Scope Of Practice Update: Where Things Stand

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

   Furthermore, David Teuscher, MD, the Texas Orthopedic Association representative, observes that the court’s decision squarely made any medical care of the ankle and leg the “practice of medicine,” and not podiatry. He noted that even podiatrists who were currently allowed to do foot and ankle surgery would now have to be limited to just the foot.

   The Texas Podiatric Medical Association planned to ask for a re-hearing but instead is trying to work directly with the Texas Orthopedic Association and Texas Medical Association to reach a middle ground. Currently, it is the Texas Podiatric Medical Association’s viewpoint that the only thing the appellate court limited was treatment to the leg and it agrees with the appellate court on this point. However, the Texas Podiatric Medical Association asserts that podiatrists still have ankle privileges in Texas.

   Richard Pollak, DPM, who practices in San Antonio, points out that the Texas State Board of Podiatric Medical Examiners decided to expand the scope of practice’s wording without notifying most practicing podiatrists in the state of Texas. However, he says, “that’s not to say we wouldn’t have supported it. We just didn’t know about it.”

   It is doubtful that a change of podiatry’s scope made by the Texas Podiatric Medical Association, a member organization, would have been any better received than the one made by the Texas State Board of Podiatric Medical Examiners, a body that consists of six governor-appointed podiatric physicians and three consumer members. The courts in Texas have made clear that any changes in laws must go through the legal system and not just be adopted into rule by an unelected administrative board.

   Regardless of which podiatric group made the initial scope expansion move, Dr. Pollak says that because of it, many podiatric privileges did increase. Noting that reform has been a 10-year process, he says many podiatrists are better trained now than they were 15 years ago.

   “As the profession has grown over the past 30 years … most podiatrists can practice within their training,” says Dr. Pollak. “Even though we’re having this quandary with the word ‘ankle,’ there are a lot of podiatrists with satisfactory training that have ankle privileges. Very few podiatrists have been negatively impacted by the (Texas) Supreme Court decision.”

Establishing A Standard Of Training

Since podiatrists in Texas are not regulated by the Texas Medical Practice Act, and are “neither licensed nor trained to practice medicine,” opponents in the Texas Medical Association and Texas Orthopedic Association maintain that podiatrists have no right to “engage in the practice of medicine.”

   Training and education have long been part of the scope of practice debate as orthopedic and medical groups continually cite the fact that podiatrists have no standard in their education or residency requirements. Many state podiatric associations, including the Iowa Podiatric Medical Society and the Ohio Podiatric Medical Association, note that “the preparatory education of most podiatrists includes four years of undergraduate work, followed by four years in an accredited podiatric medical school, followed by a two or three year hospital-based residency.”

   The problem here again hinges on one word: most. Orthopedists and MDs must attend four years of undergraduate college, then four years of medical school, an internship program and then a residency.

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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