Scope Of Practice Update: Where Things Stand

Rachel L. MacAulay, Contributing Editor

   In Abilene, Texas, two podiatrists, together with the Texas Podiatric Medical Association, filed suit against Hendrick Medical Center, asking for a judgment that the current scope of practice for podiatrists is the treatment of ailments at or below the ankle. The plaintiffs also asked the court to enjoin the hospital from denying qualified podiatrists privileges necessary to treat injuries at or below the ankle. The court issued a temporary injunction preventing the hospital from denying the podiatrists any ankle privileges they previously had while the litigation was pending. Due to another motion to dismiss filings and appeals, the case is currently undecided.

   The New York State Podiatric Medical Association, with the assistance of the APMA, came close in both 2010 and earlier this year to getting first measure S2992B and then S583 passed. The earlier measure passed the Senate but died in Assembly. This year’s version, first S583 and subsequently S3758-2011, “expands the definition of the practice of podiatry to include conditions of the ankle and all soft tissue structures of the leg below the knee anatomically affecting the foot and ankle” and further “establishes podiatrists licensed prior to the effective date of this act need to be certified to operate on the ankle.” S3758-2011 once again passed through the New York State Senate and was referred to Higher Education by the Assembly.

   It is a higher education issue because, as explained in S583, all of the podiatric schools in the U.S., including the New York College of Podiatric Medicine, teach the expanded scope of practice that the bill hoped to pass in New York state. However, because of the restrictions, podiatrists graduating from the New York College of Podiatric Medicine were increasingly choosing to practice in other, more liberal states. Thus, while enrollment at the college is steadily increasing, the number of new podiatrists starting a practice in New York is steadily decreasing.

   Charles M. Lombardi, DPM, trained in Philadelphia but chose to practice in New York. As the Director of Podiatric Medical Education and Director of Podiatry at New York Hospital Queens in New York City, he encounters scope of practice issues “daily” and definitely feels that they have restricted his practice.

Emerging Insights On Reform Efforts In South Carolina

In South Carolina, strict definitions limit DPMs to “diagnosis, medical and surgical treatment” of the foot, and the medical and orthopedic community aims to keep it that way.

   Dr. Butterworth has had a podiatric practice in South Carolina with her husband for 12 years now. She says the law is especially frustrating because she works in a rural area with limited resources for her patients. Many of her patients have limited transportation and have great difficulty traveling to see other physicians.

   “It is aggravating because I have the skills to provide treatments my patients need the majority of the time but because of our restricted state law regarding the ankle and amputations, I have to refer my patients out of their community, often times to those less qualified than myself,” she says. “Fortunately, my local physicians are very understanding with our ‘issues’ but are also frustrated with our restricted law.”

   The bill to enlarge South Carolina’s scope of practice guidelines for podiatrists has come tantalizingly close to passing the last few times. Dr. Butterworth explains that, “Last year at about this time, when the session ended, the chairman of the Medical, Military, Public and Municipal Affairs (3M) Committee was actually for our bill and wanted us to meet with orthopedists to compromise on the language and submit a bill that would pass.” The first time the meeting was scheduled, only the other side’s lobbyists showed up.

   They finally met face to face with orthopedists in October 2010 but not successfully. “Basically, they wanted things that we couldn’t give … things they knew we couldn’t accomplish,” recalls Dr. Butterworth. “We said we’d put in the bill certification or qualification in ankle surgery, even though we didn’t think it should be in the law. After all, (there’s no law that says) that orthopedists have to have credentialing in particular parts of the body.”


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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