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Change of course name at Michener

Discussion in 'Canada' started by Cameron, May 5, 2009.

Tags:
  1. Mart

    Mart Well-Known Member

    bpod . . . .. Sue?

    I used to have a similar viewpoint but have gradually shifted away from this.
    Here’s my current perception

    The sources of division in Canada include that;

    1 Health care legislation is a provincial affair.
    2 There is no nationally recognised educational establishment.
    3 There is no nationally recognised educational requirement
    4 There is no cohesive definition regarding what a podiatrist does and what the public can expect from a podiatrist nationally.
    5 There has been no comprehensive objective evaluation of level of competencies between the various educational options internationally.

    As you mention there are provinces which have no legislation and hence no access to the reserved acts of prescribing drugs, accessing investigational testing and performing any type of foot/ankle surgery.

    Provincial legislation does 2 things. It defines scope of practice and it protects title. This is important because no jurisdictions to my knowledge attempt to do this for the term “foot care”. Footcare is provided legitimately from all kinds of background including nurses, pedorthists, primary care physicians, physiotherapists, orthopaedic surgeons and so on. So a “cohesive idea of what foot care is in Canada” is not the issue as far as interprovincial mobility for podiatrists is concerned.

    Currently BC requires that new podiatry applicants need to have completed a DPM followed by a 3 year surgical residency to be eligible for licensure. Also the expectation of all graduates from the Chicago DPM program is to complete a 3 year surgical residency.

    The vision of the College of Podiatrists in BC is that the expectation of those who consult a “podiatrist” should expect this as a minimum background. Those with this kind of background would probably not want to spend their careers doing what might broadly be interpreted as “foot care”, they would expect a much more specialised role.

    The issue of professional unity is closely tied to the vision and influence of those available and elected to pave a route to the future. Democratic change often requires persuasion and it is difficult to persuade those who feel threatened by what that might amount to.

    Podiatric visionaries in Canada have come from 2 educational backgrounds; The UK and the US.
    Ontario and Saskatchewan imported entire UK chiropody programs from the UK and Ontario devised an education system based on the old UK chiropody diploma at the Michener. Ontario was further complicated by restricting DPM licensure. Manitoba, until 10 years ago had such an archaic legislation with a limited scope of practice which only attracted non surgical UK grads.

    Alberta and BC adopted the more progressive DPM model and in terms of scope and integration into medicine seem to have established the most effective presence in terms of offering patients a comprehensive range of options.

    To get on the “same page” and “move forward” “we” need to look at “our” vision.
    My beliefs are based on my own observations; unfortunately we have no really objective viewpoint but for what it’s worth this is my observation.

    The old UK model is still alive and kicking in the UK and continues to divide the profession there. There are those who resent the idea that their education is inadequate and feel quite happy to provide “foot care”. “Why not, there is a demand for this, it provides a reasonable income and for some job satisfaction”? There are others there who feel the need to offer their patients more, fill in knowledge gaps and get better educated. Generally the motivation to do this seems to be disillusion with typical role and status of podiatry within healthcare, boredom, recognition of clinical inadequacy and desire to have more to offer patients. Recently a formal route to upgrade knowledge and scope has been made accessible via MSc programs. I am not sure but suspect the same to be true in Australasia.

    The national division in Canada exists because of parallel educational evolution.

    The division will only be overcome if those involved adopt the same vision. We need to consider not what as individuals we have achieved but what we might aspire to if we were starting over.

    I am not sure if that is possible because “podiatrists” in Canada seem to have quite differing expectations of themselves. This seems to be true also in the UK and perhaps also in the US.

    An area of contention I have heard is whether there is sufficient demand for highly educated podiatrists. My feeling is that the better educated will have more to offer and adapt more effectively to gaps in medical services. This ultimately is the only reason podiatry exists in the first place.

    I think there is a perception of being undermined from the least educated be they from Michener program or the UK. It is difficult be candid about implied “inferiority”, our egos resent this. So to repeat “We need to consider not what as individuals we have achieved but what we might aspire to if we were starting over”. That might also translate into “what we might do now as individuals to influence the future”.
    It seems correct and typical that as knowledge grows so professional expectations rise and with it the bar to entry. This doesn’t normally eliminate those already practicing from the equation but it does change professional profile by attrition.

    Is it realistic to expect ourselves to agree on a national vision based on a Canadian education system unless it can meet the highest standard already set?

    Should Canadian educators be training podiatrists to work in certain geographic locations or to achieve a certain level of practice?

    Do “we” want our professional future in Canada to be explicitly superior or inferior given the current range of educational options, and legislative or financial limitations?

    I feel that the DPM option is likely the best and that the MSc route also much to offer, particularly as an immediate and attainable bridge for those of us who did not or were unable to choose a DPM route.


    Cheers
    <o:p></o:p>

    Martin
    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
    <o:p></o:p>
     
  2. bpod

    bpod Active Member

    Martin,
    I agree with you entirely. I also think a DPM program is the best model to go forward with. If only the provinces could have hashed out the labour mobility properly, and sorted out the differing acts.....if only if only......It is so easy to get bogged down by the belittling and sniping that appears to go on between DPM/DCh/DPodM/BSc. (Pod) groups. Reality is if you are good and create a niche for yourself in the market place, there is room for all. Would be great to see things move forward for the students coming behind us.

    Sue Davidge
     
  3. simonf

    simonf Active Member

    This is an interesting thread, I haven't been in here for a while.

    When looking at the relative merits of the different education systems, it is important to look at the method of health care delivery in the localities that the education systems are rooted.

    The philosophy of the DPM program (USA), is that all podiatrists will be exposed to all levels of practice including Podiatric Surgery. Whereas the UK and Australian programs put advanced practice such as Podiatric Surgery in the post graduate setting. This means that a high percentage of DPM's may have surgical competence, whether they regularly practice or not. In the UK a small percentage of Pods will advance to surgical practice, pretty much all of these will be engaged in surgery for the majority of their working time, typically in a publicly funded position, undertaking a high volume of surgery.

    Both of these scenarios work well for the localities involved. Canadian Podiatry sits somewhere between these two worlds in terms of how services are funded and provided.

    It is laudable to work towards a ratcheting up of educational levels, however this needs to be in line with the needs of the population and in the context of available funding.

    Perhaps some national approach should concentrate on setting up some framework whereby all education programs can be credited towards regulation across the country, based on the competencies the program delivers, rather than the locality of the educational establishment. It may also be sensible to establish registers of practitioners who have either surgical, non surgical or some other specialism.

    It is probably fair to say that a divided profession is weaker than a unified one.
     
  4. Mart

    Mart Well-Known Member


    Hi Simon

    <o:p></o:p>
    Totally agreed and perhaps you have identified the most important difficulty for us in Canada.<o:p></o:p>
    <o:p></o:p>
    My impression is that in the US, the expectation within the podiatry schools is that foot/ankle surgery is the major domain of podiatrists. This it seems is generally accepted within the multidisciplinary undergrad programs which share common interdisciplinary educational blocks. <o:p></o:p>
    <o:p></o:p>
    Now if this is true and as it seems the DPM dominated provinces are aligned to this "vision" it would seem reasonable that their legislation should re-enforce this. Not to do so would undermine the essence of podiatry as they see it.<o:p></o:p>
    <o:p></o:p>
    As you know in the UK and the non DPM provinces in Canada there is a layered framework, this accommodates non surgical podiatrists, and I agree that for us is appropriate.<o:p></o:p>
    <o:p></o:p>
    Is it unreasonable as a contemporary DPM to say "well I chose my education path because I regarded it as optimal, I want others to regard what I do in that light, nothing else is acceptable"?<o:p></o:p>
    <o:p></o:p>
    What reasonable arguments(s) can be presented those who have decided that the 3 year surgical residency is a prerequisite for optimal podiatric care and that without this background (or equivalent) the designation podiatrist cannot be used? <o:p></o:p>
    <o:p></o:p>
    I think that debating these questions is a reasonable avenue to explore and perhaps warrants a different thread because we have moved the topic somewhat from the Michener issue.<o:p></o:p>
    <o:p></o:p>
    I will create a new one and see if we can engage a wider audience<o:p></o:p>
    <o:p></o:p>
    cheers

    Martin

    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  5. Mart

    Mart Well-Known Member

  6. SarahR

    SarahR Active Member

    We have an opportunity to shape our profession for the better. We should pick and chose the best of both models and work it to fit best in our health care system, and work to change third party insurance policies to better fit our increasingly privatized system of care.

    Non-DPM programs excell in teaching biomechanics, palliative care, soft tissue, DPM programs excell in their internal medicine/surgical skills development. Lets do both.

    The defensiveness and animosity comes when some seek to throw out the baby with the bath water and continue to publically denigrate clinicians who don't have a 3 year surgical residency. The frustrating part is some of those who are most vocal in Ontario haven't even got 1 year residency under their belt!

    I was told this residency doesn't just teach surgery, it teaches "medicine". It is commonly said or implied that D.Chs and D.Pod.Ms and even B.Sc.Pods are technicians by some in this camp. Come sit over my shoulder for a week and then we'll see if you still insist upon calling me a technician. Most of the demand for care exists in the areas where our scopes overlap.

    Sarah
     
  7. Mart

    Mart Well-Known Member

    [Hi Sarah

    <o:p> </o:p>
    Couple of things. <o:p></o:p>
    <o:p> </o:p>
    I believe that non DPM education has plenty of value but also that contemporary DPM with residency is probably the best education outside of a foot/ankle orthopaedic specialty. This is based on discussions I have had recently with DPM students, MSc and BSc students and educators in the UK, the type of literature disseminated in the medical literature and presence within various internet based forums and information. <o:p></o:p>
    <o:p> </o:p>
    An important question though, even if my belief is true is; does this DPM/residency represent the best value for the current (healthcare) system? I am not sure if that question can be answered because it may be that the needs of each provincial system may differ significantly or not even be usefully measurable. <o:p></o:p>
    <o:p> </o:p>
    Compared to the UK I perceive that the increased accessibility in Canada to the legislative process allows provincial control of certain local issues to be more responsive. Perhaps it does so though at the expense of national unity in the case of podiatry.<o:p></o:p>
    <o:p> </o:p>
    Ultimately it may be that Canada’s local needs and resources are too diverse to allow generalized agreement in certain areas. Podiatric legislation may be such an area. To create unity might require that needs and resources to become aligned, I think this is in different words what Simon was saying. <o:p></o:p>
    <o:p> </o:p>
    Perhaps after proper debate we may need to accept division RESPECTFULLY and stop banging our heads and see what our diversity has to offer without feeling conflicted. <o:p> </o:p>
    <o:p></o:p>
    This presents problems for interprovincial labour mobility though and I am beginning to question the essence of what that means if we accept diversity as an appropriate response to a local situations. <o:p></o:p>
    <o:p> </o:p>
    What should take precedence; the standard of care or the unrestricted mobility of those who provide the care?<o:p></o:p>
    <o:p> </o:p>
    Much of the rational issue is over what podiatry represents. <o:p></o:p>
    <o:p> </o:p>
    It seems that in BC “podiatry” represents being able to have demonstrated competence in a comprehensive range of foot and ankle surgery. <o:p></o:p>
    <o:p> </o:p>
    Is this justifiable? <o:p></o:p>
    <o:p> </o:p>
    On the grounds of selecting applicants based on what podiatry represents in BC the answer appears to be “yes”.<o:p></o:p>
    <o:p> </o:p>
    Is it unjustifiable?<o:p></o:p>
    <o:p> </o:p>
    I cannot find a convincing argument. If there is some evidence that people in BC somehow are lacking in adequate podiatric care because of this I would find that compelling; it doesn’t seem likely. <o:p></o:p>
    <o:p> </o:p>
    <o:p> </o:p>
    I have fragmented your post to try and understand it better.<o:p></o:p>
    <o:p> </o:p>
    We have an opportunity to shape our profession for the better. <o:p></o:p>
    <o:p> </o:p>
    Does this mean “only if we can have a nationally agreed upon interprovincial labour mobility” ?<o:p></o:p>
    <o:p> </o:p>
    We should pick and chose the best of both models and work it to fit best in our health care system, <o:p></o:p>
    <o:p> </o:p>
    <o:p> </o:p>
    OK . . . . . . Which bits do you have in mind? <o:p></o:p>
    <o:p> </o:p>
    <o:p> </o:p>
    and work to change third party insurance policies to better fit our increasingly privatized system of care. <o:p></o:p>
    <o:p> </o:p>
    Doesn’t help with legislation which I think is main issue.

    Non-DPM programs excell in teaching biomechanics, palliative care, soft tissue, DPM programs excell in their internal medicine/surgical skills development. Lets do both.<o:p></o:p>

    <o:p> </o:p>
    I would argue that DPM education does all of above but most other non DPM options don’t. I feel that the idea that DPMs are somehow inherently deficient outside of surgery is unlikely …… how can we objectify this rather than carry on making what may be false assumptions?

    The defensiveness and animosity comes when some seek to throw out the baby with the bath water<o:p></o:p>

    <o:p> </o:p>
    I cannot see that adopting a DPM equivalent standard throws out anything, please expand this idea.<o:p></o:p>
    <o:p> </o:p>
    and continue to publically denigrate clinicians who don't have a 3 year surgical residency. The frustrating part is some of those who are most vocal in Ontario haven't even got 1 year residency under their belt!<o:p></o:p>
    <o:p> </o:p>
    DPMs without a 3 year residency are to my knowledge not currently eligible to practice in BC so I am not sure what they might have to say regarding this. Someone please correct me if I am wrong.<o:p></o:p>
    <o:p> </o:p>
    I was told this residency doesn't just teach surgery, it teaches "medicine".

    Agreed

    It is commonly said or implied that D.Chs and D.Pod.Ms and even B.Sc.Pods are technicians by some in this camp. Come sit over my shoulder for a week and then we'll see if you still insist upon calling me a technician. Most of the demand for care exists in the areas where our scopes overlap. <o:p></o:p>
    <o:p> </o:p>
    My observation is that most of podiatric practice like dentistry is largely performed in the manner of a technician. I feel that my "chiropody" training 24 years ago was precisely to be no more than a technician. I think that expectations today are different. To have excellent clinical reasoning skills and is an explicite part of newer Baccalauriate programs.<o:p> The level of clincal reasoning depends though on its scope and depth. </o:p>
    <o:p> </o:p>
    Can anyone address the issue of why interprovincial labour mobility is really important for podiatrists, and why BC college of Podiatrist is not justified in setting standards as they see fit for their local needs?
    Cheers
    <o:p></o:p>
    Martin
    <o:p></o:p>
    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  8. simonf

    simonf Active Member


    Well the Labour Mobility issue is a Federal policy, affecting all regulated professions. Many professions have good parity across the country,and so they are completely compliant. Podiatry is one of the professions where there have been issues. This is mainly due to the different educational models that have been at play and the difficulty getting agreements about what these different models provide.

    It seems to me that continuing to make judgements about whether someone can practice based on where they went to school, rather than the competencies they gained through their education is only going to continue the impasse.

    Whilst continuing to move the bar up in terms of education, is desirable, to continually expand of the quality of care provided, it should be recognised that the spectrum of podiatric care is wide and it may not be necessary for a Pod to have the skills required to undertake complex foot and ankle surgery in order to provide palliative care for seniors.

    On that basis it may be helpful to consider a stratified profession, with differing level of practice competencies reflected in different registers within the same College. This would provide a mechanism for the public to be protected. Looking at the UK model for a moment, initial degree education provides generalist skills, with specialisation in surgery, pod medicine etc is achieved through the masters and Fellowship program.

    The fact that BC insists on a 3 year residency does not mean that all pods in BC have this or that they regularly undertake surgery. Additionally, I would imagine that the vast majority of podiatry contacts in BC are non surgical as people are people wherever you go. For example, the area I work in currently has approx 250k population. In the last 12 months I have undertaken approx 500 surgical procedures, I am pretty much the only provider in the locality, I suspect the local orthopds have probably done another 150 or so. Assuming that there are another 20 pods serving the same area, probably seeing 20 patients a day for generalist care, diabetes care and msk pod. We can see that foot surgery is a small percentage of the overall foot care scene. Also you could say that one person undertaking 500 procedures is more appropriate than 20 pods undertaking 25 each. So it could be argued that it is not necessary for all practitioners to have a surgical skill to provide a comprehensive service to the whole population.

    It may provide more clarity for the public of BC if the individual competence of practitioners was clearly reflected in their registration. This could allow Pods from other education models being allowed to work within their defined scope.
     
  9. SarahR

    SarahR Active Member

    Thanks Simon, I like this model of care, where we all can confidently refer to competent surgeon. People want to go to the best person who does surgery often. Someone who will know what to do in cases where things aren't so text book, someone who has proven results.

    BC is still being self-regulated by an association. When such was so in Ontario, it was an old boys club with rules and regulations pertaining to registration that barred UK grads from practicing in favor of DPM trained who wanted to keep competition low. Is this what is going on in BC? Or is it truly for the benefit of the public?

    I decline to answer all your nitty picky questions, Martin, as I don't think you really want them answered and will just argue them further. You will not change your mind, you've made that clear. Perhaps your program was severely lacking, mine however was not, and I retained my learning. There is more I want to learn, and I will continue learning.

    I spent a week at one of the better DPM schools' teaching clinics a few summers ago and their palliative/routine care was almost non existent, the students didn't even know how to neutralize TCA in 4th year, (if I didn't know that in 2nd I wouldn't have been allowed to use it and would have been shamed into hitting the books), they referred all biomech and wound offloading cases to pedorthists and were not teaching any clinical biomechanics. These were my observations.

    When everyone is able to do surgery, we compete for more by lowering prices, reimbursement has dropped from $2000 per bunion to about $400 in the US. This is not good, as there is a lot of liability risk and it is expensive to maintain a sterile OR in house. Ontario hospitals are not falling all over themselves to give up OR time for our pts benefit.

    If the Ontario surgical pods had played nice in the sandbox they could have had solely surgical practices with a huge dch referral base. We would have better acceptance of privatized care and argument for allowing progression within the training. Instead we have this mess. We should all be able to assess someones suitability for surgery, and know what type would likely be done, but I will never believe that we should all be doing the cutting.

    Sarah
     
  10. Mart

    Mart Well-Known Member

    Hi Simon

    Not exactly a laugh a minute but I want to (pedantically is what I do best) take your reply apart, tedious perhaps but I think only way to make progress.


    Well the Labour Mobility issue is a Federal policy, affecting all regulated professions. Many professions have good parity across the country,and so they are completely compliant. Podiatry is one of the professions where there have been issues. This is mainly due to the different educational models that have been at play and the difficulty getting agreements about what these different models provide.
    Agreed


    It seems to me that continuing to make judgements about whether someone can practice based on where they went to school, rather than the competencies they gained through their education is only going to continue the impasse.
    Agreed

    Whilst continuing to move the bar up in terms of education, is desirable, to continually expand of the quality of care provided, it should be recognised that the spectrum of podiatric care is wide and it may not be necessary for a Pod to have the skills required to undertake complex foot and ankle surgery in order to provide palliative care for seniors.
    My understanding of the BC DPM viewpoint is that palliative footcare for seniors is no longer necessarily the domain of the podiatrist as perhaps it was and that this is adequately and safely provided by foot care nurses and podiatry assistants. Likewise provision of foot orthoses is similarly the domain of the pedorthist. In other words, others have raised their educational bars and this has made the historic role of the podiatrist as many still regard, somewhat obsolete. I cannot objectively flaw this viewpoint but I guess it is contentious.

    On that basis it may be helpful to consider a stratified profession, with differing level of practice competencies reflected in different registers within the same College. This would provide a mechanism for the public to be protected. Looking at the UK model for a moment, initial degree education provides generalist skills, with specialisation in surgery, pod medicine etc is achieved through the masters and Fellowship program.
    I agree that a stratified profession is currently the best option for most provinces given their definition of podiatry; certainly I think that is true in Manitoba where I practice. However it seems in BC that is idea has been challenged. If we are to understand the merits of this then generality may not be appropriate and I think we need to get to how these generalities stand up . . . more later in the post.

    The fact that BC insists on a 3 year residency does not mean that all pods in BC have this or that they regularly undertake surgery. Agreed


    Additionally, I would imagine that the vast majority of podiatry contacts in BC are non surgical as people are people wherever you go. For example, the area I work in currently has approx 250k population. In the last 12 months I have undertaken approx 500 surgical procedures, I am pretty much the only provider in the locality, I suspect the local orthopds have probably done another 150 or so. Assuming that there are another 20 pods serving the same area, probably seeing 20 patients a day for generalist care, diabetes care and msk pod. We can see that foot surgery is a small percentage of the overall foot care scene. Also you could say that one person undertaking 500 procedures is more appropriate than 20 pods undertaking 25 each. So it could be argued that it is not necessary for all practitioners to have a surgical skill to provide a comprehensive service to the whole population.
    Agreed,

    It may provide more clarity for the public of BC if the individual competence of practitioners was clearly reflected in their registration.
    My understanding of the BC podiatry viewpoint is that that clarity amounts to “ podiatrists are de facto foot surgeons and therefore registration requires that competence”. My understanding is also that although currently this is defined as being via the DPM educational route, other systems which include UK surgical model are to be objectively considered and that the legislation might be worded accordingly, currently that needs further exploration and I understand that process is to start this year.

    This could allow Pods from other education models being allowed to work within their defined scope.
    I think this is the important area to really explore and what I intended as the thrust of my last post.

    How do you feel about the following points?

    The intent of AIT is to prevent self regulating bodies from creating “professional barriers” to those from other jurisdictions (provinces) which are intended not to protect public interests but to further self interested professional ambitions. Is that a fair assessment?

    If a jurisdiction (BC) defines podiatry as a surgical specialty and another (Manitoba) defines it a surgical OR a non surgical specialty, logically they are related but different specialties which happen to use the same name.

    Since for the past one year podiatrists are regarded de facto as foot surgeons in BC then different regulatory standards are appropriate.

    This seems logically coherent and is the thrust of BC podiatry regulators argument.

    My understanding of the situation in the US is simplistically this.

    Podiatrists in the US have aligned themselves to the idea that DPM training should mirror that of medicine except for the explicit specialization to the foot and ankle. This is to meet the contemporary expectations of the healthcare system which regards medical training as optimal. Hence the historic rhetoric of those orthopaedic surgeons who feel that podiatric education is deficient compared to their own would be mute and podiatrists can cement their professional position.

    Given the issues which I see locally regarding inclusion of podiatry within the mainstream healthcare system of medicare, and much of the political wrangling in the UK, particularly regarding provision of foot surgery, this seems like a wise approach.

    So if this is in the long term a wise vision, then BC might argue adopting this model for there is reasonable, and if successful, by attrition will follow the US model.

    I am not sure how much power the Federal Govt feels that it can or should exert to override provincial professional opinion. If the situation in BC is to be changed then I would see persuasive argument towards the Feds necessary.

    The AIT process seems to have failed. I am not sure why but I suspect that it boils down to my points above.

    If I am right, then successfully persuading the Feds against the BC proposal needs carefully consideration of this vision rather than to re-iterate ideas pertaining to the past or even the present which seems far from ideal.

    Cheers

    Martin

    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  11. Mart

    Mart Well-Known Member


    Hi Sarah


    I am not sure why you think this but sorry that you feel that way. Nothing could be further from the truth. :eek:.



    cheers


    Martin

    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  12. SarahR

    SarahR Active Member

    Martin, please carefully research pedorthic education and nursing foot care education before promoting the idea that these tasks should be put upon other professions and removed from the podiatry profession.

    Sarah
     
  13. Mart

    Mart Well-Known Member

    Hi Sarah

    Perhaps I am not making my points very well.

    I am not promoting any idea, simply debating the merits of what I perceive as legitimate arguements. As you know there is a lack of objective information about what we are talking about here; that is large part of the problem.

    What is possible though is a logical examination of our premises, if they are inconsistent or flawed then we can re-examin the implications of that and visa versa.

    So far I am trying to probe the arguements in favour of what BC is proposing. I dont neccessarily hold that what I am arguing is right or wrong, simply to determine if the arguements are sound.

    Sometimes that is the limitation of reasonable debate.

    hope that clarifies why I am bothering to "think out loud"

    cheers

    Martin
     
  14. simonf

    simonf Active Member

    tedious perhaps but I think only way to make progress.

    you are probably right

    My understanding of the BC DPM viewpoint is that palliative footcare for seniors is no longer necessarily the domain of the podiatrist as perhaps it was and that this is adequately and safely provided by foot care nurses and podiatry assistants. Likewise provision of foot orthoses is similarly the domain of the pedorthist.

    I do not know anything of podiatry on BC, but could this shift be due to lack of interest of existing practitioners?


    The intent of AIT is to prevent self regulating bodies from creating “professional barriers” to those from other jurisdictions (provinces) which are intended not to protect public interests but to further self interested professional ambitions. Is that a fair assessment? Yes, that is essentially correct, a regulator is not allowed to ask something of an applicant from another province that they would not ask one of their own. However by redefining the profession in the way that they are attempting, this creates an uneven playing field.

    If a jurisdiction (BC) defines podiatry as a surgical specialty and another (Manitoba) defines it a surgical OR a non surgical specialty, logically they are related but different specialties which happen to use the same name.

    MB legislates for Surgery too, but this is related to extended education, allowing non surgeons to make a crust, whereas they are denied this in BC as the minimum standard is considered advanced practice in many other jurisdiction. I'm not going to argue which is correct, there are fors and against for each model

    Maybe canada should adopt the kind of overarching regulatory body like the UK & Australians do(Australia is more akin to Canada, with its state and federal administration). As I see it we are spending a lot of time chewing over issues that would be nullified if the various provincial regulators were in effect one body, regulating the whole spectrum of the profession in a stratified manner, safeguarding the public with a transparent regulatory framework. Possibly with local representation at a local level to make sure that local jurisprudence is met at a provincial level. But also providing parity from one province to another. Imagine how confused patients must be as they move from one province to another and try to get treatment. I had a patient in Mb who was very happy to find that i could (and would) debride his bulky toe nail, so that he could wear shoes comfortably, whereas the pod he has seen in another province was resistant.

    Hell, it might even be possible to devise a sensible educational program to continue to supply new pods.

    I think once the profession becomes more cohesive in a model like this, it stands more chance of being taken seriously by the medical profession and health care organisations. You never know, there might even be publicly funded Podiatry across the country.
     
  15. Mart

    Mart Well-Known Member

    Just to sqeeze the last drop of blood . . . .


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    My understanding of the BC DPM viewpoint is that palliative footcare for seniors is no longer necessarily the domain of the podiatrist as perhaps it was and that this is adequately and safely provided by foot care nurses and podiatry assistants. Likewise provision of foot orthoses is similarly the domain of the pedorthist.

    I do not know anything of podiatry on BC, but could this shift be due to lack of interest of existing practitioners?

    I should have used the word “necessarily” with some emphasis. I suspect that palliative care is currently provided by some pods as well as other in BC as is true elsewhere.

    ------------------------------------------------------------------------------------------------------
    The intent of AIT is to prevent self regulating bodies from creating “professional barriers” to those from other jurisdictions (provinces) which are intended not to protect public interests but to further self interested professional ambitions. Is that a fair assessment?

    Yes, that is essentially correct; a regulator is not allowed to ask something of an applicant from another province that they would not ask one of their own. However by redefining the profession in the way that they are attempting, this creates an uneven playing field.

    This is the reflex reaction from most non DPMs I think and part of me “feels” that too. Taking their argument in good faith I can see why it might be appropriate given what I understand of their vision.

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    If a jurisdiction (BC) defines podiatry as a surgical specialty and another (Manitoba) defines it a surgical OR a non surgical specialty, logically they are related but different specialties which happen to use the same name.

    MB legislates for Surgery too, but this is related to extended education, allowing non surgeons to make a crust, whereas they are denied this in BC as the minimum standard is considered advanced practice in many other jurisdiction. I'm not going to argue which is correct, there are fors and against for each model.
    I have become sympathetic to the notion that podiatry doesn’t have much future unless it raises its bar to be a truly “medical specialty” equivalent This seems to be the mantra coming out of the US and I can see why Canadians who have bought into this idea do not want to see it undermined by those who haven’t.

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    Maybe canada should adopt the kind of overarching regulatory body like the UK & Australians do(Australia is more akin to Canada, with its state and federal administration). As I see it we are spending a lot of time chewing over issues that would be nullified if the various provincial regulators were in effect one body, regulating the whole spectrum of the profession in a stratified manner, safeguarding the public with a transparent regulatory framework. Possibly with local representation at a local level to make sure that local jurisprudence is met at a provincial level. But also providing parity from one province to another. Imagine how confused patients must be as they move from one province to another and try to get treatment. I had a patient in Mb who was very happy to find that i could (and would) debride his bulky toe nail, so that he could wear shoes comfortably, whereas the pod he has seen in another province was resistant.
    I think that it would be more cost effective for podiatry assistants to do this kind of work under supervision of podiatrist. My understanding is that the new physiotherapist model will adopt this approach as the newer MSc cohorts become available and this will gradually replace current practice.
    Much of the task of orthopaedic surgeons is being done currently by surgical assistants and physicians by nurse practioners who are better qualified than many “podiatrists” practicing here.
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    Hell, it might even be possible to devise a sensible educational program to continue to supply new pods.
    What we do to earn honest crusts . . . . .
    --------------------------------------------------------------------------------------------------------
    I think once the profession becomes more cohesive in a model like this, it stands more chance of being taken seriously by the medical profession and health care organisations. You never know, there might even be publicly funded Podiatry across the country.
    I guess it remains to be seen which model succeeds, perhaps there is room for more than one. It will be interesting to see how the challenges to BC develop.

    Cheers

    Martin
    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
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