Scope Of Practice Update: Where Things Stand
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.