01/17/2013    Paul Kesselman, DPM

Podiatrists and Flu Shots (Elliot Udell, DPM)

The last time the New York governor declared a
flu emergency, we heard the same suggestions
from podiatrists statewide. Due to scope of
practice issues and other nonsensical reasons,
podiatrists were not given the okay.

Unfortunately, even if we were given the okay,
there is a more practical and business side of
the questions surrounding flu vaccinations.
According to an internist who I am closely
connected to, a solo practitioner cannot order
only a few doses of flu vaccine for the few
patients most podiatrists would ever vaccinate.
Most likely you would need to order several
hundred or a thousand doses.

Currently, there are even local branches of a
nationwide retail pharmacy chain who are running
low or out-of-stock on flu and waiting to get
their stocks replenished (should be this week).

Several other physicians commented:

Why would a specialist would want to cross over
and perform the duties usually performed by a
primary care physician?

He further commented you don't see radiologists,
general or orthopedic surgeons clamoring to
administer flu shots. Even though they have the
ability to perform vaccines, they don't.

The business side of medicine often gets in the
way of what's philosophically correct (as per
Elliot's desire to assist during a public health
crisis). After all, how many podiatrists (or
other specialists or even PCPs) actually draw
blood and send it out to labs today vs. 10 years
ago. The time and labor costs associated with
drawing the blood and sending it out are far
higher than what Medicare reimburses for the
veinpuncture.

While I applaud Elliot's desire to help out
during this current emergency crisis, it's
likely something which would need a permanent
fix and would require:

1) Adding flu vaccinations to the DPM's scope of
practice;

2) Your practice pre ordering flu vaccine in the
summer for fall delivery;

3) A financial investment in flu vaccine which
you may never use and consideration for what to
do with any excess (e.g. donating it
or selling it to another practitioner).

Perhaps it might be wiser to better educate our
patients on how to prevent the spread of germs
in the first place; and donate one's time
somewhere they are short on staff to administer
the vaccine.

As a profession, we ought to also consider
delaying performing any elective and non urgent
procedures requiring in-patient admission.
Hospital beds are scarce in certain sections of
the country not only due to the flu, but because
of managed care issues and others temporarily
closed due to Superstorm Sandy.

This is an interesting topic and certainly there
are many sides to it. I want to personally thank
Elliott for bring it up in this forum.

Paul Kesselman, DPM, Woodside, NY,
drkesselmandpm1@hotmail.com

Other messages in this thread:

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11/13/2009    James J DiResta,DPM,MPH

Podiatrists and Flu Shots (Elliot Udell, DPM)

I just wanted to punch in on the comments re:
podiatrists involvement in H1N1 and seasonal flu
vaccine program. This problem is a far greater
issue then it might first appear. I understand
fully the concerns on the scope of practice
issue, poor reimbursement and the burden of
increased paper work. All road blocks for
change.

In my opinion, these concerns are unfortunately
shortsighted. If you want your profession to
move forward you cannot detach yourself from
public health concerns. If you ever want to
achieve parity with medicine you must
embrace a change in your practice behavior to
include public health. You should perceive your
daily work entwined with public health
initiatives.

What day goes by that you are not confronted
with podiatric concerns directly involved with
patients needing smoking cessation,
addressing the problems of obesity, advising
children about injury prevention on the playing
field, better diabetes control, elderly adults
about fall prevention and osteoporosis?? All
major public health issues.

So, when it comes to flu and the H1N1 scare you
should at the very least educate yourselves as
to who is at risk and who should or should not
be vaccinated and discuss with your
patients. If they are surprised that you know
anything about the subject, ask yourselves why?
How do these patients who trust the care of
their foot health to you not realize just who
you are?

I'm certain they would assume any other medical
specialist would know about flu vaccine. Of
course, they are doctors. Why not you their
podiatrist? Administering a flu vaccine is not
rocket science and a service that we as
healthcare providers and physicians are
more then capable of doing. How unfortunate for
public health departments and officials to look
to dentists and pharmacists and ignore
podiatrists when serious health concerns need to
be addressed and where are we standing on
what could have been a major public health
problem?

Worrying about how much we are going to get paid
or our liability exposure? So far, the comments
I've read on PM News only reinforce this selfish
behavior. So when you wake up and you hear or
read comments by elected politicians and public
health department officials who haven't a clue
on your training and capabilities and don't
recognize you as a doctor don't be surprised
because you don't perceive yourself as one
either.

Jim DiResta, Chair-elect, APHA Podiatric Health
Section

James J DiResta,DPM,MPH, Dept. of Surgery
Anna Jaques Hospital, Newburyport, MA,
James.J.DiResta.DMS04@Alum.Dartmouth.ORG