Here’s a win to be proud of. On September 14, 2017, Jerry Brown, Governor of California signed into law bill AB 1153, sponsored by the California Podiatric Medical Association (CPMA). This new law, taking effect January 1, 2018, gives podiatrists in California the legal scope to treat leg ulcerations below the tibial tuberosity, an action that was previously illegal as outside our scope of practice. The scope had been limited to treatment only including and below the ankle. In case you weren’t sure, this is a BIG DEAL. For podiatrists, this improves our scope to include a pathology many of us are trained to treat. For our patients, this gives them access to those physicians best capable of understanding and treating leg ulcers. In fact, in my experience, podiatrists are among the very few providers who even want to treat leg ulcers. Additionally, the work of Rebecca Moellmer, DPM and her team demonstrates that with proper leadership and organization, it is possible to move our profession forward. In full disclosure, Dr Moellmer is one of my academic partners at Western University of Health Sciences and a very close personal friend.

For today’s Practice Perfect, Dr Moellmer agreed to a short interview to help us understand from where this success came and how it happened. You’ll see the clear theme of working with our non-podiatric colleagues and the power of communication. I send my congratulations and deep thanks to Dr Moellmer and her CPMA team for the strong work they have done on our behalf.

Can you give us an overview of the history behind this bill and why the CPMA decided to take this on?

For those who don’t recall, in the 1990s, AB932 was a monumental bill that passed, allowing California DPMs to perform amputations, assist in non-podiatric surgeries, and to perform history and physical exams. Because of heavy opposition to leg ulcer privileges from the California Medical and Dermatologic Associations, leg ulcers were removed from the language.

Fast forward to the fall of 2015 when CPMA’s lawyer reminded the board of directors that DPMs in California are not legally allowed to treat leg ulcers above the level of the ankle. This reminder was met with silence. It was clear that this was still a large problem for many of our members as well as many hospitalists who refer these patients to us.

As is CPMA’s custom, the President Elect announces the agenda for his/her year as President. I announced that I wanted California DPMs to be legally allowed to treat leg ulcers to the tibial tuberosity. Other board members were supportive.

What is the significance to the passage of AB1153 both for California and nationally?

As our education, training and experience more closely mirrors allopathic and osteopathic colleagues, our privileging has become representative of that.

How did the leadership team of the CPMA make this success a reality? What methods were helpful?

Once we decided that we would be seeking leg ulcer legislation, we spoke with our lobbyist, who helped us determine which key stakeholders to speak to first (we all know that legislators hate scope bills and that they can get nasty and expensive). Rather than proceeding in a bubble, we scheduled face-to-face meetings and conference calls with the top leadership of other medical and surgical associations and helped them to better appreciate our current level of training and experience while answering any concerns they had.

Fortunately, during this process, our current President was able to establish a better relationship with the current COA (California Orthopedic Association) President and a MOU (Memorandum of Understanding) calling for collaborative work in the future was drafted and signed.

Based on your experience, what recommendations do you have for the leadership of other states to move forward legislation that favors podiatry in the future?

Get to know your medical colleagues prior to an ask. Determine how your association can help resolve a mutual problem.

What other laws do you think would be amenable to the podiatric community taking on to help the profession?

There are, of course, a few… but the most important is being tackled by the Physician & Surgeon Taskforce. Representatives from the California Medical Association, the California Orthopedic Association, the Osteopathic Physicians and Surgeons of California, and the California Podiatric Medical Association serve on the taskforce. They get to objectively learn about the current training and education of Podiatric Medical Specialists in the state of California. Granting Podiatric Specialists a plenary license would make any changes in scope laws unnecessary. By granting the plenary license, California DPMs would essentially have obstructive laws removed that have kept California DPMs from practicing to their full training and education.

What role do you see political activism playing in the lives of healthcare professionals going forward?

There are so many little problems that can be resolved when we all work together. Communication can get so much accomplished.