New York Scope of practice

[Twin2012]

Hello,
I was wondering if any one practices in new york. I have a few questions.
Thank you!

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[king22]

Hello,
I was wondering if any one practices in new york. I have a few questions.
Thank you!

Ask away

 

[Twin2012]

Ask away

I was wondering what the scope of practice is in New York? I'm a first year resident just trying to see where I might possibly look for a job. What made you choose to practice in new York?

 

[king22]

I was wondering what the scope of practice is in New York? I'm a first year resident just trying to see where I might possibly look for a job. What made you choose to practice in new York?

My choice to stay in New York was simply due to family.

The scope of practice is convoluted in NY. There are essentially 3 levels of podiatric licensing- Standard Podiatry License, Podiatry license with standard ankle surgery endorsement, Podiatry license with Advanced ankle surgery endorsement. Only the 3rd one allows you to perform Ankle ORIF, scopes, and fusions. The requirements to get these endorsements can be found here NYS Podiatry: Ankle Surgery Privileges

Even if you have the advanced endorsement, chances are you will rarely use it. The overwhelming majority of surgical treatment of ankle structures are performed by Ortho.

 

[CutsWithFury]

My choice to stay in New York was simply due to family.

The scope of practice is convoluted in NY. There are essentially 3 levels of podiatric licensing- Standard Podiatry License, Podiatry license with standard ankle surgery endorsement, Podiatry license with Advanced ankle surgery endorsement. Only the 3rd one allows you to perform Ankle ORIF, scopes, and fusions. The requirements to get these endorsements can be found here NYS Podiatry: Ankle Surgery Privileges

Even if you have the advanced endorsement, chances are you will rarely use it. The overwhelming majority of surgical treatment of ankle structures are performed by Ortho.

Are their podiatrists doing total ankle replacements in New York?

 

[josebiwasabi]

NYS Podiatry: Ankle Surgery Privileges

Licensed Professions: Podiatry

www.op.nysed.gov

​

​

Types and Scope​

Chapter 438 of the Laws of 2012 established two new credentials, the holders of which are authorized to perform podiatric ankle surgery. The two new credentials are:

• Podiatric Standard Ankle Surgery Privilege – Podiatrists who hold a privilege to perform podiatric standard ankle surgery may perform surgery on the ankle1 which may include soft tissue and osseous procedures, except those procedures specifically authorized for podiatrists holding a podiatric advanced ankle surgery privilege.
  
  
• Podiatric Advanced Ankle Surgery Privilege – Podiatrists who hold a privilege to perform podiatric advanced ankle surgery may perform surgery on the ankle1 which may include:
  • ankle fracture fixation,
  • ankle fusion,
  • ankle arthroscopy,
  • insertion or removal of external fixation pins into or from the tibial diaphysis at or below the level of the myotendinous junction of the triceps surae, but does not include the surgical treatment of complications within the tibial diaphysis related to the use of such external fixation pins, and
  • insertion and removal of retrograde tibiotalocalcaneal intramedullary rods and locking screws up to the level of the myotendinous junction of the triceps surae.

Possession of a podiatric ankle surgery privilege does not authorize:

• the surgical treatment of complications within the tibial diaphysis related to the use of external fixation pins;
• partial or total ankle replacements; or
• the treatment of pilon fractures.

 

[G0dFather]

Are their podiatrists doing total ankle replacements in New York?

they made sure to prevent that and pilons from happening even with the advanced ankle .... whoever wants to do one just takes it to NJ right over the bridge

 

[G0dFather]

the surgical treatment of complications within the tibial diaphysis related to the use of external fixation pins;

And look at that language ... so you can put the exfix on... but if it gets infected ( which its a possible complication) its out of your scope to treat and youd have to call someone else in to help you ... they made sure to put you in your place so you can always be reminded of what you really are

 

[CutsWithFury]

And look at that language ... so you can put the exfix on... but if it gets infected ( which its a possible complication) its out of your scope to treat and youd have to call someone else in to help you ... they made sure to put you in your place so you can always be reminded of what you really are

It is the New York Podiatric Medical Association's fault. APMA as well. What kind of message does that send to profession? We pump our chests saying we have great training blah blah but we still have states where the scope is extremely limited. There is NOT a unified urgency to fix these scope discrepancies. It is more..."we will take what we can get" mentality from our national organization.

All the while the NYPMA has agreed to these three levels of certification which most likely creates a lot of infighting in the profession. Podiatrists holding the highest level of certification doing their best to limit other DPMs. Just my two cents...

 

[G0dFather]

."we will take what we can get"

You are a smart .... this is exactly what was said to me when i questioned how could they let this happen

 

[NobodyDPM]

All the while the NYPMA has agreed to these three levels of certification which most likely creates a lot of infighting in the profession. Podiatrists holding the highest level of certification doing their best to limit other DPMs. Just my two cents...

Did the folks at the NYPMA "agree to", or did they impose/create these levels? Betcha it's the latter. As you said, Podiatrists doing what they do to make their colleagues incapable of compete with them. Happens everywhere.

 

[Twin2012]

they made sure to prevent that and pilons from happening even with the advanced ankle .... whoever wants to do one just takes it to NJ right over the bridge

If thats the case then why not just practice in NJ since their laws are better for the scope of practice? Is NJ saturated with podiatrists?

 

[NobodyDPM]

If thats the case then why not just practice in NJ since their laws are better for the scope of practice? Is NJ saturated with podiatrists?

The NJ area surrounding NYC is pretty densely populated with Podiatrists.

 

[Boba Foot]

If thats the case then why not just practice in NJ since their laws are better for the scope of practice? Is NJ saturated with podiatrists?

The NY/NJ/PA tri-state area is saturated with podiatrists as a whole. A rule of thumb, is that wherever there’s a pod school is over saturated with podiatrists.

 

[G0dFather]

If thats the case then why not just practice in NJ since their laws are better for the scope of practice? Is NJ saturated with podiatrists?

yes as others stated ... NY is where the volume is ... in the NYC/Long island area there is about 12 million people that reside there ... is there anywhere else in the US that matches that density per sqft ?

 

[HardRoadPaved]

The population density of the Los Angeles urbanized area is indeed greater than that of the New York urbanized area, with 7,009 people per square mile versus 5,239 people per square mile.

 

[heybrother]

I feel like I heard this joke like 30 years ago.

Why did they call New York the Big Apple?
Cuz it's rotten to the core... with podiatrists.

 

[king22]

Are their podiatrists doing total ankle replacements in New York?

Not that I'm aware of

 

[G0dFather]

The population density of the Los Angeles urbanized area is indeed greater than that of the New York urbanized area, with 7,009 people per square mile versus 5,239 people per square mile.

The population density of the Los Angeles urbanized area is indeed greater than that of the New York urbanized area, with 7,009 people per square mile versus 5,239 people per square mile.

Wow!! thanks for bringing that up insane !! ... how much pod concentration there ?

 

[GreenHousePub]

Wow!! thanks for bringing that up insane !! ... how much pod concentration there ?

lol

 

[air bud]

Yeah we don't talk much about California and pods, specifically LA and San Francisco. I don't knowany big time speakers ( lol as we know that does not require being a good surgeon and vice versa) from those areas. I know there is a dude in Northern California like north north that is killing it and doing crazy good stuff.

 

[diabeticfootdr]

One of the issues in the NYS Scope is that access to the full scope of practice of podiatry is dependent on board certification. There is no comparison in the MD license. For example, an MD doesn't get a license which is restricted so you can't treat the skin unless you're board certified in dermatology. Licensure, and thus scope, should not be tied to board certification. In our opinion, that practice is discriminatory and otherwise illegal. A license is a license. What procedures you're allowed to perform is borne out in the hospital privileging process, which by federal law is to be based on your education, training, and experience.

 

[CutsWithFury]

One of the issues in the NYS Scope is that access to the full scope of practice of podiatry is dependent on board certification. There is no comparison in the MD license. For example, an MD doesn't get a license which is restricted so you can't treat the skin unless you're board certified in dermatology. Licensure, and thus scope, should not be tied to board certification. In our opinion, that practice is discriminatory and otherwise illegal. A license is a license. What procedures you're allowed to perform is borne out in the hospital privileging process, which by federal law is to be based on your education, training, and experience.

You keep quoting this over and over but the ABPM has not done anything to defeat these policies in CT and NY. So what is the point?

 

[Pronation]

You keep quoting this over and over but the ABPM has not done anything to defeat these policies in CT and NY. So what is the point?

I think it's because the APMA has not received enough donations. They should send members more frequent requests by snail mail asking for money.

 

[G0dFather]

Licensure, and thus scope, should not be tied to board certification.

This is so true ... but leave it to podiatry to complicate this simple statement and tie everything to a board certification completely negating your degree and your training, so sad.

 

[dtrack22]

Nurses and PAs have expanded their scope, practically unchecked, all over the country. And here us Podiatrists are, limiting ourselves and creating our own hurdles to credentialing/licensing/board certification. We are so dumb

 

[CutsWithFury]

Nurses and PAs have expanded their scope, practically unchecked, all over the country. And here us Podiatrists are, limiting ourselves and creating our own hurdles to credentialing/licensing/board certification. We are so dumb

Not starting a flame war here but it is amazing how APRNs have expanded their scope with zero pushback from anyone.

 

[CutsWithFury]

I think it's because the APMA has not received enough donations. They should send members more frequent requests by snail mail asking for money.

What are the membership dues lately? I am not a member clearly.

Last time I heard about it was because the APMA cold called me and asked me why I won't pay over $1000 to be a member.

 

[dtrack22]

What are the membership dues lately? I am not a member clearly.

Last time I heard about it was because the APMA cold called me and asked me why I won't pay over $1000 to be a member.

You typically have to join both your state association as well as APMA. At least I’ve never heard of someone being able to join one or the other. Dues increase as you get further out of residency. Once you’ve been out for like 4-5 years it maxes out. I believe APMA is around $900 once you’ve been out 4-5+ years and my state association (for example) is around $500.

My job pays for it, but if they didn’t I wouldn’t be a member. I’ve got better things to do with $1400 every year. And $1400 over the year isn’t a ton in the grand scheme of things, but ACFAS wants another $500-600, and ABFAS wants a few hundred bucks every year, and ABPM wants a few hundred bucks, and your state license is $700-800 every two years. It starts to add up.

State Association + ABPM is the largest dues payment you will make every year, and if you’re practicing in NY (for example) what is it getting you other than saving a few hundred on CME registration fees and an incredibly convoluted licensing/scope of practice process?

 

[DYK343]

APMA could be better but I feel like money is better spent with them.

ABFAS is necessary money spent for me to maintain my certification but what do they actually do other than throw a mediocre conference every year for the profession? Brag? They do a lot of that.

At least APMA does something year to year for the profession legislative wise.

But my MSG pays for both so I dont care.

Edit: I've said it before and ill say it again. Dont practice in NY.

 

[NobodyDPM]

One of the issues in the NYS Scope is that access to the full scope of practice of podiatry is dependent on board certification. There is no comparison in the MD license. For example, an MD doesn't get a license which is restricted so you can't treat the skin unless you're board certified in dermatology. Licensure, and thus scope, should not be tied to board certification. In our opinion, that practice is discriminatory and otherwise illegal. A license is a license. What procedures you're allowed to perform is borne out in the hospital privileging process, which by federal law is to be based on your education, training, and experience.

This is not altogether true. Which is why there are specializations in the MD and DO world. A vascular surgeons would raise eyebrows if they showed up to do an ankle fracture. And MDs and DOs have board certifications which preclude from certain areas of practice if they don't get it. I know in Anesthesiology, it is a HUGE deal if you fail your boards. In big practices, you would be out of a job and then good luck getting hired without it.

 

[NobodyDPM]

The APMA is an interesting animal. They made a very big mistake in the fight with ACFAS years ago, which not only split the profession somewhat, but also lost them a lot of support. And still does. ACFAS is the organization for Board Certified Podiatric Surgeons. ASPS tries, but how many people are really invested in it? The fact that "affiliate organizations" have to assure that their members are also APMA members makes no sense at all. One should have nothing to do with the other.

When the one year residencies were abolished, I was very vocal about how that would hurt those that didn't succeed in getting a residency at the time. The APMA had a multi-million dollar rainy day fund (and they still do) and I asked them to start small one year residencies to fill the gap for those that didn't get a residency. To at least give them a chance to practice anywhere they like. Most states require at least one year of post graduate training, and believe it or not, some people were left out of that because of the residency changes. The APMA's answer was to ignore the issues. It was infuriating to me.

 

[G0dFather]

The APMA is an interesting animal. They made a very big mistake in the fight with ACFAS years ago, which not only split the profession somewhat, but also lost them a lot of support. And still does. ACFAS is the organization for Board Certified Podiatric Surgeons. ASPS tries, but how many people are really invested in it? The fact that "affiliate organizations" have to assure that their members are also APMA members makes no sense at all. One should have nothing to do with the other.

When the one year residencies were abolished, I was very vocal about how that would hurt those that didn't succeed in getting a residency at the time. The APMA had a multi-million dollar rainy day fund (and they still do) and I asked them to start small one year residencies to fill the gap for those that didn't get a residency. To at least give them a chance to practice anywhere they like. Most states require at least one year of post graduate training, and believe it or not, some people were left out of that because of the residency changes. The APMA's answer was to ignore the issues. It was infuriating to me.

To THEM, its a small price to pay ... sacrifice the few for the survival of the whole ... disgusting, it didnt even need to go that way