How Could Modernization of Scope of Practice Impact DPMs and Patients?

What is the difference between medical licensure and board certification? As defined by the American Board of Medical Specialties (ABMS), “Medical licensure sets the minimum competency requirements to diagnose and treat patients and is not specialty specific. All physicians and medical specialists in the United States must be licensed to practice medicine by licensing boards in each state. The individual medical licensing authorities, or state medical boards of the various jurisdictions (represented by the Federation of State Medical Boards) grant the licenses to practice medicine.”¹
 
Furthermore, ABMS notes, "Board certification is specific to specialties and subspecialties and represents an individual's advanced knowledge, training, and skills in a particular area of medicine. While a license is required to practice medicine, board certification is a voluntary process."¹
 
Although modernizing a state's scope of practice for podiatrists is daunting, compromise is often involved. For example, board certification and length of residency are recent bargaining chips to add ankle privileges. While necessary and understandable, this is not consistent with state licensure within medicine and not commonplace in podiatry. Moreover, the trend is antithetical to established precedent.
 
Today's podiatric physicians follow the same 4-4-3 educational model as allopathic and osteopathic physicians—having different state licensure laws based on the letters after our name is discrimination. Podiatric physicians operate, prescribe medication, admit patients, serve as chiefs of staff, monitor hyperbaric oxygen therapy, etc., all within our scope of practice, just like any physician. Protecting public safety is imperative always, but I feel that credentialing must occur at the local hospital level, not the state licensing or regulatory level.
 
The argument that podiatric residency training varies significantly does not hold water. The training may differ, but so do residencies in all specialties within medicine. Rigorous yet fair credentialing based on a multitude of factors at the local level should be the authority for patient safety concerns. The Agency for Healthcare Research and Quality's (AHRQ) Patient Safety Organization (PSO) program's mission is to "collect and analyze data voluntarily reported by healthcare providers to help improve patient safety and healthcare quality."² Many hospitals are PSOs, and those that are not, should be.²
 
The Oregon State Medical Board's will have a hearing later this month on the proposed rule to remove board certification for "a podiatric physician to perform ankle surgery and allow that aspect to be a credentialing issue at the hospital level."³ The proposed change conforms with 46 other states' credentialing regulations for podiatric physicians and that of the entire house of medicine. The outcome of the proposed rule will establish a precedent for the subject. More importantly, as states modernize their podiatric scope of practice laws to align with the paradigm shift in education and training for podiatric physicians, this discriminatory bargaining chip can be taken off the table. States that fail to modernize their scope of practice laws for podiatric physicians do a disservice to their population by restricting access to care for those requiring lower extremity health care.
 
A byproduct of a restrictive scope of practice is that graduating residents will choose not to practice in a state that does not allow them to practice to the full extent of their education and training. That is an actual patient safety concern, not removing a board certification requirement for state licensure for podiatric physicians.

Dr. DeHeer is the Residency Director of the St. Vincent Hospital Podiatry Program in Indianapolis. He is a Fellow of the American College of Foot and Ankle Surgeons, a Fellow of the American Society of Podiatric Surgeons, a Fellow of the American College of Foot and Ankle Pediatrics, a Fellow of the Royal College of Physicians and Surgeons of Glasgow, and a Diplomate of the American Board of Podiatric Surgery. Dr. DeHeer is a Partner with Upperline Health and the Medical Director of Upperline Health Indiana. Dr. DeHeer discloses that he is a speaker for Paragon 28.

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References
1.    American Board of Medical Specialties. What is ABMS board certification?
2.    Agency for Healthcare Research and Quality. Patient Safety Organization (PSO) Program.
3.    State of Oregon. Notice of Proposed Rulemaking. Chapter 847: Oregon Medical Board.