DPM Scope of Practice By State List

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Cheetos

Cheetos

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I know I should be studying but it's a Friday night, hence SDN. Thought this would be helpful for those who were wondering about their own state scope of practice and across the nation. Attached is the scope list by state. This was courtesy of Dr. Page.

Also, from what we were told, there is currently a strong push towards unifying a single common scope of practice for the majority of the states. If all goes well, then we should have this unified scope by the time we finish residency I hope. Hope this helps!

View attachment Scope.doc
View attachment Scope2.doc
 
Cheetos said:
I know I should be studying but it's a Friday night, hence SDN. Thought this would be helpful for those who were wondering about their own state scope of practice and across the nation. Attached is the scope list by state. This was courtesy of Dr. Page.

Also, from what we were told, there is currently a strong push towards unifying a single common scope of practice for the majority of the states. If all goes well, then we should have this unified scope by the time we finish residency I hope. Hope this helps!

View attachment 9084
View attachment 9085
Click to expand...


Very good information. Thanks for the post.
 
Cheetos said:
I know I should be studying but it's a Friday night, hence SDN. Thought this would be helpful for those who were wondering about their own state scope of practice and across the nation. Attached is the scope list by state. This was courtesy of Dr. Page.

Also, from what we were told, there is currently a strong push towards unifying a single common scope of practice for the majority of the states. If all goes well, then we should have this unified scope by the time we finish residency I hope. Hope this helps!

View attachment 9084
View attachment 9085
Click to expand...

Thanks!
 
Thanks a lot. Very helpful information..👍
 
in some columns they contain "silent", is that a yes or no? like some may say toe amputation with silent.
 
UWP said:
in some columns they contain "silent", is that a yes or no? like some may say toe amputation with silent.
Click to expand...
It means you can do them as long as everyone in the operating room is 100% quiet. Even a single peep from the podiatrist, assistant, or anesthesia makes it a violation of the law. If the patient moans or somebody coughs, game over. 😱

Silent just means the state's law doesn't cover that issue or leaves it very ambiguous. It defines that term in the paragraph above the list.
 
Feli said:
It means you can do them as long as everyone in the operating room is 100% quiet. Even a single peep from the podiatrist, assistant, or anesthesia makes it a violation of the law. If the patient moans or somebody coughs, game over. 😱
Click to expand...

"Silent" means:
  1. You don't talk about toe amputations.
  2. You don't talk about toe amputations.
  3. When someone says stop, or goes limp, even if he's just faking it, the toe amputation is over.
  4. Only two guys to a toe amputation.
  5. One toe amputation at a time.
  6. They amputate toes without shirts or shoes.
  7. The toe amputations go on as long as they have to.
  8. If this is your first night at surgery, you have to amputate.
 
NatCh said:
"Silent" means:
  1. You don't talk about toe amputations.
  2. You don't talk about toe amputations.
  3. When someone says stop, or goes limp, even if he's just faking it, the toe amputation is over.
  4. Only two guys to a toe amputation.
  5. One toe amputation at a time.
  6. They amputate toes without shirts or shoes.
  7. The toe amputations go on as long as they have to.
  8. If this is your first night at surgery, you have to amputate.
Click to expand...

:laugh: Hahaha.....if it's your first night, do you just amputate the toe or toes or is this also silent?
 
SportPOD said:
:laugh: Hahaha.....if it's your first night, do you just amputate the toe or toes or is this also silent?
Click to expand...

My assignment for you all is to go out into the city this week and amputate a toe.
 
"Includes hands"? I didn't realize that podiatrists treated hands in some states. Does this mean just simply treating a wart on a hand, or performing surgery?? In states where this is allowed, is hand treatment common? Do you see this very often in residency? I'm so confused right now.
 
one of those FINE PRINT type things....no podiatrists treat hands (or at least i hope they dont)....the hand in scope rule probably dates back to days of Chiropody in the U.S.?? I hope pods don't treat hands...we aren't really trained to do so ....(even though in residency I'm sure you will occasionally do such things, the similarities between the two body parts is supposed to be quite astonishing..)

Generally speaking ..we are limited to Foot and Ankle care to the best of my knowledge... don't be confused...


P.S. Did you hear about the two podiatrists that were ARCH rivals? HAHAA 👍
 
Some podiatrists in states where hands are allowed in their scope of practice will treat warts on the hand for patients already seeing them. It's kinda of a captive market thing, like buying an expensive lunch at the ski hill. But, anything beyond ancedotal wart tx of the hand, no podiatrist would do that.
 
WannaBeDPM said:
one of those FINE PRINT type things....no podiatrists treat hands (or at least i hope they dont)....the hand in scope rule probably dates back to days of Chiropody in the U.S.?? I hope pods don't treat hands...we aren't really trained to do so ....(even though in residency I'm sure you will occasionally do such things, the similarities between the two body parts is supposed to be quite astonishing..)

Generally speaking ..we are limited to Foot and Ankle care to the best of my knowledge... don't be confused...


P.S. Did you hear about the two podiatrists that were ARCH rivals? HAHAA 👍
Click to expand...


HA HA HA HA. Oh, WannaBeDPM, you are SO funny. LOL, no, actually I love bad jokes. thanks for the information on the hand thing. Hands just don't thrill me the way feet do.
 
WannaBeDPM said:
P.S. Did you hear about the two podiatrists that were ARCH rivals? HAHAA 👍
Click to expand...

Noo but I did hear about the podiatrist who gave up his "sole" to get the dual DPM-MD/DO degree :laugh:😴
 
What does it mean by "includes leg"? Is this referring to something above the crus or the leg in general (anything below the hip)?
 
"it is unlawful to discriminate against podiatrists."- Rhode Island... geez... makes us sound like we have a disability or handicap
 
At least Rhode Island respects us it seems.

texas cracks me up with IT'S A CRIME TO AMPUTATE!

And what's with the state's attorney generals being so anti-pod? Those old geezers need to wake up and smell the coffee and realize that the Pods of today is not the Pods of the 60-80's Even the early 90's.
 
I thought using this topic instead of making another would be better but I have a few questions related to this if anybody could help.

First, is the list provided in the first post current\accurate to how things sit today? If not, which states exactly don't allow DPM's to perform ankle surgery? I'd also like to know if it would be a smart move to attempt and avoid a residency in said states so that you don't miss out on the training because it isn't allowed?
 
fivescrew said:
I thought using this topic instead of making another would be better but I have a few questions related to this if anybody could help.

First, is the list provided in the first post current\accurate to how things sit today? If not, which states exactly don't allow DPM's to perform ankle surgery? I'd also like to know if it would be a smart move to attempt and avoid a residency in said states so that you don't miss out on the training because it isn't allowed?
Click to expand...

From what I understand, we are able to work with the ankle in any state during our residency. It is after the residency when we begin to practice that we are limited due to state legislation.
 
jotfinos said:
From what I understand, we are able to work with the ankle in any state during our residency. It is after the residency when we begin to practice that we are limited due to state legislation.
Click to expand...

I think the list is slightly outdated as well. I think there have been a couple states back east that have passed or are passing legislation for ankle privileges. Someone else may know more about it. There are very few states where we can't do ankle.
 
jonwill said:
I think the list is slightly outdated as well. I think there have been a couple states back east that have passed or are passing legislation for ankle privileges. Someone else may know more about it. There are very few states where we can't do ankle.
Click to expand...


After further research there are two eastern states that are marked as no ankle states on the list that have either changed or in the process. CT now lets DPM's do ankle but requires a permit and NY as late as last month is in the process of changing the laws to allow it.

Links for anybody interested...

http://open.nysenate.gov/legislation/bill/S3758-2011

http://www.ct.gov/dph/lib/dph/practitioner_licensing_and_investigations/plis/podi/ankleprmtapp.pdf
 
about the hand thing...chiropody means to treat the foot WITH the hand. Some states along time ago took this word to mean to treat the foot AND the hand. This is why some states allow podiatrists to treat the hand even though we have no training.
 
pej722 said:
about the hand thing...chiropody means to treat the foot WITH the hand. Some states along time ago took this word to mean to treat the foot AND the hand. This is why some states allow podiatrists to treat the hand even though we have no training.
Click to expand...

I know that in Minnesota it is legal for podiatrists to treat the hand.

http://www.podiatry.state.mn.us/beta/Portals/17/Statutes153.pdf (the second paragraph.)

I really hope that no pods in Minnesota do too much work on the hand - even though the law permits it, a pod doing surgery on a hand is a lawsuit waiting to happen...
 
doc1107 said:
At least Rhode Island respects us it seems.

texas cracks me up with IT'S A CRIME TO AMPUTATE!

And what's with the state's attorney generals being so anti-pod? Those old geezers need to wake up and smell the coffee and realize that the Pods of today is not the Pods of the 60-80's Even the early 90's.
Click to expand...

In Texas you can amputate just not the entire foot. I know it doesn't make sense that states will allow you (Texas included) to do a circular frame, IM nail for a fusion, tendon transfers in the leg, an H&P, order hepato/nephrotoxic drugs etc. but your out of control if you take off more than 99% of the foot. You have to remember that our state statues were a slow evolutionary process and old laws, over the years, were modified or added to .

It's funny IMO the statement "may not perform amputations of the foot" was written decades ago and was meant to prohibit a DPM from doing any amputations of the foot even toes. Some savvy DPM then started the mantra "we can do partial amputations we just can not amputate the entire foot" and it worked.
 
I encountered an awkward situation at the hospital where my partner and I perform surgery on a weekly basis. We perform the full spectrum of cases, including amputations. We routinely receive referrals/consults for surgical procedures for in-house patients from the hospitalists, vascular surgeons, I/D and even ortho (they hate diabetic cases, amps, infections).

Additionally, my partner is chairman of the department.

Although I know the state law regarding H&P's and DPM's, our practice has chosen to let the patient have his/her H&P be performed by his/her physician. We feel this allows the doctor to be involved in the case and aware of the surgery, the fact we are performing surgery, etc.

It has always been protocol in this hospital that in the pre-op area, we review the H&P, review any pre-op testing and then "sign-off" on the H&P/co-sign the H&P verifying the patient is OK for surgery.

I found out that the hospital just implemented a "rule" that a DPM can NOT co-sign or "sign off" on the H&P!!! I can perform major surgery on this patient, write for any pre or post op orders, write for any appropriate prescriptions, but can NOT sign off that the patient is stable for surgery???

On a positive note, the nurses genuinely seemed upset, but one said the order came from the "higher ups" and it had "something to do with JCAOH", which I doubt.

I consider this a major step backwards, and if Podfather or anyone else knows anything about this, please fill me in.
 
PADPM said:
I found out that the hospital just implemented a "rule" that a DPM can NOT co-sign or "sign off" on the H&P!!! I can perform major surgery on this patient, write for any pre or post op orders, write for any appropriate prescriptions, but can NOT sign off that the patient is stable for surgery???

I consider this a major step backwards, and if Podfather or anyone else knows anything about this, please fill me in.
Click to expand...

That is unfortunate and upsetting news to hear.
 
Are there any type of procedures that particularly necessitate the use of a hospital O.R instead of using an ambulatory surgical center?

What I'm alluding to is why not avoid the hospital O.R if at all possible?
 
PADPM said:
I encountered an awkward situation at the hospital where my partner and I perform surgery on a weekly basis. We perform the full spectrum of cases, including amputations. We routinely receive referrals/consults for surgical procedures for in-house patients from the hospitalists, vascular surgeons, I/D and even ortho (they hate diabetic cases, amps, infections).

Additionally, my partner is chairman of the department.

Although I know the state law regarding H&P's and DPM's, our practice has chosen to let the patient have his/her H&P be performed by his/her physician. We feel this allows the doctor to be involved in the case and aware of the surgery, the fact we are performing surgery, etc.

It has always been protocol in this hospital that in the pre-op area, we review the H&P, review any pre-op testing and then "sign-off" on the H&P/co-sign the H&P verifying the patient is OK for surgery.

I found out that the hospital just implemented a "rule" that a DPM can NOT co-sign or "sign off" on the H&P!!! I can perform major surgery on this patient, write for any pre or post op orders, write for any appropriate prescriptions, but can NOT sign off that the patient is stable for surgery???

On a positive note, the nurses genuinely seemed upset, but one said the order came from the "higher ups" and it had "something to do with JCAOH", which I doubt.

I consider this a major step backwards, and if Podfather or anyone else knows anything about this, please fill me in.
Click to expand...

Although we have H&P privileges at my hospital, another less friendly hospital nearby does not permit them. They have no intentions of changing their bylaws to permit DPMs to do them. Since their DPMs are not permitted to perform them they can not update them the day of surgery. Needless to say this has curtailed surgery there by DPMs. I believe some of the anesthesiologists are signing them as a partial fix.
 
Last edited:
Ferocity said:
Are there any type of procedures that particularly necessitate the use of a hospital O.R instead of using an ambulatory surgical center?

What I'm alluding to is why not avoid the hospital O.R if at all possible?
Click to expand...


Very valid questions. It's simply that we've had a very strong presence at this hospital for many years and a significant amount of our referring doctors like the fact that we are supporting the hospital. For me personally, it's been convenient since my weekly "on-call" day coincides with the day I perform surgery at this hospital. So it's convenient that I'm already there to take care of in-house patients or perform consults. It's one less place to have to run to, since I'm already there.

However, lately the O.R. has been constantly running behind schedule and taking a long time to turn rooms around between cases. This week I had 3 cases and they asked me to come a half hour EARLY to start my first case, so I happily obliged. However, due to delays on their side, the case didn't start for 1.5 hours. To me, that's unacceptable. If you're going to ask me to show up early, then make me wait 1.5 hours, I have a problem with that scenario, UNLESS I was bumped for an emergency which wasn't the case.

Therefore, I believe I will begin performing some of my cases at a local surgery center for my elective cases that have no co-morbidities that may necessitate admission.
 
Ferocity said:
Are there any type of procedures that particularly necessitate the use of a hospital O.R instead of using an ambulatory surgical center?

What I'm alluding to is why not avoid the hospital O.R if at all possible?
Click to expand...
Cases in which one would need to admit the patient overnight (e.g., major reconstruction that needs parenteral pain control or medical stabilization) would need the hospital, but day surgeries can go to the surgery center.

Edit:
Also, Medicare does not reimburse surgery centers for implants whereas they will reimburse hospitals for implants. If you have a case in which you want to use a bunch of expensive hardware it can end up costing the surgery center more than they'll make, and they frown upon that.
 
Last edited:
NatCh said:
Cases in which one would need to admit the patient overnight (e.g., major reconstruction that needs parenteral pain control or medical stabilization) would need the hospital, but day surgeries can go to the surgery center.

Edit:
Also, Medicare does not reimburse surgery centers for implants whereas they will reimburse hospitals for implants. If you have a case in which you want to use a bunch of expensive hardware it can end up costing the surgery center more than they'll make, and they frown upon that.
Click to expand...


We often perform cases on patients who are already in-house. They may have infections, complications, wounds, trauma, etc., and we are consulted to perform a procedure while they are in-house.

Additionally, we often do use a fair amount of "hardware" and sometimes I'm relatively specific regarding which company I may want to use for a particular case. It's often much easier to get these reps into the hospital than the surgery center, and as NatCh said, the surgery center isn't always thrilled when I go crazy with the hardware.
 
Could a podiatrist do a hand surgery fellowship that is typically done by MD/DO's in a state like Minnesota, and then start practicing on the hand? It seems that if it is within the scope of practice for the state and then you further trained to specialize in hand surgery it wouldn't be the "lawsuit waiting to happen" that you guys have been talking about. It would be interesting to know and financially very relevant if it is possible.. hand surgeons make 524,000 dollars/year on average. If a 2 or 3 year fellowship would add hand surgery to your repertoire as a podiatrist and you can pretty much guarantee yourself a massive salary increase.
 
DPMxPodiatryStudent said:
Could a podiatrist do a hand surgery fellowship that is typically done by MD/DO's in a state like Minnesota, and then start practicing on the hand? It seems that if it is within the scope of practice for the state and then you further trained to specialize in hand surgery it wouldn't be the "lawsuit waiting to happen" that you guys have been talking about. It would be interesting to know and financially very relevant if it is possible.. hand surgeons make 524,000 dollars/year on average. If a 2 or 3 year fellowship would add hand surgery to your repertoire as a podiatrist and you can pretty much guarantee yourself a massive salary increase.
Click to expand...

I would PAY to see a podiatrist explain why he is doing hand surgery when his title entails treating the foot. I think we all came into podiatry wanting to treat ailments of the lower extremity. Despite parallels in function and form between the foot and hand, hand surgery should be left to orthopaedic/general surgeons.
 
Why would someone who has the words DPM after their name ever be working on the hand??? People go to MD and DO school to specialize in the hand.
Are you a pre-podiatry student or a pre-med student because what you want is not gonna be found at a podiatry school.
 
To be certified in Surgery of the Hand these are the requirements:
General Requirements
  • To be eligible to apply for this exam, applicants must:
  • Certification: Be currently certified in general surgery by the American Board of Surgery and in compliance with the ABS MOC Program.
  • Medical License: Have a currently registered full and unrestricted license to practice medicine in the U.S. or Canada. Applicants are required to immediately inform the ABS of any conditions or restrictions in force on any active medical license they hold.
  • Accredited Program: Have satisfactorily completed a one-year training program (48 weeks of full-time experience) in surgery of the hand accredited by the Accreditation Council for Graduate Medical Education (ACGME).
  • Professional Activity: Have been in the active practice of surgery of the hand for at least two years following completion of training and be currently engaged in the practice of surgery of the hand.
  • Adhere to the ABS Ethics and Professionalism Policy.
  • Operative Log: Submit for the ABS' review a list of at least 125 cases managed during a consecutive 12-month period within the two years preceding application. Surgery of the hand includes only those procedures performed on the upper extremity distal to the elbow. The case list must include cases fulfilling at least six of the following nine categories:
There is NO mention of being a DPM is acceptable... End of this discussion for doing hand surgery.
 
DocBlin said:
To be certified in Surgery of the Hand these are the requirements:
General Requirements
  • To be eligible to apply for this exam, applicants must:
  • Certification: Be currently certified in general surgery by the American Board of Surgery and in compliance with the ABS MOC Program.
  • Medical License: Have a currently registered full and unrestricted license to practice medicine in the U.S. or Canada. Applicants are required to immediately inform the ABS of any conditions or restrictions in force on any active medical license they hold.
  • Accredited Program: Have satisfactorily completed a one-year training program (48 weeks of full-time experience) in surgery of the hand accredited by the Accreditation Council for Graduate Medical Education (ACGME).
  • Professional Activity: Have been in the active practice of surgery of the hand for at least two years following completion of training and be currently engaged in the practice of surgery of the hand.
  • Adhere to the ABS Ethics and Professionalism Policy.
  • Operative Log: Submit for the ABS' review a list of at least 125 cases managed during a consecutive 12-month period within the two years preceding application. Surgery of the hand includes only those procedures performed on the upper extremity distal to the elbow. The case list must include cases fulfilling at least six of the following nine categories:
There is NO mention of being a DPM is acceptable... End of this discussion for doing hand surgery.
Click to expand...
Thanks!
 
hughesn2 said:
Why would someone who has the words DPM after their name ever be working on the hand??? People go to MD and DO school to specialize in the hand.
Are you a pre-podiatry student or a pre-med student because what you want is not gonna be found at a podiatry school.
Click to expand...
It isn't what I want. I was just curious. And no, I'm a pod student. Had you read the thread, you would have realized that podiatrists are allowed to practice on the hand in 5 or 6 states. Scope of practice varies from state to state for podiatrists, and podiatrists of this generation complete a 3 year surgical residency which can be limited to the foot, be foot and ankle, or can be foot ankle and knee. This depends on how competitive of a residency you can place into, and the scope of practice in the state where you do your residency. When I found out that the scope of practice for podiatrists included the hand in certain states, I was curious as to what that could theoretically entail from a surgical perspective. Something that DocBlin kindly answered for me.
 
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