Is it true you can do Rearfoot surgery with PM & S-24?

[cool_vkb]

i met a PM&S-24 resident in chicago few days back. he said that PM & S can do rearfoot surgery and other stuff. lol he even said that if you are in new mexico or florida you can very well work all the way upto your scope ((basically major soft tissues of leg). according to him :-

1) Its true you cant get board certified. but that doesnt mean you cant do rearfoot or other soft tissue stuff.

2) Hospitals just want you to be board certified (doesnt matter which one. so you could be forefoot certified and still do rearfoot as long as hospital allows you or if you hve ambulatory surgery center access then it doesnt even matter)

3) Insurance doesnt says anywhere that this surgery has to be performed by only board certified. there is nothing in the insurance form of that sorts.

Is this really true or is he just trying to justify his choice.

I was always under the impression that anything rearfoot whether its bony structure or soft tissue repairs like Achilies Lengthening or other stuff is waaaaaaay out of scope for 2yr guys.

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[Feli]

A lot of hospitals, surg centers, etc don't really understand our boards, and it's tough to blame them since there are too many BS boards that were made up. Insurance companies and hospitals with DPMs on staff are coming around, but it's a slow process. There are still a lot of community hospitals where you could probably get in and get RRA privileges by flashing a ABPA-CADABRA certification and telling them that's the main pod surgery certification board. Would that work in major medical centers or where there's several ACFAS DPMs on staff? No. However, many DPMs just get ABPS foot cert and never bother to get RRA since they don't do enough cases, don't have time, or don't pass the RRA test... yet they probably still have privileges to do the cases anyways. The ABPS site's public search doesn't distinguish between foot and RRA cert, just lists who is cert in either...
http://www.abps.org/content/resources/FindADoctor.aspx

As for cases being "out of scope for 2yr guys," it all depends on surgery volume and quality during residency, not just time. There are 24s out there that are solid but just newer and provisionally approved... or old and not converted over yet. There are also 36s that are a low quality now but manage live off their name and/or not get caught fudging their numbers. Besides, some individual residents read more on their own to have a supreme appreciation of the deformities and 3D anat, understand the equipment and tools they are working with, and possess good motor skills to just pick up surgery well no matter where they go. Some others could do 1000 bunions with Dr. Fantastico during their residency and still struggle with each and every one because they didn't prep for the case by learning the pt history/expectations/deformity, don't use the instruments/equipment efficiently, etc. The old "if you fail to plan, then plan to fail" saying has never been more true than in surgery... and there's a lot to plan for. Many things look good on the table, and while technique is important, good overall surgery certainly doesn't start or end in the OR.

 

[diabeticfootdr]

I was always under the impression that anything rearfoot whether its bony structure or soft tissue repairs like Achilies Lengthening or other stuff is waaaaaaay out of scope for 2yr guys.

The scope of practice is the scope of practice, it doesn't matter whether you're 1, 2, 3, or 4 year trained. It is determined by state law. So there is no difference, as long as you're a DPM licensed in the state.

Where you might be restricted is by your hospital privileges. Most hospitals care more about the number of cases you've performed, and not what type of residency you've performed. Most DPMs in practice have only 1 or 2 year residencies, so to limit RRA surgery to only 3 year trained DPMs would exclude most of the profession.

Of course ABPS wants to make a distinction. It is in their best financial interest. 1. They make 2x as much money if you are RRA. 2. DPMs MD inferiority complexes usually cause one to self-stratify the DPM profession so you can say "I'm not a regular podiatrist, I'm better than them because I am RRA Certified by the ABPS". Response from Dr. MD, "Huh? Can you do surgery on this patient or not?"

 

[NatCh]

I am RRA Certified by the ABPS". Response from Dr. MD, "Huh? Can you do surgery on this patient or not?"

Ha! So true.

 

[Feli]

... I am RRA Certified by the ABPS". Response from Dr. MD, "Huh? Can you do surgery on this patient or not?"

Ha! So true.

I agree also, but those days probably won't last a whole lot longer. Our profession's overall postgrad training is getting pretty solid. The more ABPS/ACFAS guys you have getting chief of pod surg, residency director, etc positions, the harder it will get for non-RF trained/experienced DPMs to get those privileges.

It can't be underscored enough that it's much more about numbers and competency than chronological residency +/- fellowship length, though.

 

[NatCh]

I agree also, but those days probably won't last a whole lot longer. Our profession's overall postgrad training is getting pretty solid. The more ABPS/ACFAS guys you have getting chief of pod surg, residency director, etc positions, the harder it will get for non-RF trained/experienced DPMs to get those privileges.

It can't be underscored enough that it's much more about numbers and competency than chronological residency +/- fellowship length, though.

I think Dr. Roger's comment more refers to the fact that anyone who is not a podiatrist does not know or care about the intricacies of our certification boards. ABPS, PM&S, ACFAS, ABPPOM, FF/RRA, etc. are initials that have meaning only within our profession. Even if you have the highest levels of training within our profession, if you start dropping those initials in conversation to an M.D. or D.O. his or her eyes will probably glaze over. All they want to know is, "can you take care of this patient or not?"

 

[Podfather]

I think Dr. Roger's comment more refers to the fact that anyone who is not a podiatrist does not know or care about the intricacies of our certification boards. ABPS, PM&S, ACFAS, ABPPOM, FF/RRA, etc. are initials that have meaning only within our profession. Even if you have the highest levels of training within our profession, if you start dropping those initials in conversation to an M.D. or D.O. his or her eyes will probably glaze over. All they want to know is, "can you take care of this patient or not?"

Most hospitals are aware of ABPS certification. I believe that exclusion based solely upon certification is wrong and although I am Foot and Ankle certified we have a pathway for privileges for DPMs of any training. If you did not do a residency or only 1 year you do have to show experience with any procedure you are requesting whether of the foot, ankle, or leg. It is reasonable and is 30 op reports for the entire category. Those with a PSR-24 or PM&S-36 and qualification/or certification in Foot get Foot privileges and RRA get those privileges. Our hospitals requires certification within 5 years for surgeons (MD, DO, DPM) and for podiatry requires ABPS. In regards to the bifurcation of Foot into RRA being some idea ABPS put in place to create haves/have nots or to make money is absurd. The bifurcation was in response to those who could not get rearfoot/ankle cases either because of training or state law and therefore could not be Foot and Ankle certified. Thus a Foot certification permitted those individuals the opportunity to become board certified. RRA was added since the Foot excluded those procedures of the rearfoot and ankle. For today's grads if you have the training and are TRULY doing the work why would you not sit???

 

[NatCh]

Most hospitals are aware of ABPS certification. I believe that exclusion based solely upon certification is wrong and although I am Foot and Ankle certified we have a pathway for privileges for DPMs of any training. If you did not do a residency or only 1 year you do have to show experience with any procedure you are requesting whether of the foot, ankle, or leg. It is reasonable and is 30 op reports for the entire category. Those with a PSR-24 or PM&S-36 and qualification/or certification in Foot get Foot privileges and RRA get those privileges. Our hospitals requires certification within 5 years for surgeons (MD, DO, DPM) and for podiatry requires ABPS. In regards to the bifurcation of Foot into RRA being some idea ABPS put in place to create haves/have nots or to make money is absurd. The bifurcation was in response to those who could not get rearfoot/ankle cases either because of training or state law and therefore could not be Foot and Ankle certified. Thus a Foot certification permitted those individuals the opportunity to become board certified. RRA was added since the Foot excluded those procedures of the rearfoot and ankle. For today's grads if you have the training and are TRULY doing the work why would you not sit???

I'm not talking about hospitals (aka Credentialing Committees). I'm talking about the MD or DO in the office down the street who has a patient he or she wants to refer out. Mention the terms "PSR-24, PM&S 36, RRA, and ABPS" and see if he or she doesn't ask what the heck you're talking about. That doc just wants to know if you can manage the patient's particular problem or not.

 

[Brodiatrist]

So someone just mentioned in another thread that PMS 24 grads can't sit for the ABPS rearfoot/reconstructive ankle boards but PMS 36 grads can..true?

 

[that1guyfromFL]

So someone just mentioned in another thread that PMS 24 grads can't sit for the ABPS rearfoot/reconstructive ankle boards but PMS 36 grads can..true?

From the ABPS website:

Upon completion of a four-year doctoral training program, residency training is required to qualify for ABPS certification. Candidates must complete a minimum of two years of residency training in a program approved by the Council on Podiatric Medical Education (CPME). One of the two years of training must be in a CPME-approved podiatric surgical residency.
Candidates who attend a 24-month podiatric medicine and surgery (PM&S) program are eligible only for Certification in Foot Surgery. Candidates who attend a 36-month PM&S program are eligible for both Certification in Foot Surgery and Certification in Reconstructive Rearfoot/Ankle Surgery.

 

[Brodiatrist]

Where on the website is that coming from? Here is what it says under the "Qualifications" tab of the same website:

"Candidates who complete a PSR-24 or PM&S-36 may take Part I of the Certification in Reconstructive Rearfoot/Ankle Surgery Examination"...I'm curious what the difference is..

EDIT: Nevermind I found it...interesting how the two tabs seem to contradict each other.

 

[that1guyfromFL]

Where on the website is that coming from? Here is what it says under the "Qualifications" tab of the same website:

"Candidates who complete a PSR-24 or PM&S-36 may take Part I of the Certification in Reconstructive Rearfoot/Ankle Surgery Examination"...I'm curious what the difference is..

EDIT: Nevermind I found it...interesting how the two tabs seem to contradict each other.

Maybe the difference is in board qualified vs board certified, I'm not sure.

The ABPS website is confusing to me too.

 

[Brodiatrist]

OK I just confirmed that PMS 24 graduates CAN be certified in AAR. Check out the thread in Pre-pod.

EDIT: Actually I think they were wrong. This is the response I received from ABPS:

"A PM&S-24 (Podiatric Medicine and Surgery 24) and a PSR-24 (Podiatric Surgical Residency-24) are two different programs (PSR-24 is an older program type most of which have converted to PM&S-36). Certification in RRA requires completion of either a PM&S-36 or the earlier PSR-24 program.
PM&S-24 graduates may only certify in Foot Surgery"