"Practicing" Podiatric Medicine

[hightower]

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I have heard repeatedly that you need to get good training and log your cases appropriately during residency. Then when you want hospital privileges you have to show them your case logs and they will ultimately determine which procedures you are allowed to perform in their OR. I am guessing you will be granted permission to do all the procedures you did in residency (of course considering state scope of practice, etc). Ok, now my questions: So when there is a new surgical procedure or a different way of doing something how far can you get away from what the hospital has determined you can do? Does the innovation in surgical procedure focus more on how you get to the end result? In other words, are you allowed to do a bunion any way you want as long as its a bunion at the end of the day? Is there any way you can learn a new procedure you did not perform in residency and be approved by your hospital to do such procedure? I guess in summary, how much wiggle room is there outside what you have done in residency?

 

[347932]

Generally you do have to show some type of proficiency before you will get privileges to perform a certain procedure. In my community you have to show that you've done five of any specific procedure before you will be allowed to perform that procedure, assuming you are just out of residency. Once you're out of residency, it may rest on your Board Status. It just really depends on the individual community.

You are correct about perform a procedure how you see fit. For instance, if you have privileges to do triple athrodeses, then you can use pretty much anything you want to do that procedure. Ex-Fix, Screws, Absorbable Fixation or anything else you see unless its cost prohibitive and the hospital doesn't stock that particular product.

When new technology or new procedures come up, that's when it gets a bit tricky. Ankle Replacement is the perfect example. In our area this is how it works. First you need a letter from the hospital that tells the company that will train you to do the procedure with their product that the hospital will give you privileges to do that procedure. To get that letter you have to have participated in or observed at least 5 of that procedure. At that point the company that makes the product will decide whether they want to train you or not, based on your ankle volume and board certification. Once you get trained by them, you can then do Total Ankle Replacement using any product you want at our hospital. Currently only one Pod in our area does them.

Just as a total aside, Ortho surgeons do not have to jump through any of these hoops. Even if they never touched a foot before, all they need to do is check off that little box on their App for foot/ankle privileges and they get them. I know this for certain. They don't need to prove a thing. They could have never done a bunion in their 6-7 years of residency, but they can tell patients that they do them now. Its caused some major legal issues for some of the Orthos in our area, but that doesn't stop them.

 

[hightower]

Generally you do have to show some type of proficiency before you will get privileges to perform a certain procedure. In my community you have to show that you've done five of any specific procedure before you will be allowed to perform that procedure, assuming you are just out of residency. Once you're out of residency, it may rest on your Board Status. It just really depends on the individual community.

You are correct about perform a procedure how you see fit. For instance, if you have privileges to do triple athrodeses, then you can use pretty much anything you want to do that procedure. Ex-Fix, Screws, Absorbable Fixation or anything else you see unless its cost prohibitive and the hospital doesn't stock that particular product.

When new technology or new procedures come up, that's when it gets a bit tricky. Ankle Replacement is the perfect example. In our area this is how it works. First you need a letter from the hospital that tells the company that will train you to do the procedure with their product that the hospital will give you privileges to do that procedure. To get that letter you have to have participated in or observed at least 5 of that procedure. At that point the company that makes the product will decide whether they want to train you or not, based on your ankle volume and board certification. Once you get trained by them, you can then do Total Ankle Replacement using any product you want at our hospital. Currently only one Pod in our area does them.

Just as a total aside, Ortho surgeons do not have to jump through any of these hoops. Even if they never touched a foot before, all they need to do is check off that little box on their App for foot/ankle privileges and they get them. I know this for certain. They don't need to prove a thing. They could have never done a bunion in their 6-7 years of residency, but they can tell patients that they do them now. Its caused some major legal issues for some of the Orthos in our area, but that doesn't stop them.

Thanks for the insights!

 

[347932]

My pleasure!! That's what I'm around for😉.

 

[jonwill]

At both of my hospital systems, privileges are divided into classes. I think class I is forefoot/soft tissue, class two is forefoot and some rearfoot osseous, and class III is full foot and ankle trauma/reconstruction with admitting privilges. They just asked for my surgical logs from residency and reviewed them, granting me privileges accordingly. I also had an interview with the section chief of each hospital system. At one of the hospital systems, I have to have a podiatrist review 10 of my cases over the next two years. All in all it has been pretty painless.

 

[hightower]

At both of my hospital systems, privileges are divided into classes. I think class I is forefoot/soft tissue, class two is forefoot and some rearfoot osseous, and class III is full foot and ankle trauma/reconstruction with admitting privilges. They just asked for my surgical logs from residency and reviewed them, granting me privileges accordingly. I also had an interview with the section chief of each hospital system. At one of the hospital systems, I have to have a podiatrist review 10 of my cases over the next two years. All in all it has been pretty painless.

👍, thanks