The PMA Identity Crisis: Where Do We Go From Here?
The aforementioned ASPMA pamphlet also lists a number of duties that focus on what a “certified” PMA could perform. Interestingly enough, while certification may pump up a sense of professionalism and self-esteem, it provides no legal status or endorsement (except for taking X-rays in less than a handful of states). In effect, the duties listed can be performed by any PMA, provided of course that the PMA’s supervising doctor feels he or she is trained and capable. Andrew Feldman, the General Counsel to the New York State Podiatric Medical Association (NYSPMA), provided me with a document from the New York Education Department, dated 1/9/03, that specifically concerns certified assistants for a podiatrist. This document does not recognize a “certified assistant” for a podiatrist and PMAs are referred to only as “unlicensed personnel” or “unlicensed assistant.” The document refers to PMAs in these terms “because they have met no particular qualifications” and giving them a title such as “podiatric assistant” could create a “misconception.” Essentially, without an identified scope, they are not officially recognized. Mr. Feldman’s memo refers to the “Office of Professions” Web site which addresses what an (unlicensed) assistant may do. These duties involve helping the patient on and off the treatment chair, removing bandages, taking the patient’s history and vital signs, and performing duties “which are not considered the practice of podiatry.” It states that the podiatrist may not delegate surgical procedures or ultrasound treatment to unlicensed personnel. However, this memo does recommend the podiatrist consider several factors including supervision, responsibility and pathology before delegating a task. As per the memo, podiatrists should: • remain in the podiatric office where the services are being performed; • personally diagnose the condition to be treated; • personally authorize the procedure; and • evaluate the services performed by the unlicensed person prior to dismissing the patient. Since the licensed podiatrist “must assume responsibility and accountability” for the services performed by the unlicensed assistant, it is also recommended that DPMs exercise prudent judgment in assigning tasks. What is the bottom line? If an unlicensed assistant is given authority to perform tasks that (specifically) require a license, these actions could result in charges of professional misconduct. I also contacted the PICA Group, a malpractice insurance company in Tennessee, in order to find out from PICA how a PMA with no written scope of practice fits into the risk management picture of health care. PICA cannot offer a list detailing what a PMA can and cannot do, according to Barbara Bellione, PICA’s Director of Risk Management. However, she does say that podiatric assistants should have appropriate education and training in the tasks they are to perform and be able to demonstrate competency in those tasks prior to performing them. Additionally, she points out that podiatric assistants should have written job descriptions that reflect any state laws, required education and training, continuing education requirements, necessary supervision, etc. Does much of this sound familiar? In Conclusion It is no secret that I am an absolute advocate of training an assistant to the highest level possible and then utilizing those skills to the maximum potential. Without formal schooling, our lack of training makes certain a continued unstable career. My hope for our scope of practice is, that someday soon, our profession will realize the importance of defining the PMA role, help facilitate appropriate credentialing through a recognized educational process and help create a standard of identity that can be accepted throughout the country. Based on the comments doctors nationwide have shared with me, the benefits of having an educated, skilled and clinically trained podiatric medical assistant on their team elevates the professionalism of their practice, greatly contributes to practice efficiency and, most importantly, to patient care. Moreover, legal standardization of the assistant’s role would provide a sense of “compliance comfort” when delegating duties (in much the same way that radiology standards have in some states). In a profession where DPMs continuously struggle to maintain their unique identity as the foot and ankle specialists, it is not surprising that PMAs have followed in their footsteps.