President's Perspective October 2012

Michelle ButterworthScope of Practice: A Restricted Perspective
By Michelle L. Butterworth, DPM, FACFAS, President

While I love living in South Carolina, I do not enjoy its limited scope of practice for podiatric physicians. South Carolina law does not allow a podiatrist to perform ankle surgery and is one of only five states with such a restriction. I moved here in 1999 upon completion of my residency where I was trained in all aspects of foot and ankle surgery, but I chose to move here with the hope that the law would be changed, and I could utilize the full extent of my surgical training.
After 13 years of being intimately involved with the scope of practice battle for South Carolina, I can honestly say I have never been more wrong. We have lost every legislative battle, significant money, and are no better off than when I moved here.
We have educated the public and legislators on our education, training, and certification. We have done our grassroots campaigning. We made our PAC contributions. We met with the orthopaedists and tried to reach a compromise, even going so far as to require rearfoot certification, similar to what recently passed in New York. Bottom line: We have done all and given all that we could.
I say it’s time for a change of strategy. Let’s call it what it is: We are in an economic turf war– and always have been. And you see it in dozens of specialties: anesthesia, psychology, optometry, APRNs vs. MDs, and many others. It has nothing to do with our education, training, or patient safety. It’s a restriction of trade and I think it’s time to get the Federal Trade Commission (FTC) involved.
The FTC is a law enforcement agency charged by Congress with protecting the public against anticompetitive behavior and deceptive and unfair trade practices. When healthcare markets are competitive, consumers benefit from lower costs, better care, and more innovation. Restricted scope of practice acts preclude many podiatric surgeons from performing the full range of services that they were educated, licensed, and board certified to deliver, as well as restrict patient access to their services. Such anticompetitive measures limit competition, impair free markets for healthcare services, risk additional cost increases to our already costly healthcare system, and fail to improve patient safety.
By responding to state-based requests to evaluate state regulatory and legislative proposals that jeopardize or threaten patient access to quality healthcare, the FTC is fulfilling its duty to promote market competition and its benefits.
In just the past few months, the FTC has supported bills to make it simpler for APRNs to serve Kentucky and Louisiana health consumers by eliminating restricted practices. They have also recommended that the Maine Dental Board not impose certain restrictions to dental hygienists. And when the FTC fulfilled its duty, the American Medical Association criticized them, charging that the FTC shouldn’t interfere with states’ rights.
AMA President Jeremy Lazarus, MD, said the FTC does not have the clinical expertise to make judgments regarding the competency of healthcare professionals to perform medical procedures, stating that the “FTC staff are not experts in patient care or safety and should not offer advice on such matters.” If so, then I must ask, “What qualifies our state legislators as healthcare experts?”
I applaud the work of the FTC. Ensuring competition in healthcare is more important than ever as the U.S. seeks to identify and promote cost-effective, team-based models of healthcare delivery. As our population ages and healthcare needs expand, healthcare professionals, such as ACFAS surgeons, must be allowed to practice to the fullest extent of their education, training, licensure, and certification.
In the late 1970s the FTC overcame strong objections from the pharmaceutical industry and mandated generic prescribing. The sky did not fall on Pharma then, nor would the sky fall on any medical practitioner today if the FTC mandated free and unfettered patient access to healthcare practitioners who are, in fact, even better trained in their subspecialties than MDs.
It’s predicted there will be a huge shortage of healthcare practitioners when all Americans gain access to health insurance. If the AMA refuses to acknowledge that their 19th century vision of MDs being the only medical providers on the planet is outdated, then perhaps it’s time for the FTC to help them see the new realities of healthcare.
Questions for Dr. Butterworth? Write her at

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