12/27/2014    Lawrence M. Rubin, DPM

Becoming a Certified Foot Care Nurse (Stephen Peslar, BSc, DCh)

I believe the answer to Stephen Pessler's question
about whether podiatrists have opened the door for
nurses to treat "minor" foot problems is an
unequivocal "Yes." There is a need and a public
demand for medical care of minor foot problems. If
podiatrists in any locale are not willing to
provide it, others will.

Much of this relatively recent "door opening" to
nurses has to do with economics. With past
insurance payments for surgical services being
generous, and with little or no out-of-pocket
expense for patients motivating them to opt for
elective foot surgery, many podiatrists equipped
themselves with the education and training
necessary to perform as much major foot surgery as
possible.

There are only so many hours in a work day, and
after investing in all the education and surgical
training, and with patients and insurance payments
plentiful, spending time providing "routine" and
other minor foot care did not make a lot of
financial sense. The result is that the podiatric
focus on major foot surgery has opened the door
for for foot care nurses and others who are very
happy to spend their work day providing minor foot
care.

There is irony in this, because times have changed
dramatically, much due to "Obamacare." Huge
deductibles are causing many patients to opt out
out of elective surgery, and constantly declining
insurance payments for the surgery that is
performed has now decreased the profit that was
previously attainable in the major surgery
oriented practice. The major surgery-oriented
podiatrist is not necessarily earning a greater
livelihood than the podiatrist with a large volume
practice working with well trained assistants to
perform lots of "minor" ingrown toenail "I&D's,"
nail avulsions as part of the treatment for
onychomycosis, chemocautery of verrucae,
dispensing prefab orthotics, and other relatively
"minor" care.

Lawrence M. Rubin, DPM, Las Vegas, NV

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