The resistance of an established profession towards an emergent occupation
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This study examines the relationship between orthopaedic and podiatric surgeons which has formed since the NHS reforms of the 1990s facilitated the establishment of podiatric surgery as a mainstream health-care service. Relations between these two disciplines are considered against the traditional background of dominance of health-care by the medical profession. The study seeks to understand the resistance shown towards podiatric surgery by orthopaedic surgeons and to determine if there is a willingness among orthopaedic and podiatric surgeons, respectively, to develop a more satisfactory working relationship. Two methods of data collection were employed to gather information on the views of orthopaedic surgeons on podiatric surgery. Firstly, questionnaires were sent to all Fellows of the British Orthopaedic Association with the intention to collect a breadth of data. In this way a total population was contacted by means of the survey. Secondly, personal interviews were undertaken with fifty orthopaedic surgeons who indicated a willingness to take part in their questionnaire responses. These interviews were designed to add richness and depth to the data gathered from the questionnaires. All podiatric surgeons in the UK were also sent questionnaires in order to investigate their professional experiences with, and their attitudes towards, orthopaedic surgeons. Once again, a total population was surveyed. A range of attitudes towards podiatric surgery was found among orthopaedic surgeons but significant opposition was identified. Reasons for this opposition are multi-factorial and complex. Overall, there appears to be an imperative to maintain control and, therefore, medical dominance over a competing occupation. For some orthopaedic surgeons, this control is perceived as necessary if the prestige and status of orthopaedic surgeons are to be protected. For others, collaboration with podiatric surgeons is a possibility although many orthopaedic surgeons have reservations about a formal union which often result from a lack of understanding about many aspects of podiatric surgery. Podiatric surgeons are generally in favour of developing closer links with orthopaedic surgeons, though they have concerns about a possible loss of autonomy arising from any collaboration. The development of a closer working relationship between orthopaedic and podiatric surgeons could have benefits for health-care but it seems likely that this may only occur on a gradual basis and through negotiations conducted at local levels.
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