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The ridiculous culture of Podiatric Surgery in the UK

Discussion in 'United Kingdom' started by do it with sole!, May 12, 2009.

  1. do it with sole!

    do it with sole! Welcome New Poster


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    Once again, here we are!

    Recent Job Advertisement on NHS jobs

    Job Title: Podiatric Surgery Trainee
    Employer: Northamptonshire Teaching PCT
    Department: Podiatry
    Salary: N/A

    oh, and why is it N/A, because its a bloody honorary post!

    This is a joke, only in Podiatry would you expect someone working at AfC grade 7/8a to work for free!

    I myself currently work within a Podiatric Surgery unit and am looking for podiatric surgery trainee posts. I however will not be applying for this, i don't believe anyone should have to.

    Some Podiatric Surgeons argue that these posts may lead to paid opportunities. Brilliant, well what are we supposed to do in the mean time, live in a tent?

    Other old school surgeons argue "they had to do it" well boohoo. We are in a different economic climate than we used to be.

    You don't see SHO / ST1's (medical profession) in surgery having to work for free (lets call it honorary to make it sound good!).

    This profession is a joke, Podiatrists who are working at advanced levels being asked to work for free! You don't see bloody diabetes specialist (honorary) posts do you.

    Podiatric Surgery departments are taking advantage of those people who really have a desire to become Podiatric Surgeons, because they know people will apply!

    Unfortunately, they are making people like myself, who have worked hard to be in a position to have an MSc in Podiatric surgery and work within a busy surgery unit consider leaving the profession. What a farce!

    The consultants (not all) aren't really arsed because they are AfC band 9 are couldnt give a ****.

    (don't get me started on the fact that all consultants should have a trainee, and not sit on their arse once knighted with the title consultant)

    What do others think???
     
  2. do it with sole!

    do it with sole! Welcome New Poster

    oh and for our friends across the pond, a podiatric surgery trainee is in someway similiar to doing a PM&S 36 (removing some of the rotations and on call) for no pay, subsidies or expenses at all.
     
  3. Paul_UK

    Paul_UK Active Member

    The salary may be negotiable when the right candidate has been selected after interview and how many days they wish to do etc has been decided. Do you have the link to the full advert?
     
  4. Paul_UK

    Paul_UK Active Member

    Sorry didn't read it properly and missed the "honourary post" bit. That doesnt seen right, how can people afford to go for the post with no salary?
     
  5. simonf

    simonf Active Member

    Oh the youth of today!

    I understand where you are coming from, however I should point out that back in the old days it was not unusual for trainees to be charged for attending a pupillage. Unless you happened to work for a trust that had a surgery unit, you would at least have to loose a days wages, or reorganise your week to make the hours up somewhere else.

    If you are committed and knuckle down there are some rewards to be had down the road. Also it has been known that an unpaid post becomes a paid post over time.

    Oh and if you start comparing things to the USA, dont forget that podiatry students face extremely large student debt due to the nature of tertiary education in the US. Ten years ago I was talking to a US pod resident and he had a $100000 student debt to pay off.
     
  6. I guess it depends where one draws the "trained" line. After all we charge undergraduates to train towards being trained to degree level. If (and I stress if) one considers the "consultant" grade to be the fully trained autonomous practitioner then is it unreasonable to charge for the training to that level?

    If one considers that the consultant trains the trainee and the trainee pays the consultant by being useful and seeing patients this system seems fair. If one considers that the trainee is doing the work and the consultant trains them for free its not.

    Regards
    Robert
     
  7. do it with sole!

    do it with sole! Welcome New Poster

    simonF you have just fallen in line with the "old school" crap that i mentioned initially. who cares if you had to pay or do it for free boohoo. In those days a 3 bed semi was about 20 pence! don't get me wrong, those who paved the way in pod surg made a great contribution at there own expense, but surely things have to progress.

    I hate the comments that go along with "if you want it enough... determined...dedicated blah blah blah" simply we cannot afford to work for free anymore!!! and why should we!

    robert forgive me for sounding cynical but your babble adds nothing to this conversation.

    The simple facts are - consultants on band 8d/9 should all have to take a trainee as part of their contract. How else do we progress. These positions as our medical counterparts should be well paid.

    Surgical pupils don't just learn, they are part of the team. Take myself for example, i have worked in a pod surg unit for some time. I can manage outpatient clinic and all inpatient duties barring the cutting, surely that is worth something.

    This might sound arrogant, but i don't believe anybody will be able to provide an adequate argument for honorary trainee contracts! except for saving money.

    p.s simonf yes it is worth it in the end (if you can get one of the minimal SpR posts available), but how the hell are you supposed to live for the 3 years whilst waiting to get to registrar level.

    and once again simon, i couldnt give a crap how it used to be done, having to pay for the bloody priviledge, again what a joke! smoking used to be advertised as an unharmful social engagement, yet we don't still believe that do we?!
     
  8. simonf

    simonf Active Member

    Kinda does, yes!

    As I said I understand where you are coming from. But, having a trainee in a unit does not speed up the work rate or add anything to the productivity of the surgical team, very often is slows down the process - teaching does after all take away from some direct clinic time - why should an NHS trust pay for the privilege of reducing the activity of the surgical team? Ultimately you might be useful but probably not until you are almost ready for fellowship exam.

    Have you had a bad day by any chance?
     
  9. twirly

    twirly Well-Known Member

    Further information for those following this discussion: http://www.jobs.nhs.uk/cgi-bin/vacdetails.cgi?selection=912249749

    Regards,

    Mandy.
     
  10. Peter

    Peter Well-Known Member

    DIWS,

    Whilst I understand you are not wishing to work for 2 days per week for nothing, perhaps your NHS Trust would permit you to continue for you to keep your full time NHS Salary, and be seconded to the Northampton Trust for those 2 days, after all its the same as paying for surgical training?

    As an aside, I don't think it stands you any credit to publicise your bitterness on this job advert so publicly on the internet, sorry if that offends.

    Furthermore, if you have a Pod Surgery MSc, and work full time in a busy surgical unit, where do you think you can leave the profession for?

    In my experience, Podiatry has little transferable skills other than to the private sector, or management.
     
  11. Ah. Sorry. When you said

    I presumed you were inviting opinions, rather than opinions so long as they agree with you.

    I'll leave you to bitch and whine in peace.:empathy:

    To quote the sage, lane 4 all yours sunbeam.

    Kindest regards
    Robert

    PS, Do please show the courage of your convictions and share your name. I'm sure the consultants of the nation will be burning up the telephone exchanges to offer (paid) employment to such a balanced, articulate, literate and pleasant character as yourself.
     
  12. Paul_UK

    Paul_UK Active Member

    After reading the job description and it only being 2 days a week for 3 years I agree with Peter that it would most likely be possible to either keep your current position, or move depending where in the country you are, and continue to have a salary, albeit a reduced one, whilst training. Pod surgery posts don't come up that often so a little flexibility may be needed.

    If you already work in a Pod surgery unit are you looking to become a Pod surgeon at some point?
     
  13. Lee

    Lee Active Member

    I think Simon's said it really. Sounds like you're having a bad day. Yes, of course all training opportunities should be paid as you are doing a portion of work within a unit, but they're not.... yet.

    If you are serious about your thoughts on giving up, have you considered what else you might do, or is that you are just frustrated with this situation and you are venting your anger by posting on here? I don't think it's fair to knock some of your potential employers as it's often not their decision on how a training post is funded (management, etc...). Hope you're OK and your day gets better.
     
  14. Footmeister

    Footmeister Welcome New Poster

    Been reading this stream of consciousness with interest. As a so-called senior pod, all I can add is that I really do want all the trainee posts to be paid for too, but we have to present a management case for each paid post and they are not always supportive. Until the posts are funded from region like medical training posts we will always have this problem. However someone suggested a paid secondment from your current Trust which is what I did when I trained in Lewisham in 1992 (!), so you can put forward a case for funding as a long-term course and see if you get support. The problem with all of this is it depends on the philosophy of your line management and the availability of funds (as above). We have been lucky enough in my department to build over the last 3 years from 4 full-time staff to 12 full-time paid posts including 2 paid registrar grades. Unfortunately the one thing that may have to give is the trainee post as I don't think my Trust will wear the case for more staffing and as Simon says and I agree - there is no advantage for us in having a novice surgeon in toe! Apart from the enjoyment in training you guys up so you can take the profession further forward. Don't forget the enormous gains we have made over the last 15 years. When paid consultant posts were first being discussed (Tom Galloway and Nick Gilbert's posts in Hereford), the idea was not really given much chance by our now elders of our profession. So we are still really a fledgling profession with many more battles to fight. If its too hot for you then get out of the kitchen.
     
  15. Well said, sir.

    To quote Noel Gallagher:
    "You can have it all but how much do you want it?
    You make me laugh
    Give me your autograph"

    P.S. I self-funded 3 years of my PhD time and have been self-funding research projects ever since- so I'm kind of biased.
     
  16. davidh

    davidh Podiatry Arena Veteran

    Hi diws,

    You need to look at whether you want to train or not.

    If you want to train I can't see that a couple of days a week unpaid is any different to the time taken out to do a Masters or a Phd, and plenty of people on here have done or are doing that.

    If you want a different profession go and do Medicine.

    I really can't see the problem:cool:
     
  17. W J Liggins

    W J Liggins Well-Known Member

    Hello DIWS

    I suppose that I am 'old school' in that I had to pay for my own surgical training. However, I was, and am, very grateful to those individuals - Allard-Williams, Galloway and Gilbert amongst them- who GAVE (emphasis, not shouting) me their time and knowledge to allow me to achieve what I have achieved. I take it that Reilly is likewise giving his time and expertise and it really is somewhat graceless for a junior to attack their seniors in the way that you have chosen, particularly since that senior does not dictate the management policies of his employing Trust.

    The world is not ideal - we all wish that it was. Who told you that it was going to be fair? They lied!

    I suggest that you write at length to Northamptonshire PCT providing them with your concerns and then return to this site and report back their reply. That would be the considered, appropriate, mature and courageous action to take. Incidentally, as a tip for the future, you will find that the vast majority of Consultant Podiatric Surgeons will be looking for those very characteristics in their trainees.

    Good luck

    W J Liggins
     
    Last edited: May 16, 2009
  18. Mr./Ms./Mrs. DIWS:

    First of all, your complaints would mean much more to me, and many of the rest following along, if you had the courage and courtesy of giving us your name, instead of making anonymous complaints. Complaining about the way things are, without having the conviction to let us know who you really are, carries very little weight.

    Secondly, do you think that podiatric surgeons in the United States are all paid well for the countless hours and sacrifices they put into their four years of podiatry school and surgical residencies? No they are not. Nearly all of us take out huge amounts of student loans during our four years of podiatry school and nearly all of us barely scrape by during our surgical residencies, while our student loans are often causing us to grow increasingly in debt. Getting the best podiatric education does not come cheap and is not easy. If it was, then everyone would or could do it.

    If you do want to be a surgeon, then why not take out a loan to get you through the harder times until you can make more income like we all do here in the States. Certainly, you must sometimes spend money to make money. I spent plenty of money to get where I am today and the podiatry students of today in the United States are spending much more money for their podiatric education and surgical residencies than I ever had to spend. If you don't strongly desire to be a podiatric surgeon, then I suggest that you should do something else with the rest of your life and quit complaining anonymously.

    As many individuals on Podiatry Arena already know, I don't have a lot of sympathy for someone who complains anonymously about their country's educational system. However, I do have a lot of respect for those who are not afraid to step forward into the light of day to try to improve their country's podiatric educational system, are willing to suffer the possible consequences of doing so, all with the knowledge that eventually their actions will help themselves and their colleagues that succeed them reap the rewards of an improved podiatric surgical educational system for their country.
     
  19. simonf

    simonf Active Member

    Pun intended? :drinks
     
  20. louise

    louise Member

    Hi! I got fed up reading this thread- so never finished it! I live in Scotland and would only be too glad to have an oportunity arise similar to this- even if unpaid!!! I have my final year to do for my Msc which i have put off due to the fact there are no pod surgeons in Scotland and was told by a lecturer if i wanted to pursue this as a career option i would need to leave the country!!! Thus my motivation is almost nil- i have even considered becoming a vet!!:deadhorse:
     
    Last edited: May 26, 2009
  21. Ralph Graham

    Ralph Graham Welcome New Poster

    I was notified of this thread by a colleague. I do not normally visit this site and I am unlikely to visit again to view replies if any. I entirely agree with Kevin Kirby and my old colleague Bill Liggins about the sacrifices made by others in the past and now in systems which charge for training or expect nil pay.
    If the anonymous poster is up to date with Faculty of Surgery decisions he would know that notice has been posted that from 2012 (I think, maybe 2015) no unpaid posts will be recognised for training purposes. The deal is to give time for serious people like Ian Reilly to obtain funding. It has taken me four years to develop a fully funded training post whic we intend to advertise next year, cuts permitting.
    The individual who declines to be known should appreciate that if we had waited for fully funded posts in an hostile environment he and I would not be discussing training at all.
    Progress is on the back of endeavour and the shoulders of those that have gone before, be grateful they were more prepared to make sacrifices than you are.

    Ralph Graham ralph@ralphgraham.org
     
  22. ladyfaye

    ladyfaye Active Member

    Hi Ralph

    Thanks for the response-I myself have only seen the original post by DIWS today and read through all the posts with interest.I fully agree with everyone who responded about the fact that sometimes in life one has to "sacrifice" something in order to obtain the ultimate goal.My personal opinion is that DIWS was just whining!! and personally if I had the opportunity to work with Ian Reilly I certainly would-for free as well,purely because of what I would learn from him.

    DIWS....By the way I worked for approx two and a half years in an honorary surgical post and it was honestly the best time of my life.

    I am glad though that funding will be available in the future for paying trainees.

    However I must say that working "pro-bono" to be TRAINED is a small price to pay.Surely DIWS can supplement your income by doing a Saturday locum job? DIWS you cant have your cake and eat it!If you are serious about surgery my advice is get on with it and stop whingeing.our profession doesnt need people like you-rather we need people who will go teh extra mile to get us to where we ought to be.If you think medical registarrs dont work hard think again!!!Apologies if this sounds harsh but I do beleive you are way out of line on this one.

    Faye
     
  23. amcheli

    amcheli Member

    Shouldn't the NHS invest in you as a trainee surgeon? why other medical specialty trainees get paid while training? it's about time the podiatry profession stands up for itself...treat everyone the same...pay everybody for their training, or honorary post is the standard. For podiatry to move up the scale, more podiatric surgeons are needed, however the why it's done right now is not helping...UK podiatric surgeons and the HCPC should lobby heavily.
     
  24. Dieter Fellner

    Dieter Fellner Well-Known Member

    Yup...only make this $250,000 debt in 2013 for a very many - unless daddy can pay the bills. I could wax lyrically about the many differences, since "somewhat similar" really doesn't do it justice. In addition, after the 4 years training the newly qualified DPM is required to do a full time three year, hospital residency. Looooooong hours, but yes some pay.

    This year out of a pool of 640 DPM, 104 did not get a residency post at all.... this is a tough economy - my advice, if you can get it (the training) take it. Short term pain, long term again. As pointed out here, some people had to pay for their surgical training in the UK. Survival of the fittest / most hungry?
     
  25. W J Liggins

    W J Liggins Well-Known Member

    Ah yes! What wonderful expressions are 'ought to'/'should do'/'about time'/'treat everyone the same'. I am sure that we all empathise but sadly the world does not work like that and you are ignoring some self evident facts: i) the NHS will not divert money from medical training to associated medical training ii) the HCPC exists to protect patients, not to further the interests of the professionals that fund it!

    If you can take action to alter the status quo then I am sure that you will have a great deal of support from your colleagues. It would be of interest if you will publish here your business plan of just how you intend to acheive your object, in order that we can all advise and assist.

    Best of luck

    Bill Liggins
     
  26. Agree with all Bill has said. The podiatry profession in the UK will go some way in reaching its potential when, and only when, it takes responsibility for its own future.
     
  27. amcheli

    amcheli Member

    Well by the HCPC "furthering the interests of the professionals that fund it!", is actually protecting patients and improving their general quality of life. Like I said more podiatric surgeons means more patients are treated. Podiatric surgeons are paid less (Compared to ortho Foot and Ankle surgeons, much higher salaries and cost a lot more to train from the 1st day at the medical school till they attain surgical competency) therefore mega savings are made. (maybe to invest some of it to train the ones that are saving you the money isn't a bad idea).

    I don't have a "business plan"! but maybe a strategy.
    GPC (General Podiatry Council) or General Podiatric Medical Council, would not be a bad start.
     
  28. amcheli

    amcheli Member

    Hi there Sir,

    I respect what you have said, and wish that could be true anywhere, however sir why take a loan when others are not?...of course taking a loan might be the only solution presently but there have to be made changes for the sake of all the stakeholders. What do you think the changes should be? as you probably competent in this field.

    Regarding the surgical training in the uS, does all surgical specialties trainees have to take a loan, or only the podiatric ones?

    Best regards

    Ami
     
  29. Really. Can you elaborate?
     
  30. Dieter Fellner

    Dieter Fellner Well-Known Member

    Ami,

    The answer to this question is somewhat entrenched in the socio-economic context of Podiatry education. I have trained in both the UK and the USA. And I am often asked about similarities and differences. These exist, in education, training and delivery of Podiatry services. The US trains Podiatrists for the US market, the same for the UK.

    In the US this market is directed, to a large extent, by the health insurance carrier, and Medicare / Medicaid. In the UK, of course, it's mostly NHS, a little health insurance as well as some direct, out-of-pocket, payments.

    Regarding the surgical training in the US. All Podiatrists are required to complete surgical training. In 2013 this means a three year, full time, hospital residency. During this time the Podiatric Doctor will mix it with residents of other medical disciplines i.e. surgical, medical. And is expected also to function to the same level. Residents rotate through multiple departments (general surgery, orthopedics, ER etc). The modern podiatric resident needs to be as comfortable with a stethoscope as a scalpel.

    In the US all doctors have to pay for education. Nothing is free. So, the short answer is yes, most will take out a loan, to pay for this education. For a very many this amounts to $250,000, at the end of the fourth year.

    After graduating with the doctorate and upon entering residency there is a stipend. The national average for this is $45,000 per year. Some hospitals pay more. In an expensive city, like New York, a studio apartment will cost $1100 or more, a month. Residents are also now taxed on income, thanks to Obama. So, the point is, the stipend doesn't go very far. The massive student debt also has to be paid off, somehow, as interest rapidly adds to the principle loan. On the other hand, residents work very long hours, and often live out their residency time in the hospital.

    When I completed my UK surgical training, Podiatric Surgery had the tremendous benefit of support, promotion and encouragement. SOCAP, the Department of Health, local politicians - all played a role in promoting and encouraging the role of the Podiatric Surgeon.

    The Orthopedic faction, of course, was not in favor - the honest Orthopedist would freely admit the reason for this antagonism: private practice & territorial concerns. More recently, I hear from my UK colleagues, this faction has launched an aggressive campaign against the UK Podiatric Surgeon. SOCAP seems somewhat muted in its' response. Some feel SOCAP is not delivering adequate support. The Department of Health also is no longer actively supporting the goals and aspirations of the profession. Others on the front line of surgery may be able to offer additional insight.

    What is the Zeitgeist? Podiatric surgery has made an impact in the UK, and a profession such as Orthopedics, feels threatened. That Podiatric Surgery is more cost effective, as an argument, in of itself is no longer enough, seemingly - this point is built into any surgical service proposal and managers are well aware.

    What's the solution? Collaboration? Tighter integration with medical school might offer a solution? Recognition from the Royal College of Surgeons, perhaps?
     
  31. Sage words. There is certainly a coordinated opposition against Podiatric surgery in the UK - and it would appear this is active not only in the NHS but private hospitals also. I understand quite a few surgeons have had their consultant status withdrawn and downgraded to a support specialist with orthopaedic supervision.

    I don't think collaboration with the RCS is the answer - podiatry medicine and surgery need a new training platform and delivery environment. Dentistry managed the latter and are developing the former - outside of NHS influence. We would do well to follow suit...
     
  32. amcheli

    amcheli Member

    Hi DJ

    Thanks a lot for your response DJ, and as you have worked in both sides of the atlantic, it would be great if you could inform us please a little about UK Surgical training compared to US one, in terms of lengths of training, education and scope of practise.

    Ami
     
  33. Dieter Fellner

    Dieter Fellner Well-Known Member

    Ami,

    This seemingly simple query can make for a lengthy discourse.

    In order to address your question more concisely please tell us why you seek this understanding?
     
  34. I understand that Foot & Ankle Specialist is the front runner for entitling podiatric surgeons, which might placate the orthopods and DoH - but would still represent a monumental shafting for the podiatry profession. In hindsight, one might lament the PA's decision to amalgamate with the Society a few decades ago. By establishing a new route to surgical practice outside the remit of the RCS - but in the same practice arena - the NHS and private hospitals - was always going to present barriers - even the joint program with RCS Scotland has borne little fruit. Surgical colleagues would do well to consider establishing their practice outside the NHS and existing private hospital network - both arenas well controlled by the present hegemony.

    Is the proposal to protect the title Foot and Ankle Specialist and regulate under the same framework as podiatry?
     
  35. rosherville

    rosherville Active Member

    If UK Podiatric Surgeons havn't the strength and determination to hold on to their title in the face of pressure from self interest groups, we'll see a rapid demise.

    Podiatric Surgery is an internationally recognised title, to give it up would see 'lackeys' grateful for the odd procedure thrown to them.

    Re: Scotland. The Orthopods quite openly admitted that they wanted a stranglehold on any development of Podiatric Surgery so they went along with the SoCaP plans. Despite warnings SoCaP agreed, grateful for the percieved benefits of that particular association. Several years on, how many Podiatric Surgeons are there in Scotland ?
    Answer - None !
     
  36. wdd

    wdd Well-Known Member

    The special relationship between dentistry and medicine was undoubtedly timely. Historically it was based on a synchronicity of unique and partly shared histories, eg historical development of dentistry, historical development of of medicine, british political history, social development and changing concepts of health.

    A lot can be learned from a study of the past with respect to forming strategies for future professional development but the historical model can not be directly applied to current or future situations and without an in depth study of the history of the evolution of the professions, including podiatry, informing future strategies, they are likely to be little more than tilting a windmills

    Bill
     
  37. It's also protected - with the use of 'podiatric' in the title - Foot and Ankle Specialist certainly isn't! I would assume the title change has little relevance in the private sector - it may be enforceable in the NHS but I think the future of UK podiatric surgery lies elsewhere anyway..
     
  38. W J Liggins

    W J Liggins Well-Known Member

    It is useful to bear in mind some simple facts:

    i) you can never advance by retreating
    ii) you should never give up secure positions which others have gained for you and which you now command without the most compelling of reasons eg. you are moving to better, even more secure position
    iii) you will be treated with contempt by your enemy and by non partisan observers as a result of surrendering, unless you have fought to the last bullet and the last breath

    Bill Liggins
     
  39. bmjones1234

    bmjones1234 Active Member

    Curious: Should the Society not be pushing this agenda further on our behalf for us i.e. more paid training posts? Could the training be made the responsibility of the SCP? They could then design the courses they select and work with the College of Surgeons perhaps? - Speculating ideas, fully admit to not having thought the whole process through.
     
  40. amcheli

    amcheli Member

    A great response, thanks a million!
     
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