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

 

[DPM TRUTH]

Ladies and gentlemen a quick thought....imagine ANY other business having the "success rate" the ABFAS has when it comes to the successful pass rate...especially first attempts.

Think about it....would you fly an airline that crashes with the same pass rate as ABFAS? Would you do business with a bank that only gets your balance right like the ABFAS pass rate? Would you eat at a restaurant that gives you food poisoning the same as the ABFAS pass rate?

Now imagine that airline/bank/restaurant doing the same thing for DECADES. Crashing planes/messing up your balance/making you sick with successful rates similar to the ABFAS pass rate. Do you think their would be any accountability or would they continue to "do business as usual" and blame it on the "stupid consumers".

This had been a KNOWN issue for 30+ years and the only progress that has been made is milking new residents 4k to "review" your cases again. Imagine that failing airline charging 4k to review why the plane crashed. How many more decades do we give them to clean things up?

 

[de Ribas]

As a relatively recent grad, ABPM is very appealing if it can become more accepted at hospitals. The ABFAS is a long drawn out process of case reviews with most associates needing to go back to previous jobs to pick out cases. On top of this the ABFAS shows their true colors with the abysmal pass rates in what seems like one large money grab. Why would I want to support a board that has failed the majority of my colleague just to force them to pay more test dues if there is an alternative choice. The only thing right now that is holding me back from not paying the qualification dues and switching to ABPM is the fact that hospitals in my area do not recognize the ABPM. Hopefully the leadership of the board start to work on that.

I guess it is not so much money but gatekeeping. So if good surgical jobs are limited to ABFAS certified pods and pass rates are around 50% then that narrows it down to about 300 people entering surgical market. That aligns with what some in SDN suggest number of graduating pods should be. Is it a way to eliminate competition for low number of good jobs? Maybe.

 

[Boba Foot]

As a relatively recent grad, ABPM is very appealing if it can become more accepted at hospitals. The ABFAS is a long drawn out process of case reviews with most associates needing to go back to previous jobs to pick out cases. On top of this the ABFAS shows their true colors with the abysmal pass rates in what seems like one large money grab. Why would I want to support a board that has failed the majority of my colleague just to force them to pay more test dues if there is an alternative choice. The only thing right now that is holding me back from not paying the qualification dues and switching to ABPM is the fact that hospitals in my area do not recognize the ABPM. Hopefully the leadership of the board start to work on that.

This is why ABFAS is getting scared and doing petty things like disallowing ABPM at ACFAS. People are seeing through their scam and they are resisting any sort of change to dispute their monopoly on surgical board privileges.

 

[PMG03470]

This is why ABFAS is getting scared and doing petty things like disallowing ABPM at ACFAS. People are seeing through their scam and they are resisting any sort of change to dispute their monopoly on surgical board privileges.

Wait are you saying they won’t let ABPM certified attend ACFAS conference?!? If so that’s just insane.

 

[icebreaker32]

Wait are you saying they won’t let ABPM certified attend ACFAS conference?!? If so that’s just insane.

No I think have a booth at ACFAS conference

 

[Boba Foot]

Wait are you saying they won’t let ABPM certified attend ACFAS conference?!? If so that’s just insane.

What icebreaker said.

 

[diabeticfootdr]

What icebreaker said.

I posted the letter in one of the threads.

They cashed our check, then refunded ABPM sponsorship and said we’re not welcome.

Also excluded from the Residency Director’s summit.

We’ve been there as long as I can remember.

Which means we have no business purpose there so none of the BOD will go. We’re not going to spend diplomate money just for us to go to ACFAS as attendees.

Although a Costa Rican retreat sounds nice … #PuraVida

 

[myfeetrkillingme]

Ladies and gentlemen a quick thought....imagine ANY other business having the "success rate" the ABFAS has when it comes to the successful pass rate...especially first attempts.

Think about it....would you fly an airline that crashes with the same pass rate as ABFAS? Would you do business with a bank that only gets your balance right like the ABFAS pass rate? Would you eat at a restaurant that gives you food poisoning the same as the ABFAS pass rate?

Now imagine that airline/bank/restaurant doing the same thing for DECADES. Crashing planes/messing up your balance/making you sick with successful rates similar to the ABFAS pass rate. Do you think their would be any accountability or would they continue to "do business as usual" and blame it on the "stupid consumers".

This had been a KNOWN issue for 30+ years and the only progress that has been made is milking new residents 4k to "review" your cases again. Imagine that failing airline charging 4k to review why the plane crashed. How many more decades do we give them to clean things up?

I would only get on a plane whose pilot passed that examination. The pilot passes a rigorous test that truly measures their individual skill set and decision-making when they are solo. The same goes for an ABFAS diplomate that passed their solo exam.

 

[Adam Smasher]

Is a Costa Rican retreat more extravagant than office space in Hermosa Beach?

 

[podwho]

I would only get on a plane whose pilot passed that examination. The pilot passes a rigorous test that truly measures their individual skill set and decision-making when they are solo. The same goes for an ABFAS diplomate that passed their solo exam.

First off you don't get to choose your pilot. I bet no one has ever asked ever if their commercial airline pilot passed their exam. You can pick your doctor.

Second, I bet the pilot exam actually tests their ability to be a pilot. Can't say the same for abfas and surgery.

I have no issue with abfas except their exam is total trash. It wouldn't pass the most basic of stardards for an Ortho board exam.

 

[DPM TRUTH]

It was stated:

I would only get on a plane whose pilot passed that examination.

To get your commercial pilots license you need to pass a standardized test and prove you are competent in that aircraft from previous logs. They make NO EXCEPTIONS like the abfas has done. Unlike the abfas exam, they don't grandfather in pilots to get your license if you never flown that plane. You are not allowed to fly (get your type rating) for an aircraft you NEVER flown. The ABFAS gives ankle certificates to people that never touched an ankle. Why is that?

It was also stated :

The pilot passes a rigorous test that truly measures their individual skill set and decision-making when they are solo. The same goes for an ABFAS diplomate that passed their solo exam.

Are you talking about the grandfathered in crowd also? Do you think the people that never completed a surgical residency had their decision making measured by the abfas? Please explain how never completing a surgical residency, but having a surgery certificate, is safe for the public.

 

[Feli]

...grandfathered in crowd ...

...Grandfathered individuals were not required to ...

About the grandfathered in crowd...

... those grandfathered into the abfas...

[could have quoted 100 more of same/similar]

This loop has been playing awhile. Wow.

Time will solve that big scary problem, man. Everyone knows podiatry training has changed a ton.

 

[DPM TRUTH]

Yes time will solve this problem, you are right. The problem is, it will take 15-20 more years until the grandfathered in crowd is FULLY retired.

So until ALL grandfathered in abfas dpms retire, please ALWAYS remember there are people with ABFAS certification that NEVER did a surgical residency. How is that ok for another 15-20 years? Should we just ignore this and act like "its no big deal"? This does not happen in orthopedics. There is no boarded orthopedic surgeon that NEVER completed a surgical orthopedic residency. Why do we allow it?

All I am saying is at least the abpm caq REQUIRED a surgical residency to take the test. Even if it was "poor training", it is better than ZERO surgical residency at all.

Please address how it's "cool" for the grandfathered in crowd to be "certified in surgery" but the abpm caq is not? Because someone said so? Who gets to make these rules for diffrent groups? Public safety right?

 

[Feli]

...ZERO surgical residency at all...

Where are you practicing that folks with no surgical residency or case logs are doing surgery? Serous question.
Are you talking about some antiquated no residency DPMs holding on to toe amp privileges they somehow acquired decades prior?

I have held licenses in over a half dozen states, practiced in 3... haven't ever seen a hospital or ASC that doesn't ask for both residency logs and attending logs. Some are public hospitals, some private, some are physician ASCs... but all demand logs. Ditto for my co-residents, colleagues, friends in the profession nationwide. This is one of the main reasons why the good residencies are the good residencies (good LEGIT logs, esp RRA + skills to do the cases well).

I am sure that perhaps such a place exists somewhere that lets in surgeons with no case logs (likely some VA?), but ask yourself this:
If a facility is handing out surgical privi withOUT logs, do you think that any real or fake board cert is something they care enough to learn or ask???

Again, 100% of facilities I've ever applied to ask for diploma, residency cert (and fax to verify that), resident case logs, attending logs, BQ/BC, etc etc. Some ask for much more or have stricter privi criteria (most call residency, req ABFAS, req references). Regardless of what their nuances may be, no surgical residency = done for surgical privi at any facility I've seen. One could be 1968 Am Board Galactic Judo Surgery in foot, ankle, hand, and spine surgery and the most likeable DPM in the world... but no logs, no surgical residency = nope.

I'm afraid that you are fighting invisible enemies here, man.

 

[DPM TRUTH]

They aren't practicing my friend, they are using it against non-boarded (PM&S-36 trained) collegues in litigation. But since "they are board certified in surgery" they can use it how they want and make people think they are "surgeons". That's not invisible at all, it costs collegues lots of money. I personally know 2.

 

[Feli]

They aren't practicing my friend, they are using it against non-boarded (PM&S-36 trained) collegues in litigation. But since "they are board certified in surgery" they can use it how they want and make people think they are "surgeons". That's not invisible at all, it costs collegues lots of money. I personally know 2.

This happens no matter what... some dip DPM with no board cert and nothing but APMA membership does a dozen or more depositions every year against surgery DPMs in suits. They get in bed with certain contingency malprac lawyers...
"Orthotics would have fixed the problem..."
"Patient was rushed into surgery..."
"Conservative care was not exhausted..."
"Patient has CRPS now..."
"Low dye strapping would have fixed the flat foot..."
"They needed a skived met pad, not a 15 blade..."
"Gentian violet would have prevented that gas gangrene amputation..."

..."but Dr. Cheeseball, you don't even do surgery."
"No, no... but I go to scientific meetings. I read books about surgery and I know about it. I have the same degree as Dr. Training..."

..."Dr. Cheeseball, how many depos have you done and how many were plaintiff?"
"Fourteen last year, all plaintiff side. I truly like to help where I can..."

I'm not sure what can be done about this... this is a function of the saturation of podiatry. We have some people with such low training and so little work that this is their best path. It is much more abundant in chiro (injury occurs with manip and 100 other DCs are jumping to get expert fee).

At the end of the day, regardless of their fake cred, it takes much digging and legal time to get these tools disqualified as an expert - on the surgery part, anyways. That's why they do it. The end goal is just to coax a settlement and waste time or bluff expensive and long trial that'll never happen. It's sad. It's a time waste. Unfortunately, it's not totally ineffective. Been there, done that (and even managed to not bust out laughing in depo).

 

[Boba Foot]

"Gentian violet would have prevented that gas gangrene amputation..."

I've only been in post-residency job for 8 months and I've already seen 3 patients with gas/nec fasc/severe diabetic infection with friggin gentian violet on their wounds. I'm slowly realizing that anyone who uses gentian violet has no idea how to do actual wound care. It is the mark of an incompetent pod or wound care doc.

 

[PMG03470]

I've only been in post-residency job for 8 months and I've already seen 3 patients with gas/nec fasc/severe diabetic infection with friggin gentian violet on their wounds. I'm slowly realizing that anyone who uses gentian violet has no idea how to do actual wound care. It is the mark of an incompetent pod or wound care doc.

That’s ridiculous… colleague of mine at my last practice was part time, he DID residency. Before I was leaving for maternity leave I introduced him to some of my wound patients. I had one patient with a new heel eschar that was stable and I had referred to vasc and he was being worked up by them. I told him not to debride and that we were just monitoring and keeping stable until revascularization and then we could debride/partial calc, or whatever needed to be done at that point.

Apparently the first follow up after I was on leave he told the patient I was wrong and that “the debridement process needed to be started”. Over the next couple of weeks he ended up debriding down to calc. Vascular surgeon saw him for a follow up, took one look at the wound and advised BKA because of how infected it got with what he did. I return from leave and he no leg… I was pissed and in disbelief honestly that someone with apparently the same training as me (this guy was “fellowship” trained) would debride a non vascular wound down to bone without revascularization first. The variability of training is the real problem with this profession.

 

[PatchAdamsFan]

I've only been in post-residency job for 8 months and I've already seen 3 patients with gas/nec fasc/severe diabetic infection with friggin gentian violet on their wounds. I'm slowly realizing that anyone who uses gentian violet has no idea how to do actual wound care. It is the mark of an incompetent pod or wound care doc.

But doesn't one gentian violet a day keeps the nec fasc away?
If someone is not optimizing, working up, or surgically managing wounds, they are not wound experts. They are band-aid changers who will soon lose that patient to an amp. I'm describing a large number of podiatrists.

 

[heybrother]

During residency I was consulted for an admit on a guy with a wound on the anterior ankle. A fellowship trained podiatrist had been debriding him for months until the anterior tibial tendon was showing - like it was fully exposed. She told him the tendon was cutting a path through his skin and that he needed to limit its range of motion by wearing a CAM boot. I think she had 20+ debridement notes in a row without any adjustment of plan or discussion or anything. The debridements were all done in a peripheral hospital that was part of my residency system. I filtered his notes by vascular surgery and the patient had already been told he needed vascular intervention a few months before the debridement began.

So whenever you feel like a screw up. Whenever your best just doesn't seem to be working. Remember that at any moment your tendons could come exploding through your skin and you need some DME to control it.

 

[DYK343]

gentian violet

I dont use it for DFUs but try it on post matrixectomy. It dries it up quick.

 

[FedPod]

So whenever you feel like a screw up. Whenever your best just doesn't seem to be working. Remember that at any moment your tendons could come exploding through your skin and you need some DME to control it.


Thank you for this gem.

 

[deleted285117]

Ironically, i’m treating a lady now with an anterior ankle incision dehisence from a total ankle. Have to immobilize to prevent shear/gliding of the TA tendon, causing it to interfere with granulation.

The surgeon told her to “air it out” and use gauze. Then when I called him he acted all macho and asked me what I was doing for it. He’s a big name F&A orthopod BTW.

Amazing how many clean up jobs I do. Don’t get me started on dermatologist post-excision wound messes...

 

[DYK343]

Ironically, i’m treating a lady now with an anterior ankle incision dehisence from a total ankle. Have to immobilize to prevent shear/gliding of the TA tendon, causing it to interfere with granulation.

The surgeon told her to “air it out” and use gauze. Then when I called him he acted all macho and asked me what I was doing for it. He’s a big name F&A orthopod BTW.

Amazing how many clean up jobs I do. Don’t get me started on dermatologist post-excision wound messes...

Ive seen these go to absolute $hit. BKA.

Depending on how bad it is I would consider a delta frame to 100% immobilize until granulation tissue covers the TA and/or wait for full epithelialization. I wouldnt mess with casting, TCC, or CAM. Throw a vac on there if necessary. Maybe even some biomagic grafts.

I know ROM is important for a TAR but when that TA is exposed its headed towards BKA.

 

[Pronation]

Ive seen these go to absolute $hit. BKA.

Depending on how bad it is I would consider a delta frame to 100% immobilize until granulation tissue covers the TA and/or wait for full epithelialization. I wouldnt mess with casting, TCC, or CAM. Throw a vac on there if necessary. Maybe even some biomagic grafts.

I know ROM is important for a TAR but when that TA is exposed its headed towards BKA.

Totally agree, can easily become a complete disaster. I would get plastics instantly involved for a flap. Couldn’t care less about ROM at that point.

 

[deleted285117]

Totally agree, can easily become a complete disaster. I would get plastics instantly involved for a flap. Couldn’t care less about ROM at that point.

Plastics on speed dial for sure.

Maybe throw some Gentian violet and HBOT at it for good measure? 🤪

 

[AttackNME]

Wound care and limb salvage really is a whole different animal. You have to do a lot of it to be comfortable with big and high risk wounds and infections. Sure basic limb salvage doesn't require the highest level of technical skill, but it requires a deep understanding and experience to actually be good at it. I think it's a shame the way residency is organized where third years mostly will never scrub and do big incisions for nec fasc cases because addon cases like that are usually a "first year case". Once they come out of training they're chicken with severe infections, afraid to cut or manage and jumping to recommending BKAs when its salvageable, yet also wanting to do big elective cases.

 

[Feli]

Totally agree, can easily become a complete disaster. I would get plastics instantly involved for a flap. Couldn’t care less about ROM at that point.

100% agree... if you don't do TAAs, ankle fusions, etc type surgery... then I would NOT mess with the associated wounds.
It is just a rough area with very little between the wound and the implant or fixation. It is not a plastics issue... the TA tendon with sheath will barely... sometimes... maybe... unlikely to take a STSG; it's a terrible area for any grafts or flaps... they can obviously compound the issue. If a TAA surgical wound surface contam/infect becomes a deep one, you have to move fast with IV abx and surgery both. BKAs or complex last-ditch salvages are very common from what was an anterior ankle "minor wound" a week or two prior. Those are not cases you want, and if you don't do the ankle salvage fusions/spacers/etc, it will be too late to refer.

They can really blow up in your face, esp the TAAs since the TA and tissues move a lot more than fusion. People won't stop walking. A lot of times, it won't be the orig surgeon who gets the major legal blowback from a BKA or septic ankle either... it will be the last guy who had their hand in the cookie jar. I would send that one back asap.

... A fellowship trained podiatrist ...

They don't call them that anymore. All podiatrists are fellowship or multi-fellowship trained now.
...but they are called foot and ankle surgeons.

Antiquated pre-2015 DPMs are the only "podiatrists" left. See ya at podiatry clinic tomorrow. 🙂

 

[wakaflocka88]

Wound care and limb salvage really is a whole different animal. You have to do a lot of it to be comfortable with big and high risk wounds and infections. Sure basic limb salvage doesn't require the highest level of technical skill, but it requires a deep understanding and experience to actually be good at it. I think it's a shame the way residency is organized where third years mostly will never scrub and do big incisions for nec fasc cases because addon cases like that are usually a "first year case". Once they come out of training they're chicken with severe infections, afraid to cut or manage and jumping to recommending BKAs when its salvageable, yet also wanting to do big elective cases.

Great commentary. I agree. It amazes me how these young grads brag about these big cases they do but we never hear about any complications 😂

If you ain’t ready to handle the worst case scenario don’t do it. I’m looking at you, FellowBro/Gal.

 

[heybrother]

They don't call them that anymore. All podiatrists are fellowship or multi-fellowship trained now.
...but they are called foot and ankle surgeons.

Antiquated pre-2015 DPMs are the only "podiatrists" left. See ya at podiatry clinic tomorrow. 🙂

You got me. I pulled their website and its heavy on foot and ankle light on the P.

 

[Pronation]

Wound care and limb salvage really is a whole different animal. You have to do a lot of it to be comfortable with big and high risk wounds and infections. Sure basic limb salvage doesn't require the highest level of technical skill, but it requires a deep understanding and experience to actually be good at it. I think it's a shame the way residency is organized where third years mostly will never scrub and do big incisions for nec fasc cases because addon cases like that are usually a "first year case". Once they come out of training they're chicken with severe infections, afraid to cut or manage and jumping to recommending BKAs when its salvageable, yet also wanting to do big elective cases.

I think there’s a huge difference between wanting to do big cases and actually doing them. You think any of the pods that do heavy elective hindfoot/ankle surgery can’t easily handle some nec fasc? Cmon now…

 

[Feli]

I think there’s a huge difference between wanting to do big cases and actually doing them. You think any of the pods that do heavy elective hindfoot/ankle surgery can’t easily handle some nec fasc? Cmon now…

Yeah, the vast majority of DPMs are way too likely to pussyfoot on the severe infections... too slow to OR, too slow to PO abx, way too slow to admit/IV, too slow to amp, etc. That's sometimes a confidence hope-and-pray thing, sometimes embarrassed their elective case or office wound care went south, sometimes training and not realizing severity or DME needs, and many are that they get paid to "salvage" as long as possible.

The highly surgical trained/cert ones seldom are "conservative" with serious/deep infections... they lean to over-aggressive (both because that's what works and they don't have time to putz). You want to clear the infect and get them on with their life... $ isn't the goal there (esp in PP, since the infect/ulcer pts usually have bad insurance anyways).
I did and presented research on gas gangrene outcomes, pathogens, abx, etc in residency... the crux of it is that you usually want to open amp at least one (functional) joint level behind the gas proximal extent to have best chance of avoiding BKA. Plenty of even digit/ray cases went to BKA if initial surgeon didn't do that.

It is no different with abscess, contaminated punctures, post-op infections, etc... early and aggressive wins the day, if it can be won. Recon it or amp it or do the best DME you can, and know when it works or fails. There are hardly any surgeons who can do bigtime elective/trauma who don't know this... it's the office/graft wound wizards/centers who will finally send an infected un-braceable re-ulcer x6 patient with WBC 22 and cellulitis to mid tibia to the ER who should've had BKA years ago.

 

[PMG03470]

Yeah, the vast majority of DPMs are way too likely to pussyfoot on the severe infections... too slow to OR, too slow to PO abx, way too slow to admit/IV, too slow to amp, etc. That's sometimes a confidence hope-and-pray thing, sometimes embarrassed their elective case or office wound care went south, sometimes training and not realizing severity or DME needs, and many are that they get paid to "salvage" as long as possible.

The highly surgical trained/cert ones seldom are "conservative" with serious/deep infections... they lean to over-aggressive (both because that's what works and they don't have time to putz). You want to clear the infect and get them on with their life... $ isn't the goal there (esp in PP, since the infect/ulcer pts usually have bad insurance anyways).
I did and presented research on gas gangrene outcomes, pathogens, abx, etc in residency... the crux of it is that you usually want to open amp at least one (functional) joint level behind the gas proximal extent to have best chance of avoiding BKA. Plenty of even digit/ray cases went to BKA if initial surgeon didn't do that.

It is no different with abscess, contaminated punctures, post-op infections, etc... early and aggressive wins the day, if it can be won. Recon it or amp it or do the best DME you can, and know when it works or fails. There are hardly any surgeons who can do bigtime elective/trauma who don't know this... it's the office/graft wound wizards/centers who will finally send an infected un-braceable re-ulcer x6 patient with WBC 22 and cellulitis to mid tibia to the ER who should've had BKA years ago.

I mentioned the one joint proximal rule to my current boss and he was dumbfounded. He had never heard that and thought it was too aggressive. I follow it with acute OM even because I don’t want to risk leaving unclean margins

 

[AttackNME]

I think there’s a huge difference between wanting to do big cases and actually doing them. You think any of the pods that do heavy elective hindfoot/ankle surgery can’t easily handle some nec fasc? Cmon now…

I know for a fact a lot of them can’t because I get referrals and questions all the time from docs who routinely do big elective cases. And that’s okay, it’s two different skill sets, not easy to be good at both. If you don’t think you can ever improve your i&ds and amputations then we have nothing to discuss

 

[FootGuy]

First, let me establish my position "somewhere in the middle ground."

I do not see a problem with having 2 boards, ABFAS and ABPM for certification, nor do I believe that just because a DPM is ABPM certified they should be automatically restricted from performing surgery (foot or RRA). While I agree the ABFAS process is far more difficult, It would seem that there are good DPM's on both sides. Surgical privileges should be based on education, training, and experience in my opinion and require proctoring as determined by hospital medical staff if needed to assess competency. If competent, I believe a DPM should have privileges granted.

I know great surgeons on both sides and a few on each side that are also a bit scary. I also agree that if able to pass, it is better to pursue ABFAS qualification, if for no other reason than to avoid the headaches that discussions such as this create with credentialling committees, and amongst our small profession.

To clarify, I am ABFAS certified and not certified through ABPM. It was a larger headache to pass for sure, but I felt it was worth it overall. The problem lies with ABFAS having created a feeling of alienation amongst many DPM's "attempting to get in" and creating the aura of "rigidity" and "exclusion". This is the area where our ABFAS leaders should be focusing in my opinion. It would seem we have created an "us against them" feeling, which ultimately has led to further division and conflict, including the ABPM CAQ. This would seem completely unnecessary and also misleading when a DPM advertises his/her certification as a "foot and ankle surgeon", when not having been certified by a surgical board. - again, I am in no way proposing that an ABPM certified DPM not be allowed to perform surgery if meeting proctoring and competency requirements, but if that is the case there should be transparency on the nature of the certification and from which entity.

There are many ABPM certified podiatrists advertising themselves to be "board certified foot and ankle surgeons", yet failing to designate the board from which they are certified. From what I can see, it looks like both ABPM and ABFAS "require" their respective board certified diplomates to designate from which board their certification is granted, yet this is not enforced even in the most publicly promoted instances.

I personally, at least on its face, would choose the ABFAS surgeon over the ABPM surgeon, because I know what it takes to achieve and it does indicate at least a commitment to surgery with a level of basic competency at some point. This may or may not remain the case over time, dependent on case numbers, diversity, etc. over the years. Also, there are DPM's like Dr. Rogers who do a lot of surgery, advocate for our profession, etc. who are most certainly very competent.

Now for my "2 cents" - STOP FIGHTING, start enforcing "truth in advertising" amongst diplomates, and personally I would drop the CAQ as this seems to be divisive and potentially misleading (at least in the setting of the things above), unless of course there are steps taken to clearly differentiate what the CAQ means vs. ABFAS certification in layman's terms that are easily visible to patients. Honestly, patients don't seem to care from which board a surgeon is certified, but this could be due to lack of transparency, confusion, or lack of concern.

As a profession, I would propose at a minimum, we should be clear on the facts surrounding certification and allow the patient to choose the best podiatric physician or surgeon for them. I also believe it is the responsibility of each respective board to take corrective action, which is probably merely enforcing the requirement that their respective diplomates appropriately advertise their certification in each respective specialty.

I am hopeful this is found to be reasonable, non-inflammatory, and develops some traction amongst the leaders of both certifying boards.

This is above my advocacy level by far, but perhaps at least some of this is something that can be discussed between both of our groups, in order to regain some cohesiveness?

@diabeticfootdr​

Thank you for any consideration and insight

 

[diabeticfootdr]

I am hopeful this is found to be reasonable, non-inflammatory, and develops some traction amongst the leaders of both certifying boards.

This is above my advocacy level by far, but perhaps at least some of this is something that can be discussed between both of our groups, in order to regain some cohesiveness?

@diabeticfootdr​

Thank you for any consideration and insight

Thanks for providing your opinion. And I think you seem reasonable.

Here’s one of the problems with the term “Foot and Ankle Surgeon” … it’s not a legally protected term. Anyone can use it - MD, DO, DPM, even others possibly. You don’t have to demonstrate anything to use it. No board certification or special training. Thus any DPM can refer to themselves as a Foot and Ankle Surgeon (as long as it doesn’t violate any other state law).

Podiatry/Podiatrist/Podiatric Physician or Surgeon are legally protected terms. By law in every state, the only people who can advertise themselves as such, must have a Podiatry license.

Truth in advertising from a Board Certification perspective only pertains when someone is BC and advertises their status not in compliance with the bylaws or policies of the Board.

For example: it’s against our advertising policy for an ABPM-certified podiatrist to advertise themselves as a “Board Certified Foot and Ankle Surgeon”. They must adhere to the guidelines.

On BC in your comments:

The need for 2 Boards in the specialty of podiatry has expired because every resident has been trained in both podiatric medicine and surgery since 2003.

No MD training program leads to two different boards. And no MD board has a tiered certification (aka Foot and RRA).

We need a single board and a single tier for everyone that finishes a PMSR. Then, with advanced training in fellowship, there could be subspecialty certification (like a CAQ).

Until that point at which the other leaders realize this and change to meet the current/future needs of the public and the profession, ABPM will continue with our vision of fairness and parity and building this on our own by offer a single-tier primary certificate and voluntary CAQs for additional levels of distinction.

 

[DYK343]

We need a single board and a single tier for everyone that finishes a PMSR. Then, with advanced training in fellowship, there could be subspecialty certification (like a CAQ).

Until that point at which the other leaders realize this and change to meet the current/future needs of the public and the profession, ABPM will continue with our vision of fairness and parity and building this on our own by offer a single-tier primary certificate and voluntary CAQs for additional levels of distinction.

I was nodding my head in agreement until the last 2 paragraphs. Then got lost/Im not following well.

If someone is well trained (Lets say the classic podiatry institute residency in Georgia) but did not do a fellowship what surgeries should they be permitted to do? What could they do with your CAQ?

 

[diabeticfootdr]

I was nodding my head in agreement until the last 2 paragraphs. Then got lost/Im not following well.

If someone is well trained (Lets say the classic podiatry institute residency in Georgia) but did not do a fellowship what surgeries should they be permitted to do? What could they do with your CAQ?

They should be able to do nothing more than they have the education, training, and current experience to do.

If someone is BC in Gen Surg or Ortho, they don’t have privileges to do everything in those specialties and no one is jumping up and down complaining that it’s a patient safety issue to have board certification in Ortho if you don’t have experience/not competent to do spine. Why? Because MDs don’t worry that this Ortho will get spine privileges and harm patients because no hospital would give them privileges to do it (without current experience) even though they’re BC.

Podiatrists do this to themselves (others).

 

[myfeetrkillingme]

They should be able to do nothing more than they have the education, training, and current experience to do.

If someone is BC in Gen Surg or Ortho, they don’t have privileges to do everything in those specialties and no one is jumping up and down complaining that it’s a patient safety issue to have board certification in Ortho if you don’t have experience/not competent to do spine. Why? Because MDs don’t worry that this Ortho will get spine privileges and harm patients because no hospital would give them privileges to do it (without current experience) even though they’re BC.

Podiatrists do this to themselves (others).

you really did not answer the question as it pertains to Podiatry residency and Podiatry fellowships. Why is the CAQ necessary if someone reached all of their MAVs in podiatric surgery during their three-year residency? What does the surgical CAQ offer that well-trained resident or fellow?

 

[AttackNME]

you really did not answer the question as it pertains to Podiatry residency and Podiatry fellowships. Why is the CAQ necessary if someone reached all of their MAVs in podiatric surgery during their three-year residency? What does the surgical CAQ offer that well-trained resident or fellow?

Seems like you need to do some more reading on understanding the hospital credentialing process and its regulations. Dr Rogers answered this so many times already

 

[myfeetrkillingme]

Seems like you need to do some more reading on understanding the hospital credentialing process and its regulations. Dr Rogers answered this so many times already

Not specifically for podiatry he didn't. I really want to understand. Thanks

 

[AttackNME]

Not specifically for podiatry he didn't. I really want to understand. Thanks

What specifically do you want to know? Have you tried to do some research to understand what a CAQ is and what is generally needed to obtain surgical privileges at hospitals?

Edit: re-reading your post, I think what you want to know is: is it possible to maintain surgical priviledges at hospitals without board certification? Answer is depends on the hospital, most bylaws require board cert within a certain number of years after residency.

Look! Here’s chat GPT’s answer:

In many cases, board certification is a requirement for obtaining and maintaining surgical privileges in a hospital or other medical facility. However, the specific requirements for maintaining surgical privileges can vary depending on the institution and the state or country in which the physician practices.

Some hospitals and medical facilities may require board certification as a condition of granting surgical privileges, while others may accept alternative forms of credentialing or documentation of qualifications. For example, a hospital may allow a physician to maintain surgical privileges if they can demonstrate a certain number of years of experience in the specific surgical procedure, even if they are not board-certified in the specialty.

It's important to note that not being board-certified in a surgical specialty may limit a physician's career opportunities and potentially affect their earning potential. In addition, some insurance providers may require board certification as a condition for providing malpractice insurance coverage.

Ultimately, the requirements for maintaining surgical privileges will depend on the policies of the specific medical facility, as well as the regulations of the state or country in which the physician practices. It's important for physicians to stay up-to-date on these requirements and work to maintain the necessary qualifications and certifications to ensure their ability to practice in their chosen specialty.

 

[Pronation]

I’m having a dystopian vision of us unknowingly blowing away time going back and forth with a chatGPT plant on this forum.

 

[diabeticfootdr]

you really did not answer the question as it pertains to Podiatry residency and Podiatry fellowships. Why is the CAQ necessary if someone reached all of their MAVs in podiatric surgery during their three-year residency? What does the surgical CAQ offer that well-trained resident or fellow?

Firstly, the system doesn’t make sense. When you finish your training (with all your MAVs), you’re deemed competent to perform surgery by most hospitals for 5 years - albeit ABFAS gives you 7 years to get certified. But at 5 years if you’re not yet certified, you’re suddenly not competent to perform surgeries, despite how many you may have already performed at that hospital.

Secondly, hospitals look for some method of external validation to verify your ongoing competence. That could be Board Certification or a CAQ.

That’s why you need it.

 

[Boba Foot]

But at 5 years if you’re not yet certified, you’re suddenly not competent to perform surgeries, despite how many you may have already performed at that hospital.

ABFAS at the magic year marker you are suddenly no longer competent.

 

[pod squad]

For ABFAS Case Review, do they typically pull all surgeries that you performed at each Facility? Or only the ones that you submit on your PLS logs? In other words, if you 'omit' logging a certain case, can ABFAS still pull it for case review?

 

[DMEpod]

For ABFAS Case Review, do they typically pull all surgeries that you performed at each Facility? Or only the ones that you submit on your PLS logs? In other words, if you 'omit' logging a certain case, can ABFAS still pull it for case review?

They will request all logs from a specific facility from a certain time range. If your logs are missing a case from the date range that was done at that facility they will request you send that in. If you omit a case you are taking a gamble on them calling you out on it.

 

[Utvolsdpm]

They will request all logs from a specific facility from a certain time range. If your logs are missing a case from the date range that was done at that facility they will request you send that in. If you omit a case you are taking a gamble on them calling you out on it.

Yea failing the audit is one way to fail case review. I’ve only heard of it happening once and was kind of amazed. Why would you not log all of your cases?

 

[dtrack22]

They will audit one month at one facility. You could easily not log anything at a particular facility and they would never know.

 

[Utvolsdpm]

They will audit one month at one facility. You could easily not log anything at a particular facility and they would never know.

But why? Just too lazy to log? Or are people scared to log certain cases?