What Would You Do with a "Plenary Degree?"

[Adam Smasher]

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I still read PM News a lot. Sometimes there's good insights, sometimes the ridiculousness is entertaining. One common topic from the letter-writers is that podiatry needs a "plenary degree," in other words we need to be licensed to treat conditions head-to-toe. While I wouldn't oppose any steps towards any such legislation, I don't understand how a plenary degree helps podiatrists practice podiatry better. And that's it--what everyone is thinking, and no one is saying, is that they want podiatrists to have a plenary license so they can stop practicing podiatry.

So here's the question: what would you do with a plenary license? If your answer is "moonlight in an urgent care," you prove my point. Other things I can think of:

Iliac Crest BMA: Probably the only thing I truly would want to try using if I did more arthrodesis cases. But I'm not aware of FA Orthos doing this so I dunno.

Autologous adipose tissue grafting: Another thing I've only read about/listened about in seminsars

Anterior Thigh STSG: I've been able to get by without using these, but I can see it being a really helpful tool. I know pods are taking these from the calf already though.

Tibia fractures: yeah ortho is going to love that scope creep

Hand stuff: It would be nice to be able to zap the occasional palmar wart, but ultimately hand privileges are just 10 more nails to trim.

Laser Treatments: Making a monthly payment on a laser? Not getting enough toenail fungus patients? It can also be used for hair removal, vein treatments, wrinkle reduction, a whole lot of other aesthetic indications, which brings me to:

Open a Med Spa: Treat cosmetic concerns from head to toe. Fillers, botox, anything you could devote a weekend to learning, you can do. But guess what, you're not practicing podiatry anymore.

 

[air bud]

I still read PM News a lot. Sometimes there's good insights, sometimes the ridiculousness is entertaining. One common topic from the letter-writers is that podiatry needs a "plenary degree," in other words we need to be licensed to treat conditions head-to-toe. While I wouldn't oppose any steps towards any such legislation, I don't understand how a plenary degree helps podiatrists practice podiatry better. And that's it--what everyone is thinking, and no one is saying, is that they want podiatrists to have a plenary license so they can stop practicing podiatry.

So here's the question: what would you do with a plenary license? If your answer is "moonlight in an urgent care," you prove my point. Other things I can think of:

Iliac Crest BMA: Probably the only thing I truly would want to try using if I did more arthrodesis cases. But I'm not aware of FA Orthos doing this so I dunno.

Autologous adipose tissue grafting: Another thing I've only read about/listened about in seminsars

Anterior Thigh STSG: I've been able to get by without using these, but I can see it being a really helpful tool. I know pods are taking these from the calf already though.

Tibia fractures: yeah ortho is going to love that scope creep

Hand stuff: It would be nice to be able to zap the occasional palmar wart, but ultimately hand privileges are just 10 more nails to trim.

Laser Treatments: Making a monthly payment on a laser? Not getting enough toenail fungus patients? It can also be used for hair removal, vein treatments, wrinkle reduction, a whole lot of other aesthetic indications, which brings me to:

Open a Med Spa: Treat cosmetic concerns from head to toe. Fillers, botox, anything you could devote a weekend to learning, you can do. But guess what, you're not practicing podiatry anymore.

Always comes back to nails

 

[DYK343]

Anterior Thigh STSG: I've been able to get by without using these, but I can see it being a really helpful tool. I know pods are taking these from the calf already though.

I do these pretty regularly. Most states allow this.

 

[Bored Snorlax]

Always comes back to nails

We can debate plenary licensure all day, but somehow it always comes back to nail dust

 

[Adam Smasher]

I do these pretty regularly. Most states allow this.

https://www.acfas.org/getattachment/18233bf0-cee3-4ef3-b395-dc74219c1887/Scope-of-Practice-Grid-2023-(1).pdf

I count 20 states that allow "leg" privileges, not including states like Washington where you can do it so long as you're placing the graft on the foot. So I'm not sure that it's most states.

 

[DYK343]

https://www.acfas.org/getattachment/18233bf0-cee3-4ef3-b395-dc74219c1887/Scope-of-Practice-Grid-2023-(1).pdf

I count 20 states that allow "leg" privileges, not including states like Washington where you can do it so long as you're placing the graft on the foot. So I'm not sure that it's most states.

Im no so sure how accurate that document is?

Ive practiced in a few states and 2 of the states listed dont match with what I was able to do. I practiced in a "no amputation" state but I amputated quite frequently.

I trained in a state that says "no leg" but I was strained to do STSG from the thigh by DPMs.

Also does leg include thigh in these states? I would say no?

Also In the past I have read my current state regulations very carefully and it doesnt totally match what the document above says. I have a lot of grey area where things are not legally defined.

 

[dtrack22]

I don't understand how a plenary degree helps podiatrists practice podiatry better. And that's it--what everyone is thinking, and no one is saying, is that they want podiatrists to have a plenary license so they can stop practicing podiatry.

Correct. It doesn’t make you better at podiatry, it gives you additional clinical options and (more importantly IMO) non-clinical options

So here's the question: what would you do with a plenary license?

Be the director of a wound care center that’s essentially run by nurses but needs a “physician” with head to toe scope to sign orders and sign off on treatment plans. Insurance work, chart review for appropriateness of hospitalizations. IME’s. Owner/director of non-Podiatric clinics. Healthcare admin (not that you can’t as a DPM but it is much more difficult for us than MD/DOs).

So yes, I would do it to at least practice “less” podiatry, but the answer does not necessarily have to be “moonlight in an urgent care.”

 

[Stormblest]

I just hate when patients ask me to look at something like a skin condition on their arm and I feel that I am in this awkward space of hey it’s out is scope for me but you should have your PCP look at it and maybe try some steroid cream if you have some.

It would be nice to be able to say “looks like dermatitis, I’ll prescribe a steroid cream you can try. If it doesn’t work I can refer you to a dermatologist”. I guess I would like to be able to give some general medical advice without feeling like I could get in trouble for it. Anyone else feel the same way?

 

[eyeeye_captain]

I had a great podeyetry encounter yesterday. Terrible diabetic retinopathy, basically wouldn’t speak to me. Despite meeting legal blindness criteria, it took his wife dragging him in to *maybe* get something done - left without scheduling a follow up.

Had a 1+ inch diameter open ulcer above his medial malleolus, maybe I should have used my plenary degree and at least debrided that puppy since he wouldn’t let me touch the eyes.

If I can’t save the eyes, maybe I can save a foot. (I know we aren’t saving any of them for this guy)

 

[dtrack22]

I just hate when patients ask me to look at something like a skin condition on their arm and I feel that I am in this awkward space of hey it’s out is scope for me but you should have your PCP look at it and maybe try some steroid cream if you have some.

It would be nice to be able to say “looks like dermatitis, I’ll prescribe a steroid cream you can try. If it doesn’t work I can refer you to a dermatologist”. I guess I would like to be able to give some general medical advice without feeling like I could get in trouble for it. Anyone else feel the same way?

This is how you end up also cutting fingernails…

But seriously, I understand where you’re coming from I just think all of us are more likely to use “it’s out of my scope” as an excuse to not see/treat/give advice than we would use an unrestricted license to treat non-foot related pathology during a clinic appointment. If you’re the opposite, I would bet money you’re the outlier.

 

[Stormblest]

This is how you end up also cutting fingernails…

But seriously, I understand where you’re coming from I just think all of us are more likely to use “it’s out of my scope” as an excuse to not see/treat/give advice than we would use an unrestricted license to treat non-foot related pathology during a clinic appointment. If you’re the opposite, I would bet money you’re the outlier.

Luckily I rarely have to cut toenails other than ingrowns. But yeah it’s mostly for simple stuff that couldn’t really hurt the patient that would be nice. I wonder if dentists get asked non teeth things sometimes. I’ll have to ask mine for shoe recommendations next time I see them and see what they say.

 

[Hybrocure]

Nails

 

[Feli]

Podiatry has been spinning this nonsense since the dawn of time.

 

[Weirdy]

I had a great podeyetry encounter yesterday. Terrible diabetic retinopathy, basically wouldn’t speak to me. Despite meeting legal blindness criteria, it took his wife dragging him in to *maybe* get something done - left without scheduling a follow up.

Had a 1+ inch diameter open ulcer above his medial malleolus, maybe I should have used my plenary degree and at least debrided that puppy since he wouldn’t let me touch the eyes.

If I can’t save the eyes, maybe I can save a foot. (I know we aren’t saving any of them for this guy)

11042 go to town