Title change push for controversial podiatric surgeons

The health insurance industry has thrown its support behind a push to prevent a controversial group of podiatrists from describing themselves as surgeons.

Private Healthcare Australia, which represents the country’s largest private health insurers, has called for podiatric surgeons to be renamed “proceduralists” to avoid confusion among patients over their qualifications.

The call comes after an investigation by this masthead and 60 Minutes found many patients were shocked to discover their surgeons could legally operate on them despite not having medical degrees. The patients’ discoveries often occurred after foot and ankle procedures they were unhappy with.

Private Healthcare Australia director of policy and research Ben Harris said patients could be confused about qualifications held by podiatric surgeons, who can lawfully call themselves “doctor”.

“I’d prefer they weren’t called ‘podiatric surgeons’ and [instead] called ‘proceduralists’. The data we have is that people assume a medical professional who calls themselves a surgeon is a surgeon,” Harris said.

“It is very important that consumers are clear if their practitioner is a Fellow of the Royal Australasian College of Surgeons or if they have a different qualification.”

Who can call themselves “doctor” and “surgeon”?

“Doctor” is not a protected title in Australia, meaning a range of health practitioners (podiatrists, dentists, chiropractors) can use “doctor” as a courtesy title without completing a medical degree. People who complete post-doctorate degrees in any field can also use “doctor”. It is an offence for a health practitioner to mislead patients into thinking they are medical doctors. 

“Surgeon” is a protected title in Australia, with recent changes requiring all surgeons to complete a medical degree and training approved by the Australian Medical Council (AMC). Podiatric surgeons are exempt from this requirement. 

Podiatric surgeons often have university qualifications in podiatry or science, followed by courses provided by the Australasian College of Podiatric Surgeons (ACPS) – one of the few institutions that provides surgical training but is not accredited by the Australian Medical Council, the independent education body for medical professionals.

The Podiatry Board of Australia is reviewing the industry in partnership with the watchdog Australian Health Practitioner Regulation Agency, after receiving a high number of complaints about podiatric surgeons. It will examine greater regulation and training as well as greater protection of titles for “doctor” and “surgeon”. Private Healthcare Australia did not make a submission to this review.

President of the ACPS Angelo Salerno said the college supported the continued use of the title “surgeon” for healthcare practitioners who had accredited training and practised in a regulated environment.

The intervention from the health funds in the debate about the use of titles comes as podiatric surgeons are pushing for private insurers to offer greater coverage for their procedures.

PHA represents 98 per cent of Australian private health insurers, including major funds Bupa, Medibank and HCF. Harris met representatives from the ACPS earlier this year.

Harris said health funds do not cover podiatric surgeons for a range of reasons, including that the small number of practitioners nationally (there are about 41 podiatric surgeons currently registered) means assessing the quality of their services is difficult and consumer demand is low.

Podiatric surgeons often operate from day surgeries, and a number of patients interviewed by this masthead said they only discovered procedures would be paid entirely out of pocket when their private health funds denied cover post-surgery.

The ACPS said its members provided patients with “informed financial consent” forms to outline surgical fees and no patient should be unaware of out-of-pocket expenses.

Harris said funds might change their position if the federal government approved the college’s application for Medicare cover of its members’ services. Health Minister Mark Butler on Tuesday said that application for public funding was ongoing, despite labelling this masthead’s investigation as “deeply concerning”.

“Basically, it’s up to the Australian government as to whether they allow surgery by podiatrists to go onto the MBS [Medicare Benefits Schedule],” Harris said.

“My advice to podiatric surgeons was, if you go and get MBS, you’re in with private health insurance.”

The college has also been rejected by the Medical Services Advisory Committee for Medicare funding on at least two occasions.

Harris said the need for expanding public and private support for podiatric surgeons had decreased as the number of orthopaedic surgeons – who perform the vast majority of foot and ankle surgeries – had improved.

“The issues with patient access to foot and ankle surgery in the private system are not as severe as used to be,” he said.

Meanwhile, podiatric surgeons are actively encouraging patients to pressure insurers and politicians to cover their services.

An invoice provided earlier this year from Sydney podiatric surgeon Ozan Amir, who currently has conditions on his practice after a complaint against him was upheld by the regulator, includes instructions for patients to agitate for change.

“Some health funds do not cover operating costs for podiatric surgery,” the invoice, obtained by this masthead, states. “The [ACPS] is trying to resolve this unfair issue regarding health funding for podiatric surgery.

“Some health funds have demonstrated little understanding of the needs of their clients. If you do find your fund does not cover podiatric surgery, you can change your health insurance to one that does choose to cover some or all of this service, lobby your fund to change its policy … you may also find your local federal MP helpful.”

During the meeting earlier this year, Harris said the college told him it had not expelled any members for failing to meet competency standards, unlike other colleges.

“The medical colleges will, often reluctantly, disendorse their members who don’t meet the standards,” Harris said.

“They have processes for removing bad surgeons. Is that because they have larger numbers or are more vigilant on this stuff [than the ACPS]? I don’t know.”

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