Scope Of Practice Update: Where Things Stand
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.