Texas Podiatry Scope of Practice

[dpmgrad]

Here is something interesting that I came across the PM News in my email box.

Texas Appeals Court Overturns Scope of Practice Definition

Although the Texas Podiatric Medical Association (TPMA) and the Texas State Board of Podiatric Medical Examiners were initially successful in defending the ankle as being within the scope of practice, they were handed a setback on Friday as the Texas Court of Appeals reversed the lower court’s decision.

In their decision the Court said “The statutory authority currently in place limits podiatrists to the treatment of ‘the foot.’ While it may be difficult to define that term for purposes of treatment, whatever the term means, it is clear that "the foot" does not include the full portion of the body included within the definition in the Rule. Compelling arguments might be made as to whether--from a medical standpoint--it is reasonable to allow a practitioner treating the foot to consider and treat other anatomical systems that interact with and affect the foot. This is a debate to be had at the legislature.”

A gloating Texas Medical Association (TMA) President William W. Hinchey, MD commented “I’m glad the appeals court recognizes that the proper medical care of patients is too important to be left to people who are not adequately trained to perform certain medical procedures. If people wish to practice medicine, they should attend and complete medical school.”

Read the decision at: http://www.3rdcoa.courts.state.tx.us/opinions/HTMLopinion.asp?OpinionID=16620

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[HenryH]

Here is something interesting that I came across the PM News in my email box.

Texas Appeals Court Overturns Scope of Practice Definition

Although the Texas Podiatric Medical Association (TPMA) and the Texas State Board of Podiatric Medical Examiners were initially successful in defending the ankle as being within the scope of practice, they were handed a setback on Friday as the Texas Court of Appeals reversed the lower court's decision.

In their decision the Court said "The statutory authority currently in place limits podiatrists to the treatment of ‘the foot.' While it may be difficult to define that term for purposes of treatment, whatever the term means, it is clear that "the foot" does not include the full portion of the body included within the definition in the Rule. Compelling arguments might be made as to whether--from a medical standpoint--it is reasonable to allow a practitioner treating the foot to consider and treat other anatomical systems that interact with and affect the foot. This is a debate to be had at the legislature."

A gloating Texas Medical Association (TMA) President William W. Hinchey, MD commented "I'm glad the appeals court recognizes that the proper medical care of patients is too important to be left to people who are not adequately trained to perform certain medical procedures. If people wish to practice medicine, they should attend and complete medical school."

Read the decision at: http://www.3rdcoa.courts.state.tx.us/opinions/HTMLopinion.asp?OpinionID=16620

Holy **** -- that's bold (no pun intended)! What does a podiatrist practice if it's not medicine?

I guess the pods don't get too many referrals from Texas MDs/DOs...

 

[OSUDDS]

I was just about to post that same article.

That guy sounds like a real butthurt douchebag. No offense.

 

[krabmas]

Holy **** -- that's bold (no pun intended)! What does a podiatrist practice if it's not medicine?

I guess the pods don't get too many referrals from Texas MDs/DOs...

The people that represent the MD/DOs do not always speak directly for the simple practicing doc. Most MD/DOs do what they want based on experience and not what some bigshot politico says.

 

[HenryH]

So what's the reason for the TMA fiend's vehemence towards DPMs? Afraid of competition for F&A cases?

 

[caribsurf]

.........how many are not worried about this? and why?

You have Podiatrists out there with no surgical training---a little surgical training--- and a lot of surgical training. Until Podiatry wants to include all practitioners (offer residency level ankle/rearfoot training for older and all practitioners) this trend may continue. United we stand, divided we are just a fragmented bunch of quasi foot maybe rearfoot maybe ankle surgeons.

 

[krabmas]

.........how many are not worried about this? and why?

You have Podiatrists out there with no surgical training---a little surgical training--- and a lot of surgical training. Until Podiatry wants to include all practitioners (offer residency level ankle/rearfoot training for older and all practitioners) this trend may continue. United we stand, divided we are just a fragmented bunch of quasi foot maybe rearfoot maybe ankle surgeons.

There are many practitioners that trained long ago and did a 1-2 year residency that do the full scope of podiatric surgery including ankle fx, total ankles, scopes...

If the pods that trained in the past want better skills or bigger scope and did not do a surgical residency or a 3 year residency it is up to them to find a fellowship or residency with an empty spot to go and train.

I know some one who practiced for 5-10 years and then went back and did a surgical residency.

Yes this is a big financial risk but sometimes success takes sacrifice.

I agree that divided we will not survive which is why I support all surgical residencies and then leaving it up to the boards to decide who should surgerize and who should not. I addition, each reisdency has the power to hold residents back until they are compitent.

 

[caribsurf]

If you are ABPS board certified after having done a 1 year surgical residency and move to Florida, you cannot get on staff at any hospital. If you do a 2 year residency but cannot pass the ABPS board, you can.

Why should anyone do a 3 year residency if they are not even legally permitted to fix an ankle fracture?

Do not blame MD's for not understanding a profession that does not even understand itself.

 

[MaseratiGT]

Here is something interesting that I came across the PM News in my email box.

Texas Appeals Court Overturns Scope of Practice Definition

Although the Texas Podiatric Medical Association (TPMA) and the Texas State Board of Podiatric Medical Examiners were initially successful in defending the ankle as being within the scope of practice, they were handed a setback on Friday as the Texas Court of Appeals reversed the lower court’s decision.

In their decision the Court said “The statutory authority currently in place limits podiatrists to the treatment of ‘the foot.’ While it may be difficult to define that term for purposes of treatment, whatever the term means, it is clear that "the foot" does not include the full portion of the body included within the definition in the Rule. Compelling arguments might be made as to whether--from a medical standpoint--it is reasonable to allow a practitioner treating the foot to consider and treat other anatomical systems that interact with and affect the foot. This is a debate to be had at the legislature.”

A gloating Texas Medical Association (TMA) President William W. Hinchey, MD commented “I’m glad the appeals court recognizes that the proper medical care of patients is too important to be left to people who are not adequately trained to perform certain medical procedures. If people wish to practice medicine, they should attend and complete medical school.”

Read the decision at: http://www.3rdcoa.courts.state.tx.us/opinions/HTMLopinion.asp?OpinionID=16620

M.D.'s like Dr. Hinchey make me vomit. Plus, I had to read his verbal diarrhea on my birthday.

Thanks, Dr. Hinchey.

 

[MaseratiGT]

If you are ABPS board certified after having done a 1 year surgical residency and move to Florida, you cannot get on staff at any hospital. If you do a 2 year residency but cannot pass the ABPS board, you can.

Why should anyone do a 3 year residency if they are not even legally permitted to fix an ankle fracture?

Do not blame MD's for not understanding a profession that does not even understand itself.

I think that if you have the right to call yourself "doctor," I think you also have the OBLIGATION to know what other clinicians whom you work with can also do.

To me, it's not that he doesn't understand the profession. There are a lot of things I don't understand, but I don't go around degrading the things which I don't.

Without clinicians such as DPM's, OD's, and dentists, I think our healthcare system would be drastically worse off than it is now.

Who would take over all of the F&A cases that pods see now?

 

[j0ez0r]

just what i wanted to hear since i wanna practice later on in Texas

 

[JEWmongous]

just what i wanted to hear since i wanna practice later on in Texas

I talked to one texas pod who said a few years ago, lone star pods were taken off from either medicare/medicaid services. However, they were eventually put back on as orthos did not want to deal with debriding ulcers and woundcare.

I'm curious how this ankle issue works out. Kind of an odd situation with the scope of practice laws because from what I understand, pods were doing ankle stuff for years, and then it was made into a case to put this into words. Pods "won" so ankle was included. Now it has changed to just foot.

 

[SportPOD]

I wonder how this will affect Zgonis' practice or even the UTHSC-SA program?

And are there orthopods willing to do what Zgonis does for diabetics?

 

[caribsurf]

........maybe the Podiatry schools will cut tuition in half, since the scope is getting cut in half!

Always a silver lining!

 

[Feli]

........maybe the Podiatry schools will cut tuition in half, since the scope is getting cut in half!

Always a silver lining!

How is the the Texas scope getting "cut in half"? Do you think work at or above the ankle joint is 50+% of the practice of a lot, if any, Texas DPMs? I seriously doubt it.

For some highly trained Texas pods who are truly rearfoot trained in residency or fellowship and subsequently certified, this is terrible. They should, and probably will, file discrimination suits.

IMO, the main problem here is definitely not that this will hurt the income of most current Texas DPMs. The majority of practitioners probably don't utilize that aspect of their scope to begin with since they are not trained for it. The real issue is the fact that Texas is a big state with a lot of people, politicians, doctors, etc. It'd be a tough blow for the podiatric profession overall and detrimental to the APMA goals if this DPM scope reduction to below the ankle is held up permanently in Texas courts. Somehow, I think the issue is far from over...

 

[JEWmongous]

How is the the Texas scope getting "cut in half"? Do you think work at or above the ankle joint is 50+% of the practice of a lot, if any, Texas DPMs? I seriously doubt it.

For some highly trained Texas pods who are truly rearfoot trained in residency or fellowship and subsequently certified, this is terrible. They should, and probably will, file discrimination suits.

IMO, the main problem here is definitely not that this will hurt the income of most current Texas DPMs. The majority of practitioners probably don't utilize that aspect of their scope to begin with since they are not trained for it. The real issue is the fact that Texas is a big state with a lot of people, politicians, doctors, etc. It'd be a tough blow for the podiatric profession overall and detrimental to the APMA goals if this DPM scope reduction to below the ankle is held up permanently in Texas courts. Somehow, I think the issue is far from over...

Other states have increased their scope of practice in the past year or two for pods (Mass and Conn come to mind). The interesting thing is that more or less MD/DO's worked with pods to make the new scope. One had to have a mininum 2 year residency and have other accred. in order to do ankle work. I'd rather see something like this occur (if even possible) than a "whose dick is bigger" battle that is happening in texas right now.

 

[PMSIII]

How is the the Texas scope getting "cut in half"? Do you think work at or above the ankle joint is 50+% of the practice of a lot, if any, Texas DPMs? I seriously doubt it.

For some highly trained Texas pods who are truly rearfoot trained in residency or fellowship and subsequently certified, this is terrible. They should, and probably will, file discrimination suits.

IMO, the main problem here is definitely not that this will hurt the income of most current Texas DPMs. The majority of practitioners probably don't utilize that aspect of their scope to begin with since they are not trained for it. The real issue is the fact that Texas is a big state with a lot of people, politicians, doctors, etc. It'd be a tough blow for the podiatric profession overall and detrimental to the APMA goals if this DPM scope reduction to below the ankle is held up permanently in Texas courts. Somehow, I think the issue is far from over...

I couldn't agree more. I think you are right in that this scope reduction will probably not affect the individual DPMs in Texas who don't use that scope anyway but this certainly is a step back with respect to the overall picture of what we are trying to accomplish as a profession and a medical specialty.

This issue is certainly far from over and I can see this process continuing. This is politics at its best (or worst - whichever way you look at it).

 

[Feli]

...I agree that divided we will not survive which is why I support all surgical residencies and then leaving it up to the boards to decide who should surgerize and who should not. I addition, each reisdency has the power to hold residents back until they are compitent.

I think this is very sound thinking and certainly a noble idea, but I'm just not sure it's truly viable in the real world. You worked hard and are fortunate to have secured a strong residency training spot at a teaching hospital brimming with resources. However, strong pod surg training programs don't grow on trees.

The pod school application pool is starting to grow, but some of the schools aren't getting too much more selective, they're just accepting more students and going over their limit to cash more tuition checks (since there's no enforced penalty for that). The way I see it, some of our current surgical residencies get borderline numbers and could use some work (ie merging with other residencies). There are residencies on probation, and a few programs close down every year. New ones open, but there's no way enough quality spots can be added to meet demands of current student numbers.

We cannot have some grads getting top training, some getting mediocre, and a few getting nothing. That keeps us divided. Well, why not just create a clear division and then base scope on that? The CPME could make sure all the 3yr surgical residency spots are excellent in numbers and quality. However, the downside is that there sure wouldn't be enough for everyone graduating pod school in years to come.

For the remaining graduates who are not good candidates or do not want a pod surg residency, they could complete a quality 2yr primary care podiatric medical residency. Those would be infinitely easier to create. A neurologist, hospitalist, or cardiologist sure knows when and why to refer a patient for surgery despite never having done any significant amount of surgery in residency, so the "you need surgical training to know when a patient needs surgery" doesn't really hold water. There is a huge need for residency trained medical podiatrists; they don't all have to do surgery (and we don't have enough quality residencies to train them).

 

[Dr. Gangrene]

M.D.'s like Dr. Hinchey make me vomit. Plus, I had to read his verbal diarrhea on my birthday.

Thanks, Dr. Hinchey.

Happy B-day. Best day of the year for a birthday in my opinion
I will also put on my b-day hat.

 

[Dr. Gangrene]

Will someone with more legal background comment. Is the court of appeals decision the end of the matter, or are there other legal avenues to be persued?

 

[OSUDDS]

.........how many are not worried about this? and why?

You have Podiatrists out there with no surgical training---a little surgical training--- and a lot of surgical training. Until Podiatry wants to include all practitioners (offer residency level ankle/rearfoot training for older and all practitioners) this trend may continue. United we stand, divided we are just a fragmented bunch of quasi foot maybe rearfoot maybe ankle surgeons.

so why do you come to the podiatry forums again?
you havent contributed positively yet

 

[OSUDDS]

Will someone with more legal background comment. Is the court of appeals decision the end of the matter, or are there other legal avenues to be persued?

theres maybe another court of appeals, the state supreme court and the supreme court of the US

i would assume this decision is going to get appealed

 

[Feli]

.........how many are not worried about this? and why?

You have Podiatrists out there with no surgical training---a little surgical training--- and a lot of surgical training. Until Podiatry wants to include all practitioners (offer residency level ankle/rearfoot training for older and all practitioners) this trend may continue. United we stand, divided we are just a fragmented bunch of quasi foot maybe rearfoot maybe ankle surgeons.

so why do you come to the podiatry forums again?
you havent contributed positively yet

Good question... maybe the Network54 server is down again?

 

[krabmas]

I think this is very sound thinking and certainly a noble idea, but I'm just not sure it's truly viable in the real world. You worked hard and are fortunate to have secured a strong residency training spot at a teaching hospital brimming with resources. However, strong pod surg training programs don't grow on trees.

The pod school application pool is starting to grow, but some of the schools aren't getting too much more selective, they're just accepting more students and going over their limit to cash more tuition checks (since there's no enforced penalty for that). The way I see it, some of our current surgical residencies get borderline numbers and could use some work (ie merging with other residencies). There are residencies on probation, and a few programs close down every year. New ones open, but there's no way enough quality spots can be added to meet demands of current student numbers.

We cannot have some grads getting top training, some getting mediocre, and a few getting nothing. That keeps us divided. Well, why not just create a clear division and then base scope on that? The CPME could make sure all the 3yr surgical residency spots are excellent in numbers and quality. However, the downside is that there sure wouldn't be enough for everyone graduating pod school in years to come.

For the remaining graduates who are not good candidates or do not want a pod surg residency, they could complete a quality 2yr primary care podiatric medical residency. Those would be infinitely easier to create. A neurologist, hospitalist, or cardiologist sure knows when and why to refer a patient for surgery despite never having done any significant amount of surgery in residency, so the "you need surgical training to know when a patient needs surgery" doesn't really hold water. There is a huge need for residency trained medical podiatrists; they don't all have to do surgery (and we don't have enough quality residencies to train them).

I still think that medically trained people treat patients with medicine. Surgically trained treat with medicine then surgery. I'm not saying that surgery is better, but when it comes to the point that the patient needs surgery to fix the problem the surgically trained will see it faster (IMO).

Podiatry is too small a profession to have different names. It confuses the public.

The only other specialty that I can think of that does not have a separation between conservative and surgical care is orthopedics. All orthopedic physicians are trained to be surgeons, but not every patient is a surgical candidate. It is very similar to what podiatry is evolving into - a surgical specialty.

All specialties want each doctor/physician/surgeon to be well trained and competent but each specialty also realizes that they have their black sheep. There are terrible surgeons in every specialty.

We live in a bell shaped curve. We are not going to change that.

 

[caribsurf]

For the remaining graduates who are not good candidates or do not want a pod surg residency, they could complete a quality 2yr primary care podiatric medical residency. Those would be infinitely easier to create.

The problem is that you need a 2 year surgical residency for most hospitals in many states, and soon all. Most insurance companies are linked to hospitals,therefore you cannot get on staff.Pretty hard to make a living on a 2 year non-surgical. Even medicare compliment and advantage come into play here.

I am sorry if my comments are not deemed as "positive" by some posters. I am not a cheerleader and this is not the "kumbaya" forum.

 

[OSUDDS]

The problem is that you need a 2 year surgical residency for most hospitals in many states, and soon all. Most insurance companies are linked to hospitals,therefore you cannot get on staff.Pretty hard to make a living on a 2 year non-surgical. Even medicare compliment and advantage come into play here.

I am sorry if my comments are not deemed as "positive" by some posters. I am not a cheerleader and this is not the "kumbaya" forum.

its not that, you just seem a bit abrasive for no reason. what is your purpose of posting in these forums?

dont tell me your one of those caribbean medical students who is better than everyone else

oh lawd, here we go again!

 

[krabmas]

Keep it professional or this thread will be closed.

There is no reason to call someone a douch bag.

There is also no reason to come in to the thread to tell us what is wrong with our profession. If you read thru some more threads you will realize that we are aware that there are some problems with it. Nothing is perfect.

 

[caribsurf]

I thought this was the 'Podiatric Residents & Physicians' board. I am posting my thoughts and opinions for discussion, as a Podiatrist.

Maybe you could learn something if you keep an open mind, and quit name calling. You are entering a profession that has many complex issues. In the mean time learn proper grammar and spelling.

 

[OSUDDS]

I thought this was the 'Podiatric Residents & Physicians' board. I am posting my thoughts and opinions for discussion, as a Podiatrist.

Maybe you could learn something if you keep an open mind, and quit name calling. You are entering a profession that has many complex issues. In the mean time learn proper grammar and spelling.

oh wow, youre a podiatrist now?

thats real funny, you sound more like a guy named Alleghenypod, a prehealth imbecile who could only attend a bottom of the barrell caribbean medical school and started bashing everyone else.

so do you mind saying what Pod school you went to, or what residency you completed? I would love to hear this.

i don't know who youre referring to about spelling and grammar (as i dont use punctuation and capitalization), but i wouldnt talk about spelling and grammar when you write things like "privaleges", yourself. lol.

 

[SportPOD]

I wonder how this will affect Zgonis' practice or even the UTHSC-SA program?

And are there orthopods willing to do what Zgonis does for diabetics?

Can we get back to this question?

P.S. If there is someone who seems to like to "bait" people, the best trick is to ignore them!

 

[Dr_Feelgood]

Keep it professional or this thread will be closed.

There is no reason to call someone a douch bag.

There is also no reason to come in to the thread to tell us what is wrong with our profession. If you read thru some more threads you will realize that we are aware that there are some problems with it. Nothing is perfect.

[sacrasm] I believe it is spelled douche. According to the TMA and their fearless leader you are not a real doctor and don't have the brain or skills to tie your shoe, so you should not be expected to spell big words like that.

I think that the smartest thing to do is continue working hard to improve, stop using William Hinchey's pathology company, and look at it as a speed bump. I have always felt that our time is best served working at pod friendly states and then moving to these hotbeds. I used to be for a universal scope but the more I've thought about it I'm for no scope and self policing like DOs and MDs. You get rid of the scope laws and if someone does something stupid like knee injections you give them the kiss of death (strip them of the license and have it follow them for the rest of time). That is what keeps a OB-GYN from doing brain surgery, and it should be what keeps pods from moving outside of their trained scope.

 

[krabmas]

[sacrasm] I believe it is spelled douche. According to the TMA and their fearless leader you are not a real doctor and don't have the brain or skills to tie your shoe, so you should not be expected to spell big words like that.

I think that the smartest thing to do is continue working hard to improve, stop using William Hinchey's pathology company, and look at it as a speed bump. I have always felt that our time is best served working at pod friendly states and then moving to these hotbeds. I used to be for a universal scope but the more I've thought about it I'm for no scope and self policing like DOs and MDs. You get rid of the scope laws and if someone does something stupid like knee injections you give them the kiss of death (strip them of the license and have it follow them for the rest of time). That is what keeps a OB-GYN from doing brain surgery, and it should be what keeps pods from moving outside of their trained scope.

The other thing that keeps them from doing it is the OR would not let them schedule it. And their malpractice would not cover it when things went wrong.

And it seems that other specialties know their limits.

Another interesting thing I have notice that is different between the pods and the rest of medicine...
When IR gets a call on the weekend to put an IVC filter in or to thombolyse some veins they say call vascular or wait until monday morning (or afternoon). Other specialties are pretty similar at turning down cases or giving them away if it is not 9-5ish. At least this happens where I am.

Pods get upset when a family practice doc does a nail avulsion or applies and ACE to the ankle w/out referring to a pod. Is it really that important that we remove every single ingrown toe nail? I think we can share a little.

And if the general ortho feels comfortable doing a bunion, hammertoes, flatfeet.... let them.

 

[jonwill]

I guess I'm not sure what the fight in Texas encompasses but as I read the ruling, it sure didn't mean much to me. I don't really think it will change anything.

"allow a practitioner treating the foot to consider and treat other anatomical systems that interact with and affect the foot"

This is all really vague. Yea, the foot is attached to the rest of the body but that doesn't mean I can treat the heart or brain. I can, however, treat the effects of PVD or neuropathy. In other words, this doesn't tell any reasonable podiatrist anything they already don't know!

I don't take this to mean that they somehow lost ankle priveleges either.

 

[OSUDDS]

Actually, the way I understood it podiatrists did lose privileges for the ankle.
This is a quote that I have read:
"The court sided with TMA and the Texas Orthopaedic Association, and opposed the Texas State Board of Podiatric Medical Examiners’ assertion that the definition of the foot should include the bones in the ankle. "

 

[SportPOD]

What is a Podiatrist’s scope of practice in Texas?

A Podiatrist’s scope of practice in Texas is defined, at least, in three parts:
First, Section 202.001(4) of the Texas Occupations Code (Statute) states: "Podiatry" means the treatment of or offer to treat any disease, disorder, physical injury, deformity, or ailment of the human foot by any system or method. The term includes podiatric medicine.
Second, Section 375.1(2) of the Texas Administrative Code, Title 22, Part 18 (Rules) states: "Foot"--The foot is the tibia and fibula in their articulation with the talus, and all bones to the toes, inclusive of all soft tissues (muscles, nerves, vascular structures, tendons, ligaments and any other anatomical structures) that insert into the tibia and fibula in their articulation with the talus and all bones to the toes.
Third, in accordance with Texas Health & Safety Code Subchapter E relating to Medical Staff Membership & Privileges (§241.101 et al): Procedures to treat the foot/ankle by a Podiatrist at the hospital/surgical facility level are within the scope of practice for Podiatric Medicine in the State of Texas (by “any system or method”) as long as the Podiatrist is qualified and credentialed to do so and has hospital/surgical privileges for the same, for performance of the procedure at the hospital/surgical level as cleared by medical staff.

--
So this was taken from the following website:
http://www.foot.state.tx.us/qa.htm#q1

I think at this moment, podiatrist are still performing surgeries until this appeal is placed as an addendum to the above statutes. Anyone with any legal experience have any input?

 

[cool_vkb]

........maybe the Podiatry schools will cut tuition in half, since the scope is getting cut in half!

Always a silver lining!

That is just a court ruling. dont make it a final judgement. Its the decision given out by Court of Appeals, there are still 3 - 4 courts remaining for all the appeals. already the previous court had given the decision in favor of DPMs. so there might be chances that the upper courts can overturn this decision. and either way, by then time this whole thing gets settled its easily 4-5 yrs. By then vision 2015 will gain enough momentum to put everything under its umberalla.

I assure you, if you ever needed ankle treatment. You will find Poditrist names in your phone directory. be it today or be it 50 yrs. so live with it.

I dont even know why the moderators allow peope like you in the Podiatric Resideny & physicians section. Go play in the pre-pods section. run run run....

 

[cool_vkb]

FYI,

You guys might find this interesting. When we get a patient for Foot MRI. The standard MRI protocol is that the MRI should include areas from toe to MIDTARSAL joint. We dont include Talus and Calcaneus. Atleast thats what the standard is in the MRI centers in Chicago when we get Foot MRIs. Talus and Calcaneus are taken or inculded during the ANKLE MRI.

lol! i guess the Texas Medical association is going by these standards in defining foot.

 

[Dr. Gangrene]

Will someone with more legal background comment. Is the court of appeals decision the end of the matter, or are there other legal avenues to be persued?

Answered my own question. Pods in Texas are appealing the recent ruling. If that doesn't go well, they are off to the Texas supreme court.

 

[whiskers]

The state of Texas has the right to regulate Podiatrists. The law clearly states "foot."


The foot does not = the ankle ... and we as L/E experts should know that.

Does it make many in podiatry mad? Yes, but we have about 11k folks in our entire profession, country wide. There are over 40k TMA members in one state.

Pods in Tx should be happy to even have the foot. Forefoot surgery, bunions and hammer toes are rewarding and so are cutting nails, all pay well.


Next we'll have L/E experts telling some court that the hip and knee are part of the foot.

If they don't like the law, don't make fools out of their education, petition for a change in the law!

Calling the ankle a foot and dragging this through the legal system is amazingly silly and IMO is an amazing waste of taxpayer dollars and people work too hard to pay for crap like this. Sorry guys and gals.

And as far as the medical school jab, I could care less because I know and acknowledge that I did NOT go to medical school and that instead I went to Podiatry school which I am just as proud of.

I didn't want to go to medical school so I am not even insulted nor do I care in fact I chuckle that anyone in podiatry is offended. If maybe only 50% of my class were using old tests, I might have another opinion, but I can't misrepresent my own experiences.

 

[Feli]

...Pods in Tx should be happy to even have the foot. Forefoot surgery, bunions and hammer toes are rewarding and so are cutting nails, all pay well...

...Calling the ankle a foot and dragging this through the legal system is amazingly silly and IMO is an amazing waste of taxpayer dollars and people work too hard to pay for crap like this. Sorry guys and gals...

The issue is not "calling the ankle a foot." It is simply that those who are best trained and most experienced should be doing the cases. Someone who has completed dedicated rearfoot surgical training should be allowed to utilize their skills to help patients; they shouldn't be discriminated for or against just because of their degree.

MDs have "unlimited scope," but not a single one would ever practice that way; the knowledge base and levels of specialization simply don't allow that anymore... unless you are a rural FP doc or gen surgeon living in BFE who is basically forced to dabble in everything since you are geographically isolated from the support of other specialists.

General orthopedists have some post grad training in F&A, and I'd imagine that so do trauma surgeons. Some of them take F&A cases if they feel competent, and others will refer it out. I don't think anyone would argue that well-trained podiatrists or an orthopedist who has done a dedicated F&A fellowship are the most adequately trained and the most experienced for F&A surgery. A simple glance at the literature or case logs will tell you that.

...Next we'll have L/E experts telling some court that the hip and knee are part of the foot...

The ankle joint, subtalar joint, and joints distal to them have an obvious intimate biomechanical and functional relationship that is evidenced not only clinically but also in the literature. Yes, everything's connected, but you don't really see studies of how a TN fusion can cause OA of the hip, ACL instability, or shoulder impingement, now do you? There's a reason there are F&A, hand, shoulder, hip, knee, etc fellowships and specializations.

The bottom line is that if a DPM has training at or above the level of another doc and has passed the appropriate boards or certifications, why should the pod be prevented from utilizing the extent of his training while a doc with a different degree is unconstrained? It is discrimination... pure and simple.

 

[CashMcCallister]

That's interesting to know... I work for the California Board of Podiatric Medicine and the scope of practice as defined by California State Law does include the ankle:

Doctors of Podiatric Medicine (DPMs) are licensed under Section 2472 of the State Medical Practice Act. They diagnose and treat medical conditions of the foot, ankle and related structures (including the tendons that insert into the foot and the nonsurgical treatment of the muscles and tendons of the leg). Any procedure and modality is within the DPM scope if utilized to diagnose and treat foot, ankle or other podiatric conditions.

In addition to performing foot and ankle surgeries, DPMs are also licensed to assist medical and osteopathic doctors (MDs, DOs) in any surgery--podiatric or non-podiatric.

DPMs are trained and fully licensed under California law to independently perform full-body history and physical (H&P) examinations in any setting for any patient. With new regulations finalized by the federal Centers for Medicare & Medicaid Services (CMS), there is no longer any conflict with federal criteria.

DPMs, many of whom develop expertise in the care and preservation of the diabetic foot, perform partial amputations of the foot as far as proximal with the Chopart's joint, to prevent greater loss of limb, ambulation, or life. They order and administer anesthesia and sedatives, as indicated. The administration of general anesthesia, of course, may only be performed by an anesthesiologist or certified registered nurse anesthetist (CRNA). DPMs commonly administer intravenous (IV) sedation.

Note that some DPMs licensed prior to 1984 have not met the Board of Podiatric Medicine's (BPM's) licensure requirements for ankle surgery, amputation, and surgical assistance to MDs. They may assist other DPM surgeons in any podiatric procedure and may assist MDs as non-licensed operating room technicians do in non-podiatric procedures. Facilities may verify license status online [http://bpm.ca.gov/] by clicking on the Quick Hit for license verification. Most DPMs are in fact "ankle licensed." This will be indicated by "License or Registration Class: ANK", and authorizes the full DPM medical scope.

Section 2472 also specifies the various peer-reviewed facilities in which ankle surgery may be performed. It may be viewed in its entirety from BPM's website under Laws & Regulations. BPM interprets surgical treatment of the ankle to include those parts of the tibia, fibula, their malleoli and related structures as indicated by the procedures.

All of our licensees are required to have one year of surgical residency, did I read where that's not the case in Texas or am I mistaken?

 

[cool_vkb]

In addition to performing foot and ankle surgeries, DPMs are also licensed to assist medical and osteopathic doctors (MDs, DOs) in any surgery--podiatric or non-podiatric.

Can you elaborate more on this! and is this financially rewarding?

 

[krabmas]

Can you elaborate more on this! and is this financially rewarding?

This works especially well if you did residency in CA or know MD surgeons in cali. You can scrub and assist them when not yet fully booked in the beginning and get the assistant's fee which I think is sometimes several hundred dollars.

 

[SportPOD]

This works especially well if you did residency in CA or know MD surgeons in cali. You can scrub and assist them when not yet fully booked in the beginning and get the assistant's fee which I think is sometimes several hundred dollars.

Depending on the insurance the assistant's fee is around 60% of the original billed charges.

 

[cool_vkb]

Depending on the insurance the assistant's fee is around 60% of the original billed charges.

but this Assistant is not equal to surgical technologist/assistant right!

 

[SportPOD]

but this Assistant is not equal to surgical technologist/assistant right!

No! You are a physician who is assisting on the case. More than likely you will be holding the retractors most of the time. It's a pretty easy way to get some extra cash in the beginning and to spend some time in the OR getting to know the staff.

 

[Feli]

Depending on the insurance the assistant's fee is around 60% of the original billed charges.

This might not be case everywhere. I think a DPM here told us the assistant fee used to be 50% but is now less.

That would be nice to be able to assist vascular or plastics for continuity of care on the diabetic patients, though. It's also be nice to get paid well for much needed help to/from other pod/ortho docs on complex reconstions.

 

[SubRosa]

This works especially well if you did residency in CA or know MD surgeons in cali...

Are there any other states with laws allowing as broad a spectrum of practice as California?

 

[SportPOD]

This might not be case everywhere. I think a DPM here told us the assistant fee used to be 50% but is now less.

That would be nice to be able to assist vascular or plastics for continuity of care on the diabetic patients, though. It's also be nice to get paid well for much needed help to/from other pod/ortho docs on complex reconstions.

It would depend on the cases. If the DPM is assisting another DPMs case, certain insurances are only reimbursing around 30%. The reimbursement is dependent on the complexity of the case. I will be assisting a vascular surgeon on some cases and the insurance companies verified that they reimburse 60% as an assistant for the procedures that the vascular surgeon is performing.

 

[HenryH]

Can this assisting be done anywhere in the US or only in states around Cali?