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09/07/2013    Bryan C. Markinson, DPM

Podiatrists and Hospital Privileges

The notion that non-surgical podiatrists do not
need hospital privileges keeps popping up in the
discussions involving the residency crisis. This
immature notion is only propagated by selfish
colleagues, period. While our profession,
colleges, and APMA markets podiatry as
the "guardians of foot health," I ask the
following: Doesn't a diabetic foot specialist,
who does not do surgery, have a need to admit
patients for infections, wounds, etc.

Does the removal of a metatarsal head or toe
amputation require 46 initials after your name?
And what of the poor lot of us who have
distinguished ourselves in sports medicine,
dermatology, wound care, infectious disease,
etc.? No role for us in the hospital
environment? WRONG.

Every time this is addressed, chiefs of service
of hospitals state that they exclude no one and
that their colleagues are credentialed according
to documented training and experience. If that
is true, then the discussion about who does not
and who does need hospital privileges should
cease, because just the expression that some
don't is at the core of most of our
problems....and that is that we treat each other
poorly.

Let the practitioner decide if he or she needs
the hospital, and let us credential them fairly,
leaning towards their success. Hiding behind
policies in the name of credentials and
protecting the public is a cop-out.

On the other hand, I also think it is wrong to
take on serious diabetic foot cases in your
office without informing the patient that if
they need hospitalization, that you will not be
able to take care of them. This results in a
dumping on colleagues in the hospital with a
patient unknown to us and the need to engage
other medical specialists not familiar with the
patient. This too is extremely selfish.

I suggest that if you are in that situation,
that you identify a colleague who can take the
patient to the hospital and recommend that the
patient see that doctor for at least an
introductory visit while you continue your care
so that you can discuss your intended treatment
(s). Then if it does not go well,
the "admission" will not be a "back against the
wall situation" for the patient, resulting in a
dumping to the emergency room.

I have seen way too many needless amputations
occur as a direct result of merely sending a
patient to the emergency room to unfamiliar
doctors.

Bryan C. Markinson, DPM, NY, NY,
Bryan.Markinson@mountsinai.org

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