Scope Of Practice Update: Where Things Stand

Author(s): 
Rachel L. MacAulay, Contributing Editor

Even as the APMA continues its efforts to establish a uniform scope of practice for podiatrists, battles continue over how much of the lower extremity podiatrists are allowed to treat. This author speaks to various podiatrists about scope of practice developments in Texas, South Carolina, New York and across the country.

The power of words is very apparent in the ongoing podiatric scope of practice debate. Words like “physician,” “education” and “ankle” continue to be front and center in these debates that have been taking place in state legal arenas and various publications over the last decade.

   To help facilitate a “uniform scope of practice,” the American Podiatric Medical Association (APMA) rolled out its Vision 2015 Plan. The APMA notes this is a roadmap to ensure that by 2015, “podiatrists are to be universally accepted and recognized as physicians consistent with their education, training and experience.” The plan is multifaceted and seeks to make changes in four areas: education, legislation, public relations and inter-professional relations.

   When it comes to expanding podiatry’s scope to include the ankle, momentum has been slow in recent years (see “Scope of Practice: Where Things Stand” in the May 2007 issue). The road to 2015 has had its share of obstacles, not the least of which are ongoing legislative fights in states like Texas, New York and South Carolina. Podiatrists in restrictive states keep pushing at the limited definition for their field, only to be meet with massive and well-funded resistance from medical and orthopedic associations.

   The current economic situation in the United States has also played a part in the uncertainty surrounding much of the legislation to expand upon podiatric privileges. Legislators are much more likely to focus on and pass bills that have to do with reduced spending or job growth, steering clear of potentially volatile issues.

A Closer Look At Court Decisions In Texas

In Texas, the Texas Podiatric Medical Association has spent more than $1 million fighting to get “ankle” into law over the last decade. The fight began in 2001 when the Texas State Board of Podiatric Medical Examiners published a broadened scope of practice for Texas podiatrists. The new scope, as the board presented it, attempted to define the foot as including “the tibia and fibula in their articulation with the talus, and all the bones to the toes, inclusive of all soft tissues ... that insert into the tibia and fibula in their articulation with the talus and all bones to the toes.”

   Both the Texas Medical Association and the Texas Orthopedic Association balked, filing suit against not just the Texas State Board of Podiatric Medical Examiners but also the Texas Podiatric Medical Association. Together with then Texas Attorney General John Cornyn, they alleged that the examiners board had acted outside its authority when it illegally attempted to change the definition of podiatry in the state.

   Although a lower court upheld the Texas State Board of Podiatric Medical Examiners’ definition, in 2008, the Texas Third District Appellate Court concluded that the board had “exceeded its authority when it promulgated the rule and that the rule is invalid.” In June 2010, the Texas Supreme Court passed on reviewing the 2008 decision, which left the 2008 ruling as the final legislative word for now. In the absence of a state Supreme Court judgment, both sides have reverted to their own takes on the 2008 ruling.

   The Texas Medical Association asserted that the decision upheld the association’s opinion that in the Texas scope of practice for podiatrists, the foot does not include the ankle or leg. The Texas Orthopedic Association posited that the court decision confirmed that the boards of “limited-license” professionals could not determine their own profession’s scope — that redefining scope of practices was solely a legislative act.

Comments

Look at all the effort, expense and animus with the MDs we expend by trying to legislate our license instead of earn it. We would have the support of the MDs, increase our scope and, once and for all, end ALL podiatry's problems by changing our schools to have exactly the same 4-year curriculum and rotations, and announce our desire to offer the MD instead of keeping us apart with the disdained DPM.

It is time to drop the sentimentality of our chiropodal past and return to allopathy where we originated from. Even if the MDs acquiesce to "giving us the ankle," there's still the rest of the body and a majority of diseases we will be considered too inferior to treat. For the next 100 years, podiatrists will sue to creep up the leg. It IS possible to change pod schools to MD offering institutions but there are still too many frightened and lazy podiatrists who don't want the increased responsibility.

Podiatric politicians must be bold and brave at this stage, and scuttle the incrementalism associated with project 2015, which does not guarantee any increase in scope in and of itself. It will only provide grounds for another series of suits.

Dear colleague Dr. Bijak,

We are a specialist medical profession full of hardworking, intelligent, well educated professionals who need to explore and expand our limits. Yes, we need to prepare better. We all do.

Nevertheless, we as a profession specialized in an anatomical area need to do as other specialties do, allow the alpha dogs to cause that change and, as always, the time is now.

José A Mattei, MD, DPM
Chief of Medical Staff
Hosp Metropolitano Dr. Susoni
Arecibo, PR

According to the proposed law, the ankle means the skin. You mean since I did not complete a residency back in 1985, I cannot even cut the skin around the ankle to obtain a wound culture? And someone who completed a non-surgical podiatric approved residency in 1985 can be licensed to cut the ankle bones? How does this relate to current competence? Shouldn't proposed laws relate to current competence? Why not open it up equally for all podiatrists?

Furthermore, board certification by a nonsurgical podiatric board is not written as accepted in the law and the health commissioner may turn around and decide not to accept
a non-surgical board regarding cutting skin around the ankle to be able to get a culture and sensitivity of ankle ulcers. I should send my patients to another podiatrist who performed
a non-surgical podiatric residency program for treating and culturing ankle ulcers. How does this make me look in the eyes of my patients? Why should this law even be passed as written? There are other podiatrists in the same situation as me.

Disclaimer: The above comments are only my opinions.

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