Orthopedic Surgeon Testifies on Care of Lower Extremity Injuries

On Tuesday, May 2, 2017, orthopedic surgeon Col. James Ficke, MD (ret.) testified on behalf of the American Association of Orthopaedic Surgeons (AAOS) and the American Orthopaedic Foot and Ankle Society (AOFAS) before the House Veterans’ Affairs Subcommittee on Health on the issue of lower extremity injuries among veteran patients within the Department of Veterans Affairs (VA). Dr. Ficke specializes in foot and ankle care and served in the United States Army for 30 years. He has also led the Extremity War Injuries Project Team for twelve years, which focuses on improving care of battlefield injuries.

During the hearing, the subcommittee sought to assess needed actions to ensure the VA is able to recruit and retain high-quality medical professionals and quickly procure appropriate prosthetic devices to treat lower extremity issues. In his testimony, Dr. Ficke acknowledged the significant access to care challenges at the VA in lower extremity conditions and stated that musculoskeletal care for Veterans is imperative.

“Current statistics are staggering regarding the burden of injury and disability,” Dr. Ficke stated. “My own teams have reported and published literature showing that up to 92 percent of Warriors with battlefield injuries will have permanent disability in the musculoskeletal system…we will only meet their needs with a strong force of well-trained providers of all backgrounds.”

However, Dr. Ficke expressed that both the AAOS and the AOFAS have concerns with two aspects of H.R. 1058, the VA Provider Equity Act, which has been referred to the subcommittee. First, Dr. Ficke said, this legislation would label podiatrists within the VA as “physicians,” elevating them to the category currently reserved for doctors of medicine (MDs) and doctors of osteopathy (DOs). Second, the bill would allow podiatrists to attain clinical leadership positions over MDs and DOs.

“Podiatrists are an essential part of the care team at the VA and provide excellent service to Veterans… but podiatrists and orthopaedic surgeons are trained differently,” said Dr. Ficke. “The lower extremity is one of the more complex areas of the human musculoskeletal system, and an orthopedic surgeon will attend four years of medical school, serve a five-year orthopedic surgery residency, and typically take an additional year of subspecialty fellowship training…While recent changes have improved podiatric education, it is not the same as the multi-system medical education required to become a MD or DO, nor is it the same accreditation process…AAOS and AOFAS stand ready to work with the subcommittee to improve this legislation and increase Veteran access to the care provided by both orthopaedic surgeons and podiatrists.”