Scope of practice

[buBBa15]

Does anyone have info on the scope of practice for DPMs in the USA?

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[CapCrunch]

Depends on the state. There is no universal scope of practice for a DPM. Is there any particular state that you're curious about? You can probably use Google to find the answer quicker than if you posted it and asked us to look it up.

 

[heybrother]

I made an excel table - search the forum for my old posts. Some of the states have lengthy overly specific scopes so I wasn't able to include all the information. However, I included links to each state's scope of practice so you can search the web and see if my information is the most up to date. The APMA or one of the podiatry organizations has a similar table (its not mine to share so no I will not post it) and some charts concerning ankle and amputation rights.

 

[pacpod]

For in depth information, you will need to google the state board of podiatric medicine in the states you are interested in practicing.

For a quick and dirty look, follow the link in my sig to the "One stop shop" sticky in pre-pod and then click on the link that says something to the effect of state ankle provisions. That will give you a map that shows what states do and don't allow ankle rights.

 

[EK18]

44 states and Washington DC currently allow Pods to treat foot and ankle. New York will allow Pods the ankle starting next year. From the top of my head, the 5 remaining states that do not allow Pods to treat the ankle are Kansas, Mississippi, Alabama, South Carolina, and Massachusetts.

Some states allow DPMs to supervise PAs, but I think most do not.

A few states like California and Florida give DPMs a relatively wide scope and basically allow them to treat soft tissue of the entire leg.

Amputation also varies considerably between states. Some states prohibit any amputation and some only allow for amputation of the toes.

 

[pacpod]

I believe Texas is fairly restrictive as well.

 

[buBBa15]

Awesome thx guys. I'm asking cuz the DPM that interviewed me at temple today stated his distaste for ny bcuz dpms r so restricted in that state.

 

[heybrother]

I'll put 1 more plug in. The table I made is a compilation of the exact wording from each state's podiatry medical board or the actual state regulation straight from the website. As I already indicated - I provide the link back to the state reg so you can view the entirety of the legislation and don't have to take my word for it. Though I didn't not have access to the APMA version at the time, my table resembles their's which is also a compilation of state language (and is unavailable to non-members).

 

[zdlamkin8195]

If you have an office in one of the restrictive states but it is on the border of a nonrestrictive state, could you schedule your more involved cases at hospital/surgery center in the less restricted state? Assuming you have a license in both states...

 

[dyk343]

If you have an office in one of the restrictive states but it is on the border of a nonrestrictive state, could you schedule your more involved cases at hospital/surgery center in the less restricted state? Assuming you have a license in both states...

If you are licensed in both states. yes. This happens a lot in New York/New jersey

 

[hughesn2]

I find it odd that New York didn't allow you to treat on the ankle (until next year). Their state gets 1 of the 9 schools in the entire country and the podiatrist they go see at clinical can't show them the whole scope of practice that they would be allowed to do in most other states in the country.

I just don't see why every state can't just allow both foot and ankle. Who knows!

 

[pacpod]

I just don't see why every state can't just allow both foot and ankle. Who knows!

I believe we are heading that way relatively shortly. Legislation is introduced frequently (or attempted to be introduced as is the case in some states) in the limited states to try and address this.

It is not so much just getting a law changed, but the lobby on the other side as well. I have MD family members in one of the limited states and they somewhat regularly get emails from the state AMA association urging opposition to pro-DPM legislation. In the end, it is a money game.

 

[Ferocity]

I would like to push for all states to include the foot, ankle, and rectal exams.

 

[XCdpm02259]

You can't treat the ankle in Massachusetts either :-(

 

[heybrother]

You can't treat the ankle in Massachusetts either :-(

Will you please provide a reference for your comment?

http://www.mass.gov/ocabr/licensee/dpl-boards/pd/regulations/rules-and-regs/249-cmr-200.html
http://www.mass.gov/ocabr/licensee/dpl-boards/pd/regulations/rules-and-regs/249-cmr-400.html

Practice of Podiatry means the following conduct: the maintenance of human podiatric health by the prevention, alleviation or cure of disorders, injuries or disease of the human foot and ankle by medical, mechanical, surgical, manipulative and electrical means, and the prescription and administration of drugs for the relief of disease or adverse physical podiatric conditions. The scope of practice of podiatry includes resections of the foot; as well as surgical procedures involving the ankle joint. In the course of treating the human foot or ankle, a registered podiatrist may perform an Achilles tendon lengthening and he or she may also perform tendon transfers that require incisions into the lower leg. The scope of practice of podiatry includes the diagnosis of systemic diseases.

 

[PatchAdamsFan]

Regarding the scope of practice:

I recently interviewed at CSPM and Dr. Tran said that California is the only state where a podiatrist can act as a secondary surgeon to other parts of the body (i.e. hands, hips, etc), and bill the SAME amount for the procedures. This is factual as he and many others have done this, but I personally believe that there are other states that allow this as well. You will find that Alaska and Minnesota, they have jurisdiction for 'hand surgery', and given the truth of this statement, pods act as secondary surgeons as well in those cases.

 

[ManUnderFire]

Regarding the scope of practice:

I recently interviewed at CSPM and Dr. Tran said that California is the only state where a podiatrist can act as a secondary surgeon to other parts of the body (i.e. hands, hips, etc), and bill the SAME amount for the procedures. This is factual as he and many others have done this, but I personally believe that there are other states that allow this as well. You will find that Alaska and Minnesota, they have jurisdiction for 'hand surgery', and given the truth of this statement, pods act as secondary surgeons as well in those cases.

wild. I would not want to work on hands or hips seeing how limited our exposure to these can be.

 

[heybrother]

wild. I would not want to work on hands or hips seeing how limited our exposure to these can be.

Don't worry. You won't be.

 

[PatchAdamsFan]

As a side-note, I'm not saying that pods should work with surgeries dealing with parts other than the lower extremity. The idea is that the 3 year mandatory residency has legislation, in CA, to be considered competent in general surgery, but there MUST be present qualified MD/DO physicians on site as primary surgeons. Again, this doesn't mean that pods should go ahead with this, as the legal ramifications for failure may prove to be devastating. Speaking practically, I doubt that they would be in charge at all during the out-of-scope procedures, but the idea is that they can give a professional helping hand, more-so than that of surgical techs.

 

[ManUnderFire]

As a side-note, I'm not saying that pods should work with surgeries dealing with parts other than the lower extremity. The idea is that the 3 year mandatory residency has legislation, in CA, to be considered competent in general surgery, but there MUST be present qualified MD/DO physicians on site as primary surgeons. Again, this doesn't mean that pods should go ahead with this, as the legal ramifications for failure may prove to be devastating. Speaking practically, I doubt that they would be in charge at all during the out-of-scope procedures, but the idea is that they can give a professional helping hand, more-so than that of surgical techs.

Hmmm...interesting. Doesn't seem practical if an MD/DO has to be present....paying two specialists for the same job. But like you said, better to play it safe

 

[EK18]

Will you please provide a reference for your comment?

http://www.mass.gov/ocabr/licensee/dpl-boards/pd/regulations/rules-and-regs/249-cmr-200.html
http://www.mass.gov/ocabr/licensee/dpl-boards/pd/regulations/rules-and-regs/249-cmr-400.html

Practice of Podiatry means the following conduct: the maintenance of human podiatric health by the prevention, alleviation or cure of disorders, injuries or disease of the human foot and ankle by medical, mechanical, surgical, manipulative and electrical means, and the prescription and administration of drugs for the relief of disease or adverse physical podiatric conditions. The scope of practice of podiatry includes resections of the foot; as well as surgical procedures involving the ankle joint. In the course of treating the human foot or ankle, a registered podiatrist may perform an Achilles tendon lengthening and he or she may also perform tendon transfers that require incisions into the lower leg. The scope of practice of podiatry includes the diagnosis of systemic diseases.

Interesting. The Ankle Scope map provided by the APMA shows differently. Maybe Massachusetts JUST passed legislation that legalized treating the ankle?

Edit: I found this http://www.malegislature.gov/Laws/GeneralLaws/PartI/TitleXVI/Chapter112/Section13

Section 13. Podiatry as used in this chapter shall mean the diagnosis and the treatment of the structures of the human foot by medical, mechanical, surgical, manipulative and electrical means without the use of other than local anesthetics, and excepting treatment of systemic conditions, and excluding amputation of the foot or toes. This and the ten following sections shall not apply to surgeons of the United States army, navy or of the United States Public Health Service, nor to physicians registered in the commonwealth. The term physician and surgeon when used in sections twelve B, twelve G, twenty-three N and eighty B shall include a podiatrist acting within the limitation imposed by this section.

Which one is accurate?

 

[pacpod]

Hmmm...interesting. Doesn't seem practical if an MD/DO has to be present....paying two specialists for the same job.

From what I understand, that used to be the case for DPMs to perform podiatric surgeries
Our field has come a long way.

 

[DrMarx]

In regards to the future of scope of practice for Podiatrists, do you guys believe that restrictions on procedures Podiatrists are fully capable of doing will go down?

 

[josebiwasabi]

In regards to the future of scope of practice for Podiatrists, do you guys believe that restrictions on procedures Podiatrists are fully capable of doing will go down?

Yes.

It really has to do with lag between the better training that podiatrists have recently been attaining and lack of awareness by lawmakers. The mandatory 3 year residency is a really recent development. In some cases they are well aware of it but certain groups are lobbying against expanding our scope. When I say "expanding" I really mean bringing the few states that have severely restricted scopes in line with the other 40something states. I think some ortho groups are looking at this in the long term and feel that podiatrists may try and expand their scope to include the entire lower extremity (knee and hip = $$), but I don't think podiatrists feel comfortable with performing knee and hip surgery, and our residency training definitely does not provide enough exposure to those procedures for us to do those on our own. Our residency definitely does provide us with sufficient training on the ankle though, and that is something that should be universal in scope across all 50 states.

Progress is slowly being made. Take a look at NY scope including the ankle starting in 2014 as an example. The political action committee is playing a crucial role right now and can hopefully effect similar changes in legislation in the other restricted states in the near future.

 

[PatchAdamsFan]

Orthopedic surgeons have good reason to prevent legislation from passing, regarding podiatry scopes: It's a money game. Many f/a surgeons are crying foul already for encroachment of their niche, yet podiatrists are fully capable in performing many of the complex surgeries that were in the past exclusively MD area, more-so now with the mandatory residency. The fear of expansion of scope to the entire lower extremity also has valid points, as is seen from DNP and OD degrees wanting more jurisdiction and autonomy. Honestly, I feel that the residency may well include training above the knee if allowed, and some, not many, podiatrists would gladly accept that. Unfortunately, some orthopedists see podiatrists as a threat, and ultimately acts as a hurdle for complete foot and ankle scope, which is greatly needed in the podiatric community.

 

[XCdpm02259]

Will you please provide a reference for your comment?

http://www.mass.gov/ocabr/licensee/dpl-boards/pd/regulations/rules-and-regs/249-cmr-200.html
http://www.mass.gov/ocabr/licensee/dpl-boards/pd/regulations/rules-and-regs/249-cmr-400.html

Practice of Podiatry means the following conduct: the maintenance of human podiatric health by the prevention, alleviation or cure of disorders, injuries or disease of the human foot and ankle by medical, mechanical, surgical, manipulative and electrical means, and the prescription and administration of drugs for the relief of disease or adverse physical podiatric conditions. The scope of practice of podiatry includes resections of the foot; as well as surgical procedures involving the ankle joint. In the course of treating the human foot or ankle, a registered podiatrist may perform an Achilles tendon lengthening and he or she may also perform tendon transfers that require incisions into the lower leg. The scope of practice of podiatry includes the diagnosis of systemic diseases.

Oh well I guess you can, my bad. I was told by someone at my interview as well as by the man I shadow that you could not. But thanks for the info!

 

[zdlamkin8195]

Orthopedic surgeons have good reason to prevent legislation from passing, regarding podiatry scopes: It's a money game. Many f/a surgeons are crying foul already for encroachment of their niche, yet podiatrists are fully capable in performing many of the complex surgeries that were in the past exclusively MD area, more-so now with the mandatory residency. The fear of expansion of scope to the entire lower extremity also has valid points, as is seen from DNP and OD degrees wanting more jurisdiction and autonomy. Honestly, I feel that the residency may well include training above the knee if allowed, and some, not many, podiatrists would gladly accept that. Unfortunately, some orthopedists see podiatrists as a threat, and ultimately acts as a hurdle for complete foot and ankle scope, which is greatly needed in the podiatric community.

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