Most Podiatrist Friendly States?

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GypsyHummus

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Hey everyone,

I was wondering which states are the most "pod friendly" as far as hospital privileges, scope of practice, liability, and pay is concerned. I would think any place with a podiatry school would have more autonomy for their practicing foot surgeons.

It is a bit worrying that in some states, pods don't have admitting privileges. On the bright side, it seems like the new crop of DPMs coming out of schools are dead set on progressing foreword with getting podiatrists parity on par with DO and MD students. I noticed this with the pod schools that are in conjunction with DO students.

What are all of your thoughts?

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States that include the entire foot and ankle + distal tib-fib with soft tissue up to the hip have the best scope ex: FL and many others. JAHCO already permits DPM's to do full physical exams in all states so long as the hospital/surgery center also agree in their bylaws.

The most interesting thing currently in the works is the VA equity law which has already passed the House and is currently sitting in the senate VA committee. If Trump signs then DPMs are automatically "physicians" in all VAs across the US and will even be able to serve as medical directors and be on the same pay scale as MD/DO/Dentists.
 
States that include the entire foot and ankle + distal tib-fib with soft tissue up to the hip have the best scope ex: FL and many others. JAHCO already permits DPM's to do full physical exams in all states so long as the hospital/surgery center also agree in their bylaws.

The most interesting thing currently in the works is the VA equity law which has already passed the House and is currently sitting in the senate VA committee. If Trump signs then DPMs are automatically "physicians" in all VAs across the US and will even be able to serve as medical directors and be on the same pay scale as MD/DO/Dentists.

Were they not on the same pay scale before within VA systems? Sorry I don't know much about VA systems. Everything I've heard from both physicians/veterans is its extremely antiquated and care doesn't get through nearly as efficient or fast enough.
 
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Were they not on the same pay scale before within VA systems? Sorry I don't know much about VA systems. Everything I've heard from both physicians/veterans is its extremely antiquated and care doesn't get through nearly as efficient or fast enough.

Podiatrists are paid on the same payscale as Chiropractors and Optometrists at VA hospitals. Neither Podiatric Residents nor Attendings are considered "physicians" at VA hospitals, hence the proposed law.
 
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Podiatrists are paid on the same payscale as Chiropractors and Optometrists at VA hospitals. Neither Podiatric Residents nor Attendings are considered "physicians" at VA hospitals, hence the proposed law.

Same thing with the military, military DPMs are "allied health" professionals. Not physicians. If what you are saying is true, that bill passing would be huge.
 
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Do you think Senetor Bernie Sander would vote on this bill?
I don't see why not, assuming it makes it to the senate floor this time. It's usually got bipartisan support. In fact, I think the sponsors on it now include republicans and democrats. I don't see much of a problem in the house again because the congressman who keeps introducing it is a republican DPM and I believe he's on the committee that needs to approve it so it can go on to the floor. I think last year it passed the house but got held up at the senate. I assume it'll at least get that far again this year.

The problem is it's a small bill with a small overall impact so they probably have to sneak it onto a larger bill to push it all the way through.

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I don't see why not, assuming it makes it to the senate floor this time. It's usually got bipartisan support. In fact, I think the sponsors on it now include republicans and democrats. I don't see much of a problem in the house again because the congressman who keeps introducing it is a republican DPM and I believe he's on the committee that needs to approve it so it can go on to the floor. I think last year it passed the house but got held up at the senate. I assume it'll at least get that far again this year.

The problem is it's a small bill with a small overall impact so they probably have to sneak it onto a larger bill to push it all the way through.

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This is exciting, history is literally happening for our profession! We could literally change the future

I'm going to call my representatives in the house and see where they stand on the bill. Hopefully they are on board, if not, time to complain ;)
 
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This is exciting, history is literally happening for our profession! We could literally change the future

I'm going to call my representatives in the house and see where they stand on the bill. Hopefully they are on board, if not, time to complain ;)
Hopefully it goes through, though they've been trying for a while and it hasn't yet. I'm sure it will eventually.

I'm also hoping to see Trump direct some of his signature deregulation towards healthcare and decrease the paperwork burden of doctors. We'll see, I guess.

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Hopefully it goes through, though they've been trying for a while and it hasn't yet. I'm sure it will eventually.

I'm also hoping to see Trump direct some of his signature deregulation towards healthcare and decrease the paperwork burden of doctors. We'll see, I guess.

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Why hasn't it gone through as of yet? Do the opponents of the bill really have that much clout?
 
Why hasn't it gone through as of yet? Do the opponents of the bill really have that much clout?
I don't think there are necessarily opponents of the bill. I think it's just because it's such a small bill with little impact on $$, it gets little attention and so isn't ever gonna be the first bill put on the calendars for consideration—not when there are bills that could save or cost multimillions of dollars that need to be considered or other bills that are high priorities of one party or another. The bill's got bipartisan support, it just either needs to get attached to a larger (bigger impact) bill or wait its turn. The problem with waiting its turn is that there are only so many days in a legislative session and there are only so many bills that can be considered. A good number of bills just don't make it on the calendars and so don't even have the opportunity to be considered. That's what happened last year. Nobody voted against it. It passed in the house and then never made it onto the calendar in the senate. It essentially just died waiting its turn.

Also, that progress is lost after the session ends. So it has to be reintroduced every session and start from scratch until it eventually makes its all the way through.

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It is true but the AOFAS is trying to do everything in their power to stop it because if DPMs are paid like physicians in the VA then theoretically non-VA DPMs could argue for equal pay with insurance companies for foot and ankle procedures. MD/DOs get paid more for the same procedure that DPM performs.

The AOFAS put out an official statement commenting on our training and education awhile ago. You can find it if you search online. It would be a big blow to their anti-DPM resolve if this gets passed.




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Please understand the fact that in many states there is parity with reimbursement. DPMs and MDs get the exact same amount for the same procedures.

When I went into practice I did my homework to assure that I worked in a state with parity. I had no intention of rolling over and letting someone else get reimbursed more for the same exact procedure.
 
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It is true but the AOFAS is trying to do everything in their power to stop it because if DPMs are paid like physicians in the VA then theoretically non-VA DPMs could argue for equal pay with insurance companies for foot and ankle procedures. MD/DOs get paid more for the same procedure that DPM performs.

The AOFAS put out an official statement commenting on our training and education awhile ago. You can find it if you search online. It would be a big blow to their anti-DPM resolve if this gets passed.


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That could be dangerous, as when there are equal salaries, the person with the more extensive training will take the job/get the contract. Be careful what you wish for.
 
That could be dangerous, as when there are equal salaries, the person with the more extensive training will take the job/get the contract. Be careful what you wish for.

The only way I could possibly see this scenario playing out is if in the far future podiatrists were full scope and completed training on the entire musckoloskeltal system and could command $400K+ salaries right out of residency. But then again that would make our training equal, thus rendering your argument void.

Podiatrist are foot & ankle only and will usually always earn less than a F&A ortho (who can take general ortho call) at the same hospital. MGMA confirms this in the many states where DPMs are already compensated the same $ amount for FA procedures as Ortho.
 
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The only way I could possibly see this scenario playing out is if in the far future podiatrists were full scope and completed training on the entire musckoloskeltal system and could command $400K+ salaries right out of residency. But then again that would make our training equal, thus rendering your argument void.

Podiatrist are foot & ankle only and will usually always earn less than a F&A ortho (who can take general ortho call) at the same hospital. MGMA confirms this in the many states where DPMs are already compensated the same $ amount for FA procedures as Ortho.

Ortho call $ makes a big difference, that's a good point. $1500 for a day of call. That's an extra $70-80k per year just to have your phone on 1 day a week. And if you take more than one day per week of call...
 
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Regarding the VA provider equity act - the 114th congress version had steam but like others have said - died in the senate after ortho involvement. The current version, as mentioned and linked, is sitting in committee in the house. I agree that this likely will not get past the senate without being rolled into something else which is a distinct possibility. We will see what also happens with Price being HHS secretary being an ortho.

The current APMA president noted in the APMA news interview that the va provider equity act and moving podiatry into the medical corp are priorities for him as well as title 19. At least in the interview he feels va provider equity and military medical corp are easier than title 19 - I kind of feel they are all relatively equal in difficulty but I'll take any advancement.
 
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Regarding the VA provider equity act - the 114th congress version had steam but like others have said - died in the senate after ortho involvement. The current version, as mentioned and linked, is sitting in committee in the house. I agree that this likely will not get past the senate without being rolled into something else which is a distinct possibility. We will see what also happens with Price being HHS secretary being an ortho.

The current APMA president noted in the APMA news interview that the va provider equity act and moving podiatry into the medical corp are priorities for him as well as title 19. At least in the interview he feels va provider equity and military medical corp are easier than title 19 - I kind of feel they are all relatively equal in difficulty but I'll take any advancement.

The current APMA president also said something about if the goals are accomplished for the VA and medical corps, then they have to put podiatry in title XIX—like that's basically a second pathway to getting title XIX knocked out as well. But he didn't really explain how that works.

Also, didn't APMA send out a news brief or something a couple of weeks ago saying that they're optimistic because Price has been pro-podiatry in the past? Granted, the APMA spouts optimism about these bills every year and it hasn't worked yet.

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The current APMA president also said something about if the goals are accomplished for the VA and medical corps, then they have to put podiatry in title XIX—like that's basically a second pathway to getting title XIX knocked out as well. But he didn't really explain how that works.

Also, didn't APMA send out a news brief or something a couple of weeks ago saying that they're optimistic because Price has been pro-podiatry in the past? Granted, the APMA spouts optimism about these bills every year and it hasn't worked yet.

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They said that had worked together in the past and sounds like it was cordial. I don't think they said he was pro-podiatry but they didn't say he was anti. I'm hopeful, but you never know until it comes down to it. I tried to find Price's vote on the 114th's VA provider equity act but it was a voice vote so no official record.
 
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People from the ABPM, APMA, AOFAS, AAOS, and VHA spoke before the house committee on veterans affairs health subcommittee today about HR 1058, the VA provider equity act. Video below if you've got nothing better to do, it starts around 1:09:00.

Basically, everybody was like "this is a good idea".

Then ol' boy from AOFAS/AAOS was like "we support everything except podiatrists being labeled physicians and having administrative positions over MDs and DOs" and also made the point "podiatrists don't learn about systems".

At some point an MD on the subcommittee basically told the AOFAS/AAOS guy "We're all physicians and we're all here to help patients so we shouldn't be arguing over semantics. Podiatrists are physicians." And the AOFAS/AAOS guy was like "bruh". Then the AOFAS/AAOS guy admitted that the definition of physician was probably the least important part of his opposition and so he seemed OK with podiatrists being labeled physicians at the VA.

Then the VHA guy explained that no specialties are allowed to have direct clinical oversight over other specialties per the Joint Commission, peers evaluate peers. Like a neurologist couldn't have clinical oversight over an orthopedist and so even if podiatrists could have administrative roles in the VA (Chief of Surgery, Chief of Staff, etc.) they wouldn't have direct clinical oversight over MDs or DOs. And the AOFAS/AAOS guy was like "bruh". And so when he was asked again if he supported podiatrists having administrative roles he basically said "yes, since it's another incentive to bring them onboard at the VA".

Then Wenstrup was all "I diagnose systemic pathologies all the time, heart disease, diabetes, etc. and we have full H&P rights and prescription rights because we are trained in systems". And one of the MDs on the subcommittee backed him up. And the AOFAS/AAOS guy was like "bruh".

 
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People from the ABPM, APMA, AOFAS, AAOS, and VHA spoke before the house committee on veterans affairs health subcommittee today about HR 1058, the VA provider equity act. Video below if you've got nothing better to do, it starts around 1:09:00.

Basically, everybody was like "this is a good idea".

Then ol' boy from AOFAS/AAOS was like "we support everything except podiatrists being labeled physicians and having administrative positions over MDs and DOs" and also made the point "podiatrists don't learn about systems".

At some point an MD on the subcommittee basically told the AOFAS/AAOS guy "We're all physicians and we're all here to help patients so we shouldn't be arguing over semantics. Podiatrists are physicians." And the AOFAS/AAOS guy was like "bruh". Then the AOFAS/AAOS guy admitted that the definition of physician was probably the least important part of his opposition and so he seemed OK with podiatrists being labeled physicians at the VA.

Then the VHA guy explained that no specialties are allowed to have direct clinical oversight over other specialties per the Joint Commission, peers evaluate peers. Like a neurologist couldn't have clinical oversight over an orthopedist and so even if podiatrists could have administrative roles in the VA (Chief of Surgery, Chief of Staff, etc.) they wouldn't have direct clinical oversight over MDs or DOs. And the AOFAS/AAOS guy was like "bruh". And so when he was asked again if he supported podiatrists having administrative roles he basically said "yes, since it's another incentive to bring them onboard at the VA".

Then Wenstrup was all "I diagnose systemic pathologies all the time, heart disease, diabetes, etc. and we have full H&P rights and prescription rights because we are trained in systems". And one of the MDs on the subcommittee backed him up. And the AOFAS/AAOS guy was like "bruh".



I hope the outcome is a good though for the Pods. There is no date to know when the bill might be passed, right? Also, read the following and glad he did it:

Dr. Steve Goldman set to Testify before VA House Committee, Subcommittee on Health - ABPM News
 
I hope the outcome is a good though for the Pods. There is no date to know when the bill might be passed, right? Also, read the following and glad he did it:

Dr. Steve Goldman set to Testify before VA House Committee, Subcommittee on Health - ABPM News
As far as timing, that's a hard thing to say for any bill. I'm sure it'll get out of this committee but when or if it would get put onto the calendar for a floor vote nobody could know. Could take a few weeks to get through congress, could die in limbo without ever making it onto the calendar. IF it does make it to a full house vote I would expect it to make it out of the house but that's still a big IF. Then it would still need to pass the senate and get signed off by Trump.

I think the major thing is that the AOFAS/AAOS opposition pretty much boils down to "but I don't wanna :(" and even the MDs in congress realize it. In light of that, I don't see opposition to this bill ever stopping it (in this session or future sessions). If it doesn't make it through it'll probably just be because of logistics and scheduling and the fact that the congress/senate can only consider so many bills in a session.
 
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So podiatrists don't learn about systems? Oh thank goodness, I was worried about all that anatomy, physiology and systems approach to podiatry that Midwestern told me that we were gonna learn side by side and be tested with the DO students.
 
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So podiatrists don't learn about systems? Oh thank goodness, I was worried about all that anatomy, physiology and systems approach to podiatry that Midwestern told me that we were gonna learn side by side and be tested with the DO students.

Nah of course you don't learn systems. Not even Western or DMU or Temple learn anything remotely related to their MD/DO counterparts.

Systems = completely irrelevant to our area of healthcare.
 
Nah of course you don't learn systems. Not even Western or DMU or Temple learn anything remotely related to their MD/DO counterparts.

Systems = completely irrelevant to our area of healthcare.

I know some dumb DO's and MD's. They might have been "taught" systems, but man. An A student from midwestern knows systems more than a C student from a DO/MD school. IMO. PADPM might disagree.
 
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Thanks for sharing bob!

Dr. Abraham's response towards the end of the hearing was worth watching the whole video. Perhaps there's more within the allopathic and osteopathic communities who share his thoughts. Hopefully that's not wishful thinking.
 
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Getting back on topic....a big thing to consider is Medicaid. The reality is coming out you want to see anybody and everybody. No is not in your vocabulary. Unfortunately in Kansas I am not allowed to see people over the age of 20. Below 20 office visits and surgery is ok, above 20 no surgery. One of the Medicaid's can see 2x a year for office visits only. It is frustrating. Very frustrating. On one hand keeps me from doing pus foots at 2 am, but I turn bunions away all the time, and the other day turned a traumatic dropfoot away that would have been perfect PT transfer through IO membrane. The funny thing is I have to refer to Ortho FA ( Ortho in my group does minimal foot) and most of them won't see Medicaid. So people that want to see them can't, and people that are supposed to see them won't. Makes a lot of sense...
 
Medicaid won't let you see people over the age of 20? How much is Medicaid of your patient base? That seems unsustainable for a pod, Medicaid patients are the ones with the foot problems, diabetes and heart problems.

Getting back on topic....a big thing to consider is Medicaid. The reality is coming out you want to see anybody and everybody. No is not in your vocabulary. Unfortunately in Kansas I am not allowed to see people over the age of 20. Below 20 office visits and surgery is ok, above 20 no surgery. One of the Medicaid's can see 2x a year for office visits only. It is frustrating. Very frustrating. On one hand keeps me from doing pus foots at 2 am, but I turn bunions away all the time, and the other day turned a traumatic dropfoot away that would have been perfect PT transfer through IO membrane. The funny thing is I have to refer to Ortho FA ( Ortho in my group does minimal foot) and most of them won't see Medicaid. So people that want to see them can't, and people that are supposed to see them won't. Makes a lot of sense...
 
Medicaid won't let you see people over the age of 20? How much is Medicaid of your patient base? That seems unsustainable for a pod, Medicaid patients are the ones with the foot problems, diabetes and heart problems.
No, everybody has those problems. And I dont know what percentage would be since there is a built in gatekeeper not putting them on my schedule. Every once in awhile people slip through. But I don't take call at hospital so that cuts down on my medicaid
 
I really do hope the bill passes. I have a friend who has been in the VA for a decade who has little hope for the bill since it was supposedly "shot" down not too long ago.
 
Yea, VA provider equity act is building a little steam. It's got like 14 sponsors now, pretty bipartisan which is great. HELLPP act is looking slightly more promising with about 38 sponsors, also pretty bipartisan. Either would be a big win.

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"Received in the Senate and Read twice and referred to the Committee on Veterans' Affairs." 7/25/17
this is progress right?
Yes. Use your APMA membership to call/email your state reps. Only reason it did not pass last time around was that it was used as an Omnibus for special interests. Too many piled on and it didn't pass. It makes sense for both the left and right; left it provides greater access and improved quality of care. Right- relative small upfront cost that provides big savings on health care costs in the long term.
 
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