HISTORY OF ONTARIO PODIATRISTS AND CHIROPODISTS

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Unfortunately, the Ontario Podiatrists and the Ontario Chiropodists professions remain divided. In the OPMA (Ontario Podiatric Medical Association) submission of May 8, 2008 to the Health Regulatory Advisory Council, Podiatrist James Hill, who was president of the OPMA (Ontario Podiatric Medical Association) at that time, states “The Podiatry profession has ample experience with being a minority class within a larger College and that experience has not been happy. In the final analysis, the will of the majority profession will almost always overrule the minority profession. Too much College time and resources are taken up arbitrating interprofessional disputes within the College. Inter professional frictions between the two professions have actually militated against collaboration between the two professions”.


Please note that Mr. James Hill, Ontario Podiatrist was convicted of defrauding the Ontario Government (OHIP) of $10,000.00 in 2006 and his license to practice Chiropody in Ontario was suspended for 6 months that year. How does the OPMA reward him for his crime? By making him their President. If you want to know what Ontario Podiatrists’ attitude toward Ontario Chiropodists are, please visit the OPMA website under “about OPMA” and the heading “Podiatry and Chiropody” from the OPMA’s annual report written by Podiatrist Mr. Bruce Ramsden. The OPMA also initiated a large number of complaints to the College against Chiropodists’ advertising practices. We have witnessed a distressing trend among chiropodist's to use such terms as “podiatric”, “podiatry”, “podiatric medicine” and so on in advertisements. The objective is clearly to mislead members of the public into believing that they are in fact Podiatrists or that Chiropodists and Podiatrists are the same. While we completely understand why Chiropodists want to attach themselves to Podiatrists’ coattails, like previous Presidents I think it is incumbent upon the OPMA to do whatever it has to do to protect the Podiatry brand in Ontario. I also believe it important in order to get what we want out of the HPRAC review. If Chiropodists are allowed to appropriate the Podiatry brand they could well lose the incentive to work with us and the College in the HPRAC review. It is in my view, that such narrow minded leadership of the OPMA has continued to hamper the growth of the foot care profession in Ontario, so many wasted resources funnelled in senseless complaints against so called colleagues.


The 21 Health Regulatory Colleges were set up by the Ontario Government to protect the publics’ access to safe, competent and ethical health care for the general public in Ontario. The OPMA has placed the College of Chiropodists of Ontario in a unique position where it spends much of its time and resources responding to complaints from the Ontario Podiatric Medical Association (OPMA) against Chiropodists. This is an incredible negative waste of time, energy and resources that could be better used to further the profession.


Both Podiatry and Chiropody schools require a three or four year undergraduate degree in the associated services. Then there is a further four years training to become a Podiatrist at Podiatry school and three years more to become a Chiropodist at Chiropody school. Chiropodists can do nearly everything that a Podiatrist can in Ontario including surgery except surgery involving bone, although in 1991, Podiatrists lost their right to perform surgery to the hindfoot through legislation from the Ontario government. Podiatrists are also allowed to communicate a diagnosis. Chiropodists are not allowed to communicate a diagnosis by law to the patient, although we know that this is a conundrum because as primary health care practitioners it is hard to treat a patient who presents to you with a particular ailment and not disclose what you are treating them for. Dr. John A. Hardy, had to work under these regulations for 11 years as a Chiropractor until we were granted the right in 1991 to legally convey to our patients our diagnosis. Podiatrists were not allowed by law after 1991 to refer to themselves as a Doctor, whereas Chiropractors obtained that right in 1991. Podiatrists are also partially covered by OHIP, but as Dr. John A. Hardy, a Chiropractor who dealt with partial OHIP payments for over 20 years, we know this is more of a hindrance than helpful as in many cases patients cannot utilize their full extended health benefits. They also pay such a small portion of the total fee, combined with the added paperwork and inconvenience, it really isn’t worthwhile. Initially when they covered a greater portion of the total fee, it was. The best thing that happened to my clinic was the day we no longer had OHIP. Our Chiropractic Association fought to retain OHIP benefits, but it was only a prestige issue and everyone was glad we were removed due to the inconvenience to our patients and ourselves.


This actually places Podiatrists at a disadvantage when compared to Chiropodists when it comes to utilizing your extended health care benefits. We have had many patients choose a Chiropodist over a Podiatrist for foot care due to the fact that they didn’t get paid for treatments from a Podiatrist from their employers extended health plan. Podiatrists at the College of Chiropodists of Ontario meeting on February 5, 2012 asked the College of Chiropodists of Ontario to write to the Canadian Life Insurance Association to complain about the discrimination of Podiatrists, but at this point in time, nothing has changed and it is is more advantageous if you are using your extended health insurance benefits to attend a Chiropodist rather than a Podiatrist in many cases. You should phone your Employers Extended Health insurance Plan to see if you consult a Podiatrist, whether or not you will be reimbursed if the Podiatrist is billing OHIP. Chiropodists and Podiatrists are treated on an equal basis in the eyes of Ontario Extended Health Insurance companies and their subscribers are reimbursed at the exact same rate. Chiropodists can perform surgery of muscles, tendons and nails. Both are licensed to prescribe pharmaceuticals. Podiatric medicine in Ontario is based on the American definition of Podiatry. Chiropody in Canada was originally based on the British model. Podiatrists are allowed to own and operate an x-ray machine as well as order x-rays.


In Ontario, the OPMA and specifically the Ontario Orthopedic Surgeons successfully lobbied the Ontario Government to impose a cap on the new Podiatrists in July 1991. At the council of the College of Chiropodists of Ontario meeting of June 3, 2011, at which the current President, Mr. Bruce Ramsden, a Toronto Podiatrist, was present, a history was provided by Mr. Goldberg, a Toronto Podiatrist regarding the Podiatry Cap, “Podiatrist Goldberg provided a short history of the Podiatric Cap for those who were unaware of its history. The OPMA may have been against the registration of Podiatrists as they could have been seen to be in conflict with Orthopedic Surgeons. The government model provided only for Chiropodists, although Podiatrists could continue to practice under the 1991 Chiropody Act”.


In the study called Podiatry, Chiropody and the struggle for legitimacy in Ontario undertaken by Dr. Alan M. Borthwick, Podiatrist, University of Southampton, UK and Brian Craig, D. Ch., of Markham, Ontario who is a Chiropodist, under the section titled the committee on healing arts (1966-1970) states “the chief concern to the Medical Doctors was the desire of Podiatrists to perform surgery of the foot, and administer anaesthetics for this purpose and to prescribe drugs for internal use… If this really is the claim, it is surely preposterous… (Grove, 1969). Also from the same study, a former President of the COCOO states, “the relationship that the Podiatrists established with the provincial government, and particularly the civil servants who remained in place, was not a positive one.. And one of the reasons they got a consultant, but the die was cast.” Another quote from the same study from a former president, board of regents, DPM, Podiatrist: "the minister of health, Dennis Timbrell told me to my face, sitting in the caucus room in the conservative party at queens park in the legislative building, that as long as my influence prevails around this ministry, you will never have the same status as your counterparts in the USA. I like the way we do it in Great Britain, where the MD’s tell the Chiropodists if and what and why.”


All new Podiatrists would have to be registered and as a result the number of Podiatrists continues to diminish in Ontario as the aging Podiatrists retire and only 12 Podiatrists trained in the states have come to Ontario to practice as Chiropodists since 1993, while the number of Chiropodists in Ontario continues to increase, Podiatrists are now outnumbered 8 to 1 by Chiropodists who are in fact the smallest profession in Ontario regulated by the Health Regulatory College. Ontario is the only jurisdiction in the world where the term Chiropodists is still in use, but because we cohabitate with Podiatrists, this situation will continue for the near future. Ontario remains an enigma in regards to foot care, as we are the only jurisdiction where 2 classes of foot specialists, Podiatrists and Chiropodists are practicing under different regulations, regulated by the same regulatory body the College of Chiropodists of Ontario. It is the hope of Academy Foot and Orthotic Clinics that eventually Podiatrists and Chiropodists can eventually work together to further the advancement of the two professions for the common good of their patients.


If you want to know how our colleagues, Ontario Podiatrists regard Chiropodists, please look at some excerpts from their yearly financial reports.


2011


The OPMA also initiated a large number of complaints to the College against Chiropodists advertising practices. We have witnessed a distressing trend among Chiropodists to use terms such as "podiatry", "podiatric" and "podiatric medicine" and so on in their advertisements. The objective is clearly to mislead members of the public into believing that they are in fact Podiatrists or that Podiatrists and Chiropodists are the same. While we completely understand why Chiropodists want to attach themselves to Podiatrists coattails like previous Presidents I think it incumbent upon the OPMA to do whatever it has to do in order to protect the podiatry brand in Ontario. I also believe it is important to get what we want out of the HPRAC review. If Chiropodists are allowed to appropriate the podiatry descriptors and brand they could well lose the incentive to work with us and the College in the HPRAC review.


2012 


As has been the case with my predecessors, I perceive one of my priorities as President of the OPMA to safeguard the reputation of podiatrists in Ontario and to protect the podiatry brand into which so much has been invested throughout the years. As a consequence, the OPMA has made a total of seven complaints pertaining to five Chiropodists whose advertising stated or implied that they were Podiatrists and were offering podiatric care. Some complaints included other issues such as misuse of the "Dr." title plus other infringements of the Regulated Health Professions Act and our College's advertising regulations and guidelines.


2015


When the OSC attempted several times to convince the government to amend the Chiropody Act to allow them to call themselves Podiatrists, the OPMA was there to stop it.


2017


Podiatry had made itself very unpopular with the health bureaucracy and the government of the day. The profession defended podiatry for the benefits for the profession and rarely talked about benefits for the public. The profession's leadership was out of touch. It assumed that podiatry had more capital and leverage with the government than it actually had. Not only had the profession not built bridges with other professionals and stakeholders, it had burnt the very few bridges that existed. The profession completely ignored the adage, "Keep your friends close and your enemies closer" by alienating both friends and enemies. 


According to the Canadian Podiatric Medical Association (CPMA), the skills of Podiatrists are in increasing demand because disorders of the foot and ankle are among the most widespread and neglected health problems. There is one school of Podiatry in Canada where you can be trained to be a Podiatrist located in Trois-Rivieres, Quebec. The school for Chiropodists is located in Toronto at the Michener Institute with clinical training at the Michener Foot Clinic.


Please note that Dr. John A. Hardy, has provided a $4,500.00 scholarship to 3 years of students for excellence to the Michener Chiropody School in the past.



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