced for podiatrists that removed the
financial constraints, would you not think that this might be the better
road to go down, if for no other reason but to end the damaging
relationship with the medical fraternity. If not, why?
Best wishes
Mark Russell
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