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Podiatry Assistants

Discussion in 'Australia' started by chellesil84, Nov 20, 2011.

  1. chellesil84

    chellesil84 Member


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    Hey all,

    General questions and thoughts, looking for some feedback and opinions.
    TAFE runs a Allied Health Assistance course which streams in Physio, OT and Pod. As a Cert IV qualified Pod A. you are allowed to work unsupervised.

    As yet, not a lot of Pod A. positions are out there, what are the thoughts from all of you Pods regarding an assistant? Through my placement at 2 hospitals with Physio and OT, both professionals have outlined a real need for more pod care in hospitals, retirement villages and nursing homes for a start. Their view with regards to the hospitals is a Pod A should be employed and take care of the basic nail cutting on some of these long stay patients as the poor state of their nails can effect their therapy due to them being unable to wear shoes. They have been told that the Pods in the hospitals only see to the patients with diabetes and vascular conditions (which in turn means the assistant couldn't see them anyway), so there really is a big gap there.

    But, would it be something worth considering for the pods to take on pod a's, line up with nursing homes and retirement villages that the patients interested could get nails cut at a reduced fee, taking some load off the pod's and also meaning more affordable and accessible foot care.

    Just putting the thoughts out there, interested to read some opinions.
     
  2. Tuckersm

    Tuckersm Well-Known Member

    Richelle,

    While as a Cert IV AHA, you may not be required to have supervision, the Podiatry Board of Australia requires that any podiatrist working with an AHA does provide suitable supervision.

    from http://www.podiatryboard.gov.au/Policies-Codes-Guidelines.aspx

    This pretty much rules out the easy use of AHAs in hospital settings to provide nail/foot hygiene services, as the "pre" supervision work would take as long as providing the treatment. There are a few around providing a true assistant role, working with the podiatrist to provide care, inclding wound dressings and footwear fitting.

    There are also a number of Podiatrsist using AHAs/Podiatry assistants in the aged care sector.
     
  3. chellesil84

    chellesil84 Member

    Thanks, yes I understand you do need some supervision and in the way the board says etc, but my local pod also feels that a letter (or in terms of the hospital, case notes) clearing them of having any high risk factors may also be suitable as a prescreening tool as to whether the assistant can see them. Which then can cut out the time taken from the Podiatrists for the initial screening. We have been taught on foot screening, and what to look out for, so if anything ticked red flags there of course it would be referred back to the pod immediately anyway.

    Just brainstorming ideas, so thankyou for replying :)
     
  4. surfboy

    surfboy Active Member

    "But, would it be something worth considering for the pods to take on pod a's, line up with nursing homes and retirement villages that the patients interested could get nails cut at a reduced fee, taking some load off the pod's and also meaning more affordable and accessible foot care."

    More 'affordable' foot care you say. Whilst I appreciate your enthusiasm, Richelle, please do not assume that your course is a back door entry to becoming a registered health professional with a provider number.

    Let's face it, most low care residents in retirement villages are eligible to be financially covered for treatment under the Medicare EPC program. The cost for a patient to attend for routine Podiatry care is thus very marginal. The current rebate is $51.95 per Podiatry appointment.

    Also, out of curiosity, what happens if you inadvertently cause injury to a patient? As you are not a registered practitioner with professional indemnity insurance, on whose neck would the axe fall ??
     
  5. pdoan01

    pdoan01 Active Member

    I believe podiatry assistants/nurses whaterver you want to call them are very similiar to dental nurses or even medical nurses. I believe the use of a pod.a should only be for 'low risk' nails but thats it no more! not even debriding. because scalpels are for the podiatrist because thats generallly how a podiatric treatment starts with callus as it leads to corns then ulceration yadda yadda

    other roles of a pod.a include cleaning and sterilizing instruments, setting up the consultation room for the podiatrist, assisst patient, possibly reception work ie doctors letters, update patient files,

    with regards to insurance iam only aware that AON is the company that provides insurance for students/assisstants. not sure bout othrs.

    however if you have a practice with heaps of GTs and EPCs you can offload to the pod.a if you want but your're descision
     
  6. Tuckersm

    Tuckersm Well-Known Member

    Surfboy,

    If the Pod A is working under your supervision, you, as the podiatrist and registered health professional ultimately carry the can. That is the way the PodBA guidelines set it out, and why the podiatrist supervising makes the decsion as to which patients the Pod A can see. But if they are working independantley, they would carry the can, and could be sued by the patient.

    You should also remember that there is a large unregulated group of degree qualified health professionals already out there. Occupational Therapists (for another 7 months), Speech Pathologists, Orthotists, exercise physioloists etc. and AHAs have been working with other disciplines for 20yrs.
     
  7. julesrose

    julesrose Member

    Surfboy,
    yes a lot of people might qualify for EPC but a lot of elderly arent mobile enough to get down to the clinic. Not many podiatry clinics still do home or hospital visits (i know we dont).
    I think there is a HUGE need for people who will cut nails who have at least some training. I even knew a GP who was cutting patient's nails because no one else would cut them!! Let's face it in the hospitals the nurses can't cut the nails because they're not covered by insurance, but the hosptial pod wont cut the nails because their not high risk.
    The hospital pods are focussed on ulcers, private pods are usually geared towards orthosis. The less low risk tonails we cut the better. (i also wonder where the high risk nails will get cut when there's not enough hospital pod's to cut their nails and their EPC visits are spread between several allied health).
     
  8. Look, for now medicare is paying the most for "SURGICAL debridement of fungal toenails that are painful and debiltating to patients". In 2011 they paid the most they've ever paid for something that potentially can cause joint issues such as carpel tunnel syndrome for the podiatrists that performs these in masses since 1996 when they were paying as much as 45.00 for 11721 (presently it is 42.11 which is still short changing us given that nearly 20 years have elapsed and inflation kept rising)! Between 1996 and 2010, as little as 38.00 (this is in Illinois by the way) has been reimbursed. With that said, it is bad enough that medicare only managed now to pay more than $40 for SURGICAL nail debridement of greater than 5 toenails. About two months ago, I attended a so-called biomechanical seminar sponsored by Langer Biomechanics where these NON-physicians were going on about letting these mere assistants do nail debridement, callus trimming and even orthotic fitting and dispensing! I was outraged and so were others except for the FOOLS stupid enough to actually already let these untrained assistants do these things that medicare for now is paying DPMs to do! As I said, it is bad enough that medicare insults us with these fees given that diabetic specialists realize the utter importance of these potentially limb threatening diseased toenails. Suppose they learn that podaitrists do not even bother to take this procedure seriously enough to perform them themselves! They will simply one day do away with even paying the CPT codes all together and this will hurt a lot of podiatrists like myself who take pride in this procedure and am appreciated by PATIENTS for providing it. If you want to work on feet even if it is just toenails then you better drop out of that allied school and go to podaitric medical college, get licensed and most importantly get liabilty insurance to do so! I am tired of you lazy people such as yourselves and those nurses taking the easy route and then get out and try for procedures that should only be performed by LICENSED podiatrists who paid their dues and more through 4 years of podaitric medical college and 1 to 3 years of residency training! You don't see dentists letting assisants pull teeth! Heck many still take pride in simple cleaning! And podiatrists are always complaining about not being taken seriously! This is why!

    Dr. Brooks
     
  9. chellesil84

    chellesil84 Member

    I would never even consider debridement, cutting nails would be ALL that I would do, maybe moisturise and massage, simple. I'm most definitely not talking about any surgical procedures what so ever. I'm not entirely sure how it came about that debridement was suggested as a task to be done by an assistant.

    You all raise interesting points. As I said, I was putting it out there to get feedback, and I have got it, so thanks
     
  10. julesrose

    julesrose Member

    Wow, I think Dr Brooks needs to look at this from an Australian perspective.
    Currently I have heaps of patients that cant afford to come to see me (a podiatrist) outside of the one or two visits medicare decides to give them. The community podiatrist works one day a week and has a gigantic waiting list with some people waiting 2 years! So there are people out there with deformed nails, with neuropathy, high risk of ulceration and guess who cuts their nails? Either their blind spouse or themselves normally taking half the toe off at the same time. Can you honestly tell me it wouldn't be better for a trained assistant to cut their toenails?
    Podiatry is quite expensive here and many pensioners just cant afford it.

    I have to stress it would be a very long time before Pod assistants would be allowed to cut these kinds of toenails- but do you understand what i'm getting at?
    Then there are all the elderly people without a chronic medical condition that get no visits to the podiatrist from medicare. Many might be widowed and have no immediate family living nearby and they have no one to cut their nails. To come to a private podiatrist every 6 weeks at our clinic it would cost them $480 a year, many can't afford it.

    As another point, beauticians cut people's toenails everyday with often no qualification or sterilization of instruments. So if you think podiatrists should be the only ones allowed to cut toenails, I think the battle is already lost.
     
  11. surfboy

    surfboy Active Member

    Thanks for this excellent post, Dr. Brooks.


    Perhaps the solution here in Australia, is for Medicare to increase the number of Podiatry visits available from 5 each year, to say 10.

    Rather than farming out patients to 'assistants' to "keep costs down", how about Medicare increases the financial coverage available to patients so that proper Medical care can be obtained.

    I do not agree with 'assistants' being able to perform routine Podiatry care. As Dr. Brooks advises, go back to Podiatry Medical School and become properly trained and licensed.
     
  12. julesrose

    julesrose Member

    By taking the stance "only a podiatrist is allowed to cut nails" you force people to go underground. I know there is a lady in the next town who cuts elderly patients toenails for $6. My patient said she goes back evey 4 weeks because she doesnt cut them very short- I thought "yeah she doesnt want to cut your toe and get sued!". Even with 10 medicare visits there are not enough podiatrists to go round to cut all the babyboomer's toenails. In 3 years out of 40 graduates, I know of 10 that are already not practicing podiatry anymore. There is already a desperate need for podiatrists and yet they're dropping out like flies.
     
  13. pdoan01

    pdoan01 Active Member

    I believe surfboy was referring to routine podiatry care which isnt just nails. I agree nails is the max any assistant or footcare nurse can do. But when it comes to debriding then thats where podiatric intervention is.
     
  14. julesrose

    julesrose Member

    That's where i got the "only pods are allowed to cut toenails" vibe and surfboy seems to agree.

    Of course callus should go to pods- because hopefully a decent pod will also apply padding to try and prevent the built up of callus when possible.
     
  15. pdoan01

    pdoan01 Active Member

    we should also determine between 'low risk' nails to 'high risk'

    of course if we have geriatric patients losing flexibility and no longer reach their feet then by all means assistants can cut nails, however if they are presented with mycotic or really thick chauxic nails what do u propose? referral? then we have many other nail pathologies and without a treatment plan the assistant is just a 'chop and go' person without any regard for patient goals.
     
  16. julesrose

    julesrose Member

    I agree with what you're saying, assistants should be allowed to cut uncomplicated nails and be insured for it (ideally independently in their own clinic/house?), with referral to pods for more difficult nails.
    I know this is a LONG way away but maybe in the future assitants could cut fungal nails (just cut! no surgery) and recommend fungal nail treatments if there is a big enough need. As far as i know fungal nails dont qualify for EPC so if they cant afford a pod they'll find someone else to cut their toenails.
    If there arent enough pods to go around (especially in country areas- where I currently live and practice) dividing patients into low and high risk may help to ease some of the waiting lists (as i previously mentioned can be up to 2 years).
    And i agree 10 medicare visits would be a great help but there are gaps that could be filled by assistants (e.g hospital or home visits)
     
  17. pdoan01

    pdoan01 Active Member

    Actually letting our pod nurses practice 'independently' would be a mistake, big mistake!

    there are reasons why nurses operate under supervision of doctors, dental nurses operate under dentist supervision etc. thats why it goes the same for our nurses.

    let me ask you this what if something goes wrong? I dont think insurance companies are going to insure pod nurses independently. The ideal situation would be podiatrists employing pod nurses/assistants in the private sector for the assistant to do RNCs but must be referred by the podiatrist and deemed worthy as low risk by the podiatrist. The same would go in the public sector. With medicare thats APodC lobbying and getting the PBA on board to get us maybe exception to EPC where there is 5 visits to any allied health and mabe 5 - 10 just for podiatric care I mean most EPCs come to us do they not?
     
  18. julesrose

    julesrose Member

    In an ideal world, I would love that senario. From the pod clinics i've been in there's just no space for a pod assistant. More space = higher rent plus you'd be paying for an assistant.
     
  19. pdoan01

    pdoan01 Active Member

    times are changing and in the next few years many pods will be working with assistants
     
  20. julesrose

    julesrose Member

    I'm sure that will be the case and then they'll have to start charging more. A check up/clean at the dentist the other day cost $150 for 15 minutes not to mention the price of a filling- so that's how they can afford an assistant.
     
  21. pdoan01

    pdoan01 Active Member

    you should probably do $85 gt from a pod, $55 RNC from an assistant each for 15min if you want to make money (this is just a suggestion and I do not imply that I charge this)
     
  22. pdoan01

    pdoan01 Active Member

    I might have missed something. Why is the occupational therapy profession getting a government regulatory board?? why do they need professional imdemnity insurance??
     
  23. Tuckersm

    Tuckersm Well-Known Member

    OTs will need to be registered from July 2012, and that is why they need a Board and insurance. Why is this happening? Lobbying during the preparation of the National Act a few years ago, as OTs and Radiographers, chinese medicine practicioners are registered in just some states currently but will be nationally registered next year.
     
  24. pdoan01

    pdoan01 Active Member

    hmm this sounds like Roxons plan to 'unite' everything.

    Personally I think it seems that there shouldnt really be so many boards, I mean next the Allied health assistants want a national board, the real reasons might be that OTs or radiographers want more political power??
     
  25. Tuckersm

    Tuckersm Well-Known Member

    The decision wasn't based on anything more than which professions in the first instance had registration in all states and territories, (podiatry only snuck in at the last minute, as we were not registered in the NT, with lobbying of the A.Pod.C and the Vic and NSW state governments) The second wave are those registered in more than one state.

    Speech Pathology and Social Work remains partially regulated (Qld only I think) and others not at all.

    Registration IS only about protecting the public, not enhancing professional political power.
     
  26. Banksy

    Banksy Welcome New Poster

    Hi

    I'm a uk qualified podiatry assistant and have recently moved to Adelaide but am struggling to find work?

    In the uk, the majority of my work involved cutting toe nails and giving foot care advice to patients in clinic, nursing homes and their own homes.

    I also assisted the podiatrists during nail surgery and helped with wound care, I did very little admin work, the job was very 'hands on', thus, helping the podiatrists with the work load so that they could concentrate on the very high risk patients.

    Myself and the other podiatry assistants in my team were very skilled and committed and I think the podiatrists really appreciated us.
     
  27. toughspiders

    toughspiders Active Member

    We did!!! Or should i say I did!! Our Podiatry Assistance were fabulous and well trained and never attempted anything they should have. They had clear boundaries and stuck to them but,,,,,,saying that,

    Its very different here. Majority of Podiatric Care is Private. Hence a bulk load of our private work is general treatments. A lot of which may be just nail care. Take that away from Podiatrists in highly concentrated employed podiatrist and i guess you'd be taking away a significant amount of their workload and hence turnover!
     
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