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[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

 

[Boba Foot]

Part I Board Qualification Examinations

How nice of ABFAS to release pass rates from the spring exam, and not from the ITE training in the fall where they deliberately write very difficult exams with low pass rates so they can double dip $$ and push residents into retaking it in the spring. I sat both times and the fall ITE RRA was MUCH more difficult than the spring RRA exam. Classic feigning "transparency" while pissing on everyone's back and telling them it's raining. Show us all the pass rates for the last 5 years or GTFO.

 

[malleolusman]

This thread should be stickied.

 

[AttackNME]

The best is the ABFAS statement having a link to their “pass rates” not being an issue then they show the 60-80% pass rates for the RRA stuff.

I’m in a state that is being threatened with a lawsuit for requiring ABFAS RRA just to get a special state license to perform any ankle surgery. Only 30 podiatrists in the whole state have RRA. It’s a small state but that’s still only 20% of podiatrists here. So the state podiatry organization was going to come out with a statement or position saying they support the removal of ABFAS requirements just for licensure. Theeeeen they have a board meeting and the state org board decides to support the requirement for licensure…joining the state Ortho organization and the state medical association saying it’s a patient safety issue. The state podiatry organization is supporting scope restriction for 80% of its members. A majority of those people should withdraw their membership and not renew next year when dues come due…but it’s podiatry. So they won’t. And we continue to be the only profession that puts restriction on our own scope to make MDs and DOs and a small % of RRA cert DPMs happy. They have no data to suggest patient safety has actually improved since requiring ABFAS for licensure/ankle privileges. Name me a single medical specialty who is actively preventing their physicians (go ahead and throw PAs and NPs in there) from practicing the thing they were trained to do?

And if @diabeticfootdr is reading this, and you need a podiatrist in the state to join the lawsuit, let me know. I’m sick and tired of our dumbarse profession. Literally zero podiatrists (and really no ortho) on the entire east side of the state (other than myself) will do any ankle surgery that isn’t a fracture. No charcot recon. No post traumatic salvage. They are actively limiting access to care for hundreds of thousands of people.

So new grads in your state aren’t allowed to touch the ankle and will have no chance of getting RRA unless they work out of state first?

 

[air bud]

So new grads in your state aren’t allowed to touch the ankle and will have no chance of getting RRA unless they work out of state first?

Donny you're out of your element

 

[dtrack22]

So new grads in your state aren’t allowed to touch the ankle and will have no chance of getting RRA unless they work out of state first?

You can if you are board qualified. Which makes it even more silly when you think about it. Coming out of residency you can fix an ankle fracture based on training and case logs (which is the only way you will get those privileges in most cases). You can continue to do them successfully for years and have your local hospital or surgery center’s approval. You can even get board certified by a specialty board that your hospital or ASC recognizes as being adequate in their bylaws. And then suddenly, years later, if you don’t pass an exam by a single outside organization, despite your local community saying that you’re doing just fine, boom…no ankle surgery for you.

This was probably a bigger deal when all of the diversity requirements (put in under an ABFAS President that didn’t do a diverse array of cases herself) were in place. It would be easy to go into a podiatry group and not get much trauma or even ankle recon, so you have enough cases but not the “diversity” of cases ABFAS required. You don’t get ABFAS cert. Sorry, can’t do a Brostrom any more. I think that’s changed but honestly I haven’t looked in years. Regardless, it’s still the principal of podiatrists and podiatry organizations (who are supposed to be fighting to advance our scope, or at least prevent it from being trampled on) actively supporting limitations on the practice of other podiatrists.

ABFAS tries to make things extra rigorous to prove the MD/DOs that we are good enough to do the thing that orthopedic surgeons with minimal foot and ankle experience or case volume are allowed to do (with no questions asked). Only to be used as a weapon by state orthopedic associations and other podiatrists. ABFAS is a guy who goes out of his way to impress a girl (ie real doctors), only to get ****ed by said girl, over and over again. As the kids would say, ABFAS is a total simp.

 

[AttackNME]

You can if you are board qualified. Which makes it even more silly when you think about it. Coming out of residency you can fix an ankle fracture based on training and case logs (which is the only way you will get those privileges in most cases). You can continue to do them successfully for years and have your local hospital or surgery center’s approval. You can even get board certified by a specialty board that your hospital or ASC recognizes as being adequate in their bylaws. And then suddenly, years later, if you don’t pass an exam by a single outside organization, despite your local community saying that you’re doing just fine, boom…no ankle surgery for you.

This was probably a bigger deal when all of the diversity requirements (put in under an ABFAS President that didn’t do a diverse array of cases herself) were in place. It would be easy to go into a podiatry group and not get much trauma or even ankle recon, so you have enough cases but not the “diversity” of cases ABFAS required. You don’t get ABFAS cert. Sorry, can’t do a Brostrom any more. I think that’s changed but honestly I haven’t looked in years. Regardless, it’s still the principal of podiatrists and podiatry organizations (who are supposed to be fighting to advance our scope, or at least prevent it from being trampled on) actively supporting limitations on the practice of other podiatrists.

ABFAS tries to make things extra rigorous to prove the MD/DOs that we are good enough to do the thing that orthopedic surgeons with minimal foot and ankle experience or case volume are allowed to do (with no questions asked). Only to be used as a weapon by state orthopedic associations and other podiatrists. ABFAS is a guy who goes out of his way to impress a girl (ie real doctors), only to get ****ed by said girl, over and over again. As the kids would say, ABFAS is a total simp.

If a new grad in your state isn’t doing enough to get diversity and volume in 7 years (which I got in 2 years), then what would you suggest is fair with regard to RRA? Let’s say you’re the gatekeeper and you make the rules. What would you do as ABFAS?

 

[dtrack22]

If a new grad in your state isn’t doing enough to get diversity and volume in 7 years (which I got in 2 years), then what would you suggest is fair with regard to RRA? Let’s say you’re the gatekeeper and you make the rules. What would you do as ABFAS?

Does an orthopedic surgeon who doesn’t do more than a few calc fractures over 7 years still have calc fracture privileges? The answer is yes. Do they do them if they are doing a low volume? The answer is generally no, someone else in the group does. If they started getting more volume 15 years out of practice and wanted to do calcs should they be able to do them? Sure.

How did any podiatrist do ankle surgery before ABFAS RRA designation existed? How can we possibly function without it?

This is simple. There is one board. Let’s call it the American Board of Podiatric Medicine and Surgery. You take a didactic exam (we’ll keep the CPBS stuff to make ABFAS feel good) and then you have a case review, 12 cases TOTAL (like ortho). No diversity requirement. Basically everyone does this their second year out of residency. If you land a job where you don’t have some minimal surgical volume of any kind then you have to wait for the case review part until you do and you only have 5 years instead of 7. If you don’t have really any surgical volume after 5 years or don’t pass the oral case review then you get some random board cert and practice office based podiatry forever. After 5 years something like 90-95% of podiatrists (easily) are certified by the American Board of Podiatric Medicine and Surgery. The local hospitals and ASCs throughout your career will then dictate what you can do based on your training or your practice experience (if you change jobs). Someone who doesn’t do enough ankle fractures or fusions or TARs to make ABFAS happy can still lengthen an Achilles or do a brostrom or perform a flatfoot reconstruction (all of which contain procedures that are a part of ABFAS RRA cert). But what if you change jobs and start seeing some ankle trauma and you want to do it? Well, just like every single old podiatrist who was never trained to do them and somehow started doing them in their career before ABFAS RRA was a thing, you take some continuing education courses, your hospital will require you to have a certain number proctored by a doctor with those privileges, and now you can do ankle fractures. The profession as a whole advocates for all podiatrists as foot and ankle specialists/surgeons. Individuals will almost universally self select practice environments and surgical scope based on training and post-residency experience and then the place where they are performing surgery is the gate keeper. The individual podiatrist is already a gate keeper as a vast majority of people aren’t trying to perform surgeries they don’t see for 7 years after getting out of residency or surgeries that they were never trained to do. The ABFAS is not necessary in this process at all and the fact that they have so many people, like attacknme who think that they are tells me that the ABFAS marketing people need raises.

Weird, that all sounds a lot like the ortho board cert and subsequent practice scope and privileging process huh?

Just in case I lost someone there, if dtrack was made king of podiatry:

-One board to get hospital/OR privileges called the American Board of Podiatric Medicine and Surgery

-part I didactic and part II case review consisting of 12 cases without a diversity requirement at all

-most everyone is board certified to be a podiatrist who operates on patients in 2-3 years. You only get 5 years to complete. There is still random boards to certify people who will do office work forever (because they still need board cert to get on many insurance panels).

-local hospital determines privileges based on training/experience and most places start off with a fairly broad number of privileges as part of the core podiatry privileges, most places are still going to require case logs and proof of competency for stuff ortho wants like ankle fractures and TAR (they don’t give a crap about anything else we do). That’s fine.

-once you are board certified you can still get privileges for surgery you don’t have experience with by doing continuing education and having cases proctored. Just like all the old, big name podiatrists who had subpar residency, practiced before ABFAS RRA was a thing, but now regularly do TARs.

-nothing compromises “patient safety,” Atlanta VA trained podiatrists are still not allowed to fuse ankles, the profession as a whole supports the advancement or protection of our scope instead of trying to limit it like we do now, and all of this is accomplished without ABFAS even existing. You’re welcome Podiatry.

 

[dtrack22]

If a new grad in your state isn’t doing enough to get diversity and volume in 7 years (which I got in 2 years), then what would you suggest is fair with regard to RRA?

I’ve got a question based on this quote that is separate from my last reply. Why should a podiatrist who moves into my state, 15 years out of residency, without ABFAS RRA but has been doing some ankle surgery routinely and has case logs to prove it, be limited in their scope of practice after moving to my state?

 

[DexterMorganSK]

This thread should be stickied.

done

 

[PMG03470]

Does an orthopedic surgeon who doesn’t do more than a few calc fractures over 7 years still have calc fracture privileges? The answer is yes. Do they do them if they are doing a low volume? The answer is generally no, someone else in the group does. If they started getting more volume 15 years out of practice and wanted to do calcs should they be able to do them? Sure.

How did any podiatrist do ankle surgery before ABFAS RRA designation existed? How can we possibly function without it?

This is simple. There is one board. Let’s call it the American Board of Podiatric Medicine and Surgery. You take a didactic exam (we’ll keep the CPBS stuff to make ABFAS feel good) and then you have a case review, 12 cases TOTAL (like ortho). No diversity requirement. Basically everyone does this their second year out of residency. If you land a job where you don’t have some minimal surgical volume of any kind then you have to wait for the case review part until you do and you only have 5 years instead of 7. If you don’t have really any surgical volume after 5 years or don’t pass the oral case review then you get some random board cert and practice office based podiatry forever. After 5 years something like 90-95% of podiatrists (easily) are certified by the American Board of Podiatric Medicine and Surgery. The local hospitals and ASCs throughout your career will then dictate what you can do based on your training or your practice experience (if you change jobs). Someone who doesn’t do enough ankle fractures or fusions or TARs to make ABFAS happy can still lengthen an Achilles or do a brostrom or perform a flatfoot reconstruction (all of which contain procedures that are a part of ABFAS RRA cert). But what if you change jobs and start seeing some ankle trauma and you want to do it? Well, just like every single old podiatrist who was never trained to do them and somehow started doing them in their career before ABFAS RRA was a thing, you take some continuing education courses, your hospital will require you to have a certain number proctored by a doctor with those privileges, and now you can do ankle fractures. The profession as a whole advocates for all podiatrists as foot and ankle specialists/surgeons. Individuals will almost universally self select practice environments and surgical scope based on training and post-residency experience and then the place where they are performing surgery is the gate keeper. The individual podiatrist is already a gate keeper as a vast majority of people aren’t trying to perform surgeries they don’t see for 7 years after getting out of residency or surgeries that they were never trained to do. The ABFAS is not necessary in this process at all and the fact that they have so many people, like attacknme who think that they are tells me that the ABFAS marketing people need raises.

Weird, that all sounds a lot like the ortho board cert and subsequent practice scope and privileging process huh?

Just in case I lost someone on there, if dtrack was made king of podiatry:

-One board to get hospital/OR privileges called the American Board of Podiatric Medicine and Surgery

-part I didactic and part II case review consisting of 12 cases without a diversity requirement at all

-most everyone is board certified to be a podiatrist who operates on patients in 2-3 years. You only get 5 years to complete. There is still random boards to certify people who will do office work forever (because they still need board cert to get on many insurance panels).

-local hospital determines privileges based on training/experience and most places start off with a fairly broad number of privileges as part of the core podiatry privileges, most places are still going to require case logs and proof of competency for stuff ortho wants like ankle fractures and TAR (they don’t give a crap about anything else we do). That’s fine.

-once you are board certified you can still get privileges for surgery you don’t have experience with by doing continuing education and having cases proctored. Just like all the old, big name podiatrists who had subpar residency, practiced before ABFAS RRA was a thing, but now regularly do TARs.

-nothing compromises “patient safety,” Atlanta VA trained podiatrists are still not allowed to fuse ankles, the profession as a whole supports the advancement or protection of our scope instead of trying to limit it like we do now, and all of this is accomplished without ABFAS even existing. You’re welcome Podiatry.

 

[AttackNME]

I’ve got a question based on this quote that is separate from my last reply. Why should a podiatrist who moves into my state, 15 years out of residency, without ABFAS RRA but has been doing some ankle surgery routinely and has case logs to prove it, be limited in their scope of practice after moving to my state?

I agree with you, nice post explaining your thoughts, I’ll vote for you if you run for king of podiatry 🙂

I’m not a fan of ABFAS gate keeping, I agree with getting rid of diversity. I think ABFAS needs to consider a path for podiatrists who gain skills over experience to get certified rather than award only those lucky enough to get the case variety within the time frame like myself. I was just playing devil’s advocate

 

[dtrack22]

I think ABFAS needs to consider a path for podiatrists who gain skills over experience to get certified rather than award only those lucky enough to get the case variety within the time frame like myself. I was just playing devil’s advocate

Fair enough. You never know who has let ABFAS messaging get balls deep inside of them and who’s just legitimately asking for another solution or opinions.

I think “luck” is unfortunately an appropriate word in podiatry when it comes to that first job out of residency. Less so if you’re willing to pack up and move/live anywhere. If I had my current job out of residency I would easily be whatever cert I wanted to. But I didn’t. I spent 3 years moving practices and doing surgery but not the volume or diversity that I do now. With ABFAS not going away (because I will never be in charge of anything), then I think they have to keep the time to cert at 7 years, for exactly situations like mine where you get hosed for a few years before you can even start collecting cases in year 3, 4, 5 out of practice.

We need someone to destroy ABFAS from within. Or at least neuter them and their process/power. A hostile takeover.

 

[Boba Foot]

Does an orthopedic surgeon who doesn’t do more than a few calc fractures over 7 years still have calc fracture privileges? The answer is yes. Do they do them if they are doing a low volume? The answer is generally no, someone else in the group does. If they started getting more volume 15 years out of practice and wanted to do calcs should they be able to do them? Sure.

How did any podiatrist do ankle surgery before ABFAS RRA designation existed? How can we possibly function without it?

This is simple. There is one board. Let’s call it the American Board of Podiatric Medicine and Surgery. You take a didactic exam (we’ll keep the CPBS stuff to make ABFAS feel good) and then you have a case review, 12 cases TOTAL (like ortho). No diversity requirement. Basically everyone does this their second year out of residency. If you land a job where you don’t have some minimal surgical volume of any kind then you have to wait for the case review part until you do and you only have 5 years instead of 7. If you don’t have really any surgical volume after 5 years or don’t pass the oral case review then you get some random board cert and practice office based podiatry forever. After 5 years something like 90-95% of podiatrists (easily) are certified by the American Board of Podiatric Medicine and Surgery. The local hospitals and ASCs throughout your career will then dictate what you can do based on your training or your practice experience (if you change jobs). Someone who doesn’t do enough ankle fractures or fusions or TARs to make ABFAS happy can still lengthen an Achilles or do a brostrom or perform a flatfoot reconstruction (all of which contain procedures that are a part of ABFAS RRA cert). But what if you change jobs and start seeing some ankle trauma and you want to do it? Well, just like every single old podiatrist who was never trained to do them and somehow started doing them in their career before ABFAS RRA was a thing, you take some continuing education courses, your hospital will require you to have a certain number proctored by a doctor with those privileges, and now you can do ankle fractures. The profession as a whole advocates for all podiatrists as foot and ankle specialists/surgeons. Individuals will almost universally self select practice environments and surgical scope based on training and post-residency experience and then the place where they are performing surgery is the gate keeper. The individual podiatrist is already a gate keeper as a vast majority of people aren’t trying to perform surgeries they don’t see for 7 years after getting out of residency or surgeries that they were never trained to do. The ABFAS is not necessary in this process at all and the fact that they have so many people, like attacknme who think that they are tells me that the ABFAS marketing people need raises.

Weird, that all sounds a lot like the ortho board cert and subsequent practice scope and privileging process huh?

Just in case I lost someone there, if dtrack was made king of podiatry:

-One board to get hospital/OR privileges called the American Board of Podiatric Medicine and Surgery

-part I didactic and part II case review consisting of 12 cases without a diversity requirement at all

-most everyone is board certified to be a podiatrist who operates on patients in 2-3 years. You only get 5 years to complete. There is still random boards to certify people who will do office work forever (because they still need board cert to get on many insurance panels).

-local hospital determines privileges based on training/experience and most places start off with a fairly broad number of privileges as part of the core podiatry privileges, most places are still going to require case logs and proof of competency for stuff ortho wants like ankle fractures and TAR (they don’t give a crap about anything else we do). That’s fine.

-once you are board certified you can still get privileges for surgery you don’t have experience with by doing continuing education and having cases proctored. Just like all the old, big name podiatrists who had subpar residency, practiced before ABFAS RRA was a thing, but now regularly do TARs.

-nothing compromises “patient safety,” Atlanta VA trained podiatrists are still not allowed to fuse ankles, the profession as a whole supports the advancement or protection of our scope instead of trying to limit it like we do now, and all of this is accomplished without ABFAS even existing. You’re welcome Podiatry.

Agreed, but I think a board cert didactic exam is unnecessary. At the point of residency graduation, we’ve taken 3 didactic boards… why do we need another? Make 2 or 3 tougher and then just make board cert a case review as you outlined. Didactic exams tell nothing about the quality and capability of a surgeon anyway, case review does.

 

[deleted285117]

I’m not sure how it is now, but when I was in a residency and in my third year, the stigma was you had to take ABFAS as “proper” certification. You were a cop-out if you decided to take ABPM instead.

Well, I was a cop-out I suppose and did ABPM. Happy with my decision. I’m also actively involved with ACPM and hope one day to make its educational offerings comparable with ACFAS.

 

[DPM TRUTH]

Great conversation everyone, this is how you make progress by discussing ways to move forward!

One question I have, what THIRD party audits the ABFAS exams and or the case review process? Please don't say the CPME or APMA, they eat and drink off the same tab as the ABFAS leadership. Every legit organization needs third party oversight.

Why not create an INDEPENDEPENT advisory board that audits the exam or case review process? Make this advisory board comprised of DPM's that represent all different factions of the profession. Represent the ENTIRE profession, EVERYONE from strictly "medicine and office procedures" to "simple bunions n toes" to "RRA ankle". Make sure you represent ALL ages, races, and genders. Furthermore make sure these people on the advisory board have no conflicts of interest (never had a position in ABFAS/ABPM/CPME/APMA leadership). Yes it would take some work to get this cohert of DPMs, but every Q5 years would work.

Allow this advisory board to audit EVERY aspect of the exam process. Along with auditing the people who are the "case reviewers" and "question makers". For example, are the "case reviewers" peer review files' or malpractice history ever reviewed? Again, is it fair to have people saying pass or fail that have peer review files as big as books or in court every month? Yes, as division chief, there are many ABFAS (ff and rra) "surgeons" who have to come in front of my committee (peer review) and respond to M&M's where they were negligent. Do we want those people "grading" collegues and dictating if their cases are OK when they are being written up for negligence (or being sued)?

Also, ABFAS please stop "treating the xrays vs the patients" when reviewing cases. Just because the xray shows some lucency at 12wks, if there is zero swelling and pain (and the patient is happy 2 yrs out) it should be considered a success. I had a recent resident fail case review for a "xray lucency issue". I tried to explain to the ABFAS, STOP TREATING THE XRAY, WE TREAT PATIENTS! The ABFAS fails DPM's for xrays "issues", then next year the patient comes back for the other side (along with their friends and fam) but the ABFAS considers it a FAILURE bases on one set of xrays. Is this "cool"? Then 4k to review?

So is it really case review or xray review ABFAS? Do they care AT ALL about patient satisfaction? Over the years, I have had some HORRID xrays that made the patient super happy (back for other side in 6 months). I also have had the most "textbook" xrays that ended up swelling/pain/dissatisfaction. So please, use the xrays as "part of the puzzle" vs putting such weight into "how the xrays look".

And yes everyone, I would also expect the new ABPM to adhere to the previous oversight in the future for their surgical CAQ certificate. If your "doing everything by the book", why not open the books up ABFAS?

 

[deleted1138023]

How nice of ABFAS to release pass rates from the spring exam, and not from the ITE training in the fall where they deliberately write very difficult exams with low pass rates so they can double dip $$ and push residents into retaking it in the spring. I sat both times and the fall ITE RRA was MUCH more difficult than the spring RRA exam. Classic feigning "transparency" while pissing on everyone's back and telling them it's raining. Show us all the pass rates for the last 5 years or GTFO.

Yeah I mean it’s a clear scam and nothing is done about it. Classic podiatry.

 

[DPM TRUTH]

Remember everyone, the MD/DO world already does a "third party audit" via the ABMS.

Imagine The American Board of Orthopedic Surgery being overseen by The American Orthopedic Association (or worse, by themselves like the ABFAS). All the ABFAS "oversight" comes via "in house committees" and the APMA deems what boards are legit. The The American Orthopedic Association doesn't choose what boards are legit, the third party ABMS does.

I get podiatry is not a ABMS member, but shouldn't they have the same independent oversight?

 

[Feli]

Agreed, but I think a board cert didactic exam is unnecessary. At the point of residency graduation, we’ve taken 3 didactic boards… why do we need another? Make 2 or 3 tougher and then just make board cert a case review as you outlined. Didactic exams tell nothing about the quality and capability of a surgeon anyway, case review does.

Every MD board has a didactic... they don't just take USMLE 3 steps and start doing chest, ENT, plastic, etc surgery.
The idea is national boards are minimum competency just for state license and such... and specialty boards are higher level for hospitals, public, etc to use. Podiatry would not be wise to divert from that.

The wild thing is ABPM new CAQ lets someone be CAQ for foot surgery without ever doing a single foot surgery on their own. That is crazytown. They could have thought that through a bit. There is no MD surgical board that does that.

...We need someone to destroy ABFAS from within. Or at least neuter them and their process/power. A hostile takeover.

...Dtrack hit it: one main podiatry med + surg board (just like ENT, OB, etc), reasonable pass rates, reasonable reqs. So, everyone who isn't a total hack or who can study and pass a reasonable didactic after a few tries gets board cert (just like ortho, plastic, neurosurg, etc etc).

The problem is basically twofold: podiatry training varies WIDELY, and we have two boards grappling for power right now...
1) What is a joke and too basic of didactic exams and avg knowledge base to some residency programs is "unfair" and impossible to others. That gap won't close anytime soon.
2) Both boards want to "win" at all costs. "Ain't nobody wanna grow up and be Vice President!"

ABFAS will win every day and twice on any given Sundays. They have 90% of the best minds in our profession, more $, much more history and much more political power. ABPM has made huge strides in the last decade or so, but they always have been and always will be the 'backup board.' In the good idea above of one main med+surg, they'd be the alternate one for the small % of DPMs who can't pass the main board didactic or did zero surgery after training and couldn't sit for case review cert portion. It happens to a few orthos, gen surgeons, etc... they usually do a different residency and try to cert in that instead, or they just practice non-op or do sports med or wound care or something... probably no board cert and yet they make it work.

Back in podiatry, one can hope the negotiating table comes to fruition someday...
"...It should also be noted that for nearly two decades, since APMA Vision 2015 (written in 2005), the ABPM has periodically sat at the negotiating table with the APMA and the other recognized certifying board in an endeavor to unify the profession through a common certification pathway. One organization has unilaterally opposed these efforts. Thus, understandably, we feel the sudden calls for negotiation and cries of divisiveness to be disingenuous. However, if a serious attempt at unification or improvement in the process of podiatric board certification is made by all organizations, we will be first at the table, as we always have been..."

 

[deleted1138023]

Who makes money off the apmle exams? Is it just separate?

 

[PTPuser]

I know this is probably the stupidest question possible, but I can't find any answers via search, google and even the actual ABFAS website.

Theoretically, what happens to a ABFAS qualified DPM if they are unable to successfully get ABFAS cert by their 7 years limit? This is for a pod who doesn't have anything else other than ABFAS qual.

 

[deleted1138023]

I know this is probably the stupidest question possible, but I can't find any answers via search, google and even the actual ABFAS website.

Theoretically, what happens to a ABFAS qualified DPM if they are unable to successfully get ABFAS cert by their 7 years limit?

They can’t ever be certified

 

[PTPuser]

They can’t ever be certified

Does this mean you loose all privileges and get let go from insurance panels?

 

[PTPuser]

I guess the blunt and stupid question is can one still work, keep their practice, gets privileges, get paid by CMS and other insurance etc

 

[Utvolsdpm]

Does this mean you loose all privileges and get let go from insurance panels?

That’s my understanding. Unless you graduated residency before 2014 then for some reason you get to keep trying but start over from the beginning.

 

[Feli]

I know this is probably the stupidest question possible, but I can't find any answers via search, google and even the actual ABFAS website.

Theoretically, what happens to a ABFAS qualified DPM if they are unable to successfully get ABFAS cert by their 7 years limit? This is for a pod who doesn't have anything else other than ABFAS qual.

Nobody who can pass ABFAS qual would fail to pass ABPM cert (which knows this and gives ppl until 8yrs after residency so they have at least one or two chances). The person would just do that. They'd be ABPM cert, ABFAS window would be closed.

Assuming you do decent work, you'd stay on hospital staff - at least for consults or wound center or whatever. You might lose some/all surgical privi at some hospitals - depending on their bylaws and how rigorously they enforce them. It's very doubtful you'd lose insurances as long as you are cert by a recognized board... a lot of people who pass ABFAS qual still do ABPM cert right out of residency for that reason (insurances want "board cert" and some don't understand "qualified").

Some hospitals and jobs are ignorant or desperate enough that a podiatrist can even roll around with the fake boards if they couldn't past ABFAS or ABPM. There are more than a few of those out and about (it was ABPS and ABPOPPM back in their day), and you'd be surprised how many of them are even doing surgery at VAs, etc. Fun times and makes us all look great

 

[PTPuser]

Nobody who can pass ABFAS qual would fail to pass ABPM cert (which knows this and gives ppl until 8yrs after residency so they have at least one or two chances). The person would just do that. They'd be ABPM cert, ABFAS window would be closed.

Assuming you do decent work, you'd stay on hospital staff - at least for consults or wound center or whatever. You might lose some/all surgical privi at some hospitals - depending on their bylaws and how rigorously they enforce them. It's very doubtful you'd lose insurances as long as you are cert by a recognized board... a lot of people who pass ABFAS qual still do ABPM cert right out of residency for that reason (insurances want "board cert" and some don't understand "qualified").

Some hospitals and jobs are ignorant or desperate enough that a podiatrist can even roll around with the fake boards if they couldn't past ABFAS or ABPM. There are more than a few of those out and about (it was ABPS and ABPOPPM back in their day), and you'd be surprised how many of them are even doing surgery at VAs, etc. Fun times and makes us all look great

Thanks, Doc! These convo aren't being talked about enough at any level of schooling so far. It helps to have an idea for what to do with my life cause I've been just super anxious lately.

 

[Boba Foot]

Every MD board has a didactic... they don't just take USMLE 3 steps and start doing chest, ENT, plastic, etc surgery.
The idea is national boards are minimum competency just for state license and such... and specialty boards are higher level for hospitals, public, etc to use. Podiatry would not be wise to divert from that.

Fair enough. Though I still don’t understand what doing well on a didactic portion of an exam tells anyone about surgical competency. Many people can fake their way through a didactic exam but you can’t fake it through quality work and outcomes in the OR.

 

[CutsWithFury]

I guess the blunt and stupid question is can one still work, keep their practice, gets privileges, get paid by CMS and other insurance etc

I know of a board qualified podiatrist who did a fellowship and who is practicing in the New England area that never got ABFAS certified within the 7 year time frame and is doing ankle work.

Personally this is a grey area. You would need a whistle blower to throw them under the bus to stop them from operating since they are technically not board certified.

I have mentioned this before but I have seen podiatrists board certified in foot by the ABFAs doing rearfoot and ankle work because the hospitals are simply confused because all they see is board certified when they submit the paperwork.

 

[Feli]

Fair enough. Though I still don’t understand what doing well on a didactic portion of an exam tells anyone about surgical competency. Many people can fake their way through a didactic exam but you can’t fake it through quality work and outcomes in the OR.

It's more the indications/contra and complications, workups. That's the point of didactic exams (or CBPS/oral exams).

I could do the best xray Lapidus and ankle fusions and stuff the world has ever seen... but if I'm doing Lapidus on ppl with hallux rigidus, PAD, drug addiction, growth plates... then I'm not a very good surgeon after all. If my amazing ankle fusions dehisce and I Rx cipro and Medrol and take them back for TAR infected and without a fibula, hmmm. You know? "But I've got great hands" only goes so far.

It's the old saying "you can teach a monkey to do surgery. A good surgeon knows what surgery to do, why it's done, and when or when not to do it."

A lot of the best surgeons you'll ever see are keen on workup, likable, lights out on procedure selection (based on pt needs/social/health, not just XR) and they might be only fair/good in terms of hands... but they work stuff up well, plan very well, have few complications, handle complications well, ask for help when they need it. It's a lions and foxes thing... lions = young surgeons super aggressive and cut on most anything, foxes = good surgeons but more wise and pass on some stuff that will turn out crap no matter how good you execute it. Skill can't compensate for pt who is terrible medical health or terrible compliance.

 

[dtrack22]

Who makes money off the apmle exams? Is it just separate?

The NBPME and their board, executive director, employees, etc.

 

[dtrack22]

Fair enough. Though I still don’t understand what doing well on a didactic portion of an exam tells anyone about surgical competency. Many people can fake their way through a didactic exam but you can’t fake it through quality work and outcomes in the OR.

Feli is right that it won’t happen, but podiatry IS different than those other surgical specialties that he listed in that we start specializing essentially by our 4th year old podiatry school. So APMLE II and APMLE III are primarily loaded with podiatry questions. So part I of any board cert (the didactic portion) absolutely feels redundant to all of us. Whereas an ENT has never really been tested on purely ENT competency prior to the completion of residency. Their USMLE steps are general medicine. All of that being said, I have no problem with a reasonable didactic exam that does test your surgical indication knowledge as well as all of the stuff that won’t show up on a case review (abx and infectious diseases, systemic disease that you should understand since it affects the foot, Derm pathologies, etc.)

 

[DPM TRUTH]

Feli states:

The ABFAS have 90% of the best minds in our profession, more $, more political power.

Has Feli checked how many people belong to the ABPM/ACPM vs ABFAS/ACFAS? Remember Feli money is in numbers.

He also states:

ABFAS will win every day and twice on any given Sundays

How many times did they win last 2 weeks Feli? They are 0/2 the past two weeks. They tried to shut down the CAQ and ABPM said what? The ABFAS really flexed their muscles and had tons of power? ABPM really cared what they had to say, ABFAS really flexed their muscles!

Feli some advice from an elder DPM, you should really respect your elders doc. 2012 is only 10 years out, You are young and have a lot to learn in this profession. Unlike me, who is semi retired, you have a long career. Remember, podiatry is a small profession, everyone knows everyone and your post don't age well with people in my generation that fought for your ankles and RRA. We fought for you, and know your talking about us in a negative pejorative. What do you think we think about you posting stuff like 90% of the best minds? We don't like others talking about others like that. Remember, we are all on the same team in the end.

Several of my collegues Feli (and close friends) never got boarded by ABPS/ABFAS for one reason or another. I was lucky and got one of the few PSR-24's, they did not. Guess what though Feli, many of those "non 90% of the best minds" are very talented podiatrists and have a very successful careers in podiatry. They don't appreciate you (and all the smart guys from your era) talking down to them.

I'm not trying to be argumentative, I'm trying to help feli by encouraging him not to bash "people not as great as him", as he sees himselves and his rra collegues. Never forget who got podiatry ankles and rearfoot. Feli you were in elementary school when we were fighting for podiatry. Start showing some respect for your elders doc. 🙂

 

[air bud]

Feli states:

The ABFAS have 90% of the best minds in our profession, more $, more political power.

Has Feli checked how many people belong to the ABPM/ACPM vs ABFAS/ACFAS? Remember Feli money is in numbers.

He also states:

ABFAS will win every day and twice on any given Sundays

How many times did they win last 2 weeks Feli? They are 0/2 the past two weeks. They tried to shut down the CAQ and ABPM said what? The ABFAS really flexed their muscles and had tons of power? ABPM really cared what they had to say, ABFAS really flexed their muscles!

Feli some advice from an elder DPM, you should really respect your elders doc. 2012 is only 10 years out, You are young and have a lot to learn in this profession. Unlike me, who is semi retired, you have a long career. Remember, podiatry is a small profession, everyone knows everyone and your post don't age well with people in my generation that fought for your ankles and RRA. We fought for you, and know your talking about us in a negative pejorative. What do you think we think about you posting stuff like 90% of the best minds? We don't like others talking about others like that. Remember, we are all on the same team in the end.

Several of my collegues Feli (and close friends) never got boarded by ABPS/ABFAS for one reason or another. I was lucky and got one of the few PSR-24's, they did not. Guess what though Feli, many of those "non 90% of the best minds" are very talented podiatrists and have a very successful careers in podiatry. They don't appreciate you (and all the smart guys from your era) talking down to them.

I'm not trying to be argumentative, I'm trying to help feli by encouraging him not to bash "people not as great as him", as he sees himselves and his rra collegues. Never forget who got podiatry ankles and rearfoot. Feli you were in elementary school when we were fighting for podiatry. Start showing some respect for your elders doc. 🙂

Sorry bro, you lose all of us with "show some respect.". Us whipper snappers are a different generation.

 

[deleted1138023]

Sorry bro, you lose all of us with "show some respect.". Us whipper snappers are a different generation.

 

[Pronation]

The respect your elders garbage is exactly why podiatry has all these associate mills taking advantage of associates.

 

[DPM TRUTH]

Not talking about that pronation, I fully agree pronation concerning elders using their young for cheap labor in PP mills.

But last time I checked Pronation, this thread is not about "podiatry mills", it's named abfas/abpm. If you would like to start another thread about podiatry mills and PP DPMs who abuse associates I would agree with you and call them out also.

 

[de Ribas]

Like many of you, we were disappointed in this week’s decision by the American Board of Podiatric Medicine (ABPM) to open applications for a Certificate of Added Qualification (CAQ) in Podiatric Surgery outside of the profession’s traditionally rigorous certification process. Several leading podiatric organizations have raised serious concerns about ABPM’s rush to launch the new CAQ and the potential confusion it may cause among patients and hospitals. We have been encouraged to see many comments that reflect concerns we share, including:

Podiatry profession as a whole causes "confusion among patients and hospitals."

 

[air bud]

Podiatry profession as a whole causes "confusion among patients and hospitals."

This

 

[icebreaker32]

I guess the blunt and stupid question is can one still work, keep their practice, gets privileges, get paid by CMS and other insurance etc

I know of no one who was board qualified and failed to become certified who lost hospital privileges or was kicked off of insurance plans. It is totally possible it could happen, and some hospitals might be stricter than others at actually checking this.

If one moves to a new area it is more likely to cause problems for initial hospital and insurance credentialing.

Are they lying on their re credentialing applications for insurance and hospitals? I have no idea. Many put on their website or hospital websites they are board qualified or certified when they are not board certified and their qualification status expired.

Podiatry is a mess. Board qualified, double board certified, fake boards etc.....other professions you need to get board certified (and most do) or you could have great difficulty finding jobs...in theory. Supply/demand is currently in their favor so MDs/DOs that are not board certified, as long as they can get a state licenses can still probably find work.

Medicare and Medicaid have never cared about board status.

 

[PMG03470]

I know of a board qualified podiatrist who did a fellowship and who is practicing in the New England area that never got ABFAS certified within the 7 year time frame and is doing ankle work.

Personally this is a grey area. You would need a whistle blower to throw them under the bus to stop them from operating since they are technically not board certified.

I have mentioned this before but I have seen podiatrists board certified in foot by the ABFAs doing rearfoot and ankle work because the hospitals are simply confused because all they see is board certified when they submit the paperwork.

I don’t think it’s confusion… areas that don’t have as many pods just don’t care. As long as you have “foot” they observe rearfoot cases you do and decide whether or not to give you privileges in rearfoot regardless of the separate RRA cert

 

[PTPuser]

I know of no one who was board qualified and failed to become certified who lost hospital privileges or was kicked off of insurance plans. It is totally possible it could happen, and some hospitals might be stricter than others at actually checking this.

If one moves to a new area it is more likely to cause problems for initial hospital and insurance credentialing.

Are they lying on their re credentialing applications for insurance and hospitals? I have no idea. Many put on their website or hospital websites they are board qualified or certified when they are not board certified and their qualification status expired.

Podiatry is a mess. Board qualified, double board certified, fake boards etc.....other professions you need to get board certified (and most do) or you could have great difficulty finding jobs...in theory. Supply/demand is currently in their favor so MDs/DOs that are not board certified, as long as they can get a state licenses can still probably find work.

Medicare and Medicaid have never cared about board status.

The bolded part is really interesting cause isn't it for MD/DO world they need to have an active certification in whatever their accrediting body is to be paid by CMS...?

Cause isn't there some states out there that allow MD/DO to practice as a general practitioner with just 1 year of internship but 99% don't just stop there cause even tho they can hang a sign and open shop as GP, CMS and other insurance won't recognized them cause of the risk.

So theoretically speaking, as of today, if one were to have their BQ expire cause today is their 7th year, they can still keep CMS, work and do whatever they were doing before unless someone whistle blow to the hospital or ASC?
And because their ABFAS expire, based on what's written a couple of posts earlier, one can try out for ABPM cause it's 8 years right?

I know I'm no where near the level of you doctors right now but these things are life altering situations and that's why I am asking these stupid questions. This whole process is starting to feel like a constant road blocks and battles that are starting to feel unwinnable.

 

[newfeet]

I don’t think it’s confusion… areas that don’t have as many pods just don’t care. As long as you have “foot” they observe rearfoot cases you do and decide whether or not to give you privileges in rearfoot regardless of the separate RRA cert

yup. They just want you to be board certified.

 

[DPM TRUTH]

Again everyone, you will generally have no issues "doing what you want" with respect to cases if you completed a 3 year PM&S-36 residency with almost ANY board status (of course if your residency logs concur). That's not the issue here everyone. The issue is having these new DPMs live in COMPLETE FEAR that someone will testify against them even if they did everything correct. Why, because someone from the ABFAS will sell out their soul for $4500 to be an expert witness. They will "go after" their young collegue for not being board certified. How sick is that?

A recent study looking at foot surgery malpractice from over a 13-year period found that of the 72 cases it analyzed, 76.4 percent of the lawsuits were against podiatrists, and 15.3 percent were against orthopedic surgeons. Wonder why its this lopsided?

Hey ABFAS mavericks who testify AGAINST your collegues, do you feel good spending that $4500 bucks by destroying your young? Yes there are some legit cases, 95% are pure BS. Yes some mess up (in every field) they should be disciplined. But 1million for an "ugly scar" on the 5th toe?

I'm sick of defending young DPMs in court who did NOTHING wrong but have their lives DESTROYED by a collegue. Again, they tell the jury "he isn't board certified, so he is wrong". Sick, sick sick.

So again, most don't care about board status except to protect them legally. Is it fair to have people live in complete fear? This fear destroys their families and life. The wise guys on here don't care. Anyway they can make a quick buck, so be it! Doesn't matter who they hurt or lives they destroy.

To all my ABFAS/ABPS collegues who do this... what's wrong with you for going after your collegues and using the "board certified card"? $4500 really? You all must have great practices if you let the plaintiff attorneys extort you for that.

 

[SouthPod7]

A recent study looking at foot surgery malpractice from over a 13-year period found that of the 72 cases it analyzed, 76.4 percent of the lawsuits were against podiatrists, and 15.3 percent were against orthopedic surgeons. Wonder why its this lopsided?

Well, isn't that because Podiatrists do the most foot surgery in the country? It makes sense that they would also have the majority of the malpractice lawsuits since they are doing most of the cases, right?

 

[Boba Foot]

But 1million for an "ugly scar" on the 5th toe?

Practice in Texas where you don't get sued for BS like that, and stay far far away from the uber-litigious northeast with medicaid patients looking to score a quick buck.

 

[DPM TRUTH]

Boba Foot - 100% agree, I would never practice in the northeast due to the sue-happy nature of the population. I once visited some coastal beaches up in the northeast and the largest mansions on the beach blocks were all personal injury lawyers.

This is why the newly graduated residents need some "cover" when they first get out. The CAQ by ABPM will allow them to have this peace of mind while they accumulate cases for ABFAS diversity if so desired. That's it, plain and simple. Again, it's not a replacement, just an added tool to keep outr collegues safe.

The ABFAS does not want them to have this cover. They just want to label them BQ....QUALIFIED vs. CERTIFIED. That makes them "sitting ducks" if anything ever goes wrong (we ALL have complications). They can fool the jury they are less capable.

Remember everyone, all those frivolous lawsuits would NOT occur if their were not ABFAS diplomats' who were looking to make a quick buck testifying against a collegue. Yes, if the ABFAS would stop allowing their diplomates to advertise as "expert witnesses for PLAINTIFFS", the CAQ would not be needed. This is why "they" are so freaked out about a simple CAQ, now the defendent will have a certificate by an ACCREDITED board so the scumbag who got grandfathered in can't testify he/she is not board certified. That will make them argue facts, not process like the ABFAS wants it to be about in litigation That's all, plain and simple everyone!

Stange isn't it how the ABFAS/APMA/CPME could care less about what I just said. I care about my collegues, I don't wanna see them being sued. They know it happens and don't want to help the problem. I feel so bad for these young physicians who have to put up with this. Again, anyone doing this should be ashamed of themselves!

Until there is NATIONWIDE tort reform, the CAQ is needed to give cover to the new residents. Period.

 

[SouthOrBust]

You can if you are board qualified. Which makes it even more silly when you think about it. Coming out of residency you can fix an ankle fracture based on training and case logs (which is the only way you will get those privileges in most cases). You can continue to do them successfully for years and have your local hospital or surgery center’s approval. You can even get board certified by a specialty board that your hospital or ASC recognizes as being adequate in their bylaws. And then suddenly, years later, if you don’t pass an exam by a single outside organization, despite your local community saying that you’re doing just fine, boom…no ankle surgery for you.

This was probably a bigger deal when all of the diversity requirements (put in under an ABFAS President that didn’t do a diverse array of cases herself) were in place. It would be easy to go into a podiatry group and not get much trauma or even ankle recon, so you have enough cases but not the “diversity” of cases ABFAS required. You don’t get ABFAS cert. Sorry, can’t do a Brostrom any more. I think that’s changed but honestly I haven’t looked in years. Regardless, it’s still the principal of podiatrists and podiatry organizations (who are supposed to be fighting to advance our scope, or at least prevent it from being trampled on) actively supporting limitations on the practice of other podiatrists.

ABFAS tries to make things extra rigorous to prove the MD/DOs that we are good enough to do the thing that orthopedic surgeons with minimal foot and ankle experience or case volume are allowed to do (with no questions asked). Only to be used as a weapon by state orthopedic associations and other podiatrists. ABFAS is a guy who goes out of his way to impress a girl (ie real doctors), only to get ****ed by said girl, over and over again. As the kids would say, ABFAS is a total simp.

Said ABFAS president was also only foot certified. She did not have the RRA certificate.

 

[SouthOrBust]

I know of a board qualified podiatrist who did a fellowship and who is practicing in the New England area that never got ABFAS certified within the 7 year time frame and is doing ankle work.

Personally this is a grey area. You would need a whistle blower to throw them under the bus to stop them from operating since they are technically not board certified.

I have mentioned this before but I have seen podiatrists board certified in foot by the ABFAs doing rearfoot and ankle work because the hospitals are simply confused because all they see is board certified when they submit the paperwork.

Or perhaps they are still doing ankle work because hospital privileging is ACTUALLY based on training and education, not board certification.

You can get ABFAS RRA certification and never do an ankle scope, ex-fix or TAR. Hospitals won’t give you ankle scope, ex-fix, or TAR privileges just because you have a signed piece of paper saying you’re one of the chosen few. They will ask to see your previous cases first.

Now the wildcard in all this is whether or not a sneaky ABFAS diplomat convinced their hospital to require the RRA certification to perform these surgeries. Which does happen. The orthopods don’t keep podiatrists down; the real villains are other entitled podiatrists.

Disclaimer: I sit on my hospitals medical executive board and privileging board and have done so for 6+ years.

 

[air bud]

Boba Foot - 100% agree, I would never practice in the northeast due to the sue-happy nature of the population. I once visited some coastal beaches up in the northeast and the largest mansions on the beach blocks were all personal injury lawyers.

This is why the newly graduated residents need some "cover" when they first get out. The CAQ by ABPM will allow them to have this peace of mind while they accumulate cases for ABFAS diversity if so desired. That's it, plain and simple. Again, it's not a replacement, just an added tool to keep outr collegues safe.

The ABFAS does not want them to have this cover. They just want to label them BQ....QUALIFIED vs. CERTIFIED. That makes them "sitting ducks" if anything ever goes wrong (we ALL have complications). They can fool the jury they are less capable.

Remember everyone, all those frivolous lawsuits would NOT occur if their were not ABFAS diplomats' who were looking to make a quick buck testifying against a collegue. Yes, if the ABFAS would stop allowing their diplomates to advertise as "expert witnesses for PLAINTIFFS", the CAQ would not be needed. This is why "they" are so freaked out about a simple CAQ, now the defendent will have a certificate by an ACCREDITED board so the scumbag who got grandfathered in can't testify he/she is not board certified. That will make them argue facts, not process like the ABFAS wants it to be about in litigation That's all, plain and simple everyone!

Stange isn't it how the ABFAS/APMA/CPME could care less about what I just said. I care about my collegues, I don't wanna see them being sued. They know it happens and don't want to help the problem. I feel so bad for these young physicians who have to put up with this. Again, anyone doing this should be ashamed of themselves!

Until there is NATIONWIDE tort reform, the CAQ is needed to give cover to the new residents. Period.

Wait I thought new residents are doing just fine right now with ABPM and not the CAQ.?

 

[air bud]

Or perhaps they are still doing ankle work because hospital privileging is ACTUALLY based on training and education, not board certification.

You can get ABFAS RRA certification and never do an ankle scope, ex-fix or TAR. Hospitals won’t give you ankle scope, ex-fix, or TAR privileges just because you have a signed piece of paper saying you’re one of the chosen few. They will ask to see your previous cases first.

Now the wildcard in all this is whether or not a sneaky ABFAS diplomat convinced their hospital to require the RRA certification to perform these surgeries. Which does happen. The orthopods don’t keep podiatrists down; the real villains are other entitled podiatrists.

Disclaimer: I sit on my hospitals medical executive board and privileging board and have done so for 6+ years.

Can you tell us how you have chosen to gatekeep your fellow podiatrist?