09/15/2023    Richard M. Maleski, DPM, RPh

RE: The Increasing Podiatric Abandonment of “Routine Foot Care" (Fred Ferlic, MD)

I'm somewhat confused by the responses to this
topic. I retired a few years ago, but I believe my
information is current. In Pennsylvania,
podiatrists are prohibited from using ancillary
personnel to cut nails or calluses. Podiatrists
must perform those services themselves, otherwise
they are committing insurance fraud (if sent in to
insurance.) Admittedly this took place years ago,
but in 2008, I spoke with the PPMA about training
my certified podiatric assistant to cut nails and
calluses, and was told that this was fraudulent if
sent in to a third party payer,(billing for
services that I wasn't providing) and allowing a
person to perform services that I was not legally
entitled or licensed to supervise.

I was seeing 40-50 patients daily 4 days per week
at that time, and typically on any given day about
1/2 to 2/3 were "routine care." I was giving up
new patients because my schedule was already
keeping me running at full speed. I purposely
established my practice in my old hometown, which
was a typical economically depressed rust belt
town, so the payor mix was Medicare/Medicaid/self-
pay with a small percentage of commercial
insurance. I had a busy hospital consult practice
for diabetic foot infections/wound care, so the
majority of my surgeries were I&Ds, amputations,
debridements, etc. Not high paying CPT codes.
There was no way that I could afford hiring a DPM
with that practice. It wasn't until I opened a
second office with a partner in a more affluent
area that I was able to hire another DPM.

The point is, until we are allowed to use
ancillary personnel, I don't believe our
profession will be able to thrive as it should. I
don't know what it will take, but until we are
recognized as full-fledged physicians, we will
keep running up against this. Pharmacists use
pharmacy techs to count pills and type labels,
physical therapists use techs and assistants to
apply virtually all of their modalities, dental
hygienists' clean teeth and fill cavities,
physician assistants do almost everything and
anything for the supervising physician. This frees
up time for all of those other providers to devote
time and energy to the management, decision-
making, and surgical interventions that only the
physician is qualified to perform. How are we
going to be able to provide the same type of high
quality medical care if we don't have the time?

Richard M. Maleski, DPM, RPh, Arnold, PA

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