Scope Of Practice Update: Where Things Stand
“Many orthopedists and MDs do not view us as ‘real doctors,’” notes Michelle Butterworth, DPM, FACFAS, who practices in South Carolina. “They go through four years of medical school and so do we. With evaluation of our schooling, I think they would see that our education is very similar to theirs. Unfortunately, they do not understand the depth of our education and training, nor do they really want to. We are not considered ‘equal’ to them because we have a different degree. This is a primary issue in our state scope of practice battle. Since we have a DPM (degree) and not a MD (degree), our scope battle has become very ego driven and turned into a turf war.”
Most podiatrists undergo 11 years of schooling, just like MDs and DOs. Those who pursue a Fellowship with the American College of Foot and Ankle Surgeons (ACFAS) have an extra, year-long advanced training in specializations such as advanced rearfoot reconstruction and diabetic limb salvage. This puts them on equal footing, experience-wise, with orthopedists.
“Our profession has had their problems because not everybody has had the same training. Some had one-year residencies and some had three-year residencies,” says Dr. Butterworth. She adds that recently, “all (podiatric) residencies have converted to three years, resulting in three years of surgical training at the very least. A lot of people are doing fellowships after their residency.”
Licensing boards are leading the change. Currently, the State Board of Podiatry in Kentucky only approves licensing for podiatrists who have attended one of seven colleges of podiatric medicine. Applicants who have graduated from the more newly established podiatry colleges — the Arizona School of Podiatric Medicine at Midwestern University in Glendale, Ariz., and the College of Podiatric Medicine at the Western University of Health Sciences in Pomona, Calif. — currently have to wait for a license while the Kentucky board evaluates their college for academic standards and requirements.
As part of the APMA’s Vision 2015 goal, a single three year training program — the Podiatric Medicine and Surgery Residency (PMSR) for all podiatric medical school graduates — began in 2011. This will help ensure that all new podiatrists have similar skills and knowledge before they go into practice, and it is just one of several steps the APMA is taking to standardize podiatrist’s education. The burden now is to ensure that an evolution in education leads to an evolution in scope.
While a standard of education is a necessary step toward undermining any argument against enlarging the podiatry scope of practice laws, it appears that those who currently have the necessary education and training, even in some states with narrow scope of practice definitions, are able to practice what they were trained to do anyway.
With a nod to the inter-professional relations touted by the APMA, most podiatrists I talked to were quick to point out that most allopathic and osteopathic physicians are not their opponents. Many work in the same practice and in collaboration with orthopedists, or treat patients with the help of “friendly” doctors, such as DOs. As with anything, knowledge and familiarity can lead to a better understanding.
Why There Is Looming Uncertainty In Many States With Reforms
As Dr. Pollak explains, while podiatrists were doing ankle work at small surgical centers and smaller hospitals in Texas, when courts first upheld the law expanding the scope of practice, larger hospitals that had been conservative in what they let podiatrists do had to then give them ankle privileges. Now that the decision may have been overturned, he says these same hospitals are not sure what to do.
In the year since the state Supreme Court decision, the Texas Podiatric Medical Association has received requests for more information regarding the podiatric scope of practice from 80 hospitals and surgical centers. The bulk of these facilities decided that podiatrists were still legally allowed to perform ankle procedures, according to the Texas Podiatric Medical Association. However, the association notes that four facilities have terminated or at least put a hold on ankle privileges for podiatrists, pending further research.