The PMA Identity Crisis: Where Do We Go From Here?
Mention creating a legal scope of practice for the podiatric medical assistant (PMA) to a group of doctors and you will likely stir some opinions and controversy. Unfortunately, at this point, only opinions can frame the discussion. Without a written scope of practice, there is no standardization of what an assistant can and cannot do. There is only individual interpretation and this is usually based on personal experiences within one’s own office. Here is the only reality that we know to be true. Some individuals are hired to file charts, answer the phone and bring patients back to a treatment room while others are directly involved with hands-on patient care. Sadly, in the minds of many, “front” and “back” office staff are as close as we have come to defining our roles. The vast majority of doctors admit they have no idea what a PMA legitimately can and cannot do. Without this knowledge, doctors are left to make that determination themselves. As to whether doctors are interested in clarifying the role of PMAs, it depends upon whom you talk to. Some doctors are indifferent because, whatever the case, they have no intentions of changing their own office protocol. To the contrary, there are those who feel it would be helpful to know exactly where the lines are drawn so they can maximize their staff duties without crossing any ethical or legal boundaries. This also allows for clearer responsibilities and expectations between the employer and employee during the hiring process. Finally, there are practitioners who would oppose attaching any legally defined scope to the role of the assistant through an accredited curriculum because they feel that credentialed assistants would command a higher wage for what they do. As you might suspect, I would argue that a credentialed PMA would have a higher value but that is another topic. I first decided to become a PMA back in 1971. My employer, Rosario La Barbera, DPM, encouraged me to make the most of it. However, he noted there were no established educational courses available for assistants. Then I turned to the American Society of Podiatric Medical Assistants (ASPMA) as a possible resource for other options but was surprised to discover there were no legal guidelines concerning an assistant’s scope of practice. Worse yet, there were no efforts to create any. Unfortunately, this has not changed. I proceeded to contact my state legislators to see if there was anything written at the state level regarding this issue and, if not, what we could do to change that. The New Jersey State Board of Medical Examiners (the licensing board for New Jersey podiatrists) informed me that before the legislature could adopt a formal scope of practice for the PMA, the role of the PMA had to first be identified and documented, ideally through the creation of a formal educational course. Only a matriculated program, outlining the scope and training of a PMA, could open new doors for the profession. Coincidentally, around that time, a New Jersey vocational/technical school approached me and my friend/co-worker, Marlene Kern, RN, PRT, to write and introduce a PMA syllabus into its already credentialed medical assistant program. We enthusiastically laid the groundwork by developing the necessary syllabus and also agreed to be their first instructors. Sadly, after only two short years, the podiatric portion of the course was terminated. Aside from the fact that there was no one willing to continue teaching the course, there were not enough podiatrists in the area willing to employ the graduates. I feel we conquered the fight on our own turf but lost the overall battle. It was termed a successful failure. Why A Defined PMA Scope Of Practice Would Be Beneficial Today, after having spent 35 years as a PMA, I remain in a career that still suffers from an all too familiar identity crisis. While the scope remains undefined, concerned podiatrists everywhere continually ask me the unanswered question: “What am I legally allowed to let my staff do?” My response has not changed: “Without a formal, written scope of practice, the role of the PMA differs not only from state to state but from office to office. Ultimately, it comes down to allowing (staff) to do whatever duties you feel they can competently perform.” After all we went through, it is unnerving that the scope of practice for a PMA remains so ambiguous.