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

 

[heybrother]

Several years ago I was an an event where some residency directors were advocating a "competency" based training model for residency. The attendings at a program would theoretically "sign off" on the ability of a resident to accomplish a procedure. At the time I was immediately dismissive of the idea. To me - it sounded like a ploy to continue to decrease numbers/training ie. a program with much lower numbers could simply continue to graduate residents with smaller numbers simply by stating the resident had achieved competency in the disciplines in question.

 

[icebreaker32]

No but the steps for you to earn that piece of paper does demonstrate those three attributes if the certification process evaluates your actual outcomes. How can you truly say someone is competent to slice on a loved one when they only pass a didactic exam after “standard training” without any personal case results once out. Yes it can be a crap shoot when the public selects a surgeon but the more verification of their actual outcomes the better off for the most part. I wouldn’t let someone who read about flying and did simulations with a trainer take my family for a solo plane ride. They would have to demonstrate being checked off by a third party several successful solo flights. Same goes for any surgeon that would cut on any of my children.

I agree with your thought process and think showing you have done your own cases and have active privileges is a good idea, but 3 potential issues.

1. Board qualified surgeons only become board certified by doing surgery.

2. I know ortho requires cases, but I am not certain if all MD surgical specialties do. Some might be exams only.

3. There is such a shortage in some communities they would have no surgeon (not podiatry) if they were too selective.

****of course you have more say in elective surgery, but when on a road trip and have serious trauma you go to the closest ER/Hospital of the appropriate level.

 

[Pronation]

...I strongly disagree with those who say podiatry residencies are 'pretty much standardized' and 'much improved.' We can't act like the job is finished. They're standard in length only, and we all know it. My skillset and job options and board pass abilities would be drastically different had I gone to different '3year surgical' programs. That goes for any of us. That has been the biggest area for improving DPM education/demand/respect... and it still is. We went from light years behind MD surgeon specialty training standards to now still significantly behind. There is still much work to do.

There are virtually no MD surgical training programs where the grads are not well versed and trained in all common core procedures and pathologies to the specialty - and most advanced procedures (academically, and often practically). They work with dozens of appropriately board cert attendings at multiple bona fide teaching hospitals and other arranged community rotations. They are prepped to pass the boards. Podiatry doesn't uniformly have that. Not even close.

It's up to 'leaders,' if they want to regulate quality, saturation, respect, demand for DPMs. As it stands, we have a mix of fantastic, good, fair, and completely unacceptable residency spots. We have at least twice as many as are needed. We have "PMSR/RRA" residencies where the residents never scrub a single ankle fracture with a DPM - or at all - or scrub even a single flat foot or Lapidus. Job market and low board pass and existence of a second alternative much easier board are testament to this huge variance. Again, MD training programs have almost none of these issues.

The way to regulate it is both painful and simple. If the low quality and low volume residencies stay accredited and open, the pod schools WILL find people to borrow 300k+ to go to them, to fail boards, to struggle in a saturated market. Look at what MDs do: when a specialty gets even a bit saturated or lower apps/USMLE, they freeze or reduce residency spots.

The counter-argument is "what about podiatry students who don't want to do surgery?" Same as OB, ortho, gen surg who dont do OR in practice: they can still learn it, finish residency, and pass boards so that they know indications, complications, etc to practice optimally and refer to colleagues appropriately. I don't do BKAs or femur fx or fem-pop that I assisted in residency, but it helps to know them in broad strokes. I don't do TARs or MPJ1 imolants either, but I know how to salvage them and the indications to pass a test or ID and send an implant candidate to area surgeons who believe in them and do them well. More training and knowledge never hurt anyone.

Agree. We all know that the bottom 20% (at least) produce graduates that literally clipped toenails and triple scrubbed an hour long toe amp.

HOT TAKE: These programs need to be shutdown and these doctors of pedicure medicine not allowed to have hospital surgical privileges. We talk about lowest common denominator in other fields yet we know that pod schools will take anyone with a pulse.

This isn’t a damn cosmetology job. Like all of the other health fields, there needs to be gate keeping at some level. For the non ass backwards professions this generally happens at the school admissions level. Unfortunately, in podiatry, greed has broken this process.

I get it, we can’t gate keep at the hospital privileging level with board certification. Look, all I’m saying is that we need to open at least 5 more schools because I want to open a $65k salary associate mill so I can retire young. Carry on…

 

[Pronation]

I agree with your thought process and think showing you have done your own cases and have active privileges is a good idea, but 3 potential issues.

1. Board qualified surgeons only become board certified by doing surgery.

2. I know ortho requires cases, but I am not certain if all MD surgical specialties do. Some might be exams only.

3. There is such a shortage in some communities they would have no surgeon (not podiatry) if they were too selective.

****of course you have more say in elective surgery, but when on a road trip and have serious trauma you go to the closest ER/Hospital of the appropriate level.

First I'll say that we were all on the same page as far as the ridiculous saturation and garbage job market in podiatry but I don't particularly agree with the above points

1. In the very least it could potentially reduce a doctor of pedicure medicine from butchering patients for an entire career down to 5-7 years

2. Can't compare to MD/DO, our field is completely ass backwards because pod schools take anyone with a pulse, and some of these imbeciles graduate, and even worse some of them go on to complete "residencies" to become doctors of pedicure medicine

3. Again can't compare to MD/DO because of the above ass backwards reasons.

Serious trauma gets transferred. Hell, even simple bimals get transferred out of critical access hospitals.

 

[icebreaker32]

First I'll say that we were all on the same page as far as the ridiculous saturation and garbage job market in podiatry but I don't particularly agree with the above points

1. In the very least it could potentially reduce a doctor of pedicure medicine from butchering patients for an entire career down to 5-7 years

2. Can't compare to MD/DO, our field is completely ass backwards because pod schools take anyone with a pulse, and some of these imbeciles graduate, and even worse some of them go on to complete "residencies" to become doctors of pedicure medicine

3. Again can't compare to MD/DO because of the above ass backwards reasons.

Serious trauma gets transferred. Hell, even simple bimals get transferred out of critical access hospitals.

I agree podiatry is different....we all know that. This is the elephant in the room. The million dollar question is at what point is our schooling and training enough? This is up for debate. We have "standardized" medical and surgical residencies now. Is ABFAS enough? Is ABFAS RRA enough? Is ABFAS RRA and a name brand fellowship enough?

Is the gatekeeper the residencies, the boards, the hospital or the state boards? We know it is not the schools. We need to police our own.

In reality though you need to place the credentialing on the individual podiatrist and have the same process as other professions like density, MDs and DOs are held to for privileges at hospitals and licensing through state boards.

 

[Pronation]

I agree podiatry is different....we all know that. This is the elephant in the room. The million dollar question is at what point is our schooling and training enough? This is up for debate. We have "standardized" medical and surgical residencies now. Is ABFAS enough? Is ABFAS RRA enough? Is ABFAS RRA and a name brand fellowship enough?

Is the gatekeeper the residencies, the boards, the hospital or the state boards? We know it is not the schools. We need to police our own.

In reality though you need to place the credentialing on the individual podiatrist and have the same process as other professions like density, MDs and DOs are held to for privileges at hospitals and licensing through state boards.

Yup, podiatry is different for sure. Also shorter than other surgical specialties. I've included some picture diagrams to further clarify longer vs shorter

Longer:

Shorter:

 

[Boba Foot]

Yup, podiatry is different for sure. Also shorter than other surgical specialties. I've included some picture diagrams to further clarify longer vs shorter

Longer:

The Utah bus is notably longer to hold the copious amounts of Mormon kids.

 

[icebreaker32]

Yup, podiatry is different for sure. Also shorter than other surgical specialties. I've included some picture diagrams to further clarify longer vs shorter

It is not PC to make fun of those who ride on the short bus.

 

[dtrack22]

Well said! We must maintain a high standard for us to have parity amongst our allopathic peers not a pay to play certification that does nothing for the protection of the public or our reputation.

ABFAS has entered the chat

 

[HardRoadPaved]

Everyone gets into podiatry school and certainly should not all be surgeons by taking a simple didactic exam.

They should be a surgeon as allowed by the scope of their state allowed by the requirements to obtain a license to practice.

Boards are nothing more than a middle man trying to police something we already have at the government level.

 

[icebreaker32]

They should be a surgeon as allowed by the scope of their state allowed by the requirements to obtain a license to practice.

Boards are nothing more than a middle man trying to police something we already have at the government level.

Maybe so, but many hospitals and insurance plans still think boards are important even if it is more about another layer of CYA and public perception than it is protecting the public. Hospitals to the extent the law allows can set up their own bylaws. States can also vary as we are well aware.

Due to the fact we are saturated, if a good employer does not trust the quality of a typical podiatrist that the schools and residencies graduate, they can demand what they want board wise, fellowship wise, and experience etc.

 

[malleolusman]

Feli has said so eloquently what I want to say with profanity>>>

It's up to 'leaders,' if they want to regulate quality, saturation, respect, demand for DPMs. As it stands, we have a mix of fantastic, good, fair, and completely unacceptable residency spots. We have at least twice as many as are needed. We have "PMSR/RRA" residencies where the residents never scrub a single ankle fracture with a DPM - or at all - or scrub even a single flat foot or Lapidus. Job market and low board pass and existence of a second alternative much easier board are testament to this huge variance. Again, MD training programs have almost none of these issues.

The way to regulate it is both painful and simple. If the low quality and low volume residencies stay accredited and open, the pod schools WILL find people to borrow 300k+ to go to them, to fail boards, to struggle in a saturated market. Look at what MDs do: when a specialty gets even a bit saturated or lower apps/USMLE, they freeze or reduce residency spots

-

ABFAS and ABPM take note. At some point you will get called out in person. It won’t be pleasant.

 

[diabeticfootdr]

-

ABFAS and ABPM take note. At some point you will get called out in person. It won’t be pleasant.

Appreciate your passion … but direct it at CPME. Therein lies the problem with residency oversight.

 

[Feli]

One thing to also remember: there are about 75-80 ortho F&A fellowship AOFAS spots available (some go unfilled as in the chart, so roughly ~60-70 grads finish and enter into practice per year as F&A Orthos).

543 graduated DPMs matched this year.

It simply can't be rationalize that we need almost 10x more grads than F&A ortho does annually.
That really puts the saturation and greed of podiatry into perspective. That's crazytown.

And, before we start saying "well DPMs do more than just bone/joint... we do wounds and nail and derm and biomech, etc," realize that Ortho - both general or F&A - can do that stuff too, if they choose to. I just helped clean out the office of a (gen) ortho, and there were moleskin toe pads, surgical shoes, bunion pads, wound/nail instruments, phenol, etc. Plenty of Vasc Surg and Derm and Gen Surg and Plastics and ER and IM and PCPs and midlevels and pedicure shops others obviously handle some of that F&A work also.

There is just no way to justify having ~500+ DPM residency grads/spots... unless one has vested interest in more DPMs/grads. That's not to mention DPM "fellowships!!!" We have nearly as many DPMs as orthos (all specialties combined!) coming out each year and licensed in practice, and that small gap will get even closer with new podiatry schools. It is not good for our job markets and our competency or standardization to have training cases spread thin. The board pass rates, like most podiatry issues, are a function of the saturation.

 

[icebreaker32]

One thing to also remember: there are about 50-80 ortho F&A fellowship AOFAS spots available (some go unfilled as in the chart, so roughly ~60-70 finish and enter into practice per year).

543 graduated DPMs matched this year. It can't be rationalize that we need almost 10x more grads than F&A ortho does annually. That really puts the saturation of podiatry into perspective. That's crazytown.

And, before we start saying "well DPMs do more wounds and nail and derm and biomech, etc," realize that Ortho - both general or F&A - can do that stuff too, if they choose to. Plenty of Vasc Surg and Derm and Gen Surg and Plastics and ER and IM and PCPs and midlevels and pedicure shops others handle some of that work also.

There is just no way (unless one has vested interest in more DPMs/grads) to justify having ~500+ DPM residency spots (not to mention DPM "fellowships!!!"). We have nearly as many DPMs as orthos (all specialties combined!) coming out each year, and that small gap will get even closer with new podiatry schools. It is not good for our job markets and our competency or standardization to have training cases spread thin. The board pass rates, like most podiatry issues, are a function of the saturation.

Graduating this many makes NO SENSE unless:

1. We want chiropody to continue and feel it is a good ROI and use of our training.

It does not pay well and is heavily audited!

Stories like below will persist on PM News if we depend on chiropody. Fraud is fraud, but all things considered 30K per year is not even a lot of money to risk one’s license and jail time.

A podiatrist who practiced in East St. Louis pleaded guilty in a U.S. district court on Thursday to committing healthcare fraud from 2016 to 2020. Howard Jackson, 69, of Florissant, Missouri, admitted he routinely billed Medicare and Medicaid for procedures he did not perform. Dr. Jackson admitted in court records that, on many occasions when he billed for a nail avulsion, he had not used anesthesia and had provided only routine foot care like trimming and clipping nails. Jackson cheated Medicare and Medicaid out of at least $144,694.69 as a result of the fraud, court records state.

2. We think podiatry should be a sales profession like Chiro. Sell elective surgery that was not a patient‘s chief complaint, sell orthotics for all foot pain, sell laser for all toenail fungus and graft everything that walks through the door.

If we expect podiatry to be a surgical speciality more like ortho foot and ankle but with a focus more on forefoot surgery, limb salvage and small in office procedures then 200 a year is plenty. God forbid we ever work our way out of saturation and thrive collectively as a profession to where it is more common than not that we need to hire midlevels.

 

[Boba Foot]

A podiatrist who practiced in East St. Louis pleaded guilty in a U.S. district court on Thursday to committing healthcare fraud from 2016 to 2020. Howard Jackson, 69, of Florissant, Missouri, admitted he routinely billed Medicare and Medicaid for procedures he did not perform. Dr. Jackson admitted in court records that, on many occasions when he billed for a nail avulsion, he had not used anesthesia and had provided only routine foot care like trimming and clipping nails. Jackson cheated Medicare and Medicaid out of at least $144,694.69 as a result of the fraud, court records state.

Imagine being so dependent on fraud that you still have to go frauding at age 69, and as a result of that fraud you'll probably have to cut toenails until you're 80 because now Medicare has you bent over and you owe the government.

 

[heybrother]

The data was there for anyone who wanted to see it. They didn't even include this year in his data but it was assuredly fraudulent too. Medicare Advantage plans obviously have diluted the numbers slightly but for comparison my partner and I together billed Novitas for 21 11730s and one 11732 in 2022 which was a busy year.. This guy did ~1000 nail avulsions on Medicare in 2015.

I wish Medicare had kept releasing the data out so the WSJ/NYTimes could have kept compiling it. I still remember looking up someone's data and seeing they had billed Medicare for like 100 wart debridements. I remember thinking how interesting it was that I hadn't billed a single wart destruction on a patient with Medicare (young people get warts, old people get pressure calluses).

 

[icebreaker32]

View attachment 369148

The data was there for anyone who wanted to see it. They didn't even include this year in his data but it was assuredly fraudulent too. Medicare Advantage plans obviously have diluted the numbers slightly but for comparison my partner and I together billed Novitas for 21 11730s and one 11732 in 2022 which was a busy year.. This guy did ~1000 nail avulsions on Medicare in 2015.

I wish Medicare had kept releasing the data out so the WSJ/NYTimes could have kept compiling it. I still remember looking up someone's data and seeing they had billed Medicare for like 100 wart debridements. I remember thinking how interesting it was that I hadn't billed a single wart destruction on a patient with Medicare (young people get warts, old people get pressure calluses).

Nail avulsions and kickbacks have been the most common fraud cases against podiatrists for a couple decades now.

If one is an outlier in this profession for Medicare nail avulsions they are pretty stupid. Maybe nail avulsions are just easy fraud cases for the OIG, but I can only imagine the brazen and blatant fraud by most of those convicted.

 

[Adam Smasher]

I still remember looking up someone's data and seeing they had billed Medicare for like 100 wart debridements. I remember thinking how interesting it was that I hadn't billed a single wart destruction on a patient with Medicare (young people get warts, old people get pressure calluses).

This is very diagnosis dependent, and it doesn't help that we don't even have consistent nomenclature for what you describe as "pressure calluses." Also known as IPKs or tylomas or porokeratosis or Steinberg's Lesion or other things. If you diagnosis it as a L84, then that's all it is.

If you diagnose it as a benign skin lesion (D23.7x), and then proceed to use some modality of destruction on it (eg cantharone), the use of 17110 is appropriate. I understand this is commonly done, my residency director did it this way.

I've biopsied these things out, and I can tell the pathologist is confused about what to call it some times because it's one of those stupid podiatric things that dermatologists aren't going to waste their time characterizing. So they'll call it a callus occasionally. More often they'll call it an involuting wart. If you pay attention to the photomicrographs that come back, it's clear from the cellular architecture that there is a localized proliferation of keratinocytes within the stratum corneum--so calling this L84 really understates the disease process.

I'm sure I'll get flamed for this, someone's going to say the above paragraph is a bunch of BS. To which I fall back on my standard line, idgaf, I don't need to convince you, I just need to convince whoever audits my charts.

 

[air bud]

This is very diagnosis dependent, and it doesn't help that we don't even have consistent nomenclature for what you describe as "pressure calluses." Also known as IPKs or tylomas or porokeratosis or Steinberg's Lesion or other things. If you diagnosis it as a L84, then that's all it is.

If you diagnose it as a benign skin lesion (D23.7x), and then proceed to use some modality of destruction on it (eg cantharone), the use of 17110 is appropriate. I understand this is commonly done, my residency director did it this way.

I've biopsied these things out, and I can tell the pathologist is confused about what to call it some times because it's one of those stupid podiatric things that dermatologists aren't going to waste their time characterizing. So they'll call it a callus occasionally. More often they'll call it an involuting wart. If you pay attention to the photomicrographs that come back, it's clear from the cellular architecture that there is a localized proliferation of keratinocytes within the stratum corneum--so calling this L84 really understates the disease process.

I'm sure I'll get flamed for this, someone's going to say the above paragraph is a bunch of BS. To which I fall back on my standard line, idgaf, I don't need to convince you, I just need to convince whoever audits my charts.

Excellent post. I suggest you start the Podiatric Council on Skin Lesions. May the tax write-offs and annual fees forever be in your favor.

 

[Adam Smasher]

Excellent post. I suggest you start the Podiatric Council on Skin Lesions. May the tax write-offs and annual fees forever be in your favor.

Yes, and this shall be our motto:

I don't need to convince you, I just need to convince whoever audits my charts.

 

[Pronation]

This is very diagnosis dependent, and it doesn't help that we don't even have consistent nomenclature for what you describe as "pressure calluses." Also known as IPKs or tylomas or porokeratosis or Steinberg's Lesion or other things. If you diagnosis it as a L84, then that's all it is.

If you diagnose it as a benign skin lesion (D23.7x), and then proceed to use some modality of destruction on it (eg cantharone), the use of 17110 is appropriate. I understand this is commonly done, my residency director did it this way.

I've biopsied these things out, and I can tell the pathologist is confused about what to call it some times because it's one of those stupid podiatric things that dermatologists aren't going to waste their time characterizing. So they'll call it a callus occasionally. More often they'll call it an involuting wart. If you pay attention to the photomicrographs that come back, it's clear from the cellular architecture that there is a localized proliferation of keratinocytes within the stratum corneum--so calling this L84 really understates the disease process.

I'm sure I'll get flamed for this, someone's going to say the above paragraph is a bunch of BS. To which I fall back on my standard line, idgaf, I don't need to convince you, I just need to convince whoever audits my charts.

Wow, this is deep.

 

[AttackNME]

View attachment 369148

The data was there for anyone who wanted to see it. They didn't even include this year in his data but it was assuredly fraudulent too. Medicare Advantage plans obviously have diluted the numbers slightly but for comparison my partner and I together billed Novitas for 21 11730s and one 11732 in 2022 which was a busy year.. This guy did ~1000 nail avulsions on Medicare in 2015.

I wish Medicare had kept releasing the data out so the WSJ/NYTimes could have kept compiling it. I still remember looking up someone's data and seeing they had billed Medicare for like 100 wart debridements. I remember thinking how interesting it was that I hadn't billed a single wart destruction on a patient with Medicare (young people get warts, old people get pressure calluses).

What is this website?

 

[Boba Foot]

I've biopsied these things out, and I can tell the pathologist is confused about what to call it some times because it's one of those stupid podiatric things that dermatologists aren't going to waste their time characterizing. So they'll call it a callus occasionally. More often they'll call it an involuting wart. If you pay attention to the photomicrographs that come back, it's clear from the cellular architecture that there is a localized proliferation of keratinocytes within the stratum corneum--so calling this L84 really understates the disease process.

 

[deleted285117]

Fixed 😁

 

[DYK343]

View attachment 369157

I just made this the background/desktop image on my work computer.

 

[GreenHousePub]

View attachment 369148

The data was there for anyone who wanted to see it. They didn't even include this year in his data but it was assuredly fraudulent too. Medicare Advantage plans obviously have diluted the numbers slightly but for comparison my partner and I together billed Novitas for 21 11730s and one 11732 in 2022 which was a busy year.. This guy did ~1000 nail avulsions on Medicare in 2015.

I wish Medicare had kept releasing the data out so the WSJ/NYTimes could have kept compiling it. I still remember looking up someone's data and seeing they had billed Medicare for like 100 wart debridements. I remember thinking how interesting it was that I hadn't billed a single wart destruction on a patient with Medicare (young people get warts, old people get pressure calluses).

Where did you find this chart? I'm curious to see myself

 

[PatchAdamsFan]

Where did you find this chart? I'm curious to see myself

Medicare Unmasked: Behind the Numbers

Search Medicare billing records of over one million doctors and medical providers—a type of data long kept confidential. Then read our Pulitzer Prize-winning investigation into the motives and practices of America's health care providers.

graphics.wsj.com

 

[icebreaker32]

This is very diagnosis dependent, and it doesn't help that we don't even have consistent nomenclature for what you describe as "pressure calluses." Also known as IPKs or tylomas or porokeratosis or Steinberg's Lesion or other things. If you diagnosis it as a L84, then that's all it is.

If you diagnose it as a benign skin lesion (D23.7x), and then proceed to use some modality of destruction on it (eg cantharone), the use of 17110 is appropriate. I understand this is commonly done, my residency director did it this way.

I've biopsied these things out, and I can tell the pathologist is confused about what to call it some times because it's one of those stupid podiatric things that dermatologists aren't going to waste their time characterizing. So they'll call it a callus occasionally. More often they'll call it an involuting wart. If you pay attention to the photomicrographs that come back, it's clear from the cellular architecture that there is a localized proliferation of keratinocytes within the stratum corneum--so calling this L84 really understates the disease process.

I'm sure I'll get flamed for this, someone's going to say the above paragraph is a bunch of BS. To which I fall back on my standard line, idgaf, I don't need to convince you, I just need to convince whoever audits my charts.

Agree with this and I do see true

Yes, and this shall be our

Medicare Unmasked: Behind the Numbers

Search Medicare billing records of over one million doctors and medical providers—a type of data long kept confidential. Then read our Pulitzer Prize-winning investigation into the motives and practices of America's health care providers.

graphics.wsj.com

An example of what some make doing home/nursing home/assisted living visits. Obviously they don't take home all, but also have other insurances not listed. One of top billers in state.

 

[Weirdy]

Agree with this and I do see true


An example of what some make doing home/nursing home/assisted living visits. Obviously they don't take home all, but also have other insurances not listed. One of top billers in state.

View attachment 369222

There's no way that's all from patients who meet class findings etc right?

 

[icebreaker32]

There's no way that's all from patients who meet class findings etc right?

That was just one provider. Cut the name off, left the company on.

 

[DPMFoot]

I created this account to discuss my future in podiatry in regards to board certification.

I have a hospital job lined up in my home state. The pay is $200K+ with a great bonus structure. Unfortunately, I did not pass the ABFAS exam (only passed 2 sections). The hospital requires AFBAS certification (according to the contract). How long does one have to take ABFAS if they are working for a hospital? I know it's hospital dependent, but on average how long does a podiatrist have to pass the exam?

My plan is to take the ABPM certification exam in the fall, that way I am board certified in something.

I am not someone who wants to do crazy reconstructive/rearfoot surgeries. Will ABPM limit me in the future (in case my hospital decides to let go of me)? Does anyone know podiatrists working at a hospital with ABPM?

Basically, if I were to leave this hospital job...will I be okay with ABPM certification?

Thank you!

 

[heybrother]

I created this account to discuss my future in podiatry in regards to board certification.

I have a hospital job lined up in my home state. The pay is $200K+ with a great bonus structure. Unfortunately, I did not pass the ABFAS exam (only passed 2 sections). The hospital requires AFBAS certification (according to the contract). How long does one have to take ABFAS if they are working for a hospital? I know it's hospital dependent, but on average how long does a podiatrist have to pass the exam?

My plan is to take the ABPM certification exam in the fall, that way I am board certified in something.

I am not someone who wants to do crazy reconstructive/rearfoot surgeries. Will ABPM limit me in the future (in case my hospital decides to let go of me)? Does anyone know podiatrists working at a hospital with ABPM?

Basically, if I were to leave this hospital job...will I be okay with ABPM certification?

Thank you!

There is unfortunately no answer to this question. Everyone's circumstances will vary. A friend of mine worked for a hospital that required them to be board certified within 2 years but accepted ABPM. This was also their residency hospital. My main surgery center requires qualification/certification in rearfoot to perform ankle surgery but allows generous priviledges with ABPM. Your situation is going to vary / depend on their rules and bylaws and what not. ABFAS currently allows like 7 years to get certified but hospitals often limit you to 5. Getting certified in ABPM will obviously allow you to say you are certified. It may or may not open doors in your community or area. This is obviously a subject of much discussion on the forum and regardless of what is right or wrong or could ultimately be resolved with litigation - obviously your goal most of the time is to keep things agreeable with your employers, fellows physicians etc.

I know you would like a definitive yes or no answer. There isn't going to be one. Most people on this forum will tell you to be ABFAS because of whatever reason they believe - functionality, quality assessment, Stockholm Syndrome, etc

 

[HardRoadPaved]

Depends if you have risk involved. Are you uprooting a family for this job that if caught you could be terminated for breach?

 

[DPMFoot]

There is unfortunately no answer to this question. Everyone's circumstances will vary. A friend of mine worked for a hospital that required them to be board certified within 2 years but accepted ABPM. This was also their residency hospital. My main surgery center requires qualification/certification in rearfoot to perform ankle surgery but allows generous priviledges with ABPM. Your situation is going to vary / depend on their rules and bylaws and what not. ABFAS currently allows like 7 years to get certified but hospitals often limit you to 5. Getting certified in ABPM will obviously allow you to say you are certified. It may or may not open doors in your community or area. This is obviously a subject of much discussion on the forum and regardless of what is right or wrong or could ultimately be resolved with litigation - obviously your goal most of the time is to keep things agreeable with your employers, fellows physicians etc.

I know you would like a definitive yes or no answer. There isn't going to be one. Most people on this forum will tell you to be ABFAS because of whatever reason they believe - functionality, quality assessment, Stockholm Syndrome, etc

I've heard ABPM certification is valid at most surgery centers and some hospitals. I have no interest in rearfoot cases. I prefer and enjoy doing forefoot procedures and limb salvage. I will attempt retaking ABFAS in the fall, however, I do not have much hopes. Not sure why I am struggling to pass the exam. I've passed every board exam first try since the start of podiatry school.

I really hope the hospital allows ABPM certification when the time comes 🙏

 

[DPMFoot]

Depends if you have risk involved. Are you uprooting a family for this job that if caught you could be terminated for breach?

What do you mean "if caught"? I will technically become board eligible after residency and will have a few years to attempt the ABFAS.

 

[air bud]

I've heard ABPM certification is valid at most surgery centers and some hospitals. I have no interest in rearfoot cases. I prefer and enjoy doing forefoot procedures and limb salvage. I will attempt retaking ABFAS in the fall, however, I do not have much hopes. Not sure why I am struggling to pass the exam. I've passed every board exam first try since the start of podiatry school.

I really hope the hospital allows ABPM certification when the time comes 🙏

How do you do limb salvage without rearfoot work?

 

[Feeter]

I created this account to discuss my future in podiatry in regards to board certification.

I have a hospital job lined up in my home state. The pay is $200K+ with a great bonus structure. Unfortunately, I did not pass the ABFAS exam (only passed 2 sections). The hospital requires AFBAS certification (according to the contract). How long does one have to take ABFAS if they are working for a hospital? I know it's hospital dependent, but on average how long does a podiatrist have to pass the exam?

My plan is to take the ABPM certification exam in the fall, that way I am board certified in something.

I am not someone who wants to do crazy reconstructive/rearfoot surgeries. Will ABPM limit me in the future (in case my hospital decides to let go of me)? Does anyone know podiatrists working at a hospital with ABPM?

Basically, if I were to leave this hospital job...will I be okay with ABPM certification?

Thank you!

Maybe Dr. Lee can chime in. See if they'll change your contract.

But this is what he and lot of ABPM folks are saying. ABFAS certification has such a low pass rate that it can be devastating to folks who do not pass after spending so much time and money into being a podiatrist.

Obviously the other side of it also valid that we have people graduating from residency that shouldn't operate because they get poor training and that is probably a factor into poor pass rates for ABFAS.

 

[DPMFoot]

How do you do limb salvage without rearfoot work?

I meant elective rearfoot cases, total ankles, ankle fractures, etc.

 

[DPMFoot]

Maybe Dr. Lee can chime in. See if they'll change your contract.

But this is what he and lot of ABPM folks are saying. ABFAS certification has such a low pass rate that it can be devastating to folks who do not pass after spending so much time and money into being a podiatrist.

Obviously the other side of it also valid that we have people graduating from residency that shouldn't operate because they get poor training and that is probably a factor into poor pass rates for ABFAS.

I'm honestly not sure what can be done, but I'll definitely reach out to ABPM in a couple of months.
The other podiatrists at the hospital are ABFAS qualified/certified, so I'm losing hope. The podiatrists in the group do everything, so it makes sense for them to have ABFAS. I would be happy doing bread and butter (which I mentioned during my interview).

 

[icebreaker32]

Hospital vary so much more than you would imagine. Some places you can nothing without ABFAS and other places you can do a lot or potentially anything with logs and ABPM.

Most hospitals really break down the higher level cases and are much stricter on their criteria for privileges for major rear foot and ankle recon cases.

Employment contracts also vary a good bit

1. You need to really read the bylaws about podiatry in a detailed manner.

2. Contacts can vary so you need to read what contract said about being board eligible (same thing as podiatry being qualified), board certified and if a particular board was mentioned.

 

[icebreaker32]

What do you mean "if caught"? I will technically become board eligible after residency and will have a few years to attempt the ABFAS.

Board eligible is what podiatry calls board qualified. You are not eligible until you are qualified for ABFAS..

Maybe you are board eligible for ABPM.

 

[NatCh]

When someone asks you what you do for a living how do you answer? I still answer podiatrist as I consider it my occupation regardless of how people feel about the word. No matter how you answer the question there will be a follow up question.

1. Podiatrist

The next question will be do you do surgery?

2. Podiatric Surgeon

The next question will be that is children correct?

3. Foot and Ankle Surgeon

The next question will be are you a podiatrist or an orthopedic surgeon.

4. "Sooooo I have this spot on my foot..."

That's why I always answer, "I'm unemployed."

 

[icebreaker32]

What do you mean "if caught"? I will technically become board eligible after residency and will have a few years to attempt the ABFAS.

Looks you are board eligible for ABPM

Again if you did not pass the exams you are not board qualified/board eligible for ABFAS.

 

[Pronation]

13 years to get certified… 🤣

 

[AttackNME]

If a new podiatrist starts doing cases at your hospital and theyre incompetent, what are the steps needed to take away their hospital priviledges? How bad does one need to be for this to happen?

 

[icebreaker32]

If a new podiatrist starts doing cases at your hospital and theyre incompetent, what are the steps needed to take away their hospital priviledges? How bad does one need to be for this to happen?

Complaints from hospital staff/peers/patients, board action, multiple malpractice claims, complications during surgery, too many returns to operating rooms after procedures, infection rate too high, operating time too long…..combinations of previous

One horrible high profile mishap could make one lose all privileges immediately, sometimes things are investigated and nothing happens unless more concerns, could restrict certain privileges but not all……like everything else it varies and sometimes one get away with a whole lot and sometimes they do not, sometimes something is unfairly used against a podiatrist…..like a bad ex fix result on a train wreck diabetic that ortho would have gotten away with (things like this probably less common now than in the past when pushing state scope and unfriendly ortho on staff).

Think of it like firing a Union employee. You need a paper trail and a couple poorly performed bunions are not as high of a priority as someone dying, The thing is once it goes past the warning stage, or sometimes it skips that stage, every time that name comes up there will be a lot of documentation needed from committees at meetings to discuss what action to take. Usually one gets a hint pretty quick to do better, do less complex cases, take their cases elsewhere or risk very severe actions that will follow them their whole career.

 

[dtrack22]

If a new podiatrist starts doing cases at your hospital and theyre incompetent, what are the steps needed to take away their hospital priviledges? How bad does one need to be for this to happen?

The hospital will have various reporting mechanisms. Case(s) will get reviewed by medical executive, credentialing, quality, etc. committees (basically a group of physicians on staff). If there are concerns the doctor will generally require proctoring before they can regain the privileges in question.

I’ve seen an ortho require proctoring on various total joint procedures due to a series of bad outcomes. Hospital had to fly in orthopedic surgeons to do the proctoring. If this is a common enough thing then I would love to know how I can sign up to be a proctor for podiatrists. They got paid well to do it. And it’s not your patient. And you don’t have to chart. It looked like a really sweet gig.

 

[Boba Foot]

My plan is to take the ABPM certification exam in the fall, that way I am board certified in something.

Maybe you’ll get lucky and they’ll botch the exam and auto-pass everyone out of fear of litigation like they did the fall before last.

I love it when people refer to ABFAS as some sort of gold standard board after that debacle. They can’t even properly upload images to their exams. Incompetent hacks.

 

[AttackNME]

Thanks @icebreaker32 and @dtrack22 , I was genuinely curious because I don’t think boards really protect the public. stuff like this does. we have to be willing to take down our peers when necessary, doing the uncomfortable but right thing, knowing the proper channels of reporting, and knowing the bylaws that govern our own institutions