Ralph
I apologize for the delay in responding to your question of whether I concur with the views expressed by Mark. I have just spent a month in the UK and several days in Dubai so I am afraid responding to emails had to wait until my return to Australia on the 6th July. Whether I agree with all of Mark's comments and views of the podiatry profession in the UK is largely irrelevant and I am sure that Australia would probably not be too concerned about comment on our profession by UK podiatrists. I only comment because I can relate to his philosophies. What I do see in Marks proposals and comment is a sense of frustration for dialogue to discuss areas of professional interest in an effort to achieve desirable outcomes for the future. If Mark's views reflect the views of a large percentage of the Society membership, and I have no way of confirming that, then surely open dialogue with people who go out on a limb because they are passionate about the future of their profession can only be beneficial even if it is to prove that their concerns are baseless.
On a personal basis I am on record in Australia for airing concern that the national body had no education sub committee or that there was no representation from the education sector on the Council. Educational matters were probably discussed but only with State representatives who were almost 100% private practitioners. Due to lobbying of the National Council we now have a Podiatry educators group who do meet to discuss relevant educational matters and the Council has a course accrediting committee who will review each of the podiatry programs in the country. All of this came about due to raising these issues with the Council and clearly demonstrating the benefits to be gained by the profession as a whole.
If change is initiated through dialogue with all interested parties then surely it is worth the effort to do so. I will not presume to speak for Mark but my reading of his emails is to acknowledge his frustration that dialogue is not on the agenda and that the profession is the poorer as a result. If my interpretation is correct, then as in Australia, I suggest there is nothing to be lost and possibly a great deal to be gained by getting interested parties together to try and resolve the areas of concern. Regards, Alan
At 02:55 PM 5/06/2004 +0100, you wrote:
>Alan,
>
>In response to your comments I would ask whether the views expressed by
>Mark Russell are also yours and whether this judgement would be
>reflected by the generality of practice in Australia?
>The true position in the UK bears no relation at all to the version
>given by MR. As a simple example the total of managers and podiatric
>surgeons on Council is 11 of 24. This includes 2 surgeons whose main
>work on the Council has been the development of the fellowship in
>podiatric medicine and the private practitioners. The remainder being
>education (4) and general practice (9). As Chair of Industrial relations
>for the last two years my activity has had little or nothing to do with
>surgery and has been in the new negotiations for NHS pay.
>What is particularly poor about his analysis is that he assumes
>(wrongly) that anyone from a particular sphere of practice has no
>interest or knowledge about the rest. The only accurate statement is
>that general practice is the bedrock of the profession both in the UK
>and internationally. Colleagues should be in no doubt that this
>recognition has never been lost in the UK and where it may have slipped
>from the forefront elsewhere it is now firmly in place.
>I have too little direct experience of Australia but I would be
>surprised if the main thrust of issues were much different.
>
>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 Alan Crawford
>Sent: 04 June 2004 04:21
>To: [log in to unmask]
>Subject: Re: Professional Representation; Podiatric Surgery et al.
>
>
>Mark
>I was waiting for a deluge of responses to your mailbase contribution.
>In some ways I was not surprised at the zero result. Those who firmly
>believe in what they say whether supported by the majority or not will
>hopefully continue to stimulate debate and through that debate produce
>the willingness to consider change and provide a vision for the future.
>We appear to have lost the fact that despite our personal professional
>interests we are all part of the one profession and should be able to
>work together to achieve benefits for all members. Regards, Alan
>
>Alan Crawford
>Queensland University of Technology
>Brisbane
>Australia
>
>
>
>
>
>At 09:04 PM 26/05/2004 +0100, you wrote:
>>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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