Certified Foot Care Specialist Nurses, cause for concern or no?

[PillzDrillzSkillz]

Greetings,
I am a college junior looking forward to career in podiatry. I was introduced to the profession after one of my grandparents had major foot surgery last year and I shadowed the doctor who performed the surgery.

There are several MD physicians in my family and the issue of nurse practitioner encroachment on physician roles is often a topic of discussion at family gatherings.

Surprisingly when I announced that I was pursuing a DPM and not an MD the family seemed ok with it and mentioned that fact that I wouldn’t have to deal with NPs as a potential benefit. My uncle even mentioned how the DPM he sends his diabetics to is “making a killing”.

But I was googling and came across something called a Certified Foot Care Specialist aka Foot Care Nurse. They offer what seems to be Podiatric services such as ingrown toenail removal, toenail bracing, wound debridement, toenail reconstruction, diabetic foot care, etc. I know there are wound care nurses that treat wounds on the feet, but this type of foot care nursing seems like its targeting all non-surgical podiatry cases.

I know that podiatrists have surgical training, but those I have shadowed only perform surgery 1-2 days a week. The remainder is clinic. And this setup is what appealed to me.

The internet is promoting this type of nursing as a way for a nurse to be independently employed entrepreneurs. Will these nurses/RN, who aren’t even required to be a NP, have a negative effect on DPM practice or income?

---

Members don't see this ad.

 

[heybrother]

I'm not worried. I say this semi-jokingly, but in my state I can reasonably delegate to a "properly trained person" so if they want to race us to the bottom then an MA we hired off the street (or, true story - at a golf course) can trim toenails or other tasks I don't want to do.

Our services have value. We receive referrals for a variety of things.

 

[DexterMorganSK]

Greetings,
I am a college junior looking forward to career in podiatry. I was introduced to the profession after one of my grandparents had major foot surgery last year and I shadowed the doctor who performed the surgery.

There are several MD physicians in my family and the issue of nurse practitioner encroachment on physician roles is often a topic of discussion at family gatherings.

Surprisingly when I announced that I was pursuing a DPM and not an MD the family seemed ok with it and mentioned that fact that I wouldn’t have to deal with NPs as a potential benefit. My uncle even mentioned how the DPM he sends his diabetics to is “making a killing”.

But I was googling and came across something called a Certified Foot Care Specialist aka Foot Care Nurse. They offer what seems to be Podiatric services such as ingrown toenail removal, toenail bracing, wound debridement, toenail reconstruction, diabetic foot care, etc. I know there are wound care nurses that treat wounds on the feet, but this type of foot care nursing seems like its targeting all non-surgical podiatry cases.

I know that podiatrists have surgical training, but those I have shadowed only perform surgery 1-2 days a week. The remainder is clinic. And this setup is what appealed to me.

The internet is promoting this type of nursing as a way for a nurse to be independently employed entrepreneurs. Will these nurses/RN, who aren’t even required to be a NP, have a negative effect on DPM practice or income?

I think the midlevel crisis is more a primary care issue than those of a specialist. City hospitals/urgent care around me are basically run by PAs/NPs and a few are even in charge of the emergency department. They do need the attending there are at times but not necessarily within the same building. I would also worry about being in anesthesiology due to anesthesia assistants and CRNAs. As a DPM, you are doing a multitude of cases involving simple to complex procedures (that a midlevel is not trained/licensed in), which is why as stated above, PCPs refer to Pods.

 

[PillzDrillzSkillz]

I think the midlevel crisis is more a primary care issue than those of a specialist. City hospitals/urgent care around me are basically run by PAs/NPs and a few are even in charge of the emergency department. They do need the attending there are at times but not necessarily within the same building. I would also worry about being in anesthesiology due to anesthesia assistants and CRNAs. As a DPM, you are doing a multitude of cases involving simple to complex procedures (that a midlevel is not trained/licensed in), which is why as stated above, PCPs refer to Pods.

Thank you for your responses. I respect your opinions as podiatrists/medical students.



But I just had to ask to make sure this issue isn’t flying under the radar. They have various certifications and trainings to put forward to say they are qualified. If it was just clipping nails then I wouldn’t worry since nail salon do that as well. But they are using scalpels! They have websites saying they provide “routine foot care similar to podiatrists”!



I am becoming a podiatrist because I want to, not because I have not other choice. In 8 years, when I am fully licensed, I don’t want to be facing a RN epidemic in foot care. If independently employed RNs are treating more foot patients and thinking they are equal to podiatrists, I am sure when they encounter a patient that needs more advanced care they will be referring that patient to Ortho not Podiatry. That will cut Podiatry out of the referral loop.



Also if these nurses start promoting their services directly to PCPs, that will also cut referrals to DPMs.



Sorry, I know I may sound a little paranoid. But I really want to be a podiatrist and a lot can change in 8 years before I am an attending.



Thanks again, I don’t intend to come off as argumentative. But I think podiatrists should protect their turf the way other specialists do, even the menial work. At the very least these nurses should be required to be supervised by a licensed DPM.



Again, I apologise if I sound irrational.

 

[Immense]

if you want a more detailed response, id suggest posting this query in the forum for podiatric residents/physicians

 

[DPMStudent159]

At the end of the day, it really depends on where the PCP sends their patients. Not because a patient will wake up one day and say "I am going to go find a foot care specialist on my own" (which they probably can do), but because many insurances require the PCP to refer their patients to podiatry, than a patient can check with their insurance what podiatrist is covered under their insurance. Typically, the PCP would probably refer them to someone they personally know, and this will mostly be podiatrists, not a foot care nurse, unless the PCP's practice hired someone to do that routine nail care stuff.

Since most of the diabetic procedures are covered by medicare and most insurance policies, I would assume the PCP's want to send their patient's to a trained specialist that also did a 3 year residency, not to a nurse that did a certification class on diabetic wounds and opened up a clinic next to a supermarket (not bashing nurses, but just saying that the pods will definitely be more trained and qualified to treat these cases).

Also, unless they are NPs, these certified foot specialists cannot prescribe medication to patients. People with these wounds might need a course of antibiotics, and because they might have diabetes, they probably could develop things like neuropathy. It would just be easier for the PCP to send them to a podiatrist that can treat them with medications they need as well as the actual wound care.

The only thing I can see happening is podiatrists hiring a foot care nurse to help them run their busy practice by doing the bread and butter procedures (nail stuff, wound debridement, etc), with the podiatrist being the overlooking physician, kind of like what PAs do.

 

[Robin-jay]

Honestly sounds like they should be nurses who work with podiatric physicians. win/win.

 

[GreenHousePub]

Since most of the diabetic procedures are covered by medicare and most insurance policies, I would assume the PCP's want to send their patient's to a trained specialist that also did a 3 year residency, not to a nurse that did a certification class on diabetic wounds and opened up a clinic

Primary care give zero thought about who they are sending their patients to and they know we trim nails, so they'll send you every diabetic who qualifies/doesn't qualify. They have no idea the type of training we undergo. They know we do nails, foot wounds, bunions, and will also send you ankle instability. That's consistent.

The only thing I can see happening is podiatrists hiring a foot care nurse to help them run their busy practice by doing the bread and butter procedures (nail stuff, wound debridement, etc), with the podiatrist being the overlooking physician, kind of like what PAs do.

A lot of states podiatry is not even allowed to have a PA underneath them, so it's probably a moot point.

I have literally never heard of a "foot care nurse" anyways. It'll pay so little there is no point to it anyways.

Your wound care nurses are going to be in wound clinics staffed by either a general or vascular surgeon. NP's seem to be more concerned about the appearance of being a doctor and will view trimming nails as below them. There's one out by me that goes by the title of Doctor-nurse Smith.