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

 

[MicroPod]

Are you able to take the ABPM exam in 3rd year of residency or do you have to be graduated?

 

[icebreaker32]

Are you able to take the ABPM exam in 3rd year of residency or do you have to be graduated?

Must graduate

 

[diabeticfootdr]

Are you able to take the ABPM exam in 3rd year of residency or do you have to be graduated?

No you can take it in October after you finish residency.

 

[diabeticfootdr]

I created this account to discuss my future in podiatry in regards to board certification.

I have a hospital job lined up in my home state. The pay is $200K+ with a great bonus structure. Unfortunately, I did not pass the ABFAS exam (only passed 2 sections). The hospital requires AFBAS certification (according to the contract). How long does one have to take ABFAS if they are working for a hospital? I know it's hospital dependent, but on average how long does a podiatrist have to pass the exam?

My plan is to take the ABPM certification exam in the fall, that way I am board certified in something.

I am not someone who wants to do crazy reconstructive/rearfoot surgeries. Will ABPM limit me in the future (in case my hospital decides to let go of me)? Does anyone know podiatrists working at a hospital with ABPM?

Basically, if I were to leave this hospital job...will I be okay with ABPM certification?

Thank you!

Reach out to us early - like now. We have a committee, including 2 lawyers, that addresses these issues. We meet weekly.

We’ve never lost a case. But there were 2 people we couldn’t help, because they reached out too late and had already agreed to an unattainable FPPE.

If you have adequate training, you shouldn’t need any other BC besides ABPM for full surgical privileges.

Either send me an email, or better, go to www.podiatryprivileges.com and click on the mediation tab to complete the webform.

 

[DPMFoot]

Reach out to us early - like now. We have a committee, including 2 lawyers, that addresses these issues. We meet weekly.

We’ve never lost a case. But there were 2 people we couldn’t help, because they reached out too late and had already agreed to an unattainable FPPE.

If you have adequate training, you shouldn’t need any other BC besides ABPM for full surgical privileges.

Either send me an email, or better, go to www.podiatryprivileges.com and click on the mediation tab to complete the webform.

Thank you! I will reach out soon.

 

[deleted1138023]

Thanks @icebreaker32 and @dtrack22 , I was genuinely curious because I don’t think boards really protect the public. stuff like this does. we have to be willing to take down our peers when necessary, doing the uncomfortable but right thing, knowing the proper channels of reporting, and knowing the bylaws that govern our own institutions

 

[Adam Smasher]

Thanks @icebreaker32 and @dtrack22 , I was genuinely curious because I don’t think boards really protect the public. stuff like this does. we have to be willing to take down our peers when necessary, doing the uncomfortable but right thing, knowing the proper channels of reporting, and knowing the bylaws that govern our own institutions

This will be an unpopular but in my opinion correct opinion. I remember in residency attending an ortho grand rounds where they were talking about how X% (I forget) of total knee arthroplasties were being done by surgeons who do fewer than 25 per year, and the attending was suggesting that the "proper" surgeon to be doing any given procedure is someone who does it a lot over and over and all the rest should opt out.

Meanwhile in foot world, how many of us do more than 25 bunioniectomies/year?

 

[Pronation]

If you have adequate training, you shouldn’t need any other BC besides ABPM for full surgical privileges.

How do we determine adequate training?

Submit some cases to a surgical board to be evaluated?

Take a board cert test with like a 90% pass rate even though the pod school APMLE pass rates are less than 80%?

No certification at all if the person feels confident that their training is adequate?

Also I was wondering if we could convince Medicare to reimburse Grafix graft applications daily instead of weekly.

Thanks

 

[DMEpod]

This will be an unpopular but in my opinion correct opinion. I remember in residency attending an ortho grand rounds where they were talking about how X% (I forget) of total knee arthroplasties were being done by surgeons who do fewer than 25 per year, and the attending was suggesting that the "proper" surgeon to be doing any given procedure is someone who does it a lot over and over and all the rest should opt out.

Meanwhile in foot world, how many of us do more than 25 bunioniectomies/year?

How does a surgeon start at that volume though? It takes time to build a patient and referral base. Even ortho surgeons need a year or two under their belt to start getting a comfortable volume of patients.

 

[icebreaker32]

How does a surgeon start at that volume though? It takes time to build a patient and referral base. Even ortho surgeons need a year or two under their belt to start getting a comfortable volume of patients.

Many orthopedic surgeons do fellowships and join a group where they work on a particular part of the body so get the volume that way, but take enough call to keep it with the basics on other parts of the body. That or if if they are not specialized they are often busy in an underserved area.

Wait we only work on a particular part of the body....what is our excuse?

 

[Adam Smasher]

How does a surgeon start at that volume though? It takes time to build a patient and referral base. Even ortho surgeons need a year or two under their belt to start getting a comfortable volume of patients.

In theory, every podiatrist who aspires to be a surgeon would receive rigorous surgical training and then be able to join a group/system with a built-in referral base. Not watered down surgical training from attendings who do bunionectomies once every few months.

 

[Pronation]

Wait we only work on a particular part of the body....what is our excuse?

Something something prosperity something something shrinking a profession

 

[DMEpod]

I agree that if someone is doing a case, it should be something they are regularly doing. The issue is that in reality very few pods, even if we graduate with 2x or 3x our numbers and quality training, get a huge influx of surgical patients within 1-2 years. It takes some time to build up to that level and new grads should not be punished for that. They have enough things to deal with

 

[Adam Smasher]

I agree that if someone is doing a case, it should be something they are regularly doing. The issue is that in reality very few pods, even if we graduate with 2x or 3x our numbers and quality training, get a huge influx of surgical patients within 1-2 years. It takes some time to build up to that level and new grads should not be punished for that. They have enough things to deal with

You're right. New grads should be able to build a surgical referral base. And this profession should support new grads by producing fewer of them.

 

[air bud]

Many orthopedic surgeons do fellowships and join a group where they work on a particular part of the body so get the volume that way, but take enough call to keep it with the basics on other parts of the body. That or if if they are not specialized they are often busy in an underserved area.

Wait we only work on a particular part of the body....what is our excuse?

So you are saying we need to do a fellowship?

 

[air bud]

I agree that if someone is doing a case, it should be something they are regularly doing. The issue is that in reality very few pods, even if we graduate with 2x or 3x our numbers and quality training, get a huge influx of surgical patients within 1-2 years. It takes some time to build up to that level and new grads should not be punished for that. They have enough things to deal with

Going to disagree actually. We are not doing rocket surgery. The anatomy does not change. If you do lots of RRA work and then a cavus recon comes up 2 or 3 times a year and you are dumb enough to want to tackle that....then no reason you shouldn't do it. If you understand concepts and are a good surgeon none of this is that hard.

 

[AttackNME]

This will be an unpopular but in my opinion correct opinion. I remember in residency attending an ortho grand rounds where they were talking about how X% (I forget) of total knee arthroplasties were being done by surgeons who do fewer than 25 per year, and the attending was suggesting that the "proper" surgeon to be doing any given procedure is someone who does it a lot over and over and all the rest should opt out.

Meanwhile in foot world, how many of us do more than 25 bunioniectomies/year?

Shouldn’t be an unpopular opinion, but i get it. No one ever wants to be put in a position to have to tell someone else “you suck”. But that’s life. Unless you’re okay with people doing bad work. If you notice a doctor doing terrible things down the road, who do you think should take notice and do something about it? ABFAS? How would they know what this person is doing? No single entity or exam can do that. Ultimately gatekeeping is our own responsibility and we have to do it to each other, at all levels. Including residency. But most would rather be mister nice guy/gal cus they don’t want to be shunned as a rat or hired gun.

 

[icebreaker32]

So you are saying we need to do a fellowship?

Yes in left 5th digit female total toenail replacement surgery

 

[Pronation]

female

biological or identifies as?

 

[icebreaker32]

Shouldn’t be an unpopular opinion, but i get it. No one ever wants to be put in a position to have to tell someone else “you suck”. But that’s life. Unless you’re okay with people doing bad work. If you notice a doctor doing terrible things down the road, who do you think should take notice and do something about it? ABFAS? How would they know what this person is doing? No single entity or exam can do that. Ultimately gatekeeping is our own responsibility and we have to do it to each other, at all levels. Including residency. But most would rather be mister nice guy/gal cus they don’t want to be shunned as a rat or hired gun.

biological or identifies as?

You just created more fellowship opportunities

 

[diabeticfootdr]

How do we determine adequate training?

Submit some cases to a surgical board to be evaluated?

Take a board cert test with like a 90% pass rate even though the pod school APMLE pass rates are less than 80%?

No certification at all if the person feels confident that their training is adequate?

Also I was wondering if we could convince Medicare to reimburse Grafix graft applications daily instead of weekly.

Thanks

You’re confusing training with current experience. Both are categories hospitals are required to evaluate.

Training = residency
Current experience = case logs

 

[NatCh]

A lot of surgical problems don't present to your office 25 or more times per year (or to my office, anyway).

Damn. I only did 24 Jones fracture ORIFs this year. I guess I'm done with that forever...

 

[icebreaker32]

A lot of surgical problems don't present to your office 25 or more times per year (or to my office, anyway).

Damn. I only did 24 Jones fracture ORIFs this year. I guess I'm done with that forever...

I am sure they are talking bread and butter elective.

 

[NatCh]

I am sure they are talking bread and butter elective.

Are they?

 

[Adam Smasher]

Don't fixate on the number 25. @air bud is right, certain pathologies don't come along 25x per year no matter how busy you are.

The moral of the story really is the best person to do a case is someone who does them consistently. I had attendings in residency who did <5 bunions/year when probably they should have been doing 0 per year. See also, the Pareto principle.

 

[Adam Smasher]

First: Not sure what proper forum etiquette is, but this is a very good thread, is it better to merge here or let it stand on its own?

Anyway, many have come out as either pro-ABPM or pro-ABFAS. I honestly feel like I don't have a dog in this fight. I hope they both continue to antagonize one another. It forces them to be accountable.

"But what about promoting the profession and protecting the public?"

The boards claim to do that to give them legitimacy. But this is the purpose of licensure. Certifying boards are basically a protection racket. If you want to work in this town, you better pay your dues. It's true for all of the certifying boards, ABIM extracts money from internists, and so on. As long as ABFAS and ABPM continue feuding, they can't do anything truly abusive because the rest of us will just ally with whoever is the least oppressive. If you disagree with what either of them are doing now, imagine if they kissed and made up and formed a unified "American Board of Podiatry." What recourse would we have?

 

[deleted1138023]

ABPM should just add surgery into its name somehow

 

[deleted1138023]

ABPM should just add surgery into its name somehow

Sorry to quote myself. But this would make abfas so mad. Do it Dr. Rogers lol

 

[deleted285117]

Sorry to quote myself. But this would make abfas so mad. Do it Dr. Rogers lol

Since ABPM does test surgical didactics... why not?

ABPMS it is 😎

 

[deleted1138023]

Since ABPM does test surgical didactics... why not?

ABPMS it is 😎

I don’t see why not

 

[Adam Smasher]

Sure, if we can have an organization called ACFAP dedicated to pediatrics, why not have an organization called ABPMS in response to a group that is always annoyed/irritable

 

[deleted1138023]

Sure, if we can have an organization called ACFAP dedicated to pediatrics, why not have an organization called ABPMS in response to a group that is always annoyed/irritable

They operate from an inferior position not having surgery in its name. ABPM should definitely change it’s name

 

[deleted285117]

They operate from an inferior position not having surgery in its name. ABPM should definitely change it’s name

Would be the ultimate troll move switching ABPM’s name to ABPS (ABFAS old name) 🤣

 

[icebreaker32]

Would be the ultimate troll move switching ABPM’s name to ABPS (ABFAS old name) 🤣

In reality they could lose their CPME backing if they did that. Like it or not they are the profession's medicine board. Many would argue we do not need 2 boards and the surgical board offering both foot and rear foot ankle certification...but that is where we are at unless they merge.

 

[deleted1138023]

In reality they could lose their CPME backing if they did that. Like it or not they are the profession's medicine board. Many would argue we do not need 2 boards and the surgical board offering both foot and rear foot ankle certification...but that is where we are at unless they merge.

hmm why are they in reality our medicine board?

 

[DYK343]

hmm why are they in reality our medicine board?

Because they are the american board of podiatric medicine...........

It wasnt until recently they introduced their CAQ

 

[FutureDPM323]

When it to comes to residency training all I know is that there needs to be better standardization and monitoring.

You will have some programs who have two second years double scrub a cheilectomy and each of the residents gets a primary number. One logs the first met exostectomy as primary and the second logs the proximal phalanx base exostectomy as primary (these are words straight from one of the resident’s mouth) and suddenly this program has 2 first ray procedures logged when in actuality it was 1. Or you’ll have the programs that have residents triple scrubbing a Lapidus procedure because they don’t see many.

Meanwhile at the really good programs, first year residents will primarily scrub a cheielctomy or other first ray procedures on their own!!!! While second and third years have progressed to doing more midfoot and rear foot cases with forefoot stuff sprinkled in.

How is this level of discrepancy in training allowed? And this is just one example. Doesn’t CPME audit programs? Are they not actually looking closely enough?

I know some will say not every program can be like the *good* programs and maybe that’s a big part of the problem.

 

[icebreaker32]

When it to comes to residency training all I know is that there needs to be better standardization and monitoring.

You will have some programs who have two second years double scrub a cheilectomy and each of the residents gets a primary number. One logs the first met exostectomy as primary and the second logs the proximal phalanx base exostectomy as primary (these are words straight from one of the resident’s mouth) and suddenly this program has 2 first ray procedures logged when in actuality it was 1. Or you’ll have the programs that have residents triple scrubbing a Lapidus procedure because they don’t see many.

Meanwhile at the really good programs, first year residents will primarily scrub a cheielctomy or other first ray procedures on their own!!!! While second and third years have progressed to doing more midfoot and rear foot cases with forefoot stuff sprinkled in.

How is this level of discrepancy in training allowed? And this is just one example. Doesn’t CPME audit programs? Are they not actually looking closely enough?

I know some will say not every program can be like the *good* programs and maybe that’s a big part of the problem.

You have learned what most of know to be true about podiatry residencies.

This is with "standardized" residencies.
You can only imagine what it was like before residencies were standardized.

With enrollment being down it would be an excellent time to get rid of the weaker residencies and cut down on saturation some.

Instead we open more schools because we can not shrink ourselves into prosperity.

 

[Pronation]

You have learned what most of know to be true about podiatry residencies.

This is with "standardized" residencies.
You can only imagine what it was like before residencies were standardized.

With enrollment being down it would be an excellent time to get rid of the weaker residencies and cut down on saturation some.

Instead we open more schools because we can not shrink ourselves into prosperity.

I just wanted to say that “weaker” residences is a massive understatement. Some of these turds should not be operating at all when they graduate from these garbage programs.

 

[FutureDPM323]

You have learned what most of know to be true about podiatry residencies.

This is with "standardized" residencies.
You can only imagine what it was like before residencies were standardized.

With enrollment being down it would be an excellent time to get rid of the weaker residencies and cut down on saturation some.

Instead we open more schools because we can not shrink ourselves into prosperity.

I just wanted to say that “weaker” residences is a massive understatement. Some of these turds should not be operating at all when they graduate from these garbage programs.

The more and more stories I hear about a lot of programs, the more I question everything. And the reality is that a large majority of programs are completely unnecessary and should be shut down. It’s not something I noticed until I actually started talking to residents at programs and asking them for their experiences. I would argue there’s probably 25-30 residencies MAX (I feel like I’m being generous too) that are actually of quality and churning out high quality surgeons/doctors.

 

[Pronation]

The more and more stories I hear about a lot of programs, the more I question everything. And the reality is that a large majority of programs are completely unnecessary and should be shut down. It’s not something I noticed until I actually started talking to residents at programs and asking them for their experiences. I would argue there’s probably 25-30 residencies MAX (I feel like I’m being generous too) that are actually of quality and churning out high quality surgeons/doctors.

I think this is a bit extreme. Probably at least half of all residency programs are good enough. The top 25% churn out high quality grads.

No doubt the bottom 30% need to be shut down.

 

[619]

I think this is a bit extreme. Probably at least half of all residency programs are good enough. The top 25% churn out high quality grads.

No doubt the bottom 30% need to be shut down.

Unfortunately the top 25% well trained grads are not guaranteed a good job. They still start out as associates making $100k base salary.

 

[dtrack22]

Unfortunately the top 25% well trained grads are not guaranteed a good job. They still start out as associates making $100k base salary.

*raises hand*

 

[Pronation]

Unfortunately the top 25% well trained grads are not guaranteed a good job. They still start out as associates making $100k base salary.

Yea obviously we know that, this is why you need to do a fellowship...





















...




























loooooooooooooooooooool

 

[Adam Smasher]

With enrollment being down it would be an excellent time to get rid of the weaker residencies and cut down on saturation some.

I think it was @ChiPod17 who alluded to something.

Good programs want to stay good and reduce residency slots to ensure case volume. So we should predict that as enrollment drops, good programs reduce positions while bad programs keep or possibly add positions meaning that an increasing % of grads will place into bad programs.

 

[Pronation]

I think it was @ChiPod17 who alluded to something.

Good programs want to stay good and reduce residency slots to ensure case volume. So we should predict that as enrollment drops, good programs reduce positions while bad programs keep or possibly add positions meaning that an increasing % of grads will place into bad programs.

that's the way the toenail crumbles​

 

[Feli]

I think this is a bit extreme. Probably at least half of all residency programs are good enough. The top 25% churn out high quality grads.

No doubt the bottom 30% need to be shut down.

Yes, I think roughly half of the current spots are probably good enough (volume, diversity, academics, board pass results, etc).
Some of those barely making the cut could definitely go from 3 to 2 per year, 4 to 3, etc to beef numbers, though.

For my match, I ultimately felt comfortable with the Detroit programs that I ranked 1 and 2. They had good history, good volume, good quality residents, many good alumni... and I'd witnessed that firsthand with clerk or visit. DMC was very good also (still one of the top in the country at the time), but it was not as much my style from the clerk month and they went to a different CRIPS location, and mainly, I already knew where I wanted to go anyways. The programs I ranked 3, 4, 5 were all ok... would've been adequate and ok with a match there but much lower volume, more double/triple scrubbing, far fewer RRA attendings and attendings overall. The rest of the dozen or more programs in the city were ones I'd honestly rather scramble than go to... probably could've passed boards with MUCH self-study, but volume and surgical exp would have been seriously lacking. So yeah... basically 3/12 good, another 3/12 acceptable but with some holes in them, 6/12 basically inadequate in my eyes.

There were other good programs across the country of course, but overall, for podiatry, it's basically ~25% high quality, ~25% adequate, ~50% highly suspect.

I think it was @ChiPod17 who alluded to something.

Good programs want to stay good and reduce residency slots to ensure case volume. So we should predict that as enrollment drops, good programs reduce positions while bad programs keep or possibly add positions meaning that an increasing % of grads will place into bad programs.

Yep, the effect of programs adding or removing spots is profound.

During the residency shortage of the early 2000s, the program I went to was getting pressure to have 7 or 8 spots (they had 4 spots with very good numbers). They politely declined to become an average program and stayed with 4 approved ever since (and declined to fill all in some years with big surplus of unfilled spots vs take anyone), but some other programs obviously increased spots and took whoever in match/scramble and have watered down or even ruined their training/rep. CPME was advising all of the good programs to add spots. That's too bad.

Bar none, the biggest dilution effect I saw firsthand was at West Penn... they'd gone from 3 or 4 for years up to 5 per year, and it was a huge hit on overall exp from what I could tell. This was a program that was churning out ACFAS presidents and stuff just a decade or so prior. It was still an amazing program with the kind of advanced elective recon and the whole mix of elective/trauma/diab you really only see at a small handful of programs, great academics, tip top attendings... but my conclusion is that there was just way too much double/triple scrubbing among residents to be working those hours. It was still a highly adequate program, but I would assume it was quite a bit better at 3/yr or 4/yr in the cycles before I visited. In the end, it's hard to say since programs obviously lose and gain attendings and facilities constantly. The program has since gone back down to 4/yr and then to 3/yr residents, so that's good. They did also lose their #1 or #1A attending since then, but the point is that adding even one spot (3 residents) is potentially very big on volume/exp.

 

[diabeticfootdr]

Since ABPM does test surgical didactics... why not?

ABPMS it is

Did you happen to notice what website is parked?

 

[deleted1138023]

Did you happen to notice what website is parked?

Abfas reading this

 

[diabeticfootdr]

In reality they could lose their CPME backing if they did that. Like it or not they are the profession's medicine board. Many would argue we do not need 2 boards and the surgical board offering both foot and rear foot ankle certification...but that is where we are at unless they merge.

We are in compliance with all CPME standards for recognition of our primary certification.

We’ve addressed any CPME requests for information and notices of potential non-compliance related to the CAQs and subsequently received continuing recognition, multiple times.