Podiatrists losing priveleges in Florida

[caribsurf]

I just read that Podiatrists in Florida are going to lose leg privaleges.That they will only be able to work on feet. This is a huge step backward for Podiatry.I read the letter from the Florida Podiatry Assn. Anybody else hear about this?

bob

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[Dr_Feelgood]

I just read that Podiatrists in Florida are going to lose leg privaleges.That they will only be able to work on feet. This is a huge step backward for Podiatry.I read the letter from the Florida Podiatry Assn. Anybody else hear about this?

bob

I have not heard about this but there was a push in the past. This goes back to topics discussed before. Ther will always be a fight between any two groups that compete in business. I was just talking to a pediatric cardiologist today. Cardiologist and vascular surgeons are fighting interventional radiologists over stents and various other procedures. Those are two groups that have the same degree. They both feel they do it better but it boils down to money, nothing else.

Here is a somewhat recent articel about the national foot and ankle orthopod society and their feelings on podiatric scope. http://www.aaos.org/news/bulletin/jul07/reimbursement2.asp. Here is an article by a podiatric journal on the same topic http://www.podiatrytoday.com/article/7068

 

[jonwill]

I just read that Podiatrists in Florida are going to lose leg privaleges.That they will only be able to work on feet. This is a huge step backward for Podiatry.I read the letter from the Florida Podiatry Assn. Anybody else hear about this?

bob

No, they would still have ankle privileges. I rotated down there as a student and spoke with the doctor that actually wrote the scope of practice for podiatry which includes soft tissue up to the thigh. The big stink was that some pods started doing knee injections which understandably upset orthopods. So ortho was trying to decrease the pod scope to foot and ankle only. The push failed last year and I haven't heard anything about them bringing it up again this year. But even if it were successful, little would change in reality other than the few pods that were giving knee injections would have to stop.

 

[Feli]

No, they would still have ankle privileges. I rotated down there as a student and spoke with the doctor that actually wrote the scope of practice for podiatry which includes soft tissue up to the thigh. The big stink was that some pods started doing knee injections which understandably upset orthopods. So ortho was trying to decrease the pod scope to foot and ankle only. The push failed last year and I haven't heard anything about them bringing it up again this year. But even if it were successful, little would change in reality other than the few pods that were giving knee injections would have to stop.

This basically sums up my understanding also.^

Bottom line is that whenever you try to gain scope and change the laws, ortho or other groups could also put a bill in to do the exact opposite. That's what happened, but there are a ton of pods in Florida, a pod school, and a very active FPMSA here, so that bill to decrease scope died very fast.

I'm not sure the date of the orig article the OP is referencing, but here's a blurb from 2007:
"... In 2006, Florida — with its plethora of medical colleges — was the battleground for a skirmish over state House Bill 575, which sought to amend the definition of 'practice of podiatric medicine' from its current scope (extending to the tibial tubercle) to a more restricted area (stopping at the ankle). The bill would have also limited optional Medicaid services reimbursements for certain podiatric procedures. The efforts of the Florida Podiatric Medical Association and other DPMs in the area were reportedly crucial in the defeat of the bill, which died in committee...."
-Robert Smith in Podiatry Today

 

[cool_vkb]

This basically sums up my understanding also.^

Bottom line is that whenever you try to gain scope and change the laws, ortho or other groups could also put a bill in to do the exact opposite. That's what happened, but there are a ton of pods in Florida, a pod school, and a very active FPMSA here, so that bill to decrease scope died very fast.

I'm not sure the date of the orig article the OP is referencing, but here's a blurb from 2007:
"... In 2006, Florida — with its plethora of medical colleges — was the battleground for a skirmish over state House Bill 575, which sought to amend the definition of 'practice of podiatric medicine' from its current scope (extending to the tibial tubercle) to a more restricted area (stopping at the ankle). The bill would have also limited optional Medicaid services reimbursements for certain podiatric procedures. The efforts of the Florida Podiatric Medical Association and other DPMs in the area were reportedly crucial in the defeat of the bill, which died in committee...."
-Robert Smith in Podiatry Today

As far as i heard, they tried this ridiculous act on texas pods also but fortunately in both Florida as well as texas the bills were defeated easily. or else that would have been a deep slope for Pods. Plus i heard this bill's defeat is being used by pods in states that do not have ankle privedledges to persuade law makers to include Ankle in their law. This is wat i heard from the pod i shadowed.And this is like 3-4 month back converstation. Dont know whats happening now.

 

[Dr_Feelgood]

As far as i heard, they tried this ridiculous act on texas pods also but fortunately in both Florida as well as texas the bills were defeated easily. or else that would have been a deep slope for Pods. Plus i heard this bill's defeat is being used by pods in states that do not have ankle privedledges to persuade law makers to include Ankle in their law. This is wat i heard from the pod i shadowed.And this is like 3-4 month back converstation. Dont know whats happening now.

Texas was a little different. The Texas Podiatric Medical Board interrupted the Texas law that states pods can work on all structures of the foot to mean they can also work on the ankle. They were sued by the Texas Medical Association and the Texas Orthopedic Society. The Podiatry Board won and now ithe case is in appellate court. The orthopedic society is also trying to reword the scope law. Both look like they will be unsuccessful.

 

[caribsurf]

"To:
Florida Podiatric Medical Association Members
From:
Dr. Joe Strickland and Dr. Michael Rivera
Subject:
Protection of our Practice Act
The next 12 months will be critical to FPMA members and the practice
of podiatry. We anticipate a major legislative battle next year during the
2007-2008 Legislative Session. There is a national push to limit our
surgical privileges to the ankle and below......"
-


This is from July 2007. This is happening now. This is a "national push" not a state level battle. I wonder how many people are aware of this. This is not about conflicting interests of overlapping M.D. specialties. This is about all of Podiatry everywhere. As it is, Podiatrists get paid less. So I guess that battle has already been lost.




carib

 

[cool_vkb]

"To:
Florida Podiatric Medical Association Members
From:
Dr. Joe Strickland and Dr. Michael Rivera
Subject:
Protection of our Practice Act
The next 12 months will be critical to FPMA members and the practice
of podiatry. We anticipate a major legislative battle next year during the
2007-2008 Legislative Session. There is a national push to limit our
surgical privileges to the ankle and below......"
-


This is from July 2007. This is happening now. This is a "national push" not a state level battle. I wonder how many people are aware of this. This is not about conflicting interests of overlapping M.D. specialties. This is about all of Podiatry everywhere. As it is, Podiatrists get paid less. So I guess that battle has already been lost.




carib

Well even if we go by lowest of lowest surveys, we still make $130-140K and if we go by latest surveys we make around 180K. Hello! we still make pretty decent income.

So far by the history of these law suits and bills. All have been defeated very easily. So i wudnt get worried abt it much. There might be an increase in scope of podiatry but a decrease in scope, i seriously doubt it. Its not gonna happen man! If that had to be happened, it would have happened long time back. These professions are here to stay brother! stop getting worried or making new pre-pods worried.

 

[rainbowman]

Correct me if I'm wrong, but I thought Podiatric surgeons were just ankle and foot surgeons to begin with.

 

[podoc123]

Correct me if I'm wrong, but I thought Podiatric surgeons were just ankle and foot surgeons to begin with.

Yes, this is a little confusing to some of us pre-pods without a lot of understanding of the entire scope of the profession. So these changes they are talking about would affect a pods ability to work on or up to the tibial tuberosity, but would not affect their scope of working on the ankle and foot? Is this correct? And if this is the case, wouldn't it have little affect on the profession either way since most pod procedures only pertain the the ankle and foot? I understand that some rural areas it would be nice to have a higher scope because they don't have anyone to refer patients to, but for a majority of pods, would this alter their practice at all? Also, where can I find a list of states that do not allow pods to perform surgery on the ankle?

 

[cool_vkb]

Correct me if I'm wrong, but I thought Podiatric surgeons were just ankle and foot surgeons to begin with.

yeah they are. but some states the medical assoications are pushing to reduce the ankle from the scope of practice.

 

[NatCh]

yeah they are. but some states the medical assoications are pushing to reduce the ankle from the scope of practice.

Remove the ankle completely for all DPM's, or making it within scope only for those who have rearfoot/ankle training?

 

[jonwill]

This may be an unpopular statement but I'm all for states that have privileges above the ankle being reduced to ankle and foot only. I think this because the states that have these laws are few (NM, FL are a few of them) and pods in these states generally don't do anything above the ankle anyway as their training generally doesn't include it. We need a national scope of practice and I believe it should include foot and ankle only as that is our training and specialty. And yes, that means that a few states will, dare I say, have a reduction in scope of practice (really in theory only). So maybe a few pods in FL will have to stop doing knee injections (which is how the whole FL thing came about). So what?

A unified profession with one national scope of practice will create much less confusion to the public.

 

[Feli]

This may be an unpopular statement but I'm all for states that have privileges above the ankle being reduced to ankle and foot only. I think this because the states that have these laws are few (NM, FL are a few of them) and pods in these states generally don't do anything above the ankle anyway as their training generally doesn't include it. We need a national scope of practice and I believe it should include foot and ankle only as that is our training and specialty. And yes, that means that a few states will, dare I say, have a reduction in scope of practice (really in theory only). So maybe a few pods in FL will have to stop doing knee injections (which is how the whole FL thing came about). So what?

A unified profession with one national scope of practice will create much less confusion to the public.

I agree with you.

The only downside is cases like the one I saw on a private practice rotation last month: adolecent distal fib tumor (path lab came back nonossifying fibroma) that needed ostectomy of 5cm of fib just proximal to lateral malleolus. They put a Steinman pin in it and put an ex-fix on the fibula's proximal metaphysis to lengthen and fill the gap with callus distraction over the next couple months. I guess you can always bone graft in that gap or something, but it's nice to have options and do what's best for the patient if you have the skills. With that reduced scope, that ex-fix option would then be gone because it's way above the ankle, right?

Would pilon fractures and PER4s with Maisonneuve be out of scope too, or are you suggesting ankle and directly anything affected by injury to it?

 

[cool_vkb]

delete...

 

[Dr_Feelgood]

I agree with you.

The only downside is cases like the one I saw on a private practice rotation last month: adolecent distal fib tumor (path lab came back nonossifying fibroma) that needed ostectomy of 5cm of fib just proximal to lateral malleolus. They put a Steinman pin in it and put an ex-fix on the fibula's proximal metaphysis to lengthen and fill the gap with callus distraction over the next couple months. I guess you can always bone graft in that gap or something, but it's nice to have options and do what's best for the patient if you have the skills. With that reduced scope, that ex-fix option would then be gone because it's way above the ankle, right?

Would pilon fractures and PER4s with Maisonneuve be out of scope too, or are you suggesting ankle and directly anything affected by injury to it?

FYI: You don't fix a Maisonneuve fxs.

My worry would be can we still harvest graft from the tibia or fibula? I think that ex-fix and pilions are fine b/c you are treating the ankle joint no matter how high the fx or pins go.

 

[Dr_Feelgood]

This may be an unpopular statement but I'm all for states that have privileges above the ankle being reduced to ankle and foot only. I think this because the states that have these laws are few (NM, FL are a few of them) and pods in these states generally don't do anything above the ankle anyway as their training generally doesn't include it. We need a national scope of practice and I believe it should include foot and ankle only as that is our training and specialty. And yes, that means that a few states will, dare I say, have a reduction in scope of practice (really in theory only). So maybe a few pods in FL will have to stop doing knee injections (which is how the whole FL thing came about). So what?

A unified profession with one national scope of practice will create much less confusion to the public.

I disagree about losing osseous up to the tibial tuberosity. I think that instead you make an example of these idiots and take away their license and open them up for legal consequences. They have never been trained to do knee injections. While you can argue that it is the same as the ankle, if the needle broke off in the knee they can't go get it. It is battery in my mind.

Again, cut out the cancer to save the body.

 

[jonwill]

I agree with you.

The only downside is cases like the one I saw on a private practice rotation last month: adolecent distal fib tumor (path lab came back nonossifying fibroma) that needed ostectomy of 5cm of fib just proximal to lateral malleolus. They put a Steinman pin in it and put an ex-fix on the fibula's proximal metaphysis to lengthen and fill the gap with callus distraction over the next couple months. I guess you can always bone graft that or something, but it's nice to have options. With that reduced scope, that ex-fix option would then be gone because it's way above the ankle, right?

Would pilon fractures and PER4s with Maisonneuve be out of scope too, or are you suggesting ankle and directly anything affected by injury to it?

Well, the ex-fix would still be OK because the way many states word the law, we can fix any osseous pathology that involves the ankle joint so pilons definitely involve the ankle joint. Maisonneuve would be fine too because the high fib fracture itself is generally not fixated. It usually reduces when you fix the ankle (syndesmotic screw).

 

[jonwill]

I disagree about losing osseous up to the tibial tuberosity. I think that instead you make an example of these idiots and take away their license and open them up for legal consequences. They have never been trained to do knee injections. While you can argue that it is the same as the ankle, if the needle broke off in the knee they can't go get it. It is battery in my mind.

Again, cut out the cancer to save the body.

That is the arguement. Pods started having weekend seminars and training people to do knee injections in workshops (freaking scary, I know). That is where it all started.

I like the tibial tuberosity too but I don't see every state being able to increase to that scope, unless it was a national law which I would be all for too. But if it's dealt with on a state by state basis, I really don't see it happening.

 

[Dr_Feelgood]

That is the arguement. Pods started having weekend seminars and training people to do knee injections in workshops (freaking scary, I know). That is where it all started.

I like the tibial tuberosity too but I don't see every state being able to increase to that scope, unless it was a national law which I would be all for too. But if it's dealt with on a state by state basis, I really don't see it happening.

I really like the article I posted above. A national law would be impossible b/c health care is run at the state level. A universal law would be a better approach. Get the APMA to set a universal law and take it to the streets. Use the PPAC money for a good cause that has at least a chance of working, unlike some things that they have wated money on. Concentrate by regions, start in the South or West b/c of the strong scopes and after you have a few states pass the scope it will be easier, until the last lingering states which will take time.

 

[caribsurf]

That is the arguement. Pods started having weekend seminars and training people to do knee injections in workshops (freaking scary, I know). That is where it all started.


Actually a big part of the problem was when podiatrists started doing a nerve decompression surgery up near the top of the leg that they learned at weekend seminars. It was pioneered by neurosurgeons years ago and fell out of favor with neurosurgeons for various reasons. Podiatrists got leg priveleges and had a lot of complications that they could not handle up into the thigh. Most of the clampdown is coming from neurosurgeons, because of the historic long term failure and Podiatrists lack of ability to deal with problems.

The weekend seminar thing is a big problem. Killing the goose that lays the golden egg has always been a big problem with Podiatrists eager to make $ or prove themselves.


carib

 

[oldManDO2009]

when it comes to scope of practice - I am the first to refer to a DPM (if I am asked...) I do not have the specialized training nor do I want it. You are the expert and I would rather have you work on it then me f it up.

But that is for F&A problems ONLY. I find it problematic that some DPMs are moving away from their training. It would be like me (EM interest) deciding that since I already have placed a fem line - why not just toss a stent in there or repair a valve (ignore the obvious anatomical problems with this example)

As long as people stick to their scope I am all about referrals. My last 2 FP rotations had great relationships with the local DPM and many referrals were sent because patients were happy with the service/outcome. Can this be the case if we are experimentally venturing out of our scope (with extensive weekend training of course)

 

[Dr_Feelgood]

when it comes to scope of practice - I am the first to refer to a DPM (if I am asked...) I do not have the specialized training nor do I want it. You are the expert and I would rather have you work on it then me f it up.

But that is for F&A problems ONLY. I find it problematic that some DPMs are moving away from their training. It would be like me (EM interest) deciding that since I already have placed a fem line - why not just toss a stent in there or repair a valve (ignore the obvious anatomical problems with this example)

As long as people stick to their scope I am all about referrals. My last 2 FP rotations had great relationships with the local DPM and many referrals were sent because patients were happy with the service/outcome. Can this be the case if we are experimentally venturing out of our scope (with extensive weekend training of course)

You'll get no arguement in this group. Just like any other medical professions we all have our members that ashame us. These are just bad eggs.

 

[Feli]

FYI: You don't fix a Maisonneuve fxs...

... Maisonneuve would be fine too because the high fib fracture itself is generally not fixated. It usually reduces when you fix the ankle (syndesmotic screw).

Thanks guys, I found the 1977 Yablon article on this and restoring the mortise...
http://www.ncbi.nlm.nih.gov/sites/e...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

I'm in Pod Surg I (forefoot) right now but don't have the ptII with RF until next semester. You darn 4th year students and 1st year residents know it all and think you're sooooooo cool

 

[IlizaRob]

Actually a big part of the problem was when podiatrists started doing a nerve decompression surgery up near the top of the leg that they learned at weekend seminars. It was pioneered by neurosurgeons years ago and fell out of favor with neurosurgeons for various reasons. Podiatrists got leg priveleges and had a lot of complications that they could not handle up into the thigh. Most of the clampdown is coming from neurosurgeons, because of the historic long term failure and Podiatrists lack of ability to deal with problems.

The weekend seminar thing is a big problem. Killing the goose that lays the golden egg has always been a big problem with Podiatrists eager to make $ or prove themselves.


carib

You're talking as if this does not happen within the entire health care organization, especially allopathic. If you think podiatrists are the only ones who start procedures after a weekend seminar you are sorely mistaken. Although I agree with what you are saying, I dont agree that the problems come from the neurosurgeons. I think there is a larger battle within the ortho community than anything else.

 

[caribsurf]

You're talking as if this does not happen within the entire health care organization, especially allopathic. If you think podiatrists are the only ones who start procedures after a weekend seminar you are sorely mistaken. Although I agree with what you are saying, I dont agree that the problems come from the neurosurgeons. I think there is a larger battle within the ortho community than anything else.

I never said that only Podiatrists go to weekend seminars and learn how to do procedures, I don't know where you got that from.

Podiatrists are in danger of losing privileges. It may very likely happen.That information is from the President of the Florida Podiatrists. That has never ever ever happened in allopathic medicine. It is unique to Podiatry. It has nothing to do with orthopedists. It is the American Medical Association doing this as a way (they feel) to protect the public.


carib

 

[jonwill]

I never said that only Podiatrists go to weekend seminars and learn how to do procedures, I don't know where you got that from.

Podiatrists are in danger of losing privileges. It may very likely happen.That information is from the President of the Florida Podiatrists. That has never ever ever happened in allopathic medicine. It is unique to Podiatry. It has nothing to do with orthopedists. It is the American Medical Association doing this as a way (they feel) to protect the public.


carib

That was from me. When I was at U of F last year, I was talking with the past president of the FPMA and he was telling me about the whole knee injection thing and how he had to testify before the Florida House, etc. I hadn't heard anything about the nerve thing.

Anyway, I wouldn't worry too much about it. I can't find any news about it. And I haven't heard anything through the APMA which would be all over it just like the scope issue a few years ago in FL. Not to mention the fact that podiatric medical associations in every state tend to get worked up quite easily!

 

[cool_vkb]

Podiatrists are in danger of losing privileges. It may very likely happen.That information is from the President of the Florida Podiatrists.

carib

Relax buddy! nothing is gonna happen. There is too much money and politics involved in it. Its not a game of snatching a lollipop from kid. Even if they decide to pass there will be tons of news, articles,etc. Not just one Mr xyz coming on SDN and crying "The sky is falling, the sky is falling..".

I dont know where you get your news from or what presidenct you sit with. but unless that is on some noted pod journal or apma or from a reliable senior SDN member. i kind of think you are trying to simply stretch and exagerrate this thing for some reason.

 

[Feli]

...just one Mr xyz coming on SDN and crying "The sky is falling, the sky is falling.."....

...i kind of think you are trying to simply stretch and exagerrate this thing for some reason.

I was getting this vibe also^. Kinda feels like when the network54 doom-and-gloom-ers pop in every now and then? See what you think:

...This is a huge step backward for Podiatry...

...Killing the goose that lays the golden egg has always been a big problem with Podiatrists eager to make $ or prove themselves..."

...As it is, Podiatrists get paid less. So I guess that battle has already been lost...

It's always important to be aware that scope can change and that getting too greedy for scope/$/etc can backfire, but I think the tone there is a bit melodramatic.