Issue 485

Subscribers: 21,846

Nov 8, 2022

Practice Perfect 835
Podiatry Growth - A Time of
Transition with New Challenges

  Jarrod Shapiro, DPM, FACFAS, FACPM, FFPM, RCPS Glasg

PRACTICE PERFECT   November 8, 2022

I’m almost afraid to put it down in words, but is it possible we’re in a post-COVID period? Probably not. In reality, it appears instead we are experiencing COVID as an endemic infection, where a bit like influenza, it hangs around in a less deadly form due to a very successful vaccination program. At least most of us can go to work unafraid that we’re going to die from COVID. Yes, people are still deeply harmed by this virus, but our daily lives have at least normalized to some extent.

Or have they?

Whenever possible, I like to look for trends, and I’ve noticed one major trend that seems to have crept into our lives as a result of the last two or so years of social distancing. My friends, it appears we’re in a new world – or at least in a transitory state where there is an imbalance in a previously ubiquitous online life. For a while everything we did, every way we interacted with the world around us, was through teleconferencing. Now that things are slowly returning back to normal, many of us are experiencing what I can only describe as a hybrid existence with a mixture of in-person and online activities. The hybrid world, however, conflicts with our past world while simultaneously creating new opportunities – if we can see them as such.

Clinical Conflicts

I may be one of the last people on the planet to like telemedicine. During the pandemic, when we were doing a larger number of these visits, I found them to be limiting both the social aspects of patient encounters and the inability to perform physical examinations. The minute it was safe to limit my telemedicine visits and return in-person, I did so. Because podiatric medicine is so procedurally based, it was necessary to see most of our patients in person, which was just fine with me.

But for the family practice group at my university, teleconferencing with their patients was a huge boon to them. They were able to improve the efficiency of their practice by having some providers at home doing telemedicine visits and others present in person. The administration, though, didn’t realize at first the strain to support staff caused by all of those providers returning to the office. Our front staff was severely strained by the larger influx of patients through both the family practice and our podiatry practice. When you couple the ideas of telemedicine’s efficiency with the ever declining need to see patients in person, it makes one wonder if the larger role of telemedicine should become permanent. Maybe less so in podiatry, though.

I have an upcoming in-person encounter scheduled with my own primary care doctor. However, it would actually be more efficient if I could schedule it as a telemedicine visit. The primary actions that will result from my visit will be ordering labs and a couple of referrals, none of which will need my body to be present. My own son, overseas in college, has been sick twice to the point that he needed a doctor. In both cases, he had telemedicine visits which were very effective for him. In the cases where masks are still being worn in clinic settings, the advantage of seeing each other’s faces in telemedicine visits can be profound and a real communications advantage.

These situations represent opportunities to adjust our current model of care. Clearly it works in primary care. What about specialty care? There are many opportunities to leverage internet connectivity to make patient encounters better than before. It just takes some thought and creativity. But for people like Dr Abraham Verghese, one of the minds behind the famous Stanford 25 and always a strong advocate for improving the bedside relationships between doctors and their patients (and an amazing writer), the idea of not seeing patients in person is anathema.

Featured Lecture
CTPs-How Do You Choose?
Windy Cole DPM,  CWSP
CTPs-How Do You Choose?

Windy Cole, DPM discusses complications that cause wound healing to stall. Dr Cole also reviews the treatment of chronic wounds using cellular and tissue products (CTPs) as well as distinguishing between the variety of commercially available CTPs and when to best use each type.

Available Credits: CPME 0.5

Residency Challenges

For the past couple of years, we have been holding residency interviews online via teleconferencing. Of course, everyone found out pretty fast just how beneficial this was to the programs. No expenses to travel to Texas, pay for hotel rooms and conference rooms. No time wasted traveling. I found it very difficult, though, to run a strong interview, advocate for my program with the strongest candidates, and really get to know them. There’s something special about holding an in-person interview.

Now, as the residency interviews are planned to be held in person this coming January, I’ve heard a number of complaints from different programs arguing they want to keep teleconferenced interviews. I don’t blame them. We have all the benefits mentioned, plus the decreased expenses for the applicants. Could there be a better way?

Conference Conflicts

Another area in our profession that may be in transition is in the CME conference world. I’m seeing some potential conflicts brewing here. After attending a number of fully online events, many in-person events (before COVID), and even a few hybrid versions post-COVID, I’ve noticed a divergence in the desires of attendees and sponsors. It appears that many podiatrists like on-line conferences, with their ease of attendance and lack of travel, while sponsors seem to prefer in-person conferences with their improved ability to directly meet with potential new customers.

I feel for both of these interest groups. While it’s definitely more convenient to attend online conferences, podiatrists stand to lose the opportunity to network, both with colleagues and vendors. The interactivity at in-person conferences is hard to duplicate online. The technology certainly allows it, but the inclination of attendees is to interact less with their colleagues and vendors online than they do at in-person events. In-person conferences are generally acknowledged to be more beneficial to vendors, putting more people directly in front of them, and that benefits attendees as well. Some vendors I’ve spoken with at recent conferences expressed concern about a lack of meaningful attendee interaction if they go all online. I can appreciate this perspective. I can also appreciate that without our industry colleagues, it becomes very difficult to fund conferences. My suggestion is that vendors and conference creators come to the table and work together to figure out new and creative formats to benefit all parties.

For me as an educator, I have a somewhat different problem with online conferences, which I’ll call a lack of engagement. The delivery of online conferences, much like pre-COVID conferences, is mostly passive, with a heavy emphasis on listening to lectures from the podium. Now, this is a well-established and common information delivery method, but it’s well known to be inferior for adult professionals who are problem-oriented and need skill-based education. My hope is that one day it will be possible to hold conferences that maximize adult learning techniques and technologies by requiring interaction but with online conferences as they have been today, this hasn’t yet happened. Along similar lines, a lack of engagement brings us back to meeting vendors face to face, and the benefit I didn’t mention before. Spending time with a particular product or service during conferences is a popular way to add new skills and services to a physician’s practice. Hands-on training like what takes place in conference workshops is the way that we learn to use hardware and apply treatments. I’ve added several new procedures and technologies to my armamentarium over the years after working with vendors at conferences. There is risk of this benefit being lost if we went to only on-line conferences, and I personally plan to focus my time at upcoming in-person conferences with the vendors.
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Desert Foot 2022

Where all this eventually goes during this period of transition is anyone’s guess. Foresight would definitely be powerful at this moment, but unfortunately, what didn’t come with the COVID pandemic is the ability to read the future. I hope all of those in power will use this moment of change as an opportunity to make something better for all of us.

Best wishes.

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
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