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Pods & Orthopods... (sorry to interrupt)

Posted by Sheila S on 12/15/02 at 01:43 (103160)

=) sorry to interrupt your stories, cleaning methods and cooking......

This may be a dumb question, but what is the difference between a Podiatrist/Foot Surgeon and an Orthopedic that specializes in Foot/Ankle?

I was reading an investigation conclusion where expert doctors reviewed a case where 2 or 3 Ortho's had complained about a Pod. They felt it was inappropriate the complaint came from 'competing' doctors (and other reasons). etc. etc. So I just wondered, what is the difference, I suppose in knowledge is what I'm asking I guess (I don't know..) And do the 'feel' in competition with each other?

I'm fixing to go to an Orthopod here because I haven't gotten proper help or investigation from Pods. (although I have gotten lots of help on this site from these doctors!) I suppose I'm wondering what this new doctor might be able to add, and if it might have offended my present Pod. when I told him I was going...

Thanks all!
S

Re: Pods & Orthopods... (sorry to interrupt)

Carole C in NOLA on 12/15/02 at 08:15 (103173)

A podiatrist isn't an M.D. They go to a college of podiatry and get a DPM.

An orthopedic surgeon is an M.D., and went to medical school.

From what I've read on these message boards, there are good and bad of each of these kinds of foot professionals.

Carole C

Re: Pods & Orthopods... (sorry to interrupt)

john h on 12/15/02 at 09:48 (103182)

An Orthopedic Foot and Ankle Surgeon is a Medical Doctor who can treat things not just involving the feet. He has been through a conventional medical school and then specialized in foot and ankle surgery and diagnosis of other foot problems. I will let the Podiatrist on the board explain their credentials. I do know that outside an MD a Podiatrist is the only other medical person who can operate on your feet.

Re: Pods & Orthopods... (sorry to interrupt)

Pauline on 12/15/02 at 11:35 (103198)

Carole,
I would add that an Orthopedic Surgeon can be either M.D. or D.O. are able to treat the entire human skeletal system, bone, tendons, muscles and ligments from head to toe because they indeed have gone through and graduated with their medical degree in Orthopedic Medicine from an accredited medical school. Additionally they must complete an internship and a residency program. Many specialize in specific areas like backs, shoulders, hips, knees, foot/ankle and hands etc.

A Podiatrist as you say is not an M.D.(Medical Doctor) and is limited by the laws in the state where they practice. The following information I found was in an article printed by the group called 'Footlaw' as they explained what they are up against in mal-practice cases. This group ia a multi-state association of trial lawyers who are also Podiatrists. I believe Brian has had some contact with this group so they do exist. I personally find the last sentence kind of scary if indeed what they are saying is true.

STATE LAWS
The scope of podiatry practice varies widely in all 50 states. While a medical doctor is licensed in most states to perform 'diagnosis or treatment . . . of human beings,' (8) a podiatrist is considered a limited-license practitioner whose scope of practice is regulated by state laws. Some states, like Georgia, allow podiatrists to practice medicine and perform surgery on the foot and leg (9). Florida limits podiatry to the foot and leg, below the tibial tubercle (10). Other states--including Alabama, Illinois, Kansas, Massachusetts, and Texas--restrict podiatric practice to the feet (11).It becomes problematic, then, when podiatrists receive post-graduate training in a state with restrictive laws and then move to a state with liberal laws. These podiatrists are inadequately trained to practice within the full scope of their licenses. Nonetheless, they often practice up to the limit that a state law allows.

As Carole points out you can find both good and bad doctors in any field of medicine it's not just limited to these two areas. It's up to the patient to do their homework before they accept any medical treatment from any doctor no matter what they condition they intend on treating.

Re: various careers

Carole C in NOLA on 12/15/02 at 12:50 (103204)

Having been raised the daughter of an eminent surgeon and professor of surgery, I was totally unaware of any D.O.'s that got their D.O. degree from an accredited medical school as you assert. My father would roll over in his grave if he thought I'd see a D.O. However, I am not my father and I would never 'put down' any foot professional since my C.Ped did such a good job for me.

When you graduate from an accredited medical school, you get an M.D. degree. Then, most go on for a residency. Back in my father's day, you had to do an internship prior to a residency. I suppose that there are probably other accrediting organizations that accredit other types of schools such as schools of podiatric medicine and osteopathy, as well as schools for many other occupations.

People who have not been through medical school to get an M.D. degree, and who then proceed to call themselves medical doctors, surgeons, and do surgery, can be arrested in most states to the best of my knowledge for practicing medicine without a license. On the other hand, M.D.'s who have not done their surgical residency can legally call themselves surgeons and do surgery, and this can be disastrous. It's always good to call your local medical board to find out the qualifications of any M.D.

Carole

Re: various careers

Sharon W on 12/15/02 at 13:33 (103206)

Thanks, Carole,

I'm glad you brought that up. The problem with podiatrists (in some cases) having the legal right and privillege to perform surgery that they are not specifically trained for, is VERY MUCH true of MD's as well.

Fortunately, most doctors (of either type!) are NOT eager to perform surgical procedures that they have never been trained in and/or have never seen performed. But I suppose there are always a few individuals, in ANY profession, with more ego than common sense...

Sharon

Re: various careers

Carole C in NOLA on 12/15/02 at 13:43 (103208)

Being my father's daughter, I would check with the local medical board before allowing surgery on myself.

However, the other side of the coin is that I would never allow surgery on myself to be done by anybody, even by a board qualified surgeon unless it was absolutely necessary. My father wouldn't have wanted me to get elective surgery, either.

Surgery is really drastic business. The fact that living things live and bodies function is utterly miraculous, and not anything to be messed with lightly.

Carole C

Re: Thanks everyone!

Sheila S on 12/15/02 at 14:10 (103209)

I appreciate everyone's help and thoughts!!

So if I'm understanding right, and you'd had surgery by a Podiatrist, or rather 2 of the same surgeries by 2 different Pods. without success, you'd probably do what I'm doing.... that's go see an Orthopod. that specializes in foot/ankle problems and surgery. Right?

I will most definitely go for at least a couple more opinions (after seeing what the Orthopod. says) before agreeing to surgery again. Meanwhile, I have found this Orthopod. that is well-respected as among the best in the field....so I figured that was my next step.

Thanks again....and thanks for your research Pauline, I've seen the footlaw.com site and didn't even think about looking there.

S

Re: various careers

Pauline on 12/15/02 at 14:56 (103215)

Carole, you are so right. Avoid surgery if at all possible, and never take any type of surgery lightly is a very good way to live.

Re: various careers

Pauline on 12/15/02 at 14:56 (103216)

Carole, you are so right.

Re: various careers

Julie on 12/15/02 at 15:34 (103218)

The consultant surgeon who did my mastectomy nine years ago remarked not long ago, during a general conversation about surgery, 'There is no surgery that cannot go horribly wrong'.

A good argument for not having any surgery that isn't absolutely necessary.

Re: various careers

Pauline on 12/15/02 at 16:21 (103225)

Carole,
I included M.D. and D.O. in the same catagory because today Doctors of Osteopathy have pretty well been accepted by the Medical Community as one in the same. They are in practice with each other and work in the same hospitals This wasn't true in your father's day. I would assume hell should freeze over before a D.O. would treat an M.D.'s daughter back then.

Some folks still have a difficult time if their M.D. takes in a D.O. as his partner.

Any M.D. or D.O. today who calls himself a surgeon and doesn't do a surgical residency I think would be hard pressed to get privileges at any hospital. They may legally call themselves a surgeon, but they are not going to do their work in a hospital.

Some surgical residences can be an additional 5 years of study especially if the doctor wants to become 'double boarded'.

Becoming an Orthopedic Surgeon is a long haul.

Re: various careers

Carole C in NOLA on 12/15/02 at 16:28 (103227)

Pauline, I think you have a very distorted viewpoint of 'what's real', but I'll agree to disagree and don't wish to argue about it.

Carole C

Re: various careers

Pauline on 12/15/02 at 16:36 (103228)

Julie,
He is so right. I can remember my son coming home from college one day with what the lay person would call a blood blister on his lip. He said it just showed up one day. It looked like a tiny red pea.

He wanted to just leave it be, but like all mothers I dragged him to our dentist and was immediately referred to an oral surgeon. As small as this thing was this doctor would not remove it in his office. He said the chance of bleeding was too great because we were only looking at the surface of it and it had a good supply of blood.

It was done out-patient at our local hosptial because they were better prepared to control bleeding should it occur. We were lucky it was removed with no complications or extra loss of blood, but I can tell you I'm glad this surgeon didn't take a chance. I'll never forget what he said to me at our office appointment. 'If this were my son, I'd want it done in a hospital, your son shouldn't mean any less to me.'

Something that looks so simple a surgery could have big consequences any time any where.

Re: Pods & Orthopods... (sorry to interrupt)

Pauline on 12/15/02 at 16:52 (103230)

John,
There are plenty of Orthopedic surgeons who are D.O.'s and can operate on feet. You do not have to have M.D. after your name. I think you and I think of M.D. and D.O. as one in the same different than perhaps our parents did.

I remember a time when D.O.'s were not allowed to have hospital privleges
at M.D. hospitals so they built their own. Some here may be toooo young to remember this or maybe it didn't exist in your state, but I can name two hospitals today near us that are still thought of as D.O. hospitals even though both M.D.'s and D.O.'s have priveleges at both and work side by side.

Re: Pods & Orthopods... (sorry to interrupt)

john h on 12/16/02 at 09:57 (103279)

Pauline: I think that in our state all Podiatrist do their surgery either in their office or small surgery centers not connected with a hospital. I would assume any Poditrist can do some surgery but for the more complex stuff they must have advanced training. I really do not know just how much complex surgery of the foot and ankle a Podiatrist can or is authorized to perform. I would like to know from one of our Podiatrist

Re: Pods & Orthopods... (sorry to interrupt)

Ed Davis, DPM on 12/16/02 at 17:28 (103323)

John:

The level of complexity of surgical accumen is related to the type of residency one has had, particularly when looking at younger practitioners.
Most surgical residencies in podiatry are two to three years with the majority of time focused on podiatric surgery. The number and diversity of foot cases exceeds that of most Foot and Ankle Orthopods although the orthopods would have more total cases since thye would have also done hips, knees, etc. Most podiatrist trained in the 1980's, including myself, had one year surgical residencies and enhanced our accumen throughout the years via post-graduate training -- I am now training second year surgical residents. One area to look is at the American College of Foot and Ankle Surgeons ( http://www.acfas.org ) since 'Fellows' of that organization include those who have been held to a high surgical standard.

Ed

Re: consider the source

Ed Davis, DPM on 12/16/02 at 17:35 (103324)

Pauline:

It is not reasonable to judge any group by focusing on worst case scenarios. Footlaw.com appears in my judgement, to do so, and lists egregious acts by a few in a means to justify their 'business.' Unfortunatley, they carry little credibility in my view and I would not view them as an authoritative source of information -- just my personal opinion.
Ed

Re: Pods & Orthopods... (sorry to interrupt)

BrianG on 12/16/02 at 17:43 (103329)

Hey John,

When I had my EPF done, by a Pod, it was done in an operating room of a hospital. I had the Pod, a nurse, and an anesthesiologist. I would not have wanted to have it done any where else. This was in Ma.

Regards
BrianG

Re: Pods & Orthopods... (sorry to interrupt)

Ed Davis, DPM on 12/16/02 at 17:46 (103330)

Sheila:

Don't worry about offending your current doc. If I cannot help a patient, I consider it my primary responsibility to find another doc that, perhaps, can and I will make the referral. Even excellent docs will, from time to time, run out of ideas and need advice. That may mean a referral to someone with more experience, a different specialty or just someone with a different approach and fresh perspective. I really expect all docs to act in a similar fashion.
Ed

Re: Pods & Orthopods... (sorry to interrupt)

Sheila S on 12/16/02 at 17:50 (103331)

Dr. Davis, thanks for your informative reply. Both of my surgeons are Fellows on acfas. But neither have corrected my problem and the second one did the same surgery with a dorsal incision, not plantar. Apparently my current Pod. does not believe plantar incisions should be made, because I asked him about it. I do, also, realize that doctors within the same profession can, and do, disagree on forms of treatment. Not only is it human nature it's also what builds and develops the profession!

I believe, as a result of your assistance and my research afterwards, that you are correct - I will require surgery via plantar incision and (because of where I can feel the problem) I believe this surgery will end this pain; it remains to be seen if I develop problems from the plantar incision itself. Before I undergo surgery again, I am obtaining the opinion of Dr. Chandler, a well-respected Foot/Ankle Ortho. specialist (which is why I was wondering just what the difference was.) And will go to yet another Podiatrist (or possibly neurosurgeon of some sort) to get a confirmation.

Thanks for your information. S

Re: Pods & Orthopods...thanks!

Sheila S on 12/16/02 at 18:01 (103332)

Thanks again, Dr. Davis. I was hoping the answer would be as you described. I do believe my doc is a good one, perhaps not agreeable to some other ideas (ie. plantar incisions), or (after reading your other post) perhaps maybe not well-trained in some of these other areas. He has truly tried and I believe exhausted all resources known to him. And I like him. I would not want to offend him and, yet, since I'm the one in pain every day, I'm also the one who hasn't been willing to discontinue researching any and every possibility.

I had rather felt that if he was a truly good doc he wouldn't mind at all (and he did ask me earlier if I wanted him to refer me to someone else. I said no, at the time) - and if he did get offended then it is possible that pride could also be hiding the solution. I think, in a way, your statement agrees with this assumption.

When I called my Pod. and asked him to fax a copy of my records to the Orthopod. I faxed him a signed request and included a note on the fax that if he'd like to be kept involved I'd be glad to (or have the other doctor) discuss with him his findings. I had hope this would show him there were certainly no hard feelings on my part.

Thanks - S

Re: Pods & Orthopods

Sheila S on 12/16/02 at 18:12 (103334)

John, I had my first neuroma surgery (11/00) in the Pods. office, he agreed to this to save me money. His preference was the hospital, but said he's done a number of them in his office. It went without any problems (except I had to say 'Hey! stop cutting there it's not numb in that spot. Whereby he shot me some more.....lol) The cost was $700 or so.

I had my second surgery (1/02) in the hospital. This Pod. does not do the surgery in his office, ever. The bill for the Pod was about $7-800 again. The total bill was $5,300!! The charges from the hospital and staff were incredible. And I was billed for the anesthesiologist AND a helper anesthesiologist (sorry, don't know what the official term is...). Ridiculous...especially since I already knew what a relatively minor surgery (as compared to heart surgery) it was since I'd already been wide awake through one.

However, in the first surgery there was no one in there except me and the doc. That kind of situation could put a doctor in a terrible compromise if he operated on someone that drank McDonald's coffee.....(which I don't like). If I were him, I'd do the surgery in the hospital if only for the expert medical witnesses in the event I had a McDonald's coffee drinker...

I'm in Virginia. Seems it's normal here for any and all surgeries to be in the hospital.

Re: Free standing outpatient surgicenters -- ideal for many outpatient procedures

Ed Davis, DPM on 12/16/02 at 20:18 (103349)

Sheila:

The ideal, in my opinion, for the type of procedure you had would be a free standing outpatient surgicenter. The fees would be higher than the office but a lot lower than the hospital.
Ed

Re: Pods & Orthopods... (sorry to interrupt)

john h on 12/17/02 at 10:43 (103393)

Brian: perhaps the Pods can use the hospitals but find it less expensive to use the outpatient operating clinics. Some of the MD's also use these outpatient operating clinics so I assume there is nothing wrong with them.

Re: Pods & Orthopods

john h on 12/17/02 at 10:47 (103395)

As I understand it Hospital Operating Rooms charge by the hour in 15-30 minute increments and depending on the hospital these charges are really large.

Re: Free standing outpatient surgicenters -- ideal for many outpatient procedures

john h on 12/17/02 at 10:51 (103396)

Ed: We have one free standing surgery center here that is about 6 stories high and appears to be very up to date in technology. We also have a number of smaller ones with five or six operating rooms. One of my former running buddies is an anathesiologist and he told me that he works with both Podiatrist and Orthopedic surgeons and from his perspective for many procedures he could detect no difference in competancy when they did foot surgery.

Re: Pods & Orthopods... (sorry to interrupt)

Suzanne D on 12/21/02 at 13:37 (103702)

That's a nice attitude, Dr. Ed, and one which I wish all doctors would have. My daughters' pediatrician ~ who was the best I've seen and who died a number of years ago ~ had the same attitude. His patients' welfare came before his ego. Once, when I had taken my younger daughter for the umpteenth time to him with a bladder infection, I timidly asked how he would feel about my taking her to a urologist whom I had seen. He seemed relieved and gave a hearty agreement with this plan. The team who took over his practice did not seem to have the same philosophy. One doctor was quite offended when I mentioned at an office visit that my daughter was seeing a dermatologist and was taking antibiotic for acne. She felt I should have consulted her first and let me know that in no uncertain terms.

Congratulations on your attitude. I would have expected as much given your selflessness in helping people on this board.

Suzanne :-)

Re: Pods & Orthopods... (sorry to interrupt)

Carole C in NOLA on 12/15/02 at 08:15 (103173)

A podiatrist isn't an M.D. They go to a college of podiatry and get a DPM.

An orthopedic surgeon is an M.D., and went to medical school.

From what I've read on these message boards, there are good and bad of each of these kinds of foot professionals.

Carole C

Re: Pods & Orthopods... (sorry to interrupt)

john h on 12/15/02 at 09:48 (103182)

An Orthopedic Foot and Ankle Surgeon is a Medical Doctor who can treat things not just involving the feet. He has been through a conventional medical school and then specialized in foot and ankle surgery and diagnosis of other foot problems. I will let the Podiatrist on the board explain their credentials. I do know that outside an MD a Podiatrist is the only other medical person who can operate on your feet.

Re: Pods & Orthopods... (sorry to interrupt)

Pauline on 12/15/02 at 11:35 (103198)

Carole,
I would add that an Orthopedic Surgeon can be either M.D. or D.O. are able to treat the entire human skeletal system, bone, tendons, muscles and ligments from head to toe because they indeed have gone through and graduated with their medical degree in Orthopedic Medicine from an accredited medical school. Additionally they must complete an internship and a residency program. Many specialize in specific areas like backs, shoulders, hips, knees, foot/ankle and hands etc.

A Podiatrist as you say is not an M.D.(Medical Doctor) and is limited by the laws in the state where they practice. The following information I found was in an article printed by the group called 'Footlaw' as they explained what they are up against in mal-practice cases. This group ia a multi-state association of trial lawyers who are also Podiatrists. I believe Brian has had some contact with this group so they do exist. I personally find the last sentence kind of scary if indeed what they are saying is true.

STATE LAWS
The scope of podiatry practice varies widely in all 50 states. While a medical doctor is licensed in most states to perform 'diagnosis or treatment . . . of human beings,' (8) a podiatrist is considered a limited-license practitioner whose scope of practice is regulated by state laws. Some states, like Georgia, allow podiatrists to practice medicine and perform surgery on the foot and leg (9). Florida limits podiatry to the foot and leg, below the tibial tubercle (10). Other states--including Alabama, Illinois, Kansas, Massachusetts, and Texas--restrict podiatric practice to the feet (11).It becomes problematic, then, when podiatrists receive post-graduate training in a state with restrictive laws and then move to a state with liberal laws. These podiatrists are inadequately trained to practice within the full scope of their licenses. Nonetheless, they often practice up to the limit that a state law allows.

As Carole points out you can find both good and bad doctors in any field of medicine it's not just limited to these two areas. It's up to the patient to do their homework before they accept any medical treatment from any doctor no matter what they condition they intend on treating.

Re: various careers

Carole C in NOLA on 12/15/02 at 12:50 (103204)

Having been raised the daughter of an eminent surgeon and professor of surgery, I was totally unaware of any D.O.'s that got their D.O. degree from an accredited medical school as you assert. My father would roll over in his grave if he thought I'd see a D.O. However, I am not my father and I would never 'put down' any foot professional since my C.Ped did such a good job for me.

When you graduate from an accredited medical school, you get an M.D. degree. Then, most go on for a residency. Back in my father's day, you had to do an internship prior to a residency. I suppose that there are probably other accrediting organizations that accredit other types of schools such as schools of podiatric medicine and osteopathy, as well as schools for many other occupations.

People who have not been through medical school to get an M.D. degree, and who then proceed to call themselves medical doctors, surgeons, and do surgery, can be arrested in most states to the best of my knowledge for practicing medicine without a license. On the other hand, M.D.'s who have not done their surgical residency can legally call themselves surgeons and do surgery, and this can be disastrous. It's always good to call your local medical board to find out the qualifications of any M.D.

Carole

Re: various careers

Sharon W on 12/15/02 at 13:33 (103206)

Thanks, Carole,

I'm glad you brought that up. The problem with podiatrists (in some cases) having the legal right and privillege to perform surgery that they are not specifically trained for, is VERY MUCH true of MD's as well.

Fortunately, most doctors (of either type!) are NOT eager to perform surgical procedures that they have never been trained in and/or have never seen performed. But I suppose there are always a few individuals, in ANY profession, with more ego than common sense...

Sharon

Re: various careers

Carole C in NOLA on 12/15/02 at 13:43 (103208)

Being my father's daughter, I would check with the local medical board before allowing surgery on myself.

However, the other side of the coin is that I would never allow surgery on myself to be done by anybody, even by a board qualified surgeon unless it was absolutely necessary. My father wouldn't have wanted me to get elective surgery, either.

Surgery is really drastic business. The fact that living things live and bodies function is utterly miraculous, and not anything to be messed with lightly.

Carole C

Re: Thanks everyone!

Sheila S on 12/15/02 at 14:10 (103209)

I appreciate everyone's help and thoughts!!

So if I'm understanding right, and you'd had surgery by a Podiatrist, or rather 2 of the same surgeries by 2 different Pods. without success, you'd probably do what I'm doing.... that's go see an Orthopod. that specializes in foot/ankle problems and surgery. Right?

I will most definitely go for at least a couple more opinions (after seeing what the Orthopod. says) before agreeing to surgery again. Meanwhile, I have found this Orthopod. that is well-respected as among the best in the field....so I figured that was my next step.

Thanks again....and thanks for your research Pauline, I've seen the footlaw.com site and didn't even think about looking there.

S

Re: various careers

Pauline on 12/15/02 at 14:56 (103215)

Carole, you are so right. Avoid surgery if at all possible, and never take any type of surgery lightly is a very good way to live.

Re: various careers

Pauline on 12/15/02 at 14:56 (103216)

Carole, you are so right.

Re: various careers

Julie on 12/15/02 at 15:34 (103218)

The consultant surgeon who did my mastectomy nine years ago remarked not long ago, during a general conversation about surgery, 'There is no surgery that cannot go horribly wrong'.

A good argument for not having any surgery that isn't absolutely necessary.

Re: various careers

Pauline on 12/15/02 at 16:21 (103225)

Carole,
I included M.D. and D.O. in the same catagory because today Doctors of Osteopathy have pretty well been accepted by the Medical Community as one in the same. They are in practice with each other and work in the same hospitals This wasn't true in your father's day. I would assume hell should freeze over before a D.O. would treat an M.D.'s daughter back then.

Some folks still have a difficult time if their M.D. takes in a D.O. as his partner.

Any M.D. or D.O. today who calls himself a surgeon and doesn't do a surgical residency I think would be hard pressed to get privileges at any hospital. They may legally call themselves a surgeon, but they are not going to do their work in a hospital.

Some surgical residences can be an additional 5 years of study especially if the doctor wants to become 'double boarded'.

Becoming an Orthopedic Surgeon is a long haul.

Re: various careers

Carole C in NOLA on 12/15/02 at 16:28 (103227)

Pauline, I think you have a very distorted viewpoint of 'what's real', but I'll agree to disagree and don't wish to argue about it.

Carole C

Re: various careers

Pauline on 12/15/02 at 16:36 (103228)

Julie,
He is so right. I can remember my son coming home from college one day with what the lay person would call a blood blister on his lip. He said it just showed up one day. It looked like a tiny red pea.

He wanted to just leave it be, but like all mothers I dragged him to our dentist and was immediately referred to an oral surgeon. As small as this thing was this doctor would not remove it in his office. He said the chance of bleeding was too great because we were only looking at the surface of it and it had a good supply of blood.

It was done out-patient at our local hosptial because they were better prepared to control bleeding should it occur. We were lucky it was removed with no complications or extra loss of blood, but I can tell you I'm glad this surgeon didn't take a chance. I'll never forget what he said to me at our office appointment. 'If this were my son, I'd want it done in a hospital, your son shouldn't mean any less to me.'

Something that looks so simple a surgery could have big consequences any time any where.

Re: Pods & Orthopods... (sorry to interrupt)

Pauline on 12/15/02 at 16:52 (103230)

John,
There are plenty of Orthopedic surgeons who are D.O.'s and can operate on feet. You do not have to have M.D. after your name. I think you and I think of M.D. and D.O. as one in the same different than perhaps our parents did.

I remember a time when D.O.'s were not allowed to have hospital privleges
at M.D. hospitals so they built their own. Some here may be toooo young to remember this or maybe it didn't exist in your state, but I can name two hospitals today near us that are still thought of as D.O. hospitals even though both M.D.'s and D.O.'s have priveleges at both and work side by side.

Re: Pods & Orthopods... (sorry to interrupt)

john h on 12/16/02 at 09:57 (103279)

Pauline: I think that in our state all Podiatrist do their surgery either in their office or small surgery centers not connected with a hospital. I would assume any Poditrist can do some surgery but for the more complex stuff they must have advanced training. I really do not know just how much complex surgery of the foot and ankle a Podiatrist can or is authorized to perform. I would like to know from one of our Podiatrist

Re: Pods & Orthopods... (sorry to interrupt)

Ed Davis, DPM on 12/16/02 at 17:28 (103323)

John:

The level of complexity of surgical accumen is related to the type of residency one has had, particularly when looking at younger practitioners.
Most surgical residencies in podiatry are two to three years with the majority of time focused on podiatric surgery. The number and diversity of foot cases exceeds that of most Foot and Ankle Orthopods although the orthopods would have more total cases since thye would have also done hips, knees, etc. Most podiatrist trained in the 1980's, including myself, had one year surgical residencies and enhanced our accumen throughout the years via post-graduate training -- I am now training second year surgical residents. One area to look is at the American College of Foot and Ankle Surgeons ( http://www.acfas.org ) since 'Fellows' of that organization include those who have been held to a high surgical standard.

Ed

Re: consider the source

Ed Davis, DPM on 12/16/02 at 17:35 (103324)

Pauline:

It is not reasonable to judge any group by focusing on worst case scenarios. Footlaw.com appears in my judgement, to do so, and lists egregious acts by a few in a means to justify their 'business.' Unfortunatley, they carry little credibility in my view and I would not view them as an authoritative source of information -- just my personal opinion.
Ed

Re: Pods & Orthopods... (sorry to interrupt)

BrianG on 12/16/02 at 17:43 (103329)

Hey John,

When I had my EPF done, by a Pod, it was done in an operating room of a hospital. I had the Pod, a nurse, and an anesthesiologist. I would not have wanted to have it done any where else. This was in Ma.

Regards
BrianG

Re: Pods & Orthopods... (sorry to interrupt)

Ed Davis, DPM on 12/16/02 at 17:46 (103330)

Sheila:

Don't worry about offending your current doc. If I cannot help a patient, I consider it my primary responsibility to find another doc that, perhaps, can and I will make the referral. Even excellent docs will, from time to time, run out of ideas and need advice. That may mean a referral to someone with more experience, a different specialty or just someone with a different approach and fresh perspective. I really expect all docs to act in a similar fashion.
Ed

Re: Pods & Orthopods... (sorry to interrupt)

Sheila S on 12/16/02 at 17:50 (103331)

Dr. Davis, thanks for your informative reply. Both of my surgeons are Fellows on acfas. But neither have corrected my problem and the second one did the same surgery with a dorsal incision, not plantar. Apparently my current Pod. does not believe plantar incisions should be made, because I asked him about it. I do, also, realize that doctors within the same profession can, and do, disagree on forms of treatment. Not only is it human nature it's also what builds and develops the profession!

I believe, as a result of your assistance and my research afterwards, that you are correct - I will require surgery via plantar incision and (because of where I can feel the problem) I believe this surgery will end this pain; it remains to be seen if I develop problems from the plantar incision itself. Before I undergo surgery again, I am obtaining the opinion of Dr. Chandler, a well-respected Foot/Ankle Ortho. specialist (which is why I was wondering just what the difference was.) And will go to yet another Podiatrist (or possibly neurosurgeon of some sort) to get a confirmation.

Thanks for your information. S

Re: Pods & Orthopods...thanks!

Sheila S on 12/16/02 at 18:01 (103332)

Thanks again, Dr. Davis. I was hoping the answer would be as you described. I do believe my doc is a good one, perhaps not agreeable to some other ideas (ie. plantar incisions), or (after reading your other post) perhaps maybe not well-trained in some of these other areas. He has truly tried and I believe exhausted all resources known to him. And I like him. I would not want to offend him and, yet, since I'm the one in pain every day, I'm also the one who hasn't been willing to discontinue researching any and every possibility.

I had rather felt that if he was a truly good doc he wouldn't mind at all (and he did ask me earlier if I wanted him to refer me to someone else. I said no, at the time) - and if he did get offended then it is possible that pride could also be hiding the solution. I think, in a way, your statement agrees with this assumption.

When I called my Pod. and asked him to fax a copy of my records to the Orthopod. I faxed him a signed request and included a note on the fax that if he'd like to be kept involved I'd be glad to (or have the other doctor) discuss with him his findings. I had hope this would show him there were certainly no hard feelings on my part.

Thanks - S

Re: Pods & Orthopods

Sheila S on 12/16/02 at 18:12 (103334)

John, I had my first neuroma surgery (11/00) in the Pods. office, he agreed to this to save me money. His preference was the hospital, but said he's done a number of them in his office. It went without any problems (except I had to say 'Hey! stop cutting there it's not numb in that spot. Whereby he shot me some more.....lol) The cost was $700 or so.

I had my second surgery (1/02) in the hospital. This Pod. does not do the surgery in his office, ever. The bill for the Pod was about $7-800 again. The total bill was $5,300!! The charges from the hospital and staff were incredible. And I was billed for the anesthesiologist AND a helper anesthesiologist (sorry, don't know what the official term is...). Ridiculous...especially since I already knew what a relatively minor surgery (as compared to heart surgery) it was since I'd already been wide awake through one.

However, in the first surgery there was no one in there except me and the doc. That kind of situation could put a doctor in a terrible compromise if he operated on someone that drank McDonald's coffee.....(which I don't like). If I were him, I'd do the surgery in the hospital if only for the expert medical witnesses in the event I had a McDonald's coffee drinker...

I'm in Virginia. Seems it's normal here for any and all surgeries to be in the hospital.

Re: Free standing outpatient surgicenters -- ideal for many outpatient procedures

Ed Davis, DPM on 12/16/02 at 20:18 (103349)

Sheila:

The ideal, in my opinion, for the type of procedure you had would be a free standing outpatient surgicenter. The fees would be higher than the office but a lot lower than the hospital.
Ed

Re: Pods & Orthopods... (sorry to interrupt)

john h on 12/17/02 at 10:43 (103393)

Brian: perhaps the Pods can use the hospitals but find it less expensive to use the outpatient operating clinics. Some of the MD's also use these outpatient operating clinics so I assume there is nothing wrong with them.

Re: Pods & Orthopods

john h on 12/17/02 at 10:47 (103395)

As I understand it Hospital Operating Rooms charge by the hour in 15-30 minute increments and depending on the hospital these charges are really large.

Re: Free standing outpatient surgicenters -- ideal for many outpatient procedures

john h on 12/17/02 at 10:51 (103396)

Ed: We have one free standing surgery center here that is about 6 stories high and appears to be very up to date in technology. We also have a number of smaller ones with five or six operating rooms. One of my former running buddies is an anathesiologist and he told me that he works with both Podiatrist and Orthopedic surgeons and from his perspective for many procedures he could detect no difference in competancy when they did foot surgery.

Re: Pods & Orthopods... (sorry to interrupt)

Suzanne D on 12/21/02 at 13:37 (103702)

That's a nice attitude, Dr. Ed, and one which I wish all doctors would have. My daughters' pediatrician ~ who was the best I've seen and who died a number of years ago ~ had the same attitude. His patients' welfare came before his ego. Once, when I had taken my younger daughter for the umpteenth time to him with a bladder infection, I timidly asked how he would feel about my taking her to a urologist whom I had seen. He seemed relieved and gave a hearty agreement with this plan. The team who took over his practice did not seem to have the same philosophy. One doctor was quite offended when I mentioned at an office visit that my daughter was seeing a dermatologist and was taking antibiotic for acne. She felt I should have consulted her first and let me know that in no uncertain terms.

Congratulations on your attitude. I would have expected as much given your selflessness in helping people on this board.

Suzanne :-)

Re: Pods & Orthopods... (sorry to interrupt)

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