scope of practice

[ucd]

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2nd yr pod student here. I know that podiatrists are expert in the foot and ankle,so treating calcaneus, tarsal bones, mets, phalanges and intrinsic foot muscles are within the scope of practice. However, where do podiatrist draw the line for extrinsic muscle such as Anterior tibialis, FHL, peroneus longus, and proneus brevis? If there was a tear somewhere along the muscle, are we able to treat the insertion of the muscle and not the origin? Or not able to treat either part of that extrinsic muscle? Thanks

 

[that1guyfromFL]

With our maddeningly inconsistent scope laws, I believe the answer to your questions would vary by state.

In FL our surgical scope extends to the tibial tuberosity.

 

[dtrack22]

Shouldn't you be studying?

 

[bobdolerson]

http://206.82.221.135/showthread.php?p=11258454
This may have changed a bit since it's posting, but either way, a good place to start.

 

[Sig Savant]

http://www.nxtbook.com/nxtbooks/apma/news_201201/#/26

Look at page 23 of the recent APMA news.

 

[PADPM]

In many states, in addition to treating ankle fractures, DPMs are allowed to treat soft tissue structures to the knee, as it relates to the foot. So where I practice, I can, and have repaired all the extrinsics you've mentioned.

 

[ucd]

Wow, didn't know the scope was so broad in certain states! In my opinion, it would make sense to be able to fix /repair extrinsic muscle of the foot. I guess the APMA/ higherups has to do a better job of educating the rest of the states to follow the progressive thinking of whatever state PADPM is working at. Thanks for everyone's insight!

 

[ucd]

Thanks sig savant for the link. I was reading that page and happened to stumble on the section that said medicaid does not pay for podiatric care in alaska, alabama, arizona, california, kansas, nevada, new york, south carolina, and wyoming?? A) How are elderly/diabetic patients getting their necessary treatment? B)Are podiatrist in these states able to make a living considering medicaid probably makes up a good percentage of their practice?

 

[347932]

A) How are elderly/diabetic patients getting their necessary treatment? B)Are podiatrist in these states able to make a living considering medicaid probably makes up a good percentage of their practice?

Most elderly have Medicare as well as Medicaid, so Medicaid is the secondary insurer and pays whatever Medicare doesn't. This generally amounts to about 20% of their medical bills. If their doc (of any kind) doesn't participate in Medicaid for any reason, the patient is responsible for the portion that Medicare doesn't.

If someone only relies on Medicaid in their practice, they are in a heap of trouble, even if they do participate. Medicaid as a primary insurer likely makes up only a very small portion of a busy practitioners office patients.

Not being on Medicaid in a state is catastrophic, not because of reimbursement, but because of patient care issues. Those patients are generally not very well off and can't afford the foot care they need to avoid disastrous foot ailments. This has been proven time and time again, and generally states that elect to exclude Podiatry from their Medicaid program, ultimately reverse the decision after the data comes out on how much more it costs the state for other care associated with foot problems that could have been avoided by including Podiatry. Then a few years later, some cowboy senator or congressperson decides to cut the budget with Medicaid and the wheels go round and round.

 

[347932]

I guess the APMA/ higherups has to do a better job of educating the rest of the states to follow the progressive thinking...

The APMA does an excellent job in this department and have lobbyist working on this day in and day out.

Almost yearly, legislation changes for the better for us because of their work.

 

[ucd]

Oops, I think i might have mixed up medicare with medicaid. Regardless, that was a very insightful reply. Thanks Kidsfeet!