Upholding the significance of professional identity

What was the independent review about?

A review was established to examine the existing regulation and regulatory practices used by the Podiatry Board of Australia and the Australian Health Practitioner Regulation Agency (Ahpra). The Independent review of the regulation of podiatric surgeons in Australia aims to ensure the appropriate standards, guidance and processes are in place to support safe practice by podiatric surgeons in Australia; and to make recommendations for any necessary changes.

 

How does the review impact podiatric surgeons?

The review has provided an opportunity to deeply reflect on current practices, to identify areas of improvement, and to collectively work together to further enhance the quality of care and safety for practitioners and patients.

 

How is the ACPS responding to the review?

The Australian College of Podiatric Surgeons (ACPS) is actively engaged in addressing the recommendations made by the independent review.

 

The independent review identifies consumer confusion surrounding the use of the titles ‘podiatric surgeon’, ‘surgeon’, and ‘doctor’ and it recommends a title change. This recommendation presents a distinct issue for the ACPS.

 

We are taking steps, through a newly-formed working party, to address the areas identified as requiring improvement. The ACPS position statement can be found on the ACPS website.

 

How do members of the ACPS feel about the recommendation for a title change?

It is a contentious matter that evokes strong emotions and is a major concern for members of the ACPS. Our argument for the retention of the title ‘surgeon’ relates to the fact that we are a sub-speciality of the podiatry profession that has completed adequate training and is regulated to perform specific types of surgery.

 

I believe any such decision should address the interplay between tradition, public perception, the issue of specialisation and scope of practice, international precedents, and professional equality and regulatory frameworks.

 

Historically, the distinction between surgeons and physicians was quite pronounced.

 

Surgery was viewed as a separate practical craft, rather than part of formal medical education. Surgeons were frequently craftspeople who learned through apprenticeship and hands-on experience, distinct from physicians who focused on medical theory and prescribing treatments. During the Renaissance, surgeons increasingly acquired their skills through formal training, though apprenticeship remained important.

 

For more historical context, Lewis Durlacher (1792-1864) was a notable figure in the field of chiropody, which is now more commonly known as podiatry. Durlacher was appointed as the surgeon-chiropodist to Queen Victoria. His surgical techniques helped to set the stage for modern podiatric surgery.

 

Regarding the public’s perception and clarity around the title ‘podiatric surgeon’, how is that a point for consideration?

The title ‘surgeon’ holds significant public recognition and clarity, conveying a clear understanding that the individual is qualified to perform surgical procedures.

 

This public recognition is crucial to establish trust and confidence among patients, particularly in fields where surgery is a central aspect of practice.

 

The term ‘surgeon’ has become synonymous with several factors: the public’s perception of specialised training, expertise in surgical techniques, and the ability to perform procedures safely and effectively. It sets a clear expectation that the practitioner has undergone rigorous education and training, specifically focused on surgical interventions.

 

This clarity fosters trust in healthcare providers and facilitates informed decision-making when seeking surgical treatment. Changing the title could undermine this expectation and lead to confusion around the expertise and training required to perform surgical procedures competently. Podiatric surgeon is the most accurate and succinct title, particularly given the specialist training and level of qualification required; and as a title that most accurately describes the activity itself, being surgery.

 

Reducing the title could lead patients to underestimate the complexity and seriousness of the surgeries performed, potentially resulting in inadequate postoperative or follow-up care.

 

Do you believe the answer is straightforward; to keep the title of ‘podiatric surgeon’ without making further adjustments?

Yes. We firmly believe there is no necessity for a change in title if regulators and the podiatry profession, including the ACPS, provide clarity and transparency in educating healthcare consumers about our role.

 

We recognise the potential for public confusion regarding the title ‘podiatric surgeon’. Terms like ‘surgeon’ and ‘doctor’ may imply that we are medical practitioners who have attended medical school. It is crucial to clarify that while we perform surgical procedures, we are not medical doctors. We are committed to ensure clarity and transparency around this issue, to avoid any misunderstanding among the public.

 

If podiatric surgeons provide full disclosure to patients as part of the consenting process, to explain our qualifications and scope of practice, this can mitigate any potential confusion.

 

Such disclosure can be reinforced through informative resources, provided by podiatric surgeons and referring practitioners. If we inform the public better than we have done in the past, we can address the issue of public confusion; negating the need for a title change.

 

Can you provide an example as to how this might work in practice?

Certainly. As an example, before a patient visits a podiatric surgeon, it is important for the referring practitioner to provide them with informative brochures that outline the identity and scope of our services. Such resources are provided by the ACPS and they will have a pivotal role in empowering patients to aid informed decision-making.

 

The podiatric surgeon then supplements this information with additional details, shared during the consultation, to ensure patients are well-informed and confident in their choices.

 

Importantly, in this example, the podiatric surgeon would provide full disclosure to patients, so this information-sharing becomes part of the consenting process. Ultimately, the patient would read, understand and sign off on this information before they have treatment with a podiatric surgeon.

 

For example, the disclosure could be along the lines of: 

I understand that a podiatric surgeon is a registered specialist podiatrist who is trained in the diagnosis and treatment of foot and ankle disorders by both surgical and non-surgical methods and is not a medical practitioner (medical doctor).

 

 

What are your thoughts on the title of ‘podiatric surgeon’ in the context of the regulatory framework and standards?

The title ‘surgeon’ is underpinned by a rigorous regulatory framework and standards, to ensure professionals are fully equipped to perform surgeries safely and effectively.

 

The process of becoming a surgeon involves extensive education and training. These programs are designed to provide in-depth knowledge of surgical techniques, anatomy, and patient care; as well as hands-on experience in performing surgeries under the supervision of experienced surgeons.

 

The documented regulation, compliance and oversight provided by Ahpra, PBA and the ACPS, ensures that anyone bearing the title ‘surgeon’ adheres to high standards of education, training, and ethical practice.

 

This not only guarantees the competence of surgeons but ensures public safety and trust in the healthcare system. Patients can be confident that podiatric surgeons have been thoroughly vetted, and are qualified to provide the highest standard of care.

 

How does the issue of specialisation and scope of practice come into consideration, when you reflect on a potential title change?

Specialisation and scope of practice are critical aspects of the title ‘surgeon’, particularly for occupational groups who are trained to perform specific types of surgeries.

• Firstly, these groups may not require full medical training, but they need a high level of specialised skill and knowledge to carry out their surgical duties effectively and safely. In many medical fields, specialisation allows practitioners to focus on particular areas of surgery, to develop deep expertise and proficiency in specific procedures. For instance, orthopaedic surgeons, cardiovascular surgeons, and neurosurgeons all undergo specialised training tailored to their particular surgical domains. Similarly, other surgical professionals, such as podiatric surgeons or dental surgeons, receive focused training that equips them to perform surgeries within their specialised fields.
• Secondly, the use of the title ‘surgeon’ acknowledges this specialised element of their practice. This title distinguishes these professionals from generalist practitioners, and highlights expertise in their particular surgical domain. This distinction is essential for patient understanding, to provide clarity around the specific skills and qualifications that the surgeon possesses. The title ‘surgeon’ thus becomes an indicator for specialised training and expertise; signifying that the individual is qualified to carry out the surgical procedures pertinent to their field.
• In Australia, oral surgeons are licensed to perform oral surgery. Their training involves extensive education in dental schools, followed by specialised surgical training. Similarly, podiatric surgeons undergo rigorous training focused on surgical procedures related to the foot and ankle. These professionals are recognised as surgeons, due to their specialised knowledge and skills; despite not having a traditional medical degree.
• Thirdly, the term ‘podiatric’ originates from the Greek word ‘podos’, which pertains to the foot. This establishes the title within the field of podiatry, being a specialised area of healthcare that focusses on diagnosing, treating, and preventing conditions that affect the feet and ankles. By including ‘podiatric’ in the title, a distinct boundary is defined, marking it as separate from other healthcare professions and differentiating it from other medical fields.
• Finally, the title ‘podiatric surgeon’ is not just a semantic choice, but an accurate designation that encapsulates the specialised nature of those it represents. This title, when examined, reveals a deliberate and precise choice of words that aligns with the unique expertise and skills possessed by this profession. Hence, ’podiatric surgeon’ is suitable given the straightforward linguistic notion that a surgeon is an individual who performs surgery.

 

One might argue that the alternative term, ‘surgical podiatrist,’ is also linguistically valid, yet it is not consistent with other similar terminologies. For instance, we refer to dental surgeons, not surgical dentists.

 

Additionally, this term is not commonly used by the professional bodies or the training institutions that represent these practitioners, and hence, it does not effectively fulfill its descriptive function. I believe this perspective is consistent with the argument presented in a paper titled ‘Foot’ and ‘surgeon’: a tale of two definitions (2010), where it critiques the concept of ‘surgical podiatrist’ as flawed in differentiation from ‘podiatric surgeon’. The publication continues to explain the adjective, ‘surgical’, can be defined as ‘relating to or used in surgery’, which infers that the podiatrist is performing surgery, and the noun for someone who performs surgery is, of course, ‘surgeon.’

 

Are there international precedents in place (which reflect also on professional equality?)

Yes. International precedents highlight the use of the title ‘surgeon’ by professionals with specialised surgical training who may not possess a traditional medical degree.

 

For instance, dental surgeons (dentists) and podiatric surgeons are recognised as surgeons within their specific scopes of practice across many countries. These professions exemplify how specialised training equips individuals to perform surgical procedures effectively, warranting the title “surgeon.”

It is important to continue to align with our international peers, such as in the UK, where terms such as ‘consultant podiatric surgeon’ and ‘podiatric surgeon’ are recognised and have been used within the National Health Service (NHS) for many years reflecting the roles podiatric surgeons fulfill. Likewise, the term ‘podiatric surgeon’ has been in use in the USA for decades.

 

Any final thoughts to share?

The protected title, ‘podiatric surgeon’ is appropriately used by podiatric surgeons under the National Law and has been accurately informing the Australian public for more than 10 years. All available evidence supports the facts that podiatric surgery is safe, effective and costs the public less than other providers of the same service.