I tend to agree with Dr. Kass, that on first
look, the recently passed scope of practice bill
potentially creates a two-tier licensing
structure for podiatrists in NYS. At first look
it may be seen as unfair to the vast majority of
DPM's who never had an opportunity to obtain
board certification, or to be trained in a two
or three year residency.
It also may seem unfair to many who have achieved
surgical board certification after a one-year
residency or alternative method. Many of the
latter categories are actually the majority of
us who teach and are attending podiatrists
in two- and three-year residency programs
(myself included). This thought process,
however, is very short sighted.
Without some tangible change in the scope of
practice it is quite likely that Dr. Kass and I
(and several thousand other DPM') would have a
very difficult time selling our practices and/or
attracting associates to our practice. What
was neglected to be mentioned was that the
current bill does allow wound care
to be performed by all licensed podiatrists in
NYS up to the tibial tuberosity, particularly
when the wound starts below the ankle. This
removes the "grey" from treating somevenous
ulcers and many other conditions treated by most
podiatrists in NYS.
This not only implies surgical care but
diagnostic and DME care for those
wounds. This by no means is something to be
forgotten and can result in significant amount
of income whichshould not be left on the table.
The reality is that even if the scope of
practice was broadened to include "ankle
surgery" for all, this would likely not change
the reality for most podiatrists irrespective of
their board certification status.
Hospital and other out-patient facilities need
to be sure they protect the public and I am sure
this was at the uppermost mind of the
legislatures. The reality is that most DPM's
would not be granted ankle privileges by the
hospitals in which we work. This
is simply because we do not have the skills or
training necessary.
Certainly residency training is an excellent
barometer but it may not be the only
barometer.
The language of the bill itself may need some
further interpretation in order to resolve my
(and others) concerns involving minor surgical
procedures (e.g. biopsies) and diagnostic
examinations (e.g. x-rays) and surgical
procedures which do not involve open surgery of
bone (e.g. closed fracture reductions w/o
manipulations on the ankle) or soft tissue
surgeries (e.g. TAL). This should be open to
most surgeons who can show their
abilities to perform these procedures.
Through reliable resources, I have been informed
that such tweaking to the current bill is still
possible. I have it on good authority that
NYSPMA will be providing some more information
to its membership very shortly on all the issues
with respect to this bill.
As one who is involved in the political process
on the national level, I have
learned that most battles we fight are
protracted and no policy or legislation
is perfect. Despite the shortcomings of this
bill, this is a huge victory for
all NYS podiatrists and not just the few who
have been board certified in rear
foot and ankle surgery.
I am proud to say that Dr. Andrew Shapiro was my
student as a resident in a one year rotating
residency and one year surgical residency
dating back to the 1980's. I am very proud that
he has seen this bill as a future for podiatry
and did not look selfishly at what may have been
(or not been) in it for himself (for now).
Rather he and the other leadership of NYSPMA
have seen fit to take a long-term solution to
securing a foundation for the future for the
podiatrists in NYS. I am extremely proud of
Andy, our president Gary Stones, Len Thaler and
all those who worked so very hard with them to
get this bill passed.
The NYSPMA should no longer be looked at by what
they failed to do for you lately (or in the
past) by its membership or by non affiliated
DPMs.
Whatever your past feelings for the association
may have been, this bill may have just have
secured your financial future. For that alone
you should strongly consider putting your past
grievances aside and consider rejoining the
association and consider joining a committee to
continue the success for our profession in NYS.
Other issues with respect to this bill are the
18 month window until this bill takes effect;
I remain concerned that there may be some push
back from the New York State Medical Association
and other specialty groups. I await word from
NYSPMA as to what the next steps for the
membership should be.
One thing for sure is that the current
generation of DPMs, no matter their level of
training needs to show their respect for their
elders. If not for those who came before us we
would not be in the position we are now in.
Let's not take for granted the lessons learned
by our predecessors who had to fight just to get
bedside privileges at community and/or
prestigious tertiary care hospitals. This
valuable lesson needs to be exhibited on a daily
basis so that those who come after us will pay
us with equal respect.
I also agree that there is still much to be done
in NYS in order for DPMs to achieve parity with
our MD and DO colleagues. Some of this may be
may be resolved with title XIX legislation and
some may not.
Podiatrists are not currently considered
physicians in NYS and are subject to the
provisions of the NYS Education Dept. A change
to the provisions of the Health Dept to put us
on par with MDs and DOs is a laudable next
objective.
Paul Kesselman, DPM, Woodside, NY,
pkesselman@pol.net
I find it a tremendous success as well as an
inspiring message what our state association has
achieved through their tireless perseverance,
optimism, and foresight. Personally, I have been
hearing the overwhelming negativity from so many
practitioners over so many years (ever since I
was a student), that our state shall never see
an expanded (rather, a 'corrected') scope come
to pass - "it will never happen" - they used to
say.
To all those who believed this, I hope your
outlook has been changed on a great many things.
A glass is either half full or half empty, and
looking at it half empty helps no one, nor does
it achieve anything. I cannot express how
inspiring it is for me as a young practitioner
to see what can be achieved through hammering
away at something with your head turned away
from the negativity.
Again, the selfless efforts put forth by our
state association members involved with this
committee is a message for ALL practitioners in
NYS - always seek to improve the future without
thought of yourselves. On that note, who
this "helps"..... well, the only answer to that
is simple - it "helps" the future of our
profession in NYS. Period. Whether you're board
certified in surgery or not, it will change the
perception of our specialty overall. Those 15-20
RRA certified will be exponentially increased
over the years to come, and New York is a
perfect place full of pathology to watch this
happen.
We need to keep well trained and interested
people in our state - not running off to other
states for training and practice because ours
falls behind the country's standard. Speaking as
an RRA QUALIFIED practitioner, I can tell you
how true this is. Great job NYSPMA!
Fred J. DeLucia, DPM, Queens, NY,
fred.delucia@gmail.com
