‘Confusing and problematic’: Podiatric surgeons urged to change their name

Podiatric surgeons may be forced to change the name of their profession after a review found there was widespread confusion among patients and the wider public about the qualifications of the practitioners, who are not medical doctors.

The review also found stronger action by the national healthcare regulator is needed to stop repeat offenders from promoting misleading information about their skills and services.

Professor Ron Paterson has called for podiatric surgeons to change titles.Credit: Warwick Smith

A joint investigation by this masthead and 60 Minutes last year found patients were shocked to discover their podiatric surgeons were not medical doctors after procedures went horribly wrong.

Melbourne Law School fellow Ron Paterson led the review on behalf of the Podiatry Board and the Australian Health Practitioner Regulation Agency (AHPRA) after regulators detected a higher-than-average rate of complaints about podiatric surgeons.

Podiatric surgeons can complete complex and invasive procedures on the foot and ankle, with no regulation around scope of practice, meaning the complexity of the procedure is determined by the risk appetite of the individual practitioner.

Paterson has recommended changing the term to “surgical podiatrist”.

His report says: “When people hear the term ‘podiatric surgeon’ they assume the practitioner is medically qualified. As seen in recent media reports, some patients were alarmed to learn that their podiatric surgeon was not a medical practitioner.

“The continued use of the title ‘podiatric surgeon’ is confusing and problematic.”

The suggested title change has been approved by the Podiatry Board of Australia and will now need approval from state health ministers. While stripping these practitioners from using the title “surgeon”, the review said it was not possible to stop them using “doctor” as this was not a protected title.

A spokesperson for federal Health Minister Mark Butler said the recommendations will be discussed at a future meeting where all state ministers are present. The next meeting is in April, although the agenda has not yet been set.

The review said the 130 submissions were divided between supporters, made up of podiatric surgeons and their lobbyists, and critics, including orthopaedic surgeons and medical professionals, which it said reflected a longstanding “turf war” in the industry.

It found that the bulk of complaints related to nine podiatric surgeons, out of a total of 40 nationally, but concluded this should not be taken as representative of the broader profession.

”Given the very small number of both podiatric surgeons and notifications about podiatric surgeons, any generalisations and comparisons should be made with caution,” Paterson said.

Podiatry Board chair Cylie Williams said the recommendations would strengthen the safety of podiatric surgery.

“We had significant concerns over the high rate of complaints concerning some practitioners. This is why we commissioned this review to find out if there were wider issues across the profession,” she said.

The review made 14 recommendations across registration, training, title, advertising, handling of complaints and safety and quality of the system.

It found podiatric surgeons’ education was sufficient, although called for an improvement to continuing professional development standards as well as guidelines around patient selection and pre- and post-operative care to be developed to promote safe practice.

“Current registration standards do not assure competent and safe practice,” it found. “Serious or repeated failure to meet the guidelines could have consequences for a practitioners’ registration.”

The review analysed the number of complaints made about podiatric surgeons to AHPRA, finding the total number was almost nine times higher than a comparable group of orthopaedic surgeons.

“Concerningly, 66 per cent of the notifications received about podiatric surgeons over that period relate to nine podiatric surgeons who were each the subject of three or more notifications.”

However, it concluded the review of notifications, which relies on patients proactively making complaints about their treatment, “does not show that most podiatric surgeons are practising unsafely”.

The review found 15 of the 25 podiatric surgeons who received at least one notification were registered before the national law came into place, “highlighting that newer graduates are less likely to be subject” to a complaint.

“Some patients have suffered significant harm due to a range of contributing factors, including poor patient selection, inappropriate surgical procedures, poor operative techniques and substandard after-care.

“They deserve to have their complaints properly investigated by regulators, with appropriate remedial action, and to be compensated if they bring a successful civil claim in the courts,” it said.

It also found repeated breaches of rules to prevent advertising in healthcare and that regulatory interventions were ineffectual. It recommended strengthening AHPRA’s enforcement approach to take a “tougher, deterrent approach to repeat offenders”.

“Consumers are vulnerable to exaggerated or misrepresented claims about the training, skills and experience of a practitioner, and the benefits of their treatments.

“Some information on podiatric surgeons’ websites appears to exaggerate the practitioner’s training, qualifications, registration, experience and competence.”

The review looked at 17 complaints about advertising that breached guidelines, including testimonials, unreasonable expectation of beneficial treatment, false or misleading use of specialist title.

“In each case the matter was closed after an educational letter to the advertiser and a subsequent check to confirm compliance. In no case was a prosecution brought, even though one podiatric surgeon was the subject of multiple advertising complaints. AHPRA needs to take a tougher, deterrent approach to repeat offenders.”

The review found that regulatory investigations into podiatric surgeons were hampered by a difficulty in finding independent expert clinical advice in such a small profession. It also criticised transparency of historic conditions.

“At present, the community is denied access to information on the register of practitioners about whether a practitioner has been subject to multiple notifications or had conditions imposed because their clinical practice did not meet an acceptable standard.

“This issue is broader than podiatric surgeons. It warrants further consideration by AHPRA and health ministers across all health professions to better meet the principle of transparency enshrined in the National Law and the legitimate expectations of the community.”

David Lunz is head of the Australian Orthopaedic Association and has been pushing for the term surgeon to be protected for years.Credit: Steven Siewert

AHPRA chief executive Martin Fletcher said some recommendations will be implemented immediately while others require additional consultation.

David Lunz, an orthopaedic surgeon and former president of the Australian Orthopaedic Association’s Foot and Ankle Society, said “surgical podiatrist” was too similar to the current title.

“Surgical, surgeon, same thing,” he said. “I think a term like ‘operating podiatrist’ or ‘podiatric technician’ would be more appropriate – something that is not derivative of surgeon.”

Lunz said it was “ridiculous” to conclude that the existing training standards are safe, and completely rejected characterisations of the industry’s concerns as a turf war. “Most of us have a 12-month waiting list,” he said. “It’s a little bit of a joke.”

He said since the joint media investigation was published, he had seen around 20 new patients who had been harmed by podiatric surgeons but had not made complaints to the regulator. “They have to use the data they have, but they should acknowledge the number of people who report problems is small.”

The Australasian College of Podiatric Surgeons did not respond to requests for comment.

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