UNIVERSITY HOSPITAL – McDUFFIE

DEPARTMENT OF SURGERY

SECTION OF PODIATRY

REQUEST FOR PRIVILEGES

To be eligible to request clinical privileges, the following threshold criteria must be met.

EDUCATION:DPM

TRAINING:

Successful completion of an approved two years of Podiatric Residency with at least one year comprised of a

Podiatric Surgical Residency (PSR-12). The residency program must have been approved by the Council on

Podiatric Medical Education (CPME) during the time of training. Applicant mustmeet the requirements for

board certification outlined in the Medical Staff Bylaws.

EXPERIENCE:

The initial applicant must be able to demonstrate training and/or experience on a level commensurate with

specialty training from an accredited Podiatric residency programor current competency inproviding

medical/surgical management and/or treatment to patients within the scope of core privileges for Podiatry.

Adequate documentation of this performance requires submission of a case list and a referenceletter. All initial

applicants at completion of residency and/or fellowship must provide an official caselist and letter of

recommendation assessing performance from the Residency and/or Fellowship Program Director. Allinitial

applicants beyond 12 months of residency/fellowship completion must provide a case list fromthe hospital

where the applicant has been actively practicing for the last year and a letter ofrecommendationassessing

performancefrom the hospital’s Chief of Staff or Department Chair.

The reappointment applicant must demonstratecontinuing competence and meet requirements for C.M.E.

according to the Medical Staff Bylaws.Reappointment is based upon unbiased, objective review of result

of care according to thehospital’s existing quality mechanisms.

CORE PRIVILEGES:

(This list is a sampling of privileges included in the core but is not intended to be an all-encompassing list

but rather reflective of the categories/types of privileges included in the core.)

REQUESTED GRANTED

Admission of patients
Provision of consultation, including evaluation, diagnosis and ordering of diagnostic
studies and procedures for patient with general podiatric problems.
Core I
(Requires completion of one year CPME recognized podiatric surgical residency)
Surgical and non-surgical treatment of clinical problems related to the digital and forefoot
Digital surgery (Hammertoe repair, fusions)
Osteotomy & ostectomy (digital and metatarsal)
Soft tissue repairs and excisions – digits and forefoot
Simple bunionectomy
Amputations of the digits
Excision of toe nails
Morton’s neuroma excision
Forefoot exostectomy
Capsulotomy/tenotomy digital M-P joints
Fasciotomy, plantar (simple, Steindler)
Repair Laceration
STJ arthroeresis with implant
Core II
(Requires completion of a two year CPME recognized podiatric surgical residency)
Extension of simple surgical procedures of the hindfoot
Sesamoidectomy
Fractures of digits and metatarsals - ORIF & closed reduction

SECTION OF PODIATRY

REQUEST FOR PRIVILEGES

PAGE 2

REQUESTED GRANTED

Core II Continued
(Requires completion of a two year CPME recognized podiatric surgical residency)
Hallux valgus repair with distal osteotomy
Hallux valgus repair with proximal osteotomy
Hallux valgus repair with cuneiform osteotomy
Hallux valgus arthroplasty without prosthesis, including Regnauld
Hallux valgus repair, with prosthesis
Hallux valgus repair with fusion (M-P or Lapidus)
Metatarsal osteotomy, lesser and ostectomy
Excision of soft tissue neoplasms, foot
Jones suspensions (+) Hallux IP fusion
Osteotomies of the midfoot and arthrodesis
Neurolysis of the foot
Fractures of the forefoot & midfoot
Retrieval of foreign body - foot
Osteomyelitis management - foot
Management of the foot in septic diabetic states
Bone Graft Harvest - Foot only
Retrocalcaneal exostosis
Midfoot exostectomy and rearfoot
Accessory bones of foot
Repair of Tendon Trauma
Coblation foot or ankle
Skin graft or rotational flap
Simple flatfoot repair
Core III
(Requires completion of a three year CPME recognized podiatric surgical residency)
Extension of surgical procedures to the lower extremity to and including the ankle joint
Flatfoot reconstruction with osteotomy, bone grafts, etc.
Cavus foot reconstruction with osteotomy, fusions
Arthrodesis/osteotomy midfoot
Arthrodesis, with implants
Major rearfoot arthrodesis – triple, subtalar
Fractures of the rearfoot – tarsals and ankle (ORIF & closed reduction)
Osteomyelitis management – foot and ankle
Skin grafts or rotational flaps
Talar dome repairs
Bone graft harvest, foot & ankle (implant & handle)
Extensive forefoot reconstruction: Panmetatarsal surgery, pansuspension of metatarsals, or Hibbs suspensions or with tibialis anterior suspensions with or without multiple Metatarsal osteotomies
Osteotomies of the midfoot & rearfoot
Grice extra-articular arthrodesis
Tarsal osteotomy
Tarsal capsulotomy or capsulorrhaphy
Pantalar arthrodesis
Repair of lacerations involving all soft tissue structures of the foot
Ankle Arthroplasty
Ankle stabilization
Heel Cord Repair
Neurolysis of posterior tibial nerve

SECTION OF PODIATRY

REQUEST FOR PRIVILEGES

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Excluded privileges: may not independently treat the following conditions, but shall
refer the patient to a properly qualified physician.
Life-threatening lesions including, but not necessarily restricted to, proximally advancing
infections or malignant tumors.
Limb threatening lesions including, but not necessarily restricted to, proximally advancing
infection, ischemia, malignant tumor, crush injuries (excluding digits), and traumatic
injury resulting in major vascular compromise.
Neonatal club foot

Applicants requesting any other special privileges listed below must present documentation oftraining in

each privilege requested with a letter from the training director attesting to theapplicant’s competence

and/or must meet any additional/other credentialing criteria which hasbeen approved by the Medical Staff

and the Governing Board of University Hospital McDuffie.

SPECIAL PRIVILEGES to include: REQUESTEDGRANTED

Laser Surgery
Extracorporeal Shockwave Therapy
Moderate Sedation – Only applicants with Core II and III privileges
The applicant is required to submit a separate letter of
request for any privilege not included on this form.

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Applicant’s SignatureDate