why cant a Pod do a physical examination?

[cool_vkb]

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I was going thru my physical examination form which i have to submit before classes start and it was written near Signature place that MD,DO,RN,NP,PA . but there was no DPM mentioned.

I know Pods are foot & ankle specialist but physical examination is not that big and i heard these days pods are doing H & P on their patients before admitting them in hospital. So compared to that physical examination is small thing.

Are pods allowed to do physical examinations , i mean can some pre-pod go to pod to fill out the form or he cant go?

 

[BarryPod]

They were just given the ok to in the state of Florida. Many don't though because they feel they are not trained. I think it's ridiculous to think like that though. If a P.A is able to do it so should we.

 

[cool_vkb]

They were just given the ok to in the state of Florida. Many don't though because they feel they are not trained. I think it's ridiculous to think like that though. If a P.A is able to do it so should we.

Forget PA man, Even people with Associate's degree - RN (Nurse) are doing it. So i was very suprised😕 as to how come Pods are not doing it or not allowed to do it.

 

[Feli]

Pods can do physicals.

You will certainly learn and do full H&Ps in physical diagnosis class/lab as well as 3rd and 4th year rotations. Some residencies are really big on having pods medically manage their patients... usually they are the big academic teaching hospitals. Whether DPMs can bill for it or not is another story, and that varies from state to state. They can certainly always bill for a podiatry workup and the H&P of a F&A complaint.

My question for you is: "why do you want to do a full H&P?"
A full head-to-toe physical takes a really long time (and even longer to write it up). I'd much rather do a focused H&P... you should go to pod school because you want to be a F&A specialist IMO. A generalist's job is to know a little bit about many things and be great at H&Ps. A pod's job is to know a ton about F&A, a fair amount about systemic diseases that affect the foot, and a little little bit about everything else. I think full initial H&P can usually be left to the docs who do dozens of them every day. Regardless of degree or area of specialty, you sure won't find very many specialists who do complete H&Ps; you don't see a psychiatrist or a OB/GYN performing Rinne and Weber tests.

In podiatry, most of your patients will be referred to you from IM/FP where they got a full physical and were turfed to podiatry for diagnosis and treatment. You can scan the results of the H&P, and then you typically do a focused podiatry physical (derm/nail, neuro, vascular, and musculosk of LE... sometimes biomechanics).

If you get a new patient or work out in the sticks where doctors are few and far between, then yes, you could do a full H&P, but you'd usually still focus it at least somewhat to their podiatry complaint that brought them into your office. As a student, you always want to be thourough, but you usually don't have an hour for each patient to be listening to lungs, asking about hobbies, and jotting down childhood immunizations. Pre-op is one exception where a good full physical is very valuable.

 

[jonwill]

I'm sitting in the doctors lounge right now waiting to take an abcess to surgery. We were consulted on the patient this afternoon and I did the complete work up, including the H&P. Pods do H&P's quite a bit.

 

[cool_vkb]

Pods can do physicals.

You will certainly learn and do full H&Ps in physical diagnosis class/lab as well as 3rd and 4th year rotations. Some residencies are really big on having pods medically manage their patients... usually they are the big academic teaching hospitals. Whether DPMs can bill for it or not is another story, and that varies from state to state. They can certainly always bill for a podiatry workup and the H&P of a F&A complaint.

My question for you is: "why do you want to do a full H&P?"
A full head-to-toe physical takes a really long time (and even longer to write it up). I'd much rather do a focused H&P... you should go to pod school because you want to be a F&A specialist IMO. A generalist's job is to know a little bit about many things and be great at H&Ps. A pod's job is to know a ton about F&A, a fair amount about systemic diseases that affect the foot, and a little little bit about everything else. I think full initial H&P can usually be left to the docs who do dozens of them every day. Regardless of degree or area of specialty, you sure won't find very many specialists who do complete H&Ps; you don't see a psychiatrist or a OB/GYN performing Rinne and Weber tests.

In podiatry, most of your patients will be referred to you from IM/FP where they got a full physical and were turfed to podiatry for diagnosis and treatment. You can scan the results of the H&P, and then you typically do a focused podiatry physical (derm/nail, neuro, vascular, and musculosk of LE... sometimes biomechanics).

If you get a new patient or work out in the sticks where doctors are few and far between, then yes, you could do a full H&P, but you'd usually still focus it at least somewhat to their podiatry complaint that brought them into your office. As a student, you always want to be thourough, but you usually don't have an hour for each patient to be listening to lungs, asking about hobbies, and jotting down childhood immunizations. Pre-op is one exception where a good full physical is very valuable.

Oh man my question was more related to filling out my Physical Examination form. I know pods do H & P in hospitals. but the Physical Examination form which i got never mentioned DPM in the list of health professionals who can do this exam for us. I mean they were OK with a RN doing it but never mentioned DPM in the list. So i was curious about that.

 

[CareBear9984]

Pods can do physicals.

You will certainly learn and do full H&Ps in physical diagnosis class/lab as well as 3rd and 4th year rotations. Some residencies are really big on having pods medically manage their patients... usually they are the big academic teaching hospitals. Whether DPMs can bill for it or not is another story, and that varies from state to state. They can certainly always bill for a podiatry workup and the H&P of a F&A complaint.

My question for you is: "why do you want to do a full H&P?"
A full head-to-toe physical takes a really long time (and even longer to write it up). I'd much rather do a focused H&P... you should go to pod school because you want to be a F&A specialist IMO. A generalist's job is to know a little bit about many things and be great at H&Ps. A pod's job is to know a ton about F&A, a fair amount about systemic diseases that affect the foot, and a little little bit about everything else. I think full initial H&P can usually be left to the docs who do dozens of them every day. Regardless of degree or area of specialty, you sure won't find very many specialists who do complete H&Ps; you don't see a psychiatrist or a OB/GYN performing Rinne and Weber tests.

In podiatry, most of your patients will be referred to you from IM/FP where they got a full physical and were turfed to podiatry for diagnosis and treatment. You can scan the results of the H&P, and then you typically do a focused podiatry physical (derm/nail, neuro, vascular, and musculosk of LE... sometimes biomechanics).

If you get a new patient or work out in the sticks where doctors are few and far between, then yes, you could do a full H&P, but you'd usually still focus it at least somewhat to their podiatry complaint that brought them into your office. As a student, you always want to be thourough, but you usually don't have an hour for each patient to be listening to lungs, asking about hobbies, and jotting down childhood immunizations. Pre-op is one exception where a good full physical is very valuable.

Good points made. Sometimes when I notice the discrepancies in the practices among the different medical professions I am oftentimes quick to interpret them as unfair or restrictive, especially with regard to DPMs (obviously!) . However, many times it definitely does seem to have a lot to do with what that particular practitioner's job may be. Such is the case here. While podiatrists definitely seem to do the basic H&P, they aren't spending most of their working day doing physical exams - with reason as you stated. I guess it's just one of those - well if we realllllly wanted to do one, why should we be restricted? And again it goes back to (at least for me) that stigma about podiatrists not being "real" doctors (again, something I wish didn't exist, but who cares about what those people think anyway!) In the end, though, it makes sense to perform those duties specific to one's field - because that is essentially a.) what you want to be doing b.) what you are trained to be doing and c.) what benefits the patient the most

 

[NatCh]

Consider another angle...

We are (or you will be) trained to do full H&P's in school and Residency. Once in practice, you may be permitted to do or restricted from doing H&P's by the hospital or surgery center. It varies by location.

There is a saying that goes, "Many hands makes your casket lighter" or something like that. If there is any question of the patient not being in tip-top shape, a lot of surgeons will send the patient to their PCP for pre-op clearance. I am talking about MD and DO surgeons, not just DPM. My wife is a Family Practice doctor and she does pre-op clearance for Orthopods, Neurosurgeons, Podiatrists, Dentists, and other specialists all the time. For one, the PCP is more familiar with an established patient's overall health picture than any specialist might be, but also one learns to share liability for when the chit hits the fan (and it does -- trust me).

Not having H&P privileges can be a pain when you have a young, totally healthy patient who needs a relatively simple procedure, but if the patient has any sort of past medical history then it may be a wise choice to send them to the PCP even if you have privileges. An FP or IM doctor may listen to hearts 20 times or more per day, and hence will probably be good at it. How often would you guess a practicing podiatrist listens to heart sounds and reads EKG's?

During training you learn to do as much as you can. During practice you learn to protect yourself and all that you've worked for.

Nat

Edit: In addition to being a good CYA maneuver, sending patients back to their PCP for pre-ops is good for the patient (even if it's bad for your ego) if you honestly aren't as good at interpreting labs or evaluating overall health as they are.

 

[APMAHelp]

Podiatrists have always been allowed to do H&Ps. In January, Medicare changed the "Conditions of Participation" to permit DPMs to do their own H&Ps in hopsitals, subject to hospital bylaws and state laws.

 

[NatCh]

Podiatrists have always been allowed to do H&Ps. In January, Medicare changed the "Conditions of Participation" to permit DPMs to do their own H&Ps in hopsitals, subject to hospital bylaws and state laws.

Doesn't the "subject to hospital bylaws" statement mean that ultimately the hospital still has the final word? Therefore, how does the Medicare ruling make any difference?

Nat

 

[APMAHelp]

You are correct in noting that every doctor's privileges at a hospital are determined by the hospital credentialing committee. However, prior to this ruling, if a hospital that accepted Medicare payments allowed podiatrists to do their own H&Ps, the hospital risked their status as a Medicare participating provider. That hurdle has now been eliminated.

For example, if you are a dermatologist, you still have to go through the hospital credentialing committee to do the things you do. The hospital would not let a dermatologist do foot surgery since the education and training would not support such a thing. In podiatric medicine, the education and training support the fact that podiatrists can do H&Ps.

 

[NatCh]

You are correct in noting that every doctor's privileges at a hospital are determined by the hospital credentialing committee. However, prior to this ruling, if a hospital that accepted Medicare payments allowed podiatrists to do their own H&Ps, the hospital risked their status as a Medicare participating provider. That hurdle has now been eliminated.

For example, if you are a dermatologist, you still have to go through the hospital credentialing committee to do the things you do. The hospital would not let a dermatologist do foot surgery since the education and training would not support such a thing. In podiatric medicine, the education and training support the fact that podiatrists can do H&Ps.

Ahhh, I understand now.

 

[dallasite]

In college, I worked at a surgery center (in TX), and I remember a MD saying something about how a DPM cannot admit a patient into a hospital (or surgery center). Does this new H&P medicare law/rule have anything to do with "admitting" a patient? Since they can do their own H&Ps, does that mean a DPM can now admit the patient? Or is that something totally different? Thanks.

 

[Feli]

In college, I worked at a surgery center (in TX), and I remember a MD saying something about how a DPM cannot admit a patient into a hospital (or surgery center). Does this new H&P medicare law/rule have anything to do with "admitting" a patient? Since they can do their own H&Ps, does that mean a DPM can now admit the patient? Or is that something totally different? Thanks.

DPMs can admit patients and have been able to for awhile now. The bulk of pod admits are generally pre-op for eval or post-op due to complications or medical needs (pain, nausea, etc). MDs, DOs, and DPMs can admit to a hospital... DDS, PA, NP, etc don't have that right to my knowledge.

A lot of pods will co-admit with the patient's family physician to let him and the house interns take care of the patient around the clock, though (many other specialists will do the same thing). Unless a specialist wants to completely medically manage the patient (ie be called at 3am about high BP or a fever), co-admission is generally a wise way to go.

 

[NatCh]

In college, I worked at a surgery center (in TX), and I remember a MD saying something about how a DPM cannot admit a patient into a hospital (or surgery center). Does this new H&P medicare law/rule have anything to do with "admitting" a patient? Since they can do their own H&Ps, does that mean a DPM can now admit the patient? Or is that something totally different? Thanks.

It ultimately depends on the hospital bylaws who can admit. Many hospitals are now using a Hospitalist system rather than the traditional system of each doc admitting his or her own patients. Hospitalists are doctors who manage inpatients full-time. If an outside doc wants to use a Hospitalist, they consult the Hospitalist on-call to manage the patient while in-house. Apparently this system leads to better outcomes with shorter stays.

http://en.wikipedia.org/wiki/Hospital_medicine

Nat

 

[cool_vkb]

It ultimately depends on the hospital bylaws who can admit. Many hospitals are now using a Hospitalist system rather than the traditional system of each doc admitting his or her own patients. Hospitalists are doctors who manage inpatients full-time. If an outside doc wants to use a Hospitalist, they consult the Hospitalist on-call to manage the patient while in-house. Apparently this system leads to better outcomes with shorter stays.

http://en.wikipedia.org/wiki/Hospital_medicine

Nat

Usually what kind of patients (surgical and non-surgical) do Pods usually admit in hospitals. And do pods regularly admit patients? (is it lucrative in terms of income). And ingeneral what is the most most common cases a Pod would see daily in his office. I know it depends on location, level of education,etc. But just in general when you hear Podiatrist what are the most common cases you would associate.

 

[NatCh]

Usually what kind of patients (surgical and non-surgical) do Pods usually admit in hospitals. And do pods regularly admit patients? (is it lucrative in terms of income). And ingeneral what is the most most common cases a Pod would see daily in his office. I know it depends on location, level of education,etc. But just in general when you hear Podiatrist what are the most common cases you would associate.

From what I've seen, podiatric inpatient admissions are either for management of severe infections or for post-op pain control. Outpatient admissions (e.g., ambulatory surgery) are far more common. I've been on staff at six hospitals and we were not permitted to do an inpatient admission unless we had a co-admitting MD or DO. At three of the hospitals we could do our own outpatient admit if the patient was ASA I or II ( http://www.answers.com/topic/asa-score ).

Is it lucrative? For me, inpatient work has accounted for almost no income in the seven years I've been in practice. I'm fine with that because personally I find inpatient work to be too time consuming. Others may enjoy it and seek more of that type of work though. If I have someone for whom an inpatient admission is indicated I either contact the PCP or consult the Hospitalists.

I and the two other DPM's in my group see mostly bunions, hammertoes, heel pain, ingrown nails, tinea, verruca, onychomycosis, neuromas, diabetic foot care, cellulitis, and assorted other complaints. We get a little rearfoot and ankle but not much compared to the stuff I listed.

 

[PODonny]

I and the two other DPM's in my group see mostly bunions, hammertoes, heel pain, ingrown nails, tinea, verruca, onychomycosis, neuromas, diabetic foot care, cellulitis, and assorted other complaints. We get a little rearfoot and ankle but not much compared to the stuff I listed.[/quote]

Do you have your own OR in your practice, or do you use a hospital's facilities to operate? And, if you do use the hospital, do your patients require a stay of any kind (i.e. be admitted)? Thanks.

 

[NatCh]

Do you have your own OR in your practice, or do you use a hospital's facilities to operate? And, if you do use the hospital, do your patients require a stay of any kind (i.e. be admitted)? Thanks.

We have a surgery center below our office and another in a nearby city. We also have privileges at both hospitals and a few remote hospitals. We do the majority of our cases in the surgery centers. We also can do some simple procedures (arthroplasties, hardware removals) in the office. I rarely take cases to the hospitals since most of mine are ambulatory.

Nat