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Is a podiatric surgeon a level 5? Can a podiatrist prescribe pain killers and narcotics? Basically what I am trying to ask is, can a podiatrist prescribe just as much as an MD?
Is a podiatric surgeon a level 5? Can a podiatrist prescribe pain killers and narcotics? Basically what I am trying to ask is, can a podiatrist prescribe just as much as an MD?
Is a podiatric surgeon a level 5? Can a podiatrist prescribe pain killers and narcotics? Basically what I am trying to ask is, can a podiatrist prescribe just as much as an MD?
We have the same unrestricted DEA license as a MD/DO. If you want to manage those diabetic or high blood pressure patient, you are certainly entitled to and you can prescribe those medications. It's up to you if you have the time and the patience to medically manage everything.
with crazy malpractice/lawsuits nowadays, i figured one would not want the extra burden.
eeeek shouldnt that be the family physicians job to manage their blood pressure problems? even if it's a common simple problem it is not the pods responsibility and is just taking more of a risk in doing so. for instance, if a patient has a small infected cut on their abdomen, i'm sure a pod could easily take care of it and prescribe antibiotics, but that is still not the foot/ankle and shouldn't be done by them right? with crazy malpractice/lawsuits nowadays, i figured one would not want the extra burden.
eeeek shouldnt that be the family physicians job to manage their blood pressure problems? even if it's a common simple problem it is not the pods responsibility and is just taking more of a risk in doing so. for instance, if a patient has a small infected cut on their abdomen, i'm sure a pod could easily take care of it and prescribe antibiotics, but that is still not the foot/ankle and shouldn't be done by them right? with crazy malpractice/lawsuits nowadays, i figured one would not want the extra burden.
Dr_Feelgood said:On the other side of the coin, are you or are you not a doctor? If a person comes in with HTN and you ignore it, or a DM comes in that has not gone to his primary care b/c of a tight money situation and you do not refill their insulin or metformin, ect are you not liable if they go into a DM coma?
On the other side of the coin, are you or are you not a doctor? If a person comes in with HTN and you ignore it, or a DM comes in that has not gone to his primary care b/c of a tight money situation and you do not refill their insulin or metformin, ect are you not liable if they go into a DM coma?
I agree with SportPOD, you can manage systemic disease you want, i.e. DM, RA, HTN, but do you want to dedicate that much time. The reason primary care has a storage is b/c FP and IM make on the bottom end of the salary spectrum. It costs you money to manage systemic diseases, that is why ortho won't manage HTN either.
as i mentioned earlier, there are so many doctors being sued and malpractice rising it is scary. lets say i did help that person with the small cut on their stomach with some bandaging and antibiotics. and lets say that patient doesnt take the antibiotics but instead goes home and picks at their wound causing the infection to worsen and spread. if he goes to court who do you think they are gonna hold responsible? and second they are going to ask you why as a podiatrist are you practicing on something other than the feet.
i personally choose to play it safe when it deals with situations like these. i trust no one these days except family.
I know the argument is between you and feelgood so sorry for interferring but i dont freakin f..kin understand why the heck wud DPM bandage an abdmonen wound . I dont know if you are regular to this forum or not but you are taking feelgood's comment out of context.
We were talking here about foot ailments and systemic diseases involved or associated with them and what kind of medications can we prescibe.
Why the f...k wud we DPMs bother to see injuries or infections on shoulder or anus . from last two posts you are stressing abdomen injuries or wounds when the essecnce of the question or feelgood's post is related with FOOT AILMENTS & their systemic involvements. NOT EVERY CONDITION ON THE BODY.
i first want to say i don't mean any disrespect to dr feelgood and appreciate all the advice he has given, i am just trying to clarify some things =)
perhaps i am stressing the abdominal wound too much, but my argument still pertains to a similar scenario: treating a condition that is not the responsibility of the podiatrist. i have reread his post a few times and this is how i am interpreting it (and correct me if i'm wrong): a person comes in to the podiatrist for a foot problem, and the podiatrist notices the patient also is hypertensive as well and decides to treat that by prescribing medication (and the pod can continue managing it as well if they like). as NatCh pointed out, the second you prescribe that HTN medication you have taken on a big responsibility and are held to that higher standard level of care.
my argument is that is even though the hypertension is obviously related to the foot and its problems, it is still primarily the responsibility of that patients FP, IM, or cardiologist. and with todays litigious society, why would the pod want the extra risk of doing such a thing?
Now your argument is perfectly in the scope of podiatry and now i guess we all can have a fair argument. from that time it was gettin confusing as to why would someone treat abdominal injuries etc. Yeah as NATCH said that a DPM will not treat it. however there are some DPMs out there who for some reason do treat the early stages. iam 100% with you as to why take a big risk.
Thanks for clarifying the post. it makes perfect sense now.
I heard Podiatrists can only prescribe medicines that will make your nuts fall off. Is this true?
I heard Podiatrists can only prescribe medicines that will make your nuts fall off. Is this true?
I also heard that Podiatrists will only prescribe a medicine after the drug rep has taken them to dinner.
In my state all prescribers are limited to prescribing within their scope:
MD/DO - humans
DDS/DDM - the oral cavity
DPM - foot (not sure about ankles)
DVM - animals
So basically an MD/DO can write for whatever they want but we still sometimes have questions. Case in point:
I was working in a community pharmacy and got a called in prescription for a sildenafil suspension (compounded) for an infant. Doc on the phone is a pediatric resident at the local university indigent clinic. I pulled up the infants profile and notice that the concentration and directions she's asking for would equal a 50% reduction in the infant's dose. I question the resident about this and am told, "look the parents just brought in the bottle and I want to refill it with those directions." I asked what the date on the bottle was. OOPS! 3 months ago. They brought in an old bottle. The child's dose had been increasing every month but the peds resident didn't know that because she wasn't managing the child's treatment for that condition. I told her that I would not be able to accept that RX from her and I suggested that she might instruct the parents to call the infant's cardiologist. She gets short with me so I ask to speak with the attending.
*long wait*
I explain that the resident 1) wanted to call in a refill on a medication that was prescribed by a specialist in another office and used old directions to call in the script and 2) I felt that the cardiologist needed to be consulted rather than just trying to refill the RX even with the most recent month's directions since the child was very, very ill and had needed a dose increase every month since birth. The attending agreed, thanked me and offered to call the cardiologist herself. Whew!
In my state all prescribers are limited to prescribing within their scope:
MD/DO - humans
DDS/DDM - the oral cavity
DPM - foot (not sure about ankles)
DVM - animals
So basically an MD/DO can write for whatever they want but we still sometimes have questions.
Good catch! Nice job. Thank goodness for knowledgeable Pharmacists.
Are there any medications that are specific to the foot and nothing else? I can't think of any.
Some medications are not specific to podiatry but have podiatric applications (e.g., Neurontin, Lyrica, Phenergan, Compazine). Hopefully the Pharmacist who is filling the script is current on podiatric treatments, including those that are off-label.
There's one local grumpy OLD pharmacist who thinks podiatrists only cut toenails and shouldn't get to prescribe meds when he himself can't. He gets huffy if he gets a script from a podiatrist.
Nat
In my state all prescribers are limited to prescribing within their scope:
MD/DO - humans
DDS/DDM - the oral cavity
DPM - foot (not sure about ankles)
DVM - animals
So basically an MD/DO can write for whatever they want but we still sometimes have questions. Case in point:
I heard Podiatrists can only prescribe medicines that will make your nuts fall off. Is this true?
Even though it is true Podiatrists are allow to prescribe most medications, it does not mean that they can. For most pharmacists, they would fill out narcs, HTN, DM, and so on. However for a script like Ambien or birth controls, that is generally out of scope. I hope this helps.
I have clinicians (podiatrists, dentists, etc) argue that they are doctors and hence they can prescribe anything they want, Ambien and birth controls included. That is not true. Lets say that even if it was true for arguement's sake. When an insurance company audits the pharmacy; the insurance company will generally reject reembursements because of this reason. This means that even if it were true, a pharmacy will not fill it because they are losing money.
I do routinely with each surgical patient and have not once been questioned.DPM's can prescribe Ambien or any type of sleep-aid.
On a slight tangent (i.e., this isn't directed at you PharmD/DPM), here's a good place for a couple of issues for anyone who might still be listening to my blathering. I knew a doctor who was on a State Board and he said that the single most common cause for professional discipline was doctors prescribing to friends, family, and colleagues without a legitimate doctor-patient relationship. If it's medically justified then it's okay to write for friends, family, colleagues as long as you have a legitimate doc-pt. relationship. In other words, start a chart. You don't have to bill them if you don't want to, but have a chart.PharmD/DPM said:I'm not saying go and prescribe it to friends or family when they complain to you about sleep, but if something you did (Sx) caused sleeping disturbances, then it is your responsibility to ammend those as a physician (DPM).
Worst comes to come, you can explain the mechanism of action to us on something current that we didnt see yet, and give us the references on where you got it from. We have the professional training to understand this, and we can also document it.
I might explain the application (e.g., "Aldara can be used to treat plantar warts too.") but the Pharmacist should know the mechanism of action of the drug itself. In all honesty though, I see myself more likely to tell the patient to go to a different retail pharmacy before I would discuss pharmacokinetics and give literature citations.
Nat
Sorry, I meant the application of the drug itself. I think if you said that, I would have documented it and filled it. For the most part, we do all the work since we call you before giving the script back to the patient. A lot of times, going to a different retail pharmacy works but really. . . the insurance companies, medicaid and medicare, etc have been cracking down really finding drugs versus prescribers are one of the easier ones to track down (in NYS, it is required that we scan w/ NYS serial and send data to them). That means in the future. . . that option will not always work. Whenever a pharmacy gets audit (I ve been in two so far in my district since I float around a lot), prescribers practicing out of scope are up there among the reasons why they wont reemburse us since that data is readily avaiable to them.
If you prescribed Ambien, the pharmacy would politely call you and ask the reason. They would then document it on the back of RX if it is resonable (post op sleep aid). On the other hand, if the Ambien has been prescribed for more than 30 days continously, I would probably stop filling it and address the issue.
There are a lot of time that a pharmacy will fill scripts without asking because they do not know what kind of a doctor you are, or might have missed it. I personally have filled a few scripts for a dentist for Ambien (personal use) because he did not tell us he was a dentist since he always call it in. Recently CVS gave us the resources to double check the prescribers. I found out and politely told him he cannot. He then got another dentist to fill it out for him. Under NYS laws and talking with a few of my colleagues that did the same for him, we had to report him to NYS board since they are really strict with controls.
Jeez, how'd I get up on this soapbox? Stepping down now...
Nat
Taking away your soapbox....................permanently.
No, seriously, Nat you have brought some good points to this discussion. I think it's important for people to understand that you have to use common sense when prescribing medications for our specialty.
I just find it great that a simple answer regarding our DEA license morphed into a huge discussion regarding laws and prescribing habits.
Given enough time I'll find something to spout off about. Is there a treatment for this affliction?
I still don't know what Level 5 is...
Is a podiatric surgeon a level 5? Can a podiatrist prescribe pain killers and narcotics? Basically what I am trying to ask is, can a podiatrist prescribe just as much as an MD?
Here is a complete list of meds footies can prescribe.
Here is a complete list of meds that glorified chiros..err...osteopaths can provide.
Thats OMM at its best!
Here is a complete list of meds that glorified chiros..err...osteopaths can provide.
Even if that were the actual case, we're still able to treat the whole body. Just remember, medicolegally and practically:
DO = physician
DPM = not a physician
Healthcare Truth and Transparency Act can't come soon enough
Even if that were the actual case, we're still able to treat the whole body. Just remember, medicolegally and practically:
DO = physician
DPM = not a physician
Healthcare Truth and Transparency Act can't come soon enough
Even if that were the actual case, we're still able to treat the whole body. Just remember, medicolegally and practically:
DO = physician
DPM = not a physician
Healthcare Truth and Transparency Act can't come soon enough
A little sensitive there? Dont bring it if you cant take it.
FYI, Every doctor (MD or DO) has a limited scope. A cardiologist is not going to do knee surgery.
Keep in mind that the limit to their scope is by choice, not by law. A cardiologist is also trained in internal med, and is permitted to medically manage medical conditions of the knee (and whole body). You'd be hard pressed to find a medical specialty that doesn't have a year of general medicine/surgery incorporated into their PGY-1, which allows them to hang a shingle as a general practitioner. You'd also be hard pressed to find a DPM who can hang a shingle as a GP since it is against the law, and rightfully so.
Keep in mind that the limit to their scope is by choice, not by law. A cardiologist is also trained in internal med, and is permitted to medically manage medical conditions of the knee (and whole body). You'd be hard pressed to find a medical specialty that doesn't have a year of general medicine/surgery incorporated into their PGY-1, which allows them to hang a shingle as a general practitioner. You'd also be hard pressed to find a DPM who can hang a shingle as a GP since it is against the law, and rightfully so.
Mere semantics. They have limited scope, even if not "by law." Find me a cardiologist who is going to manage a knee problem without referring out.....seriously, get off your soap box and take a joke.
Keep in mind that the limit to their scope is by choice, not by law. A cardiologist is also trained in internal med, and is permitted to medically manage medical conditions of the knee (and whole body). You'd be hard pressed to find a medical specialty that doesn't have a year of general medicine/surgery incorporated into their PGY-1, which allows them to hang a shingle as a general practitioner. You'd also be hard pressed to find a DPM who can hang a shingle as a GP since it is against the law, and rightfully so.
Dear 1st year DO student,
DPM students and residents rotate through general medicine/surgery as well. No DPM/DO/MD would want to hang a shingle as a GP to only make 70K/yr anyway.
Dont be mad just because a DPM scored higher than you on your last exam.
Little bit of trivia for you. The DPMs at DMU have scored higher on average than the DO class in Pharmacology in the current and past years. The entrance stats (GPA, MCAT scores) have also been neck and neck. I know you are proud to be a DO but dont forget your heritage.
Let's just get the facts straight before you go making sweeping generalizations.
CPMS:Academic performance: The class of 2011 has an average cumulative GPA of 3.39. The average science GPA is 3.25. The average MCAT score is 23.
DO:The class of 2011 has a 3.64 average overall GPA and a 3.59 average science GPA. MCAT:The average MCAT score is 26.63, with a median writing sample of O.
Those entrance stats aren't "neck and neck" as you say.
Furthermore, should the "trivia" bit be true, realize that DO students are going through their systems courses concurrently with pharm, while the DPMs go through their watered down version of systems concurrently.
Also, DPM class averages for the class of 2011 are not surpassing the DO class averages (just a little "trivia" for you).
You may "rotate" through general medicine, but you do not have the depth of exposure to safely practice general medicine (i.e. education in systems based medicine + sum of 3rd/4th year rotations + PGY-1 year in general med and beyond).
Lastly, a physician may not want to hang a shingle as a GP, but should the need arise, a physician is permitted to respond to any medical situation. Same can't be said for a podiatrist, and with the way recent scope of practice confrontations are panning out for DPMs, won't be long before all you're doing is digging out ingrowns
Being the mod that you are, you should probably just go ahead and close this thread and save yourself further embarrassment.