Who performs foot surgery... (cont.)

Generally the standards of medical care will be the same from specialty to specialty, however there may be distinct differences within each sub-specialty. In addition, training and procedures will vary between the sub specialties. It is important to establish that a particular provider is trained and qualified to perform the particular surgery that may be at issue. Board Qualification and Board Certification does not guarantee that a provider is qualified or trained to perform a particular surgery.

Tip: Make sure that you request the privileges  granted to the provider by a particular hospital or surgical center in order to confirm that the facility has granted privileges to the doctor to perform surgery. Absence of privileges may help confirm that the provider received inadequate training or perhaps no training in the procedure(s) at issue.

Who performs foot surgery and provides footcare?

Foot surgery and foot care can be provided by a variety of providers, as there is overlap amongst many different medical and surgical specialties. They include podiatrists, orthopedic surgeons (with or without fellowship training in foot and ankle disease).   Dermatologists provide skin and nail treatment. Ulcer and bedsore care may   be provided by vascular surgeons and implemented by wound care nurses and physician assitantsNeurologists commonly provide treatment for neuropathy and neurosurgeons will perform nerve surgery in the foot.   Lastly, general practitioners may provide minor treatment modalities or alternatively refer to anyone of the above.

 

 

      

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Podiatry Malpractice : What is a Podiatrist (internship, residency and fellowship)

INTERNSHIP, RESIDENCY & FELLOWSHIP 

A majority of states do require one year of podiatric residency training for licensure after matriculation from podiatry school. However, this training is in no way standardized or uniform and can vary from state to state as well as from program to program.


Podiatry residency programs range from one to four years and fall within four different categories; Rotating Podiatric Residency (RPR); Primary Podiatric Medical Residency (PPMR) ; Podiatric Orthopedic Residency (POR) or Podiatric Surgical Residency (PSR). An internship is essentially defined as the first year of training.  The PSR programs are further numerically differentiated as PSR-12, PSR-24, PSR-36 and PSR-48 which simply denote the number of months in the program. As their titles denote, each type of program exposes the resident to different aspects of podiatric care. Generally, a graduate of orthopedic and medical programs have limited surgical experiences.

Tip : Since extent and level of training may vastly differ amongst practitioners, the degree of training should be investigated in order to determine whether or not a defendant / expert was formally trained in the practice area or procedure.  The resident log book may provide some insight into the exposure obtained during training.

Continue Reading...

Podiatry Malpractice: What is a Podiatrist ? (podiatry education)

EDUCATION

I find that questions always arise with respect to the education and training of a podiatrist when compared with allopathic (M.D.) and osteopathic (D.O) physicians.  Both curriculums are 4 years in length however there are clear differences and that is purposeful. 

The first two years of podiatric medical education parallel allopathic and osteopathic education concentrating in basic science education with classes in biochemistry, gross anatomy, medical physiology.  Ultimately culminating in the administration of the NBPME I (National Board of Podiatric Medical Exam I) which is the podiatric equivalent of the USMLE I.

The following two years are clinical in nature distinguished by rotations devoted to podiatry practice (ie. podiatric medicine and podiatric surgery)  with exposure to allopathic medical disciplines including rotations in general surgery, pediatrics and medicine. Notably absent are traditional rotations in obstetrics and psychology. Matriculation is confirmed upon passage of the NBPME II, the equivalent of the USMLE II, and granting of the Doctor of Podiatric Medicine (D.P.M.) degree.

There are currently seven (8) podiatry schools located in the United States that grant the D.P.M. degree.  They are the (1) Arizona Podiatric Medicine Program, (2) Barry University School of Podiatric Medicine, (3) California School of Podiatric Medicine, (4) Des Moines University College of Podiatric Medicine and Surgery, (5) Dr. William M. Scholl College of Podiatric Medicine, (6) Ohio College of Podiatric Medicine, (7) New York College of Podiatric Medicine and (8) the Temple University School of Podiatric Medicine.  Some schools will offer an accelerated program granting an undergraduate degree.  Other schools may confer a combined medical and podiatric degrees upon completion of special programs. 


I will continue with a discussion of Internships and Residency in Podiatry in my next post.

Podiatry Malpractice :What is a Podiatrist ? (Cont.)

SCOPE OF PRACTICE (Continued from entry below)

The traditional practice of podiatry (podiatric medicine and surgery) overlaps fields of orthopedic and vascular surgery, dermatology, neurology, infectious disease, rhuematology, physical therapy , emergency medicine and radiology as they relate to the foot, ankle and lower extremity.

However, as far as proper scope of practice, it is defined by the state law of each individual state.   In some states, the practice of podiatry may fall under the auspices of the state board of medical examiners.  In others, there may be a governing board of podiatric medical examiners. It is important to ascertain which agency governs the practice, since standards of practice may be generally adopted into the General State Board of Medical Examiners regulations or standards may be defined under a corresponding agency such as the State Board of Podiatric Medical Examiners.  

In some states the practice of podiatry may be limited to the foot.  In other states the scope of practice may include the ankle.  In some cases, the practice may include the entire lower extremity.  State law will further define whether the practice is to include bone and soft tissue and in some cases, serve to restrict to the practice to soft tissue only (no bony procedures).   For example, in New Jersey a podiatrist may treat disease in the lower leg, however s/he may not perform surgery on the bones of the lower leg (tibia & fibula)  The recent  case in Texas underscores the definitional disputes that may arise in a states respective statute.

Tip #2.  In addition to the restriction placed by state law on the podiatrist limiting the anatomical location of treatment, some states will also place a further restrict on on the types of procedures to be performed in any particular location.  For example,  bony procedures may be allowed on the forefoot, however procedures involving bone may not be allowed on the rear foot or ankle.

Podiatry Malpractice : What is a podiatrist ?

Before undertaking the podiatric malpractice case, it is critical to understand what a podiatrist does and how the podiatrist differs from other medical practitioners in terms of education and scope of practice.   The Doctor of Podiatric Medicine (D.P.M.) is a peculiar breed of practitioner that is uniquely situated in the medical profession. In order to properly prosecute or defend a podiatric negligence or malpractice case, the attorney needs an understanding of podiatric principles and a familiarity with the similarities and differences between the podiatrist and other allopathic or osteopathic physicians.

SCOPE OF PRACTICE

A license to practice podiatric medicine and surgery is a limited license. State law governs the scope of podiatric practice. Scope of practice differs vastly among the states and in some states it is strictly localized to the foot only, others define practice to include the ankle and some include the entire lower leg. Furthermore, statutes and regulations may authorize or prohibit certain procedures such as amputation or define a practice limited to a specific anatomical level such as soft tissue only.

TIP # 1.   It is prudent for the attorney to check the respective state's regulations when evaluating or defending a podiatric malpractice case in order to determine if the treatment rendered was within the scope of practice as defined by state law.