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AttackNME said:
I wonder if you guys are arguing different things. There’s a difference between timing on when to operate on elective Charcot recon on a stable foot that has no wound but is preulcerative and a bit painful vs infected acute Charcot
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Probably are, but that takes the fun out of an Internet argument
 
AttackNME said:
I wonder if you guys are arguing different things. There’s a difference between timing on when to operate on elective Charcot recon on a stable foot that has no wound but is preulcerative and a bit painful vs infected acute Charcot
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Charcot recon? More like reconstructing what was said through an emoji6 minefield
 
Retrograde_Nail said:
It’s not dicey.

Everyone in the room knows these patients are gonna lose their leg if they’re not dealt with surgically for offloading or reconstructive surgery. But people like to hide behind an A1c.

If this is how you practice then do not do limb salvage surgery because you’re doing a grave disservice to the patient .

This is what bugs me about podiatry because we have so many different podiatrist. Who say they do Wound Care and limb salvage, but it really is just debridement and skin substitutes and no surgery because they are too afraid to operate if the A1C is not perfect.

Learn MIS
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Not sure if this is directed at me personally or just a broadside against more conservative DPMs. But it is a fact that there is increased risk with high HgA1c. So yes, it's dicey. That doesn't mean never do it, you just weigh risks and benefits.

I like doing MIS bumpectomies and tendon releases because I just need the patient to heal a 5mm skin portal, and nothing needs to fuse no matter how much they ignore my instructions. I don't do your Charcot heroics; I send those pts to a certain elite podiatry residency in my metro, where the DPMs there have published on this and some were formerly on the ABFAS board. They have turned away patients of mine because of...high HgA1c.

PLUS, even if I wanted to, the anesthesia dept at my hospitals/surgery center won't allow me to schedule an elective case if the HgA1c is too high.
 
Adam Smasher said:
Not sure if this is directed at me personally or just a broadside against more conservative DPMs. But it is a fact that there is increased risk with high HgA1c. So yes, it's dicey. That doesn't mean never do it, you just weigh risks and benefits.

I like doing MIS bumpectomies and tendon releases because I just need the patient to heal a 5mm skin portal, and nothing needs to fuse no matter how much they ignore my instructions. I don't do your Charcot heroics; I send those pts to a certain elite podiatry residency in my metro, where the DPMs there have published on this and some were formerly on the ABFAS board. They have turned away patients of mine because of...high HgA1c.

PLUS, even if I wanted to, the anesthesia dept at my hospitals/surgery center won't allow me to schedule an elective case if the HgA1c is too high.
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Bro, 5mm is MIS? Check the meme thread
 
ABFAS has 2 tiers of certification for the same training program. If you don't get RRA, you aren't certified in everything from your residency training. This is unlike every MD specialty certifying board. The American Board of Radiology doesn't certify you to read x-rays with one test, and then MRIs with another test. ABPM will certify you in the entirety of your residency training with one exam based on the residency curriculum.
 
diabeticfootdr said:
ABFAS has 2 tiers of certification for the same training program. If you don't get RRA, you aren't certified in everything from your residency training. This is unlike every MD specialty certifying board. The American Board of Radiology doesn't certify you to read x-rays with one test, and then MRIs with another test. ABPM will certify you in the entirety of your residency training with one exam based on the residency curriculum.
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All residency programs are not the same. Unfortunately. The training is too variable even at the residency level. Everyone knows this.

That is why there is a foot and rearfoot/ankle board.

Don't get upset at the organization. Get upset at the quality of training overall throughout this profession. If we can't all train the same and maintain the same quality then there are just too many podiatrists being pushed through school and through residency training.

This training disparity does not exist in any MD/DO specialty.
 
jehjr said:
So, I passed my RRA but failed my foot. 470/500. Dinged for patient satisfaction, Dinged presumably for not putting an ambulatory patient on blood thinners. Patient developed a DVT 6 weeks post metatarsal osteotomy.

Also heavily Dinged for a BL lakewater-contaminated open lisfranc fracture dislocation with cuneiforms also having been dislocated in opposite directions. Patient wanted to return home to the other side of the country for definitive care. I only did provisional pin fixation. They didn't like the look of my mini C intra-op films and I didn't get full post op films. Also didn't like my post op documentation. Patient was flying home the next day.

Also Dinged for not getting pre op films on a bunion. I mean, sure. But if they don't want the x-ray, how "medically necessary" is it?
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Hi Jehjr. What resources did you use for ABFAS?
 
diabeticfootdr said:
ABFAS has 2 tiers of certification for the same training program. If you don't get RRA, you aren't certified in everything from your residency training. This is unlike every MD specialty certifying board. The American Board of Radiology doesn't certify you to read x-rays with one test, and then MRIs with another test. ABPM will certify you in the entirety of your residency training with one exam based on the residency curriculum.
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Hi Dr Rogers. Do you by chance have a list of hospital that accept ABPM. I'm just planning ahead for life after residency... Mainly hospitals in Texas, California, Nevada, Arizona, or Washington. Thanks in advance.
 
blessed.pod said:
Hi Dr Rogers. Do you by chance have a list of hospital that accept ABPM. I'm just planning ahead for life after residency... Mainly hospitals in Texas, California, Nevada, Arizona, or Washington. Thanks in advance.
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Perhaps also request a list of patients who will want surgery with podiatry docs who don't pass the surgical board?

Bravo.

This was a witty joke... I hope? 🤣

Season 4 Episode 3 GIF by The Office
 
Feli said:
Perhaps also request a list of patients who will want surgery with podiatry docs who don't pass the surgical board?

Bravo.

This was a witty joke... I hope? 🤣

Season 4 Episode 3 GIF by The Office
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I hate to be that guy - truly I do. But ABFAS has shafted you twice now why do you Stan so hard for them.

We all know you do quality work and should have been board cert from the start. It’s a horrible system
 
Hybrocure said:
I hate to be that guy - truly I do. But ABFAS has shafted you twice now why do you Stan so hard for them.

We all know you do quality work and should have been board cert from the start. It’s a horrible system
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Well first, if you have only seen the Em vid, you have to see this one... genius.

...but it's not an ideal system, no.
It (ABFAS) is also a system that's pretty hard and does not discriminate. A lot of people study hard, some fail, a lot have to retry.
ABPM just passes everyone and doesn't eval cases (trusts our crummy residencies to have done that). So, they're both flawed... yeah.
But that doesn't change the fact that ABFAS is useful and ABPM is something bogus that everyone has (or has better).

But the advice to anyone remains the same: don't do anything that'll limit yourself from things you want (or may want) to do.
I don't think anyone would tell a resident "sure, you'll be fine with ABPM." No way... that's a lie. If they try ABFAS and don't pass with best effort, then that's another story.

...Podiatry is mega-saturated. Fellowships fad and the Linkedin peacocking and even the VA or podunk hospital jobs being competitive now prove this 100x over. Jobs are competitive and getting moreso (but it only takes one good one to make someone's ROI go from 3:1 to maybe 1:1). There is such a huge difference in having a hospital pod or good pay job... versus working a typical pod associate or supergroup job. Again, it only takes one.

There is obviously no list of hospitals that will take ABPM for hiring or for OR privi or etc. There's no list of groups that'll throw away non-ABFAS applications (I've been denied interview for not having ABFAS, and we all have... whether we know it or not). Things can change even once on staff or hired at a hospital that'll allow ABPM today. Bylaws may change if they have issues with DPM surgery or one who understands our boards gets hired or just gets on the med staff and/or has input on bylaws. Most quality facilities and groups/hospitals know what ABFAS is... so it's shortsighted not to try for it (assuming you want to do surgery... it's the appropriate board).

There is just no situation where having ABFAS qual or cert hurts a DPM... and there are many where it helps them.
Nobody would even say studying for ABFAS hurts anyone, so yeah... it's the recommendation to try for it.
 
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Feli said:
Well first, if you have only seen the Em vid, you have to see this one... genius.

...but it's not an ideal system, no.
It (ABFAS) is also a system that's pretty hard and does not discriminate. A lot of people study hard, some fail, a lot have to retry.
ABPM just passes everyone and doesn't eval cases (trusts our crummy residencies to have done that). So, they're both flawed... yeah.
But that doesn't change the fact that ABFAS is useful and ABPM is something bogus that everyone has (or has better).

But the advice to anyone remains the same: don't do anything that'll limit yourself from things you want (or may want) to do.
I don't think anyone would tell a resident "sure, you'll be fine with ABPM." No way... that's a lie. If they try ABFAS and don't pass with best effort, then that's another story.

...Podiatry is mega-saturated. Fellowships fad and the Linkedin peacocking and even the VA or podunk hospital jobs being competitive now prove this 100x over. Jobs are competitive and getting moreso (but it only takes one good one to make someone's ROI go from 3:1 to maybe 1:1). There is such a huge difference in having a hospital pod or good pay job... versus working a typical pod associate or supergroup job. Again, it only takes one.

There is obviously no list of hospitals that will take ABPM for hiring or for OR privi or etc. There's no list of groups that'll throw away non-ABFAS applications (I've been denied interview for not having ABFAS, and we all have... whether we know it or not). Things can change even once on staff or hired at a hospital that'll allow ABPM today. Bylaws may change if they have issues with DPM surgery or one who understands our boards gets hired or just gets on the med staff and/or has input on bylaws. Most quality facilities and groups/hospitals know what ABFAS is... so it's shortsighted not to try for it (assuming you want to do surgery... it's the appropriate board).

There is just no situation where having ABFAS qual or cert hurts a DPM... and there are many where it helps them.
Nobody would even say studying for ABFAS hurts anyone, so yeah... it's the recommendation to try for it.
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Yet they’re still failing pretty damn good surgeons.

I’d wager the criteria to pass ABFAS nowadays is likely more difficult than it was back in the day.
 
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Feli said:
Which one did you pass?
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Which “ONE” did you?

The difference is that I don’t need it because ABPM certifies me in everything I do and I have full privileges.
 
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blessed.pod said:
Hi Dr Rogers. Do you by chance have a list of hospital that accept ABPM. I'm just planning ahead for life after residency... Mainly hospitals in Texas, California, Nevada, Arizona, or Washington. Thanks in advance.
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That list would be impossible to maintain. Just like ABFAS doesn't maintain a list and the hospital's don't make their Bylaws or DOPs public. So we only get notified there's a problem reported, not if everything is ok.

But in reality, the list of those who recognize ABPM is far shorter. Off the top of my head:

In AZ, we've had issues with Yuma Medical Center. In CA, San Antonio Regional Hospital. In TX, we're having difficulty with the Memorial Hermann System, but hopefully resolved soon. I don't recall any issues in NV.

We've been successful in helping a Diplomate get privileges in almost every instance they've reached out for assistance (over 100). We have a privileging attorney on retainer and engage local counsel when needed. There have only be 2-3 in the last 5 years in which we couldn't help.
 
Has anyone had success in extending their board qualification status? I passed RRA case review but failed foot, mostly due to documentation/old office didn't have final xrays saved. This was my last year of eligibility and was curious if there is has been any exceptions for an extension
 
zeebodypod said:
Has anyone had success in extending their board qualification status? I passed RRA case review but failed foot, mostly due to documentation/old office didn't have final xrays saved. This was my last year of eligibility and was curious if there is has been any exceptions for an extension
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Call Dr Benson (Venson?) and ask. He will likely tell you to write a letter to the board and they will review your letter - possibly granting an extension. They meet like once a month I think so it takes a month or 2 to find out.
 
Utvolsdpm said:
Call Dr Benson (Venson?) and ask. He will likely tell you to write a letter to the board and they will review your letter - possibly granting an extension. They meet like once a month I think so it takes a month or 2 to find out.
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Hate to be that guy but what is the point of board certification if ABFAS is allowing this? It would be ok if due to medical illness but just running out of time should not be an excuse.
 
Retrograde_Nail said:
Hate to be that guy but what is the point of board certification if ABFAS is allowing this? It would be ok if due to medical illness but just running out of time should not be an excuse.
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I understand and will admit it is completely my fault. But where did the 7 year standard come from? Why isnt it 5 years, or 10 to become certified? I didn't have problems collecting cases, I have 3x the minimum requirement. There were personal and professional instances that contributed to my delay in submitting cases.
 
zeebodypod said:
Has anyone had success in extending their board qualification status? I passed RRA case review but failed foot, mostly due to documentation/old office didn't have final xrays saved. This was my last year of eligibility and was curious if there is has been any exceptions for an extension
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99% sure they will extend you. They just want your money.
 
zeebodypod said:
I understand and will admit it is completely my fault. But where did the 7 year standard come from? Why isnt it 5 years, or 10 to become certified? I didn't have problems collecting cases, I have 3x the minimum requirement. There were personal and professional instances that contributed to my delay in submitting cases.
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All MD/DO boards are 5 years. Podiatry gives you 7. So again not really a good arguement
 
Say that you lost your xrays in the great COVID pandemic of 2020.

Joking aside, I understand they were giving candidates COVID related extensions so if you can spin it that way they may show you some mercy. Whatever tactic you use, you don't get what you don't ask for. Good luck!
 
[QUOTE="zeebodypod, post:understand and will admit it is completely my fault. But where did the the minimum requirement. There were personal and professional instances that contributed to my delay in submitting cases.[/QUOTE]

“If you give yourself 30 days to clean your house it will take you 30 days. But if you give yourself three hours, it will take you three hours.“ – Elon Musk.

For those of us who were around when it was ABPS, you’ll remember that candidates used to have two 7 year cycles after becoming board qualified to achieve board certification. About ten years ago, the board reduced this to a single 7 year cycle for several reasons.
Most hospital bylaws require board certification within five years of joining the medical staff, which has driven some of these changes. The board still receives extension requests regularly, which are reviewed at every board meeting. Extensions are typically granted for medical reasons or significant personal hardships. Lack of preparedness, however, is generally not considered a valid reason for extension.
While I cannot speak officially for the board, if someone has passed the RRA but not Foot for certain technical reasons, they may be considered for an extension. There’s certainly no harm in submitting a written request for consideration.
 
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Retrograde_Nail said:
Hate to be that guy but what is the point of board certification if ABFAS is allowing this? It would be ok if due to medical illness but just running out of time should not be an excuse.
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Well not too long ago (prior to 2014) you used to just be able to start over, so not much different really.
 
Retrograde_Nail said:
Hate to be that guy but what is the point of board certification if ABFAS is allowing this? It would be ok if due to medical illness but just running out of time should not be an excuse.
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Hard disagree. Plenty of ****ty jobs out there for new grads to not get their numbers. Especially rearfoot in PP
 
Hybrocure said:
Hard disagree. Plenty of ****ty jobs out there for new grads to not get their numbers. Especially rearfoot in PP
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So ABFAS certification is a handout?....if you want it then you have to find a way to get it.

It's almost like there must be something wrong with the profession id all new graduating "surgeons" are not able to get board cert in 1 year like Ortho....

Pass rear foot but not foot...yeah that's fine. Hell I passed rearfoot first try and took me 3 tries for foot.

If you want the certification you have to want it. Not getting enough cases because you're in private practice is not a legit excuse.
 
air bud said:
So ABFAS certification is a handout?....if you want it then you have to find a way to get it.

It's almost like there must be something wrong with the profession id all new graduating "surgeons" are not able to get board cert in 1 year like Ortho....

Pass rear foot but not foot...yeah that's fine. Hell I passed rearfoot first try and took me 3 tries for foot.

If you want the certification you have to want it. Not getting enough cases because you're in private practice is not a legit excuse.
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But I thought we are all supposed to be surgeons? (sarcasm)

There’s only so many foot surgeries to go around.

The point I’m making is we are graduating too many podiatrists which I think we can all agree on. The problem with being a “go getter” to get basic board cert is that implies many others will not get it. What kind of standard is that for a profession?

When a good job which can generate surgical numbers has 100 apps for 1 slot that leaves a lot of people out in the dust.

What happens in reality is you end up with a ton of fresh grads cutting on people for surgeries the patient probably didn’t need but the doc needs to get their numbers
 
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[QUOTE="Hybrocure, post:But I thought we are all supposed to be surgeons? (sarcasm)

There’s only so many foot surgeries to go around.

The point I’m making is we are graduating too many podiatrists which I think we can all agree on. The problem with being a “go getter” to get basic board cert is that implies many others will not get it. What kind of standard is that for a profession?

When a good job which can generate surgical numbers has slot that leaves a lot of people out in the dust.

What happens in reality is you end up with a ton of fresh grads cutting on people for surgeries the patient probably didn’t need but the doc needs to get their numbers[/QUOTE]

This here is one reason people lose points on case review which leads to not passing.

“Surgery not indicated”
 
Its interesting to me that this has never actually been discussed on here. During Covid I wondered if my ability to get cases would ever return / would our surgical down time ultimately be the grounds for some sort of ABFAS extension. This time period was also to a degree a factor that pushed me towards getting ABPM since I thought - well I have to get board certified in something.
 
heybrother said:
Its interesting to me that this has never actually been discussed on here. During Covid I wondered if my ability to get cases would ever return / would our surgical down time ultimately be the grounds for some sort of ABFAS extension. This time period was also to a degree a factor that pushed me towards getting ABPM since I thought - well I have to get board certified in something.
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Here you go sir. Congratulations this is as valuable as your ABPM certification. And it only cost you your soul. And any future admin position within Podiatry profession.
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Not long ago, I had a lunch-and-learn with our friendly neighborhood cutera rep. If I purchase one of their units, I could become eligible for the one REAL credential you can trust. Why be a foot and ankle surgeon when you can be a laser surgeon?

RollingstonePod said:
“Surgery not indicated”
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This is really important advice to anyone fresh out. If I'm being honest with my self-appraisal, I think this more than anything else is why it took me so long to get certified. For the foot case review, you really want to cherrypick doable cases. No smokers, no homeless, no crazies, just wait until you're comfortable in your own skin to treat those people. You almost have to read people like a Vegas poker player to know who's going to have all kinds of complaints and problems vs who's going to go smoothly. Better to wait 5 years to get your numbers than to get 3 years' worth of suboptimal results and spend years "folding and reshuffling" as you resubmit case reviews.
 
Adam Smasher said:
Not long ago, I had a lunch-and-learn with our friendly neighborhood cutera rep. If I purchase one of their units, I could become eligible for the one REAL credential you can trust. Why be a foot and ankle surgeon when you can be a laser surgeon?


This is really important advice to anyone fresh out. If I'm being honest with my self-appraisal, I think this more than anything else is why it took me so long to get certified. For the foot case review, you really want to cherrypick doable cases. No smokers, no homeless, no crazies, just wait until you're comfortable in your own skin to treat those people. You almost have to read people like a Vegas poker player to know who's going to have all kinds of complaints and problems vs who's going to go smoothly. Better to wait 5 years to get your numbers than to get 3 years' worth of suboptimal results and spend years "folding and reshuffling" as you resubmit case reviews.
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Cant agree more with this. I took 5 years for foot & rra. I cant tell you how many potential cases I passed up on along the way.
 
I thought the ABFAS process was probably fair. I passed foot and RRA but don’t receive any sort of report. I had complications too but I think I documented fine and luckily my patients always got X-rays when I asked them to.
 
Retrograde_Nail said:
Patient satisfaction should never be grounds for point deduction. The point of the case review is to evaluate your work up of a pathology, execution of surgery and management of the surgery or complications in the post op period.

Documentation on patient satisfaction for medico-legal reasons is outside the scope of the exam. It is beyond comprehension. It is hard to believe honestly. If you got dinged for this on multiple cases and that caused you to not pass this is grounds for a lawsuit.
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There’s probably more than that to why they didn’t pass. He got dinged for not getting pre op X-rays on a bunion.
 
I'm pretty sure that he (and some others I think?) got dinged for "patient satisfaction"

Which sounds like a load of crap BTW - ABFAS is not shaking off the $cam allegations any time soon. It's worse than the "overly prominent screw" meme, that at least can make sense in certain contexts
 
Many candidates misunderstand the “patient satisfaction” scoring component. It is not a simple “the patient complained, so you lose points.” The reviewers are not judging whether every patient is completely symptom-free or perfectly satisfied. Rather, they are evaluating whether:

The procedure was appropriate.
The outcome was acceptable given the pathology.
The postoperative course and follow-up were appropriate.
Complications were appropriately recognized and managed.
For example:
A patient may state, “my toes are still touching,” but radiographically there is acceptable alignment, the procedure performed was indicated, and functionally the patient is improved and ambulating. In this situation, the patient’s minor dissatisfaction may not result in any scoring deduction — because the surgical care was still appropriate, and the outcome acceptable.

Common Candidate Mistake:
Where candidates lose points is when they try to “gloss over” or under-document clear issues. For example:

A nonunion is present on x-ray.
The patient is still in a CAM boot at 4 months.
The note says: “patient doing well, f/u in 3 months.”
In this situation, the candidate may lose points — not because of patient dissatisfaction — but because of lack of recognition or management of the complication. The reviewers want to see that you appropriately assess your patient, document accurately, and initiate a reasonable plan when issues arise.

Bottom Line for Candidates:

Patient satisfaction points reflect your management of the case, not just the patient’s subjective comments.
Accurately document what you see.
Recognize problems when present.
Have a reasonable plan to address complications.
The patient doesn’t have to be 100% happy for you to receive full credit — but you do need to manage the case correctly.
 
RollingstonePod said:
Patient satisfaction points reflect your management of the case, not just the patient’s subjective comments.
Accurately document what you see.
Recognize problems when present.
Have a reasonable plan to address complications.
The patient doesn’t have to be 100% happy for you to receive full credit — but you do need to manage the case correctly.
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It’s hard to admit that maybe if you fail maybe you deserved it, and you need to have a higher standard for yourself, or that you’re not as good as you think you are. No test is perfect but maybe the hate on ABFAS is more of a projection of frustration of yourself.
 
AttackNME said:
It’s hard to admit that maybe if you fail maybe you deserved it, and you need to have a higher standard for yourself, or that you’re not as good as you think you are. No test is perfect but maybe the hate on ABFAS is more of a projection of frustration of yourself.
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Showed my results to 4 different peers, and they all agree even the things that they deducted for "addressing pathology" and "technical skill" were not warranted; and can clearly be objectively seen by pre/post-op measurements. Which begs the question, what were they dinging me on points for then? Too bad I won't know unless I dish out $4000.....hmmm doesn't seem scammy at all...

this reinforces my view that ABFAS and APMA are run by greedy clowns 😊
 
PointyNippers said:
Showed my results to 4 different peers, and they all agree even the things that they deducted for "addressing pathology" and "technical skill" were not warranted; and can clearly be objectively seen by pre/post-op measurements. Which begs the question, what were they dinging me on points for then? Too bad I won't know unless I dish out $4000.....hmmm doesn't seem scammy at all...

this reinforces my view that ABFAS and APMA are run by greedy clowns 😊
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My director was a former president. I remember showing him a case that I failed and he straight up was like yeah you got screwed sorry bro that was BS.
 
air bud said:
My director was a former president. I remember showing him a case that I failed and he straight up was like yeah you got screwed sorry bro that was BS.
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Yeah, same. Mine passed before I took cert, but I remember him telling other alumni "almost everyone struggles with it, everyone goes through it."

I would maintain it'd be a lot stronger as an oral exam for board cert going through candidate's own cases (like ortho, OB, gen surg, etc), but cost would surely go up... and ppl would then just gripe about that, as they gripe about the exams/fails now. They've already passed all didactic parts by the time they sit for cert exam, so oral exam is then more seeing if candidate has any major "holes in their game," as opposed to mostly just dissecting the charts.

As it runs now, the BC/case review is really a lot like the Cbps in that you have to know what they're looking for (pre op writeup, XR read details, what views). It's definitely not unfair, but it is a documentation game of sorts. It's not only getting the job/cases in the first place... doing them, and then having the documentation right. A lot of people are busy or just don't chart very well (esp for trauma consults, add or on-call surgery, etc). Then there is the somewhat random factor of who reviews your cases, what mood they're in, etc. It's going to have some subjectivity by its very
nature, but the oral would let candidate make their rationale and thought process clear... a simple pile of scan charts and XRs often can't.

AttackNME said:
It’s hard to admit that maybe if you fail maybe you deserved it, and you need to have a higher standard for yourself, or that you’re not as good as you think you are. No test is perfect but maybe the hate on ABFAS is more of a projection of frustration of yourself.
Click to expand...
Yes. A lot of it goes back to the training... we should really have had some residencies set grads up to take Abfas and most of the residencies don't go that route (non op podiatry... dent model). As it sits, with massive variability in our training (yet all "surgical" programs), we have a lotta programs basically 100% pass (Abfas board qual) while some are consistently much lower. Seems we're only going further into that rift with more pod schools, more residencies... and only so many F&A surgery to go around for training and practice.
 
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