Finally all residencies are 3yrs now!

[cool_vkb]

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Members do not see this ad.

finally it has happened. all residencies are 3yrs.

but im sad over the fact that even though all residencies are 3yrs but not all will lead to RRA certification :-(

 

[347932]

finally it has happened. all residencies are 3yrs.

but im sad over the fact that even though all residencies are 3yrs but not all will lead to RRA certification :-(

Can you link your source please? I don't quite understand how, if you have three years of residency, you will not be eligible to sit for the RRA qualification examination.

 

[jonwill]

Can you link your source please? I don't quite understand how, if you have three years of residency, you will not be eligible to sit for the RRA qualification examination.

I've heard about this. All residencies will be three years but not all of them have the numbers/training for rearfoot/ankle so that will now be a seperate designation thus kind of standardizing residency training but not really. 🙂

 

[janV88]

What if a resident achieves the MAVs for RRA, can they sit for RRA boards or does the program have to be approved?

Something like 85% of programs are RRA so it's only a matter of time. If the CPME made RRA mandatory then we would be in an even bigger residency shortage.

 

[cool_vkb]

here is the source,

http://www.apma.org/Members/Education/CPMEAccreditation/Residencies.aspx

i mean i honestly feel its a good idea. After my non-podiatry surgery rotations i started to feel we have the shortest surgical residencies. Most of the surgical residencies are 4-5 yrs plus fellowships. So 3yrs is not a big bargain. I hope this also is a part of the infamous resolution 2015 issue also and helps us.

but timing was defintely not good.we could have waited for a year. At this moment even 1yr perceptorships should be encouraged. Because of the shortage.

 

[cool_vkb]

....

 

[dtrack22]

At this moment even 1yr perceptorships should be encouraged. Because of the shortage.

Bad idea...unless you want to go back to the 90's where we all have different training. Another year went by with empty seats. Yes, there were "qualified" students who didn't get residencies, and there may have been a few more students than spots...but there were programs available that would rather take nobody than those "qualified" students.

Looks like they finally approved the minutes from the October meeting. And it sounds like RRA cert will be granted to programs who can get all residents their numbers. Basically the programs will have some sort of RRA "seal of approval" that will be available for current students to view when looking to clerk. I'm sure the next push will be to get ALL programs RRA numbers.

They were talking about allowing programs to have RRA and non-RRA residency positions within the same program...don't know if that's still an option.

 

[347932]

Ok so I took a hard look at the new CPME guidelines and it seems reasonable that any program should be able to provide the 50 required RRA cases given the rather vague description of what an RRA case is.

In many instances, superficially at least, many "foot" cases can be considered RRA case given the proper description. For instance, a Kidner procedure is both an osseous midfoot procedure (removal of accesory ossicle?) as well as a potential tendon reconstruction (PTT repositioning and repair?). It can also be considered a peds case if the patient is under 21 (?). I think they make it purposefully vague. That's just me.

The real issue is dealing with states that have limited rear foot scope laws. I think this new CPME guideline manual may negatively impact those programs in those states as the state scope may not allow for the more complex procedures. The state of Connecticut comes to mind immediately.

So basically if a state has limited laws, the residencies in those states can't offer the same training as a state like California for instance. Previously, this was not an issue so much as there was no "RRA Credentialing" per se. It was just a matter of time spent in residency.

Conversely, there is no "Foot Requirement" to get Foot certified either. I can tell you in my residency we struggled to get our Metatarsal numbers, and did far more rear foot cases than "forefoot" cases.

What really needs to happen is eliminate this type of classification system. I've talked about this for years. There needs to be one board. Blogs online, meetings behind closed doors and the politicos have been going back and forth with this for at least 10 years. All of us should have the same training...check. All of us should be able to perform the same procedures based on a national scope of practice model...ummm not so much yet. All of us should have the same board certification. This is my view alone.

What do you all think?

 

[347932]

They were talking about allowing programs to have RRA and non-RRA residency positions within the same program...don't know if that's still an option.

This would a terrible occurrence. Can you imagine the intra-residency competition this would foster? Who gets those RRA spots? Wow, I would not want to be the residency director responsible for that!

 

[dtrack22]

This would a terrible occurrence. Can you imagine the intra-residency competition this would foster? Who gets those RRA spots? Wow, I would not want to be the residency director responsible for that!

Yeah, that was pretty much the consensus.

 

[dpmgrad]

What if a resident achieves the MAVs for RRA, can they sit for RRA boards or does the program have to be approved?

Something like 85% of programs are RRA so it's only a matter of time. If the CPME made RRA mandatory then we would be in an even bigger residency shortage.

If the 3 yr program is not approved to grant RRA credential, those residents will not be able to sit for the RRA boards even if they met the MAVs for RRA since they are not eligible to receive the RRA credential from that particular program.

 

[Podfather]

If the 3 yr program is not approved to grant RRA credential, those residents will not be able to sit for the RRA boards even if they met the MAVs for RRA since they are not eligible to receive the RRA credential from that particular program.

Every so many years our profession completely revamps residency training. Although I am for more consistent residency training, the changes never really get there. We went from the POR, RPR, PSR-12, PSR-24 to PMS-24 and PMS-36. This did not create a unified training scenario and still created 2 levels of training. Now we go to all 3 year programs and have a PMSR. However some will have RRA credentials and some will not. Again programs that are different. Each time we change the conversion is gradual and for several years we have residents leaving with the old models and some with the TWO new models. The confusion this creates for the public, hospitals, and within our profession is mind blowing. Imagine I am a credentialing committee. I have someone who did a great PSR-24, someone who did a 3 year PSR-24, someone who did a RPR plus a PSR-24, a PMS-24, PMS-36, soon a PMSR with RRA and PMSR without. You almost need a translator from CPME in the room. So what happens we have people generalizing that only 3 years can do RF/ankle. Forget about the individual who has done 100s of RF/ankle cases after a great PSR-24 in the 80s or 90s. Now we have a PMSR without RRA who did 3 years who would get the privileges. Or the RPR, POR, PSR-12 person who did 3 years. Everytime I tell our CEO about mandatory changes he simply says your profesion has schizophrenia. These changes happen so frequently that just as we stabilize faculty, schedule, staff we have to upset the apple cart. Oh let's not forget we now mandate 3 years but Medicare does not fully fund the 3rd year. My CFO loves that.......

Each time we change considerable time is required by the director and faculty. Rather than teaching or improving (often a great program) we are sepnding our time changing and working on all the new areas of compliance. God forbid if you miss some paper detail and be placed on probation even though your current residency was approved for 5 years. Oh yes lets have another site visit(earlier than planned) to show we meet the new guidelines. The hospitals (who support podiatry but have limited patience) just love the disruption and the new rules every 5 years in addition to the constant amendments of requirements.

My fear is in 5 years we will change it again. Look we need to stay consistent for a while. If we are going with this PMSR so be it but let's not change it for atleast a decade or two. We also have to realize that no matter how hard we try people will be trained differently (atleast in surgery) based upon where they trained. Plus some now are doing DPM or ortho fellowships to be "different". Hopefully someday we will become sane and adopt the dental model. Everyone does the same 2 year residency. Medically based, all rotations needed now, basic forefoot surgery, and biomechanics. Then a limited number of programs in rearfoot/reconstructive surgery, perhaps advanced wound healing, or whtever we decide fits the profession, healthcare, and the needs of the public.

Going to take my nexium now.

 

[347932]

I'm with you 100% Podfather.

Happily in my community, I didn't need to have RRA certification to do the complex cases, but just needed to prove competency via my surgical logs form residency.

We need one residency training category, one Board, and one College to represent us. I've been tooting that horn for over 10 years now.

I took my Lexapro last night so I'm good 😀.

 

[krabmas]

Dear Podfather and Kidsfeet,

thank you for preaching to the chior.

Kidsfeet, who have you been telling this to for 10 years? anyone with the ability to effect change thru the CPME/COTH or APMA?

Podfather, did you send that last post to the APMA or COTH?

I know sometimes people with positions/power log on here but for the most part these lengthy posts are just your way to vent.

I appreciate your view, I agree with it, but this may not be the most effective place to effect change.

If you feel this strongly, I highly suggest you send a letter to the people that make these decisions. Similar to sending letters to congress/state assembly instead of venting to your neighbor about the pot holes in the street.

 

[Podfather]

Dear Podfather and Kidsfeet,

thank you for preaching to the chior.

Kidsfeet, who have you been telling this to for 10 years? anyone with the ability to effect change thru the CPME/COTH or APMA?

Podfather, did you send that last post to the APMA or COTH?

I know sometimes people with positions/power log on here but for the most part these lengthy posts are just your way to vent.

I appreciate your view, I agree with it, but this may not be the most effective place to effect change.

If you feel this strongly, I highly suggest you send a letter to the people that make these decisions. Similar to sending letters to congress/state assembly instead of venting to your neighbor about the pot holes in the street.

The people who are in charge are well aware of my opinions.

 

[347932]

The people who are in charge are well aware of my opinions.

This.

If I may make a suggestion to you Krabmas. Get involved in the politics of our profession and you'll see that it is not so easy to affect change.

It takes a concerted effort. Join us and preach our cause. Only then will you realize what's at stake and who the decision makers are.

 

[podpal]

This.

If I may make a suggestion to you Krabmas. Get involved in the politics of our profession and you'll see that it is not so easy to affect change.

It takes a concerted effort. Join us and preach our cause. Only then will you realize what's at stake and who the decision makers are.

Problem is there is too much CHANGE. It seems like the residency requirements change yearly. PodFather is correct, a very viable model would be 2 years, PMS-24 and an option for those interested to apply for additional training that is more specialized.

Dentistry currently does this, they have a general residency, but those wanting to perform dental implants/surgery must obtain further training.

I too have written to the powers that be and it falls on deaf ears.

Is there no way to remove those in power so that the masses of pods who wish for training may obtain such? I never voted anyone into the CPME or APMA, yet their unilateral rules are negatively impacting my ability to practice. Their new rules have resulted in insurance companies refusing to allow licensed practitioners parity with such simple tasks as nail/callous debridement.

How can we, as a profession, remove those causing problems for the rest of us in the profession? Is there some mechanism for this?

These rule makers do not govern the State Board. How does the field allow them so much power over all of us? Formal complaints go no where. Is there a way to petition these rule makers re:their decisions affecting all of us?😕

 

[347932]

Is there no way to remove those in power so that the masses of pods who wish for training may obtain such? I never voted anyone into the CPME or APMA, yet their unilateral rules are negatively impacting my ability to practice. Their new rules have resulted in insurance companies refusing to allow licensed practitioners parity with such simple tasks as nail/callous debridement.

How can we, as a profession, remove those causing problems for the rest of us in the profession? Is there some mechanism for this?

These rule makers do not govern the State Board. How does the field allow them so much power over all of us? Formal complaints go no where. Is there a way to petition these rule makers re:their decisions affecting all of us?😕

I'm confused. How does the current change in residencies affect an insurance companies decision as far as how to pay for debriding nails and trimming callus? Parity with which other medical professional that does this? Or are you saying that I get paid more for doing this because I did three years of residency, compared to someone else who only did one year? I just don't see that. Please expand on this.

Altohugh the rule makers don't govern the State Board per se, they do have an impact on what the State legislation does. The recent change in scope of practice in the State of New York is a perfect example of this.

I've been volunteering and working with the APMA for ten years now and am only now starting to have my voice heard on some of these issues and am hopeful that I will eventually be asked to participate in some of the decision making by serving on one of the various boards within the APMA. How involved have you been? I'm not being coy. I'm simply pointing out that you've mentioned formally complaining and writing a letter or two. I'm on the phone at least weekly discussing these issues and e-mailing constantly about these issues. Involvement takes years, not days or even months.

The residency changes are just ONE of the aspects of our profession. Are you saying that the APMA, as an organization, is not working in our best interest as a profession? I would very much disagree with this statement. The CPME has a difficult job. I'm not justifying what tehir decisions are, but I also realize that you can't make everyone happy. Also, what may be good for the profession today, may not be the case for tomorrow. ITs a difficult balance and you win some and lose some.

 

[PADPM]

Every so many years our profession completely revamps residency training. Although I am for more consistent residency training, the changes never really get there. We went from the POR, RPR, PSR-12, PSR-24 to PMS-24 and PMS-36. This did not create a unified training scenario and still created 2 levels of training. Now we go to all 3 year programs and have a PMSR. However some will have RRA credentials and some will not. Again programs that are different. Each time we change the conversion is gradual and for several years we have residents leaving with the old models and some with the TWO new models. The confusion this creates for the public, hospitals, and within our profession is mind blowing. Imagine I am a credentialing committee. I have someone who did a great PSR-24, someone who did a 3 year PSR-24, someone who did a RPR plus a PSR-24, a PMS-24, PMS-36, soon a PMSR with RRA and PMSR without. You almost need a translator from CPME in the room. So what happens we have people generalizing that only 3 years can do RF/ankle. Forget about the individual who has done 100s of RF/ankle cases after a great PSR-24 in the 80s or 90s. Now we have a PMSR without RRA who did 3 years who would get the privileges. Or the RPR, POR, PSR-12 person who did 3 years. Everytime I tell our CEO about mandatory changes he simply says your profesion has schizophrenia. These changes happen so frequently that just as we stabilize faculty, schedule, staff we have to upset the apple cart. Oh let's not forget we now mandate 3 years but Medicare does not fully fund the 3rd year. My CFO loves that.......

Each time we change considerable time is required by the director and faculty. Rather than teaching or improving (often a great program) we are sepnding our time changing and working on all the new areas of compliance. God forbid if you miss some paper detail and be placed on probation even though your current residency was approved for 5 years. Oh yes lets have another site visit(earlier than planned) to show we meet the new guidelines. The hospitals (who support podiatry but have limited patience) just love the disruption and the new rules every 5 years in addition to the constant amendments of requirements.

My fear is in 5 years we will change it again. Look we need to stay consistent for a while. If we are going with this PMSR so be it but let's not change it for atleast a decade or two. We also have to realize that no matter how hard we try people will be trained differently (atleast in surgery) based upon where they trained. Plus some now are doing DPM or ortho fellowships to be "different". Hopefully someday we will become sane and adopt the dental model. Everyone does the same 2 year residency. Medically based, all rotations needed now, basic forefoot surgery, and biomechanics. Then a limited number of programs in rearfoot/reconstructive surgery, perhaps advanced wound healing, or whtever we decide fits the profession, healthcare, and the needs of the public.

Going to take my nexium now.

Amen.

Podfather, a few hundred posts ago when we both "disagreed" regarding some of my comments as to why I was no longer active with the ABPS and was no longer an examiner, etc., etc., some of the reasons are actually reflected in your post above.

I know a lot of the changes you mentioned are not initiated by the ABPS, but the experience you have had when you state that those in charge are well aware of your opinion, is the same experience I had when I decided to decrease my role within the ABPS.

I'm still a dues paying diplomate of the ABPS, but I just was very frustrated with some decisions being made at the time. So, in the long run we may actually agree on the subject that we seemed to disagree on in those earlier posts.

 

[Podfather]

Amen.

Podfather, a few hundred posts ago when we both "disagreed" regarding some of my comments as to why I was no longer active with the ABPS and was no longer an examiner, etc., etc., some of the reasons are actually reflected in your post above.

I know a lot of the changes you mentioned are not initiated by the ABPS, but the experience you have had when you state that those in charge are well aware of your opinion, is the same experience I had when I decided to decrease my role within the ABPS.

I'm still a dues paying diplomate of the ABPS, but I just was very frustrated with some decisions being made at the time. So, in the long run we may actually agree on the subject that we seemed to disagree on in those earlier posts.

We agree on many things but my rant above has more to do with the schizophrenic actions of the APMA/CPME. I respect what they stand for( I am a past state officer POTUS) and all of those who work in both organizations but they often forget about those in the trenches and penalize the wrong people. ABPS is in my opinion the guardian of the profession. I can assure you they are one of the groups who does the right thing and commits to their mission. Some day we need to fess up in an PM who we are and I can bring you up to speed as to the changes (for the good) that have occurred over the last decade. My main points above are the numerous changes mandated in residency training (for the greater good we are told) and nomenclature that has increased confusion and not resolved disparity in training. The new model only makes all programs 3 years nothing else IMO. Go back and see how just a few years ago we switched to PMS-24/36 and now a new name change and still 2 models.

BTW let me know when you want back in the game we need your insight and commitment now more than ever.

 

[dtrack22]

Podfather,

What do you think about the NBPME changing the name of our boards?

 

[krabmas]

This.

If I may make a suggestion to you Krabmas. Get involved in the politics of our profession and you'll see that it is not so easy to affect change.

It takes a concerted effort. Join us and preach our cause. Only then will you realize what's at stake and who the decision makers are.

I've been there. no thank you.

 

[PADPM]

I sincerely appreciate your comments and offer, but I'm afraid I've lost some of my "mojo". Some of it involves pressure from my partners due to a very busy practice, and some of it involves a bitter taste I have from a few ungrateful residents that have been less than respectful to some of my colleagues.

Over the years I put a lot of time and energy into our profession and I'd like to think that the majority of that time was appreciated. But just like when you raise a child, some of that is simply take for granted. Now that our practice is almost "too" busy, it would be extremely difficult to be away from the office and dedicate the necessary time to the various organizations that I would need to in order to be effective. I can't do anything half hearted.

I assure you, I'm no one "famous", though I'm known well in my area and have contributed more than your average DPM. I've never been on the lecture circuit, but many of the "big names" mentioned on this site know me very well and I believe respect me.

My goal is to bring some young blood into our practice and have that doctor attempt to start a new residency in one of our local hospitals. I've done that in the past and will be happy to help with that project, but I don't have the time or energy to do it myself at this time.

 

[diabeticfootdr]

Podfather,

What do you think about the NBPME changing the name of our boards?

What are they changing the name to?

 

[diabeticfootdr]

Oh let's not forget we now mandate 3 years but Medicare does not fully fund the 3rd year. My CFO loves that.......
.

I think the reason the 3rd year is not funded at 100% now is because it is not mandatory to complete a 3rd year to practice. My understanding is that it will be 100% funded when it is mandated.

 

[Podfather]

I think the reason the 3rd year is not funded at 100% now is because it is not mandatory to complete a 3rd year to practice. My understanding is that it will be 100% funded when it is mandated.

That is not guaranteed but I hope even with deficit reduction the talk of the day, it comes true.

 

[Podfather]

What are they changing the name to?

Same question changed to what?

 

[dtrack22]

The NBPME will still be the examining board but the name is changing to the APMLE part I, II, III

Does mimicking the USMLE really accomplish anything? Or is it something that just sounds more official and makes a few folks feel better?

 

[diabeticfootdr]

The NBPME will still be the examining board but the name is changing to the APMLE part I, II, III

Does mimicking the USMLE really accomplish anything? Or is it something that just sounds more official and makes a few folks feel better?

I guess it's a reasonable name change. NBPME is actually an acronym for the Board creating the exam, not the exam itself. It doesn't make grammatical sense to say you're taking the NBPME. It makes sense to name the exam, APMLE.

Thanks for the info. I was unaware of this.

 

[dyk343]

The NBPME will still be the examining board but the name is changing to the APMLE part I, II, III

Does mimicking the USMLE really accomplish anything? Or is it something that just sounds more official and makes a few folks feel better?

I'm really just speaking on hearsay and I really have no idea what I am talking about but I was told that the current NBPME is really random.

Apparently some students were caught cheating a couple years ago so they had to change the entire test bank. From what im told (from a professor) they changed it for the harder.

Somewhere around 75% passed last year because of the difficulty? I was told the questions on the board are really obscure and many thought they were never taught the question information before. Also, as I have been told there is no real way to study for the boards (like USMLE made easy) except maybe going back through all of your notes. Maybe changing it to a more standardized format where the student at least knows what to expect could be a good thing? Again, this is all hearsay.

 

[air bud]

I'm really just speaking on hearsay and I really have no idea what I am talking about but I was told that the current NBPME is really random.

Apparently some students were caught cheating a couple years ago so they had to change the entire test bank. From what im told (from a professor) they changed it for the harder.

Somewhere around 75% passed last year because of the difficulty? I was told the questions on the board are really obscure and many thought they were never taught the question information before. Also, as I have been told there is no real way to study for the boards (like USMLE made easy) except maybe going back through all of your notes. Maybe changing it to a more standardized format where the student at least knows what to expect could be a good thing? Again, this is all hearsay.

Or maybe the student should study harder and pay more attention. But hey, this just goes with this generation wanting everything handed to them. I get somewhat annoyed when professors basically tell you what is on their exam. Yes, it makes studying easier in the short run, but we do ourselves a disservice by only studying what is absolutely necessary. In the long run (boards and future) we never studied it because it wasn't going to be tested. That doesnt make it any less important for the real world, where peoples health counts, not what grade you wanted on the test. How about we do our job and learn what is presented, then we won't have people saying "oh, I didnt think that was going to be on the test, I didnt study that." Thats not the way life works. Know everything, be prepared for anything. (I understand it is not that simple, but work with me here.)

Isn't the MCAT a "standardized" format? Not sure about you, but I really didnt know what was going to be on the MCAT before I took it.

 

[347932]

I think the reason the 3rd year is not funded at 100% now is because it is not mandatory to complete a 3rd year to practice. My understanding is that it will be 100% funded when it is mandated.

There is currently talks that within the next residency cycle, the 3rd year will indeed be funded at 100%. Anything can happen at this point, but this is the rumbling going on.

 

[347932]

I've been there. no thank you.

I just don't get you. On one hand, you are telling people with much more experience than you to buck up and DO something other than preach on this thread, and then when the finger is pointed back at you, its "no thanks". Been there, done that.

So rather than being part of the solution and voicing an opinion on these threads, and following up with the powers that be, its easier to just complain I guess.

We need more people to be part of the solution and less who are willing to just point out the problems.

 

[densmore22]

I just don't get you. On one hand, you are telling people with much more experience than you to buck up and DO something other than preach on this thread, and then when the finger is pointed back at you, its "no thanks". Been there, done that.

So rather than being part of the solution and voicing an opinion on these threads, and following up with the powers that be, its easier to just complain I guess.

We need more people to be part of the solution and less who are willing to just point out the problems.

I understand where Krabmas is coming from. After spending 4 years in the APMSA (which is an utterly pointless organization) and hearing the powers that be (APMA board of trustee's), specifically 3 president elects tell us the same canned speech and then when you question them on any aspect of said speech, they say, well you will just have to wait and see when 2015 rolls around (or some BS like that), you get pretty jaded. Personally, I don't want anything to do with the APMA when I'm done. I will pay my dues and be a member, but beyond that, I get tired of getting all the APMA daily news emails, or getting letters saying I better update my undergrad institution because "it's imperative for our records." Utter and total BS if you ask me. They serve themselves and only themselves. They want their ego's stroked. They act like they're for the "everyday" podiatrist, but in all reality, they could care less. Site me specific examples beyond lobbying on capital hill where the APMA presence has made a substantial difference in an average podiatrist's life within the past decade? I bet you'd have a really tough time coming up with legitimate examples. Most if not all of the ideas, requests, even questions seem to always "fall through the cracks."

 

[347932]

I understand where Krabmas is coming from. After spending 4 years in the APMSA (which is an utterly pointless organization) and hearing the powers that be (APMA board of trustee's), specifically 3 president elects tell us the same canned speech and then when you question them on any aspect of said speech, they say, well you will just have to wait and see when 2015 rolls around (or some BS like that), you get pretty jaded. Personally, I don't want anything to do with the APMA when I'm done. I will pay my dues and be a member, but beyond that, I get tired of getting all the APMA daily news emails, or getting letters saying I better update my undergrad institution because "it's imperative for our records." Utter and total BS if you ask me. They serve themselves and only themselves. They want their ego's stroked. They act like they're for the "everyday" podiatrist, but in all reality, they could care less. Site me specific examples beyond lobbying on capital hill where the APMA presence has made a substantial difference in an average podiatrist's life within the past decade? I bet you'd have a really tough time coming up with legitimate examples. Most if not all of the ideas, requests, even questions seem to always "fall through the cracks."

Hmmm where to begin?

Last year the APMA with the help of the state chapter in New York State were successful in changing the scope of practice and help every practitioner in that state take advantage of this advance in the state scope. Who exactly in the APMA did this self serve? I'm not sure how many practicing Podiatrists are in NY State, but I'm sure more than those that helped with this were happy about the change.

Last year the APMA helped the State of Virigina, along with the state society, avoid Podiatrists from being booted off of Medicaid. I know a few Pods in that state and they all breathed a sigh of relief when they found out they were not to be excluded. I don't know how many Pods there are in VA, but I'm sure each and every one of them could tell you personally how thankful they are for the help the APMA provided.

When President Obama made an incorrect statement concerning how much doctors get paid for doing LE amputations, the leaders at the APMA sent a letter which helped the Pres decide to effectively retract his comment and admit to making a mistake, which also led to an apology on his part. How did that not serve the profession as a whole? Who exactly within the APMA did this help individually.

Dr. Ross Taubman, during his tenure as the APMA President, wrote a very cohesive and important letter to the AMA after they released a long statement concerning Podiatry and how is wasn't a "real" or necessary subspecialty. This letter had a huge impact on the medical community and its view on how we, as a profession, handle ourselves. I know Ross personally and can tell you, he is the last person that I would ever think to accuse of being self serving.

You say "besides lobbying", but you don't realise that that this legislation is what makes sure you get PAID as a practitioner, and also makes sure that you continue to get the same, if not better reimbursement. Recently, by tugging on the ear of some legislators, the proposed 22% reduction in medicare fees was altogether STOPPED. Who exactly does that serve individually within the APMA?

One thing that you need to understand is that many of us do these things within the APMA as VOLUNTEERS, because we are passionate about our profession and passionate about helping it to advance.

If you aren't interested in helping, that's ok. Not everyone has the time, drive or stamina to persist in something that takes YEARS to affect change with. But please, don't minimize what these people do for you. We would not be where we are as a profession without the APMA. Who represents YOU in the public eye and in the media? The APMA does. Whether you believe it or not.

The most amazing thing to me as a human being is how much people are willing to complain about just about anything, but when asked to participate, many always think that its someone else's job to be or get involved. I'm glad you're at least willing to be a member of the APMA and pay dues. There are MANY out there who aren't members, but still take FULL advantage of the strides the APMA makes everyday. How is that fair??

 

[zephryus14]

Wow, thanks Kidsfeet. Couldn't have said it better myself. I completely agree with everything you wrote, especially that last part. Imagine if everyone volunteered even a fraction of their time, the things we could do as a profession would grow exponentially!

On a side note, today I gave a presentation on podiatric medicine to the pre-med society at a local college. The APMA set everything up from contacting the school to shipping me handouts and other materials as well as a powerpoint presentation. Recruiting that resource for the future of our profession was made entirely possible by APMA.

 

[BuckeyeDoctor]

Hmmm where to begin?

Everything you said had to do with capital hill/politics. Do you have other examples?

We would not be where we are as a profession without the APMA. Who represents YOU in the public eye and in the media? The APMA does.

That's a double edge sword. The APMA does great things politically but they are also the reason people don't know what a podiatrist does. It amazes me people are surprised that after the APMA runs stories about how to choose socks, care for blisters and nail fungus our patients don't know we do surgery or treat ankles, etc.

The APMA and people associated with its leaders have a habit of pointing the finger at people who don't know enough as a reason that they are right. The APMA ego is the same reason they were unable to come to terms with ACFAS and now created a subpar, ASPS that is a poor attempt at duplicating the success ACFAS has enjoyed and will continue to enjoy.

 

[krabmas]

I just don't get you. On one hand, you are telling people with much more experience than you to buck up and DO something other than preach on this thread, and then when the finger is pointed back at you, its "no thanks". Been there, done that.

So rather than being part of the solution and voicing an opinion on these threads, and following up with the powers that be, its easier to just complain I guess.

We need more people to be part of the solution and less who are willing to just point out the problems.

I didn't write a post complaining about the profession or the residency situation.

 

[krabmas]

I understand where Krabmas is coming from. After spending 4 years in the APMSA (which is an utterly pointless organization) and hearing the powers that be (APMA board of trustee's), specifically 3 president elects tell us the same canned speech and then when you question them on any aspect of said speech, they say, well you will just have to wait and see when 2015 rolls around (or some BS like that), you get pretty jaded. Personally, I don't want anything to do with the APMA when I'm done. I will pay my dues and be a member, but beyond that, I get tired of getting all the APMA daily news emails, or getting letters saying I better update my undergrad institution because "it's imperative for our records." Utter and total BS if you ask me. They serve themselves and only themselves. They want their ego's stroked. They act like they're for the "everyday" podiatrist, but in all reality, they could care less. Site me specific examples beyond lobbying on capital hill where the APMA presence has made a substantial difference in an average podiatrist's life within the past decade? I bet you'd have a really tough time coming up with legitimate examples. Most if not all of the ideas, requests, even questions seem to always "fall through the cracks."

Thank you! I couldn't have said it better myself. After my time in APMSA I also felt that the APMA presidents/representatives withheld information from the students and just asked for our blind faith in them. The majority of the APMSA delegates are there to make connections and pad a resume and followed blindly. These students are the same people that will allow their egos to push them into positions in the APMA and blindly guide our profession.

I will also be a member of APMA but refuse to be involved any deeper. I am a firm believer that doing the same thing over and over again and expecting the same result is the definition of insanity. I refuse to drive myself insane or join in their insanity.

 

[dyk343]

Or maybe the student should study harder and pay more attention. But hey, this just goes with this generation wanting everything handed to them. I get somewhat annoyed when professors basically tell you what is on their exam. Yes, it makes studying easier in the short run, but we do ourselves a disservice by only studying what is absolutely necessary. In the long run (boards and future) we never studied it because it wasn't going to be tested. That doesnt make it any less important for the real world, where peoples health counts, not what grade you wanted on the test. How about we do our job and learn what is presented, then we won't have people saying "oh, I didnt think that was going to be on the test, I didnt study that." Thats not the way life works. Know everything, be prepared for anything. (I understand it is not that simple, but work with me here.)Isn't the MCAT a "standardized" format? Not sure about you, but I really didnt know what was going to be on the MCAT before I took it.

Some of the professors tell you everything you need to know for their exams at DMU? I can assure you I have no idea what is on my exams other than it will be out of the class notes/readings.

I had an idea what was going to be on the MCAT, at least general topics, but no I did not know what was "on" the test. Thats why I had to review.

According to your logic the allo/osteo (and pod) med students should not have any kind of prep book for the boards? No review to help joggle their memory on the role of succinate dehydrogenase in the krebbs cycle and its role with the ETC? What the difference between collagen type I II III and IV are and where they are found? Since the MD/DO's do have books for these details... they are... Cheaters?

Its impossible to remember 100% of everything we were ever taught throughout our lives. Thats why we constantly review old material when needed. When I am a resident and I know the next day I have to assist on a surgery involving an anterior abdominal wall invasion you better believe that I will be reviewing the anatomy of that area.

 

[347932]

I didn't write a post complaining about the profession or the residency situation.

You're right. I apologize for inferring this. However, you tend to be quick to point out what others should do.

 

[347932]

Thank you! I couldn't have said it better myself. After my time in APMSA I also felt that the APMA presidents/representatives withheld information from the students and just asked for our blind faith in them. The majority of the APMSA delegates are there to make connections and pad a resume and followed blindly. These students are the same people that will allow their egos to push them into positions in the APMA and blindly guide our profession.

I will also be a member of APMA but refuse to be involved any deeper. I am a firm believer that doing the same thing over and over again and expecting the same result is the definition of insanity. I refuse to drive myself insane or join in their insanity.

I don't get any ego boost by helping within the APMA, nor do I follow anyone blindly. I have no need to "pad" my resume and interestingly was never an APMSA rep. I do what I do within the APMA, once again, for the love of the profession and to help the future of our profession (read YOU) to get to a better place.

The most concerning thing is that people on these boards bash the APMA with a very limited experience with them. The APMA does nothing but help us. There is no hidden agenda, and once again, most of us do this on a VOLUNTEER basis. I spend time away from my family to help and do it on my own free time with no expectation of renumeration whatsoever.

Rather than complain, it would be nice to hear a thank you once in awhile, as a previous poster did. AGAIN, I don't do it for the "thank yous". I do it for the changes I see happening after YEARS of hard work. If you're not seeing it, it simply means you are not trying hard enough to look, and you are the one following the naysayers "blindly".

What items would you like to see the APMA focus more on? Help us to understand your needs better. I pretty sure that to some degree or other the APMA is addressing some of your concerns whether you know it or not. And, once again, to better help them understand what YOU need, get involved. One letter of complaint or one phone call is going to do NOTHING. On that note, if YOU feel that what YOU need is not being addressed, what's YOUR agenda?? The APMA is much more concerned with US than YOU. As it should be.

 

[densmore22]

I don't get any ego boost by helping within the APMA, nor do I follow anyone blindly. I have no need to "pad" my resume and interestingly was never an APMSA rep. I do what I do within the APMA, once again, for the love of the profession and to help the future of our profession (read YOU) to get to a better place.

The most concerning thing is that people on these boards bash the APMA with a very limited experience with them. The APMA does nothing but help us. There is no hidden agenda, and once again, most of us do this on a VOLUNTEER basis. I spend time away from my family to help and do it on my own free time with no expectation of renumeration whatsoever.

Rather than complain, it would be nice to hear a thank you once in awhile, as a previous poster did. AGAIN, I don't do it for the "thank yous". I do it for the changes I see happening after YEARS of hard work. If you're not seeing it, it simply means you are not trying hard enough to look, and you are the one following the naysayers "blindly".

What items would you like to see the APMA focus more on? Help us to understand your needs better. I pretty sure that to some degree or other the APMA is addressing some of your concerns whether you know it or not. And, once again, to better help them understand what YOU need, get involved. One letter of complaint or one phone call is going to do NOTHING. On that note, if YOU feel that what YOU need is not being addressed, what's YOUR agenda?? The APMA is much more concerned with US than YOU. As it should be.

You're also not on the APMA BOT, which is where Krabmas and myself have the biggest disdain for. What would I like to see? For starters, less ambiguity. What exactly does 2015 entail? Besides a big push for parity, what the hell does that even mean? I want details in regards to what is wanted to be accomplished. I personally have asked 2 past Presidents this and they couldn't give me an answer, falling back on "2015 is a great initiative we all strive to see come to fruition." Literally, that's the answer I got, um, ok. How about spending less time promoting shoe gear types and nail care and more focus on what we do as a whole, read: state how we do surgery, what types of surgeries we do. Basically educate the lay person to what we do because we don't do that. I will say, they're doing a better job of trying to get into undergrad institutions, but I would say >90% of pre-med students have no idea that podiatry is an amazing career opportunity, what about sending out a brochure to the pre-med committees that are so popular now, so that they can get info out, or better yet, we spend so much time trying to sell the profession to students who are ALREADY enrolled in pod school, spend some of that time and energy on prospective students. I know you're not going to reach everyone, but come up with some standard. I feel energy is not directed where it needs to be. Perhaps my words earlier were not the best and were, in fact, vague and harsh, but I just get so fed up beaurocratic bs, which, unfortunately, the APMA is a VERY political organization (and I don't mean about lobbying on capital hill). Stone is the first female President, but it's a good ole' boys club in there.

 

[347932]

You're also not on the APMA BOT, which is where Krabmas and myself have the biggest disdain for. What would I like to see? For starters, less ambiguity. What exactly does 2015 entail? Besides a big push for parity, what the hell does that even mean? I want details in regards to what is wanted to be accomplished. I personally have asked 2 past Presidents this and they couldn't give me an answer, falling back on "2015 is a great initiative we all strive to see come to fruition." Literally, that's the answer I got, um, ok. How about spending less time promoting shoe gear types and nail care and more focus on what we do as a whole, read: state how we do surgery, what types of surgeries we do. Basically educate the lay person to what we do because we don't do that. I will say, they're doing a better job of trying to get into undergrad institutions, but I would say >90% of pre-med students have no idea that podiatry is an amazing career opportunity, what about sending out a brochure to the pre-med committees that are so popular now, so that they can get info out, or better yet, we spend so much time trying to sell the profession to students who are ALREADY enrolled in pod school, spend some of that time and energy on prospective students. I know you're not going to reach everyone, but come up with some standard. I feel energy is not directed where it needs to be. Perhaps my words earlier were not the best and were, in fact, vague and harsh, but I just get so fed up beaurocratic bs, which, unfortunately, the APMA is a VERY political organization (and I don't mean about lobbying on capital hill). Stone is the first female President, but it's a good ole' boys club in there.

As you've conceeded that the APMA is a political entity, you have to realize that in order to get the answers you want, you have to ask the right questions. Politics is a game. Learn to play the game and your frustration will mostly evaporate when looking for specific answers to specific questions.

The proper question to ask the President of the APMA is "Who can I ask about Vision 2015?". You have to remember that the term of the APMA President is short and each President is charged with a specific agenda. "Vision 2015" started years ago and has seen many transitions over its initial agenda. People involved have a hard time keeping up with the changes, let alone a new APMA President, with a host of new things to do.

Vision 2015 is this in a nutshell as I understand it. Please realize that I'm not on that committee and just read a lot about this, so the information is there for you as well. You just need to spend the time to find it. The goal is parity, but it will take years. The first real step has been accomplished and that was that each residency would offer three years of training. The next step is to make sure that every graduate earns that three years of training. The APMA, CPME and COTH are VERY hard at work in this initiative. Once this happens, it will be easier to then approach the state legislators to have national scope of practice guidelines. Once this occurs, then there will be less confusion concerning hopsital privileging. My personal hope is that this will lead to a unifying Board and unified College to represent us. This is the basic idea, but as in anything political it is MUCH more complicated than that. If you want to know HOW, you need to get invovled, as I don't have enough time to really educate anyone about this personally.

The APMA is concerned with ALL aspects of Podiatric Medicine and Surgery. Believe it or not, on the average day, surgical intervention is only about 25% of a busy surgeon's practice, if that. Also believe it or not, you make A LOT more money NOT doing surgery for the most part (which I can expand on in another thread if you like). Probably the single biggest money maker for time/profit ratio is DME dispensing of diabetic shoes. Patient wise, I would say conservative treatment over time of Plantar Fasciitis and doing Ingrown toenail removals makes the most (again profit/time ratio), so why would the APMA focus more on thrusting Surgery to the limelight? We are complete foot and ankle physicians. The APMAs goal is to make sure everyone knows that, and they are slowly succeeding in this endeavor.

There are strong intiatives to let pre-meds know about Podiatry. We need more people to help with this and spread the good word. Are you interested?

 

[podpal]

I'm confused. How does the current change in residencies affect an insurance companies decision as far as how to pay for debriding nails and trimming callus? Parity with which other medical professional that does this? Or are you saying that I get paid more for doing this because I did three years of residency, compared to someone else who only did one year? I just don't see that. Please expand on this.

Altohugh the rule makers don't govern the State Board per se, they do have an impact on what the State legislation does. The recent change in scope of practice in the State of New York is a perfect example of this.

I've been volunteering and working with the APMA for ten years now and am only now starting to have my voice heard on some of these issues and am hopeful that I will eventually be asked to participate in some of the decision making by serving on one of the various boards within the APMA. How involved have you been? I'm not being coy. I'm simply pointing out that you've mentioned formally complaining and writing a letter or two. I'm on the phone at least weekly discussing these issues and e-mailing constantly about these issues. Involvement takes years, not days or even months.

The residency changes are just ONE of the aspects of our profession. Are you saying that the APMA, as an organization, is not working in our best interest as a profession? I would very much disagree with this statement. The CPME has a difficult job. I'm not justifying what tehir decisions are, but I also realize that you can't make everyone happy. Also, what may be good for the profession today, may not be the case for tomorrow. ITs a difficult balance and you win some and lose some.

IMHO what is happening in my region is this. When I graduated many years ago residency was not a requirement to go into practice. Like many of my fellow colleagues in my area we went into practice either because we didn't get a residency or because there was a job opportunity available.

The states eventually changed to make residency training MANDATORY.

Over the past several years Insurance Companies have changed their requirements to include residency training as necessary to become a participating practitioner. Some practitioners have been Grandfathered into these insurance companies, however any nonresidency trained practitioner wishing to move to my region, or changing from clinic type work to private practice type work will be in the same boat that I'm in.

To make matters worse, Medicare pts are switching plans to, for ex., a Blue Cross plan that demands practitioners be board certified. Board Cert is impossible without residency training. This large group of previous Medicare only pts. will disallow any reimbursements to nonpar pods, even those pods who are on par with Medicare.

The push toward bigger better residency programs is leaving the older CC practitioners in the dust. Even those grandfathered without formal residency training who are on local insurance plans cannot move and become participating on insurances in a new location.

Yes, you and others with 3 years of residency training will have the chance to be participating and get PAID for the same exact nail debridement done by nonresidency trained pods.

When I mention parity, I'm refering to parity within our own field. Why should 1 practitioner with the same state license be eligible for insurance participation and reimbursement, and another practitioner recieves no money for the same exact procedure...nail debridement, ulcer care, etc.?

As we move the field toward a 3 year surgical residency requirement, eventually the states will change to mandate 3 years of residency training for state licensure; insurance companies will jump on the band wagon and have even more reason to prevent participation and reimbursements. Pods with less than 3 years of training will be stuck in 1 locality because they will not be able to afford to move because they cannot become participating with the local insurance companies and obtain reimbursements.

IMO a 2 year model with the bread and butter surgical training would be ideal IF available to everyone. If, after 2 years of residency, someone wants more specialized training there should be a way to apply for a 3rd year fellowship/residency.


How does one become more involved with the APMA? I can't afford to join their club, and realistically don't think I'll be able to afford to remain in podiatry without residency training. 😱

 

[347932]

IMHO what is happening in my region is this. When I graduated many years ago residency was not a requirement to go into practice. Like many of my fellow colleagues in my area we went into practice either because we didn't get a residency or because there was a job opportunity available.

The states eventually changed to make residency training MANDATORY.

Over the past several years Insurance Companies have changed their requirements to include residency training as necessary to become a participating practitioner. Some practitioners have been Grandfathered into these insurance companies, however any nonresidency trained practitioner wishing to move to my region, or changing from clinic type work to private practice type work will be in the same boat that I'm in.

To make matters worse, Medicare pts are switching plans to, for ex., a Blue Cross plan that demands practitioners be board certified. Board Cert is impossible without residency training. This large group of previous Medicare only pts. will disallow any reimbursements to nonpar pods, even those pods who are on par with Medicare.

The push toward bigger better residency programs is leaving the older CC practitioners in the dust. Even those grandfathered without formal residency training who are on local insurance plans cannot move and become participating on insurances in a new location.

Yes, you and others with 3 years of residency training will have the chance to be participating and get PAID for the same exact nail debridement done by nonresidency trained pods.

When I mention parity, I'm refering to parity within our own field. Why should 1 practitioner with the same state license be eligible for insurance participation and reimbursement, and another practitioner recieves no money for the same exact procedure...nail debridement, ulcer care, etc.?

As we move the field toward a 3 year surgical residency requirement, eventually the states will change to mandate 3 years of residency training for state licensure; insurance companies will jump on the band wagon and have even more reason to prevent participation and reimbursements. Pods with less than 3 years of training will be stuck in 1 locality because they will not be able to afford to move because they cannot become participating with the local insurance companies and obtain reimbursements.

IMO a 2 year model with the bread and butter surgical training would be ideal IF available to everyone. If, after 2 years of residency, someone wants more specialized training there should be a way to apply for a 3rd year fellowship/residency.


How does one become more involved with the APMA? I can't afford to join their club, and realistically don't think I'll be able to afford to remain in podiatry without residency training. 😱

I'm not sure I understand. Were you grandfathered to be able to practice in your state and to maintain your relationship with the insurance carriers or not?

One way some people in your situation are dealing with this issue is by hiring an associate to maintain a surgical volume within the practice. Split the patients fairly, but those that need surgery, hospitalization and such go to the associate who will gladly do this if treated fairly.

When you mean "join their club" what exactly does that mean? I didn't realize that by paying my dues, I'm joining some exclusive club.

If you feel that by returning and doing a surgical residency will enhance your practice, then do it. I know several who did just that and are glad they did.

 

[podpal]

I'm not sure I understand. Were you grandfathered to be able to practice in your state and to maintain your relationship with the insurance carriers or not?

One way some people in your situation are dealing with this issue is by hiring an associate to maintain a surgical volume within the practice. Split the patients fairly, but those that need surgery, hospitalization and such go to the associate who will gladly do this if treated fairly.

When you mean "join their club" what exactly does that mean? I didn't realize that by paying my dues, I'm joining some exclusive club.

If you feel that by returning and doing a surgical residency will enhance your practice, then do it. I know several who did just that and are glad they did.

Unfortunately, prior to this year I did clinic work and was NOT grandfathered into any insurance plans. I didn't have a relationship with ins companies.

APMA isn't free, it's a tremendous expense. I'd like to have the extra funds available for APMA dues but like many of my colleagues, it's financially out of reach.

This thread shouldn't be about me, but rather about the state of the profession. How can older pods move away from their locations and get onto local insurance plans in a different location with the new rules requiring residency training? How can any pod get onto any insurance plan with the current requirments imposed by insurance demanding residency training, board cert, and active surgical privilages? How is this movement toward more surgical training going to help the large quantity of people requiring home visits for conservative podiatric care? Have we, as a profession, lost sight of the people who require CC treatments? If the vast majority of practices are comprised of 75% + CC pts, why are we pushing so hard for surgical training?

The push toward surgical training is changing the mentality of individual states and insurance companies; effectively removing CC practitioners from the ability to practice.

The field needs to take a hard look at where it wants to be. Do we, as pods, still want to offer home visits? Treat nursing home pts? If so, we should make it easier for ALL pods to offer this service and demand that once a pod has state licensure the ins companies must allow the same reimbursement for all.

What do you think? Should APMA be working with Insurance Companies and the individual states to insure that ALL licensed pods obtain reimbursement for the same procedures, such as nail debridement? Is APMA doing anything to make sure that CC pods get onto local insurance plans as is consistent with the nonsurgical malpractice agreements we have?

Currently pods have the option to buy NON surgical malpractice insurance and our profession, individual states, and insurance companies should recognize this and eliminate barriers to CC practice. Someone, I think on these forums, actually said that he/she is working with insurance companies to make plan participation more difficult. Is this the right direction? Has the profession reached a point where it no longer values the CC practitioner?

 

[347932]

Unfortunately, prior to this year I did clinic work and was NOT grandfathered into any insurance plans. I didn't have a relationship with ins companies.

APMA isn't free, it's a tremendous expense. I'd like to have the extra funds available for APMA dues but like many of my colleagues, it's financially out of reach.

This thread shouldn't be about me, but rather about the state of the profession. How can older pods move away from their locations and get onto local insurance plans in a different location with the new rules requiring residency training? How can any pod get onto any insurance plan with the current requirments imposed by insurance demanding residency training, board cert, and active surgical privilages? How is this movement toward more surgical training going to help the large quantity of people requiring home visits for conservative podiatric care? Have we, as a profession, lost sight of the people who require CC treatments? If the vast majority of practices are comprised of 75% + CC pts, why are we pushing so hard for surgical training?

The push toward surgical training is changing the mentality of individual states and insurance companies; effectively removing CC practitioners from the ability to practice.

The field needs to take a hard look at where it wants to be. Do we, as pods, still want to offer home visits? Treat nursing home pts? If so, we should make it easier for ALL pods to offer this service and demand that once a pod has state licensure the ins companies must allow the same reimbursement for all.

What do you think? Should APMA be working with Insurance Companies and the individual states to insure that ALL licensed pods obtain reimbursement for the same procedures, such as nail debridement? Is APMA doing anything to make sure that CC pods get onto local insurance plans as is consistent with the nonsurgical malpractice agreements we have?

Currently pods have the option to buy NON surgical malpractice insurance and our profession, individual states, and insurance companies should recognize this and eliminate barriers to CC practice. Someone, I think on these forums, actually said that he/she is working with insurance companies to make plan participation more difficult. Is this the right direction? Has the profession reached a point where it no longer values the CC practitioner?

Firstly, if practices are doing 75% CC (Clip and Chip I assume), they are not surviving, whether they are surgeons or not.

Again, I get the same amount for "CC" as you do. If you want to argue about why you can't get on insurances and I can, that is an entirely different topic. You can still get onto medicare and medicaid I assume? The APMA can not deal with the private insurances as you expect them to because the private insurances can make up any rules they want. Believe it or not, sometimes someone with three years of training STILL has issues.

What concerns me somewhat it that it seems like you think that simply because we advance our profession, it will leave many out in the cold. I feel for your situation. I really do, but there are also many in your generation that don't seem to have an issue with this. Advancement is inevitable. No one here has anything but positive things to say about the roots of our profession and how important they are.

As I've mentioned to you, is it not worth looking into hiring an associate who can help in your practice to do these things?

 

[Podfather]

Unfortunately, prior to this year I did clinic work and was NOT grandfathered into any insurance plans. I didn't have a relationship with ins companies.

APMA isn't free, it's a tremendous expense. I'd like to have the extra funds available for APMA dues but like many of my colleagues, it's financially out of reach.

This thread shouldn't be about me, but rather about the state of the profession. How can older pods move away from their locations and get onto local insurance plans in a different location with the new rules requiring residency training? How can any pod get onto any insurance plan with the current requirments imposed by insurance demanding residency training, board cert, and active surgical privilages? How is this movement toward more surgical training going to help the large quantity of people requiring home visits for conservative podiatric care? Have we, as a profession, lost sight of the people who require CC treatments? If the vast majority of practices are comprised of 75% + CC pts, why are we pushing so hard for surgical training?

The push toward surgical training is changing the mentality of individual states and insurance companies; effectively removing CC practitioners from the ability to practice.

The field needs to take a hard look at where it wants to be. Do we, as pods, still want to offer home visits? Treat nursing home pts? If so, we should make it easier for ALL pods to offer this service and demand that once a pod has state licensure the ins companies must allow the same reimbursement for all.

What do you think? Should APMA be working with Insurance Companies and the individual states to insure that ALL licensed pods obtain reimbursement for the same procedures, such as nail debridement? Is APMA doing anything to make sure that CC pods get onto local insurance plans as is consistent with the nonsurgical malpractice agreements we have?

Currently pods have the option to buy NON surgical malpractice insurance and our profession, individual states, and insurance companies should recognize this and eliminate barriers to CC practice. Someone, I think on these forums, actually said that he/she is working with insurance companies to make plan participation more difficult. Is this the right direction? Has the profession reached a point where it no longer values the CC practitioner?

The majority of patients seeking routine care do not meet the criteria for coverage anyway. You should be charging those patients a cash fee. In our practice we see a handful of those patients and charge 50 dollars. People who bill insurance for these type of patients are the reason it's not covered. I do agree there is a problem for people who graduated 15-30 years ago when residencies were not available for everyone now needing a residency to get a license if they move. Say you have someone in your family in another state who needs care/help and you want to move back, practice, and help them. No residency no license. That should be addressed at the state level. As far as you bein treated unfairly I feel for you but I did a PSR-24, am board certified in Foot and Ankle ,have performed complex for almost 25 years and some of the newbies want to take my privileges away. I have been told I should give back (an insult if you knew how much time/money I have given to the profession)go back for another year and become RRA.

Yea right

 

[densmore22]

As you've conceeded that the APMA is a political entity, you have to realize that in order to get the answers you want, you have to ask the right questions. Politics is a game. Learn to play the game and your frustration will mostly evaporate when looking for specific answers to specific questions.

The proper question to ask the President of the APMA is "Who can I ask about Vision 2015?". You have to remember that the term of the APMA President is short and each President is charged with a specific agenda. "Vision 2015" started years ago and has seen many transitions over its initial agenda. People involved have a hard time keeping up with the changes, let alone a new APMA President, with a host of new things to do.

Vision 2015 is this in a nutshell as I understand it. Please realize that I'm not on that committee and just read a lot about this, so the information is there for you as well. You just need to spend the time to find it. The goal is parity, but it will take years. The first real step has been accomplished and that was that each residency would offer three years of training. The next step is to make sure that every graduate earns that three years of training. The APMA, CPME and COTH are VERY hard at work in this initiative. Once this happens, it will be easier to then approach the state legislators to have national scope of practice guidelines. Once this occurs, then there will be less confusion concerning hopsital privileging. My personal hope is that this will lead to a unifying Board and unified College to represent us. This is the basic idea, but as in anything political it is MUCH more complicated than that. If you want to know HOW, you need to get invovled, as I don't have enough time to really educate anyone about this personally.

The APMA is concerned with ALL aspects of Podiatric Medicine and Surgery. Believe it or not, on the average day, surgical intervention is only about 25% of a busy surgeon's practice, if that. Also believe it or not, you make A LOT more money NOT doing surgery for the most part (which I can expand on in another thread if you like). Probably the single biggest money maker for time/profit ratio is DME dispensing of diabetic shoes. Patient wise, I would say conservative treatment over time of Plantar Fasciitis and doing Ingrown toenail removals makes the most (again profit/time ratio), so why would the APMA focus more on thrusting Surgery to the limelight? We are complete foot and ankle physicians. The APMAs goal is to make sure everyone knows that, and they are slowly succeeding in this endeavor.

There are strong intiatives to let pre-meds know about Podiatry. We need more people to help with this and spread the good word. Are you interested?

Out of anybody on this great planet who should know about 2015 in and out is the past, current and elected president of the APMA. Especially if you are coming to an APMSA meeting to talk to student representatives about 2015. That's precisely my point. The hand isn't communicating with body (or however that saying goes).