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Model Law - Guidelines for State Podiatric Medical Practice Acts

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Introduction

The Federation of Podiatric Medical Boards offers this Guide to those concerned with state licensing of Doctors of Podiatric Medicine (DPMs). It is not intended to be comprehensive in every aspect of licensing, discipline, and adjudication, but addresses those that are specific to podiatric medicine to encourage standardization.

A more comprehensive model for state practice acts is the Federation of State Medical Boards' A Guide to the Essentials of a Modern Medical Practice Act. Many elements of a podiatric practice act should be identical or nearly so to those for medical doctors. Examples include telemedicine, malpractice reporting, and record keeping requirements.

Podiatric medicine is a small medical specialty, with about 15,000 podiatric doctors practicing in the U.S. Instituted as a separate profession, it has its own association, accrediting body, national examining board, specialty boards, colleges, and degree. DPMs graduate from one of seven four-year podiatric medical schools, all in the U.S. Almost all graduates complete additional postgraduate training. Once licensed, they are independent practitioners of medicine within their scope of practice, which is generally the foot and ankle. They independently diagnose, treat, and prescribe within this scope.

Some related sections of state law, e.g., hospital administration, are usually codified separately from professional licensing and are not covered herein. It may be important to note, however, that DPMs like other doctors should be privileged based on demonstrated training and competence. They should not be granted privileges automatically for the full scope of their license, nor may they be arbitrarily denied a privilege because of their degree if the procedure is within their legal scope of practice under state law.

The Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) standards permit facilities to privilege DPMs to perform complete medical history and physical examinations (H&Ps). H&Ps are included implicitly in the model "practice authorized" provision below, as they are currently in most state laws. Like other privileges, this should be granted individually based on training and competence.

This Guide will be updated and revised as appropriate. Comments and suggestions are greatly encouraged.
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Practice Authorized

The podiatric physician license authorizes the holder to practice podiatric medicine.

“Podiatric medicine” is the practice of medicine and surgery on the lower extremity including the diagnosis and treatment of conditions affecting the human foot, ankle and leg by all appropriate systems and means and adjunctive procedures thereto including the prescribing and administering of drugs and medicines.

A podiatric physician may assist a licensed physician and surgeon holding a medical doctor or osteopathic medical doctor degree in non-podiatric procedures.
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Unlawful Representations

Any person who uses in any sign or in any advertisement or otherwise, the word or words "doctor of podiatric medicine," "podiatric physician and surgeon," "podiatrist," "foot specialist," or any other term or terms or any letters indicating or implying that he or she is a doctor of podiatric medicine, or that he or she practices podiatric medicine, or holds himself or herself out as practicing podiatric medicine, without having at the time of so doing a valid, unrevoked, and unsuspended license to practice podiatric medicine, or medicine or osteopathic medicine, is guilty of a misdemeanor.

It is unlawful for a doctor of podiatric medicine to advertise any affiliation with or recognition by any specialty certifying agency that is not approved by the Council on Podiatric Medical Education or approved by the board as having equivalent standards.
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Student Practice

Nothing shall be construed to prevent a regularly matriculated student undertaking a course of professional instruction in an approved school of podiatric medicine from participating in medical training whenever and wherever prescribed as part of his or her course of study. Such training beyond the scope of podiatric medicine shall be under the supervision of a physician and surgeon holding the degree of medical doctor or doctor of osteopathic medicine.
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Practice by Residents

Unless otherwise provided by law, no postgraduate trainee, intern, resident, postdoctoral fellow, or instructor may engage in the practice of podiatric medicine, or receive compensation therefor, or offer to engage in the practice of podiatric medicine unless he or she holds a valid, unrevoked, and unsuspended license to practice podiatric medicine.

However, a graduate of an approved school who is issued a training license by the board, which may be renewed annually, for the purpose of participating in a specified postgraduate training program approved by the board for a specified one-year period of time, may engage in the practice of podiatric medicine whenever and wherever required as a part of that program and may receive compensation for that practice. A graduate with a training license in an approved internship, residency, or fellowship program may participate in medical training rotations beyond the scope of podiatric medicine under the supervision of a physician and surgeon who holds a medical doctor or doctor of osteopathic medicine degree wherever and whenever prescribed as a part of the training program, and may receive compensation for that practice. If a graduate fails to receive a license to practice podiatric medicine within three years from the commencement of his or her postgraduate training, all privileges and exemptions under this section shall automatically cease.
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Evaluation of Applications

The board shall have full authority to investigate and evaluate each applicant applying for a license to practice podiatric medicine and to make a determination regarding the issuance of a license in accordance with the provisions of this statute.
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Qualifications for Licensure

The board may issue a license to practice podiatric medicine provided:
  1. The applicant has met the premedical requirements.
  2. The applicant has graduated from an accredited school of podiatric medicine approved by the board.
  3. The applicant has presented to the board directly from the National Board of Podiatric Medical Examiners of the United States evidence that he or she has passed all parts of its examination within the past ten years.
  4. The applicant has satisfactorily completed two years of postgraduate training approved by the board.
  5. The applicant has committed no acts or crimes constituting grounds for denial of a license.
  6. The board determines that no disciplinary action has been taken against the applicant by any licensing authority and the applicant has not been the subject of adverse judgments or settlements resulting from the practice of podiatric medicine that the board determines constitute a pattern of negligence or incompetence.
  7. The applicant has presented to the board directly from the Federation of Podiatric Medical Boards a disciplinary data bank report.
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Premedical Requirements

Each applicant shall have presented to the board directly from the educational institution an official transcript showing that he or she has completed a minimum of two years of preprofessional postsecondary education, with subjects including chemistry, biological sciences, and physics or mathematics.
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Curriculum Required

Each applicant shall have it shown by official transcript submitted directly to the board by an approved school that he or she has successfully completed a medical curriculum extending over a period of at least four academic years in an accredited school of podiatric medicine approved by the board. The total number of hours of all courses shall consist of a minimum of 4,000 hours.

The curriculum for all applicants shall provide for adequate instruction in the following:
  • Alcoholism and substance abuse detection
  • Anesthesia
  • Anatomy, including embryology, histology, and neuroanatomy
  • Behavioral science
  • Biochemistry
  • Biomechanics-including lower extremity orthopedics
  • Child abuse detection
  • Geriatric medicine
  • Human sexuality
  • Infectious diseases
  • Medical ethics
  • Medicine, including podiatric medicine and pediatrics
  • Neurology
  • Pathology, microbiology, and immunology
  • Pharmacology, including materia medica and toxicology
  • Physical and laboratory diagnosis
  • Physical medicine
  • Physiology
  • Podiatric medicine
  • Preventive medicine, including nutrition
  • Psychiatry
  • Radiology and radiation safety
  • Spousal or partner abuse detection
  • Surgery, including orthopedic and podiatric surgery
  • Therapeutics
  • Women's health
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Postgraduate Training

In addition to any other requirements, before a license to practice podiatric medicine may be issued, each applicant shall have it shown by evidence submitted directly to the board by the sponsoring institution that he or she has satisfactorily completed two years of approved postgraduate medical and surgical training in podiatric residency. This shall include training in the performance of history and physical examinations and provide entry-level clinical training in both podiatric medicine and podiatric surgery.

"Podiatric residency" means a program of supervised postgraduate clinical training, one year or more in duration, approved by the board. The board may approve only those podiatric residencies that in its determination
  1. reasonably conform with the Accreditation Council for Graduate Medical Education's institutional requirements applicable to all medical residency programs,
  2. are approved by the Council on Podiatric Medical Education, and
  3. comply with the requirements of this state.
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Continuing Competence

In order to insure the continuing competence of persons licensed to practice podiatric medicine, the board shall require those licensees to demonstrate completion of at least 50 hours of approved continuing medical education within the last two years and satisfaction of one of the following requirements at each license renewal:
  1. passage of an examination administered or approved by the board within the past ten years.
  2. passage of the part of the National Board of Podiatric Medical Examiners of the United States examination testing for clinical competence within the past ten years.
  3. passage of an examination administered within the past ten years by a specialty certifying board recognized by the Council on Podiatric Medical Education or approved by the board as having equivalent standards.
  4. successful completion within the past ten years of a residency or fellowship program approved by the Council on Podiatric Medical Education or the board.
  5. granting or renewal of current staff privileges within the past five years by a health care facility, clinic, center, or organization that is licensed, certified, accredited, maintained, operated, funded, or otherwise approved by a federal, state, or local government agency.
  6. successful completion within the past five years of an extended course of study approved by the board.