Forum Members ABFAS/ABPM

[newpodgrad]

Hey guys

While looking for jobs , I inquired with a few local hospitals about how to go about getting privileges.

Several of them sent me info and I wanted to highlight a board concern.

Not sure how to really take it, but here’s a excerpt from one of the docs re: board status.

“Board Certification Requirement means certification from one of the following boards: the American Board of Medical Specialties, the American Osteopathic Association, the American Board of Foot and Ankle Surgery, or those Boards which may be approved by the Executive Committee to satisfy this Requirement”

As a disclaimer, I’m not a HUGE surgery pod. I enjoyed it , and did it in residency because, well, that’s what we had to do. And I’m fine with my forefoot procedures. I believe I’ve done well with them at my current level. I don’t care to do TARS, scopes mid foot fusions etc. I have no problem referring them out. I took the ABFAS qualifying tests etc, because again, it’s encouraged in residency and passed them.

Looking at this doc, it almost seems like this board required if you wanted to be on staff. The little statement at the end regarding “or those boards” seems like it might open the door for ABPM with some petitioning or something.

What do you guys make of this? I have heard from others that ABPM will get involved with issues regarding privileges etc. Is there more to this picture than meets the eye?

Thanks in advance for everyone’s take

---

Members don't see this ad.

 

[Feli]

I guess it depends on your goals. Are you trying to get on staff or get OR privileges?
ABPM qual/cert is a recognized board and should get DPMs on staff (consults/office or wound center)... it will not get you any F&A surgical privileges at most competitive places.

Here is one I got from a NMexico hospital today:
"...Second, you requested privileges for rearfoot procedures. It was noted that your board certification in RRA (reconstructive rearfoot/ankle) surgery expired in August 2019. How do you wish to support that request?

Our office and the Credentials Committee look forward to your reply.

Sincerely,..."

(I am probably one of only 4 or 5 DPMs who are RRA qual/cert and doing those cases in the metro out of dozens who are practicing... told the hospital I re-qualified in RRA and had not sent it in, I do those cases, training logs, practice logs, blah blah)

...the bottom line is that every place makes its own rules. Some are very lax and others are tough. The point is that It is always better to get as many certs as you can give them no reason to reject you.

You could get ABPM involved if you just want to be on staff there. If you want to bring surgery there without ABFAS qual/cert, you are unlikely to achieve that. ABFAS qual and cert are meant to be treated equally for privileging... just apply and send them your board qual letters and maybe the ACFAS and ABFAS privileging docs if you have ABFAS Foot (or Foot + RRA) qual. I have never seen a facility where you can't get OR with ABFAS qual (although many make you get cert within 5-7yrs to keep privi).

 

[newpodgrad]

So the hospital is definitely is a more rural area. Only maybe 10 pods in the whole city. I wonder if that makes a difference when there’s a need

 

[PeaJay]

If there are 10 pods, that is not rural… I work rural and they still want ABFAS. Although they would probably take ABPM after being notified of legal ramifications. I wouldn’t be keen on making that change though as rural communities are tight knit and you do not want to be causing a commotion day 1.

 

[heybrother]

Rural means different things to different people. The real question probably is - are you underserved. 5-10 minutes in any direction from my town is straight agriculture and to a New Yorker I'd be on the edge of the earth - but we're not underserved. We have fewer podiatrists than you, but a Costco and at one point 4 foot and ankle orthos. To an east coaster Des Moines is god forsaken boonies rural agriculture but its a city. A friend of mine practices in an area where the next podiatrist is 30 miles away and he has to refer all vascular cases 2.5 hours up the road. Another poster here I believe has to refer people like 6 hours away if they have something that can't be managed.

 

[Feli]

... I took the ABFAS qualifying tests etc, because again, it’s encouraged in residency and passed them...

I'm still not understanding this part.^

If you passed ABFAS (qual) then you have that status 7 years from that time. ABFAS qual should be treated just like cert for hospitals - although it won't last forever like cert can. That should get you on wherever you want, and then you can get ABFAS cert, or you could hope they let you keep surgery privileges with ABPM if you can't pass cert. Either way, for now, you're able to get on for 5+ years with ABFAS qual at most hospitals.

ABPM cert would be useful for some insurances that don't understand our boards (most of them) and for hospital staff apps. ABFAS is the one that is usually needed for surgery privileges. That's good advice about not making waves unless you have no other choice (eg, they won't let you on staff for consults/wounds despite ABPM).

 

[dtrack22]

Rural means you either dont have a hospital in town or the one you have is critical access. No “rural” community can sustain more than 2 podiatrists, let alone 10.

That being said my rural hospital only required ABPM. I’m still not ABFAS cert though now that I have enough cases for them to pull only from my current job, I’ll submit next Dec.

 

[PeaJay]

Rural means different things to different people.

I agree. It can mean different things, however that does not make it wrong. You need an patient population of several hundred thousand to sustain 10 pods. That is far from rural.

Living in a megalopolis may warp perspectives, but doesn’t change the definition. I live in a rich area and that in no way makes a middle class neighborhood poor.

 

[heybrother]

I agree. It can mean different things, however that does not make it wrong. You need an patient population of several hundred thousand to sustain 10 pods. That is far from rural.

Living in a megalopolis may warp perspectives, but doesn’t change the definition. I live in a rich area and that in no way makes a middle class neighborhood poor.

No disagreement. I'm more so simply commenting on people who are outside the situation not really understanding it. Like a pre-pod looking at a map and saying - well I'll just move to Omaha because its rural and they'll need me. 100% agree - 10 podiatrists is a bunch.

 

[DYK343]

Here we go again....

Get ABFAS. Its less headache throughout your long career.

 

[Shadowfax12]

how many pods in the country have rearfoot and forefoot abfas

 

[newpodgrad]

Yeah after reading these threads I’m going to have to.

But in all honesty, if one doesn’t, because the time has lapsed, then what? If you’re qualified , have cases etc. You can only do so many retakes.

Worst case scenario , what happens then?

 

[DYK343]

Yeah after reading these threads I’m going to have to.

But in all honesty, if one doesn’t, because the time has lapsed, then what? If you’re qualified , have cases etc. You can only do so many retakes.

Worst case scenario , what happens then?

...youre not ABFAS certified.
Dont pass in 10 years you will never be able to sit for exam again.

 

[Feli]

Yeah after reading these threads I’m going to have to.

But in all honesty, if one doesn’t, because the time has lapsed, then what? If you’re qualified , have cases etc. You can only do so many retakes.

Worst case scenario , what happens then?

I thought you were a resident from your name/posts...

You get 7 years on ABFAS board qual if you graduated 2014 and after. Before that, grads could qualify for another 7yrs (but you'd still lose surgical privileges at some places if their bylaws said you have to be board cert within 5 or 7 or whatever years). In exchange, unless they got board cert pretty quick, those pre-2014 grads (and a few after them) also get the joys of re-taking CBPS they've already passed, and their in-training exams didn't count for anything... as it now counts for part of the board qual. Every group has their struggles, lol.

If your qualification is expired very recently, I'd talk to ABFAS and see what they say. If you are still qualified, keep working on cases. If you (or anyone) has enough cases, sit for cert CBPS and cases at least a year early so you have a re-take available. I'm sure they have a ton of BQ people who don't quite have enough cases, failed the cert exam, or failed the cert cases... yet they still want to get certified. Call them up. You don't know until you try.

https://www.abfas.org/docs/default-source/abfas-documents/bcdoc.pdf?sfvrsn=bd0d35f1_40

I have a feeling they will change the requirements (longer qual window to get cert, less cases/diversity, etc). They obviously model a lot off AAOS boards (5yr limit of board qual). I believe ABS general surgeons just do a written board qual and then oral board cert (can't exactly try to judge their cases without xrays... what are they going to do, video tape knots and dissections?).

how many pods in the country have rearfoot and forefoot abfas

I don't think they publish this. It is tough to say, especially since it was just Foot and Ankle until 30 years ago. I don't know when the Foot vs RRA cert thing started; I'm sure that's easy to find out but I didn't see it. It is really tough to get apples-to-apples comparison when our residencies and boards seem to change every decade or less. Nobody obviously remembers what a PSR-12 or a RPR was, but they were a thing at one time.

ACFAS website says they have over 7500 members... but they have many who aren't ABFAS cert (students, residents, ABFAS qualified, international, retired, grandfathered in, etc). Also, obviously not everyone who is ABFAS cert joins ACFAS.

I believe ABFAS said they have about that many people certified also since they formed also (can't find it)... but many are still grandfathered in 'Foot and Ankle Surgery' pre-1991 model, so they wouldn't hold RRA since it was a different model. Some are obviously deceased, retired, etc.

We do know there are something like 18k podiatrists in USA with ~15k practicing...
It's hard to say... I'd guess roughly two thirds of the DPMs do or did get ABFAS qual (10k) fresh out of residency, half of all DPMs (2/3 who got qual) probably go on to pass ABFAS Foot cert (~7k), and maybe a third of that 7k get get RRA also (2.5-3k?). Don't take it as gospel, but I would imagine I'm in the neighborhood... 2-3k of DPMs, so only roughly 10-20% of those practicing are RRA cert (and probably at least that many RRA qual with potential to get to RRA cert also) and maybe about half of DPMs are ABFAS Foot cert or otherwise grandfathered by doing whatever the reqs were in their day.

It would be something like this: 18k-20k USA pods > 15k practicing > 7.5k ABFAS Foot or F&A > 2.5k RRA ABFAS

If anyone who works with APMA or one of the board has real stats, that'd be good, but I don't think they are readily available.

 

[newpodgrad]

10? I though 7???

 

[DYK343]

10? I though 7???

Yeah I think I was wrong.

 

[Shiyuan]

ABLES / ABMSP will always welcome you with open arms...

 

[newpodgrad]

ABLES / ABMSP will always welcome you with open arms...

Lol jokes apart

What does one do in that situation

 

[icebreaker32]

Lol jokes apart

What does one do in that situati

If one can not become board certified by ABFAS then they should become board certified by ABPM. If one can not become board certified at all then being board certified by ABMSP or ABLES is an option that may or may not be of any help for getting privileges and on insurance panels etc compared to no boards at all. For many at that point it becomes mainly a marketing thing.

I highly advise that everyone becomes board certified by ABFAS, but I do know of some even fairly young, doing well that could never pass the exam. Many in this situation are even on staff at respected hospitals.

If bylaws change you pray you are grandfathered in and hope insurance plans that you are on don’t kick you off. In reality these things rarely happen, but they could. Some parts of the country are stricter than others.

Also getting and keeping you first job may depend on board certification.

You are not fooling most with these alternative boards. In certain situations it may help with privileges and insurance plans. You might fool some as even ABFAS and ABPM are not part of ABMS like most MD specialties. Most people still don’t fully understand our profession. Having two accepted boards for such a small profession neither part of ABMS and also having the other boards does make it confusing. Those outside of our profession and credentialing rarely know anything at all. For most it is probably a marketing thing to get these alternative boards,

 

[newpodgrad]

So this one leaves it a bit vague . What do y’all think?

Requirements for Podiatric surgeons for surgical privileges include: graduation from an accredited podiatry college and achievement of specialty board certification, or admissibility to sit for certification exam, or successful completion of a minimum of two years podiatric surgical residency (PSR-24) program approved by the Council of Podiatric Medical Education

 

[icebreaker32]

So this one leaves it a bit vague . What do y’all think?

Requirements for Podiatric surgeons for surgical privileges include: graduation from an accredited podiatry college and achievement of specialty board certification, or admissibility to sit for certification exam, or successful completion of a minimum of two years podiatric surgical residency (PSR-24) program approved by the Council of Podiatric Medical Education

Sounds to me board certified by ABFAS and possibly ABPM is good enough…..maybe you could try with other boards, but doubt it.

Sound like being board qualified is good enough.

Sounds like regardless of all the above completion of a 2 year surgical residency or any of the newer 3 year surgical residences is all you need and you don’t even need to be board certified or qualified If you completed the right residency.

If questions you can ask the credentialing committee.

2 year surgical residencies were once uncommon at one point, but there were still paths to board certification with a one year residency. Probably just a preceptorship and cases were required at one point, but those podiatrists are aging out. These bylaws seem like they were made over 15 years ago, but still seem fair to me. They need to update the residency lingo and should probably be more specific on boards.

That is what I am telling you it really depends on your area and if someone else (often a podiatrist) is trying to screw you.

I know of podiatrists not board certified that could not pass boards, but well trained and are on staff at the best local hospitals and surgery centers. I know of others in the same situation that can not get on staff at any legit hospital in their area.

 

[JewOnThis]

If you can’t get boarded by abfas in 3 of years of practice then you probably won’t get boarded by abfas.

 

[air bud]

Sounds to me board certified by ABFAS and possibly ABPM is good enough…..maybe you could try with other boards, but doubt it.

Sound like being board qualified is good enough.

Sounds like regardless of all the above completion of a 2 year surgical residency or any of the newer 3 year surgical residences is all you need and you don’t even need to be board certified or qualified If you completed the right residency.

If questions you can ask the credentialing committee.

2 year surgical residencies were once uncommon at one point, but there were still paths to board certification with a one year residency. Probably just a preceptorship and cases were required at one point, but those podiatrists are aging out. These bylaws seem like they were made over 15 years ago, but still seem fair to me. They need to update the residency lingo and should probably be more specific on boards.

That is what I am telling you it really depends on your area and if someone else (often a podiatrist) is trying to screw you.

I know of podiatrists not board certified that could not pass boards, but well trained and are on staff at the best local hospitals and surgery centers. I know of others in the same situation that can not get on staff at any legit hospital in their area.

As a board certified podiatrist (foot/rra) you bet your ass I am doing what I have to in order to keep a non certified pod 7 plus years out (qualified didn't get certified) from doing surgery at a hospital I go to.

 

[GreenHousePub]

As a board certified podiatrist (foot/rra) you bet your ass I am doing what I have to in order to keep a non certified pod 7 plus years out (qualified didn't get certified) from doing surgery at a hospital I go to.

Was this serious?

 

[Scrantonicity]

Was this serious?

Yeah, just don't let Dr Nobody know.

 

[air bud]

Was this serious?

Yes. If you are 3 year trained and got qaulifed and want to do surgery....get certified. The older dudes who got grandfathered in....gray area and if history sure fine. But if you are young and never got certified in the gold standard (ABFAS) in surgery (albeit not perfect) ....in then don't do surgery. Get abpm if you need to be boarded for insurance purposes.

Getting foot certified is not asking that much.

Edit - When ABPM starts teaching surgery courses and having surgical lectures and other surgical stuff then I am fine accepting that for hospital surgery privileges. See the common word there? Surgery. That said, there is much more to podiatry than just surgery. Not everyone has to do it. But don't ask to do surgery if you don't have the proper surgical training. As far as I know you can get hospital privileges without surgery just to see in inpatients.

 

[CutsWithFury]

What’s even more vague is that some get foot certified and never RRA because they couldn’t. Then they go to the hospital and say they are certified and then they are allowed to do ankle work. I’ve seen that.

 

[air bud]

so to the OP, completely ok and respectable to focus on forefoot surgery. ABFAS has a forefoot surgery certification, so get that. Better question - would you want your mother having forefoot surgery done by somebody with certification? Or are you just trying to rationalize things to make things easier for you and your own personal sitiuation?

 

[newpodgrad]

First off, I’ll work on getting the cert.

Secondly and more importantly, board certification , especially in podiatry, doesn’t dictate who’s a good surgeon and who isn’t. Not all podiatry residencies are the same. Some have thriving numbers and others have residents that retract and log the case as “first assist” and magically graduate into attendings.

Like I mentioned in my original post I was and am fortunate to have actually done cases, so I’m comfortable with my skill set.

Others might not have had the same training but yet are able to get by the boards and some how generate cases. I know people who get jobs with a parent that’s also a podiatrist and somehow these guys get boarded pretty quick. Kinda suspicious , no?

I would base my decisions on who can actually do cases and who does cases routinely. You can have a abfas cert dude that’s “certified” but does 1 case every other month.

Would you be comfortable with a surgeon like that operating on a loved one based on the letters after their name?

 

[air bud]

I understand board cert doesn't make you a good surgeon. But it does establish a baseline of competency. I don't even know the numbers of cases needed now, but it's low. So do your forefoot cases, do a good job, do the paperwork and get board certified. It's not that much money, it's good for you, it's good for the profession. Willing to die on this hill.

And nobody is sneaking through board certification. They did the cases and submitted them.

 

[Feli]

so to the OP, completely ok and respectable to focus on forefoot surgery. ABFAS has a forefoot surgery certification, so get that. Better question - would you want your mother having forefoot surgery done by somebody with certification? Or are you just trying to rationalize things to make things easier for you and your own personal situation?

Waydumminit. What if my mom's surgeon just has naturally good hands... played a lot of video games and did a lot of sewing and stuff?

Maybe they don't have time to take boards. Just because MDs have boards doesn't mean DPMs should. We're different. Maybe they are awesome surgeons yet too busy to study or too busy to keep track of their cases and learn from that process. What about DPMs that have a YouTube or a TV reality show, so we already know they're highest quality?

People like that don't need to actually pass tests on surgery indications or produce xrays that they can reduce IM angles, choose appropriate fixation, reduce fractures, or achieve fusions. They should just be allowed to fix cavus and TARs and whatever they say they can fix wherever they want. I would trust them operating on my family twice on Sundays.... but I guess ORs aren't doing cases that day.

...Getting foot certified is not asking that much...

No, definitely not. 65 (?) foot cases over the ~5yrs out of residency is only about one procedure per month (and then even a couple re-takes if needed). Sometimes the procedures come many in a single case, so it is not impossible by any stretch. It helps not to job-hop, but it can definitely be done by the vast majority of DPMs.

 

[newpodgrad]

I understand board cert doesn't make you a good surgeon. But it does establish a baseline of competency. I don't even know the numbers of cases needed now, but it's low. So do your forefoot cases, do a good job, do the paperwork and get board certified. It's not that much money, it's good for you, it's good for the profession. Willing to die on this hill.

And nobody is sneaking through board certification. They did the cases and submitted them.

No one is saying people are sneaking by. But it’s definitely advantageous to have cases given to you to meet the number requirements.

Also, starting off solo from scratch ? Where are you even getting patients from, let alone cases??

Puts a lot of pressure on new grads to find a job that not only will pay bills but will also provide patients that can generate into cases..which now have to fall under the “diversity” requirements of abfas aka not too many Austin’s but we need some z osteotomies, Kalish ludloff mau etc

 

[air bud]

No one is saying people are sneaking by. But it’s definitely advantageous to have cases given to you to meet the number requirements.

Also, starting off solo from scratch ? Where are you even getting patients from, let alone cases??

Puts a lot of pressure on new grads to find a job that not only will pay bills but will also provide patients that can generate into cases..which now have to fall under the “diversity” requirements of abfas aka not too many Austin’s but we need some z osteotomies, Kalish ludloff mau etc

7 years. I think you can find enough cases in 7 years. 5 years out and not certified? Whatever you still have time. But 7 years. If you don't have enough cases in 7 years even solo, new etc...then that is a you problem. If you have a pulse, know how to talk to patients and are trained well enough to recognize pathology that requires surgery...then you can get cases. If you are trying to set up shop in an over populated area because your family is from there, your wife works nearby, you like the schools...again that is a you problem.

Okay, I misinterpreted that I thought you were saying people were having other people do cases for them and they were just putting their name on it


And what new grad thinks kalish, ludloff and mau osteotomies are a thing??

 

[CutsWithFury]

First off, I’ll work on getting the cert.

Secondly and more importantly, board certification , especially in podiatry, doesn’t dictate who’s a good surgeon and who isn’t. Not all podiatry residencies are the same. Some have thriving numbers and others have residents that retract and log the case as “first assist” and magically graduate into attendings.

Like I mentioned in my original post I was and am fortunate to have actually done cases, so I’m comfortable with my skill set.

Others might not have had the same training but yet are able to get by the boards and some how generate cases. I know people who get jobs with a parent that’s also a podiatrist and somehow these guys get boarded pretty quick. Kinda suspicious , no?

I would base my decisions on who can actually do cases and who does cases routinely. You can have a abfas cert dude that’s “certified” but does 1 case every other month.

Would you be comfortable with a surgeon like that operating on a loved one based on the letters after their name?

Disagree with this thought process completely. Board certification is a standard everyone should strive to get. ABPM cert is just a test. They don't ask for logs. ABFAS sets minimum amount of cases per category you have to meet to sit for the exam.

If you look at the numbers needed to meet ABFAS criteria to sit for the exam the cut offs are LAUGHABLE. If you can't get those numbers then you don't do enough surgery and if you don't enough surgery you can't be or become a good surgeon.

Being a big time surgeon who is only certified by the ABPM doesn't even make sense. How can you even determine someone with only ABPM is a good surgeon? You can't because they have no official case logs you can refer to. ABFAS at least makes you log and you can use this information to show competency and experience.

Just get board certified by ABFAS. It is not a great system but it is the best we have.

 

[Feli]

...now have to fall under the “diversity” requirements of abfas aka not too many Austin’s but we need some z osteotomies, Kalish ludloff mau etc

Your other thread says you are a graduating resident, so you have plenty of time if you're now ABFAS qual. It is a reasonable process. I do basically nothing first ray but Lapidus, Austin, MPJ1 fusions, cheilectomy, amps for that category... I met diversity. You can log a first met head resect for osteo as amp or mgmt bone/joint infection first ray. An Austin with a bit of bone spurs can be joint salvage osteotomy. It is not very hard at all. You don't need MPJ implants (100% stupid) or midshaft/base osteotomies (99% stupid these days with how fast Lapidus can walk and heal and the long term IM correction/revision research ). Diversity reqs below are very reasonable; that's not an excuse.

-ABFAS volume/diversity is a bit harder if you go solo and start with nothing, but you will get enough for Foot - perhaps RRA - in 7yrs (but try to sit after 5 or 6yrs so you have safety nets available). Remember that, just like PPR resident logs, a patient undergoing bunion, 2 weil, 3 hammertoes is 6 procedures towards your 65 for Foot reqs... not one.
-It gets a little tricky if you job-hop (I would suggest screen-shot your XRs and notes if you know you'll be leaving a job instead of counting on them to help you years later when you sit ABFAS... I did both methods and former is a ton easier, past jobs have ZERO reason to help you and basically consider it a HIPAA risk and time waste to send you records and XRs).
-I will fully admit I screwed up getting ABFAS in a timely manner due to job-hopping (job I did the most surgery at in my first 3-4yrs out of training didn't even have digital XR... no prayer of ever tracking those down!). If I could go back, I might have just ridden out my first job or some hospital job to get the cases and get it done; which is what many of my classmates who got their ABFAS done sooner did (stayed until board cert, even if they didn't like the job).
-RRA ABFAS case numbers/diversity are quite a bit harder to get than ABFAS Foot in typical podiatry PP or solo, but it is possible and depends on area referral patterns and how your practice markets... also depend if other in your PP group will feed you RRA or whether they do it themselves. That RRA volume's significantly easier to find and do in most hospital/MSG/ortho setups, though. I know some who have achieved the ABFAS volume in a year or two for both Foot and RRA (but had to wait until 2nd year out to apply when they have enough surplus of cases and follow-up).

"

PLS Logging Requirements​

Foot Surgery Certification​

• Must log a minimum of 65 cases in Podiatry Logging Service (PLS) for eligibility.
• Must include a minimum of 30 cases, from the First Ray, Other Osseous, and Reconstructive Rearfoot/Ankle categories listed in Appendix A (see below)...

...Each category in “italics” has an allowable maximum of 2 of the 30 required cases.
Each category in “non-italics” has an allowable maximum of 15 of the 30 required cases.

Hallux Valgus Surgery

2.1.3 bunionectomy with phalangeal osteotomy
2.1.4 bunionectomy with distal first metatarsal osteotomy
2.1.5 bunionectomy with first metatarsal base or shaft osteotomy
2.1.6 bunionectomy with first metatarsocuneiform fusion
2.1.7 MTPJ fusion
2.1.8 MTPJ implant
2.1.10 bunionectomy with double correction with osteotomy and/or arthrodesis

Hallux Limitus Surgery

2.2.1 cheilectomy
2.2.2 joint salvage with phalangeal osteotomy (Kessel- Bonney, enclavement)
2.2.3 joint salvage with distal metatarsal osteotomy
2.2.4 joint salvage with first metatarsal shaft or base osteotomy
2.2.5 joint salvage with first metatarsocuneiform fusion
2.2.6 MTPJ fusion
2.2.7 MTPJ implant

Other First Ray Surgery

2.3.2 osteotomy (e.g., dorsiflexory)
2.3.3 metatarsocuneiform fusion (other than for hallux valgus or hallux limitus)
2.3.4 amputation
2.3.5 management of osseous tumor/neoplasm (with or without bone graft)
2.3.6 management of bone/joint infection (with or without bone graft)
2.3.7 open management of fracture or MTPJ dislocation with fixation
2.3.8 corticotomy with callus distraction"

 

[DYK343]

Like I said above. Its really not that hard and just get ABFAS. It will make your long career much easier.

 

[Pronation]

not too many Austin’s but we need some z osteotomies, Kalish ludloff mau etc

Fail.

 

[GreenHousePub]

Yes. If you are 3 year trained and got qaulifed and want to do surgery....get certified. The older dudes who got grandfathered in....gray area and if history sure fine. But if you are young and never got certified in the gold standard (ABFAS) in surgery (albeit not perfect) ....in then don't do surgery. Get abpm if you need to be boarded for insurance purposes.

Getting foot certified is not asking that much.

Edit - When ABPM starts teaching surgery courses and having surgical lectures and other surgical stuff then I am fine accepting that for hospital surgery privileges. See the common word there? Surgery. That said, there is much more to podiatry than just surgery. Not everyone has to do it. But don't ask to do surgery if you don't have the proper surgical training. As far as I know you can get hospital privileges without surgery just to see in inpatients.

Literally becoming a stereotype. "The only people who will want to restrict your privileges at a hospital will be other podiatrists"

 

[Feli]

Literally becoming a stereotype. "The only people who will want to restrict your privileges at a hospital will be other podiatrists"

This is the way it is for every profession... health care or otherwise. The professions largely regulate themselves.

The state nursing licensing in each state and their national board exams are by RNs (with a few consultants). The hospital director of nursing is RN, charge nurses who interview and approve hires are RNs, etc. Electrical contractors... attorneys... realtors... architects... the list is endless. They all self-regulate with some additional oversight or community members on the state boards also. Podiatry, like all the rest, does the same: "a jury of your peers."

It is natural for hospitals to get their guidelines for credentialing and privileging general surgeons from general surgeons, hospitalists from hospitalists, DPMs from DPMs, orthos from orthos. At bare minimum, the current med staff of same specialty as the applicant are consulted for any help on the applications or appropriate scope. Sometimes, if they don't have that same type of doc, they use the closest thing (gen surgeon to credential a vasc surgeon, internal med to credential a rheum or ICU doc, etc).

What would you propose as an alternative? Nobody says the current standards are perfect, but I sure don't have a better solution than to have basic competency board exams and largely parallel ortho and gen surg boards and privileging norms. Likewise, we almost invariably see any hospital CMO or chief of surg to consult with a chief of pod or reliable staff DPMs when updating bylaws or when new DPMs apply.

It would be pretty weird if cardiologist privileges were limited by ENTs or OBs or OMFS... if the new neurosurgeon was judged by ER and podiatry docs or the CRNAs. It would be even worse - and highly dangerous - if every doc just got whatever privileges they signed up for with no oversight at all (yet that's exactly what you see as some ASCs, small for-profit hospitals, and some govt hospitals... some docs/surgeons do basically whatever until serial malpractice or gross negligence eventually shuts them, or even the whole facility, down).

Is there a potential for misuse of professions regulating themselves? Of course. There is often a "stealing meat from my land" bias between the existing medical staff of that specialty and the new applicant (especially when they are a competing doc/group). That mistrust of new peers is inevitable for plastics, pods, onco surg, or anything else from mechanics to airline pilots. Boards and certifications and case logs actually quell that bias by providing objective competence and common ground in most cases. A group of DPMs in whatever city I go to next could hate me and not want my competition all they want... but they will also see I've passed same/more boards they have and my logs are solid. The objective standards and national exams make any whole specialty better in that locality, state, etc by having measured standards. It is up to each of us if we view it as a bad thing or a necessary standard that exists in all professional trades.

 

[newfeet]

Hey guys

While looking for jobs , I inquired with a few local hospitals about how to go about getting privileges.

Several of them sent me info and I wanted to highlight a board concern.

Not sure how to really take it, but here’s a excerpt from one of the docs re: board status.

“Board Certification Requirement means certification from one of the following boards: the American Board of Medical Specialties, the American Osteopathic Association, the American Board of Foot and Ankle Surgery, or those Boards which may be approved by the Executive Committee to satisfy this Requirement”

As a disclaimer, I’m not a HUGE surgery pod. I enjoyed it , and did it in residency because, well, that’s what we had to do. And I’m fine with my forefoot procedures. I believe I’ve done well with them at my current level. I don’t care to do TARS, scopes mid foot fusions etc. I have no problem referring them out. I took the ABFAS qualifying tests etc, because again, it’s encouraged in residency and passed them.

Looking at this doc, it almost seems like this board required if you wanted to be on staff. The little statement at the end regarding “or those boards” seems like it might open the door for ABPM with some petitioning or something.

What do you guys make of this? I have heard from others that ABPM will get involved with issues regarding privileges etc. Is there more to this picture than meets the eye?

Thanks in advance for everyone’s take

I have ABPM only. I’ve thought about doing ABFAS but I haven’t. I’ve gone through the credentialing process 3 times with no issues.

I don’t do much surgery and I’m transitioning to no surgery in the next few months. At the end of the day ABFAS is pointless for me. It might not be for you.

 

[air bud]

Literally becoming a stereotype. "The only people who will want to restrict your privileges at a hospital will be other podiatrists"

 

[CutsWithFury]

I have ABPM only. I’ve thought about doing ABFAS but I haven’t. I’ve gone through the credentialing process 3 times with no issues.

I don’t do much surgery and I’m transitioning to no surgery in the next few months. At the end of the day ABFAS is pointless for me. It might not be for you.

Because you are not doing ankle work. Why don’t you clarify what you actually do. If it’s toes, amps, pus then I don’t see the hospital giving much pushback with just ABPM. If you said you want to do an ankle fracture then bet your ass ortho is going to start researching and ask if you are ABFAS certified

 

[newpodgrad]

I have ABPM only. I’ve thought about doing ABFAS but I haven’t. I’ve gone through the credentialing process 3 times with no issues.

I don’t do much surgery and I’m transitioning to no surgery in the next few months. At the end of the day ABFAS is pointless for me. It might not be for you.

What’s it like running an office that doesn’t do much surgery? Do you feel like you still maintain a good patient base?

 

[Feli]

What’s it like running an office that doesn’t do much surgery? Do you feel like you still maintain a good patient base?

There are a billion ways to make money in podiatry. Having a lot of patients depends on having little/no local competition more than anything else. Those areas are few and far between... and typically not very desirable to live in.

As far as patients, I think you should have as many offerings as you can... deformities, nail/derm, injuries, sports, wounds, etc. That's up to you, though. Some people do a very limited scope in what is already a limited specialty.

The most profitable day for me (and almost any DPM) would be a lot of office patients (mostly new) that need injects, wart treaments, ingrowns, etc... quick procedure codes. This is why Derm and Rheum really kill it financially. For pod, XRs and DME boots and braces that my MAs can do are also pretty profitable. Wound care debrides are also profitable but pretty boring and depressing... and will lead to many infections and admit calls on your free time.

The problem is, it's all related... the profitable DME and the new patient referrals come with many needing surgery. Any DPM in town can do ingrown or nail trims or tinea or Rx diabetic shoes. If I couldn't also do bunion surgery, Achilles, cavus, fractures, etc... then I'd start to lose a lot of the referrals from area PCPs. They want a reliable and well-liked foot referral they can just send everything to. They don't want to think "well, Dr. DPM can do orthotic or warts... but not midfoot arthritis or repeated ankle sprains. Those get sent or ortho or DPM #2." You want to do it all (within your training)... and it can all be profitable. Limited can also do fine, but you will tend to get smashed in most areas if local competition does everything you do - plus more.

 

[newfeet]

Because you are not doing ankle work. Why don’t you clarify what you actually do. If it’s toes, amps, pus then I don’t see the hospital giving much pushback with just ABPM. If you said you want to do an ankle fracture then bet your ass ortho is going to start researching and ask if you are ABFAS certified

I don’t do ankle. I was never interested. Yes I do mostly amps. I’m moving to a diabetes center in a location more convenient for my family. I like said this is what works for me.

 

[newpodgrad]

I don’t do ankle. I was never interested. Yes I do mostly amps. I’m moving to a diabetes center in a location more convenient for my family. I like said this is what works for me.

If you don’t mind me asking was there any boards pushback on limited privileges?

Like I said I’ll take the abfas test. But I’m not a fan of ankles, mid foot fusions etc. Honestly I’m fine doing cheilectimies , Austin’s and hammertoes, soft tissue masses and toe amps. I’m totally good with that. If I can do those then I have no complaints

 

[newfeet]

What’s it like running an office that doesn’t do much surgery? Do you feel like you still maintain a good patient base?

I’m currently the only podiatrist in town. So I get all referrals. I could do more surgery if I wanted. Some one else can have a different practice.

 

[newfeet]

If you don’t mind me asking was there any boards pushback on limited privileges?

Like I said I’ll take the abfas test. But I’m not a fan of ankles, mid foot fusions etc. Honestly I’m fine doing cheilectimies , Austin’s and hammertoes, soft tissue masses and toe amps. I’m totally good with that. If I can do those then I have no complaints

I’ve had no push back. I believe someone else could really have a different experience and do more. I do consults, do amps, do bunions here and there and remove masses. The hospital has been great in letting practice how I want.

 

[JewOnThis]

I have ABPM only. I’ve thought about doing ABFAS but I haven’t. I’ve gone through the credentialing process 3 times with no issues.

I don’t do much surgery and I’m transitioning to no surgery in the next few months. At the end of the day ABFAS is pointless for me. It might not be for you.

Giving up surgery means no more operation ever in the future. Are you ok with that? Did you take a
Non surgical Job?

 

[newfeet]

Giving up surgery means no more operation ever in the future. Are you ok with that? Did you take a
Non surgical Job?

I did take a non surgical job. And I’m ok with that. The last 3 years have been rough. The moment I took this job my wife became ok looking at houses. After 3 years of finding any reason to reject a house we have an accepted offer across the street from the elementary school in a nice suburb. It’s time to settle down.