Medical marijuana is a hot topic of late.
States are permitting it to treat certain medical conditions.
Where does Podiatry fit in to all of this?
My thoughts are that podiatry should want full inclusion in this law.
Currently, podiatrists are entitled to apply for full prescription benefits including narcotics.
Why should medical marijuana differ? As medicine progresses there may be new indications for this medication/drug why would we want to be excluded from this program and then have to fight for inclusion at a later time?? Many states are allowing nurse practitioners prescribe medical marijuana, why would podiatry want to be excluded?
I can probably think of only 1-2 cases in my 20 plus yrs of practicing that I would consider, if allowed to prescribe medical marijuana, and even though the number is as mimimal as it can be as doctors with the right to prescribe medication, I think it would be important to be included in this law.
(If certain coursework was needed then so be it, but if we keep asking for parity why run away from it?).

Others thoughts?
  • Comments (16)
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  • Quote:

    So, we are really asking: why should the Podiatrist not assume the function of the internist, MD.

    Why? Because we are Podiatrists. When we spin this kind of argument we are really saying that we regret not being that MD. The solution is easy. Go to medical school and get that MD.

    The solution is not easy but an undue hardship for older board certified podiatrists in private practice who wish to increase their training and experience to include the full scope of their board certification. If a nurse practitioner or a physicians assistant is licensed to train at performing a triple arthrodesis.
    Certainly in the real world I do not know of any nurse pratitioner or PA that will train to become competent at performing triple arthrodeses. Yet their scope of license just might allow them to train to get experience at becoming competent at this. 
    The reason why I brought up the above is that there might be similarities such as the argument that a podiatrist board certified in podiatric medicine should be able to train and get the experience at the same scope that a podiatric resident can. 
    If a nurse practioner has an ulimited license to learn and grow a podiatrist should be able to do so so long as the state podiatric board widely interprets each situation as being within scope and the podiatric malpractice carrier agrees to provide coverage. 

    Dan,

    This viewpoint embraces a tremendous leap of assumptions. There is no NP or PA adopting such a practice. I have worked closely with Orthopedic PA's in the OR. The orthopedic surgeon performs the procedure. The PA closes. We all have unlimited license to learn Dan, but even the NP does not have 'unlimited' license to practice.

    Undue hardship? Well yes, medical training is undue hardship. Dan, I have had to go back to school and residency for a total of 7 years to earn the rights to work in the US. I am not overly sympathetic to complaints of hardship. We make choices in life. You and I are of a similar age.

    It is regretable there are no training mechanims outside of residency to provide for what you need. But it is what it is. It's likely in the future there will be Podiatrists in the same situation as goal posts are moved and expectations change. In the end, you are not prevented from earning a living working as a Podiatrist. But you are restricted in what you can do based on the training earned. 

  • So, we are really asking: why should the Podiatrist not assume the function of the internist, MD.

    Why? Because we are Podiatrists. When we spin this kind of argument we are really saying that we regret not being that MD. The solution is easy. Go to medical school and get that MD.

    The solution is not easy but an undue hardship for older board certified podiatrists in private practice who wish to increase their training and experience to include the full scope of their board certification. If a nurse practitioner or a physicians assistant is licensed to train at performing a triple arthrodesis.
    Certainly in the real world I do not know of any nurse pratitioner or PA that will train to become competent at performing triple arthrodeses. Yet their scope of license just might allow them to train to get experience at becoming competent at this. 
    The reason why I brought up the above is that there might be similarities such as the argument that a podiatrist board certified in podiatric medicine should be able to train and get the experience at the same scope that a podiatric resident can. 
    If a nurse practioner has an ulimited license to learn and grow a podiatrist should be able to do so so long as the state podiatric board widely interprets each situation as being within scope and the podiatric malpractice carrier agrees to provide coverage. 
  • Quote:

    Let's play devils advocate - why should a podiatrist be allowed to prescribe narcotics?

    Primarily for post-operative pain management. In all honesty, if I was not able to provide narcotics I would not cry too much. The great majority of forefoot cases can be managed well without. There is research aplenty to show that Percocet 5/325 offers little advantage to tylenol. For those cases that require heavier medication a liaison referral to the PCP is good too. That's no big deal when, in the great majority of cases patients are farmed out for medical clearance pre-operatively. For the longest time, this was our required modus operandi in England. The situation gradually changed over the years when a limited Rx facility was made available to the Podiatric Surgeon, for the sake of streamlining patient care. 

    That's all a question of risk assessment. With insulin, for example, there is a risk that you can kill your patient. Many a PCP will refer their patient to the endocrinologist. It is arrogant to assume the Podiatrist can assume this function. 



  • Let's play devils advocate - why should a podiatrist be allowed to prescribe narcotics?
  • Dan / Jeff,

    Why stop with insulin? When a RA patient has foot pain from their RA, why should the Podiatrist not Rx anti-rheumatic medication. When the pt with congestive heart failure has ankle edema why should the Podiatrist not Rx heart medication, diuretics etc etc.

    So, we are really asking: why should the Podiatrist not assume the function of the internist, MD.

    Why? Because we are Podiatrists. When we spin this kind of argument we are really saying that we regret not being that MD. The solution is easy. Go to medical school and get that MD.



  • Dan - you make an interesting point. Let me ask you this would you yourself be comfortable prescribing insulin to treat the elevated blood sugar in the "foot blood"?

    Jeff the answer is no that I would not feel comfortable doing the above. 

    However in the future other podiatrists might be if 2 things happenned: 

    1. The state podiatry board would first have to clarify it is within scope and the malpractice carrier would have to be made aware that this would be done. 

    2. An endocrinologist or an internist who is very familiar with dispensing insulin was assiting them and observing them and correcting any possible mistakes they might make. 

    This question has similarities to the question in NYS why podiatrists thata are board certified by ABPM cannot have an ankle permit so as to assist to obtain the training to ultimatley be credentialed to independently perform soft tissue ankle surgery. Every board certified podiatrist should be enabled the opportunity to increase scope by obtaining the training and or experience needed to practice an increased scope independently within the full scope of their board certification. 

    It is interesting that in New Jersey podiatric physicians can assist other surgeons well outside the podiatric scope of practice. 

    Basically if podiatric residents can learn how to give insulin in their training programs why can't older board certified podiatrists at least assist at giving insulin so long as they are supervised by an internist familiar with giving insulin or an endocrinologist? 

  • Dan - you make an interesting point. Let me ask you this would you yourself be comfortable prescribing insulin to treat the elevated blood sugar in the "foot blood"?
    I think the new podiatry school with that opened with the dual degree is a step in the right direction. I'm not sure those graduating will want to prescribe insulin but I'm not sure it would be considered out of scope for them as it would for us.
    The perceived problem is that here I think most podiatrists would state the standard is to refer that yo an MD.
    I think there are some states slready recognizing podiatrists as those allowed to rx medical marijuana and wonder why NY has opted not to be included. For a state that started with the first podiatry school we are not a very progressive state,
  • Dieter - I'm not understanding why it's any different than OxyContin. I have never had a a patient come and ask me for it.
    I am sure pain clinics do get patients coming and asking for that stuff.
    What if those in"power" decide from now on let's regulate pain management. Hence, any doctor performing surgery shall first send their patient to an MD or nurse practitioner to be evaluated for post op pain medication. You or I don't want a situation like that.....
  • Quote:

    Dieter - if it's available by every physician and or nurse practitioner I'm just not following why the "addict or junkie" is running to the foot doctor for their fix????? As I stated earlier - I really can only think of one or two realistic patients with chronic retractable pain. The point to me is are licenses are supposed to be unrestricted so why do we want them restricted?


    OK, there are two separate issues.

    Issue #1: should the doctor of podiatry have the opportunity for access? Yes

    Issue #2: revolves around the individual doctor who may or may not want to opt in.

    I just have a hunch this will create a trend, among the weedies - there are very many of them. All of a sudden it's 'Doc!!!! YOU HAVE TO HELP ME - NOTHING helps with my foot pain, only weed!!!!". And "Doc!!! I have allergies to all pain meds, only weed helps!!!" ... I'm sure the creative types will think of a bunch of other 'good' excuses. 

    There are already certain 'clinics' for weed users to obtain the herb for 'medical' reasons - everyone there knows it's a joke and a perfunctory exercise, to deal in weed. Saw a most enlightening documentary about it, a week or so ago. 

    Next, if you are genuine and conscientious, you spend a good deal of the working hour counselling that patient. And when they succeed with you it's likely this will be your patient, with the same issues, for years to come.

    I've been witness to many ugly exchanges between doctor and patient, of a similar nature over Percocet. And quite a few lawsuits can be found online when the doctor becomes the topic of investigation over their "prescribing habits"

    If it's only 1-2 patients with chronic foot pain, well there is always the pain clinic. Those doctors are well equipped to deal with chronic pain, and the addictive personality.

    I am a Podiatrist. I have no desire to become a pain management specialist. 

  • Excellent point Jeff. I must admit in many ways you and I do think alike. Any attempt for any state to restrict a podiatrists scope of license in treating the foot or any other in scope anatomic structure does not help podiatrists and their patients. Furthermore if a podiatrist is uncomfortable using marijuana they can always refer a patient to someone with more experience at using successfully. Thankyou Jeff for having such wise insight into the potential ramifications if podiatrists are excluded from being able to provide treaments that are in scope for nurse practitioners. 

    Lastly I once brought up the idea of podiatrists prescribing insulin to treat diabetic feet. Technically all anatomic structures in the foot are within scope and I thought this included blood. My argument was that the blood in the foot was traveling into and out of the foot. Thus I concluded that insulin can be used to treat a foot condition or the "foot blood" that had a high sugar level provided that the patient was told that the blood in the rest of the body was not being treated and that only a Nurse practitioner or MD could treat this. Jeff do you agree with this reasoning that it just might be within scope to for a podiatrist to rx insulin under the current law to treat the foot condition of high blood sugar in the "foot blood"?

    Once within scope this would open up the opportunity for podiatrists who wish to learn about giving insulin to obtain training and experience at doing so. 

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