about surgery

[Cyrus44]

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i was wondering if a podiatrist has to continue going to school to specialize in surgery to be able to do it. if so how many more years after does it take. I was also wondering if podiatrist do surgery up to the knee? thanks so much 🙂

 

[gustydoc]

i was wondering if a podiatrist has to continue going to school to specialize in surgery to be able to do it. if so how many more years after does it take. I was also wondering if podiatrist do surgery up to the knee? thanks so much 🙂

All podiatrists are now required to complete a two or three year surgical residency upon completion of four years of podiatric medical school. At the end of residency you are prepared to complete all surgical procedures within your scope of practice. Many of the two year programs cover all of the same procedures as a three year program. The only difference is that you cannot sit for rearfoot board certification without completing a three year program. As for surgical limitations most states allow podiatrists to perform surgery on the foot, ankle and structures that insert into the ankle. There are a couple of states that include the knee in the scope for a podiatrist, but it is not the norm.

 

[doclm]

All podiatrists are now required to complete a two or three year surgical residency upon completion of four years of podiatric medical school. At the end of residency you are prepared to complete all surgical procedures within your scope of practice. Many of the two year programs cover all of the same procedures as a three year program. The only difference is that you cannot sit for rearfoot board certification without completing a three year program. As for surgical limitations most states allow podiatrists to perform surgery on the foot, ankle and structures that insert into the ankle. There are a couple of states that include the knee in the scope for a podiatrist, but it is not the norm.

Just a question.....

When it says that a POD may do surgery on soft tissue up to the knee in some states, what does that mean. Does "soft tissue" refer to everything that is not bone, or is it just skin, fat, vessels? Does it include the Lower leg muscles?

Thanks

 

[Catayst]

I have the knife skills of an epileptic monkey. Is there hope for me?

 

[doclm]

I have the knife skills of an epileptic monkey. Is there hope for me?

I think patience is more important than super dexterity skills when it comes to foot and ankle sugery. However, if you are doing some Neurosurgery, skill should be way above average and lots of patience as well.

 

[Clovers]

I am a little confuse in regards to the board exam. Upon completion of 4 years of podiatry school, you have to take 2 board exams total? Then when you finish your residency, let say you go for a 3 yr residency, you have to sit down to take 2 more board exams?

 

[gustydoc]

Just a question.....

When it says that a POD may do surgery on soft tissue up to the knee in some states, what does that mean. Does "soft tissue" refer to everything that is not bone, or is it just skin, fat, vessels? Does it include the Lower leg muscles?

Thanks

When a states scope says that a podiatrist may perform soft tissue procedures above the ankle it means you can treat non bone related pathology of the leg. In other words you can harvest a skin graft or maybe treat a dermalogic problem, but you are not going to be fixing a proximal tibial fracture. You can treat muscle problems as well. For example a compartment syndrome in the leg as a result of an athletic injury or acute trauma is within our realm to treat.

 

[gustydoc]

I am a little confuse in regards to the board exam. Upon completion of 4 years of podiatry school, you have to take 2 board exams total? Then when you finish your residency, let say you go for a 3 yr residency, you have to sit down to take 2 more board exams?

Unfortunately as future doctors it seems as though we will never be finished taking tests. 😀 In podiatry much like allopathic or ostepathic medicine you are required to take a board exam after you first two years over basic science and then another exam after four years based on your clinical knowledge. Then after residency you are required to take a third board exam. After completing residency you can seek also seek board certification from ACFAS and if you are certified it helps you get on insurance plans and some hospitals require it to grant privaleges. Although you will learn some rearfoot and reconstructive surgery in a two year program, you must complete a three year program to become board certified in rearfoot surgery. There are other certifying boards as well such as the American College of Foot & Ankle Orthopedics & Medicine (ACFOAM), but these certifications are not nearly important and are not surgicaly based. Confusing I know, but I hope this helps. Oh yeah, don't forget about state licensing exams after residency too.

 

[capo]

Does a state w/ a better scope usually equate to a better income for the DPM? More latitude = more compensation, for more advanced/invasive procedures?

 

[gustydoc]

Does a state w/ a better scope usually equate to a better income for the DPM? More latitude = more compensation, for more advanced/invasive procedures?

Actually the opposite is true in some states. Also remeber that not only is it in the patients best interest to exhaust all conservative treatmetns before going to surgery it also can be better for a practices' bottom line. Take plantar faciitis for example. One option would be to surgicaly treat the patient right away, but there are always risks with any surgery and while it may pay more initially, you are only billing for it once. If you took the same patient and tried other treatments such as Extracorporeal Shock Wave Therapy (ESWT), injections etc. you may be able to save that patient for an unnessicary surgery and you can bill for every visit and treatment which is more in the long run. We all want to do trauma and recontructive surgery, but it definitely doesn't equal a more lucrative practice.

 

[capo]

gusty, sort of like milking the patient's insurance longer, rather than fix the problem off the go. I know chiropractors do this as they milke the cow til the insurance is all gone.

Whether this is ethical or not isn't the question (obviously it's not) but w/ so many governing restrictions on physician's nowadays, many probably feel they need to do this to remain solvent in their practices.

 

[doclm]

Actually the opposite is true in some states. Also remeber that not only is it in the patients best interest to exhaust all conservative treatmetns before going to surgery it also can be better for a practices' bottom line. Take plantar faciitis for example. One option would be to surgicaly treat the patient right away, but there are always risks with any surgery and while it may pay more initially, you are only billing for it once. If you took the same patient and tried other treatments such as Extracorporeal Shock Wave Therapy (ESWT), injections etc. you may be able to save that patient for an unnessicary surgery and you can bill for every visit and treatment which is more in the long run. We all want to do trauma and recontructive surgery, but it definitely doesn't equal a more lucrative practice.

Also, it depends on what you go into. Although going into trauma sounds good, you have to also consider your competition with the Orthopods. In most areas of the U.S. (Des Moines is an exception) your referals would be lower if you specialized in trauma. On the other hand, treating Diebetic foot or forefoot reconstructive surgery would lend you more referrals from other doctors. If you would do wound care, your competition would be pretty low and you could have lots of referrals.

Also, it all depends on if you get into a hospital system or private practice.

I was told by a DMU graduate who went to a very good 3 year surgical residency, that if you really want to focus on rear foot and ankle trauma go get your MD/DO and go orthopod. "Broadlawns is an exception when it comes to DPM's doing most of trauma cases." Chances are not likely that this is going to be your only thing you focus on. Remeber that Podiatrists do overall comprehensive foot care. Although this DPM that works with a Ortho group and has specialized in reconstructive foot sugery, he mainly does diabetic feet, some fore-foot reconstruction, occasional rear-foot reconstruction, and only 5% nail care (which he considers himself lucky).

On the flip side, if you get into a hospital that hosts a DPM residency program, the chances that you will be doing most of the foot and ankle cases is good.

Only time will tell what the future holds for DPM's versus the Orthopods. I believe that there will be less and less Orthopods that are going to be certified to do all of the foot and ankle cases.

 

[dpmgrad]

Unfortunately as future doctors it seems as though we will never be finished taking tests. 😀 In podiatry much like allopathic or ostepathic medicine you are required to take a board exam after you first two years over basic science and then another exam after four years based on your clinical knowledge. Then after residency you are required to take a third board exam. After completing residency you can seek also seek board certification from ACFAS and if you are certified it helps you get on insurance plans and some hospitals require it to grant privaleges. Although you will learn some rearfoot and reconstructive surgery in a two year program, you must complete a three year program to become board certified in rearfoot surgery. There are other certifying boards as well such as the American College of Foot & Ankle Orthopedics & Medicine (ACFOAM), but these certifications are not nearly important and are not surgicaly based. Confusing I know, but I hope this helps. Oh yeah, don't forget about state licensing exams after residency too.

There are some mistakes in your posting in regards to boards exams. As you said, Podiatry students take the NBPME (National Board of Podiatric Medical Examiners) Part 1 boards at the end of the second year and NBPME Part 2 at the end of the fourth year. Majority of the graduates will sit for the NBPME Part 3 (PMLexis). Whether you need to take the PMLexis and when you need to take the PMLexis will depend on the state that you wish to practice in. For example, Pennsylvania requires all new incoming residents to take the PMLexis before starting the residency program. On the other hand, New Jersey does not recognize PMLexis exam and does not require the practicing Podiatrists or residents to take the PMLexis.

After completing your 2 or 3 years of residency training, you will be eligible to sit in various board certification exams based on your residency training. If you completed the 2 years of residency training (PM&S-24), you will be eligible to sit for the ABPS (American Board of Podiatric Surgery) Foot Surgery Board Exam and the ABPOPPM (American Board of Podiatric Orthopedics and Primary Podiatric Medicine) Board Exam. If you completed the 3 years of residency training (PM&S-36), you will be eligible to sit for both ABPS Foot Surgery Board Exam and ABPS Reconstructive Rearfoot Surgery Board Exam and the ABPOPPM Board Exams.

In your posting you had mentioned ACFAS (American College of Foot and Ankle Surgeons) and ACFAOM (American College of Foot and Ankle Orthopedics and Medicine). These are societies that a resident or practicing Podiatrist may join. They are not responsible for board certification exams. In order for someone to attain fellow status in one of these two societies, one would need to be fully board certified in the respective exams (ABPS for ACFAS and ABPOPPM for ACFAOM). For someone to be fully board certified, one would need to pass both the written exam (most people usually take this after graduating from the residency program) and the oral exam (usually taken after attaining certain amount of cases while practicing). I hope that this would clarify some of the information in your posting and answer the question of the original poster of this thread (clovers).

 

[gustydoc]

There are some mistakes in your posting in regards to boards exams. As you said, Podiatry students take the NBPME (National Board of Podiatric Medical Examiners) Part 1 boards at the end of the second year and NBPME Part 2 at the end of the fourth year. Majority of the graduates will sit for the NBPME Part 3 (PMLexis). Whether you need to take the PMLexis and when you need to take the PMLexis will depend on the state that you wish to practice in. For example, Pennsylvania requires all new incoming residents to take the PMLexis before starting the residency program. On the other hand, New Jersey does not recognize PMLexis exam and does not require the practicing Podiatrists or residents to take the PMLexis.

After completing your 2 or 3 years of residency training, you will be eligible to sit in various board certification exams based on your residency training. If you completed the 2 years of residency training (PM&S-24), you will be eligible to sit for the ABPS (American Board of Podiatric Surgery) Foot Surgery Board Exam and the ABPOPPM (American Board of Podiatric Orthopedics and Primary Podiatric Medicine) Board Exam. If you completed the 3 years of residency training (PM&S-36), you will be eligible to sit for both ABPS Foot Surgery Board Exam and ABPS Reconstructive Rearfoot Surgery Board Exam and the ABPOPPM Board Exams.

In your posting you had mentioned ACFAS (American College of Foot and Ankle Surgeons) and ACFAOM (American College of Foot and Ankle Orthopedics and Medicine). These are societies that a resident or practicing Podiatrist may join. They are not responsible for board certification exams. In order for someone to attain fellow status in one of these two societies, one would need to be fully board certified in the respective exams (ABPS for ACFAS and ABPOPPM for ACFAOM). For someone to be fully board certified, one would need to pass both the written exam (most people usually take this after graduating from the residency program) and the oral exam (usually taken after attaining certain amount of cases while practicing). I hope that this would clarify some of the information in your posting and answer the question of the original poster of this thread (clovers).

Thanks for the clarification. 👍

 

[gustydoc]

gusty, sort of like milking the patient's insurance longer, rather than fix the problem off the go. I know chiropractors do this as they milke the cow til the insurance is all gone.

Whether this is ethical or not isn't the question (obviously it's not) but w/ so many governing restrictions on physician's nowadays, many probably feel they need to do this to remain solvent in their practices.

Capo, you completely misconstrued my entire post. Obvously we have an obligation to the patient to provide the best care possible, but your idea of what is ethical or not is a little off. The ethical way of treating any surgical candidate is to exhaust all conservative measures first before taking that patient to the OR. There are plenty of malpractice lawyers out there who would jump at the opportunity to teach you that lesson the hard way. This is not "milking the insurance company", it is called standard of care and rushing into surgery will land you in court the first time you have a non-union or non-compliant patient. There are also plenty of other doctors who would be willing to take the stand against you and go on an on about how many conservative treatments should have been tried before surgery. Obviously there are cases that warrent a surgical procedure immediately but most (like my example of plantar faciitis) must be treated conservatively first. The purpose of my post was to point out that simply wanting to do expensive surgical procedures may appear to be a great idea for you bottom line, but in all actuallity by treating your patient with the conservative standard of care you can still make a reasonable living while giving the patient the best treatment possible. This standnard of care appraoch to practicing medicine is the most ethical and will keep you out of the courtroom and in your office seeing patients. 😀

 

[Podman]

Capo, you completely misconstrued my entire post. Obvously we have an obligation to the patient to provide the best care possible, but your idea of what is ethical or not is a little off. The ethical way of treating any surgical candidate is to exhaust all conservative measures first before taking that patient to the OR. There are plenty of malpractice lawyers out there who would jump at the opportunity to teach you that lesson the hard way. This is not "milking the insurance company", it is called standard of care and rushing into surgery will land you in court the first time you have a non-union or non-compliant patient. There are also plenty of other doctors who would be willing to take the stand against you and go on an on about how many conservative treatments should have been tried before surgery. Obviously there are cases that warrent a surgical procedure immediately but most (like my example of plantar faciitis) must be treated conservatively first. The purpose of my post was to point out that simply wanting to do expensive surgical procedures may appear to be a great idea for you bottom line, but in all actuallity by treating your patient with the conservative standard of care you can still make a reasonable living while giving the patient the best treatment possible. This standnard of care appraoch to practicing medicine is the most ethical and will keep you out of the courtroom and in your office seeing patients. 😀

Right on gusty! Not only do we have to use conservative care prior to surgery but many patients don't want surgery to begin with so we must accomodate as much as we can. This is what our profession is all about, we are trained to improve the patient's lifestyle and in fact we are "feel good" docs (sorry Dr_Feel_good for borrowing your line on that one) and so surgery isn't always the best option for the patient - nothing to do with milking insurance or anything like that - it is rather more ethical to avoid surgery as much as possible unless it is absolutely necessary to do so.