I am not in agreement with the proposed wording of the current proposed law.

If certification of podiatrists are required to operate on ankles this means that competent older

podiatrists who care about their patients and do anot want to  leave their practices to complete podiatry residencies 

to qualify for certification in podiatric surgery will be discriminated against. Even the code of federal regulations state that under medical staff privileges should not be solely dependent upon certification. Any bill that

discriminates against older competent podiatrists I believe is unfair. A competent older podiatrist who is not residency trained by a program that would have been outdated had he completed it I believe would be discriminated against. Such a podiatrist would not even be licensed to obtain training at ankle surgery by training at ankle surgery by assisting other competent practitioners at doing so. How can such an older practitioner upgrade his

ankle surgical skill without leaving his practice and patients to complete a residency program to

then qualify for certification in podiatric surgery?

                                            Before even looking at anatomic scope what about the basics such as the

identity of a podiatrist in New York. Currenlty in NY apodiatrist is not allowed to even call themselves podiatric physician. As a start, this should be changed legislatively but was not even addressed in the bill. Also the legislative language should mirrorsurrounding states to maximize the ability to pass. I don't believe any of the surrounding states go up to theknee.

      New Jersey accepts experience in practice in place of podiatric residency training that would have been outdated

if it had been completed when an older podiatrist graduated and it would probably not relate to current competence.

New York should have the same degree of compassion to prevent such unfair discrimination against

older competent podiatrists. Before increasing anatomic scope allowing a podiatrist in New York to call themselves

a podiatric physician I feel is more important. Also I feel having compassion to prevent unfair discrimination

against competent older podiatrists who are not residency trained is more important than increasing anatomic scope. I feel compassion for all podiatrists is the hallmark of positive change in any profession.

Again reconsider the language of NY podiatric scope of practice law that was proposed.

Disclaimer: Do not rely on my personal opinions above, but consult with a licensed health care attorney in your state.

S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________

                                         2518

                              2009-2010 Regular Sessions

                                 I N  A S S E M B L Y

                                   January 16, 2009
                                      ___________

       Introduced  by M. of A. PRETLOW, STIRPE, GABRYSZAK -- Multi-Sponsored by
         -- M. of A. GALEF, LATIMER, LUPARDO, REILLY, WEISENBERG --  read  once
         and referred to the Committee on Higher Education

       AN ACT to amend the education law, in relation to the practice of podia-
         try

         THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
       BLY, DO ENACT AS FOLLOWS:

    1    Section 1. Section 7001 of the education law, as  amended  by  chapter
    2  677 of the laws of 1996, is amended to read as follows:
    3    S  7001.  Definition  of practice of podiatry. 1.  The practice of the
    4  profession of podiatry is defined as diagnosing, treating, operating and
    5  prescribing for any disease, injury, deformity or other condition of the
    6  foot, [and may include] ANKLE AND ALL SOFT TISSUE STRUCTURES OF THE  LEG
    7  BELOW  THE  KNEE ANATOMICALLY AFFECTING THE FOOT AND ANKLE. THE PRACTICE
    8  OF PODIATRY INCLUDES performing physical evaluations in conjunction with
    9  [the provision of] podiatric treatment.  Podiatrists may treat traumatic
   10  open wound fractures only in hospitals, as defined  in  article  twenty-
   11  eight of the public health law.
   12    2.  [The  practice  of podiatry shall not include treating any part of
   13  the human body other than  the  foot,  nor  treating  fractures  of  the
   14  malleoli  or cutting operations upon the malleoli.] Podiatrists licensed
   15  to practice, but not authorized to  prescribe  or  administer  narcotics
   16  prior  to  the  effective date of this subdivision, may do so only after
   17  certification by the department in accordance  with  the  qualifications
   18  established  by the commissioner. The practice of podiatry shall include
   19  administering only local anesthetics for therapeutic purposes as well as
   20  for anesthesia and treatment under general  anesthesia  administered  by
   21  authorized persons.
   22    3.  PODIATRISTS  LICENSED TO PRACTICE, BUT NOT AUTHORIZED TO DIAGNOSE,
   23  TREAT, OPERATE OR PRESCRIBE FOR ANY DISEASE, INJURY, DEFORMITY OR  OTHER
   24  CONDITION  OF THE ANKLE PRIOR TO THE EFFECTIVE DATE OF THIS SUBDIVISION,

        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD02162-01-9

       A. 2518                             2

    1  MAY DO SO ONLY AFTER CERTIFICATION BY THE DEPARTMENT IN ACCORDANCE  WITH
    2  THE  QUALIFICATIONS  ESTABLISHED  BY THE COMMISSIONER. QUALIFICATIONS TO
    3  OPERATE ON THE ANKLE SHALL INCLUDE, BUT NOT BE LIMITED TO, THE  SUCCESS-
    4  FUL  COMPLETION  OF  A RESIDENCY PROGRAM OR PROGRAMS, CERTIFICATION BY A
    5  NATIONAL CERTIFYING BOARD HAVING CERTIFICATION STANDARDS  ACCEPTABLE  TO
    6  THE  COMMISSIONER,  OR  COMPLETION OF A POST-RESIDENCY ACCREDITED EDUCA-
    7  TIONAL PROGRAM ACCEPTABLE TO THE COMMISSIONER WITH  DEMONSTRATED  COMPE-
    8  TENCY IN THE SURGICAL TREATMENT OF THE ANKLE.
    9    S  2. This act shall take effect one year after it shall have become a
   10  law.

  

I totally agree with Dr. Chaskin and would like to add that equal pay for equal work is likely far more important than a change in the anatomical scope of practice for the majority of older practitioners.

Certainly most DPM's older than 40 who had residency training here in NY did not receive their ankle training during residency. Since that would be a stumbling block to receiving certification for many DPM's, I would see the current version of the bill as age discriminatory. On the flip side, many even older DPM's (55+) received their surgical boards prior to ABPS certification being split into forefoot and rearfoot. So while they have the certification they may not have received the formal training. This latter scenarior may be a far more dangerous precedent, if the law only allows those with certification alone.

I believe submitting case logs and your experience is far more important to the protection of the public's health than any legislative restriction based on academic training alone. Particularly if that training was eon's ago.

It will likely be up to the hospital to determine one's scope of privilidges and their fear of malpractice actions against them for allowing an untrained surgeon to perform a procedure would likely be more influential on a practitioner's ability to perform a specific procedure.  The podiatric medical director's job should be to offer an unbiased opinion based on the practitioner's expereience and cases performed. But we all know how unbiased some podiatric medical directors can be. 

A fair unbiased way should be determined which practitioner is credentialed and who is not. One's experience is far more important than the medical director's ego or their wishes to keep the funds flowing from the ER to their pockets.

There has to be a better way!