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

 

[Feli]

If you review things like Federal Law we find that per CMS: §482.12(a)(7): Ensure that under no circumstances is the accordance of staff membership or professional privileges in the hospital dependent solely upon certification, fellowship, or membership in a specialty body or society....

This is the case for any hospital... anywhere. It is in every bylaws... but we're kidding ourselves if we think the thumbs up/down of the medical staff approval and OR privileges doesn't usually hinge on board qual/cert.
Most hospital won't risk their rep or patient outcomes on docs (MD, DO, DPM, etc etc) who aren't properly certified. Other facilities have no issue with it and will take whoever (esp govt facilities who are somewhat judgment proof, rural places with a tough time recruiting, etc).

The bottom line is to get the most appropriate accredited cert and don't limit your options, ya?
In podiatry, I've found many where ABFAS was absolutely or basically req for surgery, some where ABPM will fly, and some where you could probably do ankle fractures with a cracker jack box certificate on your resume. There is the whole spectrum. Again, nobody should limit them self.

This whole ABPM push is likely due to present leadership having no success with ABFAS back in the day... a decade old axe to grind. So, the lesson is don't limit oneself... keep all options open.

...We had a situation like this at a local hospital where a local podiatrist felt "only ABFAS" was acceptable. ABPM had an attorney get in contact with the hospital to address the situation. ..

Who is "we"?

 

[virginia_podiatrist]

Unfortunately there are a lot of DPMs out there that will encourage violation of Federal law, the Joint Commission, etc. based on ABFAS. Be positive, these people are retiring and leaving the profession. No one should be encouraging illegal and anti-competitive behavior, it is literally an ethics violation. If you experience an individual like this remind them they are encouraging illegal behavior and that it isn't right.

Was this serious?

 

[Feli]

I just received an email from ABPM about Student Doctor Network. They are basically asking members to join so they can speak positively about podiatry. Apparently they are some bad eggs in here bashing podiatry in the forums. I wonder if I’m one of them. 🤔

I saw that too... very sad and misguided....
"...The problem is that the three Podiatry Forums (Pre-Podiatry, Podiatry Students, Podiatric Residents & Physicians) have a significant volume of the posts by 10-15 users who are disgruntled practicing podiatrists...."

SDN is one of the best places for any pre-health to get info, see those who thrive, those who aren't happy, those who are everywhere in between. It is a discussion forum. It might sometimes be a cheerleader for some professions... and other times, it's griping about tuition or jobs or whatever. I have had probably hundreds of pre-pods, pod students, etc PM me over the years for info on schools, residency, jobs, etc. I encourage them all to shadow DPMs if unsure, work hard and do what it takes once they're in. I will say it's a bit more of a negative slant than it was maybe 10 or 15yrs ago, but that's just the way it is. We have to remember that 3 more pod schools have also opened since then. On the flip side, there are more DPM jobs in hospital FTE, MSG, ortho group, etc than ever before. Be that what it may, people will discuss and say what they wish. That's a good thing.

I don't feel disgruntled having every weekend off, hundreds of $K per year, challenging career that helps people... but leave it to a cert board to conclude that I am. I would say it's quite the opposite: most SDN regular contributors - past and present - do better than an average DPM and have more interest and desire to see them self and the overall profession improve/succeed. JMO?

The funny part is that it's not even ABPM's role. Not whatsoever. It'd be one thing if that email about declining app numbers came from CPME or the pod schools or even APMA... but it didn't. This is getting way out of hand. The student recruitment of schools is not the realm of the certifying board(s). As these ugly things continue to transpire, I am beginning to hope the leadership for ABPM cycles out soon. It's fine to grow and improve, but there are recent forays into MANY areas that are not their lane. Again, old axe to grind = circus. If there remains two boards, it should probably be a req that leadership of them is cert by both so that there it's less likely we see these personal vendettas that end up affecting numerous ppl.

 

[Feli]

Unfortunately there are a lot of DPMs out there that will encourage violation of Federal law, the Joint Commission, etc. based on ABFAS. Be positive, these people are retiring and leaving the profession. No one should be encouraging illegal and anti-competitive behavior, it is literally an ethics violation. If you experience an individual like this remind them they are encouraging illegal behavior and that it isn't right.

What board qual/cert do you feel is the most appropriate for one who does operating room surgery as a DPM?
Which board would you prefer me to hold if I'm operating on your family member?
Every hospital has its own politics. That is nothing new... for MDs, DOs, DPMs, or even therapists, etc.

And I do thank you for creating this new account to post in this thread. 🙂

 

[PTPuser]

I just received an email from ABPM about Student Doctor Network. They are basically asking members to join so they can speak positively about podiatry. Apparently they are some bad eggs in here bashing podiatry in the forums. I wonder if I’m one of them. 🤔

That's toxic. People should be able to speak as they please. I'm glad that we have a low admission rate this year.

 

[newfeet]

That's toxic. People should be able to speak as they please. I'm glad that we have a low admission rate this year.

I’ve said this before but I wish there were more conversations like this and others when I was reading SDN and applying to podiatry school back in the day. I think people get to make a more informed decision because of these open conversations.

 

[PTPuser]

I’ve said this before but I wish there were more conversations like this and others when I was reading SDN and applying to podiatry school back in the day. I think people get to make a more informed decision because of these open conversations.

I agree. Some of these were spoken when I was applying and I didn't listen. I don't blame anyone. But it's so hard to comprehend the bullsh*t until you're in it and experiencing it. It's like a deadly marry go round. You can get off, but the price is steep.

 

[air bud]

If you review things like Federal Law we find that per CMS: §482.12(a)(7): Ensure that under no circumstances is the accordance of staff membership or professional privileges in the hospital dependent solely upon certification, fellowship, or membership in a specialty body or society.

What that means is per federal law you cannot discriminate based on (ABPM versus ABFAS) certification for any hospital privileges.

If you do discriminate it is encouraging illegal behavior which is an ethics violation.

We had a situation like this at a local hospital where a local podiatrist felt "only ABFAS" was acceptable. ABPM had an attorney get in contact with the hospital to address the situation. Your malpractice may also cover it, and if it comes to it it would cost about $3K per an attorney I spoke with on the issue, which is way cheaper than the ABFAS process.

Good thing I am the only podiatrist at my hospital

 

[Foot&AnkleSurgeon]

What board qual/cert do you feel is the most appropriate for one who does operating room surgery as a DPM?
Which board would you prefer me to hold if I'm operating on your family member?

ABFAS for both.

 

[de Ribas]

ABFAS for both.

What about another 50% that are not ABFAS certified?

 

[Foot&AnkleSurgeon]

What about another 50% that are not ABFAS certified?

Not happening. My opinion: ABFAS sets the standard for foot and ankle surgery in our profession.

 

[de Ribas]

Not happening. My opinion: ABFAS sets the standard for foot and ankle surgery in our profession.

Lol. What is CPME for?

 

[de Ribas]

Not happening. My opinion: ABFAS sets the standard for foot and ankle surgery in our profession.

I am for 1 board and ok with it being ABFAS. But what everyone says here is that there is no standardization, no continuity, no proper communication of standards or expectations between schools, residency programs, certifying boards and CPME.

It's not how it works. Boards can't just set unrealistic or unreachable expectations. If ABFAS thinks that the standards they set are needed for FA surgeons, then they need to work with APMA and CPME to make sure residency programs train their residents accordingly. First, ABFAS needs to start using modern radographs for ITE and not reuse pictures form 1970 that are too blurred to see anything.

 

[Foot&AnkleSurgeon]

It's not how it works. Boards can't just set unrealistic or unreachable expectations. If ABFAS thinks that the standards they set are needed for FA surgeons, then they need to work with APMA and CPME to make sure residency programs train their residents accordingly.

The expectations set by ABFAS are attainable, but it's hard work. My story - High volume PSR-12 residency. Worked for a group for two years then set up my own practice. Attained ABFAS Foot certification after three or four years of practice. Then spent the next ten years attending ACFAS courses on trauma, ankle arthroscopy, reconstructive surgery etc and finally became RRA certified in 2004. It took ten years of hard work and dedication but was worth it for many, many reasons. The expectations are realistic and reachable.

 

[shadesofgrey]

The expectations set by ABFAS are attainable, but it's hard work. My story - High volume PSR-12 residency. Worked for a group for two years then set up my own practice. Attained ABFAS Foot certification after three or four years of practice. Then spent the next ten years attending ACFAS courses on trauma, ankle arthroscopy, reconstructive surgery etc and finally became RRA certified in 2004. It took ten years of hard work and dedication but was worth it for many, many reasons. The expectations are realistic and reachable.

This is no longer possible because the rules have changed. If your not certified in 7 years, game over.

 

[Foot&AnkleSurgeon]

This is no longer possible because the rules have changed. If your not certified in 7 years, game over.

I could have saved seven years of ACFAS hands-on labs if three year residencies were available way back then. So now it's seven. That's still plenty of time to get your cases together.

 

[shadesofgrey]

I could have saved seven years of ACFAS hands-on labs if three year residencies were available way back then. So now it's seven. That's still plenty of time to get your cases together.

Maybe, but the residency training isn't equal among the programs. I had 3 years of subpar training and guess what I'm doing now? I'm taking every ACFAS cadaver lab I can, just like you did, but I have less time to do it. The available training is to variable. My buddy's residency program, across town from mine, completed rearfoot numbers in like 6 months and my program took almost 2.5 years. I have another friend that scrambled into a 3 year program that literally made up cases to meet the minimum. I'm still planning to get ABFAS certified but I think the process is flawed to say the least and can admit I'm not sure the best way to fix this issue.

 

[Poddy2Hotty]

Maybe, but the residency training isn't equal among the programs. I had 3 years of subpar training and guess what I'm doing now? I'm taking every ACFAS cadaver lab I can, just like you did, but I have less time to do it. The available training is to variable. My buddy's residency program, across town from mine, completed rearfoot numbers in like 6 months and my program took almost 2.5 years. I have another friend that scrambled into a 3 year program that literally made up cases to meet the minimum. I'm still planning to get ABFAS certified but I think the process is flawed to say the least and can admit I'm not sure the best way to fix this issue.

Residency training is definitely not equal. Anyone that's done clerkships knows this.
ABFAS should be the standard and pass rates should be much higher than what they are.
The problem is too many residencies were give a free pass after the horrific residency shortage several years ago.

School enrollment should be cut in half. Residency positions should be cut in half. Minimum numbers should be doubled.

This would create an extremely well trained crop of new grads as well as improve job market allowing everyone to flourish.

Ortho, GI, Vascular surgery and other surgical specialties keep demand high by keeping supply low. Its basic economics.

New Texas school means more positions for less applicants which mean inevitably standards will nosedive (IMO this is one of the worst things Podiatry could have done). New residency spots will be squeezed out diluting training and producing less competent/confident individuals (the number of fellowships is increasing...coincidence?). As a result of this ABFAS pass rate will drop further and pods that have trouble with ABFAS will look to any other board that will get them into a hospital. Over time newer easier to pass boards will likely gain more and more members which may over time pressure ABFAS to lower standards. No one wins in this situation.

Obviously this is all hypothetical, but I can see it happening.

 

[PeaJay]

Residency training is definitely not equal. Anyone that's done clerkships knows this.
ABFAS should be the standard and pass rates should be much higher than what they are.
The problem is too many residencies were give a free pass after the horrific residency shortage several years ago.

School enrollment should be cut in half. Residency positions should be cut in half. Minimum numbers should be doubled.

This would create an extremely well trained crop of new grads as well as improve job market allowing everyone to flourish.

Ortho, GI, Vascular surgery and other surgical specialties keep demand high by keeping supply low. Its basic economics.

New Texas school means more positions for less applicants which mean inevitably standards will nosedive (IMO this is one of the worst things Podiatry could have done). New residency spots will be squeezed out diluting training and producing less competent/confident individuals (the number of fellowships is increasing...coincidence?). As a result of this ABFAS pass rate will drop further and pods that have trouble with ABFAS will look to any other board that will get them into a hospital. Over time newer easier to pass boards will likely gain more and more members which may over time pressure ABFAS to lower standards. No one wins in this situation.

Obviously this is all hypothetical, but I can see it happening.

Couldn’t agree more.

We should bring the standards up to make board pass rates higher and not the other way around. All of the tests I have taken to become licensed and board certified have been stressful, but not necessarily hard. The tests are easily passable if you actually have well rounded training.

 

[de Ribas]

The expectations set by ABFAS are attainable, but it's hard work. My story - High volume PSR-12 residency. Worked for a group for two years then set up my own practice. Attained ABFAS Foot certification after three or four years of practice. Then spent the next ten years attending ACFAS courses on trauma, ankle arthroscopy, reconstructive surgery etc and finally became RRA certified in 2004. It took ten years of hard work and dedication but was worth it for many, many reasons. The expectations are realistic and reachable.

That's not how it supposed to work. Most of what you are talking about should be done and made proficient in residency not on your own. What is residency for?

Lots of places barely do any RRA work. What do you expect them to do? "Fake it until you make it" type of approach? Screw 50 patients before they can start collecting good enough cases for logs? If ABFAS is to become one board, they will have to work with CPME and residency programs to improve education and training. Otherwise, how come those who completed 12-month residencies set requirements higher than they achieved themselves?

I am not against setting standards higher. I am for better pod education and training. Overall the quality is poor. Some programs are painful to look at. Low numbers, lack of case diversity, no education, lack of or trash academic portion. If ABFAS claims to be a leader, they should start doing something to improve the profession rather than throw away many pods without board certification and then fighting against them. That's just reinforces the notion that there is severe inconsistency in education and training within podiatry. As long as large percentage of pods will not be able to attain ABFAS the need for another board will exist. Division and inconsistency will continue as well. It hurts everyone. Even ABFAS certified pods.

 

[Feli]

Residency training is definitely not equal. Anyone that's done clerkships knows this.
ABFAS should be the standard and pass rates should be much higher than what they are.
The problem is too many residencies were give a free pass after the horrific residency shortage several years ago.

School enrollment should be cut in half. Residency positions should be cut in half. Minimum numbers should be doubled.

This would create an extremely well trained crop of new grads as well as improve job market allowing everyone to flourish.

Ortho, GI, Vascular surgery and other surgical specialties keep demand high by keeping supply low. Its basic economics.

New Texas school means more positions for less applicants which mean inevitably standards will nosedive (IMO this is one of the worst things Podiatry could have done). New residency spots will be squeezed out diluting training and producing less competent/confident individuals (the number of fellowships is increasing...coincidence?). As a result of this ABFAS pass rate will drop further and pods that have trouble with ABFAS will look to any other board that will get them into a hospital. Over time newer easier to pass boards will likely gain more and more members which may over time pressure ABFAS to lower standards. No one wins in this situation.

Obviously this is all hypothetical, but I can see it happening.

This dude gets it too. ^^^ Probably better presentation points than me with a GIF in there 🙂

The training quality is the bottom line. The high competency and the scarcity is the value.

Length of programs or everyone gets a program does nothing but create lower standards at programs that had little volume to begin with... all so that all grads get training, all get cert, etc. I get it that APMA wanted all programs 3yrs, but many weren't there in terms of volume and depth of teaching attendings. That is clearly reflected in program-to-program board qual rates for ABFAS. With more and more pod schools, it's now impossible to close or shrink spots at bad programs (without residency shortage). The easy board and bad programs love their golden chance here. It's a recipe to swing the supply/income/respect of DPM closer to chiro than to MD.

 

[de Ribas]

The expectations set by ABFAS are attainable, but it's hard work. My story - High volume PSR-12 residency. Worked for a group for two years then set up my own practice. Attained ABFAS Foot certification after three or four years of practice. Then spent the next ten years attending ACFAS courses on trauma, ankle arthroscopy, reconstructive surgery etc and finally became RRA certified in 2004. It took ten years of hard work and dedication but was worth it for many, many reasons. The expectations are realistic and reachable.

FMGs sometimes spend years and ton of money to pass STEPs to apply for US residencies. But that's because they had different, often poorer, inconsistent with US medical education. But that's not how it works for US MD students. Attainable is when more than 90% pass these STEPS. Which is true for US MDs. That is because schools teach exactly what LCME requires and what is covered on boards. Everyone in the hospital with MD residency programs knows standards and expectations of ACGME. From administration and coordinators to all physicians. They teach MD residents accordingly. Nobody knows about CPME. Nobody follows its expectations. There is barely any teaching in pod residency when I was on clerkships. Many programs just need to be shut down and not to deceive students.

 

[dtrack22]

School enrollment should be cut in half. Residency positions should be cut in half. Minimum numbers should be doubled.

This would create an extremely well trained crop of new grads as well as improve job market allowing everyone to flourish.

Ortho, GI, Vascular surgery and other surgical specialties keep demand high by keeping supply low. Its basic economics.

I’ve been pounding this drum for awhile now. I feel heard. Thank you for putting it in a way the new folks can understand.

 

[wakaflocka88]

Residency training is definitely not equal. Anyone that's done clerkships knows this.
ABFAS should be the standard and pass rates should be much higher than what they are.
The problem is too many residencies were give a free pass after the horrific residency shortage several years ago.

School enrollment should be cut in half. Residency positions should be cut in half. Minimum numbers should be doubled.

This would create an extremely well trained crop of new grads as well as improve job market allowing everyone to flourish.

Ortho, GI, Vascular surgery and other surgical specialties keep demand high by keeping supply low. Its basic economics.

New Texas school means more positions for less applicants which mean inevitably standards will nosedive (IMO this is one of the worst things Podiatry could have done). New residency spots will be squeezed out diluting training and producing less competent/confident individuals (the number of fellowships is increasing...coincidence?). As a result of this ABFAS pass rate will drop further and pods that have trouble with ABFAS will look to any other board that will get them into a hospital. Over time newer easier to pass boards will likely gain more and more members which may over time pressure ABFAS to lower standards. No one wins in this situation.

Obviously this is all hypothetical, but I can see it happening.

Refreshing to hear your perspective. Welcome to SDN. Your sentiments have been echoed numerous times but for some reason, even if ABPM ABFAS CPME have been lurking SDN for a while, seem to ignore those posts, but find Time to reply to other issues.

 

[111111194]

That's not how it supposed to work. Most of what you are talking about should be done and made proficient in residency not on your own. What is residency for?

Lots of places barely do any RRA work. What do you expect them to do? "Fake it until you make it" type of approach? Screw 50 patients before they can start collecting good enough cases for logs? If ABFAS is to become one board, they will have to work with CPME and residency programs to improve education and training. Otherwise, how come those who completed 12-month residencies set requirements higher than they achieved themselves?

I am not against setting standards higher. I am for better pod education and training. Overall the quality is poor. Some programs are painful to look at. Low numbers, lack of case diversity, no education, lack of or trash academic portion. If ABFAS claims to be a leader, they should start doing something to improve the profession rather than throw away many pods without board certification and then fighting against them. That's just reinforces the notion that there is severe inconsistency in education and training within podiatry. As long as large percentage of pods will not be able to attain ABFAS the need for another board will exist. Division and inconsistency will continue as well. It hurts everyone. Even ABFAS certified pods.

It is obnoxious. Those people always pushing for higher standards that never achieved those things themselves.

Not that higher standards are a bad thing but those setting the standard were never held to it.

 

[111111194]

School enrollment should be cut in half. Residency positions should be cut in half. Minimum numbers should be doubled.

Love it. If it was actually about the profession this is the solution.

Of course it’s never about the profession, those people who pretend to care so much are really just about their own financial gain.

 

[AttackNME]

Residency training is definitely not equal. Anyone that's done clerkships knows this.
ABFAS should be the standard and pass rates should be much higher than what they are.
The problem is too many residencies were give a free pass after the horrific residency shortage several years ago.

School enrollment should be cut in half. Residency positions should be cut in half. Minimum numbers should be doubled.

Completely agree. And I think it’s a good thing that we are stirring the pot in this forum, even better that organizations are paying attention.

Now the hard part. Who wants to be the confrontational leader of CPME and start shutting down programs? It takes a very strong personality to be able to do that. It’s easy for us to type out our opinions behind an anonymous handle. I for one know I won’t be able to handle the confrontation of letting programs and current residents of those programs know that they’re being shut down and totally screwing them over for the greater good.

 

[de Ribas]

Completely agree. And I think it’s a good thing that we are stirring the pot in this forum, even better that organizations are paying attention.

Now the hard part. Who wants to be the confrontational leader of CPME and start shutting down programs? It takes a very strong personality to be able to do that. It’s easy for us to type out our opinions behind an anonymous handle. I for one know I won’t be able to handle the confrontation of letting programs and current residents of those programs know that they’re being shut down and totally screwing them over for the greater good.

At least they could not allow school increase their class sizes and open another school.

In the last couple of years class sizes went up significantly. Completely irrational considering we don't even have 2 applicants for 1 seat. What was the logic behind that?

 

[dtrack22]

I for one know I won’t be able to handle the confrontation of letting programs and current residents of those programs know that they’re being shut down and totally screwing them over for the greater good.

Sign me up

But seriously. Cap enrollment (or shut down a couple of schools). Then give residency programs a 3 year notice for closure, during which time they are to still function but take no new residents. That actually gets their current residents a slightly better experience and they get to finish residency. No residency shortage, nobody needing to transfer programs or repeat years of training trying to find something new. You just have to do it in the correct order, unlike when “leaders” decided to open up Western during a time when residency numbers were already tight.

Sit, back, relax, and know that you made life better for far more people than you hurt.

 

[icebreaker32]

The quality of applicant, the quality of training is a concern.....but more so is the job market.

They easily need to cut the number of available seats in half for the next decade to have a chance to improve things significantly. Yes this does have unfortunate repercussions on the organizations and schools etc, but is likely necessary regardless if they want it to be true or not. It may happen on its own. If the ROI does not make sense for the majority who enter this profession versus other options they may have, it does not make sense. If this happens, it is not SDN causing the decline.

We heard that boomers were retiring, people were living longer and with increased diabetes there was going to be such a demand they actually needed to increase seats in the schools to avoid a shortage....well it did not happen so no more spin. It happened for PCPs, but not for podiatry.

We also heard how increased numbers would increase our visibility to the public and lobbying power etc. Many still do not understand what podiatry really is outside the profession. The AMA does fine with 20 percent membership and more MDs could well afford to pay the dues. It is good we have an organization as lobbying etc does take money.

Again am I trying to scare applicants away....no. Do due diligence of the pros/cons and choose a career. Most schools in any profession do a good job of emphasizing the pros. Shadow, but even that does not give the full picture in any profession. Those out less than 5 years are your best resource. Even if they are doing very well they will let you know the pros/cons better than a mid career professional in any profession and also how their friends are doing.

 

[de Ribas]

Completely agree. And I think it’s a good thing that we are stirring the pot in this forum, even better that organizations are paying attention.

Now the hard part. Who wants to be the confrontational leader of CPME and start shutting down programs? It takes a very strong personality to be able to do that. It’s easy for us to type out our opinions behind an anonymous handle. I for one know I won’t be able to handle the confrontation of letting programs and current residents of those programs know that they’re being shut down and totally screwing them over for the greater good.

I dont think there should be any confrontation. CPME, certifying board(s) have or should have specific standards for residency programs. If those are not met. Place them on probationary status. Then shut down if not improved. I bet a good portion will not be able to ever improve their training quality. There should be a process that is fair and equal for everyone. Not necessarily anyone has to make a decision about shutting down particular schools. The process will.

 

[deleted285117]

Off topic... but all y’all in path of the hurricane be safe!

 

[Feli]

Completely agree. And I think it’s a good thing that we are stirring the pot in this forum, even better that organizations are paying attention.

Now the hard part. Who wants to be the confrontational leader of CPME and start shutting down programs? It takes a very strong personality to be able to do that. It’s easy for us to type out our opinions behind an anonymous handle. I for one know I won’t be able to handle the confrontation of letting programs and current residents of those programs know that they’re being shut down and totally screwing them over for the greater good.

It doesn't have to be that way.
ABFAS site reviewers (and others) consistently recommend shutting down or probation or reducing the approved spots for programs that don't have requisite volume and diversity to produce competence or proper standards or academics to facilitate residents getting board qual/cert. Those recommendations often fall on deaf ears.

If there were the proper residency ratio (surplus of positions), it doesn't matter. Nobody has to be "the bad guy."

The lower quality programs will scramble and go unfilled time and time again... so they get their spots reduced or closed altogether (the few inadequate MD/DO programs are filled most with FMGs anyways). That's the way it should be. In podiatry's defense, the MD grads can match any specialty that will take them, but it is a numbers game nonetheless... MANY surplus spots versus US MD grads each cycle.

...In podiatry, with all of the new schools and most schools taking max allowed matriculants, this is impossible to close/reduce spots without causing residency shortage. We need all of the currently approved spots - and then some - to get most/all grads a residency.

This mismatch of quality training spots vs pod school grads is what got us into this mess in the first place: the big push for 3yr programs forced hasty creation of many crap VA programs and 1 or 2yr programs to be "3yr training" when many are inadequate training. Some were fine for a PPMR with 1yr, then those 2 approved persons graduate, then the hospital takes a couple incoming more the next year... but those programs were NOT good as 2/yr and converted to 3yrs... so 6 total residents at any time vs 2 or 3 total prior. They were told they'd grow into more residents, surgery, rotations... but few have. Good attendings who have a lot of cases and want to teach don't grow on trees. That was - and is - what separates the good pod residency programs from the joke programs.

And don't even get me started on how dumb taking some of our best DPM surgeons partially/totally out of residency training to have them run a fellowships is.

 

[malleolusman]

It doesn't have to be that way.
ABFAS site reviewers (and others) consistently recommend shutting down or probation or reducing the approved spots for programs that don't have requisite volume and diversity to produce competence or proper standards or academics to facilitate residents getting board qual/cert. Those recommendations often fall on deaf ears.

If there were the proper residency ratio (surplus of positions), it doesn't matter. Nobody has to be "the bad guy."

The lower quality programs will scramble and go unfilled time and time again... so they get their spots reduced or closed altogether (the few inadequate MD/DO programs are filled most with FMGs anyways). That's the way it should be. In podiatry's defense, the MD grads can match any specialty that will take them, but it is a numbers game nonetheless... MANY surplus spots versus US MD grads each cycle.

...In podiatry, with all of the new schools and most schools taking max allowed matriculants, this is impossible to close/reduce spots without causing residency shortage. We need all of the currently approved spots - and then some - to get most/all grads a residency.

This mismatch of quality training spots vs pod school grads is what got us into this mess in the first place: the big push for 3yr programs forced hasty creation of many crap VA programs and 1 or 2yr programs to be "3yr training" when many are inadequate training. Some were fine for a PPMR with 1yr, then those 2 approved persons graduate, then the hospital takes a couple incoming more the next year... but those programs were NOT good as 2/yr and converted to 3yrs... so 6 total residents at any time vs 2 or 3 total prior. They were told they'd grow into more residents, surgery, rotations... but few have. Good attendings who have a lot of cases and want to teach don't grow on trees. That was - and is - what separates the good pod residency programs from the joke programs.

And don't even get me started on how dumb taking some of our best DPM surgeons partially/totally out of residency training to do fellowships is.

Call me cynical, but I don’t see any of the above happening. It’s a small profession so it has lent itself to a lot of people wanting to be a big fish in a small pond; damned be the real change makers. I recall a website that I saw in podiatry school. Ah yes, “Legends of Podiatry”. Google it. It’s a good example of how things are run in our profession. Could be a meme!

Things won’t change until there is a real crisis. Hopefully the decrease in enrollment is the wake up call this profession needed. I doubt it though!

When in doubt about anything in life - follow the $$$. Same reason Turbo Tax is in business.

I will echo what the other posters have said - I enjoy what I do and genuinely feel I have helped people - but everything in this profession has felt like an uphill battle - and it has led to a deep resentment of our so called leadership. I don’t think other professions have this issue as acutely as we do and frankly - lots of podiatrists choose to put their heads in the ground because they don’t want to rock the boat.

From getting board certified to finding a job to having to continuously educate patients and other providers the scope of my training to dealing with TFP podiatrists (which there are many!) - it’s a bit much when you consider we are already dealing with insurance companies who don’t play nice.

To quote Rick James - we need some UNITY.

 

[AttackNME]

It doesn't have to be that way.
ABFAS site reviewers (and others) consistently recommend shutting down or probation or reducing the approved spots for programs that don't have requisite volume and diversity to produce competence or proper standards or academics to facilitate residents getting board qual/cert. Those recommendations often fall on deaf ears.

Reduced graduates alone will help, but bad programs still need to be shut down. The person doing the shutting down will feel like the bad guy even if they’re following protocol. I’m not a part of the CPME committee but I do not envy or want to be doing what they do.

 

[dtrack22]

I’m not a part of the CPME committee but I do not envy or want to be doing what they do.

I already volunteered to be an emotionless drone that brings the pain to underachieving residency programs. Honestly, I would do it for free. It would be my selfless contribution to our wonderful profession.

 

[wakaflocka88]

I already volunteered to be an emotionless drone that brings the pain to underachieving residency programs. Honestly, I would do it for free. It would be my selfless contribution to our wonderful profession.

Count me in.

 

[dtrack22]

Count me in.

 

[deleted664048]

I am for 1 board and ok with it being ABFAS. But what everyone says here is that there is no standardization, no continuity, no proper communication of standards or expectations between schools, residency programs, certifying boards and CPME.

It's not how it works. Boards can't just set unrealistic or unreachable expectations. If ABFAS thinks that the standards they set are needed for FA surgeons, then they need to work with APMA and CPME to make sure residency programs train their residents accordingly. First, ABFAS needs to start using modern radographs for ITE and not reuse pictures form 1970 that are too blurred to see anything.

Let's not forget that in 2021 ABFAS forgot to attach pictures to the exam, so there were like 20 questions "based on the image provided" but there was no image 🙄 And images that they provided re indeed from 1970...

How can you charge so much money and not even review an exam before releasing it? It just tells me that ABFAS only concerned about money.

I heard from people submitting cases for ABFAS review that they buy Starbucks gift cards for patients to come back 6 months after the surgery, and pay their Ubers, so they get free X-Ray and can submit it to the boards. This absolutely ridiculous.

Passing rate for qualification exam is very low, but what about case review passing? It's even lower, and after you have done your cases, you would pay whatever it takes to get it done.

Also RRA ABFAS had questions about peds that even ortho peds deformity specialists wouldn't know the answer. They were shocked to see that podiatry would get questions like that. And we all know, whoever wrote those questions never did a surgery on kids.

 

[deleted664048]

It is obnoxious. Those people always pushing for higher standards that never achieved those things themselves.

Not that higher standards are a bad thing but those setting the standard were never held to it.

Exactly! Our professors in podiatry school knew nothing about new developments, new research, they taught same thing in 2017 and they did 25 years ago. That is the problem. Same in majority of residencies, most attendings are not at the level but they have been there for 20 years, so no one cares that they do not bring anything knew to the profession, they just get extra salary for being a part of a residency.

 

[shadesofgrey]

Podiatry feels like an obstacle course where the finishers ahead of you immediately turn around and try to create another challenge for those coming behind them.

As for ABFAS, the problem is they are testing at a level that is not supported by the educational pathway. The low passing rates on the certification exams mean that either the test is not at the right level or more likely there is glaring problem with our schools and residencies.

If I was in charge over at ABFAS, I would number 1, increase the pass rate on the foot exam. This could be done by removing the nit picking during the case review. No more points deducted over mild nonsymptomatic postop edema or a screw being a thread length to long. If they can get the pass rate up to a comparable level as every other medical specialty that would alleviate much of the angst toward ABFAS. If they want to keep the RRA certification pass rate low, fine but with the foot certifications kept low it creates problems with privileging. Secondly, I would suggest they return to allowing doctors to get requalified if they haven't been certified yet. I believe the reason for the 7 year cut off was to be similar to ortho, but they don't have the failure rates or training variability we do. Why not allow the docs to hone and improve their skills over time. I'm 4 years out of residency and my skills and confidence now are so much better than they were coming out of residency. Right now I don't envision myself doing much rearfoot/ankle work, but with another 4 years of developing my skills maybe I will be up for it. The current system doesn't allow room for surgeon growth.

 

[AttackNME]

I’m curious… a lot of us acknowledge problems with residency training, but that’s usually for stuff like rearfoot and trauma. Would you say our current training standard for limb salvage and forefoot surgery is good?

 

[msion]

I actually don't mind this ABPM vs. ABFAS drama that's going on out there.
At least ABFAS knows that they are being challenged. If they continue to keep pass rate absurdly low and make the case review process subjective and unpredictable, then they will lose members to ABPM. Money talks. Those membership dues are no joke. Soon they may find it hard to pay rent for their office in San Francisco.

I mean, this prime real estate is not cheap....

When I was still a resident I stopped by the ABFAS booth at the ACFAS conference. A guy with a poker face stood there and told me to browse all the PDFs online and get certified. No freebies. Not even a pen or a bag. I was so pissed 😤

 

[CutsWithFury]

I’m curious… a lot of us acknowledge problems with residency training, but that’s usually for stuff like rearfoot and trauma. Would you say our current training standard for limb salvage and forefoot surgery is good?

Yes most likely for most infections and wounds.

But a dehisced Calc fracture or ankle fracture ORIF surgical wound can get complicated rather quickly as well as an open fracture wound. Wounds secondary to underlying Charcot deformities are also problematic. Understanding when to reconstruct vs not is sometimes something you won’t see at all residency programs as a lot of attendings don’t/won’t/can’t do these cases. Understanding when to utilize ex fix and putting one on and managing it in the post op period are experiences a lot of programs don’t offer due to attending comfort and experience.

In terms of foot a big hypermobile bunion can still be troublesome even for the most seasoned surgeon. As well as hammertoes. But I personally want to believe podiatry residents get more experience with forefoot pathology than most ortho residents and even probably most foot and ankle orthos.

 

[PatchAdamsFan]

I’m curious… a lot of us acknowledge problems with residency training, but that’s usually for stuff like rearfoot and trauma. Would you say our current training standard for limb salvage and forefoot surgery is good?

To add to CutsWithFury's response, limb salvage is a very generalized term. To some programs (and many "limb salvage" docs), this means amputations and unlimited debridements and grafts. To others it can mean large reconstruction cases, flaps, etc. In that sense, our eduction in limb salvage is all over the board. I agree wound care should be a strong aspect in every program, but it needs to be accompanied with good surgeons. That is where you will see and learn to manage complex post-op complications as well - it will absolutely happen in elective cases. The saying "if you cut, you will cry" is true. The ideal scenario would be graduating residents being comfortable doing most cases and manage complications - many do not get training in the latter.

This is why you see on these forums over and over again to get the best grades you can in school and attend the best residency you can. The training level between the best and worst programs in the country outputs two DPMS, but two almost entirely different professions in reality. I would argue that it is far better attending a high volume residency even if later on you say "no thanks" to many cases. Having the experience and the choice is very powerful and can only help you in the job hunt. At least that way you can understand most pathology and not bury your head in the sand. Also you will not be someone who shouldn't be left alone with a blade. By the way, I remember in residency that the best forefoot surgeons were the ones doing full scope as well. Even then, the forefoot complications were handled terribly by the older 'forefoot only' attendings. Go figure.

 

[malleolusman]

To add to CutsWithFury's response, limb salvage is a very generalized term. To some programs (and many "limb salvage" docs), this means amputations and unlimited debridements and grafts. To others it can mean large reconstruction cases, flaps, etc. In that sense, our eduction in limb salvage is all over the board. I agree wound care should be a strong aspect in every program, but it needs to be accompanied with good surgeons. That is where you will see and learn to manage complex post-op complications as well - it will absolutely happen in elective cases. The saying "if you cut, you will cry" is true. The ideal scenario would be graduating residents being comfortable doing most cases and manage complications - many do not get training in the latter.

This is why you see on these forums over and over again to get the best grades you can in school and attend the best residency you can. The training level between the best and worst programs in the country outputs two DPMS, but two almost entirely different professions in reality. I would argue that it is far better attending a high volume residency even if later on you say "no thanks" to many cases. Having the experience and the choice is very powerful and can only help you in the job hunt. At least that way you can understand most pathology and not bury your head in the sand. Also you will not be someone who shouldn't be left alone with a blade. By the way, I remember in residency that the best forefoot surgeons were the ones doing full scope as well. Even then, the forefoot complications were handled terribly by the older 'forefoot only' attendings. Go figure.

The thing is - even that won’t save you. All it will do is improve the odds of landing a better opportunity, opportunities which in it of themselves are limited. Goes back to what airbud and others have said - you can be DO/MD/NP and be guaranteed a good income getting out and the ability to move without difficulty - without having to explain what it is that you are trained to do every step of the way. Goes back to universal scope issue.

 

[Boba Foot]

Let's not forget that in 2021 ABFAS forgot to attach pictures to the exam, so there were like 20 questions "based on the image provided" but there was no image 🙄 And images that they provided re indeed from 1970...

Don’t forget that they basically gave everyone who had sat for an f’ed up exam a free passing result. Raising the bar for the profession, my ass. They just didn’t want to deal with refunds or legal action for running out a hastily prepared, faulty exam.

Also RRA ABFAS had questions about peds that even ortho peds deformity specialists wouldn't know the answer.

The exam was also about 25% TAR and supramalleolar osteotomies, things that most residencies do not touch nor will most RRA ABFAS want to do unless they go to fellowship to do it.

 

[Utvolsdpm]

Don’t forget that they basically gave everyone who had sat for an f’ed up exam a free passing result. Raising the bar for the profession, my ass. They just didn’t want to deal with refunds or legal action for running out a hastily prepared, faulty exam.

The exam was also about 25% TAR and supramalleolar osteotomies, things that most residencies do not touch nor will most RRA ABFAS want to do unless they go to fellowship to do it.

I sat for one of the exams in 2015 where the testing system glitched out nationwide I think and had to wait two hours for the test to load. We all got refunds then. They didn’t stay anything about extending the 7 years though.

 

[CutsWithFury]

The exam was also about 25% TAR and supramalleolar osteotomies, things that most residencies do not touch nor will most RRA ABFAS want to do unless they go to fellowship to do it.

You don't need a fellowship to do a TAR or SMO. Stop pushing this narrative. There are high powered programs that offer these experiences and residents can get competent at it.

Fellowship training is overrated

 

[Boba Foot]

You don't need a fellowship to do a TAR or SMO. Stop pushing this narrative. There are high powered programs that offer these experiences and residents can get competent at it.

Fellowship training is overrated

Not pushing any narrative, fellowship is dumb. But not a lot of programs do TAR or SMO. Certainly not enough to make board training exams focus so heavily on it. Never even saw one being done when I was a student on rotations.