Ortho vs Podiatry

[Pigmentosa]

I am a medical student looking into ophthalmology. Ophtha seems very attractive except for the constant organized push of optometry for surgical rights.

How does Ortho stops or "deals" with the constant push of podiatry into surgery? Do you guys feels that podiatry is a threat to ortho?

Any other points of view are always welcomed.

Thanks ahead!

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[TxMed]

being that they generally work from the knee down, that leaves about 75-80% of the body they can't touch. besides, somebody has to deal with those diabetic foot ulcers.



-tm

 

[SOUNDMAN]

And in some states/hospitals they can't do anything except the forefoot. I wouldn't want a podiatrist treating a complex tibia fracture, or calcaneuous fractures (some would say). Simple distal fibular fractures I think some podiatrists treat though. Other than that, it's pretty much limited to what that state will allow.

I would think that optometry would have a tough time getting privileges to do procedures where they don't do a surgical residency (do they). I thought they just did 4 years total of school. Wouldn't the hospitals be going out on a limb with approving them to do those procedures?

 

[Dr_Feelgood]

And in some states/hospitals they can't do anything except the forefoot. I wouldn't want a podiatrist treating a complex tibia fracture, or calcaneuous fractures (some would say). Simple distal fibular fractures I think some podiatrists treat though. Other than that, it's pretty much limited to what that state will allow.

I would think that optometry would have a tough time getting privileges to do procedures where they don't do a surgical residency (do they). I thought they just did 4 years total of school. Wouldn't the hospitals be going out on a limb with approving them to do those procedures?

I'm not sure how much exposure you have had to podiatry (I did see that your background is in orthopaedics as a PA) but I would dare to say that the treatment for a calcaneal fracture and a tibial plafond fracture is the same for podiatrist and F&A orthopedist. If there is any difference in care it would be in the outcomes when comparing a general orthopedist to a F&A orthopedist/podiatrist. Many of the techniques that are used in orthopaedics to treat both conditions came from pods and vice versa; also if you look into many ortho programs, the foot and ankle education is taught by podiatrist. It is a numbers game not a letters game; if you are a MD/DO/DPM and only see a calcaneal fracture once a year, you probably shouldn't touch the case not matter what your scope is (P.S. most states have a scope of the foot and ankle). The similarities are that of a nephrologist and a urologist treating bladder pathologies. They both will swear that they are better, and heck they both are MDs/DOs. What matters is training and experience not the letters after their name.

As for optometry, I think that you are right. Most MDs and DOs don't want to mess with the feet; including many orthopedist and ID physicians who deal with a lot of LE pathology. Why? Because they have a ton of other cases to work on and the LE does not pay as well. Ophthalmology does not seem to have that option, nor does it seem that they are willing to hand over any surgical area (which is basically what happened with podiatry, as many articles from orthopedist have stated ortho created the demand for podiatry). As optometry looks to expand, I see a much large battle looming. I have also heard that optometry has are already started to work on residency programs for eye surgery.

A side note: Depending on your school of thought, there is a lot of literature that states it is better to cast a calcaneal fracture and then perform a reconstructive surgery once the bone has coalesced. I've seen an acute calcaneal fracture, no matter how good you are they are never ever pretty. The calcaneus is similar to an egg and we all know about the attempts to fix Humpty Dumpty.

 

[dawg44]

Bottomline the subtalar joint is a ***** and the ankle is a stud when it comes to injuries to either.
If I had a blasted calc and was in a rural area or had insurance difficulties, I'd want to be put in a removable boot, don't touch it if you aren't familiar, let it heal and give me a subtalar fusion with a calc osteotomy in 6 months to a year if it bothers me. Heck knowing what I know now I might choose that even if the guy knew what he was doing. Wound problems can happen to anyone and I'd rather have a subtalar fusion than a wound dehiscense. Since you are a physician you know you are going to be the one with calc osteo that ends up with a amp. Thats just how it goes.

 

[Debridement]

Bottomline the subtalar joint is a ***** and the ankle is a stud when it comes to injuries to either.
If I had a blasted calc and was in a rural area or had insurance difficulties, I'd want to be put in a removable boot, don't touch it if you aren't familiar, let it heal and give me a subtalar fusion with a calc osteotomy in 6 months to a year if it bothers me. Heck knowing what I know now I might choose that even if the guy knew what he was doing. Wound problems can happen to anyone and I'd rather have a subtalar fusion than a wound dehiscense. Since you are a physician you know you are going to be the one with calc osteo that ends up with a amp. Thats just how it goes.

I was at a talk recently and the speaker was advocating non-op for everyone with socio-economic risk factors. He said he refused to operate on any cancaneal frx unless the pt agrees to quit smoking. He said that of all-comers with calcaneal frx, 95% are smokers!

Who knew that smoking was a risk factor for falling off of roofs and getting in MVAs?

But if it's me, I'm not sure I agree with you. I don't have all the sociaoeconimic risk factors that most calc frx have. With all of those confounding, it's tough to know if the operation helps. I bet that in you or me, we would be better off with a reconstruction.

 

[jonwill]

I wouldn't want a podiatrist treating a complex tibia fracture, or calcaneuous fractures (some would say). Simple distal fibular fractures I think some podiatrists treat though.

I'll be doing a 3 year surgical residency with an emphasis in trauma surgery at one of the largest teaching hospitals in the nation. I'll do thousands of foot and ankle procedures including pilon and calc fx's. And while I can't say that every pod coming out now gets that good of training, many do.

Concerning laws, almost every state allows pods to do ankle/foot. And when it comes to hospital privileges, that is easy. They will give you privileges for what you have been trained to do.

As one of the posters said, ortho will always be around because last time I checked, there were a few bones from the knee up. Podiatry has developed into a surgical sub-specialty of the foot and ankle and that is where it will stay. As far as optometry vs ophthalmo, I really don't know enough about it other than what I've read on SDN.

TxMed, are you trying to tell me that you don't love those smelly foot ulcers?

Dawg, you always have such an eloquent way of putting things

 

[SOUNDMAN]

With Calcaneal Fractures, I would agree that if you haven't done one in the last year you definitely shouldn't be doing that sort of reconstruction, and obviously the terrible wound problems that can accompany such a fracture or a whole different point. My point in all of this is that hospitals are going to allow you to do what you have training in. That's how it should be.

Also, correct me if I'm wrong, do all the podiatrists do the full surgical trauma 3 year specialty? From what I understand some don't even do a residency, some are 24 months? some are 36 months? Isn't the 24 months on medicine and forefoot, and the last 12 months if you do 36, on hindfoot?

Again someone trained only in certain areas of the foot, obviously shouldn't be doing fractures, etc above those areas. Besides those fractures suck to take care of. Give me a nice IT fracture to get in and out on, even if they are 95 years old. 🙂

 

[jonwill]

With Calcaneal Fractures, I would agree that if you haven't done one in the last year you definitely shouldn't be doing that sort of reconstruction, and obviously the terrible wound problems that can accompany such a fracture or a whole different point. My point in all of this is that hospitals are going to allow you to do what you have training in. That's how it should be.

Also, correct me if I'm wrong, do all the podiatrists do the full surgical trauma 3 year specialty? From what I understand some don't even do a residency, some are 24 months? some are 36 months? Isn't the 24 months on medicine and forefoot, and the last 12 months if you do 36, on hindfoot?

Again someone trained only in certain areas of the foot, obviously shouldn't be doing fractures, etc above those areas. Besides those fractures suck to take care of. Give me a nice IT fracture to get in and out on, even if they are 95 years old. 🙂

90% plus now do a 3 year surgical residency. The least you can now do is 2 years. To answer your question, no, not all residents receive trauma training such as I will. That is the emphasis of my program. Many programs are considered "well-rounded" while others have an emphasis on diabetic limb salvage, sports medicine, etc. But in order to be an accreditated program, all programs must have a minimal number of all types of podiatric surgery, including trauma.

As you can imagine, many that graduate from my program go on to work for ortho groups.

 

[Dr_Feelgood]

With Calcaneal Fractures, I would agree that if you haven't done one in the last year you definitely shouldn't be doing that sort of reconstruction, and obviously the terrible wound problems that can accompany such a fracture or a whole different point. My point in all of this is that hospitals are going to allow you to do what you have training in. That's how it should be.

Also, correct me if I'm wrong, do all the podiatrists do the full surgical trauma 3 year specialty? From what I understand some don't even do a residency, some are 24 months? some are 36 months? Isn't the 24 months on medicine and forefoot, and the last 12 months if you do 36, on hindfoot?

Again someone trained only in certain areas of the foot, obviously shouldn't be doing fractures, etc above those areas. Besides those fractures suck to take care of. Give me a nice IT fracture to get in and out on, even if they are 95 years old. 🙂

Jon eluded to it, but all pods are required to do a residency. 24 and 36 month programs have similar requirements in both medicine and surgery (both rearfoot and forefoot). The main difference is in the number of required cases. 24 month grads cannot sit for RF and ankle board certification; a pod must complete a minimum of 35 month post grad training to sit for all 3 board sections (FF, RF, and ankle).

 

[SOUNDMAN]

That makes sense, and is what I thought from my experience.

 

[NDESTRUKT]

Podiatry isn't worth doing unless you get into a podiatric surgical residency - which I heard are pretty competitive. Otherwise you'll end up clipping nails and looking at foot ulcers all day. You won't get called in the middle of the night at least. A lot of "foot medicine" can be treated by other specialties - internists, dermatologists, orthopedists, etc. The special cases go to the pods and those are few and far in between.

As far as optometry goes, I'm not aware of any surgical residencies for opto. One of my best friends who just graduated from Cal in opto told me most of his classmates don't care to operate. Optos that want to do surgery are pu$$ies that couldn't get into med school.

At least podiatric surgeons didn't weasel their way into what they are now.

And lastly: Dr. Feelgood, most if not all bladder pathologies get a uro consult. I've never heard of a nephron consult for a bladder problem.

 

[Dr_Feelgood]

Podiatry isn't worth doing unless you get into a podiatric surgical residency - which I heard are pretty competitive. Otherwise you'll end up clipping nails and looking at foot ulcers all day. You won't get called in the middle of the night at least. A lot of "foot medicine" can be treated by other specialties - internists, dermatologists, orthopedists, etc. The special cases go to the pods and those are few and far in between.

As far as optometry goes, I'm not aware of any surgical residencies for opto. One of my best friends who just graduated from Cal in opto told me most of his classmates don't care to operate. Optos that want to do surgery are pu$$ies that couldn't get into med school.

At least podiatric surgeons didn't weasel their way into what they are now.

And lastly: Dr. Feelgood, most if not all bladder pathologies get a uro consult. I've never heard of a nephron consult for a bladder problem.

Well, I can tell you from listening to the urologist that is not true in Iowa. He b*tched and complained for about an hour about bladder slings. He is tired of blankin OB-GYNs and nephrologists. Neither of them are blankin surgeons, blah blah blah. I just smiled and shook my head in agreement. I've seen lots of examples like this: general surgeons and ortho surgeons yelling at each other, plastics and ortho, general and vascular, ect. Everyone thinks that they do it best.

Also, even a general service pod makes a great living, most make more than FP doctors. I like to tell my DO friends that they better work hard or they should have become a pod.

 

[Debridement]

Well, I can tell you from listening to the urologist that is not true in Iowa. He b*tched and complained for about an hour about bladder slings. He is tired of blankin OB-GYNs and nephrologists. Neither of them are blankin surgeons, blah blah blah. I just smiled and shook my head in agreement. I've seen lots of examples like this: general surgeons and ortho surgeons yelling at each other, plastics and ortho, general and vascular, ect. Everyone thinks that they do it best.

Also, even a general service pod makes a great living, most make more than FP doctors. I like to tell my DO friends that they better work hard or they should have become a pod.

a podiatrist generalizing on the care of bladder slings in iowa based on a secondhand anecedote. Hrm, this is a helpful orthopaedics forum....

 

[jonwill]

Podiatry isn't worth doing unless you get into a podiatric surgical residency - which I heard are pretty competitive.

This was the case 10-15 years ago. When one of my attendings graduated, there was one residency slot for every 4 students. But residency was not required. By law, it now is.

Especially in the last decade, podiatry has evolved largely into a surgical sub-specialty. Now, the only residencies available are surgical residencies. The majority of graduates now do a 3 year surgical residency. The least you can do is a 2 year surgical residency which will allow you to sit for forefoot board certification (three years allows you to sit for forefoot/rearfoot/ankle). However, the majority of students now do 3 year surgical residencies.