There is nothing to stop you from using nail techs in basically all places. In PP, it's just MAs who get trained for that and everything else. Nail techs will still need to know how to be podiatry MA, unless you have an unreal amount of RFC.
You will hear the "that's not legal" from the occasional podiatry student who the mustache professors or APMA old heads have 'scared straight,' but it's just noise.
...in the end, just do it ethically. See new patients for talk and exam before debride (and honestly, may as well do debride yourself anyways... takes 1-2mins and creates rapport and doc f2f time that your MA doing debride will not). It needs to be documented that they meet at-risk status. For follow-ups, you can delegate, but I just do the RFC... you obviously can't delegate callus shaving or invasive stuff to people minimal/no training, so may as well do RFC while asking about shoes, glucose control, etc.
I do a relatively little amount of RFC visits, and I honestly find it's better to do the debride myself and have MA grabbing felt pads or instruments or cream or etc from drawers, doing note, getting gel toe pads or various OTC stuff, cleaning other exam room or rooming next patient, autoclaving, etc.
It's different in 'nail jail' practices where half the daily schedule is f/u RFC visits. When its only a few per day, I'm just more efficient for the DPM to quickly do those, and since you will need to do exam and calluses anyways, you don't end up with all the "make that nail shorter" and "is that edge an ingrown" and "I think she missed a corner" and "can you check circulation/neuropathy/injury."
When you think about it, any DPM out practicing has been cutting nails for many years: 3rd year student, 4th year, three years residency... plus more years of practice and shadowing. Most MA will be bad and/or afraid to do nail care, and even if your MA(s) are quite good at nail care, they'll make mistakes... and pts won't trust them or value their time as much as doc f2f time. Those few MAs who do get with good nail care are fairly rare and typically more useful doing other stuff. They also won't identify calluses, biopsies, tendonotmies, deformities, DM shoe need, etc for you while they're doing nail care... but you can.
In the end, the staff are minimum value on nails and much more added efficiency at many other office tasks IMO. I am talking about maxing revenue and efficiency. You will accomplish better care and efficiency with less overlap if you largely DIY nail care during exam + convo, assuming it's a balanced office schedule (derm, ortho, DM, deformities, RFC, etc). For those ultra-depressing offices with 10+ nail pts per day, then yeah, I get it... train MAs to cut, dremel, or both when you ask. 👍
