2yr program myths and facts?

[cool_vkb]

With residency shortage, 2yr programs arent looking that bad as a back up option.

Can residents and physicians shed some insight on 2yr programs. What are your thoughts about them and whats life after 2yr program.

There are rumors that you cant get hospital priviledges or cant do rearfoot, etc etc.


PS: Prepods and fresh students please refrain from posting or diverting the topic.

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[Feli]

I would rather scramble than take a 2yr (however, I'd rather take a 2yr than re-enter match the next year, so they would be a last resort in scramble). Soon enough (probably before you'd finish), all will be 3yr and give you the experience and case volume to sit for ABPS foot boards... some will get enough cases to let you sit for ABPS rearfoot recon ankle boards, and some won't. Hospitals and insurance plans are wising up to what our boards mean, so depending on how you'd like to practice, that's an important difference.

Basically, you'll be doing 3yrs anyways... so I'd say you should go somewhere you'll learn more techniques and have more to offer your patients/employer/etc.

 

[347932]

In the community I practice in this is how the hospitals privilege Podiatry.

The hospitals require ABPS qualified to start and then eventual transition to certified in a given number of years. They don't care if you are "Foot" or "RRA" certified, only that you are certified.

When you then apply for privileges for certain cases, they ask for documentation of 5 of each of those cases to prove proficiency. I used the logs from my residency for that. Even though I did do 3 years, I had my numbers waaaaay before my second year was complete, so I would not have had an issue at all.

Vision 2015 is to have ALL graduated attend a 3 year program. The issue is that our scope of practice is not national yet. So, it really depends what state you want to practice in to be honest. If you consider that you will be practicing in Connecticut for instance, having a 3 year rearfoot and trauma intensive program will NOT serve you well in practice.

Two years will still get you plenty of experience at a good program. Three years is better, any way you slice it for the shear amount of cases you'll do in that third year versus that 1st year in actual practice after the 2 year program. You'll be very lucky to see more than 50 cases in the OR in your first year in practice. Very lucky indeed.

 

[cool_vkb]

In the community I practice in this is how the hospitals privilege Podiatry.

The hospitals require ABPS qualified to start and then eventual transition to certified in a given number of years. They don't care if you are "Foot" or "RRA" certified, only that you are certified.

When you then apply for privileges for certain cases, they ask for documentation of 5 of each of those cases to prove proficiency. I used the logs from my residency for that. Even though I did do 3 years, I had my numbers waaaaay before my second year was complete, so I would not have had an issue at all.

Vision 2015 is to have ALL graduated attend a 3 year program. The issue is that our scope of practice is not national yet. So, it really depends what state you want to practice in to be honest. If you consider that you will be practicing in Connecticut for instance, having a 3 year rearfoot and trauma intensive program will NOT serve you well in practice.

Two years will still get you plenty of experience at a good program. Three years is better, any way you slice it for the shear amount of cases you'll do in that third year versus that 1st year in actual practice after the 2 year program. You'll be very lucky to see more than 50 cases in the OR in your first year in practice. Very lucky indeed.

Sir, thanks for the info.

One more thing that every one says is the issue of rearfoot. I am currently rotating at a program that has one pms24 spot and one pms 36 spot. Now i see no difference in the training and education these two residents are training.

last week i scrubbed with the pms-24 resident for ankle arthoscopy and then a TAL. he said he can definetly do all these procedures even after he graduates.

but then i was talking to some one else who bluntly told me that pms-24 folks cannot go beyond the base of metatarsals. thats the max they can move. because the ABPS wont certify them for rear foot.

So god forbid, i end up graduating from a 2yr program where i did tons of rear foot and ankle. in my practice i get a patient who needs a TAL or an evans. Does that mean i cannot do those procedures even though i was trained for it in my residency and have to refer it to a pms-36 guy? Or the hospital where i wanna do that procedure, sees my case log and lets me do the procedure?

Can you please elaborate on this topic.

PS: Im just inquiring. I graduate in 9-10 months and gotta keep all my options open.

 

[347932]

Sir, thanks for the info.

One more thing that every one says is the issue of rearfoot. I am currently rotating at a program that has one pms24 spot and one pms 36 spot. Now i see no difference in the training and education these two residents are training.

last week i scrubbed with the pms-24 resident for ankle arthoscopy and then a TAL. he said he can definetly do all these procedures even after he graduates.

but then i was talking to some one else who bluntly told me that pms-24 folks cannot go beyond the base of metatarsals. thats the max they can move. because the ABPS wont certify them for rear foot.

So god forbid, i end up graduating from a 2yr program where i did tons of rear foot and ankle. in my practice i get a patient who needs a TAL or an evans. Does that mean i cannot do those procedures even though i was trained for it in my residency and have to refer it to a pms-36 guy? Or the hospital where i wanna do that procedure, sees my case log and lets me do the procedure?

Can you please elaborate on this topic.

PS: Im just inquiring. I graduate in 9-10 months and gotta keep all my options open.

Your welcome!

To elaborate, it really depends on three things.

The first and most important is scope of practice in the state you want to practice in. If you know already where you'll end up (like in your home town), it may be worth your while to research the scope of practice issue.

The second is how Podiatrists are privileged in your eventual community. As I mentioned in my previous post, in my area, as long as you are going towards ABPS certification and can show that you are proficient in the procedures you are asking for privileging for, you should be good to go. The above may dictate whether you have to turf those complex cases.

The third is your personal comfort level. I've met colleagues who did the best residencies around, but know their personal limitations and only stick to procedures they are comfortable with. If you are not comfortable doing complex rearfoot recons (Charcot Recons, Ankle/Calc Fx), no one will care what training you had and realistically, you shouldn't be asking for privileges for those procedures, even if you've done 100 in residency. There are people like that out there, and I hold them in great admiration as they are humble and intelligent enough to know what their limitations are. You can't possibly know this until mid way through your training. Keep that in mind. If you did 5 evans procedures in residency, but you just don't feel that your exposure was enough to add that to your arsenal in practice, then don't do them, or you will certainly run yourself into trouble.

Also, once you're out in practice, your patients won't care whether you did 2 or 3 years. You're colleagues won't care (much) either. It will be your reputation in the community that will stand the test of time. Get the best training you can and be an intelligent, compassionate and skilled practitioner. The rest will follow.

Just my 2 cents.

 

[msa786]

Is it true the better job offers with a more rewarding salary comes from the 3 year residencies and not 2 year?

 

[347932]

Is it true the better job offers with a more rewarding salary comes from the 3 year residencies and not 2 year?

The best job is when you're your own boss and run your own show. No one cares whether you did 2 or 3 years. You are your own destiny. Best thing ever.

 

[Feli]

... Hospitals and insurance plans are wising up to what our boards mean, so depending on how you'd like to practice, that's an important difference...

It all depends if you are going to bank on that hospitals will let you do RRA work with foot cert or whether you see a trend towards ABPS mattering more and more (hint: that has definitely been the trend lately).

I think that as our training becomes more standardized, so will the privileging. As it stood 10+yrs ago, chiefs of surgery were scratching their head trying to decipher the training of various staff podiatrists and those applying for staff. Now, 3yrs is pretty much the standard - and also what ABPS requires for RRA qual/cert. I think you're severely limiting yourself by not meeting the standard which most of your peers will be aiming for.

 

[cool_vkb]

It all depends if you are going to bank on that hospitals will let you do RRA work with foot cert or whether you see a trend towards ABPS mattering more and more (hint: that has definitely been the trend lately).

I think that as our training becomes more standardized, so will the privileging. As it stood 10+yrs ago, chiefs of surgery were scratching their head trying to decipher the training of various staff podiatrists and those applying for staff. Now, 3yrs is pretty much the standard - and also what ABPS requires for RRA qual/cert. I think you're severely limiting yourself by not meeting the standard which most of your peers will be aiming for.

I know this is completely offtopic but speaking of financial rewards, Most doctors who i have spoken to say Rearfoot work is more of a prestige and self satisfaction for the doctor and financially is not that rewarding compared to the forefoot procedures. A few of them never bothered to get rra certified even though they did their 3 yr residency and dont do those procedures.

Whats your opinion on that?

I personally would love to work on rearfoot. I have scrubbed in for few ankle arthoscopy procedures and pilon fracture repairs. That just changed my mind and now im looking forward to select a program which is heavy on rearfoot work.

But these talks about less remuniration and increased aggresiveness of orthos against pods who do rearfoot is kind of discouraging.

 

[347932]

I know this is completely offtopic but speaking of financial rewards, Most doctors who i have spoken to say Rearfoot work is more of a prestige and self satisfaction for the doctor and financially is not that rewarding compared to the forefoot procedures. A few of them never bothered to get rra certified even though they did their 3 yr residency and dont do those procedures.

Whats your opinion on that?

I personally would love to work on rearfoot. I have scrubbed in for few ankle arthoscopy procedures and pilon fracture repairs. That just changed my mind and now im looking forward to select a program which is heavy on rearfoot work.

But these talks about less remuniration and increased aggresiveness of orthos against pods who do rearfoot is kind of discouraging.

I love the challenge of doing complex rearfoot procedure. My partner in practice doesn't do rearfoot and reminds me every time I do them what a losing proposition it is from a practice management standpoint. I lose more sleep over those, spend more time with these patients, deal with more complications than I care to describe. These cases end up costing us money. No doubt about it.

Just by the way, I did 3 years of residency, am not RRA certified, but since I had a lot of experience in residency, the hospitals let me do what ever the heck I want, more or less, within my scope of practice.

One thing that's interesting too is some refer to "the hospitals" getting wise to our board status. Its not the hospitals, its our colleagues. Some of them are less than honorable in their intentions with helping their colleagues out with privileging matters, and would rather limit their local competition rather than help our profession.

Case in point is ankle implants. Most companies that produce these implants won't train a podiatrist do to this procedure unless they're RRA certified. I do a huge amount of rearfoot in my practice but they won't train me. Why? Because I have colleagues who are consultants for these companies "help" them make these rules, and would rather see fewer surgeons (them) do these procedures.

Our local hospital had a panel of podiatrists (read two) make the rules about who can do ankle implants in our hospital. One of those podiatrists had one year of residency 30 years ago and was grandfathered to having "Foot and Ankle" Certification and the other is only one of 3 younger guys that have RRA certification. I'll let you guess on how the hospital rules govern who can do those procedures.

Its our colleagues making the rules folks. I hope they're on your side.

 

[Feli]

I love the challenge of doing complex rearfoot procedure....

... I did 3 years of residency, am not RRA certified, but since I had a lot of experience in residency, the hospitals let me do what ever the heck I want, more or less, within my scope of practice....

...Case in point is ankle implants. Most companies that produce these implants won't train a podiatrist do to this procedure unless they're RRA certified...

Me thinks there's a fairly straightforward solution there?^^

...I think we need to be careful with the idea that you can just get the ABPS Foot cert (ie do a 2yr and pass, or do a 3yr and pass foot but never bother with RRA cert) and do RRA cases. When I say "hospitals are wising up," of couse I'm talking about DPMs who decide on - or more likely "advise" the chief of surg at the hospital - podiatry surgery privileging.

What works "good enough for me" today might not hold water tomorrow. You never know when an anti-pod surgeon, RRA DPM, or ortho (with a F&A guy in his group or F&A interest himself) will become chief of surg or heavily influential and decide to challenge the staff DPMs on privileging. RRA cert makes it a lot tougher to challenge the ability to do those cases. Are there some general surgeons out there with ABS cert but without colorectal fellowship + cert doing those cases? Yeah. If a certified colorectal fellowship trained surgeon or group wanted to challenge who gets those privileges, who do you think would win? If nothing else, you enjoy doing the RRA cases, so get the RRA cert as a cheap and easy "insurance" policy. Our practice scope and privileging climate has changed a ton, and it will likely continue to evolve.

Related (esp see delinieation):
http://www.acfas.org/uploadedFiles/...redentialing-PrivilegingStatement_8-24-10.pdf

 

[PADPM]

I love the challenge of doing complex rearfoot procedure. My partner in practice doesn't do rearfoot and reminds me every time I do them what a losing proposition it is from a practice management standpoint. I lose more sleep over those, spend more time with these patients, deal with more complications than I care to describe. These cases end up costing us money. No doubt about.

Kidsfeet,

Take it from someone who's "been there and done that". If this is truly the scenario in your practice, you're going to eventually have to make a tough decision. Because there comes a point where you have to understand that as great as it is to live up to the challenge and feed your ego (that is not an insult), you can't keep having these cases "cost you money". A practice fortunately or unfortunately is a business, and when performing these complex cases begins to become a constant loss for your practice, it's only a matter of time before the financial stress will impact your partnership as well as your personal life.

Please be careful. I've witnessed this situation too many times.

 

[347932]

Kidsfeet,

Take it from someone who's "been there and done that". If this is truly the scenario in your practice, you're going to eventually have to make a tough decision. Because there comes a point where you have to understand that as great as it is to live up to the challenge and feed your ego (that is not an insult), you can't keep having these cases "cost you money". A practice fortunately or unfortunately is a business, and when performing these complex cases begins to become a constant loss for your practice, it's only a matter of time before the financial stress will impact your partnership as well as your personal life.

Please be careful. I've witnessed this situation too many times.

Oh I hear you man! I'm becoming much more selective with my case load these days, and with 3 kids at home, its tough spending middle of the nights on the phone with patients and EDs.

The thing that I hate is that these tend to be the only type of cases that really challenge my hands and mind, and even though they don't "pay" you are still helping someone. Challenging yourself is really the only way to maintain excellence and perhaps even keep your skills "in the now" so to speak.

I'm with you though and appreciate the feed back for sure.

 

[347932]

Me thinks there's a fairly straightforward solution there?^^

...I think we need to be careful with the idea that you can just get the ABPS Foot cert (ie do a 2yr and pass, or do a 3yr and pass foot but never bother with RRA cert) and do RRA cases. When I say "hospitals are wising up," of couse I'm talking about DPMs who decide on - or more likely "advise" the chief of surg at the hospital - podiatry surgery privileging.

What works "good enough for me" today might not hold water tomorrow. You never know when an anti-pod surgeon, RRA DPM, or ortho (with a F&A guy in his group or F&A interest himself) will become chief of surg or heavily influential and decide to challenge the staff DPMs on privileging. RRA cert makes it a lot tougher to challenge the ability to do those cases. Are there some general surgeons out there with ABS cert but without colorectal fellowship + cert doing those cases? Yeah. If a certified colorectal fellowship trained surgeon or group wanted to challenge who gets those privileges, who do you think would win? If nothing else, you enjoy doing the RRA cases, so get the RRA cert as a cheap and easy "insurance" policy. Our practice scope and privileging climate has changed a ton, and it will likely continue to evolve.

Related (esp see delinieation):
http://www.acfas.org/uploadedFiles/...redentialing-PrivilegingStatement_8-24-10.pdf

Feli,

To let you know, a new chief can't just yank privileges because they feel like it. Once I get privileges to do a procedure, I can't technically lose those privileges unless the state scope of practice changes. I am at a disadvantage with Ankle Implants because those weren't around when i did my training, but realistically, if I wanted the privileges, I could get it, BUT no company will train me because I'm not RRA certified. As I said again, I do more rearfoot than most RRA cert guys in my area. How does that make sense?

Also, just because you're RRA certified doesn't mean you will get a carte blanche to do any procedure you want. Unfortunately, in most cases you will still have to prove competency. If you didn't do them in residency, RRA cert or not, there is a good chance you won't be doing those cases at the hospital. This is very unlike orthopods who get to do ANY ortho procedure, just merely since they did an Ortho residency. What I'm saying is you may have Orthos who've never done a bunion in their life, get privileges to do bunions, but you may not get that privilege if you can't prove competency to your colleagues' satisfaction. Extreme example I know, but it happens. Believe me.

Also to add a little fuel to the fire, there was a certification called "Foot and Ankle" which grandfathered many cert docs who had only one year of training into the RRA classification. I'm not knocking them, since they were the generation that truly advanced our profession both surgically and with respect to hospital privileging, but really, how can we argue about foot vs. RRA when there are guys out there with one year of training who can get trained to do Ankle Implants if they want. Weird...I know.

We are our worst enemies in that regard. It is not as inclusive as you think or hope. You'll see.

 

[Feli]

..a new chief [of surgery or pod surgery] can't just yank privileges because they feel like it...

No, it's not likely... but anything's possible when you consider the egos a lot of surgeons lug around and the money that's at stake in some metro areas - esp high socioeconomic status suburbs hospitals. Hospital and inter/intra-dept politics never cease to amaze me.

Also, it's not as if many surgeons stay put for their entire career anymore. You want to stay flexible. A lot of guys are getting to do a fair amount at the hospital or two they're on staff at with the old 1yr training + ABPS + bringing one or two cases a month, but they would probably be quite limited if they ever left that hospital system. In time, that may be the same type of case or guys who are only ABPS foot cert but doing many RRA cases... they're fine if they stay put, but probably not given those privileges if they try to move states/cities or even across town to another hosp system? Like I said, I'd just view it as a cheap insurance policy.

...To do the ankle implant course, my understanding is that you need ABPS RRA cert + have done 10+ ankle desis cases (after residency). I could be wrong, but that's what a couple attending who have taken it or are making application have told me. Was that your exp also?

 

[Feli]

I know this is completely offtopic but speaking of financial rewards, Most doctors who i have spoken to say Rearfoot work is more of a prestige and self satisfaction for the doctor and financially is not that rewarding compared to the forefoot procedures. A few of them never bothered to get rra certified even though they did their 3 yr residency and dont do those procedures.

Whats your opinion on that?

I personally would love to work on rearfoot. I have scrubbed in for few ankle arthoscopy procedures and pilon fracture repairs. That just changed my mind and now im looking forward to select a program which is heavy on rearfoot work.

But these talks about less remuniration and increased aggresiveness of orthos against pods who do rearfoot is kind of discouraging.

You will come to realize that most DPMs do a lot more of the nonoperative and pre/post op care themselves than ortho. Most orthos (and other MD surgeons) use residents and/or PAs to do most of their rounding, pre and post op visits, and nonoperative care. That means they are essentially just doing the surgeries... and maybe the key preop visits... usually postop checks and nonoperative care only in select situations (major complication, vip patients, etc). Their PAs basically function like permanent junior residents by providing rounding/consult coverage, clinic coverage, etc.

When you combo the facts that the DPMs are spending much more pre/post and nonop time with patients... and the fact that there are referral/call discriminations against DPMs for the RRA cases in most areas, then yes, RRA is less prevalent and less profitable for most DPMs. Many states don't allow DPMs to hire PAs, and med assts can only help out to a certain level. Most of the DPMs I've seen who do an appreciable amount of major RRA have residents to help them out and these attendings also typically supplement their income with industry consulting fees, hospital/residency/society position income, expert witness fees, etc.

 

[347932]

No, it's not likely... but anything's possible when you consider the egos a lot of surgeons lug around and the money that's at stake in some metro areas - esp high socioeconomic status suburbs hospitals. Hospital and inter/intra-dept politics never cease to amaze me.

Its not only not likely, it can't happen. This is a legal nightmare waiting to happen if a hospital tries that, UNLESS scope of practice issues are changed or contested. Been there, done that. This was tried in our community by the head of a hospital who thought he was above the system, and quickly learned that you can't mess around like that. It ended up being one of the reasons he was let go as CEO of that hospital. You can't just change bylaws because your ego tells you to. Its more complicated than that.

 

[Feli]

Its not only not likely, it can't happen. This is a legal nightmare waiting to happen if a hospital tries that, UNLESS scope of practice issues are changed or contested. Been there, done that. This was tried in our community by the head of a hospital who thought he was above the system, and quickly learned that you can't mess around like that. It ended up being one of the reasons he was let go as CEO of that hospital. You can't just change bylaws because your ego tells you to. Its more complicated than that.

You might be suprised. "Hypothetical" scenerio:

Super RRA DPM comes in, does cases, wants to start a pod residency program. He decides that many of the current staff DPMs are marginally or not qualified for the RRA cases they are infrequently doing, and he doesn't want his residents to learn "the wrong way." He decides that you need RRA cert + 3yrs of training or 2yr of training + F&A cert + an appreciable amount of each RRA case you want privileges for within last 5yrs... or you lose midfoot and RRA procedures for stuff you aren't cert for and/or haven't done in awhile (also lose surgery period if not ABPS foot, but that goes without saying most places). Private practice staff DPM attendings who do mostly HAV but like to try occasional mid/RF surgery throw a fit, but money of residency program + Super RRA DPM and his group trumps the money of the other priv prac DPMs, so they lose RRA privileges there. You just never know... RRA would protect you there.

Besides that, there's always the issue of if you ever want to change location/hospitals.

 

[347932]

You might be suprised. "Hypothetical" scenerio:

Super RRA DPM comes in, does cases, wants to start a pod residency program. He decides that many of the current staff DPMs are marginally or not qualified for the RRA cases they are infrequently doing, and he doesn't want his residents to learn "the wrong way." He decides that you need RRA cert + 3yrs of training or 2yr of training + F&A cert + an appreciable amount of each RRA case you want privileges for within last 5yrs... or you lose midfoot and RRA procedures for stuff you aren't cert for and/or haven't done in awhile (also lose surgery period if not ABPS foot, but that goes without saying most places). Private practice staff DPM attendings who do mostly HAV but like to try occasional mid/RF surgery throw a fit, but money of residency program + Super RRA DPM and his group trumps the money of the other priv prac DPMs, so they lose RRA privileges there. You just never know... RRA would protect you there.

Besides that, there's always the issue of if you ever want to change location/hospitals.

Sorry man. If these docs already had privileges to do those cases, whether they do them or not has no bearing on the matter. I've seen this tried and failed. The hospital can not take away privileges you have unless they have reason to...i.e: scope of practice issues or you've personally been sued multiple times doing THAT procedure. Again, its not that simple. you can't just "lose" privileges because someone wants you to. The politics goes both ways.

 

[diabeticfootdr]

You might be suprised. "Hypothetical" scenerio:

Super RRA DPM comes in, does cases, wants to start a pod residency program. He decides that many of the current staff DPMs are marginally or not qualified for the RRA cases they are infrequently doing, and he doesn't want his residents to learn "the wrong way." He decides that you need RRA cert + 3yrs of training or 2yr of training + F&A cert + an appreciable amount of each RRA case you want privileges for within last 5yrs... or you lose midfoot and RRA procedures for stuff you aren't cert for and/or haven't done in awhile (also lose surgery period if not ABPS foot, but that goes without saying most places). Private practice staff DPM attendings who do mostly HAV but like to try occasional mid/RF surgery throw a fit, but money of residency program + Super RRA DPM and his group trumps the money of the other priv prac DPMs, so they lose RRA privileges there. You just never know... RRA would protect you there.

Besides that, there's always the issue of if you ever want to change location/hospitals.

If your privileges are restricted without cause, you can sue for restraint of trade. Retroactively reviewing the privileging criteria is not sufficient to revoke privileges. Many hospitals and groups have been sued for it before. Perhaps these guys weren't aware of their legal rights.

 

[347932]

If your privileges are restricted without cause, you can sue for restraint of trade. Retroactively reviewing the privileging criteria is not sufficient to revoke privileges. Many hospitals and groups have been sued for it before. Perhaps these guys weren't aware of their legal rights.

This.

Feli, here's what you can do to confirm this. Call up your state society, or future state society and ask to speak to their attorney on retainer and ask all the questions you want. Can't happen unless you aren't educated enough to know that your rights have been violated.

 

[newankle]

I love the challenge of doing complex rearfoot procedure. My partner in practice doesn't do rearfoot and reminds me every time I do them what a losing proposition it is from a practice management standpoint. I lose more sleep over those, spend more time with these patients, deal with more complications than I care to describe. These cases end up costing us money. No doubt about it.

Just by the way, I did 3 years of residency, am not RRA certified, but since I had a lot of experience in residency, the hospitals let me do what ever the heck I want, more or less, within my scope of practice.

One thing that's interesting too is some refer to "the hospitals" getting wise to our board status. Its not the hospitals, its our colleagues. Some of them are less than honorable in their intentions with helping their colleagues out with privileging matters, and would rather limit their local competition rather than help our profession.

Case in point is ankle implants. Most companies that produce these implants won't train a podiatrist do to this procedure unless they're RRA certified. I do a huge amount of rearfoot in my practice but they won't train me. Why? Because I have colleagues who are consultants for these companies "help" them make these rules, and would rather see fewer surgeons (them) do these procedures.

Our local hospital had a panel of podiatrists (read two) make the rules about who can do ankle implants in our hospital. One of those podiatrists had one year of residency 30 years ago and was grandfathered to having "Foot and Ankle" Certification and the other is only one of 3 younger guys that have RRA certification. I'll let you guess on how the hospital rules govern who can do those procedures.

Its our colleagues making the rules folks. I hope they're on your side.

Kidsfeet,
Just curious but why aren't you RRA certified if you do "a huge amount of rearfoot"? And what do you consider "a huge amount of rearfoot"?
FYI... I do TAR (InBone and STAR) and they care about your training/proficiency, priviledges to do them, willingness of the hospital to do/buy them, and most importantly that you are going to actually do them. They don't want to train someone who is going to just say they are trained to offer the procedure but never actually do them.

 

[347932]

Kidsfeet,
Just curious but why aren't you RRA certified if you do "a huge amount of rearfoot"? And what do you consider "a huge amount of rearfoot"?
FYI... I do TAR (InBone and STAR) and they care about your training/proficiency, priviledges to do them, willingness of the hospital to do/buy them, and most importantly that you are going to actually do them. They don't want to train someone who is going to just say they are trained to offer the procedure but never actually do them.

Probably 60% of my case load is rearfoot. I'm not RRA certified because when and where I did my residency many of the things that were focused on on the RRA test, I was simply not exposed to (CORA, Tibial Rotation and Transpositional Procedures which was about 60% of the test), so I was not successful at the written exam. Also, in my community RRA certification is not required to be able to do those cases so realistically, why bother?

I can't get trained to do the Ankle Implant due to not being RRA certified first and foremost, which is rather shallow thinking on the part of the companies IMHO. I did 3 years of residencty with over 2000 procedures in that time. Shouldn't that be enough?

 

[PADPM]

Kidsfeet,

I'm not sure your information regarding your inability to perform ankle implants because you are not RRA certified by the APBS is in fact accurate.

I MAY be wrong, but I believe I recently read that the female DPM who is the "chief" at Broadlawns was just in the news that she performs "all three" ankle implants and the same article stated that she is "board certified by the American Board of Lower Extremity Surgeons". That is NOT the same as being RRA certified by the ABPS.

I'm not questioning her abilities, etc.,as I'm confident she must be a competent/excellent surgeon, but I'm not sure that she is RRA certified by the ABPS which would negate your theory.

Dr. Rogers, aka diabeticfootdr spent time at Broadlawns, therefore may have more accurate information than I can provide. Obviously, she must have chosen not to sit for the ABPS exam for her own reasons, and that is not my point. It's simply that it appears RRA certification is not a pre-requisite.

Secondly, there is a large podiatric practice in Maryland (Dr. Weiner/Dr. Daniels, etc.) If you google the names Dr. Weiner/Maryland/Podiatry you will find the website. I believe it's marylandpodiatrist.net

On the home page there's an "ad" for a total ankle implant, yet it does NOT appear that any of the doctors in the practice are RRA certified by the ABPS.

As per newankle, I believe you have to prove competence, the ability to bring cases to the hospital and the ability to have the hospital to cooperate. These companies don't want to train docs just for the sake of training. They want to train docs that are going to UTILIZE the product.

I believe that if you pursue this matter, have the support of your hospital, etc., you CAN utilize one of these devices without RRA certification.

As far as other posts......once privileges ARE granted, you can not have them revoked without "cause". Once privileges are revoked, that is reportable to the national data bank. Therefore, no one can simply pull privileges ONCE they have been granted, unless you have done something to warrant that action.

Most of the rules and regulations are set by our own colleagues and are simply ridiculous.

I'm NOT trying to pat myself on the back with the following scenario, I'm simply trying to make a point. Our practice opened a new office in a different geographic area. I've been performing surgery for over 20 years, I've been a residency director, I'm ABPS certified and re-certified and I served as an examiner for the ABPS for many, many years.

I filled out an application for privileges at a new hospital and then received the application back from the department "chairman", who is a DPM. He wanted me to list "how many of each procedure I performed in the past 2 years".

Well, I don't do a lot of "pan metatarsal head resections". I do a lot of fusions, reconstructions, and a LOT of complicated surgical procedures. But I simply don't do a lot of "pan met head resections". So, this clown DENIED me these privileges, because I didn't do "enough" of them in the past two years!!!!!!

I can perform major rearfoot procedures, use ex-fixators and all the other fancy stuff, but I'm not competent enough to remove a metatarsal head across the board. I CAN perform Weil osteotomies and fixate the osteotomies, since I've done a lot of them, but I can't cut off the head of the bone????

This is because some DPM denied me these privileges???

He denied me excision of a plantar heel spur, because I listed I hadn't performed one in 2 years. I personally don't believe heel spurs cause heel pain and rarely perform ANY surgery for heel pain syndrome. However, if I can perform calcaneal surgical procedures, aren't I competent enough to rasp down a friggin' spur?????

That's the mindset of this genius, who has denied me "basic" privileges, as if I'm not competent enough to perform these "basic" procedures, although I can perform much more complicated procedures. Makes a lot of sense to me!!

Believe me, orthopedic surgeons are not our enemies, most of them could care less what we do or don't even know what we do. In my years of experience, it's our colleagues who you must watch like a hawk. They protect their turf. And if you're young and well trained, you're a helluva threat.

 

[347932]

I have contacted every company that currently makes Total Ankles and each of them ask me the same question above all others. "Are you RRA certified?" When I tell them "No", the conversation ends.

If anyone has more up to date information about this PM as I tried for the third time in June of 2010 and was turned down once again. Let me know.

We are our worst enemies. There is no question in my mind about that.

 

[Feli]

... she must have chosen not to sit for the ABPS exam for her own reasons...

That's quite a pleasant way of putting it. That would be like a general surgeon "choosing" not to sit for the Am Board of Surg or an ortho surgeon "choosing" not to sit for Am Board of Ortho Surg. It just doesn't happen.

Let's face it: our residencies are geared towards ABPS certification. It's becoming pretty much the only board that matters when it comes to hospital privileging and getting on insurance plans. APMA only recognizes ABPS and ABPOPPM... but ABPOPPM won't get you nearly as far in most areas. ACFAS requires ABPS cert - just as AAOS requires ABOS cert and ACS requires ABS cert. Based on the income/scope importance of getting ABPS cert and the fact that all of our residencies are now standardized with that ABPS cert as the goal, I would venture to say that nearly all the DPMs who did a PM&S (or PSR) residency but aren't ABPS cert almost invariably couldn't pass the exam. Facts of life.

One thing I think would be useful and very practical to students would be the ABPS posting the qual/cert rates from available DPM residencies... similar to this from Am Board Surgery:
http://home.absurgery.org/xfer/fyp2010summary.pdf

 

[diabeticfootdr]

Kidsfeet,

I'm not sure your information regarding your inability to perform ankle implants because you are not RRA certified by the APBS is in fact accurate.

I MAY be wrong, but I believe I recently read that the female DPM who is the "chief" at Broadlawns was just in the news that she performs "all three" ankle implants and the same article stated that she is "board certified by the American Board of Lower Extremity Surgeons". That is NOT the same as being RRA certified by the ABPS.

I'm not questioning her abilities, etc.,as I'm confident she must be a competent/excellent surgeon, but I'm not sure that she is RRA certified by the ABPS which would negate your theory.

Dr. Rogers, aka diabeticfootdr spent time at Broadlawns, therefore may have more accurate information than I can provide. Obviously, she must have chosen not to sit for the ABPS exam for her own reasons, and that is not my point. It's simply that it appears RRA certification is not a pre-requisite.

Dr. Mandi is an excellent surgeon and extremely competent. She has probably performed 100 implants by now.

She is not eligible for RRA certification by ABPS although she completed a surgical residency. She took time off work when she had children and didn't practice for a period of 10 years (I think). When she returned to practice, she spent a year doing surgery with her husband, Dr. Mandracchia to brush up on her competencies as requested by the hospital for her privileges. During the time when she was on maternity/motherhood leave. The rules about ABPS certification changed, and while she would have been eligible upon completing her residency, she was no longer eligible.

She did the only thing she could, sat for ABLES.

Kidsfeet is basically right. DePuy (Agility implant) wouldn't let her even ORDER an implant without ABPS RRA certification. This is because DPMs who were consultants for DePuy advised the company not to sell an implant to a non-RRA certified surgeon.

Eventually, they made an exception for her, because Broadlawns was doing so many implants, and starting to use a different company, that they would loose the business if they didn't.

This "rule" was also a problem for my then-partner Dr. Bevilacqua who was ABPS Foot and RRA board qualified (now he's certified), but DePuy wouldn't train a NON-CERTIFIED surgeon. I thought that was preposterous. So what? A qualified surgeon has to wait 5-7 years until they are certified to perform an implant. What if they did 100 in their residency? Very illogical, but we can thank DPM consultants for DePuy and other companies for those rules.

Now, there are more companies in the implant business. With this competition, one might be willing to train a non-ABPS RRA certified surgeon for the business.

 

[diabeticfootdr]

Let's face it: our residencies are geared towards ABPS certification. It's becoming pretty much the only board that matters when it comes to hospital privileging and getting on insurance plans. APMA only recognizes ABPS and ABPOPPM... but ABPOPPM won't get you nearly as far in most areas. ACFAS requires ABPS cert - just as AAOS requires ABOS cert and ACS requires ABS cert. Based on the income/scope importance of getting ABPS cert and the fact that all of our residencies are now standardized with that ABPS cert as the goal, I would venture to say that nearly all the DPMs who did a PM&S (or PSR) residency but aren't ABPS cert almost invariably couldn't pass the exam. Facts of life.

I did a PMS-24 and a non-CPME fellowship 1 year (limb salvage). I resigned from ABPS. You all know the story (if you don't just search on here). I am ABPOPPM certified. I have full surgical privileges at my hospital. I do Charcot foot recon with ex fix, ankle fusions, STJ fusions, basically anything a DPM can do in the scope of practice. I elect not to do certain things, like trauma, because that's not my area of expertise. So I limit myself to limb salvage. I had no problems getting privileges and getting on any insurance plan.

The only reason income is different between ABPS DPMs and non-ABPS DPMs is selection bias. Most non-ABPS DPMs don't do a lot of surgery, but you get paid the same for any service/procedure regardless of your certification.

 

[PADPM]

Thanks for the explanation of how Dr. Mandi is able to perform ankle implants despite not having RRA certification via ABPS.

However, as I also pointed out it appears that there is another group performing ankle implants without any of the group members having RRA ABPS certification.

Here is a link to the groups home page with the appearance that they perform ankle implants. If you go to the APMA website to check the credentials of each group member, NONE are RRA ABPS certified and only one is actually ABPS certified in foot surgery, the remaining are qualified in foot surgery.

The link: http://marylandpodiatrist.net/index.cfm

 

[347932]

I did a PMS-24 and a non-CPME fellowship 1 year (limb salvage). I resigned from ABPS. You all know the story (if you don't just search on here). I am ABPOPPM certified. I have full surgical privileges at my hospital. I do Charcot foot recon with ex fix, ankle fusions, STJ fusions, basically anything a DPM can do in the scope of practice. I elect not to do certain things, like trauma, because that's not my area of expertise. So I limit myself to limb salvage. I had no problems getting privileges and getting on any insurance plan.

The only reason income is different between ABPS DPMs and non-ABPS DPMs is selection bias. Most non-ABPS DPMs don't do a lot of surgery, but you get paid the same for any service/procedure regardless of your certification.

In my area, no ABPS cert = no hospital privileges at all. Say it ain't so, Joe. But it is.

 

[347932]

Thanks for the explanation of how Dr. Mandi is able to perform ankle implants despite not having RRA certification via ABPS.

However, as I also pointed out it appears that there is another group performing ankle implants without any of the group members having RRA ABPS certification.

Here is a link to the groups home page with the appearance that they perform ankle implants. If you go to the APMA website to check the credentials of each group member, NONE are RRA ABPS certified and only one is actually ABPS certified in foot surgery, the remaining are qualified in foot surgery.

The link: http://marylandpodiatrist.net/index.cfm

Maybe they were amongst the first, and once they got things rolling they were part of the crew that demanded RRA cert instituted. Sorry to be cynical, but I've seen it many times. Just saying...

 

[diabeticfootdr]

Thanks for the explanation of how Dr. Mandi is able to perform ankle implants despite not having RRA certification via ABPS.

However, as I also pointed out it appears that there is another group performing ankle implants without any of the group members having RRA ABPS certification.

Here is a link to the groups home page with the appearance that they perform ankle implants. If you go to the APMA website to check the credentials of each group member, NONE are RRA ABPS certified and only one is actually ABPS certified in foot surgery, the remaining are qualified in foot surgery.

The link: http://marylandpodiatrist.net/index.cfm

Yes, I agree. With new competition some companies are lifting their restrictions or they will drive themselves out of business. A couple years ago I remember hearing that there are only 2,000 ankle implants performed in the US annually. That used to be only Agility. Now there are 4 manufacturers competing for the same business.

Talk to SBi who has the STAR 3 component mobile bearing implant. They're doing a lot of education.

 

[diabeticfootdr]

In my area, no ABPS cert = no hospital privileges at all. Say it ain't so, Joe. But it is.

I think that could be challenged and defeated if they don't allow ABPOPPM. Send me a PM with the names of the hospitals or write ABPOPPM a letter.

 

[347932]

I think that could be challenged and defeated if they don't allow ABPOPPM. Send me a PM with the names of the hospitals or write ABPOPPM a letter.

Its been tried. Private hospitals can make any decisions about who they allow to practice in their hospitals and around here, ABPS certification is really the standard of care for podiatrists in the hospitals. Especially since, once again, this was pushed by our local colleagues who had the training, to keep those without the training away, thereby limiting their competition. Nice huh?

 

[newankle]

In my experience... For the STAR they approved as long as I did the course with one of the orthopods in our practice. For the InBone they wanted to see approval from the hospital to pay/use it, approval of priviledges from the hospital for me to do ankle arthroplasty with implant, and idea of how many cases I anticipated doing and to actually schedule a case. FYI I happen to know of the practice being alluded to in recent posts and the one certified doc was trained within the past year.

 

[347932]

In my experience... For the STAR they approved as long as I did the course with one of the orthopods in our practice. For the InBone they wanted to see approval from the hospital to pay/use it, approval of priviledges from the hospital for me to do ankle arthroplasty with implant, and idea of how many cases I anticipated doing and to actually schedule a case. FYI I happen to know of the practice being alluded to in recent posts and the one certified doc was trained within the past year.

This is how the process has gone for me.

I call the hospital to see whether I can schedule a Total Ankle. They ask me if I have the training. I say no I don't. They tell me to get the training and show competency (which I need the training for to prove). I call the companies that make the devices and ask them to train me. They then ask me if I'm RRA certified. I say no. They say "get RRA certified" and then tell me to call them back. At the same time they call the hospital without me knowing and ask how many ankle implants I've done at that hospital. The hospital tells them I've done none, and I currently don't have privileges to perform the procedure. And the wheel keeps right on spinning...You see?

 

[Feli]

I think that could be challenged and defeated if they don't allow ABPOPPM. Send me a PM with the names of the hospitals or write ABPOPPM a letter.

I'm sure it's possible esp in areas hard up for F&A surgeons, but you have to admit that you're a pretty big exception to the rule. Not many non-ABPS cert DPMs have your resume chops (multi-year residency, fellowship, numerous publications and lectures, positions, etc etc). With your cred, I think it's much easier for hospitals (where you are probably being recruited to be limb salvage director, etc) to see that it's a more of personal political beef with ABPS rather than lack of an ability to pass the qual/cert tests (esp since I think you said you were ABPS Foot BQ at one point?).

 

[cool_vkb]

Now that we are talking about ABPS. And comparing our board certifications with General Surgeon or Plastic Surgeon getting certified by their boards. let compare the boards themselve.

this is the info i get from fellow students, residents, docs and sdn. so im not saying anything on my own. just confirming if these are myths or truth.

Isnt it true that the MD boards are far better when it comes to the process of getting certified! And in many instances MD residents can get certified by their boards easily after finishing residency. Where as the ABPS boards, from what i heard getting ABPS certified is a pain in the butt and there is so much beuracricy. Thats why so many docs even after getting 3yr residency arent able to get certified by ABPS. According to the dpm i shadowed, its simply headache. Once again im just saying what i heard. i have zero experience.

Someone recently accused me that im turning out to be disgruntled student. Im really frustrated by this whole mess. As i said, i loved rearfoot procedures. As a student i have read a good number of articles. I have volunteered on saturdays and even travelled once 60 miles from one residnecy to another residency program where they were doing a ankle replacement.

From what i understood in beginning : Pod school 4 yrs + 3yr residency - then thats it, im the master of foot and ankle and can do anything i want! NO APMA Intro to Podiatry paper or senior students or websites told me the mess we have here from residency shortages, to confusing boards, to different residency setups and fighting for priveledges.

Now you guys posted that for doing Ankle Implants we need the company to get involved. Honestly does an ORTHO encounter all these problems that we encounter if he decides to start doing Ankle Implants?

I even heard, a podiatrist had to call a vascular surgeon to be present when he was doing a toe amputation because the hospital wont let him do it by himself. Can we please tell the prepods that this also happens! there are still many states that dont allow pods to do amputation! Arizona is one to remember.

I hope things improve and i get to do all the procedures that im learning in my externships and residency once i become a doctor.

 

[347932]

Now that we are talking about ABPS. And comparing our board certifications with General Surgeon or Plastic Surgeon getting certified by their boards. let compare the boards themselve.

this is the info i get from fellow students, residents, docs and sdn. so im not saying anything on my own. just confirming if these are myths or truth.

Isnt it true that the MD boards are far better when it comes to the process of getting certified! And in many instances MD residents can get certified by their boards easily after finishing residency. Where as the ABPS boards, from what i heard getting ABPS certified is a pain in the butt and there is so much beuracricy. Thats why so many docs even after getting 3yr residency arent able to get certified by ABPS. According to the dpm i shadowed, its simply headache. Once again im just saying what i heard. i have zero experience.

Someone recently accused me that im turning out to be disgruntled student. Im really frustrated by this whole mess. As i said, i loved rearfoot procedures. As a student i have read a good number of articles. I have volunteered on saturdays and even travelled once 60 miles from one residnecy to another residency program where they were doing a ankle replacement.

From what i understood in beginning : Pod school 4 yrs + 3yr residency - then thats it, im the master of foot and ankle and can do anything i want! NO APMA Intro to Podiatry paper or senior students or websites told me the mess we have here from residency shortages, to confusing boards, to different residency setups and fighting for priveledges.

Now you guys posted that for doing Ankle Implants we need the company to get involved. Honestly does an ORTHO encounter all these problems that we encounter if he decides to start doing Ankle Implants?

I even heard, a podiatrist had to call a vascular surgeon to be present when he was doing a toe amputation because the hospital wont let him do it by himself. Can we please tell the prepods that this also happens! there are still many states that dont allow pods to do amputation! Arizona is one to remember.

I hope things improve and i get to do all the procedures that im learning in my externships and residency once i become a doctor.

ABPS certification is a huge headache and a monster PITA. First you sit for a written exam that may or may not have a whole lot to do with what you do in residency. Assuming you pass this test, you then have 7 years to present 65 cases in various categories, for which the examination committee of the ABPS selects 10 of those cases for which they ask you for FULL documentation about (i.e.Medical Records, Hospital records, radiographs, MRIs). Once again, assuming you get through that and are accepted for examination, you then travel to Chicago where you have an "oral exam" of 6 oral questions with face to face examiners and then 6 computer questions. None of the cases that you are asked about have anything to do with the cases you submitted. And this is ONLY for FOOT certification. Double that amount of work if you are considering RRA cert. Then of course, assuming you are successful with this, within ten years you have to prove continued hospital privileges and pass another written examination. This is slowly changing with the times, but not fast enough IMHO. The system is not designed to be inclusive unfortunately. The percentages of people unsuccessful with this process is way too high imho.

No Orthos DO NOT have to prove any type of competency to get privileges to do foot and ankle surgery at all. An Ortho may never have done a bunion in their residency but certainly can get privileges to do bunions in private practice. There is no question about Total Ankle Implants, and whether they have to jump through the same hoops. They do not for the most part.

Being a Podiatrist is a constant struggle, but I love what I do, love the patients I have and sleep well at night knowing I am the most qualified of all medical professionals as far as the care of the Foot and Ankle.

 

[krabmas]

Orthos - foot and ankle or not - may easily get privileges to perform TAA but they still need a company to supply an implant. Most companies require you to take their course regardless of specialty.

The ABPS boards are difficult, they should be. They are not there to give you a job or status, they are there to protect the public.

The MD ortho boards have recognized the need for more specialty boards in the recent years and I would not be surprised if more than hand and sports came out with specialty boards soon.

ABPS was thinking of changing to ABFAS which some people are not in favor of since it rids the P word. If ABPS changes quickly then the ortho foot and ankles will not be able to use ABFAS and will need to either share our boards or make a longer acronym.

 

[Podmeister]

Kidsfeet,

I filled out an application for privileges at a new hospital and then received the application back from the department "chairman", who is a DPM. He wanted me to list "how many of each procedure I performed in the past 2 years".

Well, I don't do a lot of "pan metatarsal head resections". I do a lot of fusions, reconstructions, and a LOT of complicated surgical procedures. But I simply don't do a lot of "pan met head resections". So, this clown DENIED me these privileges, because I didn't do "enough" of them in the past two years!!!!!!

I can perform major rearfoot procedures, use ex-fixators and all the other fancy stuff, but I'm not competent enough to remove a metatarsal head across the board. I CAN perform Weil osteotomies and fixate the osteotomies, since I've done a lot of them, but I can't cut off the head of the bone????

This is because some DPM denied me these privileges???

He denied me excision of a plantar heel spur, because I listed I hadn't performed one in 2 years. I personally don't believe heel spurs cause heel pain and rarely perform ANY surgery for heel pain syndrome. However, if I can perform calcaneal surgical procedures, aren't I competent enough to rasp down a friggin' spur?????

That's the mindset of this genius, who has denied me "basic" privileges, as if I'm not competent enough to perform these "basic" procedures, although I can perform much more complicated procedures. Makes a lot of sense to me!!

Believe me, orthopedic surgeons are not our enemies, most of them could care less what we do or don't even know what we do. In my years of experience, it's our colleagues who you must watch like a hawk. They protect their turf. And if you're young and well trained, you're a helluva threat.

Wow, unbelievable...Thanks for sharing.

 

[347932]

The ABPS boards are difficult, they should be. They are not there to give you a job or status, they are there to protect the public.

ABPS was thinking of changing to ABFAS which some people are not in favor of since it rids the P word. If ABPS changes quickly then the ortho foot and ankles will not be able to use ABFAS and will need to either share our boards or make a longer acronym.

I do not agree about your "protect the public" comment. There are bad doctors in every specialty who do what they shouldn't and hurt people. Being successful at passing a written and oral examination is no way to assure the public's protection. The best way to "protect the public" is have residency director's rate competency and then either graduate residents or not. If you have a terrible resident who is a all thumbs in the OR, but can pass a test, how is this protecting the public?

I'm am not in favor of the ABFAS thing. I'm a Podiatrist and I expect the boards that represent me to include that terminology. Its back to the "What do you call yourself" issue. I'm a Podiatrist. I'm not strictly a Foot and Ankle Surgeons.

 

[krabmas]

I do not agree about your "protect the public" comment. There are bad doctors in every specialty who do what they shouldn't and hurt people. Being successful at passing a written and oral examination is no way to assure the public's protection. The best way to "protect the public" is have residency director's rate competency and then either graduate residents or not. If you have a terrible resident who is a all thumbs in the OR, but can pass a test, how is this protecting the public?

I'm am not in favor of the ABFAS thing. I'm a Podiatrist and I expect the boards that represent me to include that terminology. Its back to the "What do you call yourself" issue. I'm a Podiatrist. I'm not strictly a Foot and Ankle Surgeons.

Thanks for letting me know your opinion.

Whether you agree or not, the reason that boards have been set up is to protect the public. I never said that they worked. But that is the reason for them being here.

 

[347932]

Thanks for letting me know your opinion.

Whether you agree or not, the reason that boards have been set up is to protect the public. I never said that they worked. But that is the reason for them being here.

Forgive me as I presumed that when you stated that, it was your opinion. My apologies.

As we now have Evidence based medicine, we should look at ways to increase public awareness and use more than a test to determine public safety. Its all about passing the buck imho. If a residency director sees incompetence in their resident, they should be able to do something about it rather than be afraid of a lawsuit if they don't "pass" the resident.

An examination proves only that an individual can pass an examination. With the ABPS, the clear indication of this is that you are not tested on the cases you are required to submit. Ask me any question you want about those cases. If half of the written exam refers to Clubfoot correction and I haven't done one in residency or have no intention to treat young children, how is this testing my global competency as a Podiatric Surgeon?

Just saying...

 

[Podfather]

Forgive me as I presumed that when you stated that, it was your opinion. My apologies.

As we now have Evidence based medicine, we should look at ways to increase public awareness and use more than a test to determine public safety. Its all about passing the buck imho. If a residency director sees incompetence in their resident, they should be able to do something about it rather than be afraid of a lawsuit if they don't "pass" the resident.

An examination proves only that an individual can pass an examination. With the ABPS, the clear indication of this is that you are not tested on the cases you are required to submit. Ask me any question you want about those cases. If half of the written exam refers to Clubfoot correction and I haven't done one in residency or have no intention to treat young children, how is this testing my global competency as a Podiatric Surgeon?

Just saying...

The exam is never weighted in such a way. Questions given represent a "global" and representative look at the profession. Even when something like a gun shot wound is given the principles examined are those that may apply to other pathologies. The boards (as they exist today) require sitting and passing a board qualification examination. The pass rate is quite high (I believe in the 90% range) for those graduating from residency. Cases are submitted and credentialed demonstrating that what you said was appropriate on the BQ exam you are actually doing. BQ lasts 7 years and may actually be repeated for an additional 7 years. Next you sit for oral and computer clinical based questions and the Foot exam typically passes in the low 70 per cent range (reasonable IMO).

What I have found over the years is when someone passes their response is "it was stressful (or sometimes they say hard) but was fair". When they fail "it was unfair or the ABPS is run by elitists trying to keep people out".

 

[347932]

The exam is never weighted in such a way. Questions given represent a "global" and representative look at the profession. Even when something like a gun shot wound is given the principles examined are those that may apply to other pathologies. The boards (as they exist today) require sitting and passing a board qualification examination. The pass rate is quite high (I believe in the 90% range) for those graduating from residency. Cases are submitted and credentialed demonstrating that what you said was appropriate on the BQ exam you are actually doing. BQ lasts 7 years and may actually be repeated for an additional 7 years. Next you sit for oral and computer clinical based questions and the Foot exam typically passes in the low 70 per cent range (reasonable IMO).

What I have found over the years is when someone passes their response is "it was stressful (or sometimes they say hard) but was fair". When they fail "it was unfair or the ABPS is run by elitists trying to keep people out".

I passed the written and oral examinations the first time around. One third of the oral/computer questions the year I took the oral/computer examination were GSW related. I saw ONE in my whole residency and never in practice. How can that be an accurate reflection of my training and private practice life? Am I supposed to know this stuff to "protect the public"? Forgive me, but yes I know what to do with an open wound. That was not what I was asked in my oral examination and on the computer test. There are thousands of other more pertinent scenarios that reflect much more what the average Podiatric Surgeon sees and does on a daily basis that represents him or her as a surgeon. As I've stated earlier, 50% or so of the RRA written I took had to do with tibial issues, which in the state I did my residency in, we did not see hardly any. How does that test my ability and knowledge in performing other complex RRA procedures?

The oral ABPS Foot Surgery examination was an interesting experience. My take on the process, particularly with the actual oral questions was that it had much more to do with the examiners asking the questions, rather than the questions themselves. Certain examiners made it very stressful and others made it thought provoking and interesting. Yes you can challenge questions and complain about examiners, but really, you just want to pass the bloody test. Having this variation in examiner demeanor is too much of a subjective angle to have when sitting for such an important examination.

What are those 30% that don't pass the written exam supposed to do if their community requires ABPS qualification/certification? Go somewhere else? If residencies are really training their residents to be surgeons, there should be a much higher passing rate imho UNLESS residencies are graduating surgeons with no earthly business in the OR.

I am glad to know that the process is under scrutiny and is expected to change in the coming years. What I'm not thrilled about is that who is running it right now has a team of his past residents as examiners when there are so many others that have much to offer who have applied to help with the examination process. Interesting to me is all.

 

[Feli]

...What are those 30% that don't pass the written exam supposed to do if their community requires ABPS qualification/certification? Go somewhere else? If residencies are really training their residents to be surgeons, there should be a much higher passing rate imho UNLESS residencies are graduating surgeons with no earthly business in the OR...

Well, as I linked above, our pass rates are pretty much in line with gen surg, ortho, etc boards.

For those who can't pass, then they do the same thing MD/DOs who did a surgery residency but can't pass their surgery boards do:
1 study hard and retake, or
2 do non-surgical practice, or
3 get cert by some "alternate" board and work at a VA or some rural hospital with such a need they may overlook lack of appropriate cert

I would tend to agree with krabmas that the boards are there to protect the public. The type/frequency of certain cases may be different among residency hospitals, but there is no residency hospital without access to standard F&A journals and texts and nothing stops anyone from attending conferences, seminars, etc. The "I don't do that so I don't have to know it" doesn't really hold water... you still have to make the diagnosis to make the appropriate referral. That would be like me saying that residency interviews shouldn't have asked me about tibia tumors or kaposi sarcoma since I didn't see any as a student. Besides, you will end up with other F&A surgeons' complications walking into your office, so I think it helps to know other procedures besides the ones you commonly utilize. The old saying "you see what you know" if famous for a reason: if you don't read, then a lot of things won't even be in your ddx or index of suspicion... and pts could suffer from that.

...An examination proves only that an individual can pass an examination. With the ABPS, the clear indication of this is that you are not tested on the cases you are required to submit. Ask me any question you want about those cases...

As for the BC oral exam not being about the cases you personally chose to submit, why would it be totally focused on those? The reason for standardized (peer reviewed and pre-tested) case workups is so that every candidate gets a similar minimum competency ABPS exam to test their surgical decision making. If everyone just got tested on their own cases, the scoring would be comparing apples to oranges.

 

[347932]

Well, as I linked above, our pass rates are pretty much in line with gen surg, ortho, etc boards.

For those who can't pass, then they do the same thing MD/DOs who did a surgery residency but can't pass their surgery boards do:
1 study hard and retake, or
2 do non-surgical practice, or
3 get cert by some "alternate" board and work at a VA or some rural hospital with such a need they may overlook lack of appropriate cert

I would tend to agree with krabmas that the boards are there to protect the public. The type/frequency of certain cases may be different among residency hospitals, but there is no residency hospital without access to standard F&A journals and texts and nothing stops anyone from attending conferences, seminars, etc. The "I don't do that so I don't have to know it" doesn't really hold water... you still have to make the diagnosis to make the appropriate referral. That would be like me saying that residency interviews shouldn't have asked me about tibia tumors or kaposi sarcoma since I didn't see any as a student. Besides, you will end up with other F&A surgeons' complications walking into your office, so I think it helps to know other procedures besides the ones you commonly utilize. The old saying "you see what you know" if famous for a reason: if you don't read, then a lot of things won't even be in your ddx or index of suspicion... and pts could suffer from that.

As for the BC oral exam not being about the cases you personally chose to submit, why would it be totally focused on those? The reason for standardized (peer reviewed and pre-tested) case workups is so that every candidate gets a similar minimum competency ABPS exam to test their surgical decision making. If everyone just got tested on their own cases, the scoring would be comparing apples to oranges.

Sorry man, but when an examination that is supposed to test minimum competency focuses on one topic above all others, then its not a blanket minimum competency test now is it? Especially when that particular topic is not really approached by many in the field. I was successful with the test, so I knew enough about that topic to get by. Yay me.

When you go through the exam process and feel how frustrating and pointless it is to have all those cases of yours scrutinized for no particular reason we'll talk. I didn't personally chose the 10 cases they asked for all the documentation. They chose those 10 out of the 65 I submitted, which by the way is not the easiest thing to gather. If you put me through all that, you better ask me questions about it. "Why did you pick that procedure?", "What would you have done differently?", "What other options are available?", "Did you get the desired affect with that fixation?", "Why do you think you needed a bone stim?" "Why didn't you warn that patient about x,y,z?". The list can go on forever. Standardization is not always a good thing.

 

[Podfather]

I passed the written and oral examinations the first time around. One third of the oral/computer questions the year I took the oral/computer examination were GSW related.

Having been involved in the process for many years, I can assure that there never has been a year where a GSW or any other pathology has been 1/3 the exam. I can say that with certainty.



I saw ONE in my whole residency and never in practice. How can that be an accurate reflection of my training and private practice life? Am I supposed to know this stuff to "protect the public"? Forgive me, but yes I know what to do with an open wound. That was not what I was asked in my oral examination and on the computer test. There are thousands of other more pertinent scenarios that reflect much more what the average Podiatric Surgeon sees and does on a daily basis that represents him or her as a surgeon. As I've stated earlier, 50% or so of the RRA written I took had to do with tibial issues, which in the state I did my residency in, we did not see hardly any. How does that test my ability and knowledge in performing other complex RRA procedures?

Again, there is no way 50% of the exam was of any specific thing like "tibial issues". Whether you do something regularly or not it is fair game. After all you advertise yourself as a "board-certified" foot and ankle podiatric surgeon. What's next? Total ankles are becoming more common yet I would venture that many people are not doing them regularly. Should the RRA not include any questions about them? Ex-fix? How about the DPM who practices in an ortho group doing mostly trauma should they get a bye on bunions? If you are to be board certified you need to understand the principles enough to diagnose and refer if necessary.

The oral ABPS Foot Surgery examination was an interesting experience. My take on the process, particularly with the actual oral questions was that it had much more to do with the examiners asking the questions, rather than the questions themselves. Certain examiners made it very stressful and others made it thought provoking and interesting. Yes you can challenge questions and complain about examiners, but really, you just want to pass the bloody test. Having this variation in examiner demeanor is too much of a subjective angle to have when sitting for such an important examination.

There will always been some subjectivity no matter how hard you work to eliminate it. The computer questions eliminate all of it. The examiners are evaluated multiple times each cycle. Those who are not doing what is expected are re-trained or not asked back.

What are those 30% that don't pass the written exam supposed to do if their community requires ABPS qualification/certification? Go somewhere else? If residencies are really training their residents to be surgeons, there should be a much higher passing rate imho UNLESS residencies are graduating surgeons with no earthly business in the OR.

The ABPS should not change their process for the unsuccessful. Perhaps the latter portion of this statement should be investigated more thoroughly.

I am glad to know that the process is under scrutiny and is expected to change in the coming years. What I'm not thrilled about is that who is running it right now has a team of his past residents as examiners when there are so many others that have much to offer who have applied to help with the examination process. Interesting to me is all.

That is simply not true. The people on the exam committees and those who serve as examiners represent many different residencies, geographic locations, and ages. Those selected are usually taken from those who volunteer. Those who create the exam typically are out of their offices and away from family for almost a month each year. All for no pay and for the ABPS with little notoreity. Sadly most DPMs can not tell you who the current ABPS president is let alone the committee chairs. Those in leadership roles have done this for years, often serve in other organizations, train residents, and have served in APMA leadership. They give back to the profession, need no further CV enhancement, and have been the ones that have opened doors for you an others of your generation. They deserve your thanks not subtle slams.

 

[347932]

That is simply not true. The people on the exam committees and those who serve as examiners represent many different residencies, geographic locations, and ages. Those selected are usually taken from those who volunteer. Those who create the exam typically are out of their offices and away from family for almost a month each year. All for no pay and for the ABPS with little notoreity. Sadly most DPMs can not tell you who the current ABPS president is let alone the committee chairs. Those in leadership roles have done this for years, often serve in other organizations, train residents, and have served in APMA leadership. They give back to the profession, need no further CV enhancement, and have been the ones that have opened doors for you an others of your generation. They deserve your thanks not subtle slams.

I'm sorry but I call it as I see it certain situations. Unfortunately, calls for a shift in the paradigm are generally considered "subtle slams". There is a better way, and I would like things to change in that regard. With the current leadership at the helm it will be business as usual. Its interesting to me how this works. The helmers surround themselves with like minded people who they trained, and things continue on. I'm deeply involved with the APMA and the politics of our profession, as well as help run two organizations within our profession and have applied to serve on the ABPS as well as within the APMA. I volunteer a TREMENDOUS amount of my free time, which takes me away from my wife and three kids, so point the finger elsewhere please.

I'm also not sure you reviewed the exam recently, because the oral foot exam in 2008 had 4 GSW questions out of twelve. In 2002 when I took the RRA examination 50% of the examination had to do with CORA and Tibial Rotational and Transpositional surgical techniques.

I hate to think that no motion is an expectation from any professional group. If that's the case, I will retreat to my daily routine and not worry about how our profession will survive in the future. If everyone is happy with the status quo and see no reason for progress, I'm out. Happily this is clearly NOT the case. I feel the need to push to get things progressing in a positive and fruitful direction. The "good old boys" mentally is lost on me at this point, sorry.