APMA News - September/October 2023 - 26

federal advocacy forum
One Step Closer to Parity
By William S. Long, DPM, Chair
The Department of Veterans Affairs (VA) has
been aggressively addressing its medical staff
recruitment/retention crisis this year. The VA
understands the value of podiatrists in its hospitals
and is making strides to address issues such
as scope of practice to not only attract but also
to retain podiatrists. In 2018, Congress passed
the VA MISSION Act (S 2372), which includes
language from APMA's VA Provider Equity Act-
legislation requiring the VA to treat podiatrists the
same as other physicians within the VA Health
Administration (VHA) and placing us in the same
pay band with our allopathic and osteopathic
colleagues. Most if not all podiatrists practicing
at the VA received a salary increase after the VA
MISSION Act passed.
The VA is currently working on the VA National
Standards Project, which seeks to standardize the
scope of practice for health-care providers employed
by the VA, including podiatrists. If adopted,
the recommended scope of practice would allow
all podiatrists employed with the VA the opportunity
to practice to the full extent of their residency
training. APMA worked with the VA's podiatric
medical director, APMA member Jeffrey Robbins,
DPM, to develop draft language submitted to the
VA, which reads as follows:
Podiatric medicine and surgery is the specialty
that addresses the diagnosis and treatment of
pathologies and conditions of the lower leg, with
special emphasis in the diagnosis and treatment
of the foot, ankle and their governing and related
structures of the leg and by any and all means.
Osseous surgical treatment is limited to that part of
the lower leg distal to the tibial tubercle.
The VA project may serve as a target for individual
states to expand their scope of practice. The
language within the VA project, if accepted and implemented
into individual state laws, would establish
a uniform scope of practice, standardizing podiatry
scope across the country. A uniform scope would
eliminate confusion among our medical colleagues
and patients. PM News polls are neither statistically
significant nor in my mind trustworthy. I don't
think we should be quoting this publication in our
magazine. APMA has long supported this idea. The
issue with implementing a uniform scope outside of
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SEPTEMBER/OCTOBER 2023
federal facilities remains that state laws and regulations
determine scope of practice.
The VA project is forward-thinking. Article VI,
paragraph 2 of the US Constitution is referred to
as the " Supremacy Clause. " In a nutshell, it establishes
that federal law generally takes precedence
over state laws and even state constitutions.
Therefore, if the above language were adopted
by the VA, then any podiatrist employed by the
VA and working in federal institutions would be
able to practice to the full extent of their residency
training regardless of where they are licensed or in
what state they practice. This scope would include
both Massachusetts and Mississippi, which are the
only two states that limit podiatric surgeons to foot
surgery excluding the ankle. The hope is that the
component societies in both states could one day
petition to expand their scope of practice using the
language of the uniform scope of practice once
the VA National Standards Project is accepted.
It is in the best interest of our profession to
fully support the VA National Standards Project. If
implemented, it will ensure that the VA attracts and
retains highly trained podiatric physicians. Further,
podiatrists employed by the VA will be one step
closer to parity. The VA National Standards Project
could be the vehicle to achieve the uniform scope
of practice that is much needed by our profession.
I encourage all members to stay up to date on
legislative issues through the APMA eAdvocacy
website, www.apma.org/eAdvocacy.
http://www.apma.org/eAdvocacy
APMA News - September/October 2023

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