Why Podiatry Is Public Health: Expanding Impact Beyond the Foot
Key Takeaways
1. Podiatry Is Inherently Public Health
Podiatrists play a critical role in population health by preserving mobility, preventing limb loss, and helping patients maintain independence, employment, and overall quality of life.
2. Social Determinants of Health Shape Foot and Ankle Outcomes
Access to care, insurance status, and health system barriers directly influence outcomes in wound care, trauma, and chronic disease—making advocacy and systems awareness essential skills for today’s podiatrist.
3. Clinical Care and Business Acumen Must Go Hand-in-Hand
Effectively navigating hospital systems, justifying advanced therapies, and reducing delays to care require not only clinical expertise, but also an understanding of healthcare economics and leadership communication.
Transcript
Please note: This content is a direct transcript, capturing the authentic conversation without edits. Some language may reflect the flow of live discussion rather than polished text.
Jennifer Spector, DPM:
Welcome back to Podiatry Today Podcasts, where we bring you the latest in foot and ankle medicine and surgery from leaders in the field. I'm Dr. Jennifer Spector, the Associate Editorial Director for Podiatry Today, and I'm so excited to have Dr. Shital Sharma with us for this episode focusing on public health as it relates to podiatry. A little bit about her, Dr. Sharma practices with New York Sports and Joints. She's the Chief Innovation Officer for Boards Blast and holds Master's degrees in healthcare leadership and business administration. In addition to that, she's a 2027 Master's of Public Health candidate. Welcome, Dr. Sharma, to the podcast.
Shital Sharma, DPM:
Thank you so much for having me today.
Jennifer Spector, DPM:
Well, let's get started. We're going to be talking a little bit about podiatry as a public health specialty. So starting out with a little bit of the big picture. When we think of public health, a lot of DPMs may not immediately see themselves reflected in that space. How do you define podiatry's role within public health and where do you feel our greatest opportunity is to make an impact?
Shital Sharma, DPM:
It's interesting. I mean, even my journey to public health first, I never thought that public health would be a journey for myself being a podiatrist. And so as the years went by, I was working in a safety net hospital for a majority of my career. And there were a lot of patients that I was dealing with with many social determinants of health, which falls under the umbrella of population health, which falls under the umbrella of public health. And most of the stuff that I was trying to navigate actually had to do with the financial side of getting access to care for my patients. So it wasn't just simply, I think if most podiatrists see themselves as public health professionals within the space, maybe I would say like the diabetic limb salvage world. I think that many podiatrists can see themselves in that space
If they were applying it to public health. But I don't think we are limited to that. I think we are so many things. I think our overall umbrella is that we keep people walking. We help patients maintain their quality of life. If they don't have their feet, if they're not ambulatory, they cannot hold employment. Many of them can't hold employment, which means that they cannot provide for themselves and for their families, which can substantially impact their overall quality of life. Kudos to us as a profession that we are a major player in keeping our patients healthy, moving, and keeping them alive longer. And I know that sounds crazy, but we know that the average health span has decreased in the United States, especially after COVID. And I know for many of us, we think like, well, yeah, we're not dealing with the diabetes necessarily and we're not dealing with the cardiovascular compliance.
We're not medically managing those things, but we are part of that team. And many times these patients don't even know they have these underlying conditions. And we may be that frontline in certain scenarios where we're like, "Okay, listen, this toe ulcer that you have is not isolated to this toe. It's because you have this underlying X, Y, and Z medical condition. You need to have a primary care professional, you need an interventional cardiologist as part of your team." And so I think that we bridge so many professions, so many specialties. And so I started to shift in my head that, "Hey, listen, we're not just a subspecialty, that we are part of this healthcare management. We're a part of getting these patients to think better for themselves, getting them access to care, and helping them think in a preventative way so that they're not getting to a point where they're losing limbs and then it's affecting their quality of life."
Jennifer Spector, DPM:
And it's important to set the stage too, because then taking that general foundation and looking a little bit about practical implementation, you mentioned that we're really keeping patients on their feet. So since those low extremity complications do seem to disproportionately impact underserved or higher risk populations, how can we as podiatrists intentionally address some of those social determinants of health just in everyday practice?
Shital Sharma, DPM:
Again, having worked in a safety net hospital system for majority of my career, I trained in a safety net hospital. We didn't have access to everything. We didn't have the best of the best to give to our patients, nor did they have the coverage to be able to get the best care. Sometimes local wound care did mean local debridement, betadine, gauze and an ACE bandage if we were lucky. So I mean, I think it's advocacy and we do so much as it is. And I know we're always talking about burnout and mental health for our professionals and having to go out on a limb, no pun intended. But often for our patients, if you are going to work in underserved populations, under resourced populations, unfortunately it does come with this extra requirement from you, your team. For me, when I needed to get something really specialized for a patient, it was my ability to have conversations with leadership and showing them the benefit of bringing a specific, let's say, cellular tissue product on face value, they may look at the price of something and say, "Oh no, we cannot afford this. We're not going to get reimbursed."
Well, then it's also showing them, well, if this patient ends up losing their limb, this is where it's going to cost you. It's going to cost you in your emergency room, it's going to lay them up in your ICU for however long it's going to, and that's going to be way more costly for the hospital system than if they went ahead and proactively helped to heal, let's say, an ulceration on a limb. So it is about having a good understanding of some of the business aspect of it, getting some business terminology and acumen under your belt. That does not necessarily mean you have to go to business school to do that. There's a lot of information out there, a ton of podcasts, a lot of AI tools that we can use now to just break down business concepts and frameworks that you can utilize that language to advocate for your patients.
Jennifer Spector, DPM:
Now that's really helpful, some pearls to consider there for folks that really want to incorporate this more into their practice. Looking at another subset of our colleagues for people who are really focused on foot and ankle surgery and feel that their work might be primarily procedural in nature, how does surgical care intersect then with public health? It seems like limb salvage and amputation prevention are clear pathways, but what else are you thinking from that surgical perspective?
Shital Sharma, DPM:
Yeah, so I also work pretty heavily (in surgery). So my biggest population I work with is in the Bronx and we can take even workers' comp injuries. So we assume that when an individual gets hurt at work, it's a straightforward pathway. They come in, you do your assessment, you'll order your imaging. If it's a fracture, you fix it and you try to get these patients back to work as quickly as possible. Well, it's not that simple. And so in these scenarios, sometimes there's a lot of delays to care. A lot of this is carrier influence. Sometimes it's getting access to the right professional, to being able to get that whatever required surgical procedure is. So it never ends. I mean, for me, I deal with just as many public health issues in my trauma patients as I am in my wound care patients and my diabetic patients.
So yeah, I mean, I think it influences them as well. Again, working in the safety net hospital, we had to navigate a ton of trauma. We were not a level one trauma center, but we did within the community get the reputation of, okay, well, they handle the uninsured and underinsured patients. So if we had patients that were coming in with displaced tri-mal open fractures, well, you don't have time to dilly-dally in that population. We know the clinical emergency there, but there's also a financial emergency. The more you delay, the more costly that care is going to be. So telling your leadership that, listen, if something like this comes in, we need to be called right away, having systems in place, having your anesthesia team, your OR team, being part of pricing conversations on the tools that you use, the hardware that you're using, having these things in place, in system that when it comes in, you're not second guessing, you're not thinking, you're like, "Oh my gosh, I'm going to use this company.
No, I can't do that because my system said no." And okay, well, now who am I going to call to do this? No, it's set up, it's ready to go, you address it, get them operated on, and if they don't need to be in- house, get them home. So now you've contained that cost versus if it's like, "Oh, well, we're not sure. Go home. We'll see you in clinic." And that delay to care sometimes will be like, "Well, can't this just be casted because you'll get that. Well, I used to get that from leadership all the time." It's like, "Well, does it really need to be fixed?" And oftentimes I would say to them, "Well, if this patient had Blue Cross Blue Shield with a Cadillac plan, would you be asking me the same question?" Because you have to look at what are the financial incentives, clinical and financial repercussions.
And for those patients who are uninsured and underinsured, these two things come to a head very, very, very frequently.
Jennifer Spector, DPM:
It's very true. And you mentioned your experience in various hospital systems, and I know you've also worked with trainees in the past. So bringing this to residents or fellows in training, are there any competencies or experiences that you would recommend that might better prepare them for either leadership or participation in public health efforts, whether advocacy or research or just day-to-day practice?
Shital Sharma, DPM:
Yeah. So it's interesting. I ran into my former chief resident at the ASC and I loved her, Diamond Brown, Dr. Diamond Brown. She's out in Louisiana and she came up to me and she's like, "You know what? I actually understand the value of working in an under-resourced hospital system." She's like, "I can work with anything. I can literally work with anything. I can go to Home Depot if I had to and fix this bone." Where that's not always the case, right? And in some systems, they have access to everything and kudos. I think it's fabulous if you have access to all the different advanced treatments that are out there, but you don't know. When you get out there from residency, from fellowship, you don't know where you might end up. You may end up in a rural desert, a healthcare desert, sorry, in an urban healthcare desert, you might have a C-suite that is extremely financially, I should say cost conscientious, not financially, but cost conscientious.
You might be in a safety net hospital that has extremely razor thin margins. And so you may not get that fancy hardware, that fancy rod. You may need to work with a 1980s Synthes set. And by the way, those sets work perfectly as well. So you need to be able to, and I hate using this term, but skinny cat, there's multiple ways to do that. I'm sorry for all the cat lovers out there, but again, be able to have multiple ways in your armamentarium to address a problem because it's not going to be simply, I get a trimel ankle fracture and I'm always going to put a fibular nail in here and I'm going to use the best of the best, which would be ideal. In any scenario, that would be ideal, but you may not have that. So what else can you do? And your C-suite is going to come down and ask you that.
And the chair of your department is going to tell you, "No, you're not going to get this. Can you work with this because this is what we have on the shelf because this is what we've negotiated with them that works favorably for our system." So I would urge you to ask your attendings, if you can, talk to me about if I don't have all this lovely hardware, how should I be addressing this problem? What should I be? If I can't address this problem with the existing hardware on the shelf, how do I have conversations with the department chair? How do I bring my podiatry chair into this conversation to help advocate for me and help me advocate for my patient to get the best of the best? So I think getting in those conversations early and my residents at that time, they had the CMO, hospital system-wide CMO's cell phone number that they could call and that dynamic was created because if we did not do that, we would not be able to keep those doors open.
Jennifer Spector, DPM:
I don't think a lot of people think that way either. You don't think about how to have those conversations. A lot of people probably just hope they never have to.
Shital Sharma, DPM:
Yeah. Or there's intimidation there as well. Sometimes it's like, well, maybe this problem will just disappear or it'll be somebody else's or I'm not on call after the 12th of the month, it's somebody else's issue. But the fact of the matter is that if that patient seeks care in that system which you belong in, whether you are directly or indirectly employed by that system, you are part of that solution. You can be part of the solution or you can be part of the problem and you just have to figure out who you are for that scenario.
Jennifer Spector, DPM:
For sure. And thank you for sharing solutions with us today in this area and sharing your experience with us. Yeah. I know our listeners are going to take something away from this conversation and thank you to the listeners as well for joining us. Don't forget to tune into past and future episodes of Podiatry Today Podcasts on podiatrytoday.com, SoundCloud, Apple Podcasts, or Spotify, and we can't wait to meet you back here next time.
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