06/14/2021    Paul Kesselman, DPM

Scope of Practice of Nurse Practitioners (Bryan Markinson, DPM)

Having shared an office with a PCP for over
thirty five years and practicing podiatry for
just a tad longer than that and being a patient
of PCP and a myriad of medical/specialists I feel
not only qualified but obligated to respond to
this thread. There is no way that I as a
practicing podiatrist whether I had an MD/DO or
DPM degree that I want to be compared to an NP
nor can I state that I am qualified as they are
to provide primary care. I have seen not only
what the PCP does but what the NP does in the
primary setting as both patient and provider. I
have also been to four different specialists for
a variety of routine issues (nothing serious
fortunately) in the last two months.

When they ask me or I state certain things which
are related to primary care, the MD/DO
specialists immediately state that's not their
area of expertise. The same is true for the NP in
these specialty practices. So why if we are now
pushing for MD/DO equivalency(and whether that is
right or wrong is another story), do we want to
be compared to providing primary care as well as
an NP? It is absolutely dangerous and wrong! Dr.
Markinson's past comments were dead on correct!

I as a DPM don't want to be compared to being
equivalent to an NP.

Are we as DPMs qualified to do certain things
that a PCP can do in a pinch or routinely? Of
course and the PHE certainly proved that. Blood
Pressure, taking weight, height, drawing blood,
starting IVs, administering vaccines are
certainly basic medical tasks that all licensed
physicians (and nurses) should be able to
perform.

Beyond that certain PCP issues such as titrating
thyroid and insulin or oral anticoagulants and
diabetic meds are almost certainly primary care
issues which even the overwhelming majority of
surgical MD/DO specialists such as
ortho, neurosx, plastics, general, vascular etc.
would not want to touch. I dare say even the
medical specialists who are not daily practicing
internal medicine but only providing specialty
care such as pulmonary, GI pathology, radiology)
etc. would not want to touch those and other
issues unless they are also routinely handling
those matters. Furthermore their professional
liability carriers might cover them only for
those areas of their specialty unless they
specifically request primary care liability
coverage, which many medical specialists may not.

So what exactly are my colleagues missing here
about the NP issue? If the MD/DO specialists
don't want to be involved in primary care why
should I as a DPM?

I do agree with Dr. Amer w/respect to the issue
of wound care and the issues regarding our
limitation to the lower extremity. If we are
board certified in wound care and that exam is
the same regardless of your professional degree
then there should be no anatomical limit.
However, state scope of practice(s) would need to
be reflective of that in order for your
professional liability to cover you for such
acts.

That is a very tall order given that even in the
most liberal of states, podiatry has a strict
anatomical limit on its scope of practice.
So merely passing the exam as Dr. Armer appears
to have done, will have any practical effect not
only because of his degree, but because of the
state scope of practice primarily and secondary
insurance.

Which brings us right back to the first
paragraph. Even with an ophthalmologist (as an
example) having a plenary medical license, what
hospital is going to provide privileges and what
professional liability carrier is going to cover
that ophthalmologist from performing a cardiac
bypass surgery, an upper GI endoscopy, performing
a TMA etc.? Dr. Armer is correct regarding not
wanting to provide primary care, but the other
issues he raises are also correct, but will take
a radical change to implement, even with a
plenary license.

Paul Kesselman, DPM, Oceanside, NY

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