Frequently Asked Questions


Program Transfer to TRLR

1. When did the transfer of podiatry to TDLR take place?

All duties and responsibilities for the regulation of podiatry - including licenses and renewals, customer service, and enforcement - transferred to TDLR effective September 1, 2017.

2. Do I need to get a new license issued by TDLR?
No. The license you have now--issued by the Texas State Board of Podiatric Medical Examiners --remains valid until its expiration date. When you renew on or after September 1, 2017, you will receive a TDLR-issued license.

3. Will I have to renew on a different schedule?

No. You will renew on the same schedule.

4. Have the rules changed?

No. The existing podiatry rules automatically transferred to TDLR on September 1, 2017.

5. Are people at TDLR available to talk to me?

Yes. You will get a “live” person when you call TDLR. Our Customer Service division employs over 45 people who are waiting to help you. TDLR answers nearly 500,000 calls and emails per year. Customer service representatives will be trained on the details of the Podiatry program. TDLR also has the resources and expertise of more than 40 licensing specialists and 7 medical and health program experts in our Compliance division.

6. How do I file a complaint against a podiatrist?

Please submit the Podiatry Complaint Form by mail or fax.

7. How do I stay informed about changes impacting me?

You have several options to stay connected:

  • Email updates: Sign up for email updates
    When you subscribe to TDLR’s Podiatry email updates, we will provide you with everything you need to know about changes in rules, the law, fees, exam requirements, meetings and more. It’s easy and you will stay in the loop.
  • Meetings: Meeting information is posted on the TDLR Meetings page. All Advisory Board and Commission meetings are available to watch online live or later at your convenience at the TDLR YouTube page.
  • Social Media: TDLR has a Facebook page and a Twitteraccount dedicated to TDLR Health Professions.

8. Why was the regulation of podiatry transferred to TDLR?

House Bill 3078, 85th Regular Session, adopted the recommendations of the Sunset Advisory Commission that podiatry regulation be moved to TDLR “to provide institutional stability and administrative savings, improve licensing and enforcement outcomes, and better protect the people of Texas.” House Bill 3078 was signed into law by Gov. Greg Abbott on May 29, 2017.


General

1. Can Podiatrists use the word “Ankle“ in an advertisement?

Yes. The presiding Texas 3rd Court of Appeals May 23, 2008 Opinion does not prohibit “Ankle“ treatments.

However, any such advertisements or trade names must be approved by TDLR. Any advertisements or trade names NOT approved by TDLR are subject to investigation and administrative penalties.

TDLR approves practice and trade names from the standpoint that the name remains within the advertising scope of practice for podiatry. The final registration and utilization of any TDLR (scope) approved name rests upon the civil jurisdiction of the local County Clerk's office or the Texas Secretary of State.

Additionally, with regard to advertising in general and proper identification of a licensee's practice as being one of “Podiatry,“ each podiatric physician shall publish his or her own name and professionally identify himself or herself (i.e. DPM, Podiatrist, Etc.).

The purpose of TDLR’s Advertising rules and of so limiting the professional designations of a podiatric physician and his or her practice's business is to ensure that the public and all prospective patients are reasonably informed of the distinction between podiatric physicians and other medical practitioners as is reflected by the difference in training and licensing, and the scope of practice.

2. What does it mean if a Podiatrist’s license is in an Expired, Delinquent or Cancelled status; can he or she still practice?

No.

You may not practice podiatric medicine unless your license is Active.


For Patients

1. I am a prospective patient, what can I do to research the background of a podiatrist or healthcare provider?

There are several ways of doing this in addition to discussing your medical needs with your healthcare provider:

2. I am a patient who has been the victim of a sexual impropriety/act/crime and boundary violation by a physician. Where can I find assistance and information with victim’s rights beyond solely filing a complaint with TDLR or Law Enforcement?

TDLR and/or Law Enforcement authorities may investigate any allegations of Sexual Misconduct/Crimes committed by a podiatric physician. While the TDLR focuses on the investigation, patients/victims can seek advocacy assistance/services or learn more information by contacting the following.

Contacts for Patients/Victims:

3. I am a patient with a billing problem. I saw my podiatric physician, who is an out of network provider for my insurance plan. I have received a large bill for "usual and customary" rates that are not covered and I can't afford this. What can be done?

TDLR has no authority to proceed against an insurance company. However, you can file a complaint with the Texas Department of Insurance.


Practice by Podiatrist

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.

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.

  • In order for a currently licensed Texas Podiatric Physician to prescribe Controlled Substances, he or she must have an active Controlled Substances registration from the U.S. Drug Enforcement Administration (DEA) to prescribe "Schedule II, III, IV & V" Controlled Substances. A podiatrist who does not have a DEA registration cannot prescribe any medications; thus, without a DEA registration a podiatrist cannot provide minimal standards of care. In order to obtain a DEA registration, the podiatrist must first be licensed by TDLR.
  • Podiatry Residents enrolled in an accredited GPME residency (training) program who hold a Temporary license may prescribe Controlled Substances under the (training) facility's DEA registration and remain subject to the supervision of the (training) program and residency director. Under no circumstances are residents allowed to prescribe controlled substances for purposes outside of the approved residency (training) program.

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/ankle) 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/ankle surgery, that is not a waiver for a Podiatrist to do full H&P's for non-foot/ankle conditions.
  • Credentialing is a matter for local determination and community standards.

4. May Podiatrists conduct Federal Motor Carrier Safety Administration (FMCSA) DOT Medical Exams and Commercial Motor Vehicle Certifications?

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/Ankle.

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/Ankle.

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: http://www.txdmv.gov/motorists/disabled-parking-placards-plates

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. http://www.dshs.state.tx.us/radiation/laser.shtm

  • Podiatrists in Texas can treat the "foot/ankle" 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/Ankle. Fingernail Laser Therapy by a Podiatrist is outside the scope of practice for Podiatry and is not permissible.

9. Can a Podiatrist employ/supervise an Advanced Practice Nurse (APN) or Physician Assistant (PA) and delegate podiatric/medical treatments to an APN/PA (Physician Extenders)?

No.

A Texas Podiatrist (DPM) cannot employ an Advanced Practice (APN) or a Physician Assistant (PA).

Advanced Practice Nurses and Physician Assistants can only work under the delegation of a Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) (i.e. "Physicians") licensed by the Texas Medical Board.

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 foot/ankle 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?

No.

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.

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). 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.

16. Are Telemedicine or Telehealth authorized for the practice of Podiatry in Texas?

No. Texas Occupations Code Chapter 202 (Podiatry Practice Act) does not permit Telemedicine or Telehealth in any capacity for podiatrists in Texas.

17. Where do I order prescription pads for the physicians in the office?

Please contact the Texas State Board of Pharmacy to address any questions/requests related to Senate Bill 195 and the new Texas Prescription Monitoring Program (PMP), to include ordering official controlled substances prescription pads and registering for the PMP database ("PMP AWARxE"). Contact the Texas State Board of Pharmacy:


Radiology Technician

1. Does a Radiology Technician certification authorize a person to operate (office) lower extremity MRI equipment?

No.

Podiatry Radiology Technician certifications only authorize the performance of lower extremity X-rays (ionizing radiation), not Magnetic Resonance Imaging.

2. Does a Radiology Technician certification authorize a person to operate a mobile fluoroscopic machine, such as the Orthoscan Mobile DI?

No.

Only a practitioner (defined as a Texas licensed doctor of medicine, osteopathy, podiatry, dentistry, or chiropractic who prescribes radiologic procedures for medical reasons), or an MRT, may operate this unit.


Fees

1. What are the fees?

All fees paid to TDLR are nonrefundable.

The fees are as follows:

  • (1) Temporary License--$125
  • (2) Extended Temporary License--$50
  • (3) Temporary Faculty License--$40
  • (4) Provisional License--$125
  • (5) Initial Licensing Fee--$534.00
  • (6) Annual Renewal--$530.00
  • (7) Renewal Penalty--Late by 90 days or less is 1.5 times the required renewal fee; late by more than 90 days but less than one year is two times the required renewal fee.
  • (8) Non-certified podiatric technician registration--$35
  • (9) Non-certified podiatric technician renewal--$35
  • (10) Hyperbaric Oxygen Certificate--$25
  • (11) Nitrous Oxide Registration--$25
  • (12) Duplicate License--$25
  • (13) Copies of Public Records--The charge established by the appropriate state authority.
  • (14) Statute and Rule Notebook--provided at cost to the agency
  • (15) Duplicate Certificate--$10
  • (16) Criminal History Evaluation Letter--$25
  • (17) Recovery Fee--An additional $100 charge may be applied for processing special requests exceeding standard application/service costs (e.g. examination rescheduling, excessive/amended document reviews, obtaining legal/court documentation, criminal history evaluation letters, etc.).

Criminal History

1. Does my criminal history make me ineligible for licensure?

If you are worried your criminal history could prevent you from getting this license, Texas allows you to have your criminal history evaluated before submitting your application and non-refundable fees. Visit the Criminal History Evaluation Letter page for more information and to download the necessary forms.


Communication

1. How do I stay informed about changes impacting me?

You have several options to stay connected:

  • Email updates: Sign up for email updates
    When you subscribe to TDLR’s Podiatry email updates, we will provide you with everything you need to know about changes in rules, the law, fees, exam requirements, meetings and more. It’s easy and you will stay in the loop.
  • Meetings: Meeting information is posted on the TDLR Meetings page. All Advisory Board and Commission meetings are available to watch online live or later at your convenience at the TDLR YouTube page.
  • Social Media: TDLR has a Facebook page and a Twitteraccount dedicated to TDLR Health Professions.