Arizona Amputation or debridement? difference?

[cool_vkb]

i was going thru the recently updated scope of practice chart realeased by APMA. It said that Arizona scope of practice is leg & foot but no amputations are allowed.

i was wondering how do pods manage diabetic ulcers/gangrenes/other ischemic or trauma situations which could require partial amputations.

for ex:if you get a patient with osteomyelitis in 2 toe and 2met head and you gotta take that thing out to prevent further spread. can you call it debridement and finish the task. or since amputation is a big NO in arizona. you just refer it to orthopod or vasc surgeon?

And how does this affect your practice?

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[JEWmongous]

i was going thru the recently updated scope of practice chart realeased by APMA. It said that Arizona scope of practice is leg & foot but no amputations are allowed.

i was wondering how do pods manage diabetic ulcers/gangrenes/other ischemic or trauma situations which could require partial amputations.

for ex:if you get a patient with osteomyelitis in 2 toe and 2met head and you gotta take that thing out to prevent further spread. can you call it debridement and finish the task. or since amputation is a big NO in arizona. you just refer it to orthopod or vasc surgeon?

And how does this affect your practice?

I mentioned this one time on SDN too. I have heard the term "aggressive debridement" before, especially in New York with wounds above the ankle.

I'm curious of the amp scope of practice in Arizona. Isn't Armstrong down there at one of the med schools now? From doing an undergrad paper on maggot therapy, he seems to be one of the big shots in wound care. I would imagine some inroads on wound care and amputation in the near future.

 

[SportPOD]

Amps aren't allowed and if you do what's called a "radical debridement" you are setting yourself up for a red flag. Unfortunately the podiatric medical association here in AZ is a little old school and think that a can of worms will be opened up if we try to change the scope of practice.
Yes, having Dr. Armstrong helps, but the podiatrists here in AZ have to unite together to get our association united in changing the scope. It does become quite a bother hearing from other specialities "what, you can't amputate a toe?".

 

[cool_vkb]

Amps aren't allowed and if you do what's called a "radical debridement" you are setting yourself up for a red flag. Unfortunately the podiatric medical association here in AZ is a little old school and think that a can of worms will be opened up if we try to change the scope of practice.
Yes, having Dr. Armstrong helps, but the podiatrists here in AZ have to unite together to get our association united in changing the scope. It does become quite a bother hearing from other specialities "what, you can't amputate a toe?".

So what do you do to the case i mentioned. do you refer it to some other MD? and usually what kind of specialist is involved?

 

[SportPOD]

So what do you do to the case i mentioned. do you refer it to some other MD? and usually what kind of specialist is involved?

Usually you get either a vascular, plastics, ortho or general surgeon involved to do the amputation.

 

[cool_vkb]

Usually you get either a vascular, plastics, ortho or general surgeon involved to do the amputation.

damn thats bad. i kind of think treating osteomyelis or wound management (with agggreisve debridement) is one of the coolest things in pod.

 

[SportPOD]

damn thats bad. i kind of think treating osteomyelis or wound management (with agggreisve debridement) is one of the coolest things in pod.

Well, sometimes what I end up doing is getting the other surgeon in to do an open amp and then I can come in and do the secondary closure. If you have a good working relationship with one of those surgeons, you can get around the hiccup.

 

[Podmeister]

It does become quite a bother hearing from other specialities "what, you can't amputate a toe?".

That sucks.

Here in CA, we're allowed to assist on general surgery cases and one of my classmates spends one day a week assisting a GI doc.

 

[cool_vkb]

That sucks.

Here in CA, we're allowed to assist on general surgery cases and one of my classmates spends one day a week assisting a GI doc.

NJ also started a yr back. . how much do they pay in CA for first assist.

 

[Podmeister]

NJ also started a yr back. . how much do they pay in CA for first assist.

Medicare pays 16% of the surgeon's fee. Private carriers usually pay more.