How Podiatrists Can Protect Our Economic Interests

I read with great interest the recent Podiatry Today DPM Blog by Patrick DeHeer, DPM, in which the author pointed out the potential bias of orthopedic journals against podiatrists.¹ I can’t speak to his specific incident as there certainly could have been an honest mistake by the software being utilized by the publisher that caused the amazingly quick rejection of his paper. I would like to think the blinded review process is real and that no papers are categorically rejected based on the degree of the author.

However, in reality, I don’t know if that is true. Our institution has submitted many papers to an array of journals including predominantly orthopedic journals. We have had many accepted and some rejected by all of the journals so I can say there isn’t a complete bias against podiatrists. However, I can remember in at least one instance, our paper was rejected and one of the reviewers commented that this was clearly authored by podiatrists. Interestingly, we submitted that same paper to a different journal, which was not a typical podiatric journal, and it was accepted after minor revisions.

Dr. DeHeer points out that articles that are published in typically orthopedic journals do not cite podiatric references at the appropriate rate. He certainly backs that up with his excellent data. It has been my observation, as a passionate reader of orthopedic and podiatric literature, that this is commonplace. I have continually found it astounding that podiatrist-authored literature is constantly omitted from references in foot and ankle orthopedic journals. This is also the case during presentations from the podium at conferences such as the American Academy of Orthopedic Surgeons and the American Orthopedic Foot and Ankle Society (AOFAS) meetings. It appears that authors and presenters will go out of their way not to recognize podiatric contributions to the literature.

Dr. DeHeer’s blog brought up the memory of the DPM Blog I published in Podiatry Today last May.² I received many positive comments from people who were enlightened by this posting. I also heard some negative feedback from podiatric leadership, whom I feel misinterpreted my intentions.

There seems to be a systematic effort to discredit anything positive with respect to podiatric medicine and surgery. As I pointed out in the blog, the AOFAS has made it known to its constituents that participating in the educational welfare of podiatrists is unacceptable.²

There is now a concerted effort to reduce educational opportunities for podiatric surgeons. It is well known that the American Orthopedic Foot and Ankle Society (AOFAS) will not allow any of its committee chairs, board of director members, or aspiring leaders to participate in the education of podiatrists, whether it be at the residency level, fellowship level, continuing medical education or industry-sponsored events. There is a systematic effort in place to prevent podiatrists from continuing to improve their skills, thereby reducing the level of care of the American public.

Interestingly, many of the people who have been presidents, board members or committee chairs of the AOFAS have developed surgical innovations that they are currently marketing to foot and ankle surgeons worldwide. Many of these doctors have intellectual property that provides them with royalties for their inventions when surgeons utilize the products. We live in a capitalist society and there is nothing wrong with people making money on their intellectual and physical contributions to the advancement of patient care. I personally have several intellectual properties and receive royalties for different inventions.

However, I find it incredibly hypocritical that many of the orthopedic surgeons who have publicly taken an anti-podiatry stance and have created the AOFAS policy of not allowing education of podiatrists are still collecting royalties and personal financial gain from the products that podiatrists are using.

If you have any doubt about how the AOFAS feels, take a look at its website, www.AOFAS.org , and see how it subtly makes digs at podiatry. Why is this? It’s about dollars and economics. The AOFAS fears that podiatry provides outstanding care and it could cut into the economic well-being of orthopedists. Don’t let the propaganda fool you. The AOFAS accepts members from around the world with far less comprehensive education, training and proven results than American podiatrists. 

All of the above should anger the podiatric community.

In the past, people have asked me how can we change this and my answers are not very simple. Our leadership has tried to create dialogue between the orthopedic leadership and has made progress, but that is a slow process and depends on the political and policy importance of both sides.

I believe the best way to make an impact is to affect the economics of the situation. As I pointed out, many of the people who have committed to hurting podiatry are benefitting financially from the work podiatrists do. Many of the surgical products that are being used by podiatric surgeons have royalties that go to those orthopedic surgeons who are trying to bury podiatry. I would ask you to consider not using products that have royalties going to one of these people as long as one can use an alternative product with similar surgical outcomes.

I would like the American Podiatric Medical Association, American Society of Podiatric Surgeons and American College of Foot and Ankle Surgeons to require from industry that they publish which orthopedic surgeons have pledged not to train or teach podiatrists, and are receiving royalties from those products so that we as a profession can determine if we want support people who are against us.

Additionally, I would suggest that you ask your local industry representative who is getting royalties from the products you use and whether they are “anti-podiatry.” Don’t allow your friendship with a rep or an occasional lunch prevent you from asking these questions and making hard decisions. Don’t expect that just because you heard a podiatrist lecture about the product that it actually is podiatric in design and development. Personally, I almost never use a product in surgery if the royalties go to the group mentioned. It is a conscious decision on my part.

The AOFAS website that I referenced above is funded by the people who in many cases are getting royalties from podiatric use of their inventions. The AOFAS certainly don’t stop with just the website but the organization is constantly trying to market why an orthopedic-trained foot and ankle surgeon is superior to a podiatrist.

Podiatric surgery accounts for a significant part of the revenue for companies who manufacture and sell surgical implants in the foot and ankle. We are powerful. The way to effect change is to create an economic disruption. 

I urge you to take this blog to heart. We are entering the busiest surgical time of the year across the country. Take action now and let’s go into 2017 with a sense of responsibility to protect our profession. We need to stop funding our own demise.

References

1. DeHeer P. Raising concerns about podiatry submissions for an orthopedic journal. Podiatry Today DPM Blog. Published Nov. 9, 2016. Available at https://www.podiatrytoday.com/blogged/raising-concerns-about-podiatry-submissions-orthopedic-journal .

2. Weil L Jr. Clearing up the misconceptions of orthopedic surgeons over the VA Provider Equity Act. Podiatry Today DPM Blog. Published May 27, 2016. Available at https://www.podiatrytoday.com/blogged/clearing-misconceptions-orthopedic-surgeons-over-va-provider-equity-act .