07/12/2024
RESPONSES/COMMENTS (SCOPE OF PRACTICE)
From: Steven Kravitz, DPM
The ability for podiatrists to treat systemic disease affecting the lower extremity, especially the leg and foot is generally accepted in the medical community based on our current level of training. The question pertains more to the point of the amount of systemic treatment required by the specific case.
Generally speaking, good quality practice requires podiatrists to have good general knowledge of systemic disease affecting the lower extremity. This does not mean that we have to independently treat these conditions. I generally referred neuropathy, vascular disease, and similar cases to appropriate specialists, and generally, cases requiring relatively simple treatment such as various medication, etc. were referred back to me to monitor and follow up. Podiatrists, as all practicing physicians, are not necessarily required to fully treat everything...
Editor's note: Dr. Kravitz's extended-length letter can be read here.
07/11/2024
RESPONSES/COMMENTS (SCOPE OF PRACTICE)
From: Elliot Udell, DPM
The question of whether podiatrists should be allowed to treat any systemic condition that affects the foot is not clear cut. On one hand, would anyone question our right to prescribe antibiotics even though they are either orally or intravenously administered? On the other hand, if a patient presents with neuropathy caused by complicated diabetes, should a podiatrist be allowed to manage the patient's diabetes? What if the neuropathy is caused by a spinal lesion, would we be expected or allowed to operate on the patient's back?
The answer lies in the complexity of the systemic condition and the training to manage it. It takes an internist or endocrinologist many years to master the management of diabetes. I would not allow that same internist or endocrinologist to operate on my back. To sum it up, it’s not the practitioner's title which should govern whether he or she should be allowed to treat a systemic condition with pedal manifestations, but the training to treat such a condition.
Elliot Udell, DPM, Hicksville, NY
07/10/2024
RESPONSES/COMMENTS (SCOPE OF PRACTICE)
RE: Podiatrists Treating Systemic Conditions Affecting the Foot
From: Daniel Chaskin, DPM
In different states, podiatrists are licensed to carry out physical exams that involve ordering tests and other examinations alongside foot care treatments. The APMA and local podiatry groups should advocate for the licensing of podiatrists to manage all systemic conditions linked to any foot condition. The podiatric medical colleges offer a solid base of studies to support this argument. I recall that NYSPMA offered classes in anatomy, neuroanatomy, biochemistry, histology, pathology, internal medicine, and emergency medicine, etc.
If nurse practitioners have the authority to treat the whole body, podiatrists should also have the authority to treat any systemic condition that causes foot symptoms. If nurse practitioners do not remove a patient's shoes or socks during an examination and a podiatrist does, that podiatrist should be the one authorized to treat systemic conditions related to foot symptoms, since the feet are likely to be examined during every follow-up appointment. Patients are protected because a podiatrist’s code of conduct includes not independently treating conditions they lack current competence to treat.
Daniel Chaskin, DPM, Ridgewood, NY
08/18/2023 Ed Prikaszczikow, DPM
Increased Scope of Practice for Podiatrists (Paul Kesselman, DPM)
Thank you to Dr. Kesselman for his explanation of
the many ways APMA is fighting for equitable
reimbursement for its members in response to Dr.
Davis’ concerns. As a final clarification, I would
also like to point out that in 2018, APMA led a
national coalition to help avoid what would have
been a roughly 30-percent reduction in code values
solely for podiatrists. APMA met with employees at
the Department of Health and Human Services to
discuss the proposal to eliminate our ability to
bill for E/M services (which would have been
replaced with lower-paying G codes for
podiatrists). We were victorious in that effort,
and the result is that podiatrists nationwide have
earned hundreds of millions of dollars over the
past five years that otherwise would have been
lost. These earnings alone offset the cost of
member dues.
In response to Dr. Davis’ concerns about the
Medicare Orthotics and Prosthetics Patient-
Centered Care Act, APMA has been a supporter of
this bill and its predecessor. APMA originally
became aware of the bill in 2022 thanks to Dr.
Kesselman, chair of the APMA DME Work Group. The
APMA Legislative Committee reviewed the bill and
determined it would have a positive impact on
podiatry and our patients, so we would make it a
priority bill for APMA to support and push for
passage. Sadly, the congressional session ended
before the bill received a vote; however, the bill
sponsor just recently reintroduced the legislation
with some minor enhancements. APMA’s Legislative
Committee has reviewed the updated text of the
bill and again determined that it should receive
APMA’s support. APMA members can review the list
of bills supported by APMA by visiting
www.apma.org/FederalAdvocacy. This list is updated
monthly, so be sure to check for updates!
Ed Prikaszczikow, DPM, Chair, APMA Health Policy &
Practice Committee
08/16/2023 Paul Kesselman, DPM
Increased Scope of Practice (Lawrence Rubin, DPM)
Some corrections are required to clarify the DM,
ultrasound, and CTP issues:
1) Same or Similar and DME: APMA has been very
proactive since the date this policy reared its
ugly head. APMA has met with every medical
association involved with DME We have submitted
multiple rounds of documentation to attempt to
resolve this. I have worked with AOPA on their bill
to be sure it would not be harmful to DPM and
rather be supportive APMA has been calling for a
ban on drop ship orthotics for years and this is
now part of the proposed legislation.
2) APMA has a seat on the DME Medicare MAC councils
which meets with all four DME MAC. Having this
ability we have made sure that the portals are up
to date and provide free information which
specifically addresses the same or similar. Please
register to these portals. I have a 1:1
relationship with many of the higher ups at all
four DME MAC, the enrollment carriers, and
more. All of which has served to assist many
members with DME issues.
2) APMA has a seat at the RUC where the Ultrasound
Issue was brought up by the ACR. They did not
specifically target DPMs. Their aim was focused
against ortho, rheumatology, sports medicine,
neurology, etc. I can only assure you that APMA
worked with these organizations against these new
policies pushed by the ACR.
What is very important is that if you receive a
questionnaire on CPT codes from APMA and/or the
RUC, you should participate and respond.
This is your opportunity to be proactive!!! Often
our colleagues' failure to respond to these
questionnaires can be responsible for negative
responses from CMS and ultimately our payors..
3) Regarding to the recent CTP policy, APMA does
interact with many other medical associations which
provide and/or manufacture CTP. This council of
providers was largely responsible for delaying a
much worse policy last year than what was just
recently announced.
What we can't be proactive on is things that CMS
suddenly dreams up and throws at us. For all of
these issues, it is important to note that working
alone and being proactive or reactive alone, is far
less effective than working alone!
For all of the reasons above reasons, one should be
a member of APMA.
Paul Kesselman, DPM, Oceanside, NY
08/15/2023 Eddie Davis, DPM
Increased Scope of Practice for Podiatrists (Lawrence Rubin, DPM)
Dr. Rubin asked me to suggest means by which APMA
can improve it’s overall value. Dr. Rosenblatt
opined that APMA has done as well, if not better
than AMA and “their specialty Boards.”
AMA does not have a large membership base. AMA
financial support is largely derived from
publishing revenues and database sales:
https://www.citizen.org/wp-
content/uploads/hl_201211.pdf About 15 to 18
percent of MDs belong to the AMA:
https://www.physiciansweekly.com/is-the-ama-really-
the-voice-of-physicians-in-the-
us/#:':text=In%20fact%2C%20it%20is%20estimated,for%
20the%20views%20of%20doctors.
I believe that Dr. Rosenblatt was thinking about
specialty organizations because that is where MD
membership is high. The MD specialty organizations
such as the American Orthopedic Association (AOA),
American Academy of Orthopedic Surgeons (AAOS),
American College of Radiology (ACR), American
Academy of Dermatology (AAD) as well as the other
specialty organizations are strong advocates for
the their members and generally enjoy excellent
membership.
I don’t need to remind our colleagues about the
role of the AOA with respect to podiatry hospital
privileges, reimbursement issues. The ACR noted
the advances in diagnostic ultrasound equipment
over the last two decades, initially bemoaned
inadequate reimbursement rates only to later
express concern that increased adoption of
ultrasound was a threat to MRI utilization. That
led to ACR seemingly opposing podiatric utilization
and a reduction of reimbursement. APMA failed to
“fight the good fight” on this issue. APMA also
failed to inform members about this issue, to the
best of my knowledge. Diagnostic ultrasound
reimbursements were cut significantly and, within
one year after that occurred, the exhibitors of
ultrasound equipment at our conventions and
meetings seemingly vanished.
Podiatrists discuss the issues of routine foot care
ad nauseum while the dermatologists use codes such
as the 113xx series, biopsies with seeming
alacrity, supported by their specialty
organization. I am not trying to open a discussion
on this issue, nor pass judgement on the veracity
of how they are billing, just making a point with
respect to how professional specialty organizations
support the ability of their members to be
reimbursed.
The ENT organization lobbied to obtain increased
reimbursement of office-based balloon sinuplasty.
Endovascular specialists lobbied to obtain
favorable reimbursement for office based
procedures, office based labs. The list of such
efforts is long. Podiatry has its roots in office
based treatment. What has APMA done to secure fair
reimbursement for procedures that we perform in the
office?
The ability to be paid fairly for one’s services is
fundamental to our success. We are generally paid
less than orthopedic surgeons for the same CPT
codes by private insurers. What has APMA done to
secure parity in reimbursement?
Beyond reimbursement rates, consider issues of
utilization of services. One example is the
provisioning of ankle foot orthotics by DPMs.
Doug Richie DPM educated our profession on AFOs and
provided AFO designs that were, in many cases,
superior to those which patients could obtain from
O&P shops.
Unfortunately, misinterpretation of the “same and
similar” rule by DMERC carriers has restricted our
ability to provide this essential service. I have
expressed my concerns about this issue to APMA and
our state organization to no beneficial effect.
Fortunately, the O&P industry has supported a bill
introduced to the House, the Medicare O&P Patient-
Centered Care Act (H.R. 4315) was introduced on
Friday, June 23.
The American Orthotic & Prosthetic Association has
a description of the bill on it’s Federal Advocacy
page: https://www.aopanet.org/legislative-
regulatory/aopa-advocacy-on-behalf-of-you/ I
became a bit frustrated with the lack of
information from APMA on it’s perspective and
perspective support of this legislation and emailed
Scott Haag at APMA Legislative Affairs on July 11.
I have not received a response from him to date.
Another area that affects podiatry with respect to
the ability to be reimbursed is the National
Correct Coding Initiative (NCCI). NCCI creates
policy that bundles charges that it maintains
should not be billed separately. Like all
organizations or entities, this entity is subject
to lobbying by provider groups. NCCI often bundles
services inappropriately and we need to know the
role of APMA with respect to addressing such
issues. A good example are total contact casts. A
patient with a diabetic ulcer requires wound care
and offloading simultaneously.
Failure to off-load a diabetic ulcer is a violation
of the standard of care yet NCCI disallows
application of the total contact cast when wound
debridement is performed at the same visit. So are
we to give the patient a set of crutches and tell
them to come back to the office on a subsequent
visit just to get reimbursed? We could provide a
CAM walking boot instead but that is noncovered for
treatment of off-loading a diabetic ulcer. What is
APMA doing to fix this and other NCCI issues? What
is it doing to allow podiatrists to be fairly
reimbursed for offloading diabetic ulcers?
Eddie Davis, DPM, San Antonio, TX
08/03/2023 Eddie Davis, DPM
Increased Scope of Practice for Podiatrists
Podiatric medicine scope of practice relates to
the specific area of the body we treat akin to
dentists. We achieve some latitude with respect to
use of terms like "foot and related structures."
I understand the frustration of those who see too
few podiatrists supporting state and national
organizations but one must ask why that is so.
Members need perceive that such organizations are
acting in their best interest in order to be
motivated to belong. I have been an APMA and state
member since 1982 but often ask myself why.
Answers like, "that is the only organization we
have" just aren’t sufficiently compelling.
If I have an issue of concern, I can get more and
better answers from colleagues than calling our
official organizations most of the time. Major
issues such as those with respect to reimbursement,
reimbursement parity just are not adequately
addressed by our organizations in my opinion. Our
organizations need survey members to see what their
main concerns are. Our organizations need to speak
to non-members to see what their concerns are and
why they are not members - most importantly. I
often encounter anger from organization leaders
when I mention the latter. The non-members are not
slackers nor ingrates and need to be listened to.
Years ago, a bill was introduced into the
Washington State legislature, at the request of a
podiatrist who was a non-member of the state
organization. The bill granted DPMs the licensure
to act as physicians assistants. It was met by
opposition from the state association and did not
become law. The basis of the opposition was a
perceived "lowering" of our status as independent
practitioners. It was not brought up for
discussion among members. Certainly, our training
far exceeds that of mid-level practitioners so why
not be comprehensive doctors of the foot and ankle
while being able to treat the rest of the body
under MD supervision? It could have been a
stepping stone to better employment opportunities
and further scope advancement. Sometimes the best
strategy is not a full frontal assault but a
flanking maneuver.
Eddie Davis, DPM, San Antonio, TX
07/22/2022 Randall Brower, DPM
AMA and Podiatry’s Scope of Practice (Allen Jacobs, DPM)
Dr. Jacobs: You have been an amazing addition the
podiatry world. I hold you, my residency director,
Charles Kissel, and others like you in high esteem
for the selfless time and energy you have put into
our profession. Your lived experience is your lived
experience I would not dare to call that into
question. I would like to share with you, however,
that my lived experience and others like me, are
vastly different than yours.
I have been in practice for 18 years. I went to
DMU, in Iowa. The first 2 years of basic science
were the exact same as our DO colleagues. In fact
we were not separated except when they did OMM
(skeletal manipulation), psych and OB (3 classes).
WE took the same tests in every subject, the same
finals, and there were podiatrists who did take the
DO board exams and passed.
I did my PSR-36 residency at Detroit Medical
Center/Wayne State University under Charles Kissel,
DPM. We were under the department of orthopedic
surgery. The first year of residency we did the
same 6-week rotations as our Ortho and surgical
resident colleagues. ER, ICU, medicine, general
surgery, trauma surgery, vascular surgery, plastic
surgery, neurosurgery, anesthesia, and pathology.
In every single one of those rotations, we were
treated exactly the same as our Ortho, medicine,
and surgical resident colleagues. We did the same
procedures, worked up and were required and
expected to manage ICU patients, run full medical
codes on in-patients at 2 in the morning as the on-
call resident. Our colleagues treated us equally
as they were given equal expectations.
Ask any current Ortho colleague of yours if they
write for BP medications, prostate meds, psych
meds, OB meds. Nor do they treat anything that is
not directly orthopedically related. They refer out
for DVT's that happen under their watch. They
refer out for CRPS. They refer out for osseous and
soft tissue cancers. They refer out for
osteoporosis.
I am confused by your use of the word parity
MD/DOs are all specialized anyway and only treat
and manage their specialty anyway and rarely step
out of that specialty and can face legal challenges
if they do. So they end up functioning like
podiatrists in the end, anyway. The only way we are
not equal i in reimbursement from insurance
companies. That is criminal. It is the reason I
struggle to support the APMA.
Again, my lived experience. I appreciate yours. I
just respectfully disagree.
Randall Brower, DPM, Avondale, AZ
07/22/2022 James J DiResta, DPM, MPH
AMA and Podiatry’s Scope of Practice (Allen Jacobs, DPM)
I read today comments by two of our most esteemed
podiatrists Drs. Allen Jacobs and Bryan Markinson
on podiatry's scope of practice. I'm certain they
are very honest in their comments but their remarks
are discouraging. These are two very bright and
wonderful people. When you leave their lectures you
always come away proud that you share the same
cherished profession as them. They are smart. Allen
can impress the best of us with his medical and
surgical knowledge and insight. As a student at
PCPM (TUSPM) in the '70s I listened intently one
day to a lecture he prepared on metal materials for
surgical fixation procedures. When I returned home
that evening, I didn't feel as smart as I did that
morning and frankly if I needed a little more
humility that day he provided it. In my podiatry
class at that time was another bright podiatrist to
be, Charlie Arena.
Later, Charlie and I would be residents at
Northlake Hospital but before that time while we
were doing externships our paths crossed at a
hospital in New Jersey. Charlie was on medicine
that month and I was on the orthopedic service. By
chance, I was walking in a hall outside a room
where the externs on the medical service were
meeting and the attending was belittling some of
the medical students as he would ask them questions
and when they couldn't answer correctly he would
then call on Charlie to answer. Charlie continued
repeatedly to nail it answering the questions
correctly. It didn't take long for the attending to
then ask one of the medical students what benefit
would he provide to Charlie and his patients when
Charlie might need medical clearance or
consultation.
I relate this story because I think it's important
to remember we have very bright students in our
learned profession and they need to be encouraged,
as we were, to improve our standing in the medical
hierarchy and to do so requires us to look beyond
our present limitations and to do whatever we need
to do as a profession so that we can expand our
scope of practice. Our limited scope has made us
comfortable as we profess to be equal to our
physician colleagues when we practice within our
limited licensure. However, if we fail to improve
upon this position we presently enjoy then we are
ultimately going to find ourselves further behind.
I don't believe our present position is
sustainable.
It continues to surprise me that as a profession we
have failed to see what PAs and NPs have achieved
relative to both independent practice and scope of
practice. They have positioned themselves well. NPs
certainly took advantage of the recent pandemic and
skillfully increased their scope and independence.
They are not uniformly where they want to be, yet,
but they are well on their way. Drs. Jacobs and
Markinson continue to remind me that our students
are just not equal to medical students but maybe
they ought to be. There are now 22 states that
provide NPs full independent practice. They can own
their own practices, have full prescription
authority, do a number of procedures, be primary
care physicians for third party payers and no
longer have any physician supervision requirements
in those states and many hospitals are changing
their bylaws to accommodate them. I know the AMA is
still applying pressure to hold PAs in under
physician supervision even as their scope of
practice continues to expand but can they be far
behind?
Our education model doesn't align with NPs and PAs.
Our 4-4-3 model although perhaps not equal still
mirrors more to an allopathic and osteopathic
medical school model and we can change our model to
be more in line with theirs and to find a way to
get the DPM degree on some level of equal playing
field with the MD and DO degree. Perhaps we need to
start thinking out of the box. We can improve on
the APMLE to mirror more like the USMLE and COMLEX
and maintain the podiatry elements we need in the
exam, keep it unique to us and at the same time get
independent authority to certify that it is of
equal standing.
There are many routes available for us to follow so
we can reach the position we know we need to get to
but holding everyone back is going to be our demise
and unfair to our new practitioners, residents and
students of podiatric medicine who have invested so
much of themselves in our profession.
James J DiResta, DPM, MPH, Newburyport, MA
07/21/2022 Allen Jacobs, DPM
AMA and Podiatry’s Scope of Practice (Alan Sherman, DPM)
Dr. Sherman‘s quote of Frederick Douglass is hardly
applicable to the “parity” discussion regarding
podiatry and the MD and DO degree. Simply stated,
it is disingenuous to suggest that the medical
education of a podiatry practitioner is an anyway
equivalent to that of an MD or DO. It is not. Dr.
Sherman knows this, PM News readers know this. A
podiatrist is trained to be a limited licensed
practitioner. That is reality.
This is not a matter of political power as Dr.
Sherman suggests. This is a matter of public
safety. It is part of a continuing illusion
perpetuated by some in our profession. The training
of a physician is more generalized and vigorous.
Unlike Dr. Sherman, I have been continuously
involved in podiatric education, and practice. I
treat patients daily. I interact at the clinical
level with fellow practitioners daily. I work
alongside physicians as well as podiatrists daily.
I work with residents in the operating room.
I am very confident that the average podiatric
practitioner provides excellent care for foot and
ankle pathology. That is the purpose for which a
podiatry student and resident is trained. You do
not legislate equality, you do not seize power, and
you do not hold yourself out to the public to be
something that you are not. Misrepresentation of
the education of a podiatry student and resident
will not bring about equality but rather generate
continuing concern in the medical community.
The USMLE examination is the standard by which our
society determines whether or not an individual has
achieved that level of basic medical education to
be allowed to make decisions regarding the overall
health of an individual. Although I have always
been a strong supporter of this profession, the
fact is that I do not believe there is any possible
way podiatry students would pass this examination.
That is a reality with which Dr. Sherman is
apparently unfamiliar.
The continuing claim that the education of a
limited licensed practitioner, a podiatrist, is
equivalent to that of an MD or DO results in
continuing distrust by the MD and DO as well as the
concerned legislative bodies. I attend to
hospitalized patients daily. I am witness to the
difference in responsibilities accorded to the MD
or DO student as that accorded to the DPM student.
I have watched this for greater than 40 years.
Dental practitioners do not hold themselves out to
be equivalent to an MD or DO, yet their expertise
as limited license practitioners is well recognized
and well established. Our profession needs to
accept their position in healthcare. You are well
trained, as a podiatry student, and resident, for
the diagnostic and therapeutic demands with which
you will be confronted with a DPM degree. Our
profession needs to strive to maintain excellence
in the services which it provides. What we cannot
afford is a continued pretense that we are trained
in an equivalent manner to an MD or DO. We are not
and do not need to be.
Allen Jacobs, DPM, St. Louis, MO
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
08/27/2012 Paul Kesselman, DPM
Scope of Practice (Robert Bijack, DPM)
Is Dr. Bijack serious about his opinion on
podiatrists not discussing BMI with their
patients? Is it his interpretation that
podiatrists can't discuss how systemic body
functions and illnesses effect the foot and
ankle?
Why does he limit his opinion to obesity and not
also include smoking, diabetes, hypertension,
high cholesterol and other systemic maladies
which certainly DO effect the foot. I dare say
the average podiatrist sees the ravages of all
of the above on a daily basis.
Most public health policies have the exact
opposite opinion from Dr. Bijack. Why else would
BMIhypertension, smoking, and other systemic
measures be listed as one part of the meaningful
use criteria which needs to be adhered to by
all medical specialties?
What exactly is his definition of the word
discuss(ion)?
If it is an in depth analysis of what causes and
results in the treatment of those conditions
(and more) listed above,nthen I would agree that
only specific specialties should be entitled to
do so. That certainly would reduce every
physicians workload!
That however is contrary to every definition of
the word discuss(ion) and contrary to every
public health care initiative I have
ever read. His definition also promotes that
physicians of all specialties deviate from the
standard of care.
A discussion can be simply be taking notice of a
situation and referring the patient to a
colleague for more in depth analysis and
treatment. This is an action that podiatrists
and every other physician do every single day.
Getting the patient to the expert on a specific
condition starts with a conversation with the
patient. This however does not happen by magic.
It starts with a conversation with the patient
by the podiatrist(or other medical specialist)
who is going to refer the patient to another
source of expertise.
Since I'm not a master of the English language,
I did a bit of research and found:
Conversation and discussion were synonyms.
Not discussing or being silent on an issue were
antonyms.
I have had been privileged to practice for 30
years and serve as an expert witness in defense
of podiatrists in malpractice cases.
Two clear facts remains true. Being silent on an
issue and not referring your patient to another
health care practitioner (when needed) is bad
medicine and often grounds for malpractice.
In the final analysis, podiatrists should not
remain silent on how specific extrinsic
conditions impacts their patient's podiatric
conditions Then refer them to those with the
expertise in treating those extrinsic conditions.
Paul Kesselman, DPM, Woodside, NY,
pkesselman@pol.net
06/28/2012 Fred J. DeLucia, DPM
NY Assembly Passes Expansion of Scope of Practice Law (Jeffrey Kass, DPM)
I find it a tremendous success as well as an
inspiring message what our state association has
achieved through their tireless perseverance,
optimism, and foresight. Personally, I have been
hearing the overwhelming negativity from so many
practitioners over so many years (ever since I
was a student), that our state shall never see
an expanded (rather, a 'corrected') scope come
to pass - "it will never happen" - they used to
say.
To all those who believed this, I hope your
outlook has been changed on a great many things.
A glass is either half full or half empty, and
looking at it half empty helps no one, nor does
it achieve anything. I cannot express how
inspiring it is for me as a young practitioner
to see what can be achieved through hammering
away at something with your head turned away
from the negativity.
Again, the selfless efforts put forth by our
state association members involved with this
committee is a message for ALL practitioners in
NYS - always seek to improve the future without
thought of yourselves. On that note, who
this "helps"..... well, the only answer to that
is simple - it "helps" the future of our
profession in NYS. Period. Whether you're board
certified in surgery or not, it will change the
perception of our specialty overall. Those 15-20
RRA certified will be exponentially increased
over the years to come, and New York is a
perfect place full of pathology to watch this
happen.
We need to keep well trained and interested
people in our state - not running off to other
states for training and practice because ours
falls behind the country's standard. Speaking as
an RRA QUALIFIED practitioner, I can tell you
how true this is. Great job NYSPMA!
Fred J. DeLucia, DPM, Queens, NY,
fred.delucia@gmail.com
06/28/2012 Paul Kesselman, DPM
NY Assembly Passes Expansion of Scope of Practice Law (Jeffrey Kass, DPM)
I tend to agree with Dr. Kass, that on first
look, the recently passed scope of practice bill
potentially creates a two-tier licensing
structure for podiatrists in NYS. At first look
it may be seen as unfair to the vast majority of
DPM's who never had an opportunity to obtain
board certification, or to be trained in a two
or three year residency.
It also may seem unfair to many who have achieved
surgical board certification after a one-year
residency or alternative method. Many of the
latter categories are actually the majority of
us who teach and are attending podiatrists
in two- and three-year residency programs
(myself included). This thought process,
however, is very short sighted.
Without some tangible change in the scope of
practice it is quite likely that Dr. Kass and I
(and several thousand other DPM') would have a
very difficult time selling our practices and/or
attracting associates to our practice. What
was neglected to be mentioned was that the
current bill does allow wound care
to be performed by all licensed podiatrists in
NYS up to the tibial tuberosity, particularly
when the wound starts below the ankle. This
removes the "grey" from treating somevenous
ulcers and many other conditions treated by most
podiatrists in NYS.
This not only implies surgical care but
diagnostic and DME care for those
wounds. This by no means is something to be
forgotten and can result in significant amount
of income whichshould not be left on the table.
The reality is that even if the scope of
practice was broadened to include "ankle
surgery" for all, this would likely not change
the reality for most podiatrists irrespective of
their board certification status.
Hospital and other out-patient facilities need
to be sure they protect the public and I am sure
this was at the uppermost mind of the
legislatures. The reality is that most DPM's
would not be granted ankle privileges by the
hospitals in which we work. This
is simply because we do not have the skills or
training necessary.
Certainly residency training is an excellent
barometer but it may not be the only
barometer.
The language of the bill itself may need some
further interpretation in order to resolve my
(and others) concerns involving minor surgical
procedures (e.g. biopsies) and diagnostic
examinations (e.g. x-rays) and surgical
procedures which do not involve open surgery of
bone (e.g. closed fracture reductions w/o
manipulations on the ankle) or soft tissue
surgeries (e.g. TAL). This should be open to
most surgeons who can show their
abilities to perform these procedures.
Through reliable resources, I have been informed
that such tweaking to the current bill is still
possible. I have it on good authority that
NYSPMA will be providing some more information
to its membership very shortly on all the issues
with respect to this bill.
As one who is involved in the political process
on the national level, I have
learned that most battles we fight are
protracted and no policy or legislation
is perfect. Despite the shortcomings of this
bill, this is a huge victory for
all NYS podiatrists and not just the few who
have been board certified in rear
foot and ankle surgery.
I am proud to say that Dr. Andrew Shapiro was my
student as a resident in a one year rotating
residency and one year surgical residency
dating back to the 1980's. I am very proud that
he has seen this bill as a future for podiatry
and did not look selfishly at what may have been
(or not been) in it for himself (for now).
Rather he and the other leadership of NYSPMA
have seen fit to take a long-term solution to
securing a foundation for the future for the
podiatrists in NYS. I am extremely proud of
Andy, our president Gary Stones, Len Thaler and
all those who worked so very hard with them to
get this bill passed.
The NYSPMA should no longer be looked at by what
they failed to do for you lately (or in the
past) by its membership or by non affiliated
DPMs.
Whatever your past feelings for the association
may have been, this bill may have just have
secured your financial future. For that alone
you should strongly consider putting your past
grievances aside and consider rejoining the
association and consider joining a committee to
continue the success for our profession in NYS.
Other issues with respect to this bill are the
18 month window until this bill takes effect;
I remain concerned that there may be some push
back from the New York State Medical Association
and other specialty groups. I await word from
NYSPMA as to what the next steps for the
membership should be.
One thing for sure is that the current
generation of DPMs, no matter their level of
training needs to show their respect for their
elders. If not for those who came before us we
would not be in the position we are now in.
Let's not take for granted the lessons learned
by our predecessors who had to fight just to get
bedside privileges at community and/or
prestigious tertiary care hospitals. This
valuable lesson needs to be exhibited on a daily
basis so that those who come after us will pay
us with equal respect.
I also agree that there is still much to be done
in NYS in order for DPMs to achieve parity with
our MD and DO colleagues. Some of this may be
may be resolved with title XIX legislation and
some may not.
Podiatrists are not currently considered
physicians in NYS and are subject to the
provisions of the NYS Education Dept. A change
to the provisions of the Health Dept to put us
on par with MDs and DOs is a laudable next
objective.
Paul Kesselman, DPM, Woodside, NY,
pkesselman@pol.net
06/27/2012 Bryan C. Markinson, DPM
NY Assembly Passes Expansion of Scope of Practice Law
New York has a new scope bill. The leadership
has stated in e-mail to the members that they
were offered a bill by the Assembly leader with
advisement to accept it now and have it pass
now. The NYSPMA leadership then went on and
explained that they were assured by the bill's
sponsors that it could eventually be "tweaked"
pending discussions with stakeholders.
The good news is that some level of DPM training
and certification will be allowed to take
advantage of the new scope, which for the most
part will include the coveted osseous ankle.
Those meeting the requirements for osseous ankle
surgery will also be the ONLY ones who can
biopsy a skin lesion or scrape a wart off the
distal leg. It is this insanity that leads
members to feel inadequately represented.
I can attest that the legislative action
committee worked diligently to effect a change
that would encompass as many of us as possible.
With the current passage, i don't even think
that there was enough time given to even have a
small debate. But the NYSPMA leadership was
promised that discussions could follow. The
orthopedists had better politics because it was
a mistake (in my opinion) to make the osseous
ankle the primary goal, which was always the
most contested issue.
I know that they would have relented on skin and
soft tissue structures if we left the ankle out.
I also understand the point of view of view of
going for broke and getting it all (regardless
of how few it would matter to), but it did not
happen that way for us. Well, now we (a few of
us) got the enhanced scope. In fact, it may be
better to have won the ankle now, as the major
battle is over. This now presents an opportunity
for us to show that we can care about each
other.
The state must get the individuals now endowed
with their new scope, whether members or not,
but certainly members, and request that they
state as a group that the qualifications for
osseous ankle need not be the benchmark for
competency in dealing with skin lesions and
wounds. I know for a fact that we can get some
orthopedists and vascular specialists to agree
to that. It will be much easier to swallow than
the ankle, which is now resolved. I am starting
to feel more hopeful than ever.
Bryan C. Markinson, DPM, NY, NY,
Bryan.Markinson@mountsinai.org
09/30/2010 Robert Bijak, DPM
AZ Scope of Practice (Charles M Lombardi, DPM)
In answer to Dr. Lombardi's questions to me.
First: No, I never started a residency. In my
day, most podiatrists were lucky if they could
get THEMSELVES in a small DO hospital and do a
simple Mc Bride. Most podiatrists, then, had
little or no training post podiatry school
themselves. The schools left us out in the
cold.
Second: have you ever mentored a student or ever
talked about podiatry. Yes, I have. I told them
in all honesty, if they could get into medical
school go there first. I told them about the
political infighting in podiatry. I told them
about the reluctance of the profession to work
for a full scope license, the lack of parity,
and how podiatrists in states with leg laws were
looked upon as podiatric royalty. I told them
about different state licenses. on the plus side
I told them they would be able to write limited
prescriptions and do surgery if they landed a
surgical residency and if they passed the ABPS.
Third: Did I lobby for increased scope? That
would be disingenuous unless we had increased
training to match the new scope, plus I do not
believe in being extorted by politicians. Fourth
question, have I attended forums for advancement
of the profession. I've attended forums on
podiatric profits and arch support seminars, but
am not aware of many specific seminars dedicated
to advancement. I do not consider project 2015
advancement. I've also found that if your
philosophy differed from those in power you were
not getting far on committees.
You say you see no effort of me advancing the
profession. I did well in school, was
professional in practice, did not "sell"
anything and passed on my pre-podiatry medical
knowledge in an era when podiatrists were rare
in hospitals. I hope my years in practice
advanced the profession where it's most
important for recognition, at the grass roots
level. Most podiatrists practice quietly sans
politics and make up the fabric more than the
baroque buttons of our profession.
If the front line podiatrists aren't trained in
general medicine and can't speak with the MD's
at their level the profession won't advance
despite endless meetings and walkathons. I was
active in my early years but found those in
political positions were content with having a
nice business and extended efforts were answered
by the podiatric plenary phrase, "if you wanted
medicine you should have gone to medical
school". I was actually elected president of my
local society but disqualified because I
wouldn't pay dues to the state society.
Perhaps Dr. Lombardi would like to list the
criteria he approves for someone to have an
opinion. This would be consistent with podiatric
power. And, with all due respect, Dr.
Lombardi's name and accomplishments are not a
household word with me either, but I would not
criticize him "ad hominum", only his
philosophies.
Robert Bijak, DPM, Clarence Center, NY
rbijak@aol.com.
04/28/2010 Jon Purdy, DPM
Scope of Practice (Barry Drossner, DPM)
There is always an ongoing discussion on our
scope of practice and medical field inclusion.
Dr. Barry Drossner noticed podiatry was
eliminated from a medical media conversation on
foot ailments. Whenever a patient asks me,
which they often do, what type of doctor is best
at treating a certain foot condition, I give the
same answer, a podiatrist. I also inform them
that there are orthopedic surgeons who have done
fellowships in foot and ankle surgery. If the
orthopedic doctor did a fellowship and has had a
number of years of experience in foot and ankle
surgery, I’m sure they too would do a fine job.
I encourage my patients to get second opinions
and to question the training of their doctors –
including me. I also tell them, if that doctor
seems offended by your questions or wanting of
another opinion, you then know you are at the
wrong doctor’s office.
Just the other day, as I arrived for my first
surgical case at the hospital and noticed the OR
board listed a new doctor. I asked my scrub
tech who the new GI doc doing the colonoscopy in
room three was. The conversation went, “Oh,
that’s doctor M. You mean doctor M. the family
practitioner here in town!? I asked how the
hell he got privileges to do an invasive
procedure. I found myself surrounded by other OR
staff tying to include themselves in the
conversation. They thought maybe I knew
something more as he only shows up in the OR
once every year or two.
There is no way you can convince me this guy
knows what he is looking at with any accuracy,
and if he does find something he would know what
to do with it. Even worse, what would he do if
he perforated the bowel? Yet, this hospital is
more than willing to get him a room in the OR
and let him tinker with patients, all because he
has an MD behind his name.
Because podiatrists are less familiar to the
general public, and even though you may have two
hundred bunionectomies under your belt, we
apparently need further scrutiny before the
hospital will let you put your hands on a
patient. Podiatry already has the framework of
post-graduate and residency training like that
of every other medical degree. In my opinion, it
would be extremely easy to convert to the MD or
DO degree with a DPM specialty. Is it politics
that is holding us back? Are egos at stake? Is
it the money? I can imagine there is a way to
maintain egos, not remove any money from
pockets, and assure those who are resistant,
they could keep their power positions. It’s time
to move on and up.
Jon Purdy, DPM, New Iberia, LA,
podiatrist@mindspring.com
03/21/2008
PODIATRIC SCOPE OF PRACTICE NEWS
Scope of Practice Definition Could Force TX Podiatrist to Quit
A state appeals court recently sided with medical doctors when it determined that the state board that licenses podiatrists exceeded its authority in defining the ankle as part of the foot. "You don't have an ankle," said Mark Hanna, a lawyer for the Texas Podiatric Medical Association. "The foot actually includes the ankle. If you took the foot off the leg, there is nothing lying there that's the ankle."
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|
Dr. Thomas Zgonis |
San Antonio podiatrist Thomas Zgonis completed four years of training after podiatry school and specializes in reconstructive foot and ankle surgery. "I have saved all these diabetic patients' feet" from being amputated, he said. "All of a sudden you wake up one day and you question this?"
Zgonis said he will have to quit his practice if he has to cut off his practice at the ankle. "It would be a disaster. These people are crazy," he said.
Source: Associated Press [3/19/08]
03/04/2008 Stephen M. Meritt, DPM
CME and Scope of Practice (Remember the Knee)
RE: CME and Scope of Practice (Remember the
Knee)
From: Stephen M. Meritt, DPM
A lot of conversation has arisen lately about a
CME course given in Florida in 2005. Many of the
views that I have heard were negative toward the
originator of the course, Dr. Bret Ribotsky,
because the course was titled Remember the
Knee. Perhaps a few people have lost sight of
the overall role of our profession.
As podiatric physicians who specialize in the
foot and leg, it seems to me that a thorough
knowledge of the anatomy of the lower extremity
is paramount. We make orthotics and prosthetic
devices and perform surgical procedures on the
foot, ankle, and the lower leg which can alter
the function of the knee and hip. It is
therefore, incumbent upon us to know the anatomy
and understand examination of the knee and hip,
even if we dont actively treat them.
There have been numerous occasions when one of
my orthopaedic partners, a joint replacement
surgeon, has sent me one of his patients. He
requests orthotics to alter the stresses that
his patients are putting on either the medial or
lateral side of their knee joint replacement. I
need to know and understand the problems that
his patients are having with their knee
replacement in order to prepare a proper and
effective orthotic device. I get this knowledge
by studying texts, attending lectures on knee
and hip arthroplasty, and taking various CME
courses that relate to the lower extremity. This
doesnt mean that I intend to do knee or hip
surgery.
Several months prior to the course that Dr.
Ribotsky prepared on Remembering the Knee, the
Florida Podiatric Medical Association presented
its own knee course at the Scientific and
Management Seminar (SAM). The Chairman of the
Orthopaedic Department of the University of
Florida College of Medicine, Jacksonville along
with several of his orthopaedic residents
provided a hands on workshop on doing knee
examinations. Dr. Ribotskys one-day course was
taught by two orthopaedic surgeons, two
rheumatologists, two orthotists/prosthetists and
two podiatrists. Knee surgery was never a topic.
Both courses were an excellent learning
experience.
It is unfortunate that some individuals within
our profession feel that Dr. Ribotskys course
was the cause of the current challenge by the
FOS and AMA toward our profession. Those of us
on the front line in this challenge in Florida
do not harbor such feelings. We have long known
of the antipathy of a few physicians and that
predates anything done by Dr. Ribotsky. Bret
Ribotsky has been lecturing to our profession
for many years and has always provided us with
the most up-to-date information on the subjects
most needed in a CME program. I would like to
thank him for his efforts on behalf of our
profession.
Stephen M. Meritt, DPM, Jacksonville, FL,
stephen.meritt@jax.ufl.edu
05/07/2007 Ross Taubman, DPM
AAOS Provides Grants to Limit Podiatrists Scope of Practice (James DiResta, DPM)
RE: AAOS Provides Grants to Limit Podiatrists
Scope of Practice (James DiResta, DPM)
From:
It is certainly dismaying to see this type of
activity by our orthopaedic colleagues.
However, we must look at this as a possible
opportunity to change the culture in organized
medicine. The American Podiatric Medical
Associations Vision 2015 Plan provides a
blueprint for "action" by your APMA, your State
Component Societies, and you, our grassroots
members, to deal with these types of
activities.
APMA has and will continue to pursue dialogue
with other national medical organizations to
recognize DPMs as physicians based upon our
education, training and experience. Several of
these meetings have already occurred between
your APMA leadership and the highest levels of
leadership within the AMA, AOA. AAOS and AOFAS.
We have identified numerous areas of common
interest and a few contentious areas, and future
meetings are planned to continue our dialogue on
all the issues.
As part of our agenda, the path to achieving
recognition by organized medicine is being
discussed. Additionally, we continue to seek
common areas of collaboration between AMA and
medical specialty societies and APMA to
demonstrate that we deserve to be valued as a
specialty of medicine. Current examples of our
collaboration are inclusion in the current AMA
specialty society practice expense survey and
our continuing activities at RUC and CPT.
On a state level, every state component and APMA
affiliated organization must take the lead of
our components in California and New York (to
name a few), to initiate, foster and secure
meaningful relationships with state and local
medical and specialty societies. For many of
us, the only time we intersect with these
organizations is when we are in disagreement
with each other. To be candid, we are in
agreement on most issues with these
organizations, save the all important scope of
practice issue. We have an obligation to reach
out to them and work together when the issues
are central to us and our patients. This is
clearly the example set by the CPMA.
On a grassroots level, every podiatric physician
must do their part for parity to be achieved
First, there is no longer any valid excuse for
any podiatric physician to remain a non-member
of APMA. Whatever your past reasons for not
becoming a member were, they are dwarfed, in my
opinion, by necessity for unity in our
profession to achieve parity. Secondly, you, as
an individual, must interact with your
allopathic and osteopathic colleagues in your
daily practices, including at your hospitals.
They must know who you are and what your
practice means to the care of patients in this
country. We cannot afford to stay locked away
in the safely of our offices and count on
patients to sustain us.
Finally, political action is central to ensuring
that State and Federal legislators know who we
are and what we do for our patients. You have an
obligation to contribute to the APMA PAC and
your local State PAC. Most importantly, you
must get to know your local Representatives and
Senators so that you can be a trusted confidant
when health care issues arise. You must continue
to keep them abreast of our issues through
APMAs eAdvocacy. The time for action is now.
This requires a team effort.
Ross E. Taubman, DPM, APMA President-Elect,
Clarksville, MD, retaubman@apma.org
05/15/2006
NYSPMA Members Lobby Legislators on Scope Of Practice and Parity
NYSPMA Members Lobby Legislators on Scope Of
Practice and Parity
Over one hundred members of the New York State
Podiatric Medical
Association (NYSPMA) met with lawmakers in
Albany on May 9th to
deliver a vital messages to law makers affecting
the future of
podiatry in New York StateNew York must expand
its scope of
practice, currently limiting podiatrists to
treating the foot alone,
and expand it to include soft tissue to the knee
those areas that
podiatrists are trained to cover.
NYSPMA held meetings throughout the day with
leadership of the
senate and house as well as its key committee
chairs. "The
podiatrists made lasting impressions. We have
committee leaders who
have committed to taking ownership of the scope
of practice bill in
particular," commented Dr. Ed Buro, NYSPMA
president. "That means
they will see to it that stakeholders are
brought to the table and
engaged in dialogue about this critical issue,"
he adds.
According to Dr. Vito Rizzo, chair of NYSPMA's
legislative
committee, "the momentum created by lobby day
must continue. He
points our there are only four weeks left in the
legislative session
to convince lawmakers that New York must stop
driving podiatrists
out of New York to nearby states with less
restrictive scope of
practice legislation.
Len Thaler, executive director of the NYSPMA,
comments that the
association has never been closer to seeing its
legislative agenda
come to pass, but to succeed members must keep
the issues alive.
NYSPMA will assist members seeking to meet with
their legislators at
home. "All podiatrists can communicate their
opinions quickly,
easily and electronically by visiting
www.nyspma.org and clicking
the legislative action button. It only takes a
few minutes to send a
message," Thaler urged.
03/06/2006
ACFAS Board Opposes Florida Scope of Practice Bill
ACFAS Board Opposes Florida Scope of Practice
Bill
The American College of Foot and Ankle Surgeons
(ACFAS) Board of
Directors has announced that the College stands
in formal opposition
to Florida House Bill 575, which would
unnecessarily narrow the
scope of practice for podiatric physicians in
the state of Florida.
The motivation for the introduction of this bill
appears to be about
marketplace dominance and protecting income and
not about the
competency of podiatric physicians.
The College is aware that the Florida law since
1933 (full foot and
leg including surgery of the entire leg) has not
changed except one
time in 1979, when the tibial tubercle
limitation for surgery was
enacted. The First District Court of Appeal made
this point clear in
2001 that there has been no practice act
expansion in the treatment
of the foot and leg. Florida's scope of practice
for podiatric
physicians has existed in its current form
without incident or issue.
A hospital cannot reduce a surgeon's privileges
without a fair
hearing. This is considered a sanction and
normally a mandate must
exist that would justify this, such as an
immediate risk to the
welfare of a patient, for a hospital to invoke
this clause. This is
uncommon and normally confined to acts of gross
malfeasance.
By attempting to reduce the long standing
current scope of practice
for podiatric physicians in Florida, the ACFAS
believes they are
essentially diminishing the current hospital
privileges held by its
members, in seeming violation of their due
process rights.
HB 575 is a step down a very steep and slippery
slope and would be a
dangerous precedent. The ACFAS Board of
Directors believes strongly
this bill must be conclusively defeated in its
entirety. ACFAS is
working with various stakeholders, such as the
FPMA and will provide
appropriate assistance as requested.
01/12/2006 W. David Herbert DPM, JD
FPMA to Fight Proposed Limitation of Scope of Practice
RE: FPMA to Fight Proposed Limitation of Scope
of Practice
From: W. David Herbert DPM, JD
I am concerned when I hear that a state may
attempt to restrict the right to practice a
profession. For years the courts have considered
the right to practice a profession a type of
property right. I believe any state action to
limit the right to practice podiatric medicine
could be subject to the "takings" clause of the
fifth ammendment of the U.S. Constitution. To
properly employ this argument a constitutional
scholar should be consulted.
W. David Herbert DPM, JD, docnurse5@sbcglobal.net
01/10/2006 Daniel Chaskin, DPM
FPMA to Fight Proposed Limitation of Scope of Practice
RE: FPMA to Fight Proposed Limitation of Scope
of Practice
From: Daniel Chaskin, DPM
I am questioning if any current state
antidiscrimination statutes exist that would
prevent the reduction of the scope of practice
within a particular state? How can a podiatrist
who is already practicing in a state then tell
his/her patients "I cannot continue to treat
this condition I have been treating because the
state law changed?" What about continuity of
care for the patient? How can the scope of
podiatry ever be reduced in any state?
Daniel Chaskin, DPM, Ridgewood, NY,
podiatrist1@optonline.net
Editor’s comment: We believe that as the
education and training of podiatrists increases,
so should the scope of practice. Recently
orthopedists mounted a scope of practice attack
in Texas and lost (pending an appeal). We are
hopeful that FPMA will prevail.
01/06/2006
FPMA to Fight Proposed Limitation of Scope of Practice
FPMA to Fight Proposed Limitation of Scope of
Practice
The Florida Medical Association and Florida
Orthopaedic Society have, through
Representative Rene Garcia, introduced HB 575 to
limit the scope of practice of podiatrists. A
companion bill is expected to be introduced in
the Florida Senate. The proposed legislation
would change the words “foot and lower leg”
to “foot and ankle.”
The Florida Podiatric Medical Association is on
top of this situation and through the efforts of
its Legislative Committee and lobbyist are
developing a strategy to ensure this legislation
does not pass.
