U. limiting podiatrists in medical facilities

The University of Utah is limiting the practice of podiatrists in its medical facilities, severely restricting their ability to perform surgeries and ending their existing adjunct faculty appointments.

University Health Care officials say the changes and transfer of oversight from the department of surgery to the department of orthopaedics are important for the U.'s educational and treatment mission.

Podiatrists, including one who has practiced and performed surgery at the U. for a quarter-century, describe the move as a poorly executed turf battle over surgery patients. The motive is not money, they say, but feet on which to train future orthopaedic surgeons.

In February, the podiatrists were notified that their specialty would be moved from surgery oversight to orthopaedics. Signed by the chairmen of surgery, Dr. Sean J. Mulvihill, and orthopaedics, Dr. Charles Saltzman, the letters said each podiatrist could apply for adjunct faculty appointments through orthopaedics, but their scope of practice would be limited to soft tissue, nail and skin surgery and non-surgical foot care.

They would have to agree not to operate on U. patients at non-U. facilities, too.

"Basically, that means that podiatrists will be able to come up and clip toenails for them and take care of painful callouses — the kind of thing they refuse to do anyway," says Dr. Terry Smith, who has practiced podiatry at the U. part time since 1980.

A typical podiatry practice, he said, might include treatment of a painful corn or a viral wart, diabetic foot and limb salvage, ulcer care, hammer toe repair and cases where sprained ankles have become chronic problems. Podiatrists deal with medical problems from gout to sports injuries, including a fair amount of surgery, he said. Dr. David Bjorkman, dean of the U. School of Medicine, said the move does not reflect shortcomings on the part of the podiatrists. The school, he said, "is indebted to them for the years of service they provided when we did not have dedicated foot and ankle surgeons."

But the expanded department of orthopaedics now has three foot and ankle surgeons who "can and should" provide high-quality surgical care.

"That they do so is crucial for the training of our students. We're not a school of podiatry, but a school of medicine," he said. "We have an obligation to our students that they be involved in these cases.... We thought hard about this — what's the best way to deal with this that's most fair for the podiatrists involved, but will meet our obligation to patients and trainees?"