Forum Members ABFAS/ABPM

[newpodgrad]

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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

 

[malleolusman]

I dont disagree. ABFAS is not a perfect exam. But everyone here talks about how hard it is to get certified yet a dumb dumb (the RRA cert person you describe) was able to do it.

THere has to be something to show competance in the surgical world. Podiatry admissions allow in anyone with a heart beat and a paycheck. Not everyone is destined to be a surgeon with a 2.5gpa in undergrad and 2.6 in podiatry school with a residency in new york.

Hell even the 4.0 students some of them (there was one in my class) that I wouldnt let anywhere near me. Just because youre book smart doesnt mean you should be a surgeon. MDs have different paths. Podiatrists should too. ABPM cert for clinical. ABFAS for surgery.

I dont think board exams should be in charge of job market saturation. That should be on the APMA/CPME. ACFAS is a surgical board. ABPM is a board. They are not in charge of making sure everyone gets a paycheck.

I agree

I dont disagree. ABFAS is not a perfect exam. But everyone here talks about how hard it is to get certified yet a dumb dumb (the RRA cert person you describe) was able to do it.

THere has to be something to show competance in the surgical world. Podiatry admissions allow in anyone with a heart beat and a paycheck. Not everyone is destined to be a surgeon with a 2.5gpa in undergrad and 2.6 in podiatry school with a residency in new york.

Hell even the 4.0 students some of them (there was one in my class) that I wouldnt let anywhere near me. Just because youre book smart doesnt mean you should be a surgeon. MDs have different paths. Podiatrists should too. ABPM cert for clinical. ABFAS for surgery.

I dont think board exams should be in charge of job market saturation. That should be on the APMA/CPME. ACFAS is a surgical board. ABPM is a board. They are not in charge of making sure everyone gets a paycheck.

If ACFAS wants to promote the profession and ABFAS wants to promote foot and ankle surgeons, they have an obligation to keep numbers down and demand high. They chose to be in leadership… so lead.

But like true podiatrists , they aren’t looking out in a collective fashion. Pods do this to themselves. Cuts had said it before, this profession is filled with individuals largely who are self serving - again a byproduct of saturation.

 

[Steveington]

I worry that in the future that surgical privileges will be not only be restricted to ABFAS certification, but only to those podiatrists who did a fellowship.

When we allow surgical gatekeeping by just one group, don't be surprised when the "future leaders" tighten their grip.

 

[air bud]

I worry that in the future that surgical privileges will be not only be restricted to ABFAS certification, but only to those podiatrists who did a fellowship.

When we allow surgical gatekeeping by just one group, don't be surprised when the "future leaders" tighten their grip.

I think that is getting a little ahead of ourselves....the future is not this draconian

 

[GreenHousePub]

I worry that in the future that surgical privileges will be not only be restricted to ABFAS certification, but only to those podiatrists who did a fellowship.

When we allow surgical gatekeeping by just one group, don't be surprised when the "future leaders" tighten their grip.

In another thread, Dr Rogers suggested that an ABPM/ABFAS merger would include making a fellowship mandatory to become a podiatry surgical "specialty."

Like there is a huge demand for any podiatrist that only does certain surgeries.

 

[Pronation]

Like there is a huge demand for any podiatrist that only does certain surgeries.

I mean there is some demand for a podiatrist that does certain surgeries, specifically diabetic foot pus surgeries, mainly because the other surgical specialties don’t want anything to do with it.

 

[Adam Smasher]

Lol, "sorry, I can't amputate that toe, I never did a fellowship"

 

[wakaflocka88]

Lol, "sorry, I can't amputate that toe, I never did a fellowship"

It is scary that we still see pods hacking away at a toe and still wrecks the foot.

 

[diabeticfootdr]

In another thread, Dr Rogers suggested that an ABPM/ABFAS merger would include making a fellowship mandatory to become a podiatry surgical "specialty."

Like there is a huge demand for any podiatrist that only does certain surgeries.

No. Just to clarify, I wrote exactly the opposite.

I wrote that PMSR (mandatory training) and your primary certificate should qualify you for anything in your training/scope, of course with current experience (logs) demonstrated for a hospital.

If someone wants to do a fellowship, they should be allowed to and the additional certificates should be only available at the end of additional training (like the rest of medicine).

But there are already protections in place for hospital surgical privileges. CMS Conditions of Participation (federal law) state that if Board Certification is a required element of privileging, it must be certification in one's primary specialty. This is from a battle between vascular and general surgeons a couple decades ago. Vascular surgeons (who are/were fellowship-trained general surgeons) tried to limit vascular procedures, like fem-pop bypasses, to board certified vascular surgeons only. CMS is concerned about beneficiaries access to care, not professional urination distance challenges. So CMS said no. It must be certification in ones primary specialty if required. That means that a general surgeon can not be prevented from doing fem-pop bypasses if they meet all the other rules of privileging (documented training and experience).

 

[619]

I worry that in the future that surgical privileges will be not only be restricted to ABFAS certification, but only to those podiatrists who did a fellowship.

When we allow surgical gatekeeping by just one group, don't be surprised when the "future leaders" tighten their grip.

About 20 years ago or more, the flood gates was opened for anyone who completed a 3 year residency will automatically be called a "foot and ankle surgeon" regardless of competency of the individual. Looks like now they are trying to close the flood gates but it may already be too late.

 

[dtrack22]

Oh hey look, one organization is making it easier for podiatrists to practice the things they were trained to do. Wonder when the ABFAS email comes explaining how dangerous this is…

I wonder if the OPMA will ever realize that capitulating to Ortho will get them nowhere and they need to start ramming through any scope legislation they want? You know, like nurses do…

 

[diabeticfootdr]

Now … Wagons East!

 

[heybrother]

Good for ya'll. If I understand correctly this was up for debate/discussion/something yesterday in Texas. Kind of a bummer that something like this has to be made a law.

 

[deleted285117]

Good for ya'll. If I understand correctly this was up for debate/discussion/something yesterday in Texas. Kind of a bummer that something like this has to be made a law.

View attachment 368986

Wow. That's an embarassment.

 

[diabeticfootdr]

Good for ya'll. If I understand correctly this was up for debate/discussion/something yesterday in Texas. Kind of a bummer that something like this has to be made a law.

View attachment 368986

That was a senate hearing in TX yesterday. It would prohibit discrimination of podiatrists by degree. The same language (exactly) already exists for DOs and dentists.

Essentially, it means the hospital wouldn’t be able to create a separate set of rules for a DPM to do the same procedure as an MD or DO.

TPMA is leading the charge.

 

[heybrother]

Wow. That's an embarassment.

Its actually kind of fascinating. The amendment/law itself is incredibly short but the analysis of it suggests it would be fairly powerful...

 

[dtrack22]

Feli is so pissed right now. How dare podiatrists fight for their scope of practice without the blessing of ABFAS and their certification

 

[Feeter]

I just want to thank ABPM and Dr. Lee for all they are doing. This is the most I've seen anyone do something for podiatry since I became a podiatrist.

 

[diabeticfootdr]

I just want to thank ABPM and Dr. Lee for all they are doing. This is the most I've seen anyone do something for podiatry since I became a podiatrist.

You’re welcome and we’re just getting started. The whole BOD is behind this momentum.

 

[Pronation]

You’re welcome and we’re just getting started. The whole BOD is behind this momentum.

I heard there might be a way to make the overall job market not be horrible for podiatry. Can you comment?

 

[diabeticfootdr]

Announcement:

I received a Cease & Desist letter from ABFAS yesterday for disparagement, partly because of what I write on SDN, and also statement I wrote in an email to the APMA BOT that “our young podiatrists were being eaten.”

Firstly, cannibalism is a crime. And I publicly acknowledge that I have not seen any evidence that they either do, or do not, feed on the flesh of young podiatrists.

Secondly, now you know the ABFAS BOD reads SDN.

Have a happy holiday weekend!

 

[deleted285117]

Announcement:

I received a Cease & Desist letter from ABFAS yesterday for disparagement, partly because of what I write on SDN, and also statement I wrote in an email to the APMA BOT that “our young podiatrists were being eaten.”

Firstly, cannibalism is a crime. And I publicly acknowledge that I have not seen any evidence that they either do, or do not, feed on the flesh of young podiatrists.

Secondly, now you know the ABFAS BOD reads SDN.

Have a happy holiday weekend!

They don’t want any interference with their gravy train.

 

[deleted1138023]

Dr. Rogers and ABPM >>>>>> abfas

I hope the next president of ABPM fights just as hard

 

[Sweatshirt]

Go shove it ABFAS

Also, please send me a cease and desist too so I can use to light my next campfire

 

[dtrack22]

Go shove it ABFAS

Also, please send me a cease and desist too so I can use to light my next campfire

They won’t let you tag their account on Instagram so I won’t be getting a letter any time soon…bummer

 

[Feli]

Feli is so pissed right now. How dare podiatrists fight for their scope of practice without the blessing of ABFAS and their certification

I could care less what DPM scope is... more is better. It should probably be soft tissue below hip and osseous below tib tuberosity nationwide so that DPMs who are trained for STSG, pilons, etc can potentially do those everywhere.

Privileging is what matters, and we all know that.
Making a fake cert for people who can't pass the surgery exam, so that they can use the fake cert to try for privileges they probably should not have and procedures they don't do or didn't train for (if they couldn't get those privileges with their logs, exp, and board cert) is not wise. That is what ABLES and ABMSP do... pay-to-play "board certification" to dupe hospitals. It is crazy to see a recognized board now doing a form of that also. We're all judged by our lowest common denominator. It will not serve us to have more foot cripples walking around since a DPM flashing a fake CAQ decided they'd watch a video and try to do calc fx, clubfoot, even just Lapidus, etc. Not ideal.

...and if this is a reference to something Rodgers said, I don't see his msgs... have had him on ignore a long time. I wish I could quit getting the ABPM emails also.

Dr. Rogers and ABPM >>>>>> abfas

I hope the next president of ABPM fights just as hard

There are differing ways to look at it:
Make the training easier ... or make the training better.
Again, we're judged by our lowest common denominator.
We can raise the training to pass the boards, or we can set the boards difficulty level down to whatever grads the schools push through will pass. 🙂
...One answer is quicker and easier, and that's the name of the ABPM game for this prez term. It's sad. And that's why many ppl are not pleased. Many others are very pleased.

Talk is just talk. I can assure you many others in the ABPM are not on board with...
... inflaming other podiatry organizations, taking pot shots against ABFAS and ACFAS and SDN and many others on every social media imaginable, trying to take credit for everything by signing and sending their emails all with their name, and trying to change the role of what the ABPM/ABPOPPM organization did for decades (alternate board... but recognized, mostly focused on the non-surgical wound biomech sports etc podiatry, historically non-confrontational). This was very clear from the response letters from organizations throughout podiatry.

Remember that roughly half the ABPM board have actually passed ABFAS, so most of them do NOT have the same personal grudge he does. He has lost allegiance of and even alienated some of the better minds in the ABPM in the process of being a cowboy. Tunnel vision is tough. Time will tell what may or may not happen for the org going forward. 👍

 

[deleted1138023]

Again, we're judged by our lowest common denominator.

only because we have an inferiority complex.

why are NP's/PA's not judged by their lowest common denominator? we should fight to expand our scope/practice just like them.

 

[Feli]

only because we have an inferiority complex.

why are NP's/PA's not judged by their lowest common denominator? we should fight to expand our scope/practice just like them.

All are judged by lowest common denominator. Electricians. Bouncers. Dentists. Attorneys. Whatever.

Podaitrists dont' work under supervision as PA/NP do.
Do we want to be seen as skilled and highly trained practitioners of EBM... or are we much less?
Whenever a DPM cripples a hospital employee's foot with elective surgery or runs up a $5k bill for fake custom brace or gives a city council person CRPS or is on TV selling antifungal nail polish, that reflects on all of us. No joke.

Chiropractors are the best/worst example... generally considered questionable and aggressive at billing/marketing. I feel very sorry for the ethical and well-educated DCs who can do nothing but shake their head as their colleagues promise vitamins can cure rheumatoid or that a manipulation will fix a brain neoplasm. Look no further to see where podiatry could be headed with the wrong moves of increasing saturation, little regulation, bad leadership... 🙂

 

[deleted1138023]

Podaitrists dont' work under supervision as PA/NP do. Whenever a DPM causes CRPS or cripples a hospital employee's foot with elective surgery or runs up a $5k bill for fake custom braces or is on TV selling antifungal nail polish, that reflects on all of us. No joke.

When ortho butchers someone why does that not reflect on all of them?

We should strive for more privileges (ABPM) not less (ABFAS).

 

[Feli]

When ortho butchers someone why does that not reflect on all of them?

We should strive for more privileges (ABPM) not less (ABFAS).

It's a much more complex answer than you realize.

USA didn't just throw any 3 astronauts onto the moon... they picked the best ones.
The police don't put random dogs into k9 duty.
Navy Seals don't draw names out of a hat from the pool of cadets.
Law offices don't sent a random associate attorney to a big felony trial.

...podiatrists doing any surgery is still a relative new thing. Toe (bone) surgery? Newer. Midfoot? Newer yet. Ankle surgery? Even newer.
You want your best and highly qualified to be those pioneers. You want very good results... the early results WILL be under scrutiny in most facilities. You need same/better results than MDs doing those procedures. That is how dentists came to rule OMFS.

The fact that I can now do a triple or an ankle fusion is due to the fact that the guys ahead of me did toe amps and bunions pretty well, you know? The fact that I've been questioned heavily at some other places about ankles, or even midfoot work - despite logs from training and afterwards, is sometimes political... but more likely, it's because other DPMs before me have messed it up. Those are the facts.

We always want to push forward... and forward faster. Don't forget that progress ebbs and flows.
It can happen (and has!) at many facilities that DPM privileges or criteria for privileges have evolved due to bad outcomes.
Bad outcomes are almost invariably from a lack of training and/or exp. Board exams and logs and exp test and correlate to training.

So, yeah... did I mention that we are judged by our lowest common denominator? 🙂

 

[dtrack22]

Making a fake cert for people who can't pass the surgery exam, so that they can use the fake cert to try for privileges they probably should not have and procedures they don't do or didn't train for

No CAQ is getting you privileges for stuff you haven’t done. That’s not how hospital privileging works, especially as a podiatrist. You bought all the way in on that ABFAS propaganda huh?

 

[Feli]

No CAQ is getting you privileges for stuff you haven’t done. That’s not how hospital privileging works, especially as a podiatrist. You bought all the way in on that ABFAS propaganda huh?

Yeah, it would be awesome if that were the case.
That's how hospital privileging should work. It is how it works in many places: training verification, logs, board qual/cert.

That's exactly what ABLES, CAQ, and similar are, though... official-sounding things from unrecognized (or now a recognized) board that say "surgery" and are designed to pull the wool over the eyes of a facility. Everyone knows this, whether they support or oppose those things existing. I have seen it firsthand with ABLES... and the multiple major BKA amps and worse from a surgeon who shouldn't have been doing surgical decisions or procedures and would undertreat and delay care for gas gangrene, abscess, punctures, etc due to lack of training. It was very sad and gave the whole (otherwise skilled) dept a bad rep.

Will it work to use the fake creds at Baylor or UNC or UCLA or major health systems? No way... not without logs, probably not at all. Will it work (present a "surgery" certificate for ankle privileges despite never having done one on your own or learned them well in residency or passed ABFAS qual) at some VA or community hospital that doesn't know too much about podiatry? Maybe, and that's the whole point of it. At some ASC or hospital that just wants cases and $$$? You bet... probably didn't even need anything for those.

 

[diabeticfootdr]

Yeah, it would be awesome if that were the case.
That's how hospital privileging should work.

The error in this whole argument is that a board espouses the notion that a podiatrist is totally competent to have full surgical privileges (based on their training) while they are board qualified and can operate for 7 years, but then all of a sudden, they’re totally incompetent and a danger to patient safety.

Hospitals and ASCs are required by both federal and state laws to create a credentialing process that verifies the competence of providers and promotes patient safety.

How can you be safe on one day and then not safe the next?

In reality, this isn’t about patient safety, it’s about gate-keeping and anti-competition. And sadly podiatrists do this to each other. In the nearly 100 privileging cases I’ve dealt with while at ABPM, only 2 were an orthopedist restricting a podiatrist and 1 was an ENT as chair of credentials who just didn’t understand the process. All other cases were podiatrists writing rules that essentially limited competition in the hospital.

A piece of paper doesn’t make you competent to do surgery. Your training and experience do. And then hospitals have mechanisms to ensure your work is adequate by following outcomes measures (looking for outliers) and Ongoing Professional Practice Evaluations (OPPE).

 

[diabeticfootdr]

They won’t let you tag their account on Instagram so I won’t be getting a letter any time soon…bummer

That was shut off when I tagged this post.

 

[Boba Foot]

Whenever a DPM cripples a hospital employee's foot with elective surgery or runs up a $5k bill for fake custom brace or gives a city council person CRPS or is on TV selling antifungal nail polish, that reflects on all of us. No joke.

As @ToeFather mentioned, you act as if ortho doesn't screw the pooch ever. You act as if dermatologists aren't hawking BS creams and antifungals. Christopher Dunsch ("Dr. Death") went to a spine fellowship and had many absolutely botched jobs.

Yes, there are hacks and shysters within podiatry. But there are hacks and shysters in every medical specialty, this is not a podiatry-specific thing. Podiatry just has an inferiority complex that allows people such as yourself to wallow in this stereotype, and the more you lament it to others the more other specialties will continue to perceive it. And as Dunsch showed, the hacks can even fake it through fellowships. And no, ABFAS doesn't weed out all the hacks either-- there are plenty of FACFAS hacks out there.

The main qualifier for privileges should be case logs first and foremost and whatever board certification second. Passing a test hardly shows surgical capability.

...and if this is a reference to something Rodgers said, I don't see his msgs... have had him on ignore a long time.

Setting yourself up to be in your own echo chamber and not hearing conflicting points of view never does anyone good.

 

[dtrack22]

That's exactly what ABLES, CAQ, and similar are, though... official-sounding things from unrecognized (or now a recognized) board that say "surgery" and are designed to pull the wool over the eyes of a facility.

But they don’t. Keep acting like this is some prevalent problem, though. For every person getting surgical privileges with ABLES, there is an ABFAS certified podiatrist butchering someone. And it’s primarily because the former, is really a rare occurrence. And it’s becoming increasingly rare as training has been much more standardized over the last 15-20 years. Yet you act like people are using ABLES and a new ABPM CAQ to bypass credentialing committees every day.

At some ASC or hospital that just wants cases and $$$? You bet... probably didn't even need anything for those.

If you don’t need anything then the CAQ still doesn’t do anything helpful for the hacks you are worried about.

 

[Jummy Biffett]

I applaud ABPM for this, it's about damn time that the ABFAS/ACFAS gatekeepers get bent.

 

[Boba Foot]

I applaud ABPM for this, it's about damn time that the ABFAS/ACFAS gatekeepers get bent.

You have to think that through the passive aggressive newsletters that they're sending out and the cease-and-desist to Dr. Rogers that they're probably feeling it. These aren't actions that people who don't feel threatened perform.

After passing the in-training ABFAS qual last year, I haven't paid the money to convert it (of course they get paid by residencies for the exam and then they charge candidates a second time because they're greedy ****s).

At this point, I'm seriously considering not even bothering with proceeding with ABFAS cert and just doing ABPM. It's just not worth the hassle of logging, gathering a **** ton of documents and then dealing with the anxiety of getting failed on BS criteria so I can pay to re-apply 2 more times before they finally "pass" me after milking me for all they can. If ABPM vs. ABFAS is something that no one but podiatry gate keepers care about, then I'll take the path of least resistance and cost and do ABPM.

 

[deleted1138023]

wow seems like SDN is starting to fully stand behind ABPM in this debate. Where SDN goes podiatry follows… be careful abfas.

 

[Sweatshirt]

I could care less what DPM scope is... more is better. It should probably be soft tissue below hip and osseous below tib tuberosity nationwide so that DPMs who are trained for STSG, pilons, etc can potentially do those everywhere.

Privileging is what matters, and we all know that.
Making a fake cert for people who can't pass the surgery exam, so that they can use the fake cert to try for privileges they probably should not have and procedures they don't do or didn't train for (if they couldn't get those privileges with their logs, exp, and board cert) is not wise. That is what ABLES and ABMSP do... pay-to-play "board certification" to dupe hospitals. It is crazy to see a recognized board now doing a form of that also. We're all judged by our lowest common denominator. It will not serve us to have more foot cripples walking around since a DPM flashing a fake CAQ decided they'd watch a video and try to do calc fx, clubfoot, even just Lapidus, etc. Not ideal.

...and if this is a reference to something Rodgers said, I don't see his msgs... have had him on ignore a long time. I wish I could quit getting the ABPM emails also.


There are differing ways to look at it:
Make the training easier ... or make the training better.
Again, we're judged by our lowest common denominator.
We can raise the training to pass the boards, or we can set the boards difficulty level down to whatever grads the schools push through will pass. 🙂
...One answer is quicker and easier, and that's the name of the ABPM game for this prez term. It's sad. And that's why many ppl are not pleased. Many others are very pleased.

Talk is just talk. I can assure you many others in the ABPM are not on board with...
... inflaming other podiatry organizations, taking pot shots against ABFAS and ACFAS and SDN and many others on every social media imaginable, trying to take credit for everything by signing and sending their emails all with their name, and trying to change the role of what the ABPM/ABPOPPM organization did for decades (alternate board... but recognized, mostly focused on the non-surgical wound biomech sports etc podiatry, historically non-confrontational). This was very clear from the response letters from organizations throughout podiatry.

Remember that roughly half the ABPM board have actually passed ABFAS, so most of them do NOT have the same personal grudge he does. He has lost allegiance of and even alienated some of the better minds in the ABPM in the process of being a cowboy. Tunnel vision is tough. Time will tell what may or may not happen for the org going forward. 👍

Or ABFAS could write a real board certification exam that doesn't cost thousands of $$$, without blurry x-rays, bunion procedures performed from the 1960s, and an insane case review process that fails people for screws 1 thread too long (on a non-weightbearing surface). Keep the gatekeeping blinders on and don't address the real problems with ABFAS. At least we have 1 board fighting for the profession instead of milking young podiatrists like a cash cow

 

[Adam Smasher]

wow seems like SDN is starting to fully stand behind ABPM in this debate. Where SDN goes podiatry follows… be careful abfas.

Just remember, both of these organizations are in the business of extracting money from our hard work. Neither of them care how hard we struggle as long as we jump through hoops and pay our dues on time.

 

[icebreaker32]

Although I still believe one should try to get ABAS, ABPM is good enough most places.

There was a time when only surgical residents could even attempt ABFAS. Yes there was even a time before that also you only needed a preceptorship or cases form any type of residency also. Our model is now combined residencies where everyone is trained in medicine and surgery. So all residents are pretty well trained compared to years past.

Wether it is a merger of tweaking the current ABFAS process, something further needs to be done to make the case portion simplified for ABFAS. I have less of a problem with the test, but many others do, so perhaps that could be changed in some way also without it being a show up and you pass test like others. The ABFAS MOC in my opinion beats having to take a formal test every so often.

If you practice in one of the areas that will boot you off hospital and insurance panels when you fail to get ABFAS, this is very unfortunate indeed. Probably not as bad to not matching to a residency and not picking up a residency either in the scramble like happened many years ago in the past when there were only a couple states you could even practice in without a residency.

More unfortunate is the saturation that exists in our profession. There are many problems all worthy of discussion: board issues, admission standards to our colleges, scope of practice, variability in training, too many fellowships and having unaccredited fellowships etc. The enrollment crisis....sorry don't think it is a problem other than lowering admission standards.

The most pressing problem in my opinion in our profession is saturation and this is probably the one our leaders can/will do the least about. It makes no sense the explosion in demand for allopathic physicians osteopathic physicians, foreign medical doctors, RNs, CRNAs,, Anesthesia Assistants, PAs, NPs etc all while we are still opening more schools, have more doing fellowships and 75K jobs still exist. We can not shrink our selves into prosperity right? We need more schools.

 

[icebreaker32]

Just remember, both of these organizations are in the business of extracting money from our hard work. Neither of them care how hard we struggle as long as we jump through hoops and pay our dues on time.

True, but not entirely true. Sure like any organization they want to grow revenue and dues are a large part of that. You have a mix of those on the board who want to stroke their own ego, obtain more power and push their personal agenda and you also have those who give a lot of their time mainly just to give back and being very involved in podiatry has become their hobby.

 

[Feli]

Although I still believe one should try to get ABAS, ABPM is good enough most places....

...The most pressing problem in my opinion in our profession is saturation and this is probably the one our leaders can/will do the least about...

Yes, this is the start and the end of it.

If we have 200 or so high quality residency spots - standardized and high volume, basically everything else falls into place:

The demand improves.
Compensation impoves.
The schools would be selective.
Applicant demand increases if the end result is desired.
Residency training improves.
Board pass improves.

Not surprisingly, that's how MDs, particularly their surgical specialties, do it: regulate at residency level. They don't end up with a ton of people not being able to pass boards, being upset with jobs available, attempting certification-less fellowships just to get a decent job or skills they should've gotten in their core residency.

 

[malleolusman]

Yes, this is the start and the end of it.

If we have 200 or so high quality residency spots - standardized and high volume, basically everything else falls into place:

The demand improves.
Compensation impoves.
The schools would be selective.
Residency training improves.
Board pass improves.

Not surprisingly, that's how MDs, particularly their surgical specialties, do it: regulate at residency level. They don't end up with a ton of people not being able to pass boards, being upset with jobs available, attempting certification-less fellowships just to get a decent job or skills they should've gotten in their core residency.

This post by Feli should be a pop up when entering the podiatry forums. Someone print this out and send it to ABPM ABFAS ACFAS whatever other alphabet soup exists for this poor excuse of a profession.

 

[Feli]

... [podiatry] training has been much more standardized over the last 15-20 years...

...I strongly disagree with those who say podiatry residencies are 'pretty much standardized' and 'much improved.' We can't act like the job is finished. They're standard in length only, and we all know it. My skillset and job options and board pass abilities would be drastically different had I gone to different '3year surgical' programs. That goes for any of us. That has been the biggest area for improving DPM education/demand/respect... and it still is. We went from light years behind MD surgeon specialty training standards to now still significantly behind. There is still much work to do.

There are virtually no MD surgical training programs where the grads are not well versed and trained in all common core procedures and pathologies to the specialty - and most advanced procedures (academically, and often practically). They work with dozens of appropriately board cert attendings at multiple bona fide teaching hospitals and other arranged community rotations. They are prepped to pass the boards. Podiatry doesn't uniformly have that. Not even close.

It's up to 'leaders,' if they want to regulate quality, saturation, respect, demand for DPMs. As it stands, we have a mix of fantastic, good, fair, and completely unacceptable residency spots. We have at least twice as many as are needed. We have "PMSR/RRA" residencies where the residents never scrub a single ankle fracture with a DPM - or at all - or scrub even a single flat foot or Lapidus. Job market and low board pass and existence of a second alternative much easier board are testament to this huge variance. Again, MD training programs have almost none of these issues.

The way to regulate it is both painful and simple. If the low quality and low volume residencies stay accredited and open, the pod schools WILL find people to borrow 300k+ to go to them, to fail boards, to struggle in a saturated market. Look at what MDs do: when a specialty gets even a bit saturated or lower apps/USMLE, they freeze or reduce residency spots.

The counter-argument is "what about podiatry students who don't want to do surgery?" Same as OB, ortho, gen surg who dont do OR in practice: they can still learn it, finish residency, and pass boards so that they know indications, complications, etc to practice optimally and refer to colleagues appropriately. I don't do BKAs or femur fx or fem-pop that I assisted in residency, but it helps to know them in broad strokes. I don't do TARs or MPJ1 imolants either, but I know how to salvage them and the indications to pass a test or ID and send an implant candidate to area surgeons who believe in them and do them well. More training and knowledge never hurt anyone.

 

[newfeet]

Announcement:

I received a Cease & Desist letter from ABFAS yesterday for disparagement, partly because of what I write on SDN, and also statement I wrote in an email to the APMA BOT that “our young podiatrists were being eaten.”

Firstly, cannibalism is a crime. And I publicly acknowledge that I have not seen any evidence that they either do, or do not, feed on the flesh of young podiatrists.

Secondly, now you know the ABFAS BOD reads SDN.

Have a happy holiday weekend!

Nice I’m glad to hear the ABFAS are not the walking dead…I was worried.

 

[myfeetrkillingme]

I could care less what DPM scope is... more is better. It should probably be soft tissue below hip and osseous below tib tuberosity nationwide so that DPMs who are trained for STSG, pilons, etc can potentially do those everywhere.

Privileging is what matters, and we all know that.
Making a fake cert for people who can't pass the surgery exam, so that they can use the fake cert to try for privileges they probably should not have and procedures they don't do or didn't train for (if they couldn't get those privileges with their logs, exp, and board cert) is not wise. That is what ABLES and ABMSP do... pay-to-play "board certification" to dupe hospitals. It is crazy to see a recognized board now doing a form of that also. We're all judged by our lowest common denominator. It will not serve us to have more foot cripples walking around since a DPM flashing a fake CAQ decided they'd watch a video and try to do calc fx, clubfoot, even just Lapidus, etc. Not ideal.

...and if this is a reference to something Rodgers said, I don't see his msgs... have had him on ignore a long time. I wish I could quit getting the ABPM emails also.


There are differing ways to look at it:
Make the training easier ... or make the training better.
Again, we're judged by our lowest common denominator.
We can raise the training to pass the boards, or we can set the boards difficulty level down to whatever grads the schools push through will pass. 🙂
...One answer is quicker and easier, and that's the name of the ABPM game for this prez term. It's sad. And that's why many ppl are not pleased. Many others are very pleased.

Talk is just talk. I can assure you many others in the ABPM are not on board with...
... inflaming other podiatry organizations, taking pot shots against ABFAS and ACFAS and SDN and many others on every social media imaginable, trying to take credit for everything by signing and sending their emails all with their name, and trying to change the role of what the ABPM/ABPOPPM organization did for decades (alternate board... but recognized, mostly focused on the non-surgical wound biomech sports etc podiatry, historically non-confrontational). This was very clear from the response letters from organizations throughout podiatry.

Remember that roughly half the ABPM board have actually passed ABFAS, so most of them do NOT have the same personal grudge he does. He has lost allegiance of and even alienated some of the better minds in the ABPM in the process of being a cowboy. Tunnel vision is tough. Time will tell what may or may not happen for the org going forward. 👍

Well said! We must maintain a high standard for us to have parity amongst our allopathic peers not a pay to play certification that does nothing for the protection of the public or our reputation.

 

[myfeetrkillingme]

The error in this whole argument is that a board espouses the notion that a podiatrist is totally competent to have full surgical privileges (based on their training) while they are board qualified and can operate for 7 years, but then all of a sudden, they’re totally incompetent and a danger to patient safety.

Hospitals and ASCs are required by both federal and state laws to create a credentialing process that verifies the competence of providers and promotes patient safety.

How can you be safe on one day and then not safe the next?

In reality, this isn’t about patient safety, it’s about gate-keeping and anti-competition. And sadly podiatrists do this to each other. In the nearly 100 privileging cases I’ve dealt with while at ABPM, only 2 were an orthopedist restricting a podiatrist and 1 was an ENT as chair of credentials who just didn’t understand the process. All other cases were podiatrists writing rules that essentially limited competition in the hospital.

A piece of paper doesn’t make you competent to do surgery. Your training and experience do. And then hospitals have mechanisms to ensure your work is adequate by following outcomes measures (looking for outliers) and Ongoing Professional Practice Evaluations (OPPE).

No but the steps for you to earn that piece of paper does demonstrate those three attributes if the certification process evaluates your actual outcomes. How can you truly say someone is competent to slice on a loved one when they only pass a didactic exam after “standard training” without any personal case results once out. Yes it can be a crap shoot when the public selects a surgeon but the more verification of their actual outcomes the better off for the most part. I wouldn’t let someone who read about flying and did simulations with a trainer take my family for a solo plane ride. They would have to demonstrate being checked off by a third party several successful solo flights. Same goes for any surgeon that would cut on any of my children.

 

[malleolusman]

Well said! We must maintain a high standard for us to have parity amongst our allopathic peers not a pay to play certification that does nothing for the protection of the public or our reputation.

Parity among our allopathic peers? We don’t have a national scope. How about start there? How about make that the focus of your conversation? How about addressing market saturation? ABFAS are the self proclaimed “leaders in foot and ankle surgery”, so lead.

Let’s play a little logic game :

ABFAS are leaders of the profession ergo
They are supposed to exist to protect the public. But some say they shouldn’t get involved in the saturation or enrollment issue. So then therefore, we graduate a Massive number of DPMs, open new schools, poor quality students get in and perform surgery, or high quality students get in and desperate for volume are operating on what they shouldn’t be.
Public is harmed
DPM image is harmed
So how it is not the ABFAS or anyone else in leaderships job not to be involved?

Any conversations otherwise to the defense of ACFAS and the board will make you sound like a shill. Sorry if you trained with the Denver or Seattle or whatever greats ; all these guys are sitting their ivory towers while the rest of us have to duke it out in real life. They deserve every ounce of ridicule.

Both these organizations ABPM/ABFAS are after your money, ABFAS may be the “best we have”, but these greedy scum buckets don’t deserve your defense. How was their vacation to Costa Rica with my hard earned certification renewal dollars footing the bill?

 

[myfeetrkillingme]

I didn’t train at those locations and most certainly work in the real world. Yes the schools are the issue no doubt. Poor quality in usually equals poor quality out. The stronger candidates will shine in that environment but someone needs to be the gatekeeper. Everyone gets into podiatry school and certainly should not all be surgeons by taking a simple didactic exam.