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Podiatrists press for ankle-surgery authority; orthopedists raise quality concerns
Summary
Podiatrists and their supporters urged the Joint Committee to update podiatry scope of practice in Massachusetts to explicitly allow certain ankle procedures and reduce 'medical deserts,' while orthopedists opposed expanding scope above the ankle, citing outcome differences and training distinctions.
Podiatrists, hospital credentialing representatives and patient advocates told the Joint Committee on Public Health that Massachusetts should expand its statutory definition of podiatry to explicitly allow certain procedures on the ankle and to align practice authority with training, while orthopedic surgeons urged caution and opposed scope expansion above the ankle.
"Massachusetts is now 1 of only 2 states in the nation that does not explicitly allow podiatrists to perform procedures on the ankle," said Dr. Tyler Silverman, a podiatrist and legislative chair for the Massachusetts Foot and Ankle Society, during testimony supporting House Bill 2,407 and related measures. Supporters argued that modern podiatric training follows a 4/4/3 model (undergraduate, podiatry doctorate, residency) and that many procedures are safely credentialed by hospitals' committees; they also argued that expanding scope would improve access to limb-salvage care for diabetic and vulnerable patients.
Orthopaedic surgeons warned of worse outcomes if ankle and lower-leg surgery authority were extended. Dr. Scott Ryan, president of the Massachusetts Orthopedic Association and an orthopedic trauma surgeon, said his group's review found lower complication rates and lower costs when orthopedic surgeons performed ankle fracture surgery and expressed concern about widening scope without evidence of equivalent outcomes.
Both sides told the committee that access is an issue: podiatry leaders said young podiatrists are not settling in Massachusetts because of restrictive law, while orthopedists said collaboration and credentialing within hospitals remain essential safeguards. Sarah Rose, a Mass General podiatrist who runs limb-preservation programs, described podiatry's role in preventing amputations and said extending training-appropriate authority would help reduce amputations and improve quality of life.
What happened next: the committee heard extended testimony and did not take a vote during the hearing.
Ending: Sponsors promised to provide credentialing safeguards and hospital oversight language; the orthopedic community asked the committee for more outcome data before statutory change.
