Podiatric surgery: a canary in the coalmine for professional monopolies

In the evolving health workforce, a small group of professionals is redefining the boundaries of practice and challenging long-held perceptions around traditional role boundaries: podiatric surgeons. Podiatric surgeons have successfully navigated health regulatory and education systems to establish a robust training program in one of the most highly regulated and traditionally contested fields – surgery – with significant implications for the entire health workforce.¹

A historical leap in healthcare

Since the introduction of medical regulation in the mid-19th century, the practice of surgery has been dominated by medically trained surgeons, with few exceptions such as dentists and veterinarians. Over the past half-century, a small group of Australian podiatrists have defied these historic boundaries, creating their own colleges of training and convincing government and regulators of their safety and efficacy in surgical practice. A similar movement occurred in the United Kingdom.¹ In both cases, the podiatric surgeons met with opposition from members of other professions (predominantly orthopaedic surgeons).

Navigating regulatory challenges

Despite their success, podiatric surgeons have faced significant challenges. While they have achieved professional closure and recognition through regulation by the Australian Health Practitioner Regulation Agency (AHPRA), they have been unable to access funding for their services through Medicare or private health insurance.

In 2023, the Podiatry Board of Australia commissioned an independent review of the regulation and regulatory practices of podiatric surgeons in Australia in response to a relatively high number of complaints about podiatric surgeons compared to podiatrists, and negative media coverage.²

The review provided recommendations to strengthen regulation, practice and safety, and public awareness, but concluded that the quality of education and training of podiatric surgeons is sound, and that there is no basis to restrict their scope of practice. Furthermore, the review recommended that podiatric surgeons should have access to the public health system and Medicare funding as a way to address health workforce pressures while increasing safety and quality standards of podiatric surgery by delivering services in appropriately accredited facilities.

Implications for the health workforce

The significance of these findings extends beyond podiatric surgery. They highlight a critical issue in contemporary healthcare, which is the socialisation of certain tasks to specific professionals. Historically, society has been conditioned to believe that only medically trained surgeons can perform surgery. The persistence of podiatric surgeons demonstrates that in a contemporary health workforce, with appropriate training and regulation, other healthcare professionals can perform otherwise protected tasks safely and effectively.

With growing health workforce shortages, this realisation becomes even more crucial. Expanding the scope of practice for various healthcare professionals can alleviate pressure on the health system and ensure that patients receive timely and effective care.³ However, regulatory support is necessary, but not sufficient to fully mobilise the health workforce. Without access to funding and appropriate facilities to deliver the services, these roles cannot be optimally utilised, ultimately hindering the potential benefits.

A call for change

The independent review’s recommendation for podiatric surgeons to access public funding sets a precedent for other healthcare professions to follow, advocating for the recognition and support of tasks across appropriately qualified professionals.⁴ By embracing this approach, we can create a more flexible and responsive health workforce, better equipped to meet the demands of the 21st century.

The journey of podiatric surgeons from a contested profession to recognised surgical practitioners offers valuable lessons for the entire health workforce. It underscores the importance of the trio of robust training programs and regulatory support supported by public funding in expanding professional roles. As we navigate the challenges of a global health workforce shortage, these insights provide a roadmap for innovative solutions and sustainable healthcare delivery.