All 2yr residencies will now be 3yr but still wont qualify for Rearfoot

cool_vkb · Dec 7, 2009

We had a meeting today in school regarding CASPR and CRIPs. The representative from CASPR said that there is draft due in March or april which if passed will basically transform every program in USA to 3yr residency.

Now here is the catch, even if they become 3yr it doesnt means you will be rearfoot qualified for boards.

For example, if there was a 24 month program which now became 36 months. That program will write on your cerficate that rearfoot training (the cases logs,etc) eligible for board certification was not acorded. So basically its still a 2yr program interms that we will not be board certified but its an extra year.

Just wanted everybody to know. incase this draft passes and people might apply by mistake to some 24 month program thinking now that it is 3yr they will get rearfoot certification :laugh:

PodunkUDPM · Dec 7, 2009

cool_vkb said:
We had a meeting today in school regarding CASPR and CRIPs. The representative from CASPR said that there is draft due in March or april which if passed will basically transform every program in USA to 3yr residency.

Now here is the catch, even if they become 3yr it doesnt means you will be rearfoot qualified for boards.

For example, if there was a 24 month program which now became 36 months. That program will write on your cerficate that rearfoot training (the cases logs,etc) eligible for board certification was not acorded. So basically its still a 2yr program interms that we will not be board certified but its an extra year.

Just wanted everybody to know. incase this draft passes and people might apply by mistake to some 24 month program thinking now that it is 3yr they will get rearfoot certification

Wow that sucks. Sounds like a pretty pointless resolution besides the program getting another year of cheap labor.

jonwill · Dec 7, 2009

I haven't heard about that but that sounds kind of ridiculous. I'm curious to hear the details.

Brodiatrist · Dec 7, 2009

cool_vkb said:
We had a meeting today in school regarding CASPR and CRIPs. The representative from CASPR said that there is draft due in March or april which if passed will basically transform every program in USA to 3yr residency.

Now here is the catch, even if they become 3yr it doesnt means you will be rearfoot qualified for boards.

For example, if there was a 24 month program which now became 36 months. That program will write on your cerficate that rearfoot training (the cases logs,etc) eligible for board certification was not acorded. So basically its still a 2yr program interms that we will not be board certified but its an extra year.

Just wanted everybody to know. incase this draft passes and people might apply by mistake to some 24 month program thinking now that it is 3yr they will get rearfoot certification

This does not make sense. Hopefully a classmate that paid more attention can comment.

Feli · Dec 7, 2009

I heard about this awhile ago. It makes sense to me since all MD/DO postgrad training programs are 3yrs minimum.

Yeah, it sucks for ppl who do a 3yr and can only do foot surgery, but a lot of programs don't get enough RRA cases per resident to train each of the graduates well in those procedures, esp with the recent push for new programs or more spots at existing programs. The 3yr non-RRA residents stil getting much better training than the vast majority of currently practicing DPMs ever got, and they will do just fine. Maybe they should've worked harder in school if they really wanted RRA cert.

In the end, you will be suprised how few pods do RRA on a regular basis - even if they were trained/cert for it. It's all you hear about in conferences or read in journals, but RRA is actually a fairly small piece of the pie for most DPMs in terms of hours and income. There is plenty of work out there in basic care, wound care, forefoot surgery, etc... and a lot of DPMs just don't want the increased liability, testing rigors, and hospital politics hassle of RRA/trauma to begin with.

I honestly think it'll be better this way: every residency DPM will be competent in foot surg, wound care, basic care, etc... and those who get a high quality program can also do RRA. I think you will see most groups having one guy who does most of the RRA, and rightly so. Ilizarov Charcots, calc fractures, pantalar, ankle fusion/implant, etc are no piece of cake and certainly not cases you want a surgeon doing once every year or two... they're better referred to [prominent local or teritiary centers/groups and the surgeons - DPM or F&A ortho - who are the most proficient and experienced at them. JMO

PADPM · Dec 7, 2009

There is another small factor that I believe a lot of today's very well trained residents may forget. Even with tremendous training, patients aren't knocking on your door on a daily basis to undergo major rearfoot reconstructive surgical procedures!!!

Many of you are trained in programs with a handful of "power-hitters" and may not realize that in the "real world" the average practice simply isn't performing several triple arthrodesis procedures weekly, and isn't applying external frames several times a week, and isn't performing ankle fusions several times a week, etc., etc., etc., even when the practice DOES have well trained doctors.

Yes, those practices do exist, but I can assure you that they probably realistically represent about 5% of the existing practices. In today's economy, not all patients can afford to take off a few months to undergo some of our more exotic procedures. I had a hard time convincing a patient today to schedule for a Lapidus, since another DPM recommended a less complicated procedure, though in my opinion it would not address her deformity adequately. Her concern was that a Lapidus would require non weightbearing vs. the lesser procedure.

Now imagine trying to convince "private" patients to undergo major RRA procedures!!

The bottom line is that the surgical training many of you are receiving is tremendous and invaluable. But realistically, I hope that many of you realize that you may have to practice the full armamentarium of procedures from the complicated to the very simple in order to put food on your table and pay your bills. Not all patients are going to require RRA procedures, and you also have the skills and abilities to make MANY patients happy and better by not performing any surgery.

There are very few procedures that I have not performed, and some of my most grateful patients are the ones that I never brought to the O.R. And it's very satisfying to know that I was able to help these patients without surgical intervention.

cool_vkb · Dec 7, 2009

Brodiatrist said:
This does not make sense. Hopefully a classmate that paid more attention can comment.

WTF is wrong with you. I report what i hear. Read it or ignore it.

cool_vkb · Dec 7, 2009

PADPM said:
There is another small factor that I believe a lot of today's very well trained residents may forget. Even with tremendous training, patients aren't knocking on your door on a daily basis to undergo major rearfoot reconstructive surgical procedures!!!

Many of you are trained in programs with a handful of "power-hitters" and may not realize that in the "real world" the average practice simply isn't performing several triple arthrodesis procedures weekly, and isn't applying external frames several times a week, and isn't performing ankle fusions several times a week, etc., etc., etc., even when the practice DOES have well trained doctors.

Yes, those practices do exist, but I can assure you that they probably realistically represent about 5% of the existing practices. In today's economy, not all patients can afford to take off a few months to undergo some of our more exotic procedures. I had a hard time convincing a patient today to schedule for a Lapidus, since another DPM recommended a less complicated procedure, though in my opinion it would not address her deformity adequately. Her concern was that a Lapidus would require non weightbearing vs. the lesser procedure.

Now imagine trying to convince "private" patients to undergo major RRA procedures!!

The bottom line is that the surgical training many of you are receiving is tremendous and invaluable. But realistically, I hope that many of you realize that you may have to practice the full armamentarium of procedures from the complicated to the very simple in order to put food on your table and pay your bills. Not all patients are going to require RRA procedures, and you also have the skills and abilities to make MANY patients happy and better by not performing any surgery.

There are very few procedures that I have not performed, and some of my most grateful patients are the ones that I never brought to the O.R. And it's very satisfying to know that I was able to help these patients without surgical intervention.

Sir based on your practice expereince, what are the most common procedures one can encounter in an average podiatry practice? and what is % of rearfoot procedures?

Someone told me that ideally Rearfoot cases need Hospital setting for surgery instead of the ambulatory center. Is this true?

PADPM · Dec 8, 2009

Sir???? Only kidding, I appreciate your intended respect.

I would say that the most common surgical procedures for the "average" podiatric practice would be bunionectomies, arthroplasty procedures, simple "lumps and bumps", ganglion/soft tissue mass excision, "neuroma" excision, ORIF for fractures, various forms of plantar fasciotomies (which I'm not a fan of) and diabetic wound complications.

Naturally, this list is not exhaustive, but is what came to my mind this early in the am.

The list of RRA procedures is much harder to determine, because that it much more dependent on scope of training which is improving on a daily basis, and actually at times varies from region to region. Additionally, many RF procedures go in and out of "vogue" from year to year. Although not a RF procedure, the Lapidus procedure has recently gained significant popularity, yet for years was relatively unpopular among a lot of surgeons. The opening wedge has not been very popular for HAV, but is now gaining more popularity and there are new hardware systems making the performance and stability of fixating the opening wedge much easier/better.

I would agree that is usually more prudent to perform more complicated RRA procedures in the hospital. There are several reasons. One reason is that the purpose of many ambulatory centers is to move 'em in and move 'em out. Most RRA procedures are a little more time consuming and the ambulatory center doesn't want to tie up an OR for a few hours.

However, the most important reasons as a surgeon include anticipated complications. THese facilities don't always have all the ancillary products, tools, supplies, that you may need. Additionally, some complicated RRA procedures may require overnight monitoring, though one of the ambulatory facilities where I practice has a 24 hour stay. A hospital OR usually has EVERYTHING you need if something goes "wrong", whereas a surgical center often only has what they THINK you will need for your case. I'd rather have too much available than not enough. My patient's needs and concerns always take precedent over my convenience.

MaseratiGT · Dec 8, 2009

cool_vkb said:
Sir based on your practice expereince, what are the most common procedures one can encounter in an average podiatry practice? and what is % of rearfoot procedures?

Someone told me that ideally Rearfoot cases need Hospital setting for surgery instead of the ambulatory center. Is this true?

So if the new 2 to 3 years may not be able to be RRA qualified, did the CASPR rep tell you how students will be able to distinguish those programs from RRA programs on the website?

Brodiatrist · Dec 8, 2009

OP your statement, combined with the lack of detail, raises more questions than it answers. Hopefully a rep or someone with greater knowledge can add to this topic.

cool_vkb · Dec 8, 2009

MaseratiGT said:
So if the new 2 to 3 years may not be able to be RRA qualified, did the CASPR rep tell you how students will be able to distinguish those programs from RRA programs on the website?

Nope she just went thru that topic for a min and moved over to CRIPS process,etc. Iam sure they will have somesort of identification system.

and lets not forget this is still a draft. if it passes then only all this will happen.

Brodiatrist · Dec 8, 2009

"The CPME is considering requiring all residency progams to be 36 months in length. They will decide this next spring. If that is the case, only those programs which can offer RRA training will graduate residents who can sit for the RRA exam. Otherwise, residents will only be able to sit for the Foot exam. Training will be the determining factor, not length of time. Programs will be clearly delineated as to which is which."
xxx, DPM

cool_vkb · Dec 8, 2009

Brodiatrist said:
"The CPME is considering requiring all residency progams to be 36 months in length. They will decide this next spring. If that is the case, only those programs which can offer RRA training will graduate residents who can sit for the RRA exam. Otherwise, residents will only be able to sit for the Foot exam. Training will be the determining factor, not length of time. Programs will be clearly delineated as to which is which."
xxx, DPM

Aaah isnt this what i wrote. I guess my post was in chinese thats why it didnt made sense.

Brodiatrist · Dec 8, 2009

cool_vkb said:
Aaah isnt this what i wrote. I guess my post was in chinese thats why it didnt made sense.

That is NOT what your OP said...your OP said you cannot be certified in rearfoot at any of the recently converted residencies, and that is not correct. RRA will be based on training offered, not by whether its a recently converted residency or not. You're not the sharpest crayon in the box, chicken little.

cool_vkb · Dec 8, 2009

Brodiatrist said:
That is NOT what your OP said...your OP said you cannot be certified in rearfoot at any of the recently converted residencies, and that is not correct. RRA will be based on training offered, not by whether its a recently converted residency or not. You're not the sharpest crayon in the box, chicken little.

You gotta be kidding me. Are you really that naive. RRA will be based on training offered that is 100% true. but if all 2yr programs are forcibily coverted just because the resolution wants all of them to become 3yr program .How the heck are they gonna find the RF case load. So naturally none of those converted residencies will be able to certify you in RF.

Now if a program willingly converts itself to 36 month program based on its caseload its a different thing.

diabeticfootdr · Dec 9, 2009

Brodiatrist said:
"The CPME is considering requiring all residency progams to be 36 months in length. They will decide this next spring. If that is the case, only those programs which can offer RRA training will graduate residents who can sit for the RRA exam. Otherwise, residents will only be able to sit for the Foot exam. Training will be the determining factor, not length of time. Programs will be clearly delineated as to which is which."
xxx, DPM

So while CPME is attempting to raise the standard of training, ABPS couldn't stand to have everyone be trained the same and eligible for RRA. Then there is no class system in podiatry, and that's what ABPS loves best.

MaseratiGT · Dec 9, 2009

cool_vkb said:
You gotta be kidding me. Are you really that naive. RRA will be based on training offered that is 100% true. but if all 2yr programs are forcibily coverted just because the resolution wants all of them to become 3yr program .How the heck are they gonna find the RF case load. So naturally none of those converted residencies will be able to certify you in RF.

Now if a program willingly converts itself to 36 month program based on its caseload its a different thing.

Thanks for the info. It's good to know! 👍

hyperpodia · Dec 9, 2009

This is not good news many of us we were hoping that everyone will get PMS 36 training. So they basically lied to us that all programs will be 3yrs.

Brodiatrist · Dec 9, 2009

Let's wait and see. These types of threads do nothing but stir trouble because the facts are still fuzzy.

cool_vkb · Dec 9, 2009

Yep they did. In 2007 i thought since all are becoming 3yrs it would be so awesome. but this news is really saddening. Hopefully till 2011 they add more PMS36 spots

cool_vkb · Dec 9, 2009

hyperpodia said:
This is not good news many of us we were hoping that everyone will get PMS 36 training. So they basically lied to us that all programs will be 3yrs.

Yep they did. In 2007 i thought that since all are becoming 3yrs it would be so awesome. but this news is really saddening. Hopefully till 2011 they add more PMS36 spots🙂

Feli · Dec 9, 2009

diabeticfootdr said:
So while CPME is attempting to raise the standard of training, ABPS couldn't stand to have everyone be trained the same and eligible for RRA. Then there is no class system in podiatry, and that's what ABPS loves best.

Well, all residencies are definitely not created equal, and in our profession where the vast majority of residencies are still relatively new, that's even more true. At some programs "rearfoot experience" consists of 3+ residents all scrubbed in helping the attending struggle through an MBA, Brostrom, TAL, ankle scope, or Haglund's and using those as their rearfoot Cs.... or, even worse, doing basically nothing but retracting and watching ortho do rearfoot, yet logging rearfoot "C"s that way.

Meanwhile, at other higher quality pod residency hospitals, the pod surg residents are getting legit C cases on difficult fractures, midfoot and rearfoot arthrodesis, calc osteotomies, etc by 2nd year and doing very tough cases as chiefs (realignment triples, major trauma, pantalars, implants, etc). Forefoot training is almost universally at least adequate between the PMS programs, but on rearfoot, you have to admit that it's night and day between some programs... even PMS 36s.

My program's director is ABPS president next year, so I'm probably biased, but I think they are doing a tough job and helping protect patients for the most part. Yes, it's lame that many were grandfathered in and us "young guns" aren't certified right out of residency like most surgical specialties, but I think there are bigger discrepencies between the postgrad training levels in our profession when compared to most MD/DO surgical specialties. It doesn't hurt to have ABPS qual and cert exams to make sure that the candidates have the basic knowledge and have been doing cases they want certification for. I know I wouldn't want a surgeon doing major rearfoot on me if they hadn't been trained well for it in residenty +/- fellowship.

Ideally, I think we could have the top quarter or third of pod students get the full 3yr surgical residency (and high level surgical training) and the rest of DPMs get primary care, wound care, derm, etc that could probably be 2yrs or maybe even one good year. Like dent, we have a specialty where tons of people need primary care and not everyone needs the major surgical offerings. Why not let a fraction of us do all of the surgery and do tons of it so they get excellent (like basic dentists and oral surgeons)? However, with the MD/DO residency minimum being 3yrs of post-grad residency, it's a good idea for DPMs too - even though we started specializing sooner during pod school.

whiskers · Dec 9, 2009

Repost.

whiskers · Dec 9, 2009

Another worthless idea.

I mean seriously, how hard is it to standardize the profession and make us all do the same darn thing so there is no question as to what we can do?

Who thinks of this crap and why are they still pushing and hanging onto tooth and nail to a failed model of forefoot vs rearfoot training?

Simply stupid.

ABPS is utterly useless IMO. Maybe these grandfathered in folks should get some real medicine training instead of heaping on the BS?

What i find funny is that the old grandpas who are making these things up are the ones that need the retraining I bet!

Feli, if this crowd was all about protecting the patients... then why don't they redo their medicine rotations and get some better training?

Feli · Dec 9, 2009

whiskers said:
Another worthless idea.

I mean seriously, how hard is it to standardize the profession and make us all do the same darn thing so there is no question as to what we can do?...

Gotta ask for progress, not perfection. 20yrs ago, there were maybe 20 hospitals with good DPM surgical residency programs that gave high quality rearfoot knowledge and legit C volume on those cases. Now, there's maybe 50 residency hospitals (of 200 total) that can offer that - and others that are getting closer as new well trained attendings join staff. We can't pull (quality) residency spots outta thin air; it takes time. A lot of the good surgical programs have been getting fairly watered down in the rush to compensate for old pod schools expanding and new pod schools opening. Other programs have resisted financial and political pressure to dilute their surgical training level just to compensate for greed of some schools, and I applaud them.

Gotta remember that even 10yrs ago, there were DPM grads - smart grads - who got a 1yr non surg or minimal surg program... or even no program at all, which left them scouring for some preceptorship (aka low or no pay associate C&C job?). They would've killed for even the 2yr programs that are mostly wound care, clinic, and a bit of forefoot surgery, and that's the "bottom rung" programs today. Change doesn't happen overnight.

PADPM · Dec 10, 2009

I don't agree with Whiskers that the ABPS is useless, nor do I appreciate his disrespect of the "grandpas" who laid the foundation for all of us to actually obtain the training and privileges we all enjoy today.

Act like a professional and show a modicum of respect for your predecessors, even if you don't agree with the way things may have developed.

I am ABPS certified AND I was an examiner for the oral portion of the ABPS exam for many years. And I DO NOT agree with the way the "good 'ol boys" think or operate, but that doesn't mean I will speak of them with disrespect.

The ABPS must exist to maintain some level of standard and to assure that the training process maintains a level of integrity.

However, what MUST change is the multi-tiered system. Rules can not constantly change to protect those already "in place". Those making up the rules constantly are making things more difficult, while protecting their own interests.

For example, those that were certified prior to a certain year decided that "re-certification" was now a mandatory process every ten years. This was mandatory to "protect the public" and assure that surgeons were still competent, up to date, etc.

However, they made the rules so that those that were ALREADY certified (protecting their own ass) only had to take a "self assessment" exam that they graded themselves and had no real meaning. Anyone certified AFTER this time had to take a "re-certification" exam that had true meaning and you had to pay big bucks to take and had to actually have graded and had to PASS to maintain your certification. If you failed the test, you lost your certification.

Remember, this was to PROTECT THE PUBLIC. Yet, those that were certified the longest time ago (the guys that made the rule) didn't really have to take a "real test", just a self assessment exam. This way they could NEVER lose their certification.

So it was hypocritical and still is hypocritical. To protest this hypocrisy, I decided to no longer be a part of this process and stopped being an oral examiner.

When the ABPS stops it's self serving interest among it's leaders and those in charge, it will actually move forward. In the interim, you have too many that are first protecting their own interest prior to really trying to obtain parity among all their surgically trained colleagues. Many of these guys are simply threatened by the training of the new young studs.

I've been on the "inside" and it 'ain't pretty. It really is a good 'ol boys club and must change. There are some great guys in the ABPS hierarchy, but there are still a few holding it back from truly being objective.

Podfather · Dec 10, 2009

PADPM said:
I don't agree with Whiskers that the ABPS is useless, nor do I appreciate his disrespect of the "grandpas" who laid the foundation for all of us to actually obtain the training and privileges we all enjoy today.

Act like a professional and show a modicum of respect for your predecessors, even if you don't agree with the way things may have developed.

Smartest thing you said in this post

I am ABPS certified AND I was an examiner for the oral portion of the ABPS exam for many years. And I DO NOT agree with the way the "good 'ol boys" think or operate, but that doesn't mean I will speak of them with disrespect.

I am perplexed by the good ol boy comment. Please name these boys. Most of those who are truly in the "inner circle" (your words, not mine) are young, 2-3 year trained, and many are in the recertification process. Are those who are foot and ankle certified and self assess? Yes but do you believe those involved were asked to be involved because they are a danger to the public? And what is the benefit to the supposed good ol boys? They put in significant time (often a 2-4 weeks) miss practice time with loss of income and no pay. Forget that they lose personal time and often participate in multiple organizations making the profession better. I would prefer you just thank them.

The ABPS must exist to maintain some level of standard and to assure that the training process maintains a level of integrity.

However, what MUST change is the multi-tiered system. Rules can not constantly change to protect those already "in place". Those making up the rules constantly are making things more difficult, while protecting their own interests.

The posts here about POSSIBLE changes in residency training are a result of the CPME/APMA not ABPS. The ABPS as far as I can see has not commented on any changes they would make if the mandatory 3 year rule occurs. If it does happen should they allow RRA examination only by number of years? Or should it look at what type of training that has been delivered? Which would protect the public more? Let's make it simple only allow residencies to exist that provide comprehensive training and close the rest. That would mean a significant number of grads would not get a residency. The ABPS can not simply allow people to be certified just because the CPME says so.l

For example, those that were certified prior to a certain year decided that "re-certification" was now a mandatory process every ten years. This was mandatory to "protect the public" and assure that surgeons were still competent, up to date, etc.

However, they made the rules so that those that were ALREADY certified (protecting their own ass) only had to take a "self assessment" exam that they graded themselves and had no real meaning. Anyone certified AFTER this time had to take a "re-certification" exam that had true meaning and you had to pay big bucks to take and had to actually have graded and had to PASS to maintain your certification. If you failed the test, you lost your certification.

No they are maintaining the rules in effect when these people sat for their exams. Changing now would be unfair. Imagine if those who re-cert every 10 years are told that has changed to 5 or better 2 years since that is when hospitals recredential. You and others would complain. Or imagine if in 15 years graduating DPMs also receive a MD/DO and the board "to protect the public" said only those who had that credential could be certified. Then it would be your turn to be the Older guy who is slammed.

Remember, this was to PROTECT THE PUBLIC. Yet, those that were certified the longest time ago (the guys that made the rule) didn't really have to take a "real test", just a self assessment exam. This way they could NEVER lose their certification.

So it was hypocritical and still is hypocritical. To protest this hypocrisy, I decided to no longer be a part of this process and stopped being an oral examiner.

When the ABPS stops it's self serving interest among it's leaders and those in charge, it will actually move forward. In the interim, you have too many that are first protecting their own interest prior to really trying to obtain parity among all their surgically trained colleagues. Many of these guys are simply threatened by the training of the new young studs.

I've been on the "inside" and it 'ain't pretty. It really is a good 'ol boys club and must change. There are some great guys in the ABPS hierarchy, but there are still a few holding it back from truly being objective.

With respect being an examiner is appreciated but not on the inside. I have been on what you describe as the "inside". Examiners although important do not attend board meetings, work on committees, know why decisions are made, and are involved for 2-3 days a year simply giving the exam. Thanks but quit posing as someone who knows the workings of an organization that works all year and has people who give up a month of their life to maintain the integrity of the certification you hold,

diabeticfootdr · Dec 11, 2009

Feli said:
Well, all residencies are definitely not created equal, and in our profession where the vast majority of residencies are still relatively new, that's even more true. At some programs "rearfoot experience" consists of 3+ residents all scrubbed in helping the attending struggle through an MBA, Brostrom, TAL, ankle scope, or Haglund's and using those as their rearfoot Cs.... or, even worse, doing basically nothing but retracting and watching ortho do rearfoot, yet logging rearfoot "C"s that way.

No, all residencies ARE created equal - at least they all must meet a minimum CPME standard. This mentality of all residencies/training is not created equal is just the oneupmanship, class system I'm talking about that brings down this profession. How do you know your residency is better than the rest? The others meet CPME 320 requirements, just like yours.

You have to remember, it's ONLY A FOOT. It's a relatively small piece of anatomy. It makes no sense to break it up on anatomic borders. Do hand surgeons say, well if you do a 1 year fellowship you're a phalange and metacarpal surgeon, but in 2 you can call yourself a carpal and wrist surgeon. That would be completely ridiculous, just like other docs see our stratification by anatomy (within the foot) and declaration of the LisFranc joint the "Mason Dixon Line".

PADPM · Dec 11, 2009

Podfather,

I'm not about to get into a "pissing match" with you. I was on the "inside" and one of those who traveled back and forth, gave weeks of my time, etc., etc., and sat on committees for the ABPS and was not "just" an examiner that flew out for 3 days.

I'm very well aware of what I'm talking about. If you look over the list of examiners and committee members, some of them have not changed over the past 15 years.

So don't preach to me about all the hard work, lost time, lost wages and dedication. I've been there and done that for the ABPS. But their time, wages and energy must be for the benefit of ALL the members and potential members with no hidden agenda.

And if you read my post carefully, you'll read that I also wrote that there are a lot of great guys in the hierarchy, but there are also quite a few that are holding the ABPS back. That does not include the young blood that's taking over. I have no issues with the present CPME issues, etc.

Once again, take a look at the recent issue of the ABPS newsletter. Look at the list of this past year's examiners and the committees and then HONESTLY tell me how many of these docs have been giving the exam or on these committees for greater than 10-15 years???

The YOUNG blood is what I think we need.

So you can get off your pedestal, because I probably was in the same room at your "committee" meetings, "board" meetings, etc. and probably shared a few drinks with you.

Feli · Dec 11, 2009

diabeticfootdr said:
No, all residencies ARE created equal - at least they all must meet a minimum CPME standard. This mentality of all residencies/training is not created equal is just the oneupmanship, class system I'm talking about that brings down this profession. How do you know your residency is better than the rest? The others meet CPME 320 requirements, just like yours...

Would you agree that there were not anywhere near 400 surgical residency spots for DPMs - much less quality rearfoot training spots -ten years ago? Do you agree that there are currently 400+ approved PMS-36 spots (which are intended to lead to RF cert)? Well, if you agree with that, you are left with a few logical options:

A) Hundreds of quality rearfoot surgery residency training positions were generated in a very short timespan.
B) A lot of previously non- or semi-surgical programs had their surgical approval convienently expidited in order to meet pod school graduation numbers and have "standardized training" with every grad getting a "surgical residency," yet a lot of those programs still have work to do - esp in terms of legit rearfoot experience for the residents.

Podfather · Dec 11, 2009

PADPM said:
Podfather,

I'm not about to get into a "pissing match" with you. I was on the "inside" and one of those who traveled back and forth, gave weeks of my time, etc., etc., and sat on committees for the ABPS and was not "just" an examiner that flew out for 3 days.

I'm very well aware of what I'm talking about. If you look over the list of examiners and committee members, some of them have not changed over the past 15 years.

So don't preach to me about all the hard work, lost time, lost wages and dedication. I've been there and done that for the ABPS. But their time, wages and energy must be for the benefit of ALL the members and potential members with no hidden agenda.

And if you read my post carefully, you'll read that I also wrote that there are a lot of great guys in the hierarchy, but there are also quite a few that are holding the ABPS back. That does not include the young blood that's taking over. I have no issues with the present CPME issues, etc.

Once again, take a look at the recent issue of the ABPS newsletter. Look at the list of this past year's examiners and the committees and then HONESTLY tell me how many of these docs have been giving the exam or on these committees for greater than 10-15 years???

The YOUNG blood is what I think we need.

So you can get off your pedestal, because I probably was in the same room at your "committee" meetings, "board" meetings, etc. and probably shared a few drinks with you.

If you did look at the recent newsletter, Please name anyone on the oral foot or RRA that has been on the committee more than even 5 years. They are the young blood that you crave. As far as examiners there is a constant removal of historical examiners and replacement of with new ones. Examiners require years of experience, monitoring, evaluating since the administration of the exam must be more a exam than subjective inexperience. You implied you were on the board. Is that true? Then I guess when you were there you were ineffective in getting the changes you now spout are needed when you were the good ol boy? Were you on the exam committee? If so you are not now proving change occrs. Even the board and officers that are currently serving have not been there for 10 let alone 15 years. They can only serve 2, 3 year terms. But you know that as an ex-insider. Finally please tell me the "hidden" agenda some have. Great rhetoric but please educate us.

No probably didn't have a drink with you at the bar. From you post's statements you have no idea what you are talking about. Email me your identity and if you are not a poser, I will apologize in this forum.

BTW I was a spy, professional football player, astronaut, and invented the light bulb.

Podfather · Dec 11, 2009

diabeticfootdr said:
No, all residencies ARE created equal - at least they all must meet a minimum CPME standard. This mentality of all residencies/training is not created equal is just the oneupmanship, class system I'm talking about that brings down this profession. How do you know your residency is better than the rest? The others meet CPME 320 requirements, just like yours.

You have to remember, it's ONLY A FOOT. It's a relatively small piece of anatomy. It makes no sense to break it up on anatomic borders. Do hand surgeons say, well if you do a 1 year fellowship you're a phalange and metacarpal surgeon, but in 2 you can call yourself a carpal and wrist surgeon. That would be completely ridiculous, just like other docs see our stratification by anatomy (within the foot) and declaration of the LisFranc joint the "Mason Dixon Line".

It's not the anatomy but what you do to it. Yes all PM&S-36 meet minimum MAVs but anyone knows they are not equal in the experience. Not better or worse different. AND all may sit for the RRA exams. The PM&S-24s can not sit because they do not meet MAVs for a PM&S-36. If all programs become 3 years then some may not meet the MAVs for a current PM&S-36 and not be eligible for RRA.

PADPM · Dec 12, 2009

Podfather,

I've already stated that I'm not about to get into a "pissing" match with you. I can assure you that I was involved in all the capacities that I claim. If you want to sling insults and believe that I'm a fraud, I really could care less.

Read your post, and it's obvious you're not very objective since you seem to take everything so "personal". I volunteered and spent quite a bit of my time attempting to improve certain aspects of the ABPS, and became frustrated with certain people that still remain involved.

Out of respect, I will refrain from slamming any particular doctors and "outing" them on this site, especially because I'm posting anonymously. As I've stated many times, I'm part of a group practice, and my partners aren't thrilled with the idea that I post on this site, or I would have been happy to post my identity a long time ago.

Once again, I've also stated that there are many excellent and dedicated doctors working hard to improve the ABPS. But, in my opinion there are still doctors that exist that must be removed for the board to truly be functioning more effectively.

I am NOT a big fan of the computer based oral examinations. Yes, it does remove subjectivity from the exam and in essence creates a "fairness" and removes bias from the testing process.

However, I can tell you that over the years I served as an examiner, there were many brilliant candidates I passed during the oral exam that absolutely knew the material, but may have failed a computer based exam without the interaction of an oral exam and the ability to ask the "right" questions. If you've been involved with the "orals", you know exactly what I'm talking about.

Regardless, I can assure you that I'm 100% legit, and there's no need to sling insults. If you don't believe me, that's your problem not mine. But I can assure you that I will not be sending you an email for an "apology", because that's something I don't need or want.

PADPM · Dec 12, 2009

Accidental duplicate.

whiskers · Dec 12, 2009

Sorry, but I don't worship at the feet of the old guys. .

I don't give BS a free pass regardless of how I should respect the "old guys."

Sure they are the reason the profession advanced, but they are also equally responsible for the profession being held back.

IMO, the profession without their input would have advanced further.

As a matter of fact, it probably would be a MD degree by now with equal opportunities for all instead of some BS sill rearfoot and forefoot chicanery that's going on now under the auspice of the esteemed old guys who are always above the curve of change and are grandfathered in for their efforts.

Sorry if this offends.

PADPM · Dec 12, 2009

No one is asking you to "worship" anyone. There's a huge difference between "worship" and respect. You can still show respect for a group even though you may not agree with all of their actions.

As per my prior posts, I don't agree with all of the actions of some members of the group, but I still respect what they have worked for and have accomplished, despite your perception.

You seem awfully angry, and I'm not aware of your present level of training. I can assure you that this small group is NOT responsible for all the problems you blame them for, and there are many other groups that have also contributed to many of the issues you describe.

Podfather · Dec 13, 2009

PADPM said:
Podfather,

I've already stated that I'm not about to get into a "pissing" match with you. I can assure you that I was involved in all the capacities that I claim. If you want to sling insults and believe that I'm a fraud, I really could care less.

Read your post, and it's obvious you're not very objective since you seem to take everything so "personal". I volunteered and spent quite a bit of my time attempting to improve certain aspects of the ABPS, and became frustrated with certain people that still remain involved.

Out of respect, I will refrain from slamming any particular doctors and "outing" them on this site, especially because I'm posting anonymously. As I've stated many times, I'm part of a group practice, and my partners aren't thrilled with the idea that I post on this site, or I would have been happy to post my identity a long time ago.

Once again, I've also stated that there are many excellent and dedicated doctors working hard to improve the ABPS. But, in my opinion there are still doctors that exist that must be removed for the board to truly be functioning more effectively.

I am NOT a big fan of the computer based oral examinations. Yes, it does remove subjectivity from the exam and in essence creates a "fairness" and removes bias from the testing process.

However, I can tell you that over the years I served as an examiner, there were many brilliant candidates I passed during the oral exam that absolutely knew the material, but may have failed a computer based exam without the interaction of an oral exam and the ability to ask the "right" questions. If you've been involved with the "orals", you know exactly what I'm talking about.

Regardless, I can assure you that I'm 100% legit, and there's no need to sling insults. If you don't believe me, that's your problem not mine. But I can assure you that I will not be sending you an email for an "apology", because that's something I don't need or want.

You will not be sending an email because you are IMO a fraud. Every post you comment somehow that you "know" what the hidden truth is. You said it, these are your opinions. I can respect those but when you make non fact statements slamming a poster, the ABPS, or a residency I plan to call you out. If you were (and from what you have posted I am not convinced) involved at the committee and board level at ABPS you would know what you have written is incorrect.

You imply that the exam committees are filled with good ol boys. Once again name one person on the Foot or RRA that has been their more than 5 years. I can think of one person on the RRA that may be close but the rest are predominately young, recently trained grads. There are some older DPMS but they have served on the committees for a short period of time. You implied that the board and leadership has been there for a long time. In fact you claim you left because of some of these people. What you claim is impossible. A board member can sevre only 2 consecutive terms of 3 years. I believe that adds up to 6. Yes from time to time, someone may fill a term of someone who quits but the current board has several young people.

As far as the computer. I believe I heard that no one has failed purely because of the computer based test. I like the orals too but you said it anytime a person gives the exam there can be subjectivity. You stated that over all of the years you knew of bright candidates that passed the orals and failed computer based exams. Data would show that to be incorrect.

The most irritating comment you made was that some had a "hidden agenda". Thats BS. First of all you failed to explain what that was and also failed to prove it with facts.

This is not a pissing match but students who read this forum need to know that because the posters are anonymous they should not take your, my ,or others posts as the truth. They need to do their homework because from what I have seen from time to time that there are some who post here who seem to have the "hidden agendas"

PADPM · Dec 13, 2009

You seem to have a great way at twisting words and commenting on your edited version.

Despite your statistics regarding the computer vs. the examiner based oral exam, I did NOT state that I knew of canditates that failed due to the new computer model.

I did state that because of my experience, I believed that there were candidates that MAY have failed in a computer based exam since there is no ability to interact and ask questions. So go back and read my post prior to your criticism of my statement.

You argue with me, than you bury you tail between your legs. You state that a board member can "only serve" 6 years, but can fill in if a board member leaves a position. That does happen and has happened.

Once again if you read my post, I clearly stated that there are MANY excellent, hard working members of the ABPS, but there are still a few docs holding back the ideas of the young blood. Yet you keep perseverating that I state that the ABPS is "filled" with good 'ol boys. That is NOT what I stated. I simply stated that there are still some that exist, period.

I will not stoop low enough to name the doctors you want me to name. You're not stupid. Take the time and look over the names on the exam committee and the actual examiners and you will clearly see names that have not changed in well over 10 years.

You keep asking for "just one name" of someone that has been present for a prolonged time. I won't give a name, but I will provide some initials. Am I wrong, or has someone with the initials C.L. been involved for more than 5 years??? I have absolutely no problem what-so-ever with this doctor. But unless I'm wrong (and I may be), I believe he's been involved with the exam for greater than the 5 years you've mentioned.

And he's only one of several. I'm not accusing him of being one of the the good 'ol boys, but I believe some still exist. For the hundreth time, I am a strong proponent of the ABPS. However, during my involvement I watched certain members shut down residency programs that resulted in kids having no where to turn. In retrospect, I believe that with a little help/guidance and advice, these programs could have absolutely been turned around and saved. This would have kept these kids from losing their positions, and would have ultimately kept these programs viable for future graduates.

These are the types of actions I am/was referring to in my prior posts. These actions had no effect on me or my former residents, but as someone involved with the ABPS and residency training, I felt it could have been dealt with more constructively.

I also believe that there are many involved with the ABPS who have been involved for a LONG time who are invaluable. Doctors like M.P. from Connecticut in my opinion have always been fair and objective.

I can assure you that I'm not a "fraud", but once again, convincing you is not a primarily goal of mine. If you'd like to private message me via this forum, that would probably be the best way to continue this in an attempt to prevent a continued "argument" that has nothing to do with the original question.

Now let's end this, since we're obviously never going to agree.

Feli · Dec 13, 2009

Podfather said:
It's not the anatomy but what you do to it. Yes all PM&S-36 meet minimum MAVs but anyone knows they are not equal in the experience. Not better or worse different. AND all may sit for the RRA exams. The PM&S-24s can not sit because they do not meet MAVs for a PM&S-36. If all programs become 3 years then some may not meet the MAVs for a current PM&S-36 and not be eligible for RRA.

Hear, hear.

Numbers, variety, and (most of all IMO) the resident's level of involvement in the RRA cases are the difference makers.

Podfather · Dec 13, 2009

PADPM said:
You seem to have a great way at twisting words and commenting on your edited version.

Despite your statistics regarding the computer vs. the examiner based oral exam, I did NOT state that I knew of canditates that failed due to the new computer model.

I did state that because of my experience, I believed that there were candidates that MAY have failed in a computer based exam since there is no ability to interact and ask questions. So go back and read my post prior to your criticism of my statement.

You argue with me, than you bury you tail between your legs. You state that a board member can "only serve" 6 years, but can fill in if a board member leaves a position. That does happen and has happened.

Once again if you read my post, I clearly stated that there are MANY excellent, hard working members of the ABPS, but there are still a few docs holding back the ideas of the young blood. Yet you keep perseverating that I state that the ABPS is "filled" with good 'ol boys. That is NOT what I stated. I simply stated that there are still some that exist, period.

I will not stoop low enough to name the doctors you want me to name. You're not stupid. Take the time and look over the names on the exam committee and the actual examiners and you will clearly see names that have not changed in well over 10 years.

You keep asking for "just one name" of someone that has been present for a prolonged time. I won't give a name, but I will provide some initials. Am I wrong, or has someone with the initials C.L. been involved for more than 5 years??? I have absolutely no problem what-so-ever with this doctor. But unless I'm wrong (and I may be), I believe he's been involved with the exam for greater than the 5 years you've mentioned.

And he's only one of several. I'm not accusing him of being one of the the good 'ol boys, but I believe some still exist. For the hundreth time, I am a strong proponent of the ABPS. However, during my involvement I watched certain members shut down residency programs that resulted in kids having no where to turn. In retrospect, I believe that with a little help/guidance and advice, these programs could have absolutely been turned around and saved. This would have kept these kids from losing their positions, and would have ultimately kept these programs viable for future graduates.

These are the types of actions I am/was referring to in my prior posts. These actions had no effect on me or my former residents, but as someone involved with the ABPS and residency training, I felt it could have been dealt with more constructively.

I also believe that there are many involved with the ABPS who have been involved for a LONG time who are invaluable. Doctors like M.P. from Connecticut in my opinion have always been fair and objective.

I can assure you that I'm not a "fraud", but once again, convincing you is not a primarily goal of mine. If you'd like to private message me via this forum, that would probably be the best way to continue this in an attempt to prevent a continued "argument" that has nothing to do with the original question.

Now let's end this, since we're obviously never going to agree.

Now who is twisting things. C. L. is now an officer and is not on the exam committees. M.P.has been around for a while put is on neither the foot or RRA and you admitted that he is not a bad person. I can assure the young blood is not being held back and advancing quite nicely. The orals are loaded with new blood. The examiners should and do contain experienced people, however new ones are added annually. You have been the one who has implied that a few people control the ABPS and that is just not true. Again even if this were true, please once again answer the point you raised: The secret, hidden agenda. Please I would love to hear this conspiracy theory. Oh you probably can't say for fear of being whacked because you would revealing secrets you must of taken an oath to keep when you were on the inside. If you in fact were "on the inside" (such sexy prose) and you quit because you were tired of the politics then simply put you gave up/were a quitter. I tire of complainers who do nothing to fix what they perceive is bad, spout of hidden agendas, king makers, elitists and so on. Shut up or put up.

BTW if people closed residencies (not an ABPS function) could it be the program was bad? That is a CPME function and frankly is something that has not been done enough over the years. Historically bad programs harm the residents, patients, and the profession. Oh I forget you must have insider information of the CPME as well but can not tell us what that is either........

PADPM · Dec 13, 2009

I attempted to be civil, but apparently you don't have that ability.... in addition to having no reading comprehension.

I never said anything negative about M.P., all I did was compliment him. I wish more doctors would have his integrity and attitude, and less would have your obvious inability to comprehend, and simply sling insults.

Additionally, if you were careful reading my post, when discussing C.L., I even stated I MAY be wrong, since I'm not up to date on everyone's current position. At least I'm man enough to admit when I may be incorrect.

I am not a quitter, but simply decided to dedicate my energy and time to where I believed it would make a bigger difference. It was obvious that one person was not going to change the ABPS. I could no longer spend the time traveling, since some of my partners were not keen on the idea. Instead, I believe I helped improve one of the residency programs that was going to be in jeopardy due to lack of quality and numbers. I don't take full credit, so don't try slinging insults that I'm claiming to be a hero....I'm not. I simply recruited a lot of quality DPM's to help turn around the program, and now it's a quality program. As a result, a lot of kids had the opportunity to obtain a residency position and that will ultimately benefit them, the program and the patients they treat.

The programs that were shut down weren't "harming" anyone. Some of the programs were simply being run by DPM's that were not good administrators or docs that were overwhelmed by the paperwork involved. Some of the docs running the programs were less than ethical, though the programs were actually okay. If the directors were given some direction and/or replaced, the programs could have been saved with no harm to the public. The only individuals that were "victims" were the residents that were left with no program. I'm not advocating keeping low quality programs, I'm simply advocating programs that needed help and were shut down pre-maturely.

Sorry to disappoint you, but I have no working knowledge of the CPME. I don't know their "inner" workings, nor do I know their secret handshake.

Despite your consistent insults and inuendos, I have made no claims regarding any conspiracies, etc. I do however have a personal opinion based on my observations, that there are some doctors that don't agree with my philosophy and those doctors are hindering the ABPS. Those doctors are in the minority. That is simply my personal opinion, and it's obviously different than yours.

I know how and why I formed those opinions, whether you care to believe my past history or not.

There has unfortunately been distention in "our" profession and others that disagree with decisions made in our professional organizations. That's unfortunately one of the reasons some good people decided to leave the ACFAS and start the ASPS. I'm a member of the APMA and used to be active on several different levels, and I'm also a member of the ACFAS. However, in my opinion, some quality people left the ACFAS because they weren't happy with some decisions that were made.

There are good and "bad" (I don't mean bad in the true sense of the word) people in all organizations. There is no organization that is not affected, and that is exactly my point. The same reason some good people decided to leave the ACFAS (not simply the affiliation requirement with the APMA, but philopsophical differences) is/are the same reasons I decided to no longer be as active with the ABPS, in addition to my other time/committment restraints.

So, let's keep this civil for the sake of professionalism and the younger docs and simply agree to disagree.

I've been there and done that with the ABPS, and you're obviously STILL there and doing that with the ABPS. I hope you're one of the docs that's truly doing what's best for the profession and the new young guys that are better trained than most of the currently certified docs.

Podfather · Dec 13, 2009

PADPM said:
I attempted to be civil, but apparently you don't have that ability.... in addition to having no reading comprehension.

I never said anything negative about M.P., all I did was compliment him. I wish more doctors would have his integrity and attitude, and less would have your obvious inability to comprehend, and simply sling insults.

Additionally, if you were careful reading my post, when discussing C.L., I even stated I MAY be wrong, since I'm not up to date on everyone's current position. At least I'm man enough to admit when I may be incorrect.

You are correct, you and are not current so please limit your responses regarding any organizations.

I am not a quitter, but simply decided to dedicate my energy and time to where I believed it would make a bigger difference. It was obvious that one person was not going to change the ABPS. I could no longer spend the time traveling, since some of my partners were not keen on the idea. Instead, I believe I helped improve one of the residency programs that was going to be in jeopardy due to lack of quality and numbers. I don't take full credit, so don't try slinging insults that I'm claiming to be a hero....I'm not. I simply recruited a lot of quality DPM's to help turn around the program, and now it's a quality program. As a result, a lot of kids had the opportunity to obtain a residency position and that will ultimately benefit them, the program and the patients they treat.

Some do both but I respect you for teaching residents and improving post graduate education. I sincerely mean that.

The programs that were shut down weren't "harming" anyone.

Here I must disagree. It is extremely difficult to close an existing program. To be shut down a program, the programs didn't follow CPME guidelines and did not improve after I am positive multiple probations. If the hospital selected the wrong director and did not replace them then they are the problem. Not those who protect the profession by ensuring that residencies follow the rules and regs.

Some of the programs were simply being run by DPM's that were not good administrators or docs that were overwhelmed by the paperwork involved. Some of the docs running the programs were less than ethical, though the programs were actually okay. If the directors were given some direction and/or replaced, the programs could have been saved with no harm to the public. The only individuals that were "victims" were the residents that were left with no program. I'm not advocating keeping low quality programs, I'm simply advocating programs that needed help and were shut down pre-maturely.

Again if you were to check I will bet the programs had multiple chances to improve and come off probation. Yes the residents were victims but to allow bad programs to exist then each year residents are cheated and the public harmed.

Sorry to disappoint you, but I have no working knowledge of the CPME. I don't know their "inner" workings, nor do I know their secret handshake.

Too bad I had hope to learn it from you LOL.

Despite your consistent insults and inuendos, I have made no claims regarding any conspiracies, etc. I do however have a personal opinion based on my observations, that there are some doctors that don't agree with my philosophy and those doctors are hindering the ABPS. Those doctors are in the minority. That is simply my personal opinion, and it's obviously different than yours.

You said hidden agenda not me. That is different than differences in opinion.

I know how and why I formed those opinions, whether you care to believe my past history or not.

Your past history if you were truly involved is positive. It is your rhetoric I take issue with. Students and residents need to know that ABPS is truly one of the organizations that keeps the profession respectable. They have standards that let the public know the profession is legit. ABPS is the only organization that truly certifies individuals in lower extremity surgery. The orthopedists have no such organizations.

There has unfortunately been distention in "our" profession and others that disagree with decisions made in our professional organizations. That's unfortunately one of the reasons some good people decided to leave the ACFAS and start the ASPS.

Last I checked less than 300 joined ASPS. So I guess they are the Spartans and those of us who stayed with ACFAS respect what they represent. If the APMA is such an asset ( I am a member and agree with the majority of what they do) then why mandate membership to be in ACFAS?

I'm a member of the APMA and used to be active on several different levels, and I'm also a member of the ACFAS. However, in my opinion, some quality people left the ACFAS because they weren't happy with some decisions that were made.

Quality people please define and name. The thousands that stayed were not quality?

There are good and "bad" (I don't mean bad in the true sense of the word) people in all organizations. There is no organization that is not affected, and that is exactly my point. The same reason some good people decided to leave the ACFAS (not simply the affiliation requirement with the APMA, but philopsophical differences) is/are the same reasons I decided to no longer be as active with the ABPS, in addition to my other time/committment restraints.

So, let's keep this civil for the sake of professionalism and the younger docs and simply agree to disagree.

I will be civil but when the rhetoric implies exclusion, elitism, or worse, I will call you and anyone else out.

I've been there and done that with the ABPS, and you're obviously STILL there and doing that with the ABPS. I hope you're one of the docs that's truly doing what's best for the profession and the new young guys that are better trained than most of the currently certified docs.

I am. The problem is some claim the older docs are holding some back but we are the ones who train the "better trained" young guys. As one of the guys who have fought everyday for the profession, train the future, lose time from our families to help, and bring in new people to take the profession to the next level all we ask is not to be blamed for the residual weaknesses we are working to correct.

PADPM · Dec 14, 2009

I'm glad our conversation seems to have turned to a civil discussion.

You stated that the ABPS is important in maintaining standards and to let the public know the profession is legit, etc. I could not agree with you more. If you check some of my prior posts, I have discussed that issue and have defended the ABPS on that many times. That's why when I flip through "magazines" like Podiatry Managment, etc., and see articles for the "other" podiatric boards that certify in surgery it turns my stomach.

Nothing angers me more than when I see an ad in a paper, yellow page, etc. and it states "board certified in surgery", and I KNOW that doctor is not ABPS certified. Who knows what "standards" these other boards require??

I think you may have misinterpreted my comments about the ACFAS and ASPS. Remember, I am STILL a Fellow of the ACFAS and a member of the APMA, though I agree that you should not have to be a member of the APMA to be a member of the ACFAS.

Additionally, simply because I commented that some quality people left and went to the ASPS does not mean that the thousands that stayed are not quality people!! After all......I STAYED, and I'd like to at least think I'm one of the quality people!

Once again, I'm not going to name some of the people that went to the ASPS, but in my opinion, there are some good, ethical doctors that left. I believe they THINK they were doing the right thing. I also think some left because they are opportunists and thought it was a great time to get in on the "ground floor" and make a name for himself/herself.

However, from what I understand, and what you've confirmed, only about 300 docs are members. Additionally, when I visited their website, they really don't seem to be accomplishing anything. It doesn't appear that the ACFAS has much to be concerned about. The few doctors I know that joined up have no intentions of renewing next year.

I understand your last paragraph very well. I dedicated a lot of my time flying to meetings, going to Chicago and served on at an ACFAS committee which also required flying to meetings. I have been involved with resident training and even started a residency program, and you know the time and paperwork involved with that process. Although residency directors often collect a "stipend" in some programs, I always donated my "stipend" back to the program or profession and never gained one penny from the time I have volunteered. In reality, I've probably lost way too much money in the process. My partners aren't so open minded and unfortunately it has caused significant distention at times.

If you also go back and read some of my prior posts, I get pretty angry when some of the young bucks make fun of the "old guys" at the meetings that are sleeping in the back. I always defend these "old guys", because you never know if one of those "old guys" was the one that opened the doors in a particular hospital to allow one of the young bucks to now apply ex-fixators and perform rearfoot reconstructive procedures.

I'm certainly by no means "old", but when I first applied to a local hospital 15 years ago my privilege list consisted of "nails, warts, hammertoes and simple bunion repair". I fought hard (against the wishes of the current podiatrists on staff) and battled the orthopedic surgeon. I challenged HIM to see HIS case log to see the foot/ankle surgeries HE performed.

Within six months of my battle I was able to perform basically any procedure I wanted, once I performed 2-3 in front of the orthopod and chief of podiatry (even though he didn't know what he was watching).

Now the DPM's on staff basically have no restrictions, as long as they can prove they have the training.

So I will NEVER tolerate the young docs busting the stones of the "old docs" who laid the foundation for the privileges they enjoy today.

Apparently, we agree on more than we thought.

Podfather · Dec 15, 2009

whiskers said:
Sorry, but I don't worship at the feet of the old guys. .

I don't give BS a free pass regardless of how I should respect the "old guys."

Sure they are the reason the profession advanced, but they are also equally responsible for the profession being held back.

They are the reason the profession advanced AND they are responsible for holding back? That is like saying he saved my life but killed me.

IMO, the profession without their input would have advanced further.

I would disagree. Without these indivuduals efforts in the 70s, 80s, and 90s, we would still be fighting for hospital access, inclusion in insurance plans, enhanced scope, and residency positions. The batlles they fought were often brutal. Imagine being the only DPM in a room with 10 hostile orthopedists in the 80s. They wrote letters, attended meetings, requested appeals, sat before hospital boards, went to court, and were forced to take their patients across town to perhaps the only hospital that would permit DPMs privileges. While they did this they couldn't build their practices, lost time with family, and spent money out of their own pockets. I met one hero when I was a resident in the mid 80s who had been arrested in the 60s for writing a prescription for of all things Neosporin-G cream (required an Rx then). He was charged with practicing medicine without a license. Courage that requires a thank you. In addition, many of these people are the ones who trained/train today's leaders. They lengthened training from 1 to 2 to 3 years even with the risk of their own graduates running around saying they were better than their mentors and then excluding from hospital staffs and writing exclusions in state law.

As a matter of fact, it probably would be a MD degree by now with equal opportunities for all instead of some BS sill rearfoot and forefoot chicanery that's going on now under the auspice of the esteemed old guys who are always above the curve of change and are grandfathered in for their efforts.

MD degrees exist now for DPMs. It requires that you go to medical school. No one was grandfathered. The Foot and Ankle people sat for the only exam available. They submitted cases, studied, paid the fees, and had the stress of written and orals. They do self assess but this was the deal they agreed to. If your premise is true and in say 10 years all DPMs get a MD or DO degree how would you like it if these grads claimed only they were qualified to do surgery? They claimed that you were grandfathered. That only MD/DPMs should be board certified. Would you go back to medical school??

Sorry if this offends.

None taken. Do not forget history. Also let's be clear some of these 50 and 60 year old DPMs perform advanced surgical techniques weekly and have done them for decades. They are current and teach 20 somethings as residents. They are vital to the profession. Here is where medicine may be more mature. Many 50 year old orthopedists are considered at the top of their game. Even if some of the younger orthopedists feel they may have better training I rarely hear them say it in public.

hyperpodia · Dec 16, 2009

I was looking at the CPME draft document at their website and the good news is that if the draft becomes the rule
the new PM&S 36 will have better training than the old 24 month residencies
The required [FONT=Verdana, Arial, Helvetica, sans-serif]COPME MAV are higher for the new PM&S 36 than currently for 24 months. The difference is that the old PM&S 36 required [FONT=Verdana, Arial, Helvetica, sans-serif]Reconstructive rearfoot and ankle procedures but the new PM&S 36 does not. So it is still better training except no RRA procedures..
.

Brodiatrist · Dec 16, 2009

hyperpodia said:
I was looking at the CPME draft document at their website and the good news is that if the draft becomes the rule
the new PM&S 36 will have better training than the old 24 month residencies
The required [FONT=Verdana, Arial, Helvetica, sans-serif]COPME MAV are higher for the new PM&S 36 than currently for 24 months.The difference is that the old PM&S 36 required [FONT=Verdana, Arial, Helvetica, sans-serif]Reconstructive rearfoot and ankle procedures but the new PM&S 36 does not. So it is still better training except no RRA procedures...[FONT=Verdana, Arial, Helvetica, sans-serif]
.

Ok, so if residents meet the new MAV at those new programs, how do they know if they're RRA eligible if the new draft has no RRA requirements? Or are the residents of these programs automatically excluded regardless of how many cases they do?

cool_vkb · Dec 16, 2009

hyperpodia said:
I was looking at the CPME draft document at their website and the good news is that if the draft becomes the rule
the new PM&S 36 will have better training than the old 24 month residencies
The required [FONT=Verdana, Arial, Helvetica, sans-serif]COPME MAV are higher for the new PM&S 36 than currently for 24 months. The difference is that the old PM&S 36 required [FONT=Verdana, Arial, Helvetica, sans-serif]Reconstructive rearfoot and ankle procedures but the new PM&S 36 does not. So it is still better training except no RRA procedures..
.

Its obvious it will be. Its 1 extra year.

All 2yr residencies will now be 3yr but still wont qualify for Rearfoot

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