President's Perspective June 2015

Richard Derner, DPM FACFAS

"Roads? Where we're going, we don't need roads."
Back to the Future
Richard Derner, DPM, FACFAS
ACFAS President

There is no question that our profession has matured and grown over the years. With the steady enhancement of our education, training and certification (especially the standardized three-year residency), full professional parity is inevitable . . . yet one roadblock remains.

There are now only four states in our national union that have not included the diagnosis and treatment of ankle pathology in their podiatric scope of practice: Alabama, Mississippi, South Carolina and Massachusetts. Each state has worked hard to overcome the shortfall, some more than others, but the question I ask is, Who will be last? Forty-six other states, of all sizes and political influences, have successfully navigated the political waters to gain this important law. Why can’t they?

In 2012, Augusto Sarmiento, MD, writing in the Journal of Bone and Joint Surgery about the potential shortage of orthopaedic surgeons, admitted that podiatrists were then performing all types of highly technical surgical procedures, including fractures of the Tibia, ankle, os calcis hindfoot and forefoot. He said, “(Podiatrists) have become experts in the field to the point that it is ludicrous to argue that their qualifications do not allow them to cover such a wide territory.”

This is not a unique view held by one orthopaedic surgeon; it is a widely known and accepted fact by patients, 46 legislatures, many courts, and yes, by many orthopods. The technical ability of the foot and ankle surgeon is not the issue. Like many other scope battles, for MDs this is a turf issue, an economic issue and nothing else. If patient care were the main concern for those opposing this issue, they wouldn’t have a leg, let alone an ankle (sorry for the pun) to stand on. I say, if this is a patient care issue, show me the evidence. Show me the maimed, show me the bodies. If not, admit that all you’re doing is slowing and preventing quality patient care.

It is time for the four remaining states without ankle in their scopes (and the profession as a whole, especially the College) to put forth a concentrated effort to make it unanimous in all 50 states. Why is it important to those of you in the 46 states? Because without uniformity of state scopes, we will always be one inch shy of the goal line: total professional parity.

This is 2015, the year APMA’s Vision 2015 set as the goal to achieve total professional parity. While there’s work yet to be completed, great strides have been made since Vision 2015 was launched in 2008. Let us use this target year as an incentive to get the job done in Alabama, Massachusetts, Mississippi and South Carolina. If state legislators in the most recent ankle converts (Connecticut, Kansas, New York, etc.) could be convinced, why not these last four states? In some states it took a three-year surgical residency requirement . . . or ABFAS rearfoot certification requirement . . . to win allopathic support. If that’s what it makes, ACFAS would support that compromise to get this job done.

Hopefully, we can then close the door on this decades-long march. And, as we do, a new parity door is now opening. In California, the Joint Licensure Initiative between the DPM, DO and MD communities is nearing resolution. The prognosis is that a common medical and surgical license for all three medical professionals may be achieved within the new two years. And then we’ll start our next march, to achieve similar licensure in the other 49 states.

Every journey starts with a single step. Let’s take the last few steps on ankle scopes expeditiously because we’ll have a new journey to start in the not too distant future!

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