Podiatrists who perform procedures could no longer be allowed to use the title of ‘podiatric surgeon’, under recommendations from the Independent review of the regulation of podiatric surgeons in Australia.
The review, commissioned by the Podiatry Board of Australia (the Board) and Ahpra, commenced in October 2023 and sought an independent view of the current regulatory framework for podiatric surgeons, any risks to patient safety, and recommend improvements to better protect the public.
The final report, published on 27 March 2024, makes 14 recommendations to improve safety, all of which have been accepted by the Board and Ahpra.
The recent series of events in the podiatry industry – including a joint investigation by the Sydney Morning Herald and 60 Minutes in 2023 that found patients were alarmed to discover their podiatric surgeons were not medical doctors after procedures went horribly wrong – bears striking similarities to the Australian cosmetic surgery industry.
‘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,’ the review stated.
The Australian Medical Association (AMA), in response to the recommendation to remove the title of ‘podiatric surgeon’, urged health ministers to prioritise this change.
‘This follows strong advocacy over recent years by the AMA and other surgical groups about the danger posed to the public by being misled into thinking that a health care professional offering formal surgical services and who calls themselves a surgeon was a medically qualified doctor who has undertaken further extensive training leading to Fellowship of the Royal Australasian College of Surgeons – FRACS or equivalent,’ the statement says.
‘The AMA was critical of health ministers last year in failing to take the opportunity during the reforms to cosmetic surgery, which removed the ability of non-surgically qualified health practitioners to call themselves cosmetic surgeons, to also close the loophole allowing non-medically qualified podiatrists to call themselves surgeons. This failure has likely resulted in further patients being misled as to the qualifications of their health practitioner and potentially suffering unnecessary harm.
‘The AMA reaffirms its strong opposition to the use of the title “surgeon” by any practitioner who is not a medical practitioner and has not successfully completed a program of surgical training of at least the equivalent standard to that required to become a Fellow of the Royal Australasian College of Surgeons (RACS), including training programs with a substantial surgical component offered by the Royal Australian and New Zealand College of Ophthalmology (RANZCO) or the Royal Australian and New Zealand College of Obstetrics and Gynaecology (RANZCOG).’
Surgeon title to be axed
The Board will seek approval to change the title of podiatric surgeons so patients are better informed of their skills and qualifications, following a wide-ranging review of the specialist profession.
The Independent review of the regulation of podiatric surgeons in Australia found moving to a title such as ‘surgical podiatrist’ would make consumers better placed to make informed decisions when seeking specialist advice about foot and ankle surgery.
According to a media release from Ahpra, there are only 40 podiatric surgeons with specialist registration – comprising just 0.7% of the 6,038 registered podiatrists in Australia – however they have a higher rate of complaints to Ahpra and the Board than similar professions, prompting a review in October 2023.
Led by Professor Ron Paterson, the review found there was no evidence of a need to reduce or regulate the scope of practice for podiatric surgeons, but recommended measures to align some aspects of the accreditation assessment of podiatric surgery education programs and ongoing training more closely with that of medical practitioners.
‘The issues raised around the title “podiatric surgeon” do not relate to the standard of care provided by the podiatric surgeon. Rather, the issues relate to clarity and transparency for the consumer about the type of practitioner they are seeing, and the type of training the practitioner has completed,’ Prof Paterson found.
‘In my view, “surgical podiatrist” is a more apt description of this specialty. It would make it clear that the practitioner is part of the podiatry profession and should reduce consumer confusion about their qualifications and training.’
Any final decision to change the specialist title for podiatric surgeons will need to be made by Australia’s health ministers. The Board will begin a consultation process about the recommendation later this year, while the independent review has also recommended a transition period to help the current 40 practitioners to adjust to this significant change.
All 14 recommendations accepted
The Board and Ahpra have accepted all 14 recommendations of Prof Paterson’s report across registration, training, title, advertising, handling of complaints and safety and quality of the system. They include:
- Requiring all podiatric surgeons to hold an endorsement for scheduled medicines, and revamping their continuing professional development standard so it closely aligns with that of medical practitioners
- Giving additional weight to a practitioner’s complaint history, age, professional isolation and period since training, when considering a notification relating to podiatric surgery
- Greater use of performance assessments for practitioners who have had three or more substantiated notifications related to their clinical practice
- Strengthening enforcement of advertising offences by podiatric surgeons and providing additional resources to guide appropriate advertising.
- Working with governments to explore options to integrate podiatric surgeons into the broader healthcare system to enhance the quality, safety and affordability of care for patients, and enable practitioners to work to their full scope of practice.
Board Chair Professor Cylie Williams said the review’s 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,’ Prof Williams said.
Concerns about the education and training standards of podiatric surgeons were raised during the review, however Prof Paterson found there was no evidence to support the claims which appear, in part, driven by a ‘turf war’ with orthopaedic surgeons.
Podiatric surgeons were found to be five times more likely to have a notification made against them than podiatrists in recent years, although Prof Paterson’s report found two-thirds of these complaints relate to just nine practitioners and did not reflect on the safety of the wider profession.
‘These outliers significantly inflate the results. Given the very small number of both podiatric surgeons and notifications about podiatric surgeons, any generalisations and comparisons should be made with caution,’ Prof Paterson found.
‘Close analysis of the nature of the notifications about podiatric surgeons over the past 13 years reveals a pattern of patient dissatisfaction (some of it fuelled by orthopaedic surgeons) but does not indicate widespread safety and quality problems in podiatric surgery. The extensive material examined for this review does not show that most podiatric surgeons are practising unsafely.’
Ahpra CEO Martin Fletcher said some recommendations, such as changes to the risk assessments used when considering a complaint against a podiatric surgeon, will be implemented immediately. Others, such as drafting new practice guidelines and reviewing advertising guidelines, will require consultation with stakeholders across the health industry in the coming months.
Source: Ahpra
