Ralph



First, congratulations on your election to chair. May I take this
opportunity to wish you all the best during your tenure. I hope it will
prove a memorable time both for you and the wider profession.



Your submission raises a number of concerns.



I must accept what you say regarding the maxillary facial surgeons
although I am surprised to hear of the development of the ‘surgical
dentist’ – a title that has a familiarly unpleasant ring about it. I
wonder what drove the change? Was it unhappiness about the existing route –
the double degree – or is it another political initiative to ‘fast tract’
specialists into the NHS? Either way, the undergraduate course must have
changed substantially if they are now accommodating oral surgery alongside
general dental practice. Is there a lesson there for podiatry perhaps?



I hear what you have to say regarding training for podiatric surgery and I
am sure you are correct in your assertion that the knowledge gaps are
being filled by the postgraduate training course. The points you raise
regarding wider medical training have validity; teaching methodology will
change and adapt according to prevailing social and economic factors.
Maybe we are just witnessing nothing more than realignment in the
professional boundaries and their training programmes. Will it produce a
more competent and proficient practitioner - only time will tell.



If I read correctly, you propose that the status quo between podiatry and
orthopaedics is maintained. Edinburgh and Glasgow will shortly be offering
their MSc in Podiatric Surgery as will Brighton Although the Diploma in
Podiatric Surgery may be one route towards greater integration it is
unlikely that the RCS will adopt a similar qualification in England, thus
the standoff will continue for the time being.  I cannot see this as being
beneficial in any way – it nurtures bad feeling between the professions
and it frustrates podiatrists who find they have limited rights to
operating facilities – where they have any rights at all. The Royal
College in Edinburgh may be ‘endorsing’ podiatric surgery through the
Diploma but I wonder how many of these practitioners will be able to
operate in Scotland once qualified? How many have operating rights at
present?



I think the main thrust of your argument is that podiatry should be
developed – surgically and medically – as far as possible so that the
profession can ‘capture’ the foot exclusively for itself whilst training
and education should remain firmly within the confines of the profession.
You write >>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<<



Surely you mean podiatric surgery would disappear rather than podiatry? I
cannot see how an assisted place scheme in medicine for podiatrists who
wish to undertake invasive foot surgery would weaken the profession of
podiatry at all. If podiatrists are good enough to go on and make dynamic
foot and ankle surgeons, would it not be better for them to do so on the
same platform, with the same benefits and status as surgeons who practise
on the hand or eye? There is an interesting parallel here for the
profession to consider.



With the changes to the regulatory instruments, we now are seeing a
similar territorial encroachment by the independent sector trained
chiropodist/podiatrist against the old registered practitioner. The issues
are analogous. We have the ascendancy of one group of individuals against
another. The established group want to ensure standards are maintained and
there is great opposition towards parity without some test of competency
and a robust regulatory framework being put in place first (fat chance
eh?). The established group are against more ‘back-door qualifications’
and insist the ascendants cease their training programmes and all new
students subscribe to the established courses. There is an impasse here
too and if you want to see just how far relationships have deteriorated –
read some of the comments on thatfootsite.com. They are most instructive.
The question you discussed at the ‘open day’ ….Unity – who
benefits…..could equally have been asked by the medics. Maybe what is
required is some consistency in the approach to the argument in future.
There must be many colleagues who feel slightly uneasy about their
distaste for the ‘grand-parenting’ process whilst they are aware that
their own profession is being viewed in exactly the same light by the
medical profession for precisely the same reasons. We think our training
is adequate and we are reluctant to lose our ‘independence’ to the
establishment. Could Mike Batt have said it any better?



You mention the USA where the debate continues whether to drop the DPM
qualification in favour of an MD.  You argue against that, but there are
certainly arguments for change if podiatry continues to move towards
medical based practice instead of podiatric practice, as we seem to be
doing currently. There are lots of wee girlies out there who are
proficient with 10g monofilament yet lethal with a No10 Swann-Morton. That
opens another debate – should there be boundaries/limits to podiatric
education – should there be greater collaboration between the educators
and the profession to ensure we have a workforce that is highly skilled,
focussed and independent or do we allow the educational drift towards
mainstream medicine to continue with the danger that the profession may be
incorporated as a medical sub-speciality in years to come? If you haven’t
already, can I suggest you read Alan Crawford’s submission in the Podiatry
Education track in March 2004. Perhaps it’s time for greater collaboration
between the profession and the educators before we start establishing new
specialist areas of practice?



My final question regarding podiatric surgery is this; if the status quo
prevails with the SCP continuing to train podiatric surgeons and the Royal
Colleges refusing to recognise them – who do you think will capitulate
first?



I agree that we should look forward rather than backwards and I shall
strive hard to ensure any contributions I make are positive. But I hope we
can learn from past mistakes. The sooner the profession realises that the
actions of a few can have an effect on many, the better.



You also wrote that you 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.”  You say that this is to be the central
theme of your time as chairman. Can you share with us how you intend
deliver that vision?



Thank you for your response and best wishes once again for the future.



Mark Russell

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