Who owns healthcare work?

In December, 2023, the Sydney Morning Herald, The Age and 60 Minutes ran stories condemning podiatric surgeons on the basis that they can “perform surgery without having a medical degree”, that they can “pick up a knife with only a podiatry or science degree if they complete training at institutions that are not accredited by the Australian Medical Council”.? ?

The timing of this article coincided with a bid by the Australasian College of Podiatric Surgeons to access Medicare (and other insurer) reimbursement for their surgical procedures.? ?

The article, and the reader responses to the article display some common strong themes: ?

• That only medical doctors should use the title ‘doctor’. ?
• The only accrediting body for the practice of surgery should be the Australasian College of Surgeons
• The foot is complex, and therefore only orthopaedic surgeons have the expertise to understand how to perform foot surgery. ?
• People who perform surgery should have a full system of knowledge of the entire body which can only come from having studied medicine for around a decade.?

As a sociologist, health services researcher, and clinician, I have been studying and writing about health professional role boundaries with interest over the past 25 years or so. I am also a former Chair of Academic Board at an Australian University and have a professional interest, and work, in the professional accreditation and registration space.?

My colleague, Alan Borthwick, completed his PhD on the evolution of podiatric surgeons in the UK. If you would like to read more about the fascinating history of the development of podiatric surgeons, you can read more of Alan’s excellent work here. Together we recently published a book The Allied Health Professions: A Sociological Perspective, which explores the history and sociology of the allied health workforce – which inevitably explores the role of the medical profession in shaping the current roles and professional boundaries of the health workforce.?

The purpose of this article is not to support or refute the concept of podiatric surgeons, but to use this powerfully emotive topic to consider society’s assumptions about the nature of ‘health work’ and who is the rightful owner of particular tasks and titles.

The reaction of the public and of health professionals to the emergence of podiatric surgeons provides a striking illustration of deeply-rooted societal perceptions and biases regarding ‘truth’ and ‘ownership’ in healthcare roles. The perceived audacity of the somewhat humble and often maligned podiatrist to take on not just the medical profession but orthopaedic surgeons is an interesting and somewhat contentious story.?

Read our full article here and join us for a panel discussion on the 22nd February The Power Play in Healthcare: Who Really Holds the Scalpel where Professor Alan Borthwick OBE , Anne-Louise Carlton and I will be discussing the important issue of allied health scopes of practice and role boundaries, and the implications for this for health care accessibility, quality and safety in the 21st Century.