Title change for podiatric surgeons is one of 14 recommendations to improve safety

27 Mar 2024

The Podiatry Board of Australia (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.

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 the Australian Health Practitioner Regulation Agency (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.

The Board and Ahpra have accepted all 14 recommendations of Prof Paterson’s report, including:

• 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.

‘These findings underline the valuable service that podiatric surgeons provide to their patients, but also highlight important measures we and others can take make their practice safer and build public confidence.’

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.

‘I appreciate that my recommendations, if accepted, set higher requirements for podiatric surgeons, above what is expected of generally registered podiatrists, but I believe this is warranted to address some of the issues identified through this review, to better protect the public.’

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.

‘This report provides a foundation to strengthen the podiatric surgery profession, as well as the way we regulate its practitioners. We look forward to working with ministers, practitioners and other stakeholders to implement changes that will better inform and protect the public,’ Mr Fletcher said.

‘While podiatric surgery is a very small and specialist profession, the procedures undertaken are complex and the impact on patients can be significant, so everything must be done to ensure the training and safeguards hold practitioners to the highest standards.’

Background:

The Independent review of the regulation of podiatric surgeons in Australia commissioned by the Podiatry Board of Australia commenced in October 2023, to enable the Board to get 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 review was undertaken by Ron Paterson, Emeritus Professor of Law at the University of Auckland and Senior Fellow at Melbourne Law School. Prof Paterson is an international expert on patients’ rights, complaints, safety and quality and the regulation of health professions and was formerly New Zealand Health and Disability Commissioner and Parliamentary Ombudsman.

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