Scope Of Practice Update: Where Things Stand
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.