1. What is a Podiatrist’s scope of practice in Texas? What specific procedures can a Podiatrist perform?
The scope of a licensee’s practice is defined by the law and rules.
- Texas Occupations Code 202, Subchapter H
- Texas Administrative Code 130, Subchapter E
2. May Podiatrists write prescriptions?
Yes, for a valid medical purpose and within the limits of podiatry scope of practice, Podiatrists can write prescriptions to treat any disease, disorder, physical injury, deformity or ailment of the human foot. A Podiatrist, however, cannot delegate his/her prescriptive authority to any other person.
Please see the Prescribing Medication page for more information.
3. May Podiatrists take a History and conduct Physicals and make Hospital Admissions?
Yes. It falls within a Podiatrist's scope of practice and licensure to conduct “History and Physicals,” limited only by the position of the hospital/surgery center/entity/facility where privileges are granted
- Privileging is a local matter between the applicant and medical staff. Nevertheless, within licensure/scope, a Podiatrist MAY perform a full H&P (i.e. head-toe) for podiatric admission, but only if credentialed to do so by medical staff (local control) and of course, if prudent to do so understanding that most facilities take a multi-disciplinary admission approach for patient safety. This "full H&P" would include addressing "other elements in a full H&P such as cardiac, medical and/or other non-podiatric related elements." But, the Podiatrist would have to demonstrate his/her competency to medical staff to perform full H&P's (i.e. head-toe).
- A Podiatrist could NOT perform a full H&P for a patient NOT undergoing podiatric medical (foot) treatment. For example, a facility could not authorize a Podiatrist to do a full H&P on a patient for "medical" conditions such as knee, hip, back, heart, brain surgery, etc. Meaning, while a Podiatrist can do a full H&P for foot surgery, that is not a waiver for a Podiatrist to do full H&P's for non-foot conditions.
- Credentialing is a matter for local determination and community standards.
No. A Texas podiatrist cannot:
- conduct the testing and physical examination of body systems required on the "FMCSA-DOT Medical Examination Report"
- determine whether the driver is physically qualified to drive a CMV in interstate commerce
- complete the Medical Examiner’s Certificate.
It falls outside the scope of practice for podiatry in Texas for a Texas podiatrist to issue such a "FMCSA-DOT Medical Examination Report For Commercial Driver Fitness Determination” as rendering such a certification requires medical determinations for body systems beyond the foot.
5. May Podiatrists conduct University Interscholastic League (UIL) Pre-Participation Physical Evaluations - Physical Examinations?
No. A Texas podiatrist cannot conduct the testing and physical examination of body systems required on the UIL Pre-Participation Physical Evaluation/Examination Report.
It falls outside the scope of practice for podiatry in Texas for a Texas podiatrist to issue such a UIL Pre-Participation Physical Evaluation/Examination Report as rendering such a certification requires medical determinations for body systems beyond the foot.
6. May Podiatrists sign the written statement that accompanies the application for Disabled Person Placards and License Plates?
Yes. Texas Transportation Code Chapter 681 "Privileged Parking" provides that the required notarized written statement or written prescription that accompanies the initial application for a disabled person identification placard or license plate can be issued by a person licensed to practice podiatry in this state or a state adjacent to this state for a person with a mobility problem caused by a disorder of the foot that limits or impairs that person's ability to walk.
For more information, you may contact the Texas Department of Transportation.
7. Can a Podiatrist advertise and promote an off-label non-FDA approved use of lasers (& other drugs/devices) for toenail fungus treatment?
With regard to laser devices, all lasers are regulated by the Texas Department of State Health Services - Radiation Control Program (DSHS). Please contact DSHS regarding the use and safety standards for these devices.
- Podiatrists in Texas can treat the foot by "any system or method" and this COULD include the use of a laser device if it is properly registered with DSHS, used safely and for its intended purpose, and not prohibited by any other regulatory agency. The use of lasers are subject not only to Podiatry Regulations, but also to those of the Texas Department of State Health Services, the Texas Medical Board, the Texas Spa Act and the U.S. Food & Drug Administration (FDA), as well as TDLR rules related to cosmetology.
- With regard to podiatrists advertising and promoting an off-label use of lasers for toenail fungus treatment, the S. Food & Drug Administration has regulations that govern misbranding, mislabeling and false advertising by manufacturers. Medical providers are restricted from advertising or promoting an off-label indication to attract patients for an off-label procedure; such promotion and inducement of an off-label therapy is misleading/deceptive. Patients should be notified by the Podiatrist of any off-label use of drugs and devices, and informed consent should be obtained for the safety of the patient.
- The American Podiatric Medical Association (APMA) provides the following refresher on "Off-Label" Use of Marketed Drugs and Medical Devices: Sound medical practice and the best interests of the patient require that podiatrists use legally available drugs and devices according to their best knowledge and judgment. However, podiatrists may routinely utilize a Food and Drug Administration (FDA)-approved drug or medical device to treat a condition or perform a surgical procedure for which the product has not yet been approved. Podiatrists may receive information about the success of such off-label use from colleagues, seminars, medical literature, and, in some cases, from the manufacturer itself. In these cases, the podiatrist has the responsibility to be well-informed about the product; to base its use on firm, scientific rationale and on sound medical evidence; and to maintain records of the product's use and effects. When using a drug or device for an off-label use, DPMs should inform the patient of this use, advise the patient of possible complications, and document this conversation in the patient's medical record.
- Podiatrists cannot promote or advertise the off-label use of a drug or device. The podiatrist can, however, advise a patient seeking treatment of the off-label medication or device when the patient presents with a condition for which the podiatrist determines that the off-label medication or device is in the patient's best interest.
- If you have questions about the appropriateness of devices used in your practice, visit fda.govfor more information.
8. Can a Podiatrist provide fingernail fungus (laser) treatment, even upon a prescription from a MD/DO or APN-NP/PA requesting such fingernail treatment?
No. A license to practice Podiatry is limited to treatment of the foot. Fingernail Laser Therapy by a Podiatrist is outside the scope of practice for Podiatry and is not permissible.
9. Can a podiatrist employ an Advanced Practice Registered Nurse (APRN) as a podiatric physician extender?
The Texas Board of Nursing (TBON) regulates the practice of nursing in Texas. This includes professional nursing and advanced practice nursing. We recommend requestors contact TBON for further information regarding a nurse’s scope of practice. An APRN is a Registered Nurse (RN) licensed by TBON to practice as an Advanced Practice Registered Nurse on the basis of completion of an advanced educational program. The term includes a Nurse Practitioner, Nurse Midwife, Nurse Anesthetist, and Clinical Nurse Specialist.
In a hospital setting, Texas Health and Safety Code Chapter 241 authorizes a governing body of a hospital to establish policies concerning the granting of clinical privileges to APRNs.
In the office/practice setting of a podiatrist, a podiatrist may employ a nurse who happens to be an APRN. However, an APRN who is employed in this setting can only function as a RN, meaning a nurse who is practicing professional nursing under orders of a podiatrist while in the presence of the podiatrist. An order is a specific task for a specific patient and not the same as delegation.
Delegation allows for autonomous decision-making capability about the course of care for a patient. Only MDs and DOs are authorized to delegate to an APRN pursuant to Texas Occupations Code Chapter 157 (Medical Practices Act; jurisdiction of the Texas Medical Board and the Texas Board of Nursing). There is no provision in the Podiatric Medical Practice Act (Texas Occupations Code Chapter 202) that allows a podiatrist to delegate to an APRN. An APRN cannot function as an autonomous representative for, or act autonomously on behalf of, a podiatrist in an office/practice setting.
10. Can a Podiatrist be a Medical Director of a clinic/facility?
TDLR does not have any law or rule prohibiting a podiatrist from acting as a Medical Director for a facility. However, the podiatrist must still only act within the scope of practice for podiatry/podiatric medicine. A podiatrist's position as a Medical Director cannot supersede the scope of practice limitations for podiatry/podiatric medicine.
Podiatrists are permitted to work in a group setting composed of practitioners from different branches of the healing arts.
11. Can a Podiatrist be a Surgical Assistant for non-podiatry procedures?
Yes. Surgical Assistants are licensed by the Texas Medical Board (Texas Occupations Code Chapter 206 and related Texas Medical Board rules). Physicians (i.e. MD/DO; licensed by the Texas Medical Board) have the statutory authority to delegate certain medical acts (Texas Occupations Code §157.001 "General Authority of Physician to Delegate") to other persons in accordance with the law and rules of the Texas Medical Board. However, a podiatrist working as a surgical assistant under a physician’s delegation may not bill for services provided.
12. Can a Podiatrist administer Nitrous Oxide (N2O) to patients?
Yes, if the podiatric physician holds the appropriate TDLR permit.
Conscious sedation of a patient by nitrous oxide shall be induced, maintained, and continuously supervised only by the podiatric physician or by the assistant under continuous direct supervision of the podiatric physician. The nitrous oxide shall not be flowing if the podiatric physician is not present in the room. The podiatric physician must be present at all-times and cannot delegate the administration of nitrous oxide to any other person.
The utilization of N2O by a podiatrist, pursuant to the aforementioned requisite Board certification, is an approved modality pursuant to TDLR Rules "Nitrous Oxide/Oxygen Inhalation Conscious Sedation Guidelines" and Attorney General Opinion MW-435 (02/01/1982) - PDF. As long as the podiatrist is performing N2O for purposes of the practice of Podiatry, he or she is authorized to employ N2O.
Office-based procedures should not be a substitute to treat a patient outside a (properly credentialed) hospital or ambulatory surgical clinic or center setting when the standard of care dictates that a patient be treated in those settings; for the health, safety and well-being of the patient.
It is imperative during the Pre-Operative Evaluation that the podiatric physician evaluate and document in the patient's medical record, prior to the nitrous oxide/oxygen inhalation conscious sedation procedure, the patient's health and medical status to ensure that nitrous oxide/oxygen inhalation conscious sedation is medically appropriate.
Podiatry offices/practices must meet all cleanliness, sterility and infection-control standards; for the health, safety and well-being of the patient.
It is further noted that the TDLR N2O rules do not explicitly address whether or not a podiatrist is authorized to administer moderate sedation, such as versed. Persons who administer anesthetics such as nitrous oxide are subject to liability for injuries caused to a patient by their negligent administration thereof.
13. Can a Podiatrist administer General Anesthesia to patients?
No. A license to practice podiatry is NOT a license for a podiatrist to administer general anesthesia. However, podiatrists may request the provision of anesthesia services from the appropriate provider (whether that is from a MD/DO Anesthesiologist or CRNA) in consideration of the safety and well-being of a patient.
14. Can a Podiatrist sign a "Death Certificate" and "Pronounce Death"?
No. A licensed podiatrist is:
- Not authorized to sign a death certificate
- Not authorized to file a death certificate with the local or state registrar
- Not authorized to pronounce death
A Podiatrist is not one of the persons that Texas state law requires to file death certificates, or authorizes to determine and pronounce death.
15. Can a Podiatrist administer the Flu Shot?
No. The Flu (influenza) is not a disease, disorder, physical injury, deformity, or ailment of the human foot.
Please see the Prescribing Medication page for more information.