Is an Orthopedist as capable as a Podiatrist in Foot & Ankle

[cool_vkb]

Hey, I was wondering, is a regular Orthopedist (not some F & A ortho, but just a general ortho-someone who just did his residency) is as effecient as a DPM who has finished in 3yr DPM surgical residency in terms of Foot & Ankle Surgeries. Iam asking this question because i thought, orthopedics is such a big field and F & A is just a small part of it. So even if someone spends such a large time in Orthopedic residency, i wonder how much time do they exactly dedicate to F & A out of that many years. So i was thinking that since Pods just do 3yrs straight residency in F & A they must be more capable than regular Orthopedist in handling Foot & Ankle cases. Since DPMs have more practice in F&A surgeries during residency.

Plzz dont confuse my argument with an F& A ortho. iam just speaking abt a regular Ortho who just finished his ortho residency and did not do any fellowships.

A Foot & Ankle orthopedist is no doubt an efficent Surgeon of Foot & Ankle. iam just speaking about General Orthopedists.

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[Dr_Feelgood]

Hey, I was wondering, is a regular Orthopedist (not some F & A ortho, but just a general ortho-someone who just did his residency) is as effecient as a DPM who has finished in 3yr DPM surgical residency in terms of Foot & Ankle Surgeries. Iam asking this question because i thought, orthopedics is such a big field and F & A is just a small part of it. So even if someone spends such a large time in Orthopedic residency, i wonder how much time do they exactly dedicate to F & A out of that many years. So i was thinking that since Pods just do 3yrs straight residency in F & A they must be more capable than regular Orthopedist in handling Foot & Ankle cases. Since DPMs have more practice in F&A surgeries during residency.

Plzz dont confuse my argument with an F& A ortho. iam just speaking abt a regular Ortho who just finished his ortho residency and did not do any fellowships.

They have less training but I would not say they are less qualified. Many of the principles that we use on the foot and ankle hold true to any joint. I'm sure no general orthopod would get into major deformity cases if they are just general orthopods b/c of they level of experience that is needed.

I would suggest search the SDN forum for similar threads on the issue. I have mentioned an article in various orthopedic journals that admit that general orthopaedics is falling behind other specilaties (podiatry) in the area of foot and ankle care and training.

 

[cool_vkb]

I'm sure no general pod would get into major deformity cases if they are just general orthopods b/c of they level of experience that is needed.

Hey is that a typing mistake.what do you mean by "General POD", because i cudnt understand that sentence. Can you please explain me again.

 

[cool_vkb]

They have less training but I would not say they are less qualified. Many of the principles that we use on the foot and ankle hold true to any joint. I'm sure no general pod would get into major deformity cases if they are just general orthopods b/c of they level of experience that is needed.

I would suggest search the SDN forum for similar threads on the issue. I have mentioned an article in various orthopedic journals that admit that general orthopaedics is falling behind other specilaties (podiatry) in the area of foot and ankle care and training.

Oh ok! Got it Boss👍 . I will search the archives. Have a great weekend.

 

[Dr_Feelgood]

Hey is that a typing mistake.what do you mean by "General POD", because i cudnt understand that sentence. Can you please explain me again.

It should have said orthopod. I have corrected my mistake.

 

[jonwill]

Hey, I was wondering, is a regular Orthopedist (not some F & A ortho, but just a general ortho-someone who just did his residency) is as effecient as a DPM who has finished in 3yr DPM surgical residency in terms of Foot & Ankle Surgeries. Iam asking this question because i thought, orthopedics is such a big field and F & A is just a small part of it. So even if someone spends such a large time in Orthopedic residency, i wonder how much time do they exactly dedicate to F & A out of that many years. So i was thinking that since Pods just do 3yrs straight residency in F & A they must be more capable than regular Orthopedist in handling Foot & Ankle cases. Since DPMs have more practice in F&A surgeries during residency.

Plzz dont confuse my argument with an F& A ortho. iam just speaking abt a regular Ortho who just finished his ortho residency and did not do any fellowships.

A Foot & Ankle orthopedist is no doubt an efficent Surgeon of Foot & Ankle. iam just speaking about General Orthopedists.

Honestly speaking, podiatrists receive much better training in foot surgery as compared to a general orthopedist. And you'll be hard pressed to even find a general orthopod that touches the foot. Obviously, the F&A fellow being the exception. This is not a shocking statement and is well known. Orthopods have actually studied foot and ankle exposure in ortho residency and have published numerous papers. The following is an exert from one such study released in 2003 by FAI:

"Results showed that 80 programs (54.1 percent) had just one faculty member, while 21 programs (14.2 percent) had no faculty member with a dedicated interest in foot and ankle orthopedics. Fifteen programs (10.1%) did not have a committed faculty member, nor did their residents have a clinical rotation dedicated to foot and ankle care."

"Ninety-six percent of the programs had a dedicated clinical foot and ankle experience, while 33 assigned their residents to clinical foot and ankle rotations at multiple times during their training. Overall, the total duration of their foot and ankle clinical training ranged from as little as 6 weeks, to as much as 24 weeks, out of a possible 260 weeks of residency training."

 

[krabmas]

General orthopods are typically trained in trauma (and elective procedures - but not the topic here) of the whole body including the ankle and foot. Even without a dedicated faculty/attending or rotation specific for foot and ankle general orthopds are trained to perform procedures needing orthopedic aproaches with orthopedic techniques to the whole body.

The thing that only foot and ankle specialists spend time on would be gait and the function of feet in gait.

From my experience the pods spend more time making sure the alignment is just right in an ankle or foot surgery expecially metatarsal fractures compared to gen orthos.

I think some orthopods take for granted the pain that transfer lesions cause. Remember - gen orthos and even foot and ankle orthos do not typically debride calluses.

 

[SportPOD]

I've worked with a fair share of orthopods in my short career. In general, orthopods are trained in residency to treat foot and ankle conditions, but they do not see the volume that a podiatriy resident will see or even a foot and ankle fellow.

That being said, there are some orthopods who will treat the foot and ankle along with the rest of the joints in the body. Will they do massive reconstructive type surgeries? Some will and some won't. The trend that I have seen (warning only an opinion) is that the younger orthopods will treat what they feel comfortable with and refer out the rest. Most of the orthopods I work with are comfortable referring foot problems over to me and I send them the other joints back to them.👍

 

[calcaneus]

I shadowed a general orthopedic surgeon (Kevin Gerth M.D. at Gerber Memorial Hospital-if anyone feels the need to verify my comments since they're based soley on comments from him).

I worked at that hospital for 5 years and currently we are short 2 general orthopedic surgeons. A very overworked Dr. Gerth mentioned that part of the problem was the hospital isn't in a large city and has trouble drawing people due to location. He also mentioned that a very large percent of orthopedic surgeons do sub-specialize not leaving a large pool of general orthopods to pick from (small relative to the demand). I seem to remember him saying ~70% sub-specialize in a fellowship but I haven't verified that number however I can speak to Dr. Gerth's reputation as an orthopedic surgeon (currently he's the only one at the hospital and Gerber Hospital was picked as a Top 100 Hospital for Orthopedics 2 or 3 years ago).

I can also attest to the fact that Dr. Gerth doesn't do much foot work if any...far too busy with general knee and hip stuff.

Also, I'll give a tip to any pod residents out there. Dr. Gerth has been solo practice for going on 2-3 years now in a practice that had 3 surgeons so he's pretty desperate. I bet he would seriously consider a DPM to take as much foot/ankle and maybe more depending on Michigan laws. I'm not sure what all Michigan allows. I guess I won't be on the market for 8 years so I'll give that tip away.

For those considering podiatry, I know alot are concerned about how DPMs are treated. So I'll mention that there are DPM's that do their surgeries at Gerber and based on how they work and how the other surgeons and nurses act around them, you wouldn't know who's an MD and who's a DPM. In fact, most of the nurses don't know there's a difference.

 

[cool_vkb]

I shadowed a general orthopedic surgeon (Kevin Gerth M.D. at Gerber Memorial Hospital-if anyone feels the need to verify my comments since they're based soley on comments from him).

I worked at that hospital for 5 years and currently we are short 2 general orthopedic surgeons. A very overworked Dr. Gerth mentioned that part of the problem was the hospital isn't in a large city and has trouble drawing people due to location. He also mentioned that a very large percent of orthopedic surgeons do sub-specialize not leaving a large pool of general orthopods to pick from (small relative to the demand). I seem to remember him saying ~70% sub-specialize in a fellowship but I haven't verified that number however I can speak to Dr. Gerth's reputation as an orthopedic surgeon (currently he's the only one at the hospital and Gerber Hospital was picked as a Top 100 Hospital for Orthopedics 2 or 3 years ago).

I can also attest to the fact that Dr. Gerth doesn't do much foot work if any...far too busy with general knee and hip stuff.

Also, I'll give a tip to any pod residents out there. Dr. Gerth has been solo practice for going on 2-3 years now in a practice that had 3 surgeons so he's pretty desperate. I bet he would seriously consider a DPM to take as much foot/ankle and maybe more depending on Michigan laws. I'm not sure what all Michigan allows. I guess I won't be on the market for 8 years so I'll give that tip away.

For those considering podiatry, I know alot are concerned about how DPMs are treated. So I'll mention that there are DPM's that do their surgeries at Gerber and based on how they work and how the other surgeons and nurses act around them, you wouldn't know who's an MD and who's a DPM. In fact, most of the nurses don't know there's a difference.

I see that this is your first post on SDN. Welcome to SDN. you made a perfect start with this excellent and recourcefull post👍 . God bless you.🙂

 

[dawg44]

It depends on the residency program and interest level of the resident to answer your question. It also depends on if you are discussing acute trauma vs reconstruction. You can also throw pediatrics in the mix and you have an entirely too complex subject for me to discuss. Basically an internet pissing match. You won't want to listen to me though. Feelgood will let you know that I'm biased, but alas it's in the archives.

 

[cool_vkb]

It also depends on if you are discussing acute trauma vs reconstruction. You can also throw pediatrics in the mix and you have an entirely too complex subject for me to discuss.

I meant reconstruction surgeries (forefoot & rear foot). And i didnt understood the Pediatrics remark. Does pediatrics make it more harder?

 

[m326841]

More and more insurance companies are covering podiatry services so that tells me something about our abilities.

 

[oncogene]

More and more insurance companies are covering podiatry services so that tells me something about our abilities.

You are correct in that they do think that we are competent enough to perfrom the procedures but, I suspect that another reason is that they can pay us about a 1/3 of what the ortho would get. That is the bind that we have to deal with at this time. we know and they know we are just as good but since have been accepting their reimbursement rates we will have a hard time and maybe impossible time getting equal pay. I think the only way is if this resolution goes through to give us legal pairity.

onco

 

[densmore22]

Aww yes, parity. The jury is still out if the resolution will pass, I think not this year, but definitely in the next 1-2 years, congress is beginning to believe what we keep telling them.

When that occurs (and it will occur), insurance companies will be forced to recognize our training as equal or similar (for those that still think Pod med isn't real medicine) and our residencies as such also and will have to face the fact that reimbursement rates will A) have to increase for Pods or B) decrease for F/A Orthopods; either way, it will equalize and we'll be making around the same, I personally think our pay will go up, but the next thing we have to worry about is socialized healthcare. I'm all for equal care for everyone, but they gotta do something about cost of education and cost of running a practice, etc, etc. Interesting stuff, this will definitely affect ALL healthcare providers.

 

[calcaneus]

If any pre-pods still have questions about legitimacy of podiatry as healthcare providers check out the below link. This is the hospital I worked at and you'll notice James Bender DPM listed in the Physician's link. However, I'm sure there are places that pods aren't as well received, but I thought an clear example of a place that does might be nice, rather than just hearing stories from others.

Although, being a pre-pod myself, I would listen to the other people with more experience, but I think if you still have questions about the profession, you need to come to terms with them soon by talking with pods or pick another job.

http://gerberhospital.org/providers/physician.html

 

[dawg44]

I meant reconstruction surgeries (forefoot & rear foot). And i didnt understood the Pediatrics remark. Does pediatrics make it more harder?

more harder? Sorry I hate to correct, but I thought it was funny. During pediatric rotations orthopedic residents will see a variety of foot and ankle problems in addition to all of the other aspects of pediatric orthopedics. I don't know how often in podiatry training you would be exposed to casting clubfeet, distal tibia osteo, fractures and the like. I say that because I have never seen a DPM listed at a pediatric hospital I'm sure there are some, what they actually tackle I don't know.

 

[dawg44]

Aww yes, parity. The jury is still out if the resolution will pass, I think not this year, but definitely in the next 1-2 years, congress is beginning to believe what we keep telling them.

When that occurs (and it will occur), insurance companies will be forced to recognize our training as equal or similar (for those that still think Pod med isn't real medicine) and our residencies as such also and will have to face the fact that reimbursement rates will A) have to increase for Pods or B) decrease for F/A Orthopods; either way, it will equalize and we'll be making around the same, I personally think our pay will go up, but the next thing we have to worry about is socialized healthcare. I'm all for equal care for everyone, but they gotta do something about cost of education and cost of running a practice, etc, etc. Interesting stuff, this will definitely affect ALL healthcare providers.

You are leaving out the call issue though. One of the most glaring reasons ortho gets paid more is how much we can handle on call compared to a DPM. This discussion is also in the archives.

 

[jonwill]

I don't know how often in podiatry training you would be exposed to casting clubfeet, distal tibia osteo, fractures and the like. I say that because I have never seen a DPM listed at a pediatric hospital I'm sure there are some, what they actually tackle I don't know.

This is pretty much hit and miss depending upon the program. The program that I will be attending for residency has quite a bit of peds ortho so I'll get to see and do a lot. However, many pod residency programs have next to none when it comes to peds. The program that I'm rotating at now does a descent amount of clubfoot casting and that has been interesting to see.

WHAT? You mean I can't take general ortho call?

 

[dpmgrad]

more harder? Sorry I hate to correct, but I thought it was funny. During pediatric rotations orthopedic residents will see a variety of foot and ankle problems in addition to all of the other aspects of pediatric orthopedics. I don't know how often in podiatry training you would be exposed to casting clubfeet, distal tibia osteo, fractures and the like. I say that because I have never seen a DPM listed at a pediatric hospital I'm sure there are some, what they actually tackle I don't know.

You are correct in that there are some DPMs listed at a Pediatric Hospital. There are DPMs listed at Temple Children's Hospital in Philadelphia, PA. These DPMs do tackle a variety of pediatric lower extremity deformity and trauma, both surgically and conservatively. Since there are DPMs at the Children's Hospital, the Temple Podiatry residents and some TUSPM students are involved with the Podopediatric's clinic and surgeries.

 

[UCI->Scholl]

One differance I've learned this year is that an Ortho doesn't have as complete scope of the ramifications of his actions on the foot as a pod would.

For example, suppose for whatever reason part of the foot would need to be amputated. An ortho would amputate above the level of dysfunction and as long as circulation is good, that would surfice. A pod however will take into account biomechanics and other factors you will all learn about and possibly do an amputation at a different level in order to preserve foot function. Of course there are differance in every situation, but thats the jist of it.

 

[Dr_Feelgood]

One differance I've learned this year is that an Ortho doesn't have as complete scope of the ramifications of his actions on the foot as a pod would.

For example, suppose for whatever reason part of the foot would need to be amputated. An ortho would amputate above the level of dysfunction and as long as circulation is good, that would surfice. A pod however will take into account biomechanics and other factors you will all learn about and possibly do an amputation at a different level in order to preserve foot function. Of course there are differance in every situation, but thats the jist of it.

I agree and disagree. Many amputations of the foot affect the gait more than a BKA. I disagree with some tactics to keep the foot at times; sometimes I think pods keep the foot so that the patient has something to come back to the office and see them.

That being said, new literature says we quit too early. That surgeons should offer longer antibiotic therapy and less aggressive debridement/amputations.

 

[jonwill]

You are correct in that there are some DPMs listed at a Pediatric Hospital. There are DPMs listed at Temple Children's Hospital in Philadelphia, PA. These DPMs do tackle a variety of pediatric lower extremity deformity and trauma, both surgically and conservatively. Since there are DPMs at the Children's Hospital, the Temple Podiatry residents and some TUSPM students are involved with the Podopediatric's clinic and surgeries.

One of the graduating residents from my program has been hired on at Childrens Hospital in Detroit as one of the foot and ankle specialists. However, he is first doing a ortho fellowship in pediatric orthopaedics.

 

[dawg44]

I agree and disagree. Many amputations of the foot affect the gait more than a BKA. I disagree with some tactics to keep the foot at times; sometimes I think pods keep the foot so that the patient has something to come back to the office and see them.

That being said, new literature says we quit too early. That surgeons should offer longer antibiotic therapy and less aggressive debridement/amputations.

I agree with you Feelgood. You don't want to "whittle" on alot of these patients. They are usually pretty sick and subjecting them to multiple surgeries is not the right thing to do. The law of averages will catch up with you someday and you will have someone crump on the table. A BKA can be a great surgery and can empower patients and should not be thought of as the failure that it sometimes is. It will be hard for me to not be aggressive though. I think there is only one way to do a debridement, leave nothing dead behind.

 

[dpmgrad]

One of the graduating residents from my program has been hired on at Childrens Hospital in Detroit as one of the foot and ankle specialists. However, he is first doing a ortho fellowship in pediatric orthopaedics.

That is awesome.

 

[PediBoneDoc]

this was an interesting back and forth. being a practicing pedipod, i can tell you there are not many podiatrists who primarily peds. but there are some. as a pedipod, we are acutely aware of things such as gait and malalignments. because we take care of many things which go far beyond just the foot (CP, Myelo, MD) disease processes.

about amputations, for me it is about overall function. for instance, i have a kind in the hospital right now who was run over by his father's riding lawnmower. the entire lateral aspect of his right leg and 2 toes (including the great toe). this problem although it involves the foot, it is not a foot issue. if he had lost his tibial nerve and not just the peroneal nerve, we may be discussing amputation. but for now it is salvageable. although i foresee many day in the operating room in the future.

we all serve a role. i wish we had a podiatrist. painless flatfeet, adolescent bunions, and ingrown toenails, you can have 🙂

pedi out

 

[Dr_Feelgood]

we all serve a role. i wish we had a podiatrist. painless flatfeet, adolescent bunions, and ingrown toenails, you can have 🙂

I'll take all of these but I'd like your painful flatfeet too.

I agree that in most peds patients the pathology is not limited to the foot. It would take a very busy practice to have a pod on staff to just work on clubfeet, vertical talus syndrome, bunions, and all of the other strictly foot pathology. Some of my colleagues might disagree but I feel that it is best for the child to see one doctor for all of his/her skeletal issues, therefore, a orthopedic surgeon is a much better choice. I could not imagine taking a case to the OR just to find out that to truly fix the issue I need to go out of scope.