3
Crazier than recertification is the transition to MOC. Maintenance of Certification. Some specialties now have MOC which in addition to some examination sometimes requires peer review evaluations, patient surveys, and EBM proven care and other hoops. Some of the general surgeons are actually considering not maintaining their certification.
Board certification is often required for insurance and many hospitals. Some hospitals in our area although still requiring board certification within 5 years only recommend maintaining it and do not have it as a requirement.
3
347932
That discussion is only about the recert issue. I happen to agree that recert doesn't really assure competency. Once you're certified, you should be for life. What is the argument FOR recertifying? Especially since some don't have to do it and some do.
- Joined
- Feb 22, 2009
- Messages
- 1,652
- Reaction score
- 18
It's about time that the whole re-certifying process needs to be reinvestigated.
I respect Podfather significantly, so this is not to try to start another ABPS argument. It's simply to state my personal feeling about what I consider an inconsistency in philosophy.
I FULLY understand that rules change, and those certified after a specific date have to take a "real" written exam to re-certify vs. those certified prior to that date taking a self assessment exam. I FULLY undestand that it's not practical to make rules retro-active.
However, if I am correct, one of the reasons the ABPS stated that "real" re-certification was neccessary was for consumer protection, to assure quality of it's diplomates and to maintain it's high standards. And I have no problem with that idea. However, in reality, the docs that were certified a long time ago in theory should be the docs you have to monitor the closest, since they have been out the longest and in theory their training is the most out-dated.
Yes, I know about experience, etc., etc. I'm simply using this as an example of a perceived hypocrisy. Is the requirement for docs after a certain year to re-certifiy by taking a "real" exam REALLY doing anything to guarantee quality??? What assurances are being made to monitor the docs certified prior to that time?
Additionally, Podfather stated that prior to the various board delineations there was simply being board certified in "foot & ankle" surgery, and those that have that certification are considered analagous to those now certified in RRA.
THAT I have a problem with, considering many of the docs who were certified many years ago in "foot & ankle" surgery (when that was the ONLY certification), have no idea how to perform any real ankle surgery or any real reconstructive surgery, and we ALL know that's a fact.
The qualifications to become certified in "foot and ankle" many years ago did not require any significant rearfoot cases/ankle cases or reconstructive cases. The cases accepted were straightforward and included a lot of lumps and bumps, and is NO comparison to the case requirments for RRA today.
Therefore, I really believe that making those boarded years ago in foot and ankle analagous to those who are now certified in RRA is not a valid comparison.
I respect Podfather significantly, so this is not to try to start another ABPS argument. It's simply to state my personal feeling about what I consider an inconsistency in philosophy.
I FULLY understand that rules change, and those certified after a specific date have to take a "real" written exam to re-certify vs. those certified prior to that date taking a self assessment exam. I FULLY undestand that it's not practical to make rules retro-active.
However, if I am correct, one of the reasons the ABPS stated that "real" re-certification was neccessary was for consumer protection, to assure quality of it's diplomates and to maintain it's high standards. And I have no problem with that idea. However, in reality, the docs that were certified a long time ago in theory should be the docs you have to monitor the closest, since they have been out the longest and in theory their training is the most out-dated.
Yes, I know about experience, etc., etc. I'm simply using this as an example of a perceived hypocrisy. Is the requirement for docs after a certain year to re-certifiy by taking a "real" exam REALLY doing anything to guarantee quality??? What assurances are being made to monitor the docs certified prior to that time?
Additionally, Podfather stated that prior to the various board delineations there was simply being board certified in "foot & ankle" surgery, and those that have that certification are considered analagous to those now certified in RRA.
THAT I have a problem with, considering many of the docs who were certified many years ago in "foot & ankle" surgery (when that was the ONLY certification), have no idea how to perform any real ankle surgery or any real reconstructive surgery, and we ALL know that's a fact.
The qualifications to become certified in "foot and ankle" many years ago did not require any significant rearfoot cases/ankle cases or reconstructive cases. The cases accepted were straightforward and included a lot of lumps and bumps, and is NO comparison to the case requirments for RRA today.
Therefore, I really believe that making those boarded years ago in foot and ankle analagous to those who are now certified in RRA is not a valid comparison.
- Joined
- May 21, 2007
- Messages
- 1,839
- Reaction score
- 1,367
This is true. I used to work with a few docs who have the F&A cert. and their comfort level extends to the Austin. On paper they sound capable of ankle though.
At the same time I know a few docs with only one year of residency and only Foot Cert. who can do it all and do it well.
IMO podiatrists recertify because newly certified MDs do. Sometimes we want parity so much that we mimic what medicine does. Personally, I believe that categories and process should have not changed but the reasons were related to different scopes among the states rather than better training (as has been implied by many RRAs).
As far as the reassessment vs. recertification issue. Medicine did/does the same. Those certified when life certification was the rule could keep that but going forward the newly certified MD specialist would recert. When I took the exam in the late 80s I had to present more than "lumps and bumps" and my exam and certification experience was not easy. Pass rates have not changed over the years BTW.
The comment that some foot and ankle people may perform less complex procedures than younger RRA DPMs is also seen in medicine. I see what my lifetime certified orthopedists do and compared to a newly certified orthopod it would seem they were only comfortable on the "Austins" of orthopedics. In 25 years the current RRAs will seem the same compared to the newer certified ones.
You may not agree with it but according to the ABPS, Foot and Ankle is the same as Foot and RRA. Personally I train the new soon to be RRA resident DPMs and perform some of the most complex procedures in the profession. So as a Foot and Ankle certified DPM (others include LaPorta, Schoenhaus, Schuberth, Jacobs, Weil, Ruch, Catanzariti, Hutchinson, Crawford, etc.) I believe I am the same. Remember regardless of the rhetoric, certification will not get you privileges your training and experience will. Credentialing is done locally by hospital credential committees.
Next will be MOC since medicine is there and we will follow. In 15 years this issue will take care of itself as in medicine. However, IMO the recert process will change and perhaps the initial certification process. Medicine is making changes and so will we. Then it may the same for all or perhaps a third group to stir the pot?????
Wait until MD or DO DPMs or full scope DPMs (see California posts) become more common. I can't wait to read the forums then as the MD/DPMs imply a DPM who graduted prior to these new degrees should be limited and really are not the same as they are........It will make me smile while I sit in a nursing home eating jello and trying to find a MD/DPM to debride my nails.
Last edited:
- Joined
- Feb 22, 2009
- Messages
- 1,652
- Reaction score
- 18
Podfather,
I never implied that the foot and ankle test of "old" was any less difficult, or that you didn't submit complex cases for your certification process. But you really must admit that there are a significant number of docs certified in foot and ankle who did not submit ANY complex rearfoot or ankle cases, and many were "lumps and bumps".
When I completed my residency I was an associate in a practice and was asked to gather cases for my boss who was preparing for certification. His rearfoot cases included Haglund's, heel spurs, modified Kidner's, and nothing more complex than those types of procedures. I know, since I submitted the paperwork. And yes, his cases were accepted.
I am not saying this is true for the entire group, since I won't generalize. I was/am simply making a point that there are a significant number of docs certified in foot and ankle who have never REALLY performed "ankle" surgery or any true reconstructive surgery. I can personally name dozens of those docs and so can you.
On the other hand, there are docs who for some reason have only decided to certify in foot surgery who have the skill, knowledge and training to teach, write, publish and perform the full spectrum of procedures.
In my opinion, Stephen Corey, DPM is a prime example. He did the 3 year program in Atltanta with McGlammary (now DeKalb), taught at the school, etc., etc., and is certified in "foot" surgery, not RRA.
But the bottom line is that we both know that despite the letters following your name or the designation of certification, it's the quality of care you provide that will ultimately form your reputation.
And I'm surprised to hear that when you're in the nursing home some day you'll be eating Jello.....I thought you were a pudding type of guy.😀
I never implied that the foot and ankle test of "old" was any less difficult, or that you didn't submit complex cases for your certification process. But you really must admit that there are a significant number of docs certified in foot and ankle who did not submit ANY complex rearfoot or ankle cases, and many were "lumps and bumps".
When I completed my residency I was an associate in a practice and was asked to gather cases for my boss who was preparing for certification. His rearfoot cases included Haglund's, heel spurs, modified Kidner's, and nothing more complex than those types of procedures. I know, since I submitted the paperwork. And yes, his cases were accepted.
I am not saying this is true for the entire group, since I won't generalize. I was/am simply making a point that there are a significant number of docs certified in foot and ankle who have never REALLY performed "ankle" surgery or any true reconstructive surgery. I can personally name dozens of those docs and so can you.
On the other hand, there are docs who for some reason have only decided to certify in foot surgery who have the skill, knowledge and training to teach, write, publish and perform the full spectrum of procedures.
In my opinion, Stephen Corey, DPM is a prime example. He did the 3 year program in Atltanta with McGlammary (now DeKalb), taught at the school, etc., etc., and is certified in "foot" surgery, not RRA.
But the bottom line is that we both know that despite the letters following your name or the designation of certification, it's the quality of care you provide that will ultimately form your reputation.
And I'm surprised to hear that when you're in the nursing home some day you'll be eating Jello.....I thought you were a pudding type of guy.😀
Pudding makes me fat. Dr. Corey is a prime example of why the categories were changed. After leaving the school he moved to South Carolina where ankles were/are not part of a DPMs scope. So he sat only for Foot. Here is the sad part: If he were to move to another state, he may be limited in what he could do. In many hospitals and within some state laws, some of our younger RRA folks have written into bylaws etc. that to do REARFOOT (not just ankles) you need RRA.
Most of these issues will slowly take care of themselves in the next 15-20 years but until then we all must be supportive of one another. Those professions who compete with us try to divide us. They tried to do that with me when I was the only 2 year trained guy in town and now they are doing it with the 3 year and RRA folks. The hypocrisy is they divide us yet support their own regardless of training and experience.
Last edited:
- Joined
- Feb 22, 2009
- Messages
- 1,652
- Reaction score
- 18
Understood and I agree. Ironically, some of our own young are eating the old. It's been a common myth in our profession that the old eat the young, however, I know of several instances where RRA certified DPMs were trained by a DPM certified in "foot" surgery, despite these "foot certified" doctors training the residents in the full scope of foot, ankle and reconstructive rearfoot procedures. Now these young RRA DPMs get on staff at hospitals and pass bylaws that ONLY RRA DPMs can perform rearfoot cases, etc., despite the fact they may have been TRAINED by a DPM certified in "foot" surgery!!! It should really be based on experience and surgical logs/history. Regardless, it seems more like the young are eating the old!!!
I can say with certainty some are. The funny thing is when these same people (old eating RRAs) get into trouble politically or they are restricted by orthopedics, guess who they run to for help?
