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

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[diabeticfootdr]

CPME is having a "Listening Session" on the revisions to the standards for podiatric specialty board certification on Wednesday, August 30 from 7-9 PM ET. If you'd like to attend and listen, register on the link below. If you'd like to speak, you must register and then email [email protected] with that request. CPME is limiting participant's speaking time to 3 minutes.

CPME Registration Link: https://us02web.zoom.us/webinar/register/WN_G8c6sFcvTRS8JOX5dsftbQ

We sent out the email below to the podiatry community and what we believe needs to change in board certification.

Dear ABPM Diplomates and Community of Interest,

The CPME has requested comments on the revisions to the standards for podiatric board certification.

We encourage you to register and speak up. If you want to speak, you need to email Dr. Heather Stagliano at the address in the email below with your request to do so.

We are sending this to you because several important issues on the future of board certification for the profession are to be decided by this committee.

At ABPM, we think the following issues need to be addressed to improve the process for all:

1. There should be ONE BOARD for the profession that tests at the standard of podiatric medicine and surgery residency (PMSR) with ONE TIER for certification
a. The profession is not served well by two boards and the reason two exist is purely historical. There is one residency that trains in both podiatric medicine and surgery. There should be one recognized, inclusive board. This similar to all MD and DO specialties. Similarly, the other specialties don't have multiple tiers of certification for the same residency. There should be one tier for certification in podiatric medicine and surgery that encompasses all of the PMSR. Splitting certification into the "haves and have-nots" with RRA only divides our profession and it is unnecessary since hospitals have the discretion and obligation to privilege a podiatrists based on their education, training, and experience. A podiatrist who doesn't have the requisite experience should not be privileged to perform those procedures. This is no different than orthopedics or any other medical specialty. We encourage CPME to take actions that standardize the profession with our medical colleagues by enacting standards for ONE BOARD, with ONE TIER.

2. Sub-specialization should be a part of a certification process
a. Podiatrists should be allowed to subspecialize in an area of podiatric medicine if they choose. The diversity requirements by some boards is onerous and not in the best interest of public safety. Forcing a podiatrist to perform procedures they do not have interest in or perhaps the experience for is a threat to public safety. If a podiatrist wants to subspecialize their practice in diabetic limb salvage or sports medicine, etc, there should be a pathway to demonstrate that expertise. At ABPM, we created the Certificate of Added Qualification program and it has been challenged by CPME, despite the fact CPME admittedly has no authority to oversee CAQs. We don't want CPME to try to retroactively govern a process that has already benefited many podiatrists. Instead, we encourage CPME to embrace the CAQ process.

3. Boards should be required to publish their true pass rates on their website
a. Some boards have multiple exams with various pass rates of each, but the true pass rate is the percent of people that pass the entire process, not a single exam. Board certification pass rate should not be hidden from the profession or the public and should be readily accessible. We encourage CPME to adopt standards that promote disclosure of the true certification pass rate.

4. There should be a re-entry pathway for podiatrists left behind by the current process
a. Many podiatrists have been left behind by the current requirements established by CPME and are ineligible to ever be board certified. As you probably know, if you don't become board certified, it can have a significant detrimental effect on one's ability to practice. Most commercial payers require board certification as do most hospitals for privileges. The current CPME rules mandate that a podiatrist have 3 years of residency training to sit for either board. Three-year residencies were only made standard in 2011. ABPM is contacted frequently by podiatrists who wish to demonstrate their expertise and sit for the exam, but ABPM cannot allow them to test. We think this is wrong and there needs to be a re-entry pathway for people who completed approved training programs in the past.

5. There should be a process allowing for extending eligibility for certification for personal or medical reasons
a. No podiatrist should have to choose between having starting a family and board certification. But that's what happens. Also, podiatrists who have practice gaps or reduced surgical volume due to personal or family medical issues or even because of the COVID-19 pandemic's effect on demand are finding it difficult to become board certified. We encourage CPME to enact policies which acknowledge and adapt to these life challenges.

If you agree with us, you want to stay informed, or you have other ideas to improve the certification process, please register for the "Listening Session" scheduled by CPME on August 30, 2023 as below in the forwarded email.

Sincerely,

Lee C. Rogers, DPM, FFPM RCPS(Glas)​

President
American Board of Podiatric Medicine
Fellow, American College of Podiatric Medicine
Fellow, American Society of Podiatric Surgeons

 

[Feli]

One board is never possible in podiatry. Too many people fail ABFAS. Those people need an alternative.

We missed the boat on DPM surgical and non-surgical residency types (as dentists do). We claim all DPM training programs are surgical and all DPMs were trained as surgeons and all can pass ABFAS [no and no and no, based on results].

...Perhaps one board could be considered in a distant future where pod school applicants are actually vetted and residencies are more uniform in case volume, academics, quality. CPME is in no hurry to ever get there with new schools and a resultant moratorium on closing/improving/consolidation of laggard residency programs.

As it stands, the "one board" calls in podiatry are just a plea to claim training and represent services/skills and acquire job options many DPMs unfortunately did not actually attain. Of course everyone wants to coattail the ones who did achieve the higher training and competence that all of podiatry likes to advertise. So: Make the training better and more uniform; don't just make tests easier. Blame the defective training model, not those who did the best they could with it.

 

[Retrograde_Nail]

What did everyone who took ABPM use to study ?

I didn't know you needed to study to pass ABPM. It is basically 100% pass rate

 

[Adam Smasher]

I didn't know you needed to study to pass ABPM. It is basically 100% pass rate

What's crazy is it's not 100%...scary

 

[Feli]

What did everyone who took ABPM use to study ?

I'd echo that you don't really need to.

If you are studying for ABFAS, you know more than enough for passing ABPM.
ABPM is just basic very minimal competence, like pt 2 and pt3 national boards.
If you want to, just do the free practice quiz on ABPM website or app or whatever to learn the format (unless that's changed... since most of the ABPM exam designers and BOD and exec director all resigned earlier this year).

 

[diabeticfootdr]

What's crazy is it's not 100%...scary

Why is that crazy? Look up the MD board pass rates. They’re low to high 90%s.

It shows that we’re testing at the standard of the residency programs.

Board certification shouldn’t be some elitist aspiration. It’s a basic need to practice.

 

[wakaflocka88]

Why is that crazy? Look up the MD board pass rates. They’re low to high 90%s.

It shows that we’re testing at the standard of the residency programs.

Board certification shouldn’t be some elitist aspiration. It’s a basic need to practice.

IMO, as Dr. Glaucomflocken alluded to - boards are a money grab/scam. It does not protect the public, in any medical specialty.

Maybe podiatry can pave the way and abolish both boards completely. Then we as lobsters can finally have a chance to rise in the ocean.

 

[Adam Smasher]

Why is that crazy?

Because anyone who pays attention in residency and invests themselves in patient care should pass without exerting effort. If they can't, shame on them and shame on their residency director. I'm sorry if this is an insult, but your test is not hard at all. There are hard questions about some esoteric topics but the test taker doesn't need to get them all right and ultimately P=OK.

 

[Shiyuan]

Maybe podiatry can pave the way and abolish both boards completely. Then we as lobsters can finally have a chance to rise in the ocean.

 

[icebreaker32]

Board certification shouldn’t be some elitist aspiration. It’s a basic need to practice.

Getting a job after residency that pays a fair salary with good benefits in a location of one’s choice after 11 years of education/training (including college) should not be an elitist aspiration either.

Our leaders need to make it their number one priority to do everything in their power to slash enrollments permanently until this changes.

All other issues pale in comparison to saturation and most if not all other issues will fix themselves if we address this. Nope the leaders double down on doing the opposite calling it an enrollment crisis and attacking internet forums. As a profession we are expanding fellowships which in some cases offers real value, but as a whole are further reducing the already poor ROI of this profession.

 

[diabeticfootdr]

Our leaders need to make it their number one priority to do everything in their power to slash enrollments permanently until this changes.

Nice derailing. Always a broken record.

Then write them a letter. Sponsor a proposition in the HOD. Or you could just keep complaining on SDN. But if you think it’s a central issue, why don’t you do something?

 

[Shiyuan]

Nice derailing. Always a broken record.

Then write them a letter. Sponsor a proposition in the HOD. Or you could just keep complaining on SDN. But if you think it’s a central issue, why don’t you do something?

Who would be the best contact(s) at APMA? (Personally i’m avoiding my state’s association)

 

[thefootguy]

You should work with your local association and your delegates to advance a proposition at the APMA HOD. You can speak to APMA staff about the appropriate way to draft it; Stephanie Simmons is an invaluable resource for resolutions/propositions at the HOD.

 

[thefootguy]

You could also reach out to members of the Young Physician Leadership Panel for assistance/guidance.

 

[Feli]

Nice derailing. Always a broken record.

Then write them a letter. Sponsor a proposition in the HOD. Or you could just keep complaining on SDN. But if you think it’s a central issue, why don’t you do something?

Money is undefeated.

All time. All venues.

CPME and APMA don't listen to logic (DPM job market, ROI, public need, ABFAS pass rates). They know that grads are struggling. They know there is an effective residency shortage of decent quality programs (truly "surgical" training for DPMs) that will worsen with more added schools and seats. They listen to money (tuition monies, supply of associates for VC, professor and director jobs for the DPM cliques, $ from corp sponsors, GME monies).

Tuition money is the only thing the schools listen to. Prospective students aren't fools, and they can evaluate ROI and value for their dollars from compensation surveys or shadowing or SDN or blogs or social or elsewhere. Money talks. That is the "do something." It's the same way rapid expansion of pharmacy schools had to fall flat on their face in terms of salaries and jobs for grads order to finally affect changes.

It's cute to pretend that that logic is at play, but money is the same reason you sponsored your own fellowship. You probably knew things were going nowhere fast with a NYC scramble "self motivated learner" residency program... so pay your own way to add a fellowship with a research name and connects to see if that improves the outcomes for you? Money is also the same reason you got steamrolled in congress run... I'm sure the 50% victor's budget was much bigger than your 29% losing side? Talk is cheap. Money talks. Money is undefeated.

 

[ExperiencedDPM]

Hold on…..without the APMA how would Sketchers get their coveted “seal of acceptance”?

 

[podwho]

Let’s be honest these forums are used by many pre-health students including when I was first considering it. You better believe it guides students decision making. It’s no surprise enrollment is down. In my oppinion…. Good.

 

[Hybrocure]

Why is that crazy? Look up the MD board pass rates. They’re low to high 90%s.

It shows that we’re testing at the standard of the residency programs.

Board certification shouldn’t be some elitist aspiration. It’s a basic need to practice.

I agree 100%. We have so many checkpoints in our training as it is between 3 APMLE exams, residency logs/numbers, state license, CME, etc. To complete all that and still be told you can’t be on an insurance or admit to a hospital because ABFAS didn’t say so is asinine.

 

[Hybrocure]

I'd echo that you don't really need to.

If you are studying for ABFAS, you know more than enough for passing ABPM.
ABPM is just basic very minimal competence, like pt 2 and pt3 national boards.
If you want to, just do the free practice quiz on ABPM website or app or whatever to learn the format (unless that's changed... since most of the ABPM exam designers and BOD and exec director all resigned earlier this year).

Board cert should be minimum competence That’s how it is for every other medical field. That’s why their pass rates are nearly 100.

When 1/3rd to a half of clearly competent doctors fail a board exam that’s a problem with the board.

 

[Retrograde_Nail]

Board cert should be minimum competence That’s how it is for every other medical field. That’s why their pass rates are nearly 100.

When 1/3rd to a half of clearly competent doctors fail a board exam that’s a problem with the board.

It’s not a problem with the board.

It’s a podiatry problem. Too many people who have no business being a doctor are let in and greased through school to keep the tuition dollars in.

These are people who didn’t put the time and effort in during high school and college who now want the easiest path towards being doctor.

Then they get greased through school only to match at a residency program that has no business holding an RRA certification.

Do you see what I am saying? Open your eyes.

We graduate just as many orthopedists each year from residency.

We have more fellowship programs than there are foot and ankle ortho fellowships

We. Are. Saturated

Somebody needs to draw the line in the sand and stop the madness

 

[Adam Smasher]

If board certification for anything (ABIM, ABPM, etc) is 100%, what's the point of board certification? What are you proving if you pass a test that everyone else can pass? It's just a doctor tax at that point.

 

[Hybrocure]

If board certification for anything (ABIM, ABPM, etc) is 100%, what's the point of board certification? What are you proving if you pass a test that everyone else can pass? It's just a doctor tax at that point.

I mean, it’s all a money grab. ABFAS just bleeds you over time

 

[Retrograde_Nail]

I mean, it’s all a money grab. ABFAS just bleeds you over time

Don’t be an idiot. How about that doctor? This ABFAS is too hard talk is getting old.

Podiatry just let’s in too many mediocre candidates that are set up for failure to begin with.

 

[Hybrocure]

Don’t be an idiot. How about that doctor? This ABFAS is too hard talk is getting old.

Podiatry just lets in too many mediocre candidates that are set up for failure to begin with.

There are a lot of great docs I know irl and good docs on here who are retaking ABFAS. They aren’t idiots. They’re smart and well trained. Still failing.

It’s clear for most they won’t change their minds on the topic of ABFAS or ABPM, it is what it is it’s politics. I won’t convince you and you won’t convince me. Agree to disagree.

I do agree with you completely regarding pod schools being lax on admissions for $$ and it does set many up for failure. You and Feli are great posters and good docs from what I can tell. I don’t agree w you guys on ABFAS and I could be wrong, it is what it is. I can see where you’re both coming from though

 

[Retrograde_Nail]

There are a lot of great docs I know irl and good docs on here who are retaking ABFAS. They aren’t idiots. They’re smart and well trained. Still failing.

It’s clear for most they won’t change their minds on the topic of ABFAS or ABPM, it is what it is it’s politics. I won’t convince you and you won’t convince me. Agree to disagree.

I do agree with you completely regarding pod schools being lax on admissions for $$ and it does set many up for failure. You and Feli are great posters and good docs from what I can tell. I don’t agree w you guys on ABFAS and I could be wrong, it is what it is. I can see where you’re both coming from though

If they are smart and still failing there are two reasons…

1) Lazy. Lazy because they didn’t take the time to use the publicly posted resources on the ABFAS website to learn how to take the test and how to document your notes and what is needed to submit for cases. Majority of people do no prepare themselves to submit the required paperwork for cases and they lose points.

2) Smart on paper but bad surgeon. If you keep failing then your cases were not properly worked up, executed, managed post operatively.

It’s usually number 1 that gets people in trouble but sometimes you need to look yourself in the mirror and admit you can’t do ankle, Charcot, or complex limb savage. This profession does not have enough good attendings across the nation in residency programs to give residents these experiences to handle these cases as attendings themselves.

 

[Feli]

Board cert should be minimum competence That’s how it is for every other medical field. That’s why their pass rates are nearly 100.

When 1/3rd to a half of clearly competent doctors fail a board exam that’s a problem with the board.

This is an invalid point. Other training programs (MD/DO), particularly surgical and procedure ones, have more uniform standards for their residencies... core competencies, skills labs, required volume of all common case types - or outside rotations to attain such. They have actual teaching hospitals as their sponsor, trauma centers, teaching attendings, research support, scheduled academics, in-training prep and Q&A. That is not to mention that MD/DO screen heavily on student talent prior to acceptance. Podiatry programs may or may not have those things. Surgical training in podiatry is new. Surgical training for all podiatrists is VERY new.

Example: my program was one of the very first 3 year podiatry surgery residencies, and that change was only in 1995 (less than 30yrs ago!). The Atlanta Podiatry Institute and Kern and a few others might have gone to 3yr residency a few years earlier, but the point is that 3yr training at all is new. Many grads got no residency at all in those days... or non-surgical POR, PPMR, preceptor residency types nobody has ever hardly heard of today. Most of today's PMSR/RRA programs are much, much, MUCH newer as a surgical program - especially as 3yr surgical than those OG few that converted in the 1990s. Even those original ones continue to change: I was in the first class (2012) at mine to train in the large teaching hospital, as opposed to small community hospital... so that facility standard, which would be taken for granted at MD residency, was only ~10yrs ago at one of our better programs. Many other ones still are not in teaching hospitals. The standards are alllllllllll over the board for podiatry residencies. They are an evolving process.

So, with regard to podiatry, there are basically two schools of thought here:

1: Podiatry "surgical" residency training is ok.​

So, let everyone pass boards. (make the ABFAS boards easier)

2: Podiatry "surgical" residency training is NOT ok.​

It is not standardized. Not at all. The programs are standarized in 3 year length and title only, but quality is highly variable. They need much improvement, so boards serve an effective and necessary function (one board, ABFAS, to signal real F&A surgical competence and standards... and another board, ABPM, to let anyone be 'board cert').

...if you want to take point 1, fine. Not a big deal... I'd agree to disagree. The residencies can't be trusted (any more than the pod schools). Just keep in mind that many of the DPM residency "PMSR/RRA" programs turning out what you consider "clearly competent doctors" weren't even surgical programs 20 or even 10 years ago. Most were PPMR, forefoot programs, or nothing. Many were sponsored by VAs, tiny non-academic hospitals, even hospitals that are essentially ASCs. Many still are at those limiting facilities where no MD/DO program would ever be sponsored (since they couldn't meet the standards).

The pod residencies - regardless of type or quality - were all hastily created into "surgical" residency spots... and then into 3 year programs just as fast. Those were the "vision 20xx" genius doctrines. This is why DPMs, then and now, do fellowships or preceptorships or hop between residency programs or opt out of doing surgery post-residency despite "surgical" training. The 'accredited' pod programs are night and day different. The resultant graduate product is not at all uniform in skill or competency, as it would be for MD/DO residency grads, who have both front-end student screening as well as uniform standards of quality residencies. Podiatry does neither. We have a defective and variable training model.

My career - or any DPM's - would be drastically different had we done a different residency program with different case types and volume... or lack thereof. There are DPM programs which do dozens of RRA elective, dozens of rearfoot and ankle ORIF, and 100+ bunions by graduation... and there are programs which clip nails and do wounds and barely have any real RRA or elective volume at all. You can finish an 'accredited' podiatry 3yr residency having never scrubbed - much less first assisted - on an Achilles rupture repair, a subtalar arthrodesis, a CBWO, an ankle scope, etc. You can graduate without spending any time in a real (teaching) ER or having published so much as a poster or lit review. That just does not happen where an ortho graduate has never done THA or ORIF radius or knee scope or rotator cuff or trained in a major center. Never.

The residency training quality and uniformity for podiatry will get even sadder with the new schools. Weak programs won't be closed/consolidated, and good programs will get pressure to water down numbers to accommodate grads. Happy day.

...This profession does not have enough good attendings across the nation in residency programs to give residents these experiences to handle these cases as attendings themselves.

This .... x1000.

On average, our post-grad training is a joke compared to any other surgical speciality (MD/DO/DMD).
We have great programs and we have pathetic ones... and many average ones also.
Some learn elective RRA in teaching hospitals, and some cut nails and do toe amps in VA hospitals.
Academics in the residencies and board pass rates (ABFAS BQ) are naturally highly variable among programs.
When you combo many subpar podiatry student acceptances with many lacklustre residencies, the results are not rocket science.
That residency standardization needs to be fixed. Everything else (jobs, boards, income, demand) would then fall into place.
You simply don't see ENT or OMFS or neurosurg complaining about being underpaid and needing to move to Maine or Idaho just to get a decent job.

 

[Sweatshirt]

Everyone needs to take their blinders off. Multiple things can be true at once. ABFAS can be a garbage boards organization (they are, and it's ignorant to think they aren't) AND we can be saturated in a field with people who should't be doctors

Both are easily fixable

 

[diabeticfootdr]

We did another Dean’s Chat with Dr. Jensen about Board Certification. This time we get a little controversial and tell it like it is!

 

[BubbaWub]

We did another Dean’s Chat with Dr. Jensen about Board Certification. This time we get a little controversial and tell it like it is!

That's my president!!

 

[Shiyuan]

We did another Dean’s Chat with Dr. Jensen about Board Certification. This time we get a little controversial and tell it like it is!

Gonna be a good watch; thanks for posting!

 

[newfeet]

We did another Dean’s Chat with Dr. Jensen about Board Certification. This time we get a little controversial and tell it like it is!

 

[Retrograde_Nail]

We did another Dean’s Chat with Dr. Jensen about Board Certification. This time we get a little controversial and tell it like it is!

I think you made some reasonable points here but I still don't understand the CAQ or the need for it. If someone graduated from a high powered residency and did a sports medicine fellowship to boot how does this person not qualified enough to practice sports medicine specific podiatry? Why do they need a CAQ for sports medicine? What about the podiatrist who has been in practice for 15 years and their practice has evolved to a sports medicine practice based on community need or their own personal preference. How do they demonstrate competency in sports medicine then? Are they really going to do a CAQ in sports medicine? Probably not. I just don't get it.

I think the discussion surrounding the CAQ and the idea of it is way too basic as there are so many complexities involving training in podiatry due to our lack of standardization in education and residency training.

There is no answer for it.

 

[Adam Smasher]

I bet anyone with a CAQ in amputation prevention performs more amputations in practice than anyone without it

 

[Feli]

I think you made some reasonable points here but I still don't understand the CAQ or the need for it. ...

You guys are waaay overthinking this CAQ thing. These YT vids are canned promos. They are scripted and rehearsed. Note the repeated use of "I know we are going to talk about X later in our interview."

I shall explain CAQs with a fictional short story:
Charlie talks big on SDN as a student... talks up ABPS, talks down ABPOPPM.
Charlie stumbles in match, gets NYC program... tries to redeem, does fellowship.
Charlie doesn't pass ABFAS (then ABPS). Classmates pass. Co-residents pass. Colleagues passed.
Charlie is mad, twists moustache.
Charlie joins ABPM / ABPOPPM.
Charlie invents CAQ program.
Charlie adds CAQs to the program.
Charlie launches CAQ Surgery cannonball to take down ABFAS.
CAQ Surgery is not widely adopted (womp womp womp), so it doesn't work to backdoor Charlie a way into surgery cert or one board or etc.

Again, don't think about it logically... it makes little sense.
Of course an already limited DPM specialty doesn't need more certs and sub-specialties.
Look past all of the talking and altruistic smokescreen stuff.
Look at history. Look at personal motivations. Be simplistic. Life is simple.

...do need to show love to the ~17min mark where they say, after much fidgeting, that ABPM pass rate is "82-88%", though. Maybe it was meant to be 99.82-99.88%?

Honorable mention to the part explaining the ABPM president terms (which is now long lapsed for current president)... since the BOD and execs walked out and quit and they're nearly all currently non-elected appointees with an expired president. High comedy.

 

[JustAPedicurist]

whether you love him or hate him... he makes sense. we need one board, we need to be more unified as well. this profession is so fractured with the surgical egos vs the nonsurgical.

 

[BubbaWub]

whether you love him or hate him... he makes sense. we need one board, we need to be more unified as well. this profession is so fractured with the surgical egos vs the nonsurgical.

I love him. I wish we had more leaders like him in our profession. I would let him autograph my newborn child (6th by the way). I am not LDS.

Thank you.

 

[Sweatshirt]

We did another Dean’s Chat with Dr. Jensen about Board Certification. This time we get a little controversial and tell it like it is!

Good talk overall. You seem like a nice guy, keep up the good work. I hope one day we can meet up at a conference, I'll buy you a drink, and we can cheers to the bankruptcy of ABFAS

 

[Hybrocure]

We did another Dean’s Chat with Dr. Jensen about Board Certification. This time we get a little controversial and tell it like it is!

That’s a cool concept for a podcast and that a dean is going out there and doing stuff like this. Tuning in now. I like how you talk about your program doing skin to skin that’s something that more places need to be proud of having their students/residents do.

 

[Feli]

whether you love him or hate him... he makes sense. we need one board, we need to be more unified as well. this profession is so fractured with the surgical egos vs the nonsurgical.

Is that what we need? I'm not sure if one board is the answer.... lower the standards in a profession we all agree needs better avg training and admissions criteria??? Change all of the fails to pass? Lower the competency bar, so all can easily step over?

Would that help anyone to basically pardon the repeated failings or future failings of pod schools, admissions, curriculum, students, poor quality residencies?

Does that 'one board' idea do anything to address the real podiatry problems: subpar residencies, too little volume, thin academics, and far too many grads?

What is wrong with a real podiatry board with actual standards ... and an alternate board everyone passes (for insurance/hospitals)? It seems hard to have one board when many students and residents cannot seem to pass the exams. A gatekeeper is needed at some point. It seems hard to promote people as surgeons when they fail an exam the majority of their peers pass. Two boards seems like the logical play at this point, and it has been that way awhile due to HUGE variance in post-grad training of DPMs. It's unfortunate, but this is the result of the push for all DPMs doing 3yr surgical residencies - without actually having anywhere near enough such quality programs.

I would say make the DPM training better (especially post-grad, residency level). We could have more uniform residency standards and regulate our saturation, kinda like MD, DO, dent, and other successful and higher income professions do. Lowering the training/exams bar only hurts our cause. It may be unsafe to stamp off on everyone at this point; our training doesn't support it. That allows residencies to stay defective and the schools to expand, MCATs go even lower... with more low-end residencies created fast to match grads. Worst, it gives ortho and others a bunch of anti-podiatry bulletin board material to have 'certified' DPMs with certs for doing things they didn't train well on and failed tests on. JMO

 

[FutureDPM323]

I feel like a potential fix is to stop forcing these 3 year residencies on everyone who wants to practice podiatry. Allow podiatrists to complete one year of internship and if they choose can then be a non-surgical podiatrist. If they choose to continue down a surgical path then complete the full 3 years with one surgical board. The non-surgical podiatrist would have their own board.

But that would entail overhauling a lot of things and closing down crappy programs which cpme would never do.

There are so many ways that the profession can be fixed. They’re not easy fixes by any means nor are they quick but they’re much better options than us literally being in the same spot year after year after year….

Plus not everyone who goes into podiatry wants to be a surgeon and those that don’t want to shouldn’t be forced to do a full 3 surgical residency just to then practice non-op.

 

[icebreaker32]

I feel like a potential fix is to stop forcing these 3 year residencies on everyone who wants to practice podiatry. Allow podiatrists to complete one year of internship and if they choose can then be a non-surgical podiatrist. If they choose to continue down a surgical path then complete the full 3 years with one surgical board. The non-surgical podiatrist would have their own board.

But that would entail overhauling a lot of things and closing down crappy programs which cpme would never do.

There are so many ways that the profession can be fixed. They’re not easy fixes by any means nor are they quick but they’re much better options than us literally being in the same spot year after year after year….

Plus not everyone who goes into podiatry wants to be a surgeon and those that don’t want to shouldn’t be forced to do a full 3 surgical residency just to then practice non-op.

There is no easy way to roll things back now. It would be much harder than you can even imagine to make a lesser trained non operative podiatrist competitively paid and in demand.

You have to realize podiatry in general is already an office heavy surgical specialty in most settings. Many are making much of their income in the office from non surgical income sources (grafts, DME etc) though without at least offering surgery much of this income would dry up. Many well trained surgical podiatrists only do surgery one morning or day every week or two. Podiatry is not really increasing in demand, we are basically just barely replacing more than the number of retiring podiatrists. We have many surgically trained podiatrists that have replaced non operative podiatrists already over the last 20 years and more to come for the next 10-15 years.

We will likely have a surplus of surgical talent out there for the next 30 years. Midlevels can also essentially function as a non operative podiatrist in many settings with better scope of license and less pay or at least less pay if we are talking a good ROI for podiatry.

There is stil a lot of toenail trimming out there going on and enough fellowships out there for almost 20 percent of graduating residents.

Podiatry will continue to be a have and have not profession for the foreseeable future,

The only way to alter this significantly is to cut enrollment to the point where the occasional good job in a good location does not instantly fill. When enrollment dips to anywhere near the point where maybe this would be possible with 15 years of significantly reduced enrollments it is called an enrollment crisis.

Certainly we have made some progress as far as training, hospital privileges and scope etc, but we have created other problems. We even have enough organizational jobs now that they are highly visible in many communities....but the irony is they are still competitive to get.


With the cost and length of training how many want to enter this professions knowing:

1. There are limited organizational jobs that are basically the stereotypical doctor jobs these days for MDs and DOs. Good pay and good benefits often with signing bonuses, loan assistance and relocation assistance.

2. A rite of passage as an underpaid associate that you may or may not escape

3 . You might have to start your own office. It might work out, but takes capital and usually involves negative cash flow for a period of time. The risk of failure or making close to associate pay going this route is another risk with no easy organizational jobs to fall back on.

4. Still lots of mobile podiatry and nursing home jobs posted online. Is this what you want to do for a living after 11 or more years of training after high school. Working for someone else doing this has the same ROI concerns. It is not usually easy to scale on your own to where you can do this full time. You will usually eventually run into facilities that are locked down by other podiatrists or companies at that scale and be spending the nights at cheap hotels driving far enough to have enough facilities. You often have to push coding to make a decent living also. Many have got into trouble for coding way too many ingrown mail procedures without using a local anesthetic.

5. Competition from midlevels for certain jobs.

6. Expanding DO schools, expanding midlevels programs that are tempting career options to consider. Even a RN degree with travel or advanced training (NP) or an administrative route with an MBA or MHA can pay well and you take in much less debt and can often advance your training while making money and sometimes even get your current employer to foot the bill.

7. The difficulty switching jobs in your current location, finding a job in a different location or changing how you practice (not many administrative, work remote or academic jobs for podiatry).

 

[Adam Smasher]

Still lots of mobile podiatry and nursing home jobs posted online. Is this what you want to do for a living after 11 or more years of training after high school. Working for someone else doing this has the same ROI concerns. It is not usually easy to scale on your own to where you can do this full time. You will usually eventually run into facilities that are locked down by other podiatrists or companies at that scale and be spending the nights at cheap hotels driving far enough to have enough facilities. You often have to push coding to make a decent living also. Many have got into trouble for coding way too many ingrown mail procedures without using a local anesthetic.

This is it. This is the demand for podiatry services. We reduce enrollment and under everyone's breath we ask "BuT wHo WiLl CuT tHe ToEnAiLs?"

Expanding DO schools, expanding midlevels programs that are tempting career options to consider. Even a RN degree with travel or advanced training (NP) or an administrative route with an MBA or MHA can pay well and you take in much less debt and can often advance your training while making money and sometimes even get your current employer to foot the bill.

And this is why I don't think SDN is impacting enrollment as much as we're blamed. I keep saying, pre-health students ain't stupid. They can figure out what paths will pay off and which ones won't. Podiatry isn't a bad path per se, just there are too many better alternatives. Pre-health students can and are determining this without our help.

 

[newfeet]

I feel like a potential fix is to stop forcing these 3 year residencies on everyone who wants to practice podiatry. Allow podiatrists to complete one year of internship and if they choose can then be a non-surgical podiatrist. If they choose to continue down a surgical path then complete the full 3 years with one surgical board. The non-surgical podiatrist would have their own board.

But that would entail overhauling a lot of things and closing down crappy programs which cpme would never do.

There are so many ways that the profession can be fixed. They’re not easy fixes by any means nor are they quick but they’re much better options than us literally being in the same spot year after year after year….

Plus not everyone who goes into podiatry wants to be a surgeon and those that don’t want to shouldn’t be forced to do a full 3 surgical residency just to then practice non-op.

That makes some sense... but I didn't mine the 3 year residency. I think the PMSR is here to stay.

 

[icebreaker32]

Podiatry isn't a bad path per se, just there are too many better alternatives. Pre-health students can and are determining this without our help.

True much of podiatry's problem as far as enrollment is not arguing its about own ROI, but that other professions clearly offer a good ROI and a more flexible degree with a better job market. Podiatry is becoming even a longer career path with so so many doing fellowships. Many of the other options are shorter and less expensive career paths. First world problems? Sure. I still feel saturation is out of control, but other opportunities becoming increasingly desirable certainly play a role also.

The schools and organizations can not control that part. They are unsure if it is just a few students they are losing or more than a few because of these forums so they attack them and try to paint a picture of the profession which is attainable for some, but not guaranteed. Acting like you can simply have the choice after residency of taking a high paying job with flexibility and good hours or taking an employed job at a hospital.

 

[air bud]

I feel like a potential fix is to stop forcing these 3 year residencies on everyone who wants to practice podiatry. Allow podiatrists to complete one year of internship and if they choose can then be a non-surgical podiatrist. If they choose to continue down a surgical path then complete the full 3 years with one surgical board. The non-surgical podiatrist would have their own board.

But that would entail overhauling a lot of things and closing down crappy programs which cpme would never do.

There are so many ways that the profession can be fixed. They’re not easy fixes by any means nor are they quick but they’re much better options than us literally being in the same spot year after year after year….

Plus not everyone who goes into podiatry wants to be a surgeon and those that don’t want to shouldn’t be forced to do a full 3 surgical residency just to then practice non-op.

Then don't go to podiatry school in it's current iteration...simple answer for the existing structure. Decide you don't like surgery? Should have done more shadowing in most instances.

 

[Adam Smasher]

I feel like a potential fix is to stop forcing these 3 year residencies on everyone who wants to practice podiatry. Allow podiatrists to complete one year of internship and if they choose can then be a non-surgical podiatrist. If they choose to continue down a surgical path then complete the full 3 years with one surgical board. The non-surgical podiatrist would have their own board.

But that would entail overhauling a lot of things and closing down crappy programs which cpme would never do.

There are so many ways that the profession can be fixed. They’re not easy fixes by any means nor are they quick but they’re much better options than us literally being in the same spot year after year after year….

Plus not everyone who goes into podiatry wants to be a surgeon and those that don’t want to shouldn’t be forced to do a full 3 surgical residency just to then practice non-op.

Several months ago I wrote a post about an Australian DPM who was able to get her doctorate 5 years out from high school and go straight into practice. Think about it.

 

[newfeet]

Then don't go to podiatry school in it's current iteration...simple answer for the existing structure. Decide you don't like surgery? Should have done more shadowing in most instances.

I feel like a 3 year residency is the bare minimum for a "doctor". If you don't like surgery you do not have to do surgery post residency. It might be a waste of time but you are getting paid to learn during residency.

 

[air bud]

I feel like a 3 year residency is the bare minimum for a "doctor". If you don't like surgery you do not have to do surgery post residency. It might be a waste of time but you are getting paid to learn during residency.

Yeah I am just saying by definition podiatry is a surgical sub specialty. In it's current form at least. This is why myself and lots of others on here chose it over going DO and getting funneled towards FP,ER etc.....little did we know.

Anyways, Do your own research as the kids say. And as q anon says.

 

[Boba Foot]

we can cheers to the bankruptcy of ABFAS

ABFAS has called and emailed multiple times trying to get me to pay $300 per exam to “convert” my ITE pass to BQ. They sound quite desperate for cash. Sad and pathetic money grab really.

 

[SouthPod7]

Ideally, enrollment (and graduation) should roughly equal the number of good programs out there. I don't think we need a two-tiered structure like dentists. If, for the sake of conversation, 50% of all residencies were insufficient/garbage and were closed, and if we graduated about that same number of students, that would solve saturation and also guarantee a higher caliber/standard for graduating residents.