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Mississippi podiatrists want ‘ankle privileges.’ Other doctors may stand in their way

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11 months ago

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What is a foot?

Underneath the skin, tendons such as the Achilles and muscles such as the tibialis posterior run from the lower leg toward the heel and toe, complicating any attempt at a simple definition. 

Mississippi podiatrists are fighting for a new law that they claim would reflect that anatomical reality by expanding their scope of practice to include the ankle. They say the proposal would allow them to offer more comprehensive care for diabetes complications, preventing amputations, and to treat conditions such as Achilles tendonitis and ankle fractures, expanding patients’ access to care.

The ankle itself is comprised of one foot bone – the talus – and two leg bones, the tibia and the fibula. And Mississippi is now just one of two states where podiatrists lack “ankle privileges,” as the American Podiatric Medical Association puts it.

“That’s the whole thing—they think you’re a foot specialist so you’re just supposed to stop at the talus?” said Dr. Charles Caplis, the owner of Foot Specialists of South Mississippi and vice president of the Mississippi Podiatric Medical Association, who came to the Capitol Tuesday morning to talk with lawmakers about the proposal.

But they are facing opposition from the Mississippi Orthopaedic Society, whose members currently have an effective monopoly on ankle surgeries in the state.

“The Mississippi Orthopaedic Society believes all practitioners who provide surgical care should meet the uniform educational and training standards established by the [American College of Graduate Medical Education],” wrote Dr. Bryan Fagan, the society’s president, in an email to Mississippi Today. “The safest option for citizens of Mississippi is to ensure their foot and ankle surgeons are educated, trained, and credentialed by the same standards as every other medical and surgical specialty.”

Podiatrists in Mississippi and beyond say they’re not surprised by that position, which claims they lack the right training and experience to perform ankle surgeries. The American Medical Association generally opposes scope of practice expansions that allow professionals other than doctors of medicine and osteopathic medicine to perform more services.

In Massachusetts, the only other state with similar restrictions on podiatrists’ scope still in place, the big hurdle has also been opposition from the orthopedists who perform foot and ankle surgery, said Dr. James Christina, executive director of the American Podiatric Medical Association.

“It is about competition for the same patients essentially,” he said.

On Tuesday, Caplis and Dr. Steven Georgian, a podiatrist in Lucedale, stood in the Capitol rotunda to make the argument that the status quo for lower leg care in Mississippi isn’t working. Georgian, who completed his training in Ohio and Pennsylvania, moved back to Mississippi because he wanted to fight for ankle privileges.

Nearly 15% of Mississippi adults have diabetes, the second-highest rate in the country. The disease can damage blood vessels, increasing the risk of wounds that won’t heal, and nerves, creating numbness in the feet that makes it harder for people to realize they have a cut or blister– all putting people at risk of amputation. Mississippians have high amputation rates, and nationally Black patients are three times likelier to lose a limb than others. Within five years of an amputation, patients are likely to die.

With an expanded scope of practice, podiatrists say they could treat those issues more comprehensively and reduce amputations.

Bringing Mississippi’s laws in line with other states would also help bring more podiatrists to the state, they argue, which would improve access for people with diabetes. In 2020, there were only 67 licensed podiatrists in the entire state, according to the Mississippi State Board of Medical Licensure, and not all of them practice.

Christina, of the national association, shared data showing that Mississippi has one podiatrist for every 32,500, while Florida, “which has a very good ankle law,” has one for every 10,300. (Neighboring Alabama, which just changed its law last year to include the ankle, has one for every 30,000.)

State code currently limits the practice of podiatric medicine to “conditions of the human foot.” The proposal would add the words “and ankle, and their governing and related structures, including the muscles or tendons of the lower leg governing the functions of the foot and ankle.” It would also label podiatrists as physicians.

And it would require any podiatrist performing “conservative and surgical treatments” to have received training at an accredited program.

Christina said that when podiatrists first began performing surgeries, they stuck to the foot. But their training has evolved to include ankle surgery, which also makes sense anatomically.

“The foot and ankle become a little bit tough to distinguish,” he said.

Caplis offered a rebuttal to the idea that podiatrists aren’t equipped to perform ankle surgery: Maybe that was true in the past, but it no longer is. Podiatrists get four years of graduate medical education and spend three years in a hospital-based residency that includes training in surgery.

“Medicine advances,” he said. “It’s called society, and civilization. We’re not asking for more than what we’re trained to do.”

This isn’t the first time Mississippi podiatrists have sought to expand the legal limits of their work.

Angela Weathersby, executive director of the state podiatry association, said they began the push in around 2017, and a similar proposal was nearly over the finish line before the pandemic. Now, they’re trying to rebuild momentum.

Sen. Hillman Frazier, D-Jackson, has supported it in the past because he thinks it could help reduce amputations.

“Save a limb, save a life,” he said.

John Higgins traveled to the Capitol from Biloxi on Tuesday to stand with Caplis and Georgian. As a diabetic, he saw doctor after doctor to treat wounds on his legs. They sent him to the podiatrist for what they thought was a callus. But there turned out to be an ulcer underneath. Higgins also had Charcot foot, a type of nerve damage that can cause joint bones in the foot to collapse and increase the risk of infection.

Caplis said that on two different occasions, Higgins was admitted to the ER and a surgeon wanted to amputate his leg. Instead, Higgins went to see Caplis and was able to keep the limb.

That’s a common pattern, Caplis said.

“You go get admitted and they want to cut it off,” he said. “And then I’m having to say, ‘No, no, no, okay. He just needs to be stabilized for a minute. We can work on this.’”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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On this day in 1946

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6 hours ago

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December 23, 2024

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mississippitoday.org – Jerry Mitchell – 2024-12-23 07:00:00

Dec. 23, 1946

Chuck Cooper Credit: Wikipedia

University of Tennessee refused to play a basketball game with Duquesne University, because they had a Black player, Chuck Cooper. Despite their refusal, the all-American player and U.S. Navy veteran went on to become the first Black player to participate in a college basketball game south of the Mason-Dixon line. Cooper became the first Black player ever drafted in the NBA — drafted by the Boston Celtics. He went on to be admitted to the Basketball Hall of Fame.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

Podcast: Ray Higgins: PERS needs both extra cash and benefit changes for future employees

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6 hours ago

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December 23, 2024

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mississippitoday.org – Bobby Harrison – 2024-12-23 06:30:00

Mississippi Today’s Bobby Harrison talks with Ray Higgins, executive director of the Mississippi Public Employees Retirement System, about proposed changes in pension benefits for future employees and what is needed to protect the system for current employees and retirees. Higgins also stresses the importance of the massive system to the Mississippi economy.

READ MORE: As lawmakers look to cut taxes, Mississippi mayors and county leaders outline infrastructure needs

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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‘Bringing mental health into the spaces where moms already are’: UMMC program takes off

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7 hours ago

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December 23, 2024

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mississippitoday.org – Sophia Paffenroth – 2024-12-23 06:00:00

A program aimed at increasing access to mental health services for mothers has taken off at the University of Mississippi Medical Center. 

The program, called CHAMP4Moms, is an extension of an existing program called CHAMP – which stands for Child Access to Mental Health and Psychiatry. The goal is to make it easier for moms to reach mental health resources during a phase when some may need it the most and have the least time. 

CHAMP4Moms offers a direct phone line that health providers can call if they are caring for a pregnant woman or new mother they believe may have unaddressed mental health issues. On the line, health providers can speak directly to a reproductive psychiatrist who can guide them on how to screen, diagnose and treat mothers. That means that moms don’t have to go out of their way to find a psychiatrist, and health care providers who don’t have extensive training in psychiatry can still help these women. 

“Basically, we’re trying to bring mental health into the spaces where moms already are,” explained Calandrea Taylor, the program manager. “Because of the low workforce that we have in the state, it’s a lot to try to fill the state with mental health providers. But what we do is bring the mental health practice to you and where mothers are. And we’re hoping that that reduces stigma.”

Launched in 2023, the program has had a slow lift off, Taylor said. But the phone line is up and running, as the team continues to make additions to the program – including a website with resources that Taylor expects will go live next year. 

To fill the role of medical director, UMMC brought in a California-based reproductive psychiatrist, Dr. Emily Dossett. Dossett, who grew up in Mississippi and still has family in the state, says it has been rewarding to come full circle and serve her home state – which suffers a dearth of mental health providers and has no reproductive psychiatrists. 

“I love it. It’s really satisfying to take the experience I’ve been able to pull together over the past 20 years practicing medicine and then apply it to a place I love,” Dossett said. “I feel like I understand the people I work with, I relate to them, I like hearing where they’re from and being able to picture it … That piece of it has really been very much a joy.”

As medical director, Dossett is able to educate maternal health providers on mental health issues. But she’s also an affiliate professor at UMMC, which she says allows her to train up the next generation of psychiatrists on the importance of maternal and reproductive psychiatry – an often-overlooked aspect in the field. 

If people think of reproductive mental health at all, they likely think of postpartum depression, Dossett said. But reproductive psychiatry is far more encompassing than just the postpartum time period – and includes many more conditions than just depression. 

“Most reproductive psychiatrists work with pregnant and postpartum people, but there’s also work to be done around people who have issues connected to their menstrual cycle or perimenopause,” she explained. “… There’s depression, certainly. But we actually see more anxiety, which comes in lots of different forms – it can be panic disorder, general anxiety, OCD.”

Tackling mental health in this population doesn’t just improve people’s quality of life. It can be lifesaving – and has the potential to mitigate some of the state’s worst health metrics.

Mental health disorders are the leading cause of pregnancy-related death, which is defined by the Centers for Disease Control as any death up to a year postpartum that is caused by or worsened by pregnancy. 

In Mississippi, 80% of pregnancy-related deaths between 2016 and 2020 were deemed preventable, according to the latest Mississippi Maternal Mortality Report.

Mississippi is not alone in this, Dossett said. Historically, mental health has not been taken seriously in the western world, for a number of reasons – including stigma and a somewhat arbitrary division between mind and body, Dossett explained.

“You see commercials on TV of happy pregnant ladies. You see magazines of celebrities and their baby bumps, and everybody is super happy. And so, if you don’t feel that way, there’s this tremendous amount of shame … But another part of it is medicine and the way that our health system is set up, it’s just classically divided between physical and mental health.”

Dossett encourages women to tell their doctor about any challenges they’re facing – even if they seem normal.

“There are a lot of people who have significant symptoms, but they think it’s normal,” Dossett said. “They don’t know that there’s a difference between the sort of normal adjustment that people have after having a baby – and it is a huge adjustment – and symptoms that get in the way of their ability to connect or bond with the baby, or their ability to eat or sleep, or take care of their other children or eventually go to work.”

She also encourages health care providers to develop a basic understanding of mental health issues and to ask patients questions about their mood, thoughts and feelings. 

CHAMP4Moms is a resource Dossett hopes providers will take advantage of – but she also hopes they will shape and inform the program in its inaugural year. 

“We’re available, we’re open for calls, we’re open for feedback and suggestions, we’re open for collaboration,” she said. “We want this to be something that can hopefully really move the needle on perinatal mental health and substance use in the state – and I think it can.”

Providers can call the CHAMP main line at 601-984-2080 for resources and referral options throughout the state. 

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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