A state license sets what podiatry includes in that state; hospital or ASC privileges decide what you may do in that facility. Connecticut's statute says a license does not obligate a hospital to grant privileges, and California, Missouri, North Carolina, West Virginia and others require facility privileges or committee approval before ankle surgery or amputations.
Podiatrists moving to a new hospital system often treat licensing and privileges as one task. They are two, granted by different bodies under different rules. The state board decides whether you may practice podiatry in the state and what podiatry includes there. The hospital or ambulatory surgery center decides which of those procedures you may perform on its premises. You need both before the first case, and neither one guarantees the other.
What does the state license decide?
The license sets the legal scope for the whole state: the foot only in Texas, Washington and Massachusetts; the foot and ankle in states such as Iowa, Wisconsin and Colorado; amputation and anesthesia limits that vary widely. No hospital can grant a privilege beyond that scope. A Texas hospital cannot credential a podiatrist for ankle surgery, because the Texas statute defines podiatry as treatment of "the human foot" (Occ. Code 202.001). The state-by-state scope limits are in the scope by state table.
What do privileges decide?
Privileges are a facility's decision about which procedures a practitioner may perform there, based on training, experience and outcomes. They are granted and reviewed under the facility's bylaws. A license that includes ankle surgery does not require any hospital to let you operate on ankles. Our sister site explains the process in credentialing, privileging and enrollment and hospital privileging, FPPE and OPPE.
Which statutes say so directly?
Connecticut: "The Department of Public Health's issuance of a license to a podiatrist to independently engage in surgery shall not be construed to obligate a hospital or outpatient surgical facility to grant such licensed podiatrist privileges to perform such procedures." The same subsection adds that privileges for foot surgery are not affected by privileges or scope for ankle surgery (C.G.S. 20-54(f)).
Which states make privileges part of the scope?
In several states, the statute itself requires a facility decision before certain procedures are legal:
- California: ankle surgery in a surgical clinic, Medicare-certified ASC or freestanding hospital outpatient building requires that the podiatrist hold "surgical privileges, including the privilege to perform surgery on the ankle, in a general acute care hospital" (Cal. Bus. & Prof. Code 2472(e)).
- Missouri: ankle surgery only in a licensed acute care hospital or ambulatory surgical clinic, after "approval of the physician's credentialing committee" (RSMo 330.010).
- North Carolina: before ankle surgery, amputations or clubfoot correction in a multispecialty ambulatory surgical facility, the podiatrist must have "applied for and been granted privileges," based on the same criteria the state uses for hospital privileges (G.S. 90-202.2(b)).
- West Virginia: ankle surgery is authorized "only when a podiatrist has been granted privileges to perform ankle surgery by a hospital's medical staff credentialing committee" (W. Va. Code 30-3-4).
- New Hampshire: "Allowable surgical treatment in a health care facility shall be determined by that health care facility credential committee" (RSA 315:6).
- Nevada: toe amputation only in a hospital or ambulatory surgical center that "is authorized by the hospital or surgical center to perform the amputation" (NRS 635.085).
- Delaware: foot amputation only by podiatrists with an accredited surgical residency and current amputation privileges, or who meet the hospital surgical committee's credentialing criteria (24 Del. C. 502).
- Virginia: severe lower extremity ulcers proximal to the foot and ankle only by credentialed podiatrists "in an approved hospital or ambulatory surgery center at which the podiatrist has privileges" (Va. Code 54.1-2900).
Does a state credential replace hospital review?
No. New York's ankle surgery privilege, Connecticut's ankle documentation and North Carolina's board-granted surgical specialty privileges are state credentials. They make a procedure legal for you in that state. The hospital still reviews your training and outcomes before it adds the procedure to your privileges. Some state credentials even rely on hospital records: New York counts ankle procedures toward its privilege only when a program director, supervisor or chief of service verifies them. See New York's ankle surgery privileges.
Which comes first in practice?
A facility cannot privilege you for practice the state has not licensed, so the license comes first, and controlled-substance prescribing in that state also needs the state registration and DEA registration for that state. Privileging then runs on the facility's own committee calendar. A podiatrist starting in a new state should run both tracks together: license and registrations through the boards, and the privileging application with the medical staff office as soon as the facility will accept it. Ask the medical staff office early which documents it needs before it will place you on a committee agenda.
Where does payer enrollment fit?
A third, separate track. Insurers enroll the podiatrist at each practice location, usually after the license issues. Our sister site handles it; see getting on insurance panels.
Who handles which part?
White Glove Podiatry handles the state side: the license, ankle and scope credentials ($499 per state), procedure permits ($199 each), and state controlled-substance and DEA registrations ($199 per state). Prices are on the pricing page. Privileges and payer enrollment are not included in any White Glove Podiatry service; White Glove Credentialing handles them. You sign every application, and each board and facility makes its own decision.
Common questions
- Does my podiatry license give me hospital privileges?
- No. Privileges are granted by each hospital or surgery center under its own bylaws. Connecticut's statute says so directly about ankle surgery.
- Can a hospital grant privileges beyond state scope?
- No. A facility can only grant procedures the state's practice act allows. A Texas hospital cannot privilege a podiatrist for ankle surgery because the Texas statute covers the foot.
- Which comes first, the license or privileges?
- The license, because a facility can only privilege practice the state allows. Ask the medical staff office what else it needs, such as the DEA registration for that state, and start the privileging application as early as the facility allows.
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