Scope Of Practice Update: Where Things Stand

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

   Dr. Butterworth feels the hospitals, not the legislature, should decide on credentialing. “It is up to the hospital to give you credentials. We don’t want every podiatrist performing ankle surgery either. That’s not what we’re asking for.”

   The bill H.3745 was introduced on the floor of the South Carolina House of Representatives on Feb. 24, 2011 and was promptly referred back to the aforementioned 3M Committee.

   The bill seeks to amend a 1976 state law with the following mandates:
• podiatric surgery must occur in certain facilities;
• podiatric surgeons must meet certain criteria;
• certain health facilities will extend professional privileges to these podiatrists;
• health facilities must provide the right to pursue and practice full clinical and surgical privileges to podiatrists who meet certain criteria;
• facilities have an ability to limit these privileges in certain circumstances;
• health facilities are not required to offer a specific health service not otherwise offered at that facility; and
• if the facility does offer a health service, it may not discriminate among certain health professionals authorized by law to provide these services.

   With this bill, Dr. Butterworth says, “We’ve given everything we could give.”

   Acknowledging that DPMs in the state would have little to no objection to simply expanding South Carolina’s podiatric scope to include toe amputation, Dr. Butterworth says, “We don’t want to compromise because if we give in on amputation, we’ll never get the ankle. Nobody is fighting amputation law but we don’t want to pass that until we get the ankle. If we change the practice act once (for toe amputation), we’ll never get it changed again.”

   Change is still far from a given in South Carolina as the bill H.3745 has floundered once again. The 3M Committee asked for discussion from both sides but then, citing confusion, tabled the bill until next session. It is currently unclear as to when the next session will meet and what the bill might look like in yet another iteration.

Are Scope Of Practice Battles Creating A Diaspora Of Podiatrists?

One of Dr. Butterworth’s biggest fears is that, as older podiatrists start to retire, they’re not going to be replaced because “limiting laws are causing them to lose quality people” in South Carolina. Podiatrists just out of school are choosing to set up their practices in states with broad scope of practice guidelines. This is the same thing that is happening in New York and quite possibly other restrictive states such as Texas, Kansas and Massachusetts.

   As Harold W. Vogler, DPM, FACFAS, states, “restrictive state scope statutes have a tendency to discourage highly trained new podiatric physicians and surgeons from obtaining licensure in these states.” Dr. Vogler, who practices in Sarasota, Fla., admits that he has discouraged new podiatrists from going to restrictive states, citing the frustration they would encounter.

   It is a frustration that Dr. Butterworth knows all too well. When asked if she envisions the South Carolina scope of practice guidelines for podiatrists finally changing by 2015, she said she hoped so but South Carolina does things differently from other states.
“And it is not a Southern thing because all of the surrounding states have ‘ankle’ in their scope of practice,” notes Dr. Butterworth. “It is just South Carolina. South Carolina might very well be the last one” to pass a scope of practice bill.

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robert bijak,dpmsays: December 1, 2011 at 10:09 pm

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.

Reply to this comment »
Dr Jose A Mattei-Diazsays: December 3, 2011 at 8:49 am

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

Reply to this comment »
anonymoussays: December 20, 2011 at 10:21 pm

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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