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

 

[BeaverBlade]

I'm an outsider now. Not on the BOD and not representing ABPM, so these are just my opinions with the perspective of experience. But believe me, they're not going to merge. ABFAS claims it's a violation of the Sherman Antitrust Act of 1890 to even speak of it. ABPM is actually winning the long game. They're gaining membership, ABFAS has been losing membership (more yearly retirees than those who pass the exam). ABPM will soon surpass ABFAS in active Diplomates. ABPM certification is an accepted qualification at ~85% of hospitals and growing. ABPM has been winning "public opinion" for being fair, fiscally responsible and aggressively standing up to the BS for the younger DPMs. ABFAS is scared. So what does ABPM have to gain for its Diplomates by allowing ABFAS to publish meaningless kumbaya posts about "joint webinars"?

you don’t have to answer this.

But for the reasons noted above I can conclude that abfas recently made it easier to get certified in their board because of “losing ground”

So they can’t really have the argument of “protecting the public” both ways if they can arbitrarily decide to all of a sudden make it easier to pass their certification process.

When it’s all good and the gravy is flowing we’re going to make it real strict and difficult… but when we need members we suddenly lower the case requirements.

Sigh…. It’s all a business.

 

[dtrack22]

you don’t have to answer this.

But for the reasons noted above I can conclude that abfas recently made it easier to get certified in their board because of “losing ground”

So they can’t really have the argument of “protecting the public” both ways if they can arbitrarily decide to all of a sudden make it easier to pass their certification process.

When it’s all good and the gravy is flowing we’re going to make it real strict and difficult… but when we need members we suddenly lower the case requirements.

Sigh…. It’s all a business.

No, according to Feli it’s about protecting patients 😉

 

[BeaverBlade]

No, according to Feli it’s about protecting patients 😉

It’s so easy to see right through this nonsense.

 

[Feli]

ABPM is sufficient for just about every job. It’s a legitimate board that doesn’t make its members pay more money to pass 4 separate exams and then make them pay again for 2 separate case reviews

Qualified and certified is a ridicolous concept. Either you’re certified or not is how it should be. If you don’t think someone should be certified without proving themselves via cases then you should work on fixing the residencies. To graduate residency you have to have been deemed competent. Does abfas think our residencies are inadequate? Are they trying to fix them if so? Is that why there is such a push for fellowships? Or is it about getting an associate who can take unlimited call for the price of a resident?

The boards should definitely merge. It’s what everyone wants. Ego will likely get in the way though.

Uh, yeah, but...

All MD/DO surgery boards (ABMS boards) use the qualified/elgible (passed written) and then certified (passed cases, a year or more later, as attending). This is common to OB, Ortho, GSurg, Plastics, ENT, etc etc. Meanwhile, a lot of podiatry residencies ARE incompetent... look at their BQ pass rates. (the residencies DO need to be fixed/closed/merged... yes)

Podiatry schools take basically anyone, some graduate almost anyone, and residencies were all hastily converted to "3 year surgical."
These issues are nothing new. The results will be the same as when there were some grads without residency or when there were various length residencies... still end up with: too many grads, infighting, high competition for jobs, low ROI on degree cost, variable competence from DPM to DPM.

Again, guys:

1. There is no Ortho who finishes residency without exposure to femur fx, TKA, radius fx, ACLs, ankle ORIF, etc many times over in a teaching hospital... then they 98% pass boards BQ around residency end (cases for cert later on).
2. There is simply no general surgeon who didn't have appendix, hernias, lipomas, chole, hemmorhoids, scopes dozens or even hundreds of times over in teaching hospitals... then they 95% pass boards at residency end (cases for cert later).
3. But then in podiatry, we have many programs where the residents graduate yet have never done a single TMA, never a cavus foot, some don't do even one peds flat foot, an acute Achilles rupture, ankle ORIF, calc ORIF... and they fail BQ at a very high rate at some programs. We have many of our programs that are not at teaching hospitals (at VAs, small hospitals, etc). The difference from MD to pod is the student/resident quality on the front end, and it's also the standardized quality of residency training. Pure and simple.

ABPM is a joke and an alternate podiatry board. It always has been. It's the safety net. That's their bu$iness plan.
Of course newer grads may take ABPM as it's easier and cheaper and "certified" faster. But that is also why your application gets tossed for the majority of the best DPM employed jobs without ABFAS (it is clear you took the easier route to any DPM who understands our training and boards). If you do F&A surgery (as a podiatrist), then ABFAS is logically the appropriate board. If you think you might ever change jobs, same: do ABFAS. If you do just wounds and office stuff and/or failed ABFAS after a real try or two, then that'd be ABPM (which was for many many years ABPOPPM, also non-surgical).


And sure, there are hospitals/places that'll allow ABPM and most supergroup jobs could care less as long as associates take low-ish pay, and it's also fine to do that if one can't pass ABFAS. It's a risk to do that and hope to work there forever (and hope rules don't change).

"ABPM certification is an accepted qualification at ~85% of hospitals", but then ABFAS has... 100%? So, which is more logical? Careers are long. Why limit yourself? The 600 other "foot and ankle surgeon" grads every year will make the job market hard enough - even if you get ABFAS. You will be applying against fellowship pods, more exp pods, more charming ones, and many others. You have no reason to start out the podiatrist career race with a voluntary TMA just because you don't want to study or log cases! This is podiatry; the fellowships and the pay and the job maket very loudly and clearly tell you that you need every advantage you can get. 🙂

 

[BeaverBlade]

So if everyone knows some residencies suck why isn’t the actual problem addressed instead of doing all these other safety measures because of those residencies? Once again never fixing the real issue.

Also crazy enough some residencies 20+ years ago actually got more volume/hands on experience than now. Now we have fellows taking residents cases.

I think there should be a skills portion in residency that is objectively graded/reviewed somehow. Can be done in a cadaver lab, can be done on an actual case, etc. assign a number score to the residents performance. They need to actually “pass” if they’re going to get a certificate for pmsr/RRA besides just meeting minimum numbers. Yes no one wants to fail a resident.

There are good programs out there. The key is the residency director has to give a ****. Most don’t.

Abfas vs abpm debate is old. They need to merge. 90%+ podiatrists agree except those that really just want to gatekeep from jobs. If you want to protect the public it’s done via training through improving residency. Not making people who have been at this for 7+ years pass more unnecessary exams/make them fight their former employers for notes/etc

Also the hate for @diabeticfootdr is crazy. I’m not going to get on my knees here but he’s one of the few people who has ever been in leadership to show that they actually care. He’s actively going on podcasts and this site trashing private equity. He seems to mentor his residents well. He seems to run a solid very academic residency and is dedicated to the success of his residents. Some other directors are dedicated to their pocketbook only and they’re using their residents to grow their empire.

Also the CAQH thing was (imo and I have no sources) done to protect ABPM’s members. Abfas has made a push that they’re the only legitimate board to hospitals. You do not move forward the profession through exclusion. Instead they thought exactly what @Feli is saying here that in order to grow they need to force everyone to be abfas.

Also just because you’re abfas doesn’t mean you’re good. I have seen a ton (and I’m sure we all have) of terrible post ops from “abfas certified” podiatrists.

Abfas is ortho faction of our profession.
abpm seems to be the podiatry side of our profession

The real difference here is the IDENTITY crisis we as podiatrists have always had. (Just look at the five versions of residencies that existed 20 years ago)

Just my 2 cents. For the better of the profession we need the ortho part of the profession and podiatry portion united.

Create one board. American Board of Podiatric Medicine and Surgery. Don’t run from the word “podiatry”

 

[air bud]

It’s a lot of money to get ABFAS for a 1% chance.

It's not. Cut your doordash budget. When I was in residency....

 

[Adam Smasher]

Don't laugh, but I'm certified with ABWM. Because I actually like wound care. And I had time to work on this certification in spring 2020 when I was seeing 10 patients/week. But to the extent that it matters that my patients are impressed with me, ABWM is the certification that gets the most reaction. "Why settle for a common foot surgeon when I can be treated by a bona fide wound specialist?"

 

[Forcewielder]

ABPM is a joke. ABFAS would do well to update their verbiage so a qualified candidate is a certified one, but they need to present cases quicker to maintain. If you can't gather the necessary number in 3-4yrs you shouldn't be a surgeon. Whatever the number they allow is asinine.

I'm fine with 2 boards, but ABPM should be non-surgical. As a fairly recent grad I'm not a fan of all these poorly trained podiatrists watering things down. The other surgical specialists have a very rigorous case presentation, but are considered certified from day 1. We should too. I really think around half of new grads could benefit from a single year of residency. They would be nonsurgical, but it would be better than passing them along in a poor program. They're then expected to function autonomously from day 1, when many have had very few true unassisted cases.

I don't care that the numbers favor ABPM of late. That just proves my point there's too many unmotivated podiatrists.

 

[BeaverBlade]

ABPM is a joke. ABFAS would do well to update their verbiage so a qualified candidate is a certified one, but they need to present cases quicker to maintain. If you can't gather the necessary number in 3-4yrs you shouldn't be a surgeon. Whatever the number they allow is asinine.

I'm fine with 2 boards, but ABPM should be non-surgical. As a fairly recent grad I'm not a fan of all these poorly trained podiatrists watering things down. The other surgical specialists have a very rigorous case presentation, but are considered certified from day 1. We should too. I really think around half of new grads could benefit from a single year of residency. They would be nonsurgical, but it would be better than passing them along in a poor program. They're then expected to function autonomously from day 1, when many have had very few true unassisted cases.

I don't care that the numbers favor ABPM of late. That just proves my point there's too many unmotivated podiatrists.

 

[eyeeye_captain]

The other surgical specialists have a very rigorous case presentation, but are considered certified from day 1.

Respectfully, I know this part isn’t the case, so I did some digging, and I suspect you won’t be the only one surprised. Eyes, urology, OMFS, and all of general surgery including fellowships (except for plastics) use the case log to show you met the minimums, but they test on standardized cases at oral boards, not your own.

You’re qualified on day 1, not certified, and heck, ortho has to practice for 17 months in the same place postgrad to sit for orals/case review. First couple jobs don’t work out? Time to sweat.

Sorry for the aside. All boards are pretty miserable. I didn’t realize ABFAS even makes you submit nursing notes for selected cases - that seems a bit anal.

 

[Feli]

Both are true... all MD surgical boards are qual/eligible, then cert after review of their own cases or standard ones (submit logs). That's gen surg, OB, Ortho... all of them. There's a BQ span, though.

Also true is most DPMs take the easier route. Can't blame them, but it's good to at least try for ABFAS if you are doing surgery (which ~90% of modern podiatrists do, at least for awhile).

... I really think around half of new grads could benefit from a single year of residency. They would be nonsurgical, but it would be better than passing them along in a poor program. They're then expected to function autonomously from day 1, when many have had very few true unassisted cases...

Agree, but it'd really be more like 75% or 80% or more general non-op podiatry (like dentists). That's the demand, honestly... nails, calluses, wounds.

For every hospital, ortho group, real busy PP, etc podiatrist doing 5+ surgery per week, we have tons of others averaging maybe 1 real surgery case per week... or less. All but the 1% of podiatrists have paltry surgical volume in comparison to any F&A ortho, and that's just how refers go.

Podiatry missed the mark badly on "all are surgeons," as we just don't have the demand or training or overall talent for that. It was likely a marketing thing, but WOW has it turned out poorly to have so many ppl $300k+ in debt to cut nails and maybe do one or two bunions and one or two amputation and 200 nail care and 100 DM foot clinic visits and 50 other clinic visits per month. ABPM in its present form is just a sad byproduct of that reality.

It'd save a lot of debt to most DPMs and give more case volume (training and after) if we had a minority do longer surgical training. Most should do 1-2yr general podiatry residency (prac mgmt, derm, non-op fx and sports med, wound care, DME, rheum, rad, etc... ppl know how to cut nails even by end of pod school, I hope). That's just the real world demand. Most need to be prepped for that; the surgery is a small part of what we do (yet 90% of the marketing by schools/orgs).

 

[dtrack22]

The other surgical specialists have a very rigorous case presentation, but are considered certified from day 1.

 

[Forcewielder]

I was going off of what I'd been told and hadn't researched it. My bad. I've got a general surgeon colleague who is the same age and the way she described their case presentation seemed more intense than anything we do. Also, every hospital I've gotten credentialed at has only had an option for boards certification, not qualification and it has led to me having to explain to HR multiple times why I was not yet certified and what the process was.

I stand by what I said though about ABPM vs ABFAS. I'm far from a Bad Ass. But I am not a danger to patients in the OR. Getting your ABFAS numbers should be a breeze. We don't do ourselves any favors as a profession pretending that case submission should be optional for surgical privileging. We all know there are a not-insignificant number of doctors that barely make it through school, get pushed along through residency because the program doesn't want to fail anyone, and then come out applying for jobs as surgeons when they have no real idea what they're doing. I suppose that part is not unique to podiatry, but case submission is the 1 final step that can ensure those guys stay out of the OR.

 

[msion]

I was going off of what I'd been told and hadn't researched it. My bad. I've got a general surgeon colleague who is the same age and the way she described their case presentation seemed more intense than anything we do. Also, every hospital I've gotten credentialed at has only had an option for boards certification, not qualification and it has led to me having to explain to HR multiple times why I was not yet certified and what the process was.

I think the ABFAS process is actually quite intense and more intense than the general surgeons. For general surgery they have oral exams which function like our CBPS portion of the exam, except for it's done by real examiners asking you clinical scenarios. I don't think general surgery requires a case review process.

The ortho board does the case review and the process is similar. You upload imaging and notes, and then head over on your exam date to face a group of examiners to answer questions about your selected 12 cases. Our case review is done without our participation, and thus can be very subjective. You will not get any real feedback. ABFAS used to have oral boards as well but they got rid of it and changed it to the computer format.