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Who? What? When? Why? Yeah? And? So? What?

"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

Havn't we got a single united regulatory body, the HCPC ?

The other professional bodies you listed Simon were specific job related. Medicine (Surgery) is regulated by the GMC but the various jobs within have their own professional bodies; would not Podiatry be better separated from Podiatric Surgery ?

The doctor's professional body is the BMA with about 65% of the profession members; sensibly they have quite separate indemnity organisations.

The HPC are the regulatory body. They are not the professional body for podiatry per se. They regulate the professions allied to medicine, like podiatry. All of the professions I listed are regulated by the HPC, yet have single professional body's within the UK.

How many medical doctors are there in the UK? How many surgeons who are doctors are there in the UK? How many podiatric surgeons are there in the UK?

We are not medical doctors. We are aligned with the allied health professions: dentistry, physiotherapy etc. these probably have greater numbers in the UK than podiatry, yet still resolve to a single, united professional body. I'd venture that it is the notion of "separatism" advocated by many UK podiatric surgeons that I have met over the years that has helped to create some of the division within the profession and moreover, some of the lack of support from the profession as a whole that they might find when faced with situations such as described in this thread.

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Who? What? When? Why? Yeah? And? So? What?

"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

Simon, I think we're talking about different things.

When you said 'a poll to see if the profession wanted a single regulatory body' I took it as that; presumably you ment a single professional body !
If so, membership of a professional body is not mandatory, so a poll would be pointless. Those that wanted to join would, those that didn't wouldn't....

Yep, my bad; now fixed. I am interested to hear your thoughts on why podiatry might be better separated from podiatric surgery in terms of both it's regulation and professional representation.

__________________
Who? What? When? Why? Yeah? And? So? What?

"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

Regarding professional bodies, probably for the same reason there's a Royal College of Physicians and a Royal College of Surgeons. They have a common grounding but the actual jobs are quite different, they seem to attract different personalities as well.

As for regulation, a General Podiatric Council would do for both.

This could indeed be a better state of affairs. Maybe the lead should be taken from dentistry then and have a specialist register for podiatric surgeons analogous to the register for maxillofacial surgeons: "To gain entrance to the Specialist Register for the Speciality of Oral & Maxillofacial Surgery, a surgeon must have qualifications in dentistry and surgery - be a registered dentist and registered medical practitioner, according to the European Specialist Medical Qualification Order 1995. This recognition comes from both the General Medical Council and General Dental Council. Oral surgeons don't need to be dentists though"


So, the way forward should be that in order to enter the specialist register for the speciality of podiatric surgery, a surgeon must have qualifications in podiatry and surgery- be a registered podiatrist and registered medical practitioner. Foot surgeons don't need to be podiatrists though. I believe this would resolve the current issues and problems with podiatric surgeons perceived by some orthopaedic surgeons, journalists and members of the public.

How many podiatric surgeons in the UK would currently meet such a criteria? And how would those that don't currently meet this criteria feel about going to medical school to gain the required qualifications to become a registered medical practitioner?

I'd support your contention that podiatric surgery attracts a certain "personality type" at present in the UK. I don't believe that this is necessarily a good thing though. Perhaps, this "personality type" might be a stumbling block for some of those that didn't meet the criteria suggested above, if they had to apply to medical school to gain registration as a medical practitioner. Funnily enough, I have not noted this same trait in podiatric surgeons elsewhere in the world.

How would you describe the "personality type" of podiatric surgeons within the UK?

__________________
Who? What? When? Why? Yeah? And? So? What?

"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

'How would you describe the personality type of surgeons in the UK' ?

Much the same as anyone whose job involves invasive insult to the human body, with all its potential sequela.....

Hello Simon
I have a thought about the dual med qualification I'd like to add, although I'm sure its probably unnecessary:

I can see why Max-fax surgeons have the dual qualification. Max-fax as I understand is probably one of the most serious/mental specialisms out there. This story may illustrate: I once worked with a recently graduated dentist, and he had done an observational placement in a max-fax dept during his training, during one procedure lasting 7 or 8 hours, the patient had his tongue removed right from his head and pinned to a table while two Max-fax surgeons proceeded to remove strings of enlarged cancerous lymph nodes from his throat, the dentist nearly hurled. He saw other procedures like stapling peoples skulls back together ect too.

I personally think Podiatric surgery by comparison - is probably less mental. I would put money on max-fax pts having poorer odds than pod surgery pts in terms of post op survival. Thats just my opinion. But based on that, I kind of imagine the med qualification may be less important to a pod surgeon, I imagine they have everything covered at sufficient level.

I really hope I'm not miss interpreted there, pod surgeons I've spoken to have really impressed me and I do look up to them, and I hope pod surgery only grows, and I dont think foot surgery is unimportant or minor, its just less mental than max-fax. Perhaps it would be better if medics had to be dual qualified in podiatry if they wanted to do foot surgery! But yea, if pod surgeons were dual qualified then there would be a bit less for the newspapers to moan about wouldn't there...

Max

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Hi Bill,

No offence was intended and thank you for reminding everyone about the 'Chinese whisper' nature of media reporting. The bbc article states:

"He said they develop "highly skilled and meticulous surgical techniques", and had to undergo six years of podiatric medicine training before completing a masters in podiatric surgery in order to qualify for the title."

The paragraph prior to this was accurate, but this one is not entirely accurate. These days, our young surgeons in training must complete a 3 year podiatry degree. The MPodA and part 5 and the subsequent part A & B have been replaced by the MSc in theory of podiatric surgery which is 2-3 years part time. The candidate then needs to get through the OAPS/ passport system before being able to apply for a pupillage. During the pupillage they prepare for their part 1 exam (similar to the old part C), then the part 2 (similar to the old part D, 6 or FPodA) after minimum of 3 years in their pupillage. Once past the part 2, they must then be elected to fellowship to use the FCPodS/ podiatric surgeon title and apply for a registrar job. The registrar period is a minimum of 3 years before application for the certificate of completion of podiatric surgery training. Once completed, they may then apply for a job as a Consultant Podiatric Surgeon.

I would be amazed if a journalist in the land would print that, but the reality is that it would be more accurate to quote a minimum of 5 years, rather than 6 years before completion of the masters. Then it is more accurate to say that you can only qualify to use the title 'podiatric surgeon' after a minimum of 8 years training (even then you need a further 3 years before Consultancy). I suspect there may have been an element of journalistic license that has slightly distorted these facts and I apologise if my original post seemed in any way negative towards the statement, perhaps I should have used 'not entirely accurate' rather than 'inaccurate'?

Kind regards,
Bob

Hello Simon.

With regards to the first quoted paragraph, you could be right, but there would no doubt be some other profession that would take umbrage with/ encroach upon some element of your work at some point. Sometimes I wonder if having orthopods and pod surgeons in competition is such a bad thing? It is possible that competition between the 2 disciplines could be healthy and spur each other on to constantly improve. An example of this is the formation of BOFSS/BOFAS as a response to the development of podiatric surgery in the UK. At least some orthopods are doing one year foot fellowships as opposed to 'having a go' at foot surgery these days. Regardless, the Daily Mail would still print rubbish about how bunion surgery causes super-hyper-mega-aids or something similar and orthopods would probably still bitch and moan and use patients as pawns in their private practice games (as I have seen them do to their own). I am sure this is not exclusive to orthopaedic surgery by the way, I suspect there are truly horrible people in nearly every job.

You said "...a surgeon must have qualifications in podiatry and surgery- be a registered podiatrist and registered medical practitioner." Being a registered medical practitioner does not make you a surgeon. I am unsure as to how much better I would be at foot and ankle surgery if I went back to medical school for 5 years so I could call myself a doctor and prescribe drugs independently. I am willing to bet that it would have a negative impact on my personal outcomes if I stop operating for 5 years. Apart from reducing attacks from outside the profession, I am unsure how useful this could be. If you look at some of the published attempts at comparing podiatric surgery with orthopaedic, I have yet to see one that favours orthopaedics. Ideally, an entirely independent study of outcomes of both disciplines could be performed to assess the true value of each and help us to understand who really is best placed to do this sort of work.

In answer to your first question in paragraph 2 - sort of none. There was a podiatric surgeon who went to medical school (I am not sure if he is active as a podiatric surgeon currently but he was somewhere around south west London last time I heard). As far as the second question goes, I probably answered that in my last paragraph. I'm not sure how useful it would be, but if it were proven to improve outcomes for patients then we should do it. It would need to be done for the right reasons though - not just so I could call myself 'doctor bob' to make me feel like a big man.

Regarding attempts at personality typing podiatric surgeons (or others groups in the profession) - I think it is lazy. I recall expressing an interest in podiatric surgery many years ago before I headed down the path and was told at the time by a respected university lecturer about it being an old boys network filled with arrogant, jumped-up, self-important, not particularly nice people and not to bother. Thankfully they were proved wrong when I got off my behind and went to spend some time actually meeting some of the surgeons and watching them operate. I would be lying if I said that everyone I have met along the way has welcomed me with open arms and a big smile, but every rose garden has its pricks. I would appeal to all potential podiatric surgeons (and anyone who has any interest in it at all) in the profession to visit your local department and make your own mind up. If you do not like the person you meet but you are interested in surgery, move on to the next unit. Do you (Simon) believe that podiatric surgeons in the UK have a personality type? I do not. They are just people - like you and I.

The "invasive insult" personality type, your description probably sums it up nicely. Thanks. Certainly, some have this personalty type.

__________________
Who? What? When? Why? Yeah? And? So? What?

"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

I didn't say it did, I said a surgeon and a registered medical practitioner.


We don't know how useful it wold be because it seems no-one has done it. As you note:

I think medical training has more to offer than the ability to call oneself Dr. As an aside, going back many years it was pointed out to me that a podiatric surgeon who's first names were David Robert used to write his name as DR .....

I wonder where on earth they got that impression from?

__________________
Who? What? When? Why? Yeah? And? So? What?

"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

Thanks for the reply Simon.
With regard to the first 3 paragraphs - we do not know what advantages being a medical doctor has to offer the podiatric surgeon. Independent prescribing rights is on its way and the surgical scope of podiatric surgeons seems to be on a par with any other podiatrists' across the world (local facilities permitting). We do not know if being a medical doctor would open more doors to us and I suspect you would still have a perceived divide between podiatric and orthopaedic surgeons in the model you describe. As I stated before - there are very similar issues across all aspects of medicine.

Regarding the aside - I heard the same rumour you mentioned too. Since then, I met the person in question and can only take him on face value and I can vouch that he is a thoroughly nice person who is dedicated to podiatric surgery and the future training of podiatric surgeons so I can not say a bad thing about the guy. I presume the person that I heard the rumour from has a similar outlook on life to the university lecturer that I mentioned before. That person probably got the ideas about podiatric surgeons that I mentioned from the same place that he gets his other insecurities and prejudices from. Incidentally, years later I heard rumours about that lecturer and what might have motivated his views of podiatric surgeons but it is not helpful to perpetuate these stories. As I mentioned earlier, there are some not particularly nice people in many aspects of life and I believe it would be a folly to think that all podiatric surgeons are bad guys (or even all orthopods).

I do not know if the current or previous faculty of podiatric surgery have seriously looked into what benefits (or otherwise) there may be to having a medical degree. As I said somewhere else on here, I am not personally that involved in that part of the profession so I am not best placed to comment on the efforts that have gone before. It would be worthwhile looking into this in a serious way I am sure, but purely to explore how it could augment practice and training of podiatric surgeons and obviously not for less positive reasons (eg. to get the daily mail off our backs). Having spoken and worked with many medical colleagues over the years I can see some advantages of a more structured learning experience for the student (this refers to my training and I can not comment on the MSc/part 1/ 2 route that our trainees do today) but I still do not know if it would make me a better surgeon. Other surgeons (including some orthopods) are surprised to learn about the depth of current and past training in podiatric surgery when they actually find out the reality. An orthopaedic colleague of mine a few years ago commented that his trainees do not get examined on their practical skills that they have been learning at all and perform nowhere near the numbers that we expect of our trainees. Of course this is just a small example and there are many issues that hopefully have been explored by someone who is better placed than me.

Gotta go. Have a nice day,
Bob

Surgeon's personalities - I didn't and wouldn't suggest that surgeons, of whatever specialty, fitted a 'personality type'. However, certain characteristics have been shown to be stronger in surgeons than non surgeons; particularly decisiveness and extrovertiveness.
This confirms the old humourous description that physicians get the best results from 'don't just do something, stand there'; the opposite for surgeons !

Thanks Bob

You did actually say in your submission that the statement from the Institute was inaccurate. In fact it was misreported by the media, as I suggested to you. You can see the full statement which was supplied to the BBC and others on the Institute web site, and once again, I will be happy to stand corrected if anything in that statement is inaccurate. I am fully aware that podiatric surgery education has changed since the time that I qualified and I think that you will find this covered by the Institute.

I would just gently point out that since certain universities require a 4 year course for the basic BSc(Hons) in podiatry, my statement of 'up to 6 years podiatry training before undertaking an MSc in the theory of podiatric surgery' was correct, although I made it clear that 2 of those years was post graduate CPD and 3-4 years was the basic course.

The moral of the story is, beware of the media; they will broadcast/print what they want and we do not have the financial wherewithal to obtain judicial correction. However, in my view, it is still important to put up a fight rather than roll over and surrender to the first bully that comes along.

All the best

Bill

Quoted by Bob

"Thanks for the reply Simon.
With regard to the first 3 paragraphs - we do not know what advantages being a medical doctor has to offer the podiatric surgeon. Independent prescribing rights is on its way and the surgical scope of podiatric surgeons seems to be on a par with any other podiatrists' across the world (local facilities permitting). We do not know if being a medical doctor would open more doors to us and I suspect you would still have a perceived divide between podiatric and orthopaedic surgeons in the model you describe. As I stated before - there are very similar issues across all aspects of medicine."

I am sure that you are correct in this. The whole 'game' is based on control and the fact that the orthopods are nettled by the independence of our profession. If pod surgeons did undertake a medical degree then they would fit into the medical mould and how long would it be before the orthpods scuppered pod surgery and allowed only their BOFFS types to carry out foot surgery?

Just out of interest, a few years ago at my NHS hospital I asked the Max-Fax chap how many of his colleagues remained in Max-Fax having undertaken the medical degree and was told the figure was 40% - in other words a 60% loss. Also out of interest, one of my assistants (pod, not pod surgeon) who was a bright lad, was put on the fast track at Leicester medical school and he did not return to podiatric surgery. Thus, in addition to Bob's acute observations, there are 'political' elements to discourage podiatric surgeons undertaking a medical degree.

All the best

Bill