Nurse-Managed Foot Clinic...?

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if it is ran by DNPs under the supervision of DOs or MDs, I do not see any legal problems to it. Foot care is not exclusive to podiatrists. In fact there are more non-podiatrists treating foot problems than DPMs. Don't quote me on this one, but I believe only 33-35% current foot problems are seen by DPMs.
 
freshprincechir said:
if it is ran by DNPs under the supervision of DOs or MDs, I do not see any legal problems to it. Foot care is not exclusive to podiatrists. In fact there are more non-podiatrists treating foot problems than DPMs. Don't quote me on this one, but I believe only 33-35% current foot problems are seen by DPMs.
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If that statistic is indeed true, then that's disgusting to hear...😡
 
freshprincechir said:
if it is ran by DNPs under the supervision of DOs or MDs, I do not see any legal problems to it. Foot care is not exclusive to podiatrists. In fact there are more non-podiatrists treating foot problems than DPMs. Don't quote me on this one, but I believe only 33-35% current foot problems are seen by DPMs.
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I read the site that it is solely nurses running the clinic - where did you read the DNP part or the MD/DO supervision? I'm just curious. I know that MD/DOs have full scope practice capabilities, but it says nurse managed? That led me to think that it was only nurses running the clinic..
 
@MaxillofacialMN: I don't have any insights. I am just speculating. but I am sure a major university hospitals, like U of I, would have their legal aspects figured out

as far as 33-35%, I read it somewhere but I can't find it at this moment. from what i recall, it was approx 30-35% by GP, 30-35% BY DPM, ~20% by orthos and ~ 10% by PTs. I believe there are only 15000-20000 DPMs in the United States. that's not enough number of physicians to address public's needs. I believe there needs to be more DPMs to increase public visibility and to increase political power.
 
I'm really looking into this and I'm reading some articles and I don't think they do need MD/DOs watching over them and I don't think they are DNPs - just regular nurses.

read this: http://www.jstor.org/stable/3427899?seq=1

They are just doing nails, corns, calluses, and other stuff like massage and washing, but also debridement. (?!)

If nurses can do all that care (probably cheaper) and orthopods can do all the surgery (i know they can do care too)... whaaaaaaaaaaaatttt. Someone wanna help me out here? What am I missing?

Brochure: http://www.stjamespdx.org/footcare.pdf
 
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MaxillofacialMN said:
I'm really looking into this and I'm reading some articles and I don't think they do need MD/DOs watching over them and I don't think they are DNPs - just regular nurses.

read this: http://www.jstor.org/stable/3427899?seq=1

They are just doing nails, corns, calluses, and other stuff like massage and washing, but also debridement. (?!)

If nurses can do all that care (probably cheaper) and orthopods can do all the surgery (i know they can do care too)... whaaaaaaaaaaaatttt. Someone wanna help me out here? What am I missing?

Brochure: http://www.stjamespdx.org/footcare.pdf
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Relax, it's not rocket science to cut someone's toenails. Why would you become a doctor and be worried over someone who is gonna massage your patient's feet or trim their calluses? If you keep reading the brochure, you'll see "referral to a podiatrist or physician as needed." As you can see, there's plenty of work/expertise that a podiatrist will have. I know, they didn't lump us with physicians in that statement but let's assume they mean PCP...even so, the PCP will eventually scratch their heads and consult us.

Yes, orthopods can do everything we do...and a lot of times, their biomechanics skills are impressive. But when it comes to forefoot pathomechanics/surgeries, even the best guy doing pilons and flat foot recons are scared to do lapidus or even weil osteotomies. I personally know one F&A orthopod...great surgeon..but he messed up on a hammertoe once and ended up having it amputated...ever since then, he referrs all his forefoot stuff to DPMs. Radiologists don't even read foot & ankle films as well as we do largely b/c they don't know biomechanics. As a resident, i catch mistakes on a daily basis. You know how many neurologists I've encountered who've never heard of charcot arthropathy?

I can go on. In short, nothin to worry about.
 
Okay good! I was reading the newspaper and there was an ad for people with diabetic foot ulcers to participate in a study at this nurse managed foot clinic, and it just really caught me off-guard.
 
streetsweeper said:
Relax, it's not rocket science to cut someone's toenails. Why would you become a doctor and be worried over someone who is gonna massage your patient's feet or trim their calluses? If you keep reading the brochure, you'll see "referral to a podiatrist or physician as needed." As you can see, there's plenty of work/expertise that a podiatrist will have. I know, they didn't lump us with physicians in that statement but let's assume they mean PCP...even so, the PCP will eventually scratch their heads and consult us.

Yes, orthopods can do everything we do...and a lot of times, their biomechanics skills are impressive. But when it comes to forefoot pathomechanics/surgeries, even the best guy doing pilons and flat foot recons are scared to do lapidus or even weil osteotomies. I personally know one F&A orthopod...great surgeon..but he messed up on a hammertoe once and ended up having it amputated...ever since then, he referrs all his forefoot stuff to DPMs. Radiologists don't even read foot & ankle films as well as we do largely b/c they don't know biomechanics. As a resident, i catch mistakes on a daily basis. You know how many neurologists I've encountered who've never heard of charcot arthropathy?

I can go on. In short, nothin to worry about.
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I agree and disagree with some of the above quote. Although cutting nails/trimming calluses may seem trivial, we are talking about diabetic patients. Therefore, the potential for complications, even with seemingly simple procedures can be disastrous.

Nurses have no real "training" when it comes to trimming/debridement of nails or keratotic lesions. It only takes one nick or cut to set up a whole cascade of events in a certain population of diabetic patients.

It's not the simplicity of the procedure, it's making sure that a simple procedure doesn't cause the patient harm. Any of us who have been in practice long enough have seen the horrible consequences of these simple procedures performed incorrectly by family members, patients, pedicurists and nurses.

And no, I don't agree that orthopods do everything we do. Our approach to many problems differs greatly. When a patient with a "neuroma" enters an orthopod office, to you think the orthopod ever applies a metatarsal pad to try to first eliminate the pain? When a patient enters an orthpods office with heel pain, how many orthopods apply any taping/strapping/support in an attempt to address the mechanical causes?

Believe me, their approach is COMPLETELY different. I have a very busy, active practice and perform a lot of surgery, and I see the significant differences in the way problems are handled. We "coddle" our patients. the majority of orthopods treating foot/ankle pathology just don't go that extra mile.

But I do agree that we have nothing to worry about, IF we keep doing things the way we have been, and don't try to emulate them.
 
you guys have nothing to worry about. most pcp's, pa's, and np's have no desire to do foot care beyond ingrown toenails. I probably write 5 referrals/week to our local podiatry group. I prefer you guys to see my foot fxs as well over the local ortho foot guy. I have worked with pod residents before and have a world of respect for the work you do.
 
emedpa said:
you guys have nothing to worry about. most pcp's, pa's, and np's have no desire to do foot care beyond ingrown toenails. I probably write 5 referrals/week to our local podiatry group. I prefer you guys to see my foot fxs as well over the local ortho foot guy. I have worked with pod residents before and have a world of respect for the work you do.
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👍 Thanks for the feedback

I have read many of your posts previously and always appreciate your insight.
 
PADPM said:
I agree and disagree with some of the above quote. Although cutting nails/trimming calluses may seem trivial, we are talking about diabetic patients. Therefore, the potential for complications, even with seemingly simple procedures can be disastrous.

Nurses have no real "training" when it comes to trimming/debridement of nails or keratotic lesions. It only takes one nick or cut to set up a whole cascade of events in a certain population of diabetic patients.

It's not the simplicity of the procedure, it's making sure that a simple procedure doesn't cause the patient harm. Any of us who have been in practice long enough have seen the horrible consequences of these simple procedures performed incorrectly by family members, patients, pedicurists and nurses.

And no, I don't agree that orthopods do everything we do. Our approach to many problems differs greatly. When a patient with a "neuroma" enters an orthopod office, to you think the orthopod ever applies a metatarsal pad to try to first eliminate the pain? When a patient enters an orthpods office with heel pain, how many orthopods apply any taping/strapping/support in an attempt to address the mechanical causes?

Believe me, their approach is COMPLETELY different. I have a very busy, active practice and perform a lot of surgery, and I see the significant differences in the way problems are handled. We "coddle" our patients. the majority of orthopods treating foot/ankle pathology just don't go that extra mile.

But I do agree that we have nothing to worry about, IF we keep doing things the way we have been, and don't try to emulate them.
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I just wanted to throw this out there for the sake of educating others.

My "training" in trimming nails/callus went something like this. In my first day of clinic rotations as a pod student, I was handed a nail nipper and was told to get in there and cut some nails. The attending watched me do it once and then told me "good job." Overtime, I fine tuned my skills with the thousands of patients needing nails/callus debridement with tips from the NURSE practitioner. Covered myself in nail dust from the micromat from time to time. I don't see why a nurse cant do the same. They actually have wound care nurses that take care of wounds all over the body but can't touch feet? Although, good luck in finding nurses actually wanting to deal with feet.

Additionally, I happen to rotate with F&A orthos and podiatry in clinic daily for my podiatry block. I was initially shocked b/c they're doin the same thing as we are in terms of biomechanics/gait analysis..contrary to what our school has been teaching us. And they do taping, strapping, metatarsal pads, orthotics, injections (nonoperative treatments). Although to be fair, they let their med assistants do the taping/padding and they refer out for orthotics. Where as the podiatrists will do the taping, casting for orthotics personally. I arrived at the conclusion that we're not much different! Approach may be a little different but treatment the same.
 
streetsweeper said:
I just wanted to throw this out there for the sake of educating others.

My "training" in trimming nails/callus went something like this. In my first day of clinic rotations as a pod student, I was handed a nail nipper and was told to get in there and cut some nails. The attending watched me do it once and then told me "good job." Overtime, I fine tuned my skills with the thousands of patients needing nails/callus debridement with tips from the NURSE practitioner. Covered myself in nail dust from the micromat from time to time. I don't see why a nurse cant do the same. They actually have wound care nurses that take care of wounds all over the body but can't touch feet? Although, good luck in finding nurses actually wanting to deal with feet.

Additionally, I happen to rotate with F&A orthos and podiatry in clinic daily for my podiatry block. I was initially shocked b/c they're doin the same thing as we are in terms of biomechanics/gait analysis..contrary to what our school has been teaching us. And they do taping, strapping, metatarsal pads, orthotics, injections (nonoperative treatments). Although to be fair, they let their med assistants do the taping/padding and they refer out for orthotics. Where as the podiatrists will do the taping, casting for orthotics personally. I arrived at the conclusion that we're not much different! Approach may be a little different but treatment the same.
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We are very different in both respects. Wait until you get into practice before arriving at these conclusions. Sorry, but you have a lot to learn yet.
 
Kidsfeet said:
We are very different in both respects. Wait until you get into practice before arriving at these conclusions. Sorry, but you have a lot to learn yet.
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Care to illustrate the differences? Aside from the obvious nonmusculoskeletal stuff (ingrown nails, warts, fungus, foot wounds). Or length of education.

For a long time I thought we were different but my world has been shattered by following F&A ortho in clinic. So, I need some good answers! PADPM mentioned we "coddle" our patients more.
 
I'm going to have to agree with Kidsfeet on this issue. In reality, what you're exposed to during your training and what you will see in private practice may differ significantly. You are being exposed at the present time to a particular FA orthopedist or a group with similar training (fellows in the same program).

Your opinion is your opinion and no one is tryining to change that fact. I'm basing my opinion on well over 20 years of private practice and witnessing the way patients have been treated by general orthopedists as well as F/A orthopedists.

When I say "coddled", I'm referring to the amount of time/energy we will spend with/on a patient with a particular ailment in an attempt to alleviate the problem. The orthopods I know are quick to "turf" a patient to PT, the orthotist, pedorthist, or other specialist if a problem isn't resolved quickly.

Yes, there are always exceptions, but as previously stated, I've based my opinion on lots of observation over lots of years. Don't worry, we are very different, but fortunately both professions ultimate goal is to help patients with foot and ankle ailments.
 
It would be interesting to get an actual ortho attending or resident to confirm the style of medicine they practice
 
streetsweeper said:
Care to illustrate the differences? Aside from the obvious nonmusculoskeletal stuff (ingrown nails, warts, fungus, foot wounds). Or length of education.

For a long time I thought we were different but my world has been shattered by following F&A ortho in clinic. So, I need some good answers! PADPM mentioned we "coddle" our patients more.
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I would say it's rare to have a clinic where Ortho and Pod work together. I would think that they are learning as much from you as you are from them, so much of what you are seeing is more of a cross pollination factor than anything else.

You also said "aside from the obvious...stuff..." which in and of itself validates my statement.

As far as learning nail care from a nurse (which you put in caps), I learn from the wound care nurses I work with at the wound care center all the time. They do all sorts of wounds and are an invaluable resource to me when it comes to wound products and extra opinions. However, it is still my signature on the paperwork. You are the captain and ultimately they can't provide medical care. If they are providing medical care without supervision and the facility is billing for said procedures, that is consider insurance fraud. A physician needs to be "present" and sign off. If they are not, they are putting their license on the line.
 
javajava said:
It would be interesting to get an actual ortho attending or resident to confirm the style of medicine they practice
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There was a post some time ago, I can't find it atm (no coffee yet), where an Ortho resident approached this topic. I think my response was something to the effect that many of the older F&A Orthos really didn't have the knowledge this young Ortho resident did. No coffee yet, so hard to think clearly...
 
Kidsfeet said:
There was a post some time ago, I can't find it atm (no coffee yet), where an Ortho resident approached this topic. I think my response was something to the effect that many of the older F&A Orthos really didn't have the knowledge this young Ortho resident did. No coffee yet, so hard to think clearly...
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Skiznot is that ortho resident.
 
Kidsfeet said:
There was a post some time ago, I can't find it atm (no coffee yet), where an Ortho resident approached this topic. I think my response was something to the effect that many of the older F&A Orthos really didn't have the knowledge this young Ortho resident did. No coffee yet, so hard to think clearly...
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I remember that post. It confirmed my opinion on current ortho residency training.

Anyway, I appreciate all thoughts/insights from both u and PADPM. I am not sorry that I have a lot to learn.. I am excited that I have more. I also want to throw my current experience out there just to mix it up.

In the OR, biomechanics dictate every level of decision making at least with foot & ankle (where to place the osteotomy, how much bone wedge to take out/put in, range of motion, tendon transfers) then they infuse it with AO principles and u get surgical poetry. They teach it very well. Amazingly enough, they're uncomfortable dealing with first ray/digital procedures.

I primarily interact with 4 F&A orthos trained from all over and you can see the regional differences/doctrines which is no different than when I was an extern traveling all over the country and seeing different techniques/methods. Their clinic is not shared with podiatry.. i just happen to alternate days with podiatry and ortho.

But i'll stop right here. This thread is about nurses doing nails and calluses.
 
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