The future of podiatry

“The changes to the health system need to be massive, they need to start quickly, they need the cooperation of Ontario‘s fractious doctors, its well-organized nurses and non-medical staff and patients. They’ll be things Liberals never thought of or couldn’t pull off “

~ David Reevely ~ postmedia writer in the Ottawa Citizen

What Mr. Reevely was referring to was the onerous task that Rueben Devlin has as premier Doug Ford’s newly appointed chair of the Council on improving healthcare and ending hallway medicine. I would like to add to the list of things that the Liberals could not accomplish, the problem relating to the upcoming death of the profession of podiatric medicine in the province of Ontario.

Our problems actually began with the Conservative government of Bill Davis and his then Minister of Health Dennis Timbrell.
Their vision led to no new podiatrists being registered in the province of Ontario since 1993. Instead, aided by subsequent governments, the profession of chiropody was introduced to Ontario.

Recently, a competency “gap analysis“ was completed by our governing body, the College of Chiropodists of Ontario outlining the wide variety of educational backgrounds and competencies of chiropodists in the province. In spite of this, many chiropodists are pushing for a name change so that they can all be called a podiatrist.

At present, because no one can be registered as a podiatrist, it means that surgically trained doctors of podiatric medicine can be registered in Ontario but cannot be called podiatrists and cannot perform to their level of competency

I have been performing ambulatory foot surgery from my office-based surgery suite since I opened my practice in Ottawa in 1973. I take x-rays in my office and because I am able to render a diagnosis under Ontario law, I can quickly and efficiently evaluate and treat conditions without patients having to go to the hospital and wait and wait and wait.

So, it is with great frustration that over these many years I have watched successive governments ignore foot care and, instead, have spent an immense amount of money on our existing healthcare system with fewer and fewer positive outcomes. Governments have thought that by restricting access to a service, costs are contained and no monies are spent. Instead, we have higher costs with difficulty accessing services and not always with better outcomes.

Mr. Reevley then goes on to say:

“throwing money at more and bigger hospitals to hire more staff and provide more treatments is the one thing this particular government really can’t do”

But this is what has been happening to our system and why we have ended up with the problem that we have today between jammed hospitals, hallway medicine and the lack of chronic care facilities. Podiatric medicine and foot care delivery has not been a priority and with our aging population and the number of increasing diabetics, we should be near the top of the list. The care that podiatrists provide can actually keep people healthier, and out of hospitals in a cost-effective manner.

But when I retire I will be the end of podiatric medicine as we know it in on Ottawa. It is not because there are no podiatrists being trained. I know of many Canadian podiatrists forced to practice in the U.S or other provinces who would love to practice in Ontario. There is a school of podiatric medicine in Trois Rivieres Quebec but no others in Canada.

There are highly skilled surgically trained podiatrists in Windsor who, because they registered in Ontario after 1993 must register as chiropodists and can only perform a restricted number of services in Ontario. But, they provide their highly specialized skills across the river in Detroit where their expertise is appreciated and accepted.

On top of that, I receive very little from OHIP so I don’t cost the system very much money. My services are all private with many insurance companies and my patients covering the cost

The solution is actually quite simple:

Remove the Cap (The restriction on registration of podiatrists in Ontario) and allow Doctors of Podiatric Medicine to be registered as podiatrists in Ontario.
Develop programs to upgrade the competencies of existing chiropodists so that those who wish to achieve a higher level of expertise could do so.

Health minister Christine Elliott along with Reuben Develin need to be creative and come up with initiatives that will allow for better delivery of services in more cost-efficient ways. By neglecting podiatry as have previous governments, they are missing a huge opportunity. Can they do it?

~ David Greenberg ~ BA, DPM, FAAFAS