How Collegiality And Professionalism Will Advance The Profession

Many years ago, I was on the credential committee of a large general hospital here in St. Louis. Believe it or not, at that time, the hospital accepted board certification in podiatric surgery but did not accept osteopathic board certification.

An osteopathic orthopedic surgeon, albeit somewhat controversial by reputation, applied to our hospital. An Ivy League trained neurologist member of the committee objected to allowing the individual to receive privileges at our hospital. It was his position that the general allopathic medical profession simply did not accept osteopathic orthopedic training.

I felt compelled to respond to this proposition, arguing that I myself was a podiatrist and not an MD. I spoke to the committee, arguing that we should evaluate every individual doctor by his or her own credentials, and not by the degree following their name.

The neurologist, complete with bowtie in place, turned to me and said in front of the committee, “Jacobs, I am sure you are a good podiatrist. But you must remember that you are a technician. MD is a learned profession.”

While podiatrists are perceived as being technically adept at performing foot surgery, some have suggested the podiatrist is nonetheless a technician but not a true physician.

For many years, I worked with a wonderful Falstaffian attorney on the East Coast. He was an excellent defense attorney with whom I had worked on several occasions. He was dedicated to our profession and had been an integral part of education at many state meetings.

We were sitting in the hall at a state meeting. He turned to me and said, "Would you like to know the difference between medicine and podiatry? The difference,” he said, “is that the podiatrist and podiatry societies lack collegiality and professionalism."

I am reminded of these episodes as the result of a dinner I had with my wife the other evening. We were at my favorite restaurant enjoying a late dinner following a busy day at the office. We had to sit at a booth because there were two dinner meetings being held that evening.

The first of these meetings was a journal club that the foot and ankle surgeons hold every two months here in St. Louis and by foot and ankle surgeons, I mean orthopedic foot and ankle surgeons and not podiatrists. These journal clubs have been going on for many years. Every several months, the foot and ankle surgeons would gather at the restaurant and participate in continuing medical education. There were no CME credits for attending. There was no corporate support of these meetings in general although a corporation is occasionally allowed to participate but not determine the content of the meeting. For the most part, the doctors attending these journal clubs actually paid for their own dinner and drinks. The room was filled with practicing foot and ankle orthopedic surgeons as well as fellows and invited residents. The meeting did not include any podiatrists.

Those attending the meeting were present for one purpose and one purpose only: to become a better foot and ankle surgeon and better serve their patients. Professionalism. Collegiality.

In another part of the restaurant there was a large gathering of rheumatologists. It was a meeting of the St. Louis Rheumatology Association, an organization to which I had previously been an active member. The group holds four or five meetings a year. The organization will invite a local or national speaker to present educational offerings to the membership, which consists of various physicians or other healthcare providers interested in advancing their knowledge of rheumatic disorders. The room was filled with rheumatologists, therapists and the occasional orthopedic surgeon. Again, although there is the occasional meeting paid for by a pharmaceutical company, the members generally pay for their own dinner and contribute to the cost of bringing to the meeting the individual whom they wished to present educational material. Collegiality. Professionalism.

Participation in continuing medical education for self-improvement without the need for CME credits for re-licensure. Non-reliance on corporate support for continuing medical education. Professionalism. Collegiality.

Someone recently suggested in a posting to another magazine that without corporate support, podiatry CME meetings simply could not occur.

When you attend a podiatric continuing medical education program or read the program brochure, you will see terms such as "unrestricted educational grant" or references to platinum sponsors, gold sponsors, diamond sponsors, all the way down to just plain old rock sponsors.

What these references mean is that there will be a biased lecture in your program advocating the use of some product distributed by the corporation involved. It is contrary to the actions of our MD colleagues. It is something that is perhaps appropriate for technicians but not for a learned profession.

There is nothing wrong with accepting educational grant money or sponsorship from corporations so long as they do not dictate the content of the CME program. However, it is generally fantasy to pretend this is not the actual situation.

It does seem to me that there are some individuals who, although they have received corporate sponsorship support, present unbiased educational lectures. For example, I have never heard Warren Joseph, DPM, or Bryan Markinson, DPM, present any biased material at any CME program that I have attended although I suspect that both of them are frequently attending the meeting with some corporate sponsorship.

I am certain Brad Bakotic, DPM, DO, would be happy if his laboratory worked to receive every specimen obtained by every podiatrist in every office in the United States. Although he is a regular presenter at our meetings, again, I have only heard him make efforts to bring knowledge of dermatology to our meetings. I have never heard him suggest that one should send all specimens to his laboratory.

Anyone who has had the opportunity to listen to Jack Schuberth, DPM, knows that although he has received corporate sponsorship support, he has always presented academically correct and pointed lectures and has never advocated the use of any particular product.

John Steinberg, DPM, has long been a recognized academic thought leader in wound care. I am certain John has his choice of corporations to sponsor him. Again, in many years, I have never heard him offer anything but objective and unbiased information in attempting to have the average podiatrist improve his or her ability to evaluate and treat wounds.

Frequently in a deposition on a malpractice case, an attorney will ask about "authoritative sources," generally with reference to journals or textbooks. Authoritative means reliable and trustworthy.

The individuals I discussed are in my opinion reliable and trustworthy. Although they have received corporate sponsor support or otherwise disclosed some corporate interest, they present educational material at our meetings that is in fact unbiased and worthy of your attendance. Unfortunately, this is not the case with the majority of speakers at the majority of meetings.

There are some meetings, such as the New York State Podiatry Association annual meeting, meetings held by Kent State University or the No Nonsense Seminar, that invite presenters regardless of their corporate sponsorship status. At these meetings, presenters are invited based on their individual accomplishments and ability to provide true continuing education. This indeed is professionalism. This indeed represents collegiality.

Conversely, in my opinion, the content of the majority of meetings in our profession is based upon the ability of the speaker to present without cost to the meeting. In other words, if you do not have corporate sponsor support, it is unlikely that they will allow you to speak at the meeting.

(As an aside, if corporations pay all of the speakers at a particular meeting, did you ever wonder where all the exhibitor money and registration money is going? I am certain you were all not eating that much, particularly since it seems as though every breakfast, lunch and cocktail party has a sign alerting you to the fact that they had been paid for by some corporation.)

Collegiality. Professionalism.

Hopefully, the next generation of podiatrists will do a better job with these concepts than my generation did. In doing so, they will advance podiatry from a technical to a learned profession.