Interesting information

[PADPM]

This was posted on PM News and I found it interesting.

OH Court Rules That Podiatrists Need ABPS Certification for Staff Privileges​

An Ohio appeals court has affirmed the decision of the trial court that a hospital can deny staff privileges to a podiatrist who is not board certified by the American Board of Podiatric Surgery (ABPS). On December 21, 2005, Grady Memorial Hospital granted Dr. James Blaine clinical privileges, which he exercised until June 30, 2007. The hospital's bylaws stipulate that each practitioner must achieve board certification by a "recognized certification board" within five years of residency completion. Dr. Blaine failed the written portion of the ABPS multiple times, but passed an alternative board exam not included in the list of "recognized boards."
Blaine sued the hospital stating that the bylaws did not require certification through ABPS, and that any such requirement would violate the hospital's non-discrimination policy. The appeals court upheld the lower court's decision that the hospital was within its rights to deny privileges to podiatrists who did not achieve ABPS certification within the prescribed period of time.
Source: James E. Blaine, D.P.M. v. OhioHealth Corporation, et al.

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[347932]

Very interesting indeed.

 

[NatCh]

I caught that news bit too. Doomsayers may see a slippery slope. If the ruling sets a precedence and other hospitals follow suit, then only those with ABPS Cert will get hospital privileges, and since only those with hospital privileges get on insurance panels, whoever doesn't have ABPS Cert may be out of a job.

Since the Cert. pass rate is around 75%, what becomes of those remaining folks who never pass? Will their career only last 5 years?

Since fewer than half of current practicing podiatrists (~7000) have ABPS Cert, what becomes of the rest if they lose hospital privileges? I don't like being full of gloom and doom, but worst case scenario this ruling could decimate the profession.

 

[347932]

I caught that news bit too. Doomsayers may see a slippery slope. If the ruling sets a precedence and other hospitals follow suit, then only those with ABPS Cert will get hospital privileges, and since only those with hospital privileges get on insurance panels, whoever doesn't have ABPS Cert may be out of a job.

Since the Cert. pass rate is around 75%, what becomes of those remaining folks who never pass? Will their career only last 5 years?

Since fewer than half of current practicing podiatrists (~7000) have ABPS Cert, what becomes of the rest if they lose hospital privileges? I don't like being full of gloom and doom, but worst case scenario this ruling could decimate the profession.

Actually, our profession is behind the eight ball with this. I've been on credential committees before, and if ANY doctor doesn't get certified in the predominant certifying body for their specialty in the hospitals they lose their status. Period.

There has to be a standard to go by. Don't forget that hospitals are private institutions and are allowed to make their bylaws however they chose (assuming it is not against any laws). If they want ABPS cert and MOST are ABPS and ALL can be ABPS, then what's the problem? If you fail the exam (multiple times) or are delinquent with your qualification/certification, I'm not exactly sure why a hospital would want you on staff. They have to protect themselves as well.

I can't agree with the whole "decimate the profession" comment. The older graduates may have issues, but there are always exceptions that can be made, and the new graduates should have no issues, assuming they can pass the test and get the cases to sit for the orals. If you they can't pass these examinations, well, that is a topic for a whole other thread.

 

[347932]

Not trying to side track this thread but why does the profession of podiatry have other board certs not through the ABPS? Why do hospitals agree to giving surgical privileges to pods who are not certified through the ABPS?

Just curious how this came about in the profession.

The first part of your question stemmed from the time when surgical residencies were not readily available. When only a quarter of the class got surgical residencies, it meant that 75% of the class would never qualify to sit for the ABPS Qualification exam. Many of these graduates would then either go into practice and work closely with a Podiatric Surgeon in their area as a mentor and to help them get the cases to be able to get on staff at the hospital, or they would do surgery on their own in their offices. Since technically they were not "Surgeons" by formal training in a residency (although some of our most gifted podiatric surgeons started this way and eventually changed the landscape of our profession), they still felt that they should have a type of Cert and these alternate boards were created and maintained over the years.

SOME of these boards, however, were created by those who just couldn't pass the ABPS exam, and needed to be certified to maintain their hospital privileges, so they helped make these boards up. THAT is why many hospitals now use the ABPS as their standard. It is the recognized certifying body by the APMA and the gold standard for Surgeons in our profession.

There are very few, if any, hospitals that accept these alternate boards for privileging mostly because of the stigma associated with them (i.e. these podiatrists couldn't pass the ABPS examination). Some free standing surgery centers have different professional requirements, but even they are turning over to ABPS for liability protection issues.

 

[PADPM]

I agree with Kidsfeet. Although our profession, particularly those not certified by the ABPS like to argue about the board certified status, this is NOT unique to podiatry.

Most hospitals do require all professions to obtain certification with X number of years. With MD's, the hospitals only accept boards that are approved by the American Board of Medical Specialties, with DO's, it's a similar situation.

With podiatrists seeking surgical privileges, the ABPS has been the board that has been the accepted board. It is the "oldest" board and the only surgical board recognized by the APMA.

I'm not going to spend my time debating about all the boards that have popped up SINCE the ABPS, but I will state that in MY opinion, the ABPS is still the "gold standard".

There are also "alternative" boards in other medical professions that hospitals do not recognize, but similar to these boards, most hospitals do not recognize any other surgical board other than the ABPS, though there are a few.

So this isn't about attemtping to isolate our own, etc. Hospitals have to have some standard for all professions, and the majority have chosen the ABPS.

There is no reason why a relatively new graduate who is well trained should not be able to pass the exam after "multiple tries"/several years.

I DO have a problem when podiatrists begin to fraction the department into foot, rearfoot/ankle certifications within a hospital. Privileges should coincide with experience, not only your certification. Unfortunately, the actual certification certificate is something hospitals are under pressure to require for perceived quality of care, though we all know certification does not guarantee increased quality.

 

[347932]

Since the Cert. pass rate is around 75%, what becomes of those remaining folks who never pass? Will their career only last 5 years?

I'm going to play devil's advocate here so don't yell at me. Practitioners can sit for the written exam twice to get their Qualification status. IF they fail twice, they then have to present to the ABPS board and ask for another chance. So they potentially have three shots to pass the written exam. Once they pass, they then have to get through the oral exam. If a practitioner can't amass 65 cases in 5 years and gets rejected for admission to the oral exam, that in and of itself is a huge problem. Assuming they do get the cases and are accepted to sit for the orals, hen if they can't pass the orals (which I think can also be taken twice and potentially a third time), what does that say?

Maybe nothing, but every profession has to have a standard.

Careers don't end because a practitioner can't do surgery in the hospital. If they are smart and know their limitations when they enter into practice, they can team up with someone who can take on their cases IF this is something they expect CAN happen to them.

The BIGGEST issue believe it or not is for those who are associates (employees) in a practice, as if they lose their Board status, in every contract I've ever seen, this could mean getting that dreaded Trump staple "You're fired". THIS has happened and is not pretty at all.

Food for thought folks.

 

[347932]

I DO have a problem when podiatrists begin to fraction the department into foot, rearfoot/ankle certifications within a hospital. Privileges should coincide with experience, not only your certification. Unfortunately, the actual certification certificate is something hospitals are under pressure to require for perceived quality of care, though we all know certification does not guarantee increased quality.

 

[NatCh]

The older graduates may have issues, but there are always exceptions that can be made, and the new graduates should have no issues, assuming they can pass the test and get the cases to sit for the orals.

If there are 7000 Certified out of 15000+ podiatrists, that means there are an awful lot of people who didn't get ABPS cert.

Careers don't end because a practitioner can't do surgery in the hospital. If they are smart and know their limitations when they enter into practice, they can team up with someone who can take on their cases IF this is something they expect CAN happen to them.

If they can't get hospital privileges then they can't be on insurance provider panels, which means it's all cash pay or Medicare/Medicaid patients though, right? That's a big limiting factor.

 

[NatCh]

I've always been curious if the oral exam is graded on a curve. Is the 75% pass rate a result of failing the 25% lowest scores? In the near future when all new graduates have 3+ years of training and have the most extensive training available, is there potential for a 100% pass rate or does ABPS keep it 75%/25% by design?

I'm glad I'm certified so I don't have to fret about any of this. I bet non-Cert. docs will be getting anxious.

 

[347932]

If there are 7000 Certified out of 15000+ podiatrists, that means there are an awful lot of people who didn't get ABPS cert.

Yes but out of those 15 000, how many actually COULD sit for the examination.

With the new crop of residency graduates this should be a non issues. As I stated, for some people of the previous generations, there are concessions being made. I helped initiate some of them in my last practice location.

 

[347932]

If they can't get hospital privileges then they can't be on insurance provider panels, which means it's all cash pay or Medicare/Medicaid patients though, right? That's a big limiting factor.

This is entirely our fault. Some less then inclusive colleagues of ours helped this along. We know this. How do we circumvent this at this point?

 

[347932]

I've always been curious if the oral exam is graded on a curve. Is the 75% pass rate a result of failing the 25% lowest scores? In the near future when all new graduates have 3+ years of training and have the most extensive training available, is there potential for a 100% pass rate or does ABPS keep it 75%/25% by design?

I'm glad I'm certified so I don't have to fret about any of this. I bet non-Cert. docs will be getting anxious.

How I've heard they do this is statistically check each question. They then estimate what the pass rate is on EACH question and then use validity scores to see if the question was "bad" (not many got it right), and use this method to ultimately determine how many gradeable questions there actually are on each examination.

I'm sure the ABPS would love a higher pass rate, but I don't think they design it for a specific pass/fail rate.

I would be very surprised to ever see a 100% pass rate. That would raise too many questions about the statistical validity of the examination process as a whole. I know that may seem harsh, but is the reality of how these tests are statistically measured.

I too am glad I am certified and through the process. It is a stressful process no doubt, but imo, is a necessary one.

 

[PADPM]

I don't think it is realistic or expected for any test to have a 100% pass rate. And I can tell you from experience, that during my approximately 10 years as an oral examiner for the ABPS exam, it was seriously scary to know that some of the candidates I interviewed were actually that clueless.

It was even more perplexing to think that these weren't students, but doctors who graduated, completed residencies AND accumulated enough cases to actually sit for the boards.

Yes, the majority of candidates were excellent, and there were many bright candidates who were simply over anxious, scared, etc. However, there are far too many who amazed me with their lack of knowledge.

Their lack of knowledge, lack of understanding and lack of basic fundamentals left me with the firm belief that these doctors should NEVER be "board certified", if certification was to continue to have any validity or credibility. It also confirmed the idea that a monkey can actually perform surgical procedures, but it takes a lot more to actually understand what you are doing. And these doctors clearly did not understand.

 

[NatCh]

Yes but out of those 15 000, how many actually COULD sit for the examination.

I'm not sure I understand what you mean. Are you referring to docs who never got ABPS Cert by choice but could do it now if they wanted to, or are you referring to docs who would not qualify to sit for the exam even if they wanted to?

It would be only a matter of semantics though, because whether or not a non-cert doc had what it takes to sit for the exam wouldn't matter, if they lost privileges anyway. If 8000+ podiatrists lost hospital privileges then it would have pretty big ramifications. Even if half of those 8000+ docs could apply now and sit for the exam, that's a pretty big flood of applicants who would need to take the test.

BTW Ankle Breaker, hospital privileges means more than just surgical privileges in the O.R. Even inpatients consults to clip nails requires you to have hospital privileges. On all privilege applications I've filled out there was a category of "core podiatry privileges" that included nail debridement, callus trimming, ingrown nail treatment, wart treatment, giving injections, prescribing meds, etc. After core privileges they start categorizing surgical procedures.

Even a doctor who has a largely hospital-based wound center type practice who refers out his surgical cases still needs hospital privileges to see patients. That doctor might not qualify to sit for ABPS but if he lost his hospital privileges then there goes his work.

 

[NatCh]

This is entirely our fault. Some less then inclusive colleagues of ours helped this along. We know this. How do we circumvent this at this point?

Good ol' podiatry...

 

[347932]

I'm not sure I understand what you mean. Are you referring to docs who never got ABPS Cert by choice but could do it now if they wanted to, or are you referring to docs who would not qualify to sit for the exam even if they wanted to?

What I meant was those few that never had a surgical residency, therefore yes, they don't qualify to sit for the exam. Even as recently as 10 years there were a handful of graduates every year that never were able to score a surgical residency. I guess I should have been more clear about that.

I don't imagine anyone would not get ABPS cert by choice.

 

[347932]

Even a doctor who has a largely hospital-based wound center type practice who refers out his surgical cases still needs hospital privileges to see patients.

Wound debridement is considered "surgery" by many malpractice carriers as is partial nail avulsions under local anesthesia. I believe malpractice carriers also ask about board status, so this may jeopardize attaining a surgical malpractice policy as well. I may be wrong in that instance. Not 100% sure. Can anyone confirm or refute this?

 

[NatCh]

Wound debridement is considered "surgery" by many malpractice carriers as is partial nail avulsions under local anesthesia. I believe malpractice carriers also ask about board status, so this may jeopardize attaining a surgical malpractice policy as well. I may be wrong in that instance. Not 100% sure. Can anyone confirm or refute this?

My malpractice carrier requires "board certification within five years of eligibility" but they don't specify which board.

 

[NatCh]

I don't think it is realistic or expected for any test to have a 100% pass rate.

I understand your point, but I meant is the scoring of the test such that hypothetically it would be possible for everyone to pass had they scores above a certain threshold, or does the test by design cull out the lowest scoring ~25% regardless of raw score?

 

[347932]

I understand your point, but I meant is the scoring of the test such that hypothetically it would be possible for everyone to pass had they scores above a certain threshold, or does the test by design cull out the lowest scoring ~25% regardless of raw score?

100% is a statistical anomaly.

As I mentioned in a previous pots, each question is statistically rated on it's "passability". If someone consistently gets questions wrong that most get right (again, statistically speaking), and it's statistically significant that this person doesn't get the right answer, he or she fail the question and then fails the examination.

There generally are a bank of "test" questions, but the same statistical analysis holds true even with those.

The way I understand it, the examination is not constructed to make sure there is any strict percentage of failures, but is mathematically analyzed after the fact. It would be nice to have a 100% pass rate, but that's not statistically valid in most cases. As PADPM also mentioned, that would raise a lot of questions about the validity of the process as well. Not everyone passes. Not everyone will.

 

[Podfather]

I understand your point, but I meant is the scoring of the test such that hypothetically it would be possible for everyone to pass had they scores above a certain threshold
Yes
, or does the test by design cull out the lowest scoring ~25% regardless of raw score?

No

 

[NatCh]

No

Thank you.

 

[Feli]

I think this will become the standard at more and more places. Our boards are becoming more well understood by the medical community, and there's really no reason it shouldn't be that way. It's a good thing IMO. The first thing I do when looking for a doc for myself or friends/fam is check on board cert, reputation, and education. We need to get ABPS included in the ABMS.

This is entirely our fault. Some less then inclusive colleagues of ours helped this along. We know this. How do we circumvent this at this point?

Why are we trying to "circumvent" anything? It's up to the payers who they want to reimburse for services, and as was mentioned, hospitals can choose who they give admit/surg/staff/etc opportunities to.

 

[347932]

Why are we trying to "circumvent" anything? It's up to the payers who they want to reimburse for services, and as was mentioned, hospitals can choose who they give admit/surg/staff/etc opportunities to.

There has to be a standard across the board ,though. They can't just chose who they want to reimburse and who they don't as far as insurances company go. it can't be arbitrary, much the same way the hospital has to have a reason for not giving privileges.

I just ran into this situation. The head honcho of the department at one of the hospitals was a new doc's Dad, and put up roadblocks for one of my apps apparently. There was no basis for my app not to go through and even though this guy raised bloody murder about it, he couldn't stop the process and the hospital had to put my app through. There has to be a reason across the board. They can't just decide they won't give privileges to ugly docs. If that were the case, I'd never get on anywhere...

 

[NatCh]

Have you guys been following the thread on the Podiatry Management News? There has been quite a bit of anxiety showing through in people's posts. One of the posters from today's newsletter made an interesting point about podiatrists being more than just surgeons.

Those who have mostly nonsurgical practices still need hospital privileges in order to maintain malpractice insurance and insurance panel participation. By requiring ABPS certification, which is obviously our surgical board, hospitals are pigeonholing podiatrists as surgical specialists.

Internists and other nonsurgical specialties are also required to have board certification in order to have hospital privileges, but they do not need operating room privileges. Those podiatrists who have mostly nonsurgical practices and are therefore unable to apply for ABPS certification may be left out in the cold even though they don't need operating room privileges.

 

[347932]

Have you guys been following the thread on the Podiatry Management News? There has been quite a bit of anxiety showing through in people's posts. One of the posters from today's newsletter made an interesting point about podiatrists being more than just surgeons.

Those who have mostly nonsurgical practices still need hospital privileges in order to maintain malpractice insurance and insurance panel participation. By requiring ABPS certification, which is obviously our surgical board, hospitals are pigeonholing podiatrists as surgical specialists.

Internists and other nonsurgical specialties are also required to have board certification in order to have hospital privileges, but they do not need operating room privileges. Those podiatrists who have mostly nonsurgical practices and are therefore unable to apply for ABPS certification may be left out in the cold even though they don't need operating room privileges.

I have been following that PM News line and am shocked, frankly. All some of our colleagues ever do is complain about is how we don't have parity, but guess what? Now that we DO have parity in this regard, everyone is screaming bloody murder. You can't have it both ways folks. ALL hospital medical staff have to comply with some form of Board Certification route. If they don't get it, they get booted. Simple as that.

I agree that not all podiatrists had surgical training, but guess who initiated this whole ABPS compliance thing in the first place? Those colleagues of ours who wanted to make sure some couldn't compete. The hospitals aren't pigeon holing us. Sorry to say, but we did that to ourselves. Now it is a standard for better or worse. The hospital suits didn't make that decision alone. They made that decision with our help.

Pretty soon the field will be leveled. All graduates will have three years of training. If you think that that won't segregate, us you're wrong. It's already happening. I did three years of training, but didn't pass the RRA Boards. In some places that means I can't get certain privileges. Why? Because one of my colleagues with RRA Cert figured that I'm not capable. Is that the truth. Maybe, maybe not. BUT it was initiated by US.

We need to manage ourselves for the greater good.

Also, as I pointed out in the past, it's not just a hospital thing. It's a malpractice issue as well. Hospitals want to protect themselves from liability. What podiatrist only goes to hospitals to cut toenails? I would say that's rare. Many go to hospitals to take care of wounds. Debriding a wound IS surgical. Our malpractice carriers have known this for a very long time. A partial nail avulsion is considered a surgical procedure. Does debriding an ulcer make you a surgeon?

Sorry for the rant folks. I think we need to transcend these issues and figure out a way to make us stronger. One for all and all for one no? We are here in our profession's history mostly because of the very hard work of some of our predecessors. Unfortunately, some of us are rather shortsighted and don't look at the big picture or the long term effect of the decisions that are made. The bottom line is we must progress. We are progressing and some fear this change because they fear they can't keep up. Many of those that fear the most are actually the most protected due to history. Those that feel that they can't compete any longer have to look for their colleagues to help them. There are those that will help. They are out there.

 

[NatCh]

ALL hospital medical staff have to comply with some form of Board Certification route.

True, and agreed, but it seems that the main issue doesn't lie in requiring podiatric board certification in and of itself, but in requiring podiatric board certification only from a surgical board and none other.

In comparison, non-surgical MDs/DOs don't need surgical privileges. A non-surgical MD/DO still has a non-surgical certification board. If a hospital required all MDs/DOs to be boarded by the American Board of Surgery (ABS) then all FPs, Internists, Dermatologists, Neurologists, Pediatricians, etc. would be unable to have privileges.

For example, a Family Practitioner must have hospital privileges in order to care for an inpatient. If the patient needs surgery then the FP consults a surgeon to take a patient to the O.R. An FP can be certified by the American Board of Family Practice (ABFP), obviously non-surgical.

A non-surgical DPM also needs hospital privileges in order to care for an inpatient. If the patient needs surgery then he can consult a surgical colleague to take a patient to the O.R.

However, when a hospital specifies only ABPS certification then a DPM must be a surgeon by default. What of the case of a non-surgical DPM who never wanted to do surgery and is certified by the ABPOPPM? They are akin to any other non-surgical MD/DO in that their training and practice emphasizes medicine/podo-orthopedics rather than surgery, and they do have board certification (just not with the ABPS).

Nowadays DPMs all want to be surgeons but 10-20 years ago that desire wasn't universal. It's those non-ABPS docs who would have another 10-20 years of career left who may be hurt the worst.

How about requiring ABPS certification for all DPMs who want O.R. privileges, and ABPOPPM certification for all of those who don't need O.R. privileges? Those who are non-surgical could then at least maintain hospital core privileges (just not O.R. privileges) and therefore maintain malpractice coverage and insurance participation. Wouldn't that be a workable compromise?

 

[hematosis]

All some of our colleagues ever do is complain about is how we don't have parity, but guess what? Now that we DO have parity in this regard, everyone is screaming bloody murder.

 

[NatCh]

...........

 

[NatCh]

I don't imagine anyone would not get ABPS cert by choice.

I can think of only one person. He no longer posts here. Maybe he's too busy directing an amputation prevention center and running for congress?

 

[Podfather]

I can think of only one person. He no longer posts here. Maybe he's too busy directing an amputation prevention center and running for congress?

Many times (and not specifically refering to the individual you are) people "choose" not to sit for the exam because they do not have the volume, diversity of cases or have difficulty with exams. I knew of one person who suffered from test anxiety and would become ill right before the exam. Eventually they took it and eventually passed.

First of all the ABPS has nothing to do with state laws or local hospital bylaws. They create exams for certification in podiatric surgery. As mentioned above it's DPMs who either for self serving or political reasons put these criteria in place. The young are now eating the old in many locations and playing into orthopedics hands by excluding by years of residency training and/or RRA. Many of the names in the profession who trained when residencies were 1 or 2 years in length and are Foot and Ankle certified could not practice full scope in some states and hospitals. Once we are all divided then these RRA superstars will be nickel and dimed like we were coming up. "OK yes you have RRA but now I need to see 100 Op reports for every procedure you are requesting" Then these same people who have excluded their own will run back to ask for our help.

In my hospital any DPM can have admitting and consultation privileges. For surgery we do have residency and ABPS requirements but if you do not meet the residency requirements then all you have to do is show 30 op reports for the categories you are applying for. Per ABPS guidelines, Foot and Ankle is considered the same as Foot and RRA. If Foot only and RRA qualified you may apply for ankle privileges but must be certified within 5 years in RRA. If Foot only without RRA you may apply for all foot procedures not just forefoot. Many of our own are telling people Foot is LisFranc's distal and that is simply not true.

Placing training and/or certification or excluding certain procedures into state law is a slippery slope and IMO will come back to bite everyone. Why don't the MDs have training/certification written into their state laws for certain procedures? For example who can do cosmetic surgery/treatments?

 

[NatCh]

In my hospital any DPM can have admitting and consultation privileges. For surgery we do have residency and ABPS requirements but if you do not meet the residency requirements then all you have to do is show 30 op reports for the categories you are applying for. Per ABPS guidelines, Foot and Ankle is considered the same as Foot and RRA. If Foot only and RRA qualified you may apply for ankle privileges but must be certifed within 5 years in RRA. If Foot only without RRA you may apply for all foot procedures not just forefoot. Many of our own are telling people Foot is LisFranc's distal and that is simply not true.

My hospital about half a decade ago changed to accept only ABPS certification, even for admitting and consultations. They also defined "foot" as LisFranc's distal, so I suppose even an exostostectomy from the medial cuneiform side of the 1st TMTJ would be defined as "rearfoot/reconstructive." I still can't figure out though how the bylaws committee decided upon the delineations because we didn't have any RRA certified docs back then. I'm guessing they called someone outside of our community to ask.

 

[Podfather]

My hospital about half a decade ago changed to accept only ABPS certification, even for admitting and consultations. They also defined "foot" as LisFranc's distal, so I suppose even an exostostectomy from the medial cuneiform side of the 1st TMTJ would be defined as "rearfoot/reconstructive." I still can't figure out though how the bylaws committee decided upon the delineations because we didn't have any RRA certified docs back then. I'm guessing they called someone outside of our community to ask.

Yes they obviously talked to an RRA certified doc or an orthopod who knew this would limit Podiatry locally. The ABPS does not make such recommendations. Someone could question this if they wanted to. At the very least one could argue for non reconstructive rearfoot and gastrocs/TALs since they are used to treat forefoot and foot ulcers. Not having those privileges affects your ability to treat diabetic problems to their fullest. Wound care and nail consults should be excluded. Next it will be CWS to be able to treat wounds. Guess who will push that? Yes a DPM who is a CWS.

A current trend in some hospitals is that the MDs have to be boarded within 5 years but there is no requirement to maintain it.

 

[NatCh]

Yes they obviously talked to an RRA certified doc or an orthopod who knew this would limit Podiatry locally. The ABPS does not make such recommendations. Someone could question this if they wanted to. At the very least one could argue for non reconstructive rearfoot and gastrocs/TALs since they are used to treat forefoot and foot ulcers. Not having those privileges affects your ability to treat diabetic problems to their fullest. Wound care and nail consults should be excluded. Next it will be CWS to be able to treat wounds. Guess who will push that? Yes a DPM who is a CWS.

A current trend in some hospitals is that the MDs have to be boarded within 5 years but there is no requirement to maintain it.

Our hospital is "in bed" with the largest local ortho group, and that ortho group has a few very openly anti-DPM F&A orthopods, so the community DPM response has been to take our cases to the private surgery centers instead. It's been "the path of least resistance," I suppose. The surgery centers are very DPM-friendly and court our business, while the hospital has become a hostile environment. I haven't taken a case to the hospital since 2005.

 

[NatCh]

Come to think of it I do know a few friends/colleagues who graduated school in the late 1990's and never went through the process to get board certified. Their hospital didn't require it so they didn't bother. I suppose they were "too busy" with other things such as building their practice and raising children and all of that. They were very bright and now have successful practices but I guess they didn't feel any pressure to go through the certification process. Knowing these friends, I'm sure they have what it takes to pass the foot exam if they needed to.

I wonder if their hospital were to suddenly stipulate that one need be ABPS certified within five years of eligibility, would these docs be allowed time to become board qualified, collect the cases, then sit for the part II oral exam, or would their hospital simply tell them it's too late; you're out of here? I'm sure it would all vary on a hospital-to-hospital basis.

That's where my concern is. Not so much for me since I'm board certified already, but for my friends/colleagues who have established practices with family depending on them to work.

 

[Podfather]

Come to think of it I do know a few friends/colleagues who graduated school in the late 1990's and never went through the process to get board certified. Their hospital didn't require it so they didn't bother. I suppose they were "too busy" with other things such as building their practice and raising children and all of that. They were very bright and now have successful practices but I guess they didn't feel any pressure to go through the certification process. Knowing these friends, I'm sure they have what it takes to pass the foot exam if they needed to.

I wonder if their hospital were to suddenly stipulate that one need be ABPS certified within five years of eligibility, would these docs be allowed time to become board qualified, collect the cases, then sit for the part II oral exam, or would their hospital simply tell them it's too late; you're out of here? I'm sure it would all vary on a hospital-to-hospital basis.

That's where my concern is. Not so much for me since I'm board certified already, but for my friends/colleagues who have established practices with family depending on them to work.

One could argue for grandfathering if they have been on staff but that's a coin flip. Whether they could sit now is dependent on many issues. I feel for some of these people but I also think that one has to make an effort to help themselves. If they met the criteria and chose not to sit or watched as a window to sit closed they have some responsibility for the situation they may be in. I mean did I want to do the work, take review courses, study, pay the fee, and then have the stress of the exam process? Of course not but I realized this was an important part to practice and did what it took. Most have practices, family, and other responsibilities so that is a poor excuse.

 

[NatCh]

One could argue for grandfathering if they have been on staff but that's a coin flip. Whether they could sit now is dependent on many issues. I feel for some of these people but I also think that one has to make an effort to help themselves. If they met the criteria and chose not to sit or watched as a window to sit closed they have some responsibility for the situation they may be in. I mean did I want to do the work, take review courses, study, pay the fee, and then have the stress of the exam process? Of course not but I realized this was an important part to practice and did what it took. Most have practices, family, and other responsibilities so that is a poor excuse.

I'm guessing those affected folks feel the same way now and wish they'd just gone through the process. The lack of ABPS cert was not a hindrance to them back then but it could potentially become one. I also think they should have just done the work, but times change and hindsight is always 20/20.

For example, ABPS Foot and Ankle certified docs have the option of relinquishing their F&A certification and sitting for the RRA exam, correct? What if in a two years hospitals allowed only RRA docs to have privileges, F&A cert is no longer accepted, and your staff membership is terminated effective immediately? At that point I bet a lot of F&A docs would be thinking they should have just put in the time to sit for the RRA exam.

Even today's graduates who get RRA cert could someday be saying they wish they'd just put in a few extra years to become a F&A orthopod instead. Right now being a DPM is not a major hindrance but someday it potentially could be. Hopefully not.

Sometimes people need external pressure before they make a change. Sometimes people are unable to avoid a disaster even when they see it unfolding slowly in front of them

 

[347932]

In comparison, non-surgical MDs/DOs don't need surgical privileges. A non-surgical MD/DO still has a non-surgical certification board. If a hospital required all MDs/DOs to be boarded by the American Board of Surgery (ABS) then all FPs, Internists, Dermatologists, Neurologists, Pediatricians, etc. would be unable to have privileges.

For example, a Family Practitioner must have hospital privileges in order to care for an inpatient. If the patient needs surgery then the FP consults a surgeon to take a patient to the O.R. An FP can be certified by the American Board of Family Practice (ABFP), obviously non-surgical.

A non-surgical DPM also needs hospital privileges in order to care for an inpatient. If the patient needs surgery then he can consult a surgical colleague to take a patient to the O.R.

However, when a hospital specifies only ABPS certification then a DPM must be a surgeon by default. What of the case of a non-surgical DPM who never wanted to do surgery and is certified by the ABPOPPM? They are akin to any other non-surgical MD/DO in that their training and practice emphasizes medicine/podo-orthopedics rather than surgery, and they do have board certification (just not with the ABPS).

Nowadays DPMs all want to be surgeons but 10-20 years ago that desire wasn't universal. It's those non-ABPS docs who would have another 10-20 years of career left who may be hurt the worst.

How about requiring ABPS certification for all DPMs who want O.R. privileges, and ABPOPPM certification for all of those who don't need O.R. privileges? Those who are non-surgical could then at least maintain hospital core privileges (just not O.R. privileges) and therefore maintain malpractice coverage and insurance participation. Wouldn't that be a workable compromise?

I really don't like this analogy and here's why. To treat pneumonia in house on a patient who has many medical issues, there is no need for surgical intervention by an FP or PCP or hospitalist. When the patient needs a chest tube, they call surgery or an interventionalist.

Why does a podiatrist see patients inhouse generally? For wounds. This requires surgical expertise and knowledge based on our malpractice insurer. How many podiatrists who are on in hospitals ONLY see nail care? Probably a VERY small percentage.

Sorry, but we are a surgical specialty. My take on it is if you can't treat a patient from the most conservative all the way to the most complex surgical intervention, you should have someone in your office who can at this point in our history.

It is what it is. For better or worse we are pushing forward and if you can't comply you will have problems. That's what we are dealing with. We know we are not going to go backwards for a select few.

The other thing is what about those that just let things slide. There are colleagues of ours that don't pay attention to what's going on and let their Board status expire. They lose their board status due to their, ummmm, well, you know. Then they scream and yell about how unfair things are and blah, blah, blah. Do you want these people who can't even manage their careers to just slide? It happens. Not a lot, but it does. How do you separate those from the ones being left out for a whole host of other reasons? There HAS to be a standard. Believe it or not, the whole ABPS is very inclusive and will only become more inclusive with time. MOST of what a podiatrist does in the hospital is in fact surgical, isn't it?

 

[Podfather]

I'm guessing those affected folks feel the same way now and wish they'd just gone through the process. The lack of ABPS cert was not a hindrance to them back then but it could potentially become one. I also think they should have just done the work, but times change and hindsight is always 20/20.

For example, ABPS Foot and Ankle certified docs have the option of relinquishing their F&A certification and sitting for the RRA exam, correct? What if in a two years hospitals allowed only RRA docs to have privileges, F&A cert is no longer accepted, and your staff membership is terminated effective immediately? At that point I bet a lot of F&A docs would be thinking they should have just put in the time to sit for the RRA exam.

Even today's graduates who get RRA cert could someday be saying they wish they'd just put in a few extra years to become a F&A orthopod instead. Right now being a DPM is not a major hindrance but someday it potentially could be. Hopefully not.

Sometimes people need external pressure before they make a change. Sometimes people are unable to avoid a disaster even when they see it unfolding slowly in front of them

Well what you describe is happening now. I have been teaching and lecturing on complex surgeries for over 2 decades. I opened many hospitals and worked to get more DPMs (often I was the first to get RRA privileges) ankle privileges. Although some of the younger DPMs say F&A docs were grandfathered that is not true. We submitted the cases, took the written and oral and passed. Now I may have to go back and take the RRA and Foot re-cert since that may become our state law and in fact is in place at many hospitals. So be it. I have always taken one for the team and if necessary will do it again.

Here's the rub. Many of the RRAs that are quick to sign me and others away wouldn't be trained or in their hospitals without people of my generation. I made 30+trips last year for free to work on many parts of the profession with a loss of income and time away from family and friends. Recently I had a RRA person say that once in a while people have to give back to the profession. He then told me I should go back and do a third year somewhere and convert to RRA. Meanwhile he makes money and let's me and others carry his torch. I wonder what happens if in 20 years all DPMs graduating also get an MD degree. Will this young fellow who will be my age give back to the profession by going to medical school to get his MD or give up his privileges. Doubt it.

 

[347932]

Here's the rub. Many of the RRAs that are quick to sign me and others away wouldn't be trained or in their hospitals without people of my generation. I made 30+trips last year for free to work on many parts of the profession with a loss of income and time away from family and friends. Recently I had a RRA person say that once in a while people have to give back to the profession. He then told me I should go back and do a third year somewhere and convert to RRA. Meanwhile he makes money and let's me and others carry his torch. I wonder what happens if in 20 years all DPMs graduating also get an MD degree. Will this young fellow who will be my age give back to the profession by going to medical school to get his MD or give up his privileges. Doubt it.

Agreed.

 

[NatCh]

It is what it is. For better or worse we are pushing forward and if you can't comply you will have problems. That's what we are dealing with. We know we are not going to go backwards for a select few.

You realize that "select few" is 8000+ podiatrists, or over half of our profession, right?

I'm not sure that "deal with it" qualifies as "all for one and one for all."

If hospitals require RRA certification then we're down to fewer than 800 podiatrists in the USA. Think about those numbers. 15000+ down to 800.

Would you have those docs go back for more residency to get RRA? Imagine 6000 docs suddenly needing additional residency positions.

 

[347932]

You realize that "select few" is 8000+ podiatrists, or over half of our profession, right?

I'm not sure that "deal with it" qualifies as "all for one and one for all."

If hospitals require RRA certification then we're down to fewer than 800 podiatrists in the USA. Think about those numbers. 15000+ down to 800.

Would you have those docs go back for more residency to get RRA? Imagine 6000 docs suddenly needing additional residency positions.

Are there really 8000 Podiatrists in this country without surgical training? Where did you get this number? Are all 8000 looking for hospital privileges? How many of those aren't doing surgery anymore for a variety of reasons?

There are only 900 members of the ACFAOM. There are close to 8000 members of the ACFAS. There are just over 12000 members of the APMA.

I would have a really hard time believing that 8000 Podiatrists will be left out here.

If hospitals started requiring RRA they would see a HUGE decline in their earnings from podiatry cases which the suits wouldn't like at all. Podiatry cases are one of the top earners based on equipment and time spent in the OR for facilities. As soon as the suits realize that these big cases don't pay as much and then realize it's not good business to have so few on staff, things would change. I'm also dealing with what is currently the norm here. I'm in my late 30s and don't think that the hospitals I'm currently on staff at will try to switch over to the RRA thing. How do I know this? I don't. Does it worry me? Not so much. Why? Because I know that I'm already Board Certified and that the majority of what makes me money ISN'T surgery OR hospital consults. With the training I have I'll always have somewhere I can do my cases that will accept my training and will "let" me do cases in that facility.

Where are all these podiatrists who are left out?

 

[347932]

I'm not sure that "deal with it" qualifies as "all for one and one for all."

I think you misread my statement. I said that "that is what we are dealing with". Not "deal with it".

 

[NatCh]

Are there really 8000 Podiatrists in this country without surgical training? Where did you get this number? Are all 8000 looking for hospital privileges? How many of those aren't doing surgery anymore for a variety of reasons?

There are only 900 members of the ACFAOM. There are close to 8000 members of the ACFAS. There are just over 12000 members of the APMA.

I would have a really hard time believing that 8000 Podiatrists will be left out here.

If hospitals started requiring RRA they would see a HUGE decline in their earnings from podiatry cases which the suits wouldn't like at all. Podiatry cases are one of the top earners based on equipment and time spent in the OR for facilities. As soon as the suits realize that these big cases don't pay as much and then realize it's not good business to have so few on staff, things would change. I'm also dealing with what is currently the norm here. I'm in my late 30s and don't think that the hospitals I'm currently on staff at will try to switch over to the RRA thing. How do I know this? I don't. Does it worry me? Not so much. Why? Because I know that I'm already Board Certified and that the majority of what makes me money ISN'T surgery OR hospital consults. With the training I have I'll always have somewhere I can do my cases that will accept my training and will "let" me do cases in that facility.

Where are all these podiatrists who are left out?

The issue is not the number of docs with surgical training. It's the number of docs without ABPS certification (back to the lawsuit in the OP) whose privileges could be in jeopardy with the legal precedence set in this recent court case.

There are approximately 15000 practicing docs in the US:
http://www.apma.org/MainMenu/Career...PodiatricMedicinetoSurgeOverNextSixYears.aspx

There are 6949 docs with ABPS certification:
http://www.abps.org/content/news/stats/stats.aspx

15000-6949 = ~8000 docs who don't have ABPS certification, and therefore could lose hospital privileges if the precedence of requiring ABPS cert continues (again, back to the lawsuit in the OP).
.
.
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[NatCh]

I think you misread my statement. I said that "that is what we are dealing with". Not "deal with it".

"Deal with it" were my words. It's my interpretation of the solutions I've read in this thread so far. You mentioned "team up with someone who can take the cases" but if a doc loses his hospital privileges, malpractice, and insurance panel participation then he won't be seeing many patients at all, so teaming up is not really a problem.

Would you have a specific, real solution for a colleague who lost his privileges, malpractice coverage, insurance panel membership, and then had his practice in jeopardy? Pretend Dr. Blaine, the subject of the lawsuit, was a friend and asked YOU for help. What would you tell him to do?

Would you hire him? If you did, you can't bill insurance for his work if his name isn't on the insurance list.

Would you cover his malpractice? Med-mal insurers won't.

Would you tell him to go do more Residency? There's already a shortage.

Work for the VA maybe? How many available VA jobs are there?

 

[347932]

The issue is not the number of docs with surgical training. It's the number of docs without ABPS certification (back to the lawsuit in the OP) whose privileges could be in jeopardy with the legal precedence set in this recent court case.

I guess the next question is how many Podiatrists are eligible to sit for the Board Qualification exam? How many Board Qualified don't become Board Certified. Why not?

Are they not passing the test? Why not?

Are they not getting the cases for submission? Why not?

Are they being lazy and not paying attention to their status? Why?

Let me put it another way. If you don't pass your Boards for ANY other medical specialty you're SOL. Not Boarded in Anesthesia? Try finding a job as an anesthesiologist. Not Boarded in General Surgery? Try getting on staff at a hospital or getting a job in a group. SOL again.That is a fact.

The RRA vs. Not I can understand, but if you had a surgical residency (which at this point in time is moot) you SHOULD be board certified by the ABPS. What's the argument against?

You get a five year pass from the day you finish your residency to become certified in most communities. You have two chances (or three) to pass the written boards and then two chances (or three) to pass the oral boards. MOST hospitals will prolong your status with them if you show that you are in the process of (I've seen this happen all over). How can anyone possibly complain that the system is against them with this process at this point?

I know of someone who flubbed his written boards a couple of times and then was negligent with his timing and let his Qualification status expire, and then screamed about how unfairly he was being treated in the community he practiced in. He was thrown off all the local hospitals and off of several insurance plans, because of his lack of board status, which for all intents and purposes was 100% his fault and could have been avoided BY HIM. Now he is in major trouble in his practice. Do you want this person cutting on your Mom, or representing you at hospital meetings? No, he had never been sued, but seriously???

I'm not trying to be elitist here. I know plenty of people in our profession who have made this work for them and even though they may not have had the status, are all for ABPS requirements in the hospitals. The ones that are vehemently against this make me wonder.

For the future generation here...get a residency, pass the boards and you have absolutely nothing to worry about. If you are among those that have the privilege of being RRA cert, congrats, but please be careful what you do and whose ear you tug on. You never know what the next generation will have waiting for you.

 

[347932]

Would you have a specific, real solution for a colleague who lost his privileges, malpractice coverage, insurance panel membership, and then had his practice in jeopardy? Pretend Dr. Blaine, the subject of the lawsuit, was a friend and asked YOU for help. What would you tell him to do?

Find a practice looking for a non surgical associate. They are out there.

Would you hire him? If you did, you can't bill insurance for his work if his name isn't on the insurance list.

Yes, I would. Everyone can get on Medicare/Medicaid.

Would you cover his malpractice? Med-mal insurers won't.

He doesn't need surgical malpractice.

Would you tell him to go do more Residency? There's already a shortage.

Nope. I would help him to work with what he has and the situation he is in.

Work for the VA maybe? How many available VA jobs are there?

None

Let's turn this around a bit.

Would HE be willing to become an employee and never cut on another patient ever again??

Will HE be willing to give up being an owner and become a worker again?

Would HE be satisfied making a living by doing nursing homes and being a palliative care podiatrist?

Would HE be willing to take a pay cut?

What did HE do or not do to get into this situation?

My biggest thing is that the people that get into this mess know what they are getting themselves into. They KNOW beforehand what is required of them and for some reason can't keep up. Plain and simple.

WHY are these people not becoming certified when clearly they can become?

The other issue is, and I'm just being cynical here so don't get all over me about it, why should we care? There are some out there who screw up big time and then whine about getting screwed by the system. I have no sympathy for that, and I've seen it happen plenty.

I'm somewhat of a case in point. I did three years but am not RRA cert because I couldn't pass the test and don't want to spend the money to take it again. Can that bite me in the butt someday? Well it kind of already has because no company will train me (yet) to do the TAR procedure. Does it bother me? Yep. Do I whine about it incessantly. Nope. I think it's silly because I could probably help people and make these companies some money, but it is what it is and that's it. No, it's not a career making or breaking situation, but hey, again, it is what it is.

 

[NatCh]

Kidsfeet, I think you and I have gone in a full circle at this point, LOL!

Have a nice weekend.

 

[PADPM]

Let's turn this around a bit.

Would HE be willing to become an employee and never cut on another patient ever again??

Will HE be willing to give up being an owner and become a worker again?

Would HE be satisfied making a living by doing nursing homes and being a palliative care podiatrist?

Would HE be willing to take a pay cut?

What did HE do or not do to get into this situation?

My biggest thing is that the people that get into this mess know what they are getting themselves into. They KNOW beforehand what is required of them and for some reason can't keep up. Plain and simple.

WHY are these people not becoming certified when clearly they can become?

The other issue is, and I'm just being cynical here so don't get all over me about it, why should we care? There are some out there who screw up big time and then whine about getting screwed by the system. I have no sympathy for that, and I've seen it happen plenty.

I'm somewhat of a case in point. I did three years but am not RRA cert because I couldn't pass the test and don't want to spend the money to take it again. Can that bite me in the butt someday? Well it kind of already has because no company will train me (yet) to do the TAR procedure. Does it bother me? Yep. Do I whine about it incessantly. Nope. I think it's silly because I could probably help people and make these companies some money, but it is what it is and that's it. No, it's not a career making or breaking situation, but hey, again, it is what it is.

Kidsfeet,

I believe that the requirement to have RRA certification to perform a TAR is no longer valid. I can name several DPM's who have been trained AND are performing TAR procedures who are not RRA certified. If you can provide the company with proof you have training, staff priviliges and the patient population, you will be trained.

I've had the rep in my office and I can tell you that as a matter of fact. Next time you visit our office, I'll arrange for a meeting. But I would caution ANYONE that's considering performing these procedures that unless you are going to perform them on a constant/regular basis, it's not a procedure you want to "dabble" with once in a while.