An independent review found the ‘podiatric surgeon’ title was misleading to the public but put the bevy of complaints about the practitioners down to professional rivalry.
Podiatrists who use the title of “podiatric surgeon” despite not having a medical degree or surgical training are indeed misleading consumers but can keep their scope of practice, an independent review into the specialty has found.
Instead of health and safety issues leading to the high rate of notifications among podiatric surgeons, the report points the finger at professional rivalry.
Another key finding was that the Podiatry Board of Australia had never used a performance assessment as part of a regulatory response.
Besides the name change, recommendations included strengthening CPD requirements and making better use of regulatory tools for practitioners who have multiple substantiated negotiations made against them.
AHPRA and the podiatry board have accepted the report’s 14 recommendations in full but will hold a consultation before committing to a new title for the 40-odd Australian podiatrists with surgical endorsement.
Suggested new titles include “surgical podiatrist”, “operating podiatrist” and “podiatrist practising podiatric surgery”.
The independent review, completed by medical law expert Professor Ron Paterson, followed mainstream media reporting about patients whose surgery was botched by a podiatric surgeon.
Many patients assumed that the podiatrists who treated them were medical doctors or had done specialist training with a surgical medical college.
While surgical podiatrists are not trained as doctors, they do have to complete a three-year postgraduate program that covers foot and ankle surgery in order to qualify as a fellow of the Australasian College of Podiatric Surgeons.
The University of Western Australia also offers a five-year Doctor of Podiatric Surgery program.
“Considering all the evidence examined in this review, it is clear that consumers and patients of podiatric surgeons are confused by the titles ‘podiatric surgeon’ and ‘surgeon’,” Professor Paterson said.
“This is exacerbated when used in conjunction with the term ‘doctor’.”
Professor Paterson cited this confusion as the main reason behind his recommendation to eliminate the “podiatric surgeon” title, despite expressing slight misgivings about privileging one group of health professionals above another.
“Professional titles bestow ‘symbolic capital’,” he said.
“Privileging the use of the title to one group – medically qualified surgeons – with a long historical claim to the title tends to shore up the power and prestige of that group.
“It may also have the anti-competitive effect of shutting out a competing craft group performing similar tasks.”
The next big question for Professor Paterson to answer was whether the current standards for podiatric surgeons needed to be updated to ensure quality and safety.
Podiatric surgeons represent less than 1% of all Australian podiatrists but generate AHPRA notifications at a rate five times higher than their peers.
Nine of the 25 podiatric surgeons who were subject to a notification between 2010 and 2023 were subject to three or more notifications in that time.
Professor Paterson said it was a “notable feature” that many of the complaints were triggered by orthopaedic surgeons.
“The hostility and professional rivalry between podiatric surgeons and orthopaedic surgeons is longstanding and well documented,” he said.
Close analysis of the data, the pre-eminent medical law scholar said, revealed a pattern of patient dissatisfaction but not of widespread safety and quality problems.
He also pointed out that orthopaedic surgeons have a notification rate double that of other medical practitioners, and that surgeons in general have a notification rate 10 times higher than that of physicians.
“The risks involved in surgery and unfulfilled patient expectations may explain the high complaint rates,” Professor Paterson said.
The Podiatry Board and AHPRA will conduct a consultation before requesting Health Minister Mark Butler sign off on a name change for podiatric surgeons.
