December 1999 Bulletin

Foot, ankle program to expand scope

CD-ROM to translate into action a major step to address work force issue

An upcoming foot and ankle care project, Essentials of Musculoskeletal Care CD-ROM Supplement: Foot and Ankle, is an attempt to translate into action one of the major steps in addressing the work force issue in orthopaedics-expanding the scope of practice.

"This program will reacquaint the practicing orthopaedic surgeon with contemporary methods of managing the foot and ankle," says James D. Heckman, MD, 1998 Academy president, "enabling him or her to feel comfortable and confident in both the operative and nonoperative management of foot and ankle problems."

An Academy task force studied the work force issue in 1998 and concluded that "the new cadre of orthopaedic surgeons are more specialized, are poorly skilled in nonsurgical care and have no interest in it," according to the task force chairman, Michael H. Graham, MD, speaking to the Academy Board of Directors in December 1998.

If this trend continues, eventually orthopaedics will become a "surgical technocracy and we'll lose chunks (of orthopaedic care) to others," Dr. Graham said. "The physician surgeon will be reduced to a mere technician."

The task force recommended a "move back to more balance in orthopaedic care, including nonsurgical treatments." This proposal reinforced Dr. Heckman's solution to the work force issue, namely, to expand the scope of orthopaedic practice by increasing the volume of non-operative care.

The Academy's multimedia foot and ankle care program directly answers the call for more balanced orthopaedic care.

"Orthopaedic surgeons are the premier providers of foot and ankle care in this country," says Stephen F. Conti, MD, editor of the program, along with Ronald W. Smith, MD, "but one of our deficiencies is in providing basic foot and ankle care-which means providing advice and treatment for simple conditions, like ingrown toenails, some forefoot pathology and some basic nonoperative tendon problems. The Academy has wisely decided that one of the best ways for orthopaedic surgeons to increase their scope of practice is to provide them with a greater knowledge of foot and ankle care."

Dr. Conti and Dr. Smith are developing a comprehensive CD-ROM that will educate orthopaedic surgeons, as well as allied health care providers, such as nurses, physician assistants and medical assistants, on techniques of examination and treatment that can be provided in an outpatient setting. This project will focus not only on clinical skills but also will teach the orthopaedic surgeon how to apply those skills in a cost-effective fashion, through the use of physician extenders and effective billing practices. The CD-ROM also includes patient education materials that can be printed out and distributed to patients, and enables orthopaedic surgeons to insert their name, address and phone number on each document. At the bottom of each page, a tag line is included that reinforces the concept of orthopaedic surgeons as the premier providers of musculoskeletal care.

The CD-ROM is scheduled to be complete in time for the Academy's Annual Meeting in Orlando, where a four-hour instructional course "Managing Foot Care in Offices and Clinics" will be presented on Thursday, March 16, 2000.

"The course will cover a variety of topics that will demonstrate to orthopaedic surgeons that foot care can be provided in their office in an efficient and profitable manner," Dr. Conti says. "The CD-ROM will be available for purchase after the course."

This project-the result of a partnership between the Academy and the American Orthopaedic Foot and Ankle Society-also dovetails with the Academy's public relations plan to promote the services of orthopaedic surgeons as providers of musculoskeletal care to the general public. Once this PR program is in place, clinicians should be prepared to respond to patient requests.

The Essentials of Musculoskeletal Care CD-ROM Supplement: Foot and Ankle will be available on video, audio, text and animation on CD-ROM (2 disc set).

After viewing the presentations on this CD-ROM, the audience can:

The program's production will closely follow the organizational structure of the Essentials of Musculoskeletal Care CD-ROM Supplement, Discs 1 and 2. The program will include a series of video demonstrations with supporting audio, while the main menu will provide the learner with an organized approach to the content in three main sections, each with sub-sections. The three primary sections of the program include the physical examination, diagnosis and treatment of common foot disorders and patient education.

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