Pedorthist VS Chiropodist VS Podiatrist

[hijinxx7]

Hi,

There have been several threads (some started by me) about the scope of practice between chiropodists and podiatrists in general, and in Ontario.

I was wondering since fabricating and dispensing foot orthotics is not a controlled act up here in Ontario (which means basically anybody can do it from my understanding ie. Chiropractors, chiropodists, high school dropouts ...)

Is a chiropodist able to do everything that a pedorthist is able to do? Because it seems that pedorthists are only allowed to dispense and fabricate orthotics.

The reason I am asking is because I was surprised to find out that a well known business up here www.bioped.com is run by many pedorthists, and not a single chiropodist and/or podiatrist!

-Vince

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[jonwill]

Hi,

There have been several threads (some started by me) about the scope of practice between chiropodists and podiatrists in general, and in Ontario.

I was wondering since fabricating and dispensing foot orthotics is not a controlled act up here in Ontario (which means basically anybody can do it from my understanding ie. Chiropractors, chiropodists, high school dropouts ...)

Is a chiropodist able to do everything that a pedorthist is able to do? Because it seems that pedorthists are only allowed to dispense and fabricate orthotics.

The reason I am asking is because I was surprised to find out that a well known business up here www.bioped.com is run by many pedorthists, and not a single chiropodist and/or podiatrist!

-Vince

I could be wrong but I don't think that you're going to get very many responses on this one. Most pod students are from the US and know nothing of the laws in Canada. But then again, who knows? Maybe a few Canucks will show up!

 

[aktiva]

In Ontario you have a choice: practice Chiropody/Podiatry which are/is governed by the same college or cease practice and participate in a commercial venture: you may not do both simultaneously.

Therefore, Bioped, which is a chain of Orthotic/Footwear specialty stores which operate in malls and plazas are considered "commercial" and no Podiatrist/Chiropodist may practice as employees. They can cease practice and be strictly consultants, but that is their only option.

Therefore, Chiropodists/Podiatrists are not actively employed at store level by Bioped.

Pedorthists are not regulated by any college whatsover and are not part of the Regulated Health Professions Act. However, they may join the Pedorthic Association and voluntarily follow a code of conduct as a requirement of membership. Therefore, they may still participate in commercial ventures.

That is the highest level of footcare professional that may actively work in a commercial venture at this time.

Althought not regulated, it is important to remember that generally speaking in Canada, orthotics are an insurance benefit and as such insurers set high standards for what orthotics they will reimburse for as well as who made them. The vast majority of insurers will not cover any items made by "guy off the street" and only cover items provided by Podiatrists/Chiropodists/Pedorthists/Orthotists with valid license numbers. Even devices by Chiropractors/Physiotherapists are not reimbursed.

Podiatrists in Canada are a rare breed. This profession is not taught in Canada and since 1993 no new Podiatrists may come to Ontario and practice except as Chiropodists. They may also not use the term "doctor".

Pedorthists in Canada are also very few in number: most being very familiar with each other's work......Rarely do Podiatrists/Chiropodists either make their own orthotics or modify footwear. Most rely on Pedothists. The majority of Orthotists work for hospitals or private orthotic labs.

It falls primarily to the Pedorthists to liase between these worlds: private footcare practice and lab/hospital and they are well respected.

Hope this helps clear this up for you.

 

[aktiva]

To my knowledge, no classes are taught in Chiropody College on the manufacture, fitting or modification of footwear and only a general overview is provided on the fabrication of orthotics.

so the answer is no: Chiropodists and Pedothists have only thing in common: feet.......but each is a different specialty: and no, they don't practice interchangeably.

Primarily Chiropodists are medical specialists: not biomechanical specialists such as Kinesiologists or Orthopaedic Technical experts..............they prescribe orthotics but very very few have the training of a Pedorthist or Ortho. Tech. to make, modify and fit to footwear nor do Pedorthists learn to debride callouses.........very different scope............

 

[grifgin]

The thing in Ontario is quite screwed up acutally.

You can goto Michener Institute and study/practise Chiropady (soft tissue only)
There are no Pod schools in Ontario (one in Quebec - French)

For Ontario, yes there are some pods practising, however you had to start practise back in 1993. No NEW PODS are allowed to establish practice here (Im guessing there is a very very good ortho lobbying in ontario)

Good news is: the few pods that are practising are near retirement, so what they are lobbying for is to MAINTAIN the numbers of pods. so basically they want the ability to sell there practise to a new pod. (hopefully this will work out in the few years)

What you could do: study in the US, get a job here or go back to Alberta/BC to practise since it is allowed there (no ankle)

 

[greenguy]

Would appreciate if someone can explain the difference between
a) Chiropodist
b) Pedorthist, and
c) Podiatrists

and where one can study these ones in Ontario/Canada, and also what each
one of is capable to do ;;;

thanks :

 

[StudentDCh]

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. Remember 60 years ago when your own profession was at the same place as we are here in Ontario, fighting to gain recognition and the ability to improve your scope. 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 podiatrist to come to Ontario and practice with 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.

 

[347932]

Podiatrists in Canada are a rare breed. This profession is not taught in Canada and since 1993 no new Podiatrists may come to Ontario and practice except as Chiropodists. They may also not use the term "doctor".

This is not true.

There is a Podiatry school in Trois Rivieres, Quebec which confers the DPM degree, and Podiatrists in Canada can most certainly call themselves Doctors. If you know of the contrary please cite your source.

I would not call them a "rare breed" either. There are plenty around. Just check your local yellow pages.

In Ontario there may not be that many because the ones that are there locked out any competition by lobbying and succeeding to not allow any new Podiatry licenses to be granted in that province for purely selfish reasons. This has been ongoing for years and is in and out of courts, but ultimately, as of now, the stipulation stands. Nice huh?

 

[347932]

Would appreciate if someone can explain the difference between
a) Chiropodist
b) Pedorthist, and
c) Podiatrists

and where one can study these ones in Ontario/Canada, and also what each
one of is capable to do ;;;

thanks :

Chiropodists are not diagnosticians, but are generally technicians, although this may be different in the UK and Australia. They mostly do palliative care such as cutting toenails and trimming callus. They can not perform most, if any invasive procedures (injections, surgery...etc). In the States and Canada, they were the precursors of the modern day Podiatrist. There are no remaining chiropodists in the US, and one of the issues with Podiatric education in Canada is the disparity between what Chiropodists and Podiatrist can/should do. As you can see from the description in Ontario there is a fight to make the same move into Podiatry as per their scope.

Pedorthists are also not diagnosticians either. They are technicians that make custom orthotics and custom shoes for patients based on prescriptions given to them. This may be different in Canada, I'm not sure. They should not be confused with prosthetists who make prosthetic limbs.

We all know what Podiatrist are and can do, I think. Physician/Surgeons in the States, Australia and the UK. Heading that way in Canada, but there is much work to do and long way to go for that there.

 

[347932]

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. Remember 60 years ago when your own profession was at the same place as we are here in Ontario, fighting to gain recognition and the ability to improve your scope. 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 podiatrist to come to Ontario and practice with 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.

One of the issues that Canada faces is the differences in scope amongst the provinces. For instance, in Quebec, they can't prescribe antibiotics and can't read and bill for radiographs.Although our surgical scope may be different from state to state, there are basics that all of us enjoy in the US from state to state as well.

Your hope has many issues associated with it. I've been down that road, and it is virtually an impossibility at this time. The roads blocks go all the way up to the federal government. Until Podiatrists across the nation can practice in the hospital setting like they do in the US, Podiatry will be at a stand still unfortunately. THAT was what really started the forward trend in the US. THAT is what opened the doors for our surgical training. The cap that was imposed by selfish Pods in Ontario was a huge hit to the forward progress of Podiatry in Canada. They were each looking out for themselves and gave no mind to the damage they did when this came into effect in the early 90s. Sometimes we are our worst enemies. That is a purely selfish example.

The Canadian gov't needs to realize the benefits of proper foot care for it's population,embrace it and help with this push as well, and they aren't willing at this time.

Even though I am in the States, I keep a very close eye on what's going in hopes of helping anyone willing to establish this when the time is right. It can be done, but the mountain is very high and very steep.

 

[347932]

I could be wrong but I don't think that you're going to get very many responses on this one. Most pod students are from the US and know nothing of the laws in Canada. But then again, who knows? Maybe a few Canucks will show up!

-Waves hands frantically while jumping up and down-

I'm here!!

 

[StudentDCh]

Chiropodists are not diagnosticians, but are generally technicians, although this may be different in the UK and Australia. They mostly do palliative care such as cutting toenails and trimming callus. They can not perform most, if any invasive procedures (injections, surgery...etc). In the States and Canada, they were the precursors of the modern day Podiatrist. There are no remaining chiropodists in the US, and one of the issues with Podiatric education in Canada is the disparity between what Chiropodists and Podiatrist can/should do. As you can see from the description in Ontario there is a fight to make the same move into Podiatry as per their scope.

Within Ontario and the majority of Canadian provinces, it can and often does fall to a chiropodist to assess, diagnose and treat many conditions which may manifest in the feet. In my very short amount of clinical time I have diagnosed patients with conditions from Psoriasis to CMT. Of course we cut toe nails and remove callous, those things are our bread and butter. We assess biomechanics and will prescribe orthotics, footwear or perform soft tissue releases, and if more invasive surgery is required we will refer and advise the patient accordingly. If we diagnose an infection then we prescribe Abx, or gout --> Indocin, or possibly a corticosteroid injection etc etc etc.
To regard yourself as superior to perform routine care to your patients is not becoming to any practitioner of podiatric medicine. I offer foot care to those diabetic or otherwise immuno-compromised patients not as a glorified technician, but as a clinician who fully understands my patients systemic conditions and podiatric complications and appreciates the importance of our diligent care.

 

[347932]

Within Ontario and the majority of Canadian provinces, it can and often does fall to a chiropodist to assess, diagnose and treat many conditions which may manifest in the feet. In my very short amount of clinical time I have diagnosed patients with conditions from Psoriasis to CMT. Of course we cut toe nails and remove callous, those things are our bread and butter. We assess biomechanics and will prescribe orthotics, footwear or perform soft tissue releases, and if more invasive surgery is required we will refer and advise the patient accordingly. If we diagnose an infection then we prescribe Abx, or gout --> Indocin, or possibly a corticosteroid injection etc etc etc.
To regard yourself as superior to perform routine care to your patients is not becoming to any practitioner of podiatric medicine. I offer foot care to those diabetic or otherwise immuno-compromised patients not as a glorified technician, but as a clinician who fully understands my patients systemic conditions and podiatric complications and appreciates the importance of our diligent care.

The classic description of a Chiropodists is what I posted. I also mentioned that in Ontario your scope is moving towards what a Podiatrist is in the US and Canada. The question then in Ontario, is how exactly you are distinguishing yourselves from the Podiatrists in that province and how exactly you're going to make that transition to Podiatry with the lockout?
ANYONE considering a career in Podiatry/Chiropody in Ontario needs to be able to answer these questions.

 

[347932]

To regard yourself as superior to perform routine care to your patients is not becoming to any practitioner of podiatric medicine.

I'm not sure if you're taking a stab at me with this comment, but I perform palliative care every day and think it's an integral part to what we do as podiatrists in the states. There are No Chiropodists left here. Anyone considering a career in Podiatry needs to be sure they are comfortable with performing this vital service or they will be miserable in practice.

That being said, I'm not sure where I gave the impression that I'm "superior". I was giving definitions, not stating opinions.

 

[StudentDCh]

The question then in Ontario, is how exactly you are distinguishing yourselves from the Podiatrists in that province and how exactly you're going to make that transition to Podiatry with the lockout?

You are correct KidsFeet, many in the chiropody profession are content acting more in line with the definition of technician. They are content because the money is excellent and the hours are short. My comment was reactionary because as a self proclaimed podiatry activist in my graduating year, I wish to polarize myself from that group.

My understanding with the chiro vs pod 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! 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.

KidsFeet, I appreciate your comments and I apologize if I wrote offensively towards you. This is simply an exasperating topic and one which to quote you is "virtually an impossibility at this time".

 

[347932]

KidsFeet, I appreciate your comments and I apologize if I wrote offensively towards you. This is simply an exasperating topic and one which to quote you is "virtually an impossibility at this time".

I absolutely agree with this comment and share in your exasperation. I was not offended in the least, but just felt like some clarification was needed.

Once again, it is because of the inherent greed of our colleagues in your province that has led to the stagnation of the profession in the rest of Canada imo.

I have Ontarian colleagues who went elsewhere simply because they could not attain a license in their home province. American trained, but not able to return because of the cap. It is truly a tragic situation.

If I can do ANYTHING to help you and your colleagues in your struggle please contact me privately and I will do what I can to help you. Even if it means taking time out of my practice to come up there and stand before a committee/government agency or to move things forward. I have offered this to all the other provinces in the past and have never been taken up on my offer. I am willing and in a position to help if that's what's needed.

Good luck and please keep me up to date.

 

[Art Vandelay123]

I know this was touched on earlier, but what's the deal with physical therapists/chiropractors dispensing orthotics in Ontario? I know of a chiro who does it, and I've also heard PT's can do it, but do insurance companies actually reimburse orthotics dispensed by a PT or chiro?

 

[347932]

I know this was touched on earlier, but what's the deal with physical therapists/chiropractors dispensing orthotics in Ontario? I know of a chiro who does it, and I've also heard PT's can do it, but do insurance companies actually reimburse orthotics dispensed by a PT or chiro?

No they don't. That's exactly the point. Cash.

 

[freshprincechir]

Kidsfeet, this is not entirely true, I am a podiatric student, but also a licensed chiropractor. At least half of the insurance companies that I used to be in network with allowed me to bill the orthotic prescription. Now, I think it is crucial to understand that my purpose of orthotics prescription was not to correct ant foot or ankle related abnormalities, but rather to stabilize the Sacro-iliac joint so that my adjustments to the patients would hold. With all that said and done, billing for it and actually being reimbursed for my service are two different things.

 

[347932]

I stand corrected!

 

[Art Vandelay123]

Exactly. The chiro that I know does get reimbursed from some (not all) insurance companies.