Podiatry in US vs in Canada

[Yk4]

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Hi, I would like to know what is the limitation in the US (in surgery)?

 

[dpmgrad]

Hi, I would like to know what is the limitation in the US (in surgery)?

The limitation in terms of what level of the foot and ankle can a DPM operate on will depend on each individual state's scope of practice. In general, most DPM can perform surgery on both foot and ankle. Some states such as NY would limit the DPM to perform surgery below the ankle joint. There are one or two states that would allow the DPM perform surgery up to the hip.

I know that the surgical privileges in Canada are much more restrictive than in the US for the DPM.

 

[justincredible]

There are one or two states that would allow the DPM perform surgery up to the hip.

Hi, sorry to change the subject but I hear this alot. Which states are they? Anyone know? Thanks.

 

[JEWmongous]

It's only surgery on soft tissue (skin, muscles, tendons, etc) of the hip/thigh so its not like one will be doing any knee or hip surgery. I understand this increased scope of practice is more for allowing a pod to harvest skin grafts from these areas (for use in reconstructive surgeries and the like).

I know that Georgia includes the hip. Maybe Florida as well???

 

[calcaneus]

Hopefully some more experienced people will chime in after me. Most of the info I can give has been found here on SDN.

I remember reading something about Georgia allowing DPM's to do some knee and hip work but particulars I'm not sure of, nor am I sure of the truth of that statement.

I've also heard on here that Michigan is good for allowing DPM's to work on F/A and soft tissue below the knee I think.

Also from what I've gathered thus far is that the level of restriction on a DPM's practice can also depend on the hospital you work at. I would doubt a hospital could let you do something beyond what state statute allows, but I think some hospitals may place further restrictions beyond what a state says.

Sorry I don't have better info, but I'm sure the more experienced members will jump in soon, if not direct you to other posts.

 

[krabmas]

The florida law is bone up to but not including the tibial tuberosity. DPMs cannot surgically fix tibial plateau fractures. And soft tissue to the hip. A DPM cannot surgically treat the hip or thigh. They can laser vericose veins and prescribe ashley bands for internal torsion of the lower extremity.

 

[dpmgrad]

Hi, sorry to change the subject but I hear this alot. Which states are they? Anyone know? Thanks.

I should have phrased my comment about DPMs operating up to the hip better. As previous posters indicated, any surgery extending past the tibial tuberosity is usually skin / subcutaneous tissue related. Hence, DPMs can not do total knee replacement, total hip replacement, knee arthroscopy, etc... The only state that allow DPMs to do surgery on skin / subcutaneous tissue up to the hip:

New Mexico

In regard to surgical treatment shall be limited to the tuberosity of the tibia and the area distal thereto, excepting the skin and subcutaneous tissues of the thigh. (as of April 2006)

Reference: APMA State Reference Manual Part A - Scope of Practice Provision (April 2006)

Florida used to allow DPMs to operate skin / soft tissue up to the hip. However, Florida had revised the scope of practice in 2005 / 2006 and am not sure if the DPM are still allow to do anything above the tibial tuberosity. In 2001, Board of Podiatric Medicine vs. Florida Medical Association case, the following was decided. Board of Podiatric Medicine properly exercised its delegated legislative aurthority when it issued rule defining term "human leg," as used in statute defining practice of podiatric medicine, to include the entire lower extremity; several experts testified as to the multiple meanings of the term "human leg" within the anatomic, medical, and podiatric fields, a broader definition was consistent with the proposed rule, and the proposed rule did not enlarge or modify the statute.

However, the Practice of Podiatric Medicine in 2005 / 2006 in Florida states the following. "Practice of podiatric medicine" means the diagnosis or medical, surgical, palliative, and mechanical treatment of ailments of the human foot and leg. The surgical treatment of ailments of the human foot and leg shall be limited anatomically to that part below the anterior tibial tubercle.

Reference: APMA State Reference Manual Part A - Scope of Practice Provision (April 2006)

Georgia

Performing surgery on the foot or leg of a patient, except that when such surgery is performed under general anesthesia it shall be permissible only when said surgery is performed at a facility permitted and regulated as a hospital or ambulatory surgery center.
Leg is vague here and do not know if that would include up to the hip or not.

Reference: APMA State Reference Manual Part A - Scope of Practice Provision (April 2006)

I hope that this would clarify things.

 

[cgypod]

does anyone know the scope of practice in the different provinces in canada?

 

[7385]

does anyone know the scope of practice in the different provinces in canada?

From what I have read, BC, Alberta, Manitoba, and Quebec are the best provinces to practice as a DPM. That said, I really haven't figured out why... whether the provincial government pays, if there is hospital privileges, etc etc.

In Ontario, there are several practicing, but OHIP does not cover podiatric care, and there is no OR time or hospital privileges at all, the orthopods do it all. All DPMs in Ontario are in private practice (as far I know). Some have billing numbers for OHIP, but only if they have been practicing in Ontario long enough to have registered for one many years ago.

 

[gustydoc]

You have to be really careful what you believe in regards to scope in some of the states like Georgia regardless of how vague the state law is written. Even the best trained podiatrists in that state are not doing knee or hip procedures. Grafting skin from the thigh or bone from the hip maybe, but they are definitely not scoping knees or treating knee problems. I only mention this because I feel like some pre-pods are under the impression that someday they can do knee replacements if they live in Georgia or Florida. I'd hate to see them disappointed when they realize that isn't really the case.

 

[jonwill]

You have to be really careful what you believe in regards to scope in some of the states like Georgia regardless of how vague the state law is written. Even the best trained podiatrists in that state are not doing knee or hip procedures. Grafting skin from the thigh or bone from the hip maybe, but they are definitely not scoping knees or treating knee problems. I only mention this because I feel like some pre-pods are under the impression that someday they can do knee replacements if they live in Georgia or Florida. I'd hate to see them disappointed when they realize that isn't really the case.

Yea, I get the same impression sometimes. For all intents and purposes, the scope is pretty much the same in every state. We do foot and ankle surgery. The few exceptions are usually for the worse such as NY.

Here in Michigan, it is still on the books that pods can treat hands. However, I don't think you'll find any doing so.

 

[calcaneus]

Thanks for the clarifications jonwill and gustydoc.

 

[justincredible]

Thanks for the help everyone! Based on your above posts, I seem to understand this a little better now. I kept hearing about DPMs (in certain states) being able to work until just under the knee or until just under the hip, but I never got clarification on that. Even at my interview, one of the faculty members briefly mentioned it, and it made me somewhat confused. So thanks for the clarification!

 

[Yk4]

I know that in Canada, it's only very minor surgery that you can do in your clinic

Let say that I want to practice in the US (in california to be specific), do the states recognise my DPM? How about the residency?

 

[Dr_Feelgood]

I know that in Canada, it's only very minor surgery that you can do in your clinic

Let say that I want to practice in the US (in california to be specific), do the states recognise my DPM? How about the residency?

If they are completed in a US accredited college and at a US accredited residency.

There is no equivalent to DPM in any other country. Many countries have chiropody or a BS in podiatry.

 

[Yk4]

Ok, thanks for the info.

By the way Dr_FeelGood, we need more cowbell

 

[rhodie]

The scope of practice for canadian podiatrists is actually similar to the US in Alberta and BC. The problem is that it just isn't as well established. In Alberta there are podiatrists who actually are on staff with the U of Calgary orthopedics department and have hospital privileges. Problem is that in Alberta, you do not make a ton of money doing surgery in hospitals. The big money is in owning or partnering up on a surgery center or clinic. Then you can charge privately for any surgeries including the ankle. You just need ta have everything set up, billing, anesthesiology, malpractice coverage, etc. Most podiatrists in Canada are probably not that comfortable doing ankle work so no one does. In BC it is even more lucrative because provincial insurance will pay for services, but since podiatry is not under the federal health care umbrella, there is no cap to how much you can bill as in other provinces where you can only bill a certain amount per month. Hope this helps anyone wanting to go to Canada. I don't know much about anything east.