Patients are casualties in an Ontario turf war between chiropodists, orthopedic surgeons and podiatr

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Patients are casualties in an Ontario turf war between chiropodists, orthopedic surgeons and podiatrists who aren’t allowed to perform surgeries for which they’re trained, a podiatrist says.

http://www.woodstocksentinelreview.com/2012/03/12/patients-are-casualties-in-an-ontario-turf-war-between-chiropodists-orthopedic-surgeons-and-podiatrists-who-arent-allowed-to-perform-surgeries-for-which-theyre-trained-a-podiatrist-says

? our own worst enemies.

LL

 

Re: A student chiropodists prospective.

Absolutely!

As Chiropodists within Ontario we practice with a limited scope of practice with respect to our often-accepting Podiatrist counter parts down south.
The post graduate Chiropody program offered at The Michener Institute is under development and is striving to offer a curriculum deserving of the title Podiatric Medicine.
Currently, prospective students must apply to the school with the following CV.
4 Year Bachelors degree in Sciences from a recognized University.
Prerequisite Requirements are:
One (1.0) full credit equivalent in Human Physiology.
One (1.0) full credit equivalent in Life Sciences.

The school receives upwards of 600-1000 applicants with a yearly cohort of 30 students. MMI’s are the interviews organized by the college with a GPA admittance averages between 79%-90%+.

The Chiropody program is a 7-semester diploma offered over 3 years.

During the program we perform a cadaver dissection in conjunction with University of Toronto Medical School. And receive didactic instruction in the following fields.
Courses: Anatomy, Anatomy Dissection, Pathophysiology I and II, Dermatology, Pod Med 1 (Routine Foot Care), Biomechanics I and II, Clinical Pharmacology, Pod Med 2 (Conservative Care, and Emergency Medicine), Laboratory Diagnostics and Imaging, Rheumatology, High Risk Foot, Podopediatrics, Sports Medicine, Soft Tissue Surgery, Evidence Based Medicine, Legislation Practice Management, Thesis Proposal. As well as other multidisciplinary, jurisprudence and laboratory courses.

Additionally students are in clinical rounds from 1st year, with their final year being full time clinical rounds with classes by correspondence. I am currently in my final 6 months of clinical and have the option to observe both lower extremity vascular and orthopedic departments in addition to our chiropody clinic.

Therefore our scope upon graduation emcompasses: Soft tissue surgery including but not limited to nail surgeries, nerve entrapments, Morton’s neuroma excision, tenotomy, plantar fasciiectomy, incision or excision biopsy. Prescription of all major Abx classes, NSAIDs, antifungals and corticosteroids (Injections, topically ect), injectable local anesthetics. We are the only profession within Ontario that may prescribe, order and dispense CFOs, AFOs ect.

Additions to our scope currently under consideration by the government: Radiographs and lab testing covered by the OHIP (Medical Care equivalent), administration of Nitrous oxide by inhalation (An Ankle blocks a ____ without sedation). Addition of oral Valium to prescription list.

To conclude, we are a young profession within Ontario and are limited not by our own ambitions but by our governments antiquated view of foot care and fighting within our own groups; older USA trained podiatrists vs. Chiropodists, both equally hot headed. We are all practicing podiatric medicine, and are acting in the best interest of our deserving patients.

NB: I hope and actively advocate that the podiatry cap is removed, offering US trained podiatrists to come to Ontario and practice with a full scope. Not because I want the competition, but because along with the cap removal will be a grandfather clause and the ability for my classmates and I to receive bridging courses in orthopedic surgical treatment options.

My understanding with the chiropodist vs podiatrist situation is that the ON gov't wishes to open the cap but their remains both greedy chiro's and pod's who wish to keep it closed. It is the younger generation of our profession, those with a larger scopes and a small voice who are advocating for this change because with this change will be the opportunity for improving our own scope. My wish is that we would first move to the UK model, one in which their are active two scopes, Podiatrists (General Practitioner) and Podiatrist (Surgical). It is not foreseeable to switch immediately to the american model because our college whose demographics; 550+ chiro's to 55+ pod's, will not stand for it.

Another major step needs to be the education, we need general medical rotations and a blasted residency! Our current curriculum lacks the initial 2 years of general medicine (Histology, biochemistry, human physiology etc).Currently at the Michener we have 3 DPMs (one who taught a residency placement in florida) and one DPM FACFAS rearfoot reconstructive doc, they are awesome and are leading the way in our school. They are advocating now for a additional surgical residency after the completion of our 7 term program.

I digress, this is a depressing topic because even if all of the above facets begin to align we still have to start-up the battle with our Ortho's, and the Ontario Medical Association who are lobbying against us.

 

It's not just a turf war in Ontario but also nationally. So much for AIT.

 

We have all the same issues here in Australia, even as far as fighting the orthopaedic surgeon cohort to let us in the door to train as surgeons, Gp's not providing medication information in referrals because they think we only cut toenails, having to complete further training to be permitted the right to perscribe antibiotics (+ annual revision course to maintaing that right) etc.... and as you mentioned, we continue to fail to band together to make changes. I look at the Nurses Association & the strength they now have in numbers to make changes, and I feel that is the way to go. At $900 a year to be a member though, there are a lot of podiatrists not being members, er go, not a big enough united front to make national changes.

 

Re: A student chiropodists prospective.

Hi there guys,

Just adding my two cents.

I'm British and wanted add our version of events this way. We too have a similar set of issues our way.

In fact as a 3rd year Podiatry student I have strong opinions about the whole things so lets first set the scene over here a little better.

In the UK Podiatry is a growing profession. Many people still recognise it as Chiropody. At this point I must SCREAM I hate it! :bang: I have not studies for 3yrs to be labels a chiropodist, we do that as 'Part' of our who treatment, although it may be the bread and butter of general treatment it is by no means a reflection of our capacity.

Now we have started a slow shift towards this reclassification, which in the next 20 years will eliminate chiropody from classification, as the profession of Podiatry is growing, the youthful as you say are trying their up-most it is a struggle.

In the UK we had a grandparent scheme many years ago to bring all 'Chiropodist' up to the same level with various events, bureaucracy and legal involvement from our Health Professions Council [This is the simplified version]

This was great as it started to create a standard, and help create our professional body. I hope that it grows strength to strength and we become ideally like Dentist's in that we are separate but interconnected. Again that's more my wish perhaps not the view of everyone.

Now you mentioned the idea about UK Podiatrist being just Pod's or being surgically trained EEEEK! Breaks on! Ok we have huge issues here with orthopaedic surgeons not wanting us on their turf. It is really challenging and kinda off putting. Now Firstly credit where credit is due. ALL DOCTORS AND SURGEON without a doubt have my respect they work bloody hard and frankly having see some of their learning i wholeheartedly agree when they get upset and think so this 3yr podiatrist is just going to walk on in and start doing surgery I DONT THINK SO! Not after I spent 7 years of med. school and the rest training just to get here! I totally agree, that isn't fair nor is that a good reflection on maintaining standards. However, the limitations of where we can and cannot progress shouldn't be limited by opinion, but by ability. I know for a fact that only now some of the many older podiatrist are starting the courses and even with their years of experience will probably struggle to even get a placement let alone get qualified as a surgeon.

So ironically as it looks like for once the USA may have a better system. Maybe. If there is a way of bridging the divide between the orthopaedic surgeons and podiatrists (wanting to be podiatric surgeons) then we could be on to a winner. From my point ov view it's kinda dead simple, i spend my day looking at the lower limb, why not just keep training me bit by bit till I really know it to such a degree I'd be perfect to do all surgery from say the hip down. When it comes to upper body Orthos your welcome to it - The pelvis is complicated enough without including the spine! The beauty of what I can see is a constant, but gradual progression for us pod.s to eventually reach the rank of Dr/surgeon/consultant but with perhaps a different route.

Now we have to accept at the moment the economy is placing a lot of worry and strain on every one so again I can appreciate everyones concerns. The other problem at the moment is the UK has and NHS that is from my perspective about to fall apart, this is deliberate the government is tired of holding it up and is very sneakily and tactically putting it in to awkward position. It's cutbacks make it impossible to deal with the increased volume with in it and ironic because the increase work load is a result of other mistakes the government made in the past. Now this is moving away from what were discussing but it is to point out some really good and important issues.

I know one my our lecturers has finally achieved the all high rank of Podiatric Surgeon and credit to him he has worked relentlessly and no doubt had to battle many people who were opposed to him being there. He did it, so why can't the rest of us? Well what interesting is a response he had given when asked about being a Podiatric Surgeon - DON'T! In that single word I think he summed up the entire hassle of what it is like trying to face bigoted ideas and unwavering minds of the medical elite. I respect each of you as professionals admire you all in your craft, but loathe and detest any man who stands in the way of progress unless for morally and ethically sounds reasons (Environmental also too) Our profession is here to stay and its purpose is to aid the growing demand on the health service, many of us just want a decent wage and a chance to grow, I think that is very reasonable and not everyone will want to be a Dr/surgeon/consultant and many wont be cut out, but letting us progress is where in the UK like canada have issues.

I also noticed on your post about mortons neuroma removal and other various surgical techniques - we as podiatrist in the UK cannot do those. We can administer an LA and take toe nails off, with CPD (Continuing professional development) ankle blocks, but only with surgical training can we progress on to the rest. So it actually sounds like you can so more than us already within you course. Food for thought!

My real personal desire is an International Guild of Podiatry where we globally set the standards. We have the appropriate title across the board and each level comes with a generic level of responsibility and capability. It creating such a transcending order we could allow any level of participation in other countries allowing more movement of professional which could aid us in experiencing different cultures, but also improve our learning from a CPD view and as a student view too. This would also allow us globally to say to the medical establishment - ok were like dentists, we have our own body, we work at train to try and reach an impeccable level and are just as thorough, we work with you in your fields but acknowledge that our specialism is lower limb. So let us do what were trained to do and let us do it a best we can, once we reach that point where we can no longer progress then that is when we know where our boundaries stand.

I feel for your frustrating aspects, we have even more fun when it comes to the different views of Podiatrist within just the UK from Scotland v England, but despite our differences we all know one thing is certain - our patient health is our priority! (Of course it does kinda help to be able to pay for food and eat - however thats just a minor thing really!)

 

Hi to all

I fully agree with what you are saying her, I am a podiatrist currently working in Malta. I am reading to a masters in theory of podiatric surgery. it is very important to know what is the situation in different countries and it would be of great benefit if an international protocol is written down, which we can follow as our main guidelines.

I wish to continue my training as well and be confident enough in performing foot surgeries and why not maybe introduce this new area of medicine in Malta as well. it is extremely important for me to hear from you guys and the situation in your countries and if there are any studies regarding the increase of foot surgeries in your place let me know because i am thinking of doing something similar

best regards
cheers :morning:

 

"There is no turf war here
The article Foot wars (March 12) refers to a "turf war" among foot specialists that is placing those with diabetes in Ontario at risk is unfounded.
The Ontario Society of Chiropodists, the Ontario Podiatry Association and the College of Chiropodists of Ontario (the government's regulatory body) have joined forces to obtain changes to the current antiquated legislation, including standardizing the name to podiatry.
The majority of high-risk patients require non-surgical interventions that are adequately provided by chiropodists and podiatrists who share the same scope of practice.
Had the newspaper contacted our professional association, he would have come to the realization that there is no turf war, rather a united effort to improve our health care system.
John Infanti
President, Ontario Society of Chiropodists"

 

We have access to greater scope of practice in Ontario when compared to the UK and most other provinces, including some authorized acts not available in Quebec which has a partial D.P.M. (not accredited and no in province bone surgical training) program.

We continue to have to deal with individuals who do not know the whole story and like to spread misinformation to promote their own agenda. No one forced this individual to train in the US and learn procedures that she would not be able to use upon return home. We all have the option to accept domestic education or seek foreign training. We have the option to seek employment in a different jurisdiction, but I don't see any US podiatrists moving to the UK or Australia and whining about the scope of practice and expecting special exception. We are only different because the government decided not to penalize the existing podiatrists who were working beyond the 1940 Chiropody act and allowed them to continue practicing bone surgery if they had adequate training when it became clear that we needed training here and could not rely on foreign clinicians.

The government chose the chiropody program, scope and title, and put the cap on podiatry. When everyone else was on the brink of expanding, a restrictive model was chosen and implemented here and has been very slow to progress, but progress we have in spite of the challenges! The demands of private practice settings that were necessary due to funding cuts in salaried clinics has pushed things forward to ensure we can better serve the public.

We have signed a tripartite agreement between the College of Chiropodists of Ontario, the Ontario podiatric Medical Association and the Ontario society of chiropodists agreeing to work towards one title, one scope. Lifting the podiatry cap without changing the rest chiropody act would not benefit the profession. We must fix it all. All parties agree, no bandaid solutions allowed. Government is reluctant to reopen acts, we cannot do this one tiny bit at a time. We need more than just to allow foreign trained clinicians to exercise their scope of practice. All of us need access to X-rays, lab testing, minor bone scope, to effectively serve the public.

It is time to rise above the history. Make a new future for ourselves. Have a say in what our profession looks like! Support your professional association. We are getting ready for the HPRAC review which will improve the profession only if we work together! Individuals who promote this fractured view of the profession could hurt the overall process and will only end up shooting themselves in the foot in the long run, pardon the pun, if they don't get onside. It is time for professional cooperation.

Sarah

 

Hint of turf war there.

 

This is not a turf war, but a valid and necessary move to remove the barriers imposed on our own domestically trained foot health care providers AS WELL as those who have moved to our province having trained in the UK, Australia, South Africa. These places train to a similar (and often even lesser) scope to that currently practiced by Chiropodists in Ontario.

To my knowledge, in no other jurisdiction is a foreign trained individual afforded more benefits or access to an increased scope of practice in comparison to those educated domestically.

To afford those benefits automatically to an influx of foreign trained individuals while continuing to limit those who accessed their training within their own country would surely be an absurd proposition to any group and is thus very abhorrent to the Ontario Chiropodists. We must be afforded an opportunity to increase our scope of practice to level the playing field.

Lifting the "podiatry cap" without putting in place structures to level the playing field of the Ontario AND UK, Australian, South African trained individuals is quite simply discriminatory.

 

How exactly is this discriminatory?

Chiropadist - trained in x, allowed to practice x
Podiatrist - trained in x+1, not allowed to practice/capped

This is like saying: MDs trained in Canada should be allowed to practice in Canada, any non-Canadian MDs, should not be allowed, as home grown is always better.

Looking at this from a patients perspective: a patient won't care about the country of training. This is healthcare, not the dairy farmers assoc of Ontario, homegrown or not, the best healthcare is required.

 

Your comparison demonstrates a very poor understanding of the political situation in Ontario under which we currently practice.

It is rather like saying "only US trained doctors are allowed to become surgeons in Ontario, Canadian training isn't good enough AND they must do their surgical residency in the US" WHILE REFUSING to allow Canadian trained MDs access to equivalent education in their own province that would allow them to be on par with those coming from outside. Having a different scope of practice for foreign trained and domestic trained individuals and perpetuating this on an ongoing basis is discriminatory against domestic trained individuals and creates divisiveness in the marketplace.

Like all countries, Ontario school can only train to the legislated scope of practice that those students will graduate to practice. You cannot train someone to do something they are not allowed to do upon graduation.

When you change jurisdictions as a professional, if the required entry to practice is higher, you must train to INCREASE YOUR SCOPE to be in line with the basic competencies required in that country. Conversely, when you chose to move to a place that does not have as great a scope, you are limited from practicing those increased competencies that you were trained to do in your country of origin as they are not part of the legislated controlled acts afforded to the members of the regulated health profession college you have applied to and been accepted by.

I will again point out that there has NEVER been a Podiatry act in Ontario, and the Ontario government decided upon the current scope of Chiropody in Ontario. They created this can of worms when they decided to create a subclass of Chiropodists called "podiatrist members"; allowing a few DPM trained individuals to perform bone forefoot surgery and continue to use the Podiatrist title.

 

Sarah, With all due respect, we are better trained, hence allow us to practice to our scope. Holding DPMs back in Ontario so that Chirop can get better training and eventually become DPMs does not make sense to me.

 

You are trained to a different scope of practice.

Take away the better. The better is my issue. It is disrespectful to say you are "better" than others because they have been barred from reaching the same level that you have achieved in your training. I could have gone to Temple through the advanced standing program however would not have gotten return on that investment as I prefer to stay in Ontario to practice.

I am frankly tired of having my education denigrated publically as "less than" because it trained me to a scope of practice that differs from that provided in the United States of America. It is not BETTER it is DIFFERENT.

The scope of practice must change before US trained DPMs will be allowed to practice to their full training level in Ontario. The Chiropody act must be opened to make this change. These changes occur so rarely, so the opportunity must be taken to evaluate all aspects of the Chiropody act and modify it to ensure all Ontarians have access to the best possible care. Allowing US trained DPMs to practice is not the greatest concern on the table here, there is much more at stake and many important contradictions to remove.

I am personally not in charge of allowing you to practice to your full scope; that is solely the responsibility of the HPRAC committee; and the established Ontario Podiatrist Colleagues failed to convince HPRAC that Podiatry scope was the way to go.

This is a turning point in our profession. It is not about who is better, who should be allowed to do what, it is about what Podiatry should look like in Ontario. This is a bigger issue than you and me and our respective training programs. This is about how professions like ours must continue to evolve and grow to meet the needs of the public we serve, and unfortunately also about the long and arduous process of enacting changes in legislation. Other countries have gone through these growing pains while deciding upon the best scope of practice/model of health care delivery to allow residents access to necessary foot care and surgeries. Ours is just a bit more complicated because of this grandfathered "podiatrist class".

Can we convince the Ontario government that Ontarians need and will benefit from an increased Podiatry scope? If we cannot, there will be no Podiatry profession in Ontario after the current podiatrist class retires. Trust me, this "better than" attitude is not helping the situation at all.

Lifting the Podiatry cap without evaluating the whole Chiropody act is not even considered an option. I was personally at the meetings. This idea was shut down because of the detriment it would have on the whole profession's ability to grow and develop by members of the College of Chiropodists council. We cannot afford to simply slap a bandaid solution on this profession to suit those few DPMs who are disgruntled about being "held back" by the current legislated scope of practice.

Sarah Robinson
President
Ontario Society of Chiropodists

 

I take my last comment back and apologize for calling my training "better".

I understand that Chirop as a profession needs to grow and progress, increasing the scope to include surgery, establish residencies/changes in schooling etc

However, in the mean time, my take on "increase in DPMs = detrimental to the entire profession" continues to be: this is not true at all.

There are practicing DPMs in Ontario, always have been, 5 or 50 more will not cause a collapse of the Chiropody system, nor will it be detrimental to progress

If anything this could spur progress, perhaps a board certified/experienced DPM can start residencies specifically for Chiropodist for surgical training if they so choose....

Probably wishful thinking on my part.

 

It's not the "increase in (number of practicing) DPMs" that will be a detriment to the profession. It the reality of legislative changes. We cannot just magically remove what has been referred to as the "podiatry cap". This requires opening legislation.

If we just ask the government to remove that line now and allow foreign trained individuals to practice as Podiatrists performing bone surgery in a context outside the HPRAC review process we are advocating and working toward, will they even do it? Likely not.

The fact is that we must first convince the government that Podiatry is needed before any change will be made. The process in place by which that is achieved is an HPRAC review. Indeed we were looking at prescribing x-rays a few years ago, and the HARP committee recognized the need for us to be included, however recommended this change go through the HPRAC committee. Why is it this way? Because the whole thing needs to be fixed as a package, and changing bits and pieces through different departments results in contradictory legislation and grey areas; certainly not a comfortable climate for any professional to practice in. We have enough contradictions in legislation as it is.

Until we convince the government that an increased scope is needed, no one, regardless of where or when they were trained who wasn't licensed as a podiatrist in this province before 1993 will be allowed to access a bone surgery scope as per the current regulation.

If we have to work this hard, we should we not put our combined effort towards an effective review of the entire profession, and not just towards changing one line in the current legislation?

The opportunity to open legislation happens so rarely in Ontario that it must effectively deal with everything. If we just open it to change a line; delete the so-called Podiatry cap, it will put Ontario back into the position of being reliant on foreign trained individuals to meet our domestic need for a skill. It took approximately 17 years, YES I said 17 years; to get an approved drug list which was referred to in the Chiropody act 1991. Our drug list was finally entered into legislation in September 2008. We cannot waste an opportunity to make real progress in this profession.

The current Podiatry scope is more restrictive than the proposed scope we are working towards and it deals with much more than whether or not we can do bone surgery. We ALL will benefit from the changes.

If the HPRAC review is successful in achieving a bone surgery scope, there will certainly be training programs, fellowship/residencies run by foreign trained individuals including US trained DPMs.

The process of changing legislation is difficult and expensive. Our fees have increased dramatically to bear the cost of this effort. All are working towards the goal of improving the ability of all members of the College of Chiropodists of Ontario (hopefully soon the College of Podiatrists of Ontario) to meet the needs of the patients we treat everyday.

I hope this helps you understand the sheer enormity of the task that lies ahead of us all. It is not so simple a question as "who is holding back DPMs in Ontario" or a matter of us being afraid of a potential influx of foreign trained individuals.

Sarah

 

Hello Sarah

For those of us not conversant with the provincial system in Canada, can you just clarify a few matters?

I believe that many years ago a British trained chiropodist ( he was generally regarded as retroactive in the UK even then) ran a 2 year course in Canada which was regarded here as retrograde, certainly amongst the younger colleagues. Did this had a direct effect on Ontario?

There is no reciprocal arrangement between the United States and the United Kingdom as far as podiatry is concerned. This seems not to be the case in Canada. Are your graduates welcome in the USA, since the US trained pods seem to be in Canada?

Just as a note; there is no reciprocity between the countries in the European Union as far as podiatry is concerned. Obviously medicine is far more powerful and internationally recognised, so I agree with the poster who stated that working towards a similar situation in respect of podiatry would be a good thing. However, that is a long way ahead and we all need to put our houses in order before that can take place.

All the best

Bill

 

I was not there personally, but here is my understanding of where we are now based on meetings and discussions with those colleagues who were there or knew someone who was.

Before approximately 1980 Canada had no schools to train foot specialists. We were dependent on foreign trained individuals to meet our domestic foot care needs, and there just weren't enough coming. The majority of our foreign trained foot care providers were Podiatrists trained in the USA, however there was never a Podiatry act, just the Chiropody act of 1940. Additionally, the associations were still in charge of regulation and may have been biased towards their US based colleagues when recognizing credentialing.

The Ontario government looked at options, US DPM based surgical scope, Nursing foot care, and the then in existence British Chiropody model (was it retrograde? Likely, I think you were already working towards your current model). They also consulted stakeholders, the Podiatrists in the province, Doctors etc. The original program was 2 years in length, though it went through the summer so it was a 6 semester program, not a 4 semester. Many UK trained Chiropodists were hired through the years to staff the program, some remain in the province to this day and keep up on their continuing education to maintain full current scope of practice, others have left. We were not trained to prescribe medications, and there were no injections/nail procedures. We were to work under the supervision of a physician (who would take care of meds etc) in a government funded, salaried public clinic (community health care centre or hospital out patient department) model.

The fact that we were originally based on what was perhaps a retrograde version of the British Chiropody model of care perhaps did stymie our profession's growth and development; however some individuals suggest this may have been by design. I'm not sure how much of a role any one founding individual could have played in this considering the political climate at the time. Some Chiropodists have told me this model was chosen because it was the lowest cost option, less expensive than paying nurses to provide foot care, and easier to control. Yes we were payed less than the nurses, and only slightly more than the staff who cleaned the clinics and hospitals. I do not have access to the Chiropody act 1984; I am not sure if we were termed "primary care" then or not. Apart from dental, two tier medicine and self-pay was frowned upon.

Not very long after, training increased to 3 years (8 or 9 semesters though depending on the year), topical medications and injections, nail procedures were added to the scope of practice and those who were not originally trained in these competencies could access continuing education bridging programs to add these to their practice. Chiropody act 1991 made us primary care, not requiring delegation or supervision and stipulated we could prescribe as per the regulation (finalized in 2008). This act also put the limitation on DPMs coming into the country; "podiatry cap", they could not practice to podiatrist bone surgical scope after 1993 nor use the title podiatrist. This apparently not done to allow the Chiropody profession time to grow in numbers and become well known, but because the Ontario Government decided that bone surgery should be done by Orthopedic surgeons in the hospital setting, not by Podiatrists in the community. This was not intended to be temporary and there was no mechanism to lift this without first reopening the legislation.

During this educational transition, hospital and clinic based jobs were drying up, departments were being cut and no new clinics were being established. Chiropodists were pushed out into community independent practice. This funding crunch was not bad for our profession; our community based practices have allowed a certain degree of progress that may have been more difficult in a salaried setting.

Now the program is 3 years long, includes topical, oral, injection (Local and steroid injection) and soft tissue surgery, lesion excision, suturing etc. Some graduates have done bridging programs through UK schools to obtain their BScPod, some entered directly into a masters program, others have done a bridging program through Temple University which also recognized the early 2000's graduates for advanced standing and went on to do surgical residencies in the US. Some versions of the program were better recognized internationally than others. Those who wish to practice in the US must go to a US accredited DPM granting school, and there are currently no bridging programs in existence to my knowledge, as there were no applicants to the then newly developed Temple University distance program for foreign trained individuals when it opened and it was scrapped.

Our training is close to what is provided internationally by all schools in the former British empire, and our requirements for entry to practice are similar, however we do not have the academic university/research based program with an option to move on and pursue post graduate or specialist studies; there is no Masters or PhD level of training domestically. We also do not have the option of attending a bone surgical fellowship as it is not within the current scope, it just cannot be offered. I personally can practice Podiatry in the UK, Australia, NZ, South Africa without further training; I have to sit a practical and written examination as there is no reciprocity agreement for licensed individuals. I would also likely be accepted directly into a UK based Podiatry masters program without having to do the B.Sc.Pod. bridge as I have a B.Sc. from prior studies.

This is different depending on what province you are in. In the West (Alberta/BC), they require a US based DPM and surgical residency for entry to practice. It has only recently moved to a College rather than an Association based regulation. With our AIT (Internal movement of professionals legislation) this may change. Again, most of those practicing there went to Seattle or California for their podiatry training. As there is no training program in the west, there is no need for recognition of program.

To be a regulated member of the College of Chiropodists of Ontario, you must have completed a Podiatry/Chiropody program which addresses our core competencies. Most schools have already been evaluated and are on an approved list, graduates from others must submit their model route and summary of courses to have their program evaluated. Foreign trained individuals who do not have oral medication training will have a restriction on their licence until an approved course is completed. You must also sit an examination. We have individuals from Australia, South Africa and UK licensed as Chiropodists in Ontario, along with DPMs from the US. It is similar in most other provinces.

There is a DPM based program in Quebec, however much of the program is offered jointly in collaboration with a DPM program in New York. Graduates would be eligible to practice in the US.

If anyone knows differently from the above, or have documentation regarding the history of the profession, I would love to hear it or see it. Different perspectives help to flesh out the narrative and get a more accurate picture of where we came from.

Sarah

 

Thanks Sarah, that's very helpful.

When I referred to 'retrograde' I was speaking of the individual, not the programme. Of course, he may not have been retrograde but that was the impression amongst my colleagues in the UK at the time. We were young then, and doubtless knew everything, a faculty I find I am losing with age!

Cheers

Bill

 

Nothing is going to happen with AIT.

 

Nothing happened with AIT, you are correct.
The chiropody reality in Ontario is that there are about 900 graduates of the Ontario Chiropody Program. But only 600 are registered with cocoo.
When we were students we were told we would/could make a good professional income. But the instructors were ambiguous about providing us with a number. When we asked more than $50K? The answer was maybe. When we asked more than $100K? The answer was unlikely. When the clinical chiropody program ended at TGH, the chiropody instructors from the UK lost their positions at the hospital. They did not set up highly profitable private practice chiropody clinics. They went back ‘ome probably to salaried chiropody positions.

 

Apparently, Sarah Robinson, didn’t believe the rumours that private practice chiropodist were making less than $30,000 p.a. before income tax & after overhead. She heard that if you go to a town where you are the only chiropodist, you will do really well, eg more than $30,000. After 19 years of being in the chiropody profession & making much less than $30,000 net, she quit the profession. For comparison, a dentist said he absolutely hated dentistry. But he was able to employ his wife as manager, his daughter as an assistant & his son as the janitor, their combined income was $120,000. His professional income was $120,000 after overhead. He said he couldn’t pay his family members so well & make $120,000 before investing it in RRSPs & many other tax deductible ventures/investments. That’s why he was practicing dentistry. He was also planning to sell his practice in 10 years for $1 million. Did Sarah Robinson sell her chiropody practice for $10,000 or $1,000 or simply shut it down? Too bad Sarah Robinson is MIA.

 

It appears that John Infanti, wasn’t ok with making about $30,000 p.a. after overhead. He got in trouble with cocooo (look it up) because Greenshiekd Canada insurance paid him via electronic transfer $1,436,143.03 for orthotics that he dispensed to patients. Other chiropodists have done similar activities & got in trouble with cocoo.

 

Patients are casualties in an Ontario turf war between chiropodists, orthopaedic surgeons and podiatrists??? Really????? Who posted this title, someone from USA?

A patient sees a family physician for their bunions. The MD refers the patient to an orthopaedic surgeon. The patient has the osseous surgery covered by OHIP. Case closed.
FYI, in 1980, there were about 200 podiatrists and no chiropodists. Now there are about 60 podiatrists (most don’t do osseous surgery) & 600 chiropodists & 300+ foot care nurses.
How are patients casualties in an Ontario turf war between orthopaedic surgeons, chiropodist & podiatrists?

 

Open letter to College of Chiropodists of Ontario.

While cocoo is spending time (and money) to try to shift to the Full Scope Podiatry Model, pharmacists have again increased their scope of practice. As I already wrote, an Ontario Minister of Health personally told me years ago, that the Ministry of Health policy will only follow the recommendations that were made in the Chiropody and Podiatry: Regulation of the Profession and the Model of Foot Care in Ontario Report by the Health Professions Regulatory Advisory Council.
It’s sad that cocoo won’t pursue OHIP billing at a time of inflation and the public being unable to afford to pay podiatrists' or chiropodists' fees when poverty, senior citizens and diabetics numbers are at an all time high record. Asking the Minister of Health for OHIP funding of a miximum of $2,000 per Ontarian will help reduce the need for L.E. amputations. Or how about focusing on increasing the scope of practice for chiropodists? For example being able to order x-rays, MRIs, ultrasound imaging or doing swabs for C&S?
When a pharmacist diagnoses a health condition, they bill for it, prescribe and dispense an appropriate medication. Recently, I visited a pharmacist for a medical condition rather than waiting at a walk in medical clinic. I had to present my Health Card. My personal information and OHIP number were entered into the computer. After the pharmacist listened to my symptoms he made a diagnosis then I received and paid for a medication that was only available by prescription from a MD 5+ years ago.
I underlined a paragraph that again affirms a statement that the then-President of the OSC Susan Weltz said at an OSC conference I attended many years ago, “you have remember, chiropody is apart of the Ontario health care system.” A few years later, she quit the profession probably because she wasn't able to make more than $30,000 before income tax and after overhead expenses -this is my guess.
Please pay particular attention what I underlined in the copy and paste (unedited by me) as follows.

"Effective this summer, pharmacists and pharmacy technicians will be authorized to administer the following vaccinations:

• Tetanus
• Pertussis
• Diphtheria
• Pneumococcal
• Respiratory Syncytial Virus (RSV)
• Shingles vaccines

Which common ailments will pharmacists be able to prescribe for?
Ontario is also allowing pharmacists to assess and prescribe for nine additional common ailments, with plans to add up to five more early next year, which would bring the total number to 33.
Starting in July, pharmacists and qualified health-care practitioners will be permitted to treat the following ailments:

• Calluses and corns
• Dandruff
• Dry eye
• Head lice
• Jock itch
• Mild headache
• Nasal congestion
• Ringworm
• Warts

How will this change impact access to health care in Ontario?
In a news release, the health ministry said expanding pharmacists’ scope of practice will improve access to care and reduce pressure on the health-care system by making pharmacies “a one-stop location” for everyday care.
“Ontarians have experienced firsthand the convenience of pharmacist prescribing and today’s announcement continues our progress to reduce wait times and let more of our province’s health-care professionals work to the full extent of their expertise,” said Ontario Health Minister Sylvia Jones in the release.
Pharmacists can already treat 19 common ailments
As a result of legislative changes enacted in 2023, pharmacists are currently able to prescribe for 19 common ailments such as acne, canker sores, diaper rash and yeast infections.
The health ministry said the government has also directed Ontario’s regulatory colleges for optometrists, physiotherapists, chiropractors, dental hygienists, denturists and audiologists and speech-language pathologists to begin developing a regulatory framework to further expand the scopes of practice in each respective field.
Ontario also allows pharmacists to administer certain injection and inhalation treatments, such as insulin, vitamin B12 or medication for osteoporosis treatment.
Under 2022 regulatory amendments, pharmacy professionals can also collect specimens and perform point-of-care tests for medication management to treat chronic diseases.
The province said further expansions of pharmacists’ and specialists’ scopes of practice will unlock additional capacity across the health system and provide faster access to care.
The health ministry said it is not moving forward with scope expansions related to psychologists due to an ongoing governance review between the College of Psychologists and Behaviour Analysts of Ontario. "
50 years ago, I worked as a stock clerk in a pharmacy. The pharmacist could perform pregnancy tests and hand out strong meds that could be abused by teenagers. For example, I remember seeing 222 and 292 pills. Yes 292s were stronger than 222s. I didn't touch them or use them. The pharmacist sold them to customers who complained that Tylenol or ASA wasn't relieving their pain. Now look at what the pharmacists are able to do. Impressive!
FYI: To become a pharmacy technician the person has to graduate from garde 12, then successfully complete a two-year programs are offered at many Ontario colleges and cover pharmacology, calculations, and sterile compounding. The pass a qualifying exam. The pharmacy technician can diagnose & dispense drugs
Again I have to point this out. Susan Weltz said, "chiropody is apart of the Ontario health care system." Please note, the health ministry has directed, "Ontario’s regulatory colleges for optometrists, physiotherapists, chiropractors, dental hygienists, denturists and audiologists and speech-language pathologists to begin developing a regulatory framework to further expand the scopes of practice in each respective field." Why not us chiropodists????????
Unfortunately, the College of Chiropodists will continue to try to make a shift to Full Scope Podiatry.​

 

Chiropody reality:

On May 11, 2026, the Ministry of Health announced a broad series of scope‑of‑practice expansions for several regulated health professions as part of Your Health: A Plan for Connected and Convenient Care. These changes are intended to improve access, reduce wait times, and strengthen system capacity by enabling health professionals to work to the full extent of their training.
The announcement included immediate expansions for pharmacists and direction to several other regulatory colleges to begin developing frameworks for future scope enhancements, including activities such as ordering diagnostic imaging, administering local anesthetic, and performing diagnostic ultrasound.
Shortly after this announcement, the Ministry issued two communications regarding chiropody and podiatry. In these letters, addressed to the College of Chiropodists of Ontario and copied to the OSC, the Ministry confirmed that it will not be proceeding with the proposed diagnostic imaging expansion for chiropodists at this time. In a separate letter, also addressed to the College and copied to the OSC, the Ministry indicated that it is maintaining the current chiropody model while it continues to assess system‑wide priorities, fiscal considerations, and workforce planning needs.
While this outcome is disappointing, it is important to understand it within the broader health‑system context. The Ministry’s recent communications reflect a cautious approach to legislative and regulatory changes in sectors with complex histories and inter‑professional dynamics. This decision does not reflect a judgment on the competencies of chiropodists or podiatrists, nor does it diminish the essential role our profession plays in preventing complications, reducing emergency department visits, and supporting chronic disease management.
Practitioners in Ontario, including Ontario‑trained chiropodists, legacy podiatrists, and those trained in other jurisdictions, possess the competencies to safely deliver a broad range of foot and lower‑limb care. In several other provinces, regulatory frameworks have been modernized to reflect these competencies, allowing practitioners to work to their full scope of their training. Ontario’s framework has simply not yet caught up.
The Ministry’s message reinforces the importance of clarity, alignment, and a stable regulatory foundation before any future legislative change can be considered. This is the context in which the OSC continues its work.
Our Ontario Podiatric Competency Framework (OPCF) is being developed to support a responsible, evidence‑based, and RHPA‑aligned approach to future modernization. While full modernization, including one title, one class, and scope alignment with other provinces, will ultimately require legislative change, the OPCF is intended to provide the clarity and structure needed to support that long‑term work. We look forward to sharing more with the profession as this work continues to develop.
The OSC remains committed to advancing this work collaboratively and constructively. We will continue to:

• strengthen public protection by advocating for clear, competency‑based standards
• support labour mobility and national alignment
• ensure Ontario’s regulatory framework reflects the training and expertise of its practitioners
• maintain constructive relationships with the Ministry and the College, participating in consultations and providing submissions when opportunities arise

Our profession has always demonstrated resilience, professionalism, and a deep commitment to patient care. These qualities matter now more than ever. The OSC will continue to advocate for a modern, unified, and sustainable framework for foot and lower‑limb care in Ontario, one that reflects who we are today and what Ontarians need from us tomorrow.
Thank you for your continued dedication to the patients and communities we serve.
Sincerely,

Sasha Kozera‑Faye, BSc, DCh
President, Ontario Society of Chiropodists

 

Letter from the Registrar of the College of Chiropodists of Ontario.

You may have heard the announcement on Monday that several health regulators including pharmacists, dental hygienists, denturists and chiropractors will have their respective scopes expanded including, for some health professions, the ordering and taking of x-rays. You also may recall that system partners were invited to make submissions some time ago about the proposed scope expansions for certain healthcare professions which included the proposal to expand the scope of chiropodists to order and take x-rays. We have been informed by the Ministry of Health (MOH) that chiropodists will not be granted scope expansion to order and take x-rays at this time. We do not have any further details to share with you as to the rationale for this decision.
For clarity, chiropodists who have graduated from a 4-year footcare program and DPMs registered with the College remain able to order and take x-rays and are not impacted by the recent scope expansion announcement. Ontario trained chiropodists remain unable to order or take x-rays, however.
The College Council has taken the position over several years and as identified in the College’s strategic plan that the path forward to modernizing footcare regulation in Ontario is the adoption of the full scope podiatry model (FSPM). The FSPM includes a comprehensive approach to scope expansion that cannot be addressed until the antiquated ban on registering podiatrists in Ontario is removed. Once the ban is removed, the scopes of practice for both chiropody and podiatry can be expanded. The ban operates to create a barrier to chiropodists accessing scope expansion such as “communicate a diagnosis” which is included in the current scope of podiatry – a class the College is prohibited from adding to while the ban remains in place. In the College’s view, all amendments to modernize footcare in Ontario are best addressed through the Chiropody Act (1991) with removing the ban at s. 3(2) and amending the scopes of both chiropodists and podiatrists found within that legislation. Piecemeal amendments to other legislation and regulations do not address the foundational issue of insufficient numbers of footcare registrants. This is not the path forward as the recent announcement of the MOH underscores.
The College has shared the worrisome projections for the supply of footcare specialists in Ontario under the current system and the fact that we have less than a third of the registrants needed to care for Ontarians’ feet by today’s provincial population. The College has also shared recent data indicating that up to 85% of all lower limb amputations are preventable. The current system in Ontario cannot be expected to reduce the number of preventable lower limb amputations, and it has proven to be unable to adequately supply qualified footcare registrants to Ontarians as the growing and aging population demands.
With the ban in place, Ontario is not aligned with other Canadian jurisdictions where there are two distinct classes of footcare practitioners: chiropody equivalents and podiatry equivalents. Not only is Ontario not a destination of choice for footcare practitioners elsewhere in Canada, but Ontario is also not producing sufficient numbers of new chiropodists to meet the demand in Ontario. In recent years the number of new chiropodist registrants has consistently fallen short to meet demand and serves to exacerbate the gap in the number of registrants needed and the number of existing registrants. Simply put: continuing to do what we have been doing is not enough to address the shortfall. This has been clear for many years and is the basis for the College’s support of the FSPM. Further, expanding scope piecemeal without addressing the bigger supply issue will also not adequately address this shortfall. The College will continue to fulfill its duty under the Regulated Health Professions Act to advise the Minister of the number of registrants needed to support footcare in the province and will continue to recommend the adoption of the FSPM as the approach best suited to this task.
The College appreciates that many registrants may be disappointed by the recent decision that Ontario trained chiropodists will not be included among healthcare professionals who will have the ability to order and take x-rays in Ontario. We encourage registrants to not be discouraged by the announcement but to instead focus their energy and expertise on collaborative change recognizing that the FSPM offers the path forward towards the change needed. As the regulator we view the FSPM as the best approach to fulfilling our mandate of public protection as the FSPM contemplates removal of the unprecedented ban and, in turn, expanded scope for both chiropodists and podiatrists in Ontario.
The College thanks you for your continuing service to the primary healthcare needs of Ontarians and recognizes the value your skill, knowledge and judgement bring to the healthcare landscape in the province. Monday’s announcement excluding chiropodists is not a poor reflection of Ontario trained chiropodists but is a reflection of a provincial footcare system in need of change.
Sent from my iPhone