Orthopedic olive branch?

Started by gustydoc
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gustydoc

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The Journal of bone and joint surgery has always been one of my favorite publications and its hard for one to argue the quality of research that is routinely published in the Journal. That being said it is an orthopedic Journal and I think most of us would agree there has been a less than fair treatment of podiatry by most orthopedic journals in the past. For example the "Whither Podiatry" Presidential address that was published in Orthopeadic Clinics of North America in 1979 (for those of you unfamiliar google it). Not to mention that fact that many of the journals choose not to publish articles submitted by authors with a DPM behind their names.

Given all of this, you can imagine my surprise when I opened my most recent copy of the Journal of bone joint surgery to find an editorial by one of the more well known and well-respected orthopedic surgeons that could be actually interpreted as pro-podiatry. The editorial goes so far as to state that podiatric surgeons have become experts in our field and to say that it is ludicrous to argue that we do not have training to perform within are full scope of practice. It is a long overdue admission from a respected orthopod and I think it is worthwhile for all practicing podiatric surgeons to read. To me it shows an increasing willingness from orthopedic surgeons to admit what we have know to be true all along. Specifically that podiatric surgeons are as qualified as any physician regardless of degree to treat foot and ankle pathology by any means. I'm optimistic that more of Dr. Sarmiento's colleagues are beginning to feel comfortable voicing this publicly. Below is the paragraph from the editorial that references podiatry specifically. If you get JBJS definitely read the whole thing. It put a smile on my face.


To argue that such a scenario is not possible would be
blindness at its best. Osteopathic physicians and surgeons have
accomplished an enormous expansion of their provision of
health care in years past. Likewise, podiatrists, who for generations
had limited their work to minor surgeries of the toes,
managed, over a very short period of time, to become doctors/
surgeons who currently care for patients with all types of musculoskeletal
conditions below the knee. They treat traumatic
injuries as well as degenerative, infectious, and congenital diseases
with clinical and surgical means. They perform internal
fixation of fractures of the tibia, ankle, os calcis, hindfoot, and
forefoot. In addition, they perform total ankle arthroplasties
and tendon transfers. In the process, they have become experts
in the field to the point that it is ludicrous to argue that their
qualifications do not allow them to cover such a wide territory.
One can safely predict that, in the not too distant future, they
will request official authorization to perform total knee replacements
as well as other complicated procedures. Likewise,
it is quite possible that others, including chiropractors, nurse
practitioners, physical and occupational therapists, and orthopaedic
technicians, will attempt to expand their practices in the
same manner as the podiatrists.
e105(2)
THE JOURNAL OF BONE & JOINT SURGERY d JBJ S .ORG
VOLUME 94-A d NUMBER 14 d JULY 18, 2012
THE PROJECTED SHORTAGE OF ORTHOPAEDISTS MAY BE OUR FAULT
 
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I agree that on the surface this appears to be a positive commentary regarding podiatry. But I have this odd feeling that the commentary is almost a wake up call for orthopods. I was fine with the comments until he seemed to "warn" his colleagues that soon podiatrists are going to lobby for privileges to perform knee replacements, which we all know is not going to happen. He then in essence lumped us in with chiropractors, physical therapists, nurses and even orthopedic technicians. To me, that's insulting.

I feel that although there seemed to be admission that we do have skills and training, it appears he's basically saying that we will eventually want more (the knee) and that if they don't watch out, the other professions mentioned will follow our path. If that occurs, it will negatively impact their income and spread the wealth.

I think I'm open minded , but I really take this commentary as an almost sarcastic warning to help protect the turf. Maybe I'm reading between the lines too much, but maybe not........
 
I read it as call to arms, similar to when podiatrists write alarmingly of PTs and orthotists doing orthotics, and nurses doing wound care.
 
Agreed. It seemed ominous. "The battle may be over, but the war is just beginning." I hope I'm reading too much into this as well. I tend to see the glass as half empty though, but do try and keep an open mind to things.
 
😕 I didn't take it like that. I need to read it again to see what I missed.

You may not have missed anything, since it's just our interpretation. But if you read the very last line in the post, it says "The predicted shortage of orthopaedists may be our fault".

To me, that seems more like a wake up call that overshadows a backhanded compliment.
 
Just my interpretation:

He may be conceding that podiatrists have turned into expert foot and ankle surgeons, but the way he phrases it almost seems like that only happened because the orthopedists weren't resistant enough to fight off our pursuit of an increased scope of practice. If they don't "put their foot down", podiatry will continue to expand and take even more work from ortho. Then the mid-levels will follow the same path and begin encroaching on orthopedic territory.

He makes the initial concession to podiatry not as a compliment but as a "see this is what will continue to happen if we don't put an end to it."

It's cleverly disguised as his written word is all positive, but in no way is the message a compliment to podiatry. No orthopedist is going to read this and think "you know what, podiatrists really ARE great foot/ankle surgeons, because this famous ortho guy said so. I should refer all my foot cases out and make friends with all the local podiatrists." They're going to think that they should keep a firm grasp of everything that they come across, treating anything and everything, or else some hyena might nab it and it'll be gone forever. The increased podiatry scope is a great mistake that they must never let happen again.
 
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Would you say that the positives in this article (recognition of competence etc) outweigh the negatives/slights against podiatry?

In other words, if you could go back in time and vote on whether this article would be published in its entirety, how would you cast your vote? (assuming your vote was significant)
 
Would you say that the positives in this article (recognition of competence etc) outweigh the negatives/slights against podiatry?

In other words, if you could go back in time and vote on whether this article would be published in its entirety, how would you cast your vote? (assuming your vote was significant)

Read the article carefully and the positive points are minimal, with the exception of him acknowledging better training. He implies our board certification is bogus and made it clear that despite the possible training of the podiatrist he battled, the only reason the DPM had a large number of surgical cases was because he was unethical..

This guy despises and resents podiatry. It's clearly stated in his article and more than obvious. So no, I don't believe that any back handed positive comments outweigh the negative implications, comments and tone.

I would let the article be published because it shows what an unreasonable jack-ass he is and how our small profession is causing him concern.

His comments are no more complimentary than telling someone "hey, you look pretty good for a fat guy". Compliment or not?
 
Read the article carefully and the positive points are minimal, with the exception of him acknowledging better training. He implies our board certification is bogus and made it clear that despite the possible training of the podiatrist he battled, the only reason the DPM had a large number of surgical cases was because he was unethical..

This guy despises and resents podiatry. It's clearly stated in his article and more than obvious. So no, I don't believe that any back handed positive comments outweigh the negative implications, comments and tone.

I would let the article be published because it shows what an unreasonable jack-ass he is and how our small profession is causing him concern.

His comments are no more complimentary than telling someone "hey, you look pretty good for a fat guy". Compliment or not?

Agreed. This orthopod is actually quite clever. He is real careful with his words and, in fact, even seems to trick some of you into thinking that he's perhaps neutral against podiatrist (even maybe in favor?) when clearly he resents podiatric medical advancement.
 
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This is an interesting read. I think that the undertone is certainly "look what we let happen," but recognition is recognition. He does acknowledge that our training and competency scope has advanced, so that's nice to see. In the end, the work of DPMs will not go unrecognized by the referring PCPs and the other specialists. Gone are the days where people found podiatrists only in the yellow pages or word of mouth from family; we are now generally getting most of our new patient referrals from other physicians who respect our skill set and what we have to offer... just the way other MD/DO specialists gain most of their patients.

The knee replacements part is total alarmist junk, though. While we learn the anatomy on the same level as an MD student, that's never been a training competency and it's just not in scope for foot and ankle. I'm not sure why he felt the need to add that... aside from scaring some other old school orthos into refusing to train or work with DPMs.
 
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This is an interesting read. I think that the undertone is certainly "look what we let happen," but recognition is recognition. He does acknowledge that our training and competency scope has advanced, so that's nice to see. In the end, the work of DPMs will not go unrecognized by the referring PCPs and the other specialists. Gone are the days where people found podiatrists only in the yellow pages or word of mouth from family; we are now generally getting most of our new patient referrals from other physicians who respect our skill set and what we have to offer... just like other specialists do.

The total knee part is total alarmist junk, though. While we learn the anatomy on the same level as an MD student, that's never been a training competency and it's just not in scope for foot and ankle. I'm not sure why he felt the need to add that... aside from scaring some other old school orthos into refusing to train or work with DPMs.

Well said. Looking forward, the recognition was acknowledged.
 
It is helpful to read the entire article since it is actually about the future shortage of orthopedists and not focused on podiatry. Sure there is a sarcastic quip about us doing knee replacements, but any specialty seems to bemoan others encroaching on their turf including podiatry. I am sick to death of hearing DPMs crying about "foot care" nurses being unqualified to trim a toenail.

I suppose you can interpret his comments in a number of ways, but the fact remains the article makes a clear acknowledgment of podiatrists as being foot and ankle experts. Sometimes it's best to just take that for what it is, an admission that we are the best at what we do from a well know orthopedic surgeon regardless of how that came to be or if that is the way it should be. To me all the other stuff sounds like a bunch of podiatric paranoia, which does seem to be contagious in these forums.
 
It is helpful to read the entire article since it is actually about the future shortage of orthopedists and not focused on podiatry. Sure there is a sarcastic quip about us doing knee replacements, but any specialty seems to bemoan others encroaching on their turf including podiatry. I am sick to death of hearing DPMs crying about "foot care" nurses being unqualified to trim a toenail.

I suppose you can interpret his comments in a number of ways, but the fact remains the article makes a clear acknowledgment of podiatrists as being foot and ankle experts. Sometimes it's best to just take that for what it is, an admission that we are the best at what we do from a well know orthopedic surgeon regardless of how that came to be or if that is the way it should be. To me all the other stuff sounds like a bunch of podiatric paranoia, which does seem to be contagious in these forums.


Podiatric paranoia? Don't think so. First of all, although he did acknowledge our training and education which IS a positive, what were the reasons he mentioned our profession? Was it really to take the time and energy to compliment our profession, or was it to aid him in making his point regarding the future of orthopedics. And i don't believe that anywhere in his writings that he ever stated we are the best at we do.

It appears to me that he is exhibiting the paranoia. His concern seems to be focused on our expansion of practice, though realistically the vast majority of orthopods I know rarely touch the foot and treat the ankle sporadically. And I know of zero orthopods who aren't making an extremely high income.

So no, I'm not the doom and gloom guy on this site, nor am I paranoid. But if you sit back and read the article in combination with his past rants regarding podiatry ( and there have been several), I assure you that his primary intention was to attempt to make a point, not shower us with compliments.

That's simply my interpretation and apparently the Interpretation of many on this site, (and my neighbor who is an internist who read the comments). I didn't insult you after your post that you were naive or missing some points, so I don't or didn't expect you to insult me or anyone else by claiming podiatric paranoia.

It would be unique on this forum if there could actually be a thread void of insults.
 
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Podiatric paranoia? Don't think so. First of all, although he did acknowledge our training and education which IS a positive, what were the reasons he mentioned our profession? Was it really to take the time and energy to compliment our profession, or was it to aid him in making his point regarding the future of orthopedics. And i don't believe that anywhere in his writings that he ever stated we are the best at we do.

It appears to me that he is exhibiting the paranoia. His concern seems to be focused on our expansion of practice, though realistically the vast majority of orthopods I know rarely touch the foot and treat the ankle sporadically. And I know of zero orthopods who aren't making an extremely high income.

So no, I'm not the doom and gloom guy on this site, nor am I paranoid. But if you sit back and read the article in combination with his past rants regarding podiatry ( and there have been several), I assure you that his primary intention was to attempt to make a point, not shower us with compliments.

That's simply my interpretation and apparently the Interpretation of many on this site, (and my neighbor who is an internist who read the comments). I didn't insult you after your post that you were naive or missing some points, so I don't or didn't expect you to insult me or anyone else by claiming podiatric paranoia.

It would be unique on this forum if there could actually be a thread void of insults.

I have been a registered member of this forum for the last five years and I have not insulted a single member of the forum, although thank you PADPM for suggesting so. Please let me know if you are able to find something to dispute that. I don't recall saying that anyone insulted me or my post and certainly didn't react as such. The fact remains that there is a certain level of podiatric paranoia/insecurity/inadequacy that exists among people on this site and damned if I can figure out why.

It is sad to me to see the tone and decorum on what could otherwise be a really useful forum for the profession and for recruiting future DPMs to an awesome calling get so far off course. While I have been a big supporter of SDN since the podiatry forum began I have posted less than 400 times and I only tend to comment when I have something positive to say. It would be nice if some of our 2 yr members with over 1400 posts could try and restrain themselves from responding to every post without something useful to add and try and maintain some sort of civility when posting a response to a colleague who may not have been addressing them in the first place.

I have nothing more to offer to this thread, which careened wildly out of control to the point that the initial message was lost. Take Dr. Sarmiento's words for what you will. I for one found it nice to read one more prominent orthopedic surgeons admission that it was ludicrous to challenge my skills refreshing. I'll sleep well knowing there will be less drama with my orthopedic partners at work tomorrow than there is from some of the DPMs every time I am on this forum.
 
I have been a registered member of this forum for the last five years and I have not insulted a single member of the forum, although thank you PADPM for suggesting so. Please let me know if you are able to find something to dispute that. I don't recall saying that anyone insulted me or my post and certainly didn't react as such. The fact remains that there is a certain level of podiatric paranoia/insecurity/inadequacy that exists among people on this site and damned if I can figure out why.

It is sad to me to see the tone and decorum on what could otherwise be a really useful forum for the profession and for recruiting future DPMs to an awesome calling get so far off course. While I have been a big supporter of SDN since the podiatry forum began I have posted less than 400 times and I only tend to comment when I have something positive to say. It would be nice if some of our 2 yr members with over 1400 posts could try and restrain themselves from responding to every post without something useful to add and try and maintain some sort of civility when posting a response to a colleague who may not have been addressing them in the first place.

I have nothing more to offer to this thread, which careened wildly out of control to the point that the initial message was lost. Take Dr. Sarmiento's words for what you will. I for one found it nice to read one more prominent orthopedic surgeons admission that it was ludicrous to challenge my skills refreshing. I'll sleep well knowing there will be less drama with my orthopedic partners at work tomorrow than there is from some of the DPMs every time I am on this forum.

You have a holier than though attitude, and it's comical that you take the time to post that you have never insulted anyone, and a few lines later post that "It would be nice if some of our 2 yr members with over 1400 posts could try to restrain themselves from responding to every post without something useful to add ..........."

Hmmm, I wonder who you were referring to in that post. But no, that's not an insult, right?

Just in the slight chance you were referring to me (yep, 2 yrs and over 1400 posts), I'd like you to know that if I didn't think I had something to contribute when I respond to posts, I simply wouldn't respond, despite your opinion of what is valuable. I didn't get the memo that you were the guru of what posts were useful and which are not.

Now I will spend time with my podiatric partners so we can create drama.
 
You have a holier than though attitude, and it's comical that you take the time to post that you have never insulted anyone, and a few lines later post that "It would be nice if some of our 2 yr members with over 1400 posts could try to restrain themselves from responding to every post without something useful to add ..........."

Hmmm, I wonder who you were referring to in that post. But no, that's not an insult, right?

Just in the slight chance you were referring to me (yep, 2 yrs and over 1400 posts), I'd like you to know that if I didn't think I had something to contribute when I respond to posts, I simply wouldn't respond, despite your opinion of what is valuable. I didn't get the memo that you were the guru of what posts were useful and which are not.

Now I will spend time with my podiatric partners so we can create drama.

The pattern I've noticed is that drama does seem to follow you around this forum. I'm not sure why, but I don't think it's pure coincidence.


Thank you gustydoc for posting this. It's a very refreshing to read IMO.
 
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It would be unique on this forum if there could actually be a thread void of insults.

Guess the above isn't going to happen.

It's quite simple, drama doesn't follow anyone. However, on this forum if someone writes something and the next guy doesn't agree, it's suddenly a major issue. I write honestly regarding my opinion based on my experiences over the years. Yes, that may differ from another doctor's/student's/resident's opinion, but that doesn't make his/her opinion right or wrong or my opinion right or wrong. However, as soon as an opinion is challenged or a topic is looked at differently, everyone gets defensive.

For some reason, on this site people have a hard time "agreeing to disagree".
 
No problem. Good luck with your studies. The hard work will pay off.

The pattern I've noticed is that drama does seem to follow you around this forum. I'm not sure why, but I don't think it's pure coincidence.


Thank you gustydoc for posting this. It's a very refreshing to read IMO.
 
The Wookie says:
Who cares what an Ortho with a big old chip on his shoulders has to say? The Force is strong with us...if we stick together.
 
While I have been a big supporter of SDN since the podiatry forum began I have posted less than 400 times and I only tend to comment when I have something positive to say. It would be nice if some of our 2 yr members with over 1400 posts could try and restrain themselves from responding to every post without something useful to add and try and maintain some sort of civility when posting a response to a colleague who may not have been addressing them in the first place.

I pride myself on worthless posts (1470 in 2.5 years!).


Oh look... I've done it again! :laugh::laugh::laugh: