Programs converting to three year

[Creflo]

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Some programs will convert from 2 to 3 years, but may not offer a rearfoot certificate. Any thoughts on this? Is it a good idea to get an additional year of training without getting the certificate? Will it help you get hospital priviledges in the future vs. having completed a 2 year program?

 

[347932]

This is being done so it "appears" that pod students are getting similar training. Having some programs that are only two years while others are three just adds to the confusion of the profession. Making sure everyone receives the same amount (total time) of training is a priority of the powers that be.

Personally it would suck to do a three program and not get a rearfoot certificate. Thats one less year you could be making a real salary if the program was simply two years. For the greater good of the profession though its pretty important that all programs be the same length even though the quality of training might be different.

This profession needs some freaking stability for once.

Three years is better than two regardless of the whether you get a certificate or not, anyway you slice it (pardon the pun). Do the extra year NOW before you enter the fray, and get the most out of that time. The extra year will help you gain more confidence in the OR and potentially with personality skills you need to be a success in private practice.

I have read the CPME guidelines for programs and how to get the cases needed to have that "Rearfoot" distinction, and the guidelines are really not that stringent. The only programs that will have problems meeting these guidelines are programs in states that don't have great ankle laws.

Remember that these changes happen in steps for a reason. Forward thinking and progression of our profession is the goal and even though it may be taking longer than people would like, its happening. I applaud all those involved in moving our profession forward.

 

[dtrack22]

It should help with some of the residency genesis issues as well, since it will (hopefully) guarantee CME funding for all 3 years of residency. Since, up until now 2 year programs were considered adequate to practice, the 3rd year was viewed as optional by CME and therefore didn't receive the same funding.

Let's just hope our education and training stays the same for awhile. We could use some uniformity.

 

[347932]

It should help with some of the residency genesis issues as well, since it will (hopefully) guarantee CME funding for all 3 years of residency. Since, up until now 2 year programs were considered adequate to practice, the 3rd year was viewed as optional by CME and therefore didn't receive the same funding.

Let's just hope our education and training stays the same for awhile. We could use some uniformity.

Its not the CPME, its Medicare that funds residencies. The funding issue for the third year will persist for some time as discussion has been underway for years on changing this.

 

[dtrack22]

Sorry. I meant CMS. I gotta stop posting from my phone. I always type something out wrong. I get how you could think I meant CPME even though there was never a P in there.

 

[arez10]

I'm only a first year, so I don't know the in's and out's of applying for externships/residencies. But will the newly converted programs make it obvious that they're not doing rearfoot/ankle? Will you have to outright call up every residency director to clarify or will it be written somewhere online?

 

[347932]

I'm only a first year, so I don't know the in's and out's of applying for externships/residencies. But will the newly converted programs make it obvious that they're not doing rearfoot/ankle? Will you have to outright call up every residency director to clarify or will it be written somewhere online?

That is an excellent question. I imagine this will be information readily available to the applicants via the programs stat sheet through CASPR. I don't think there has been an established protocol for this just yet, but I may be wrong.

 

[densmore22]

I'm only a first year, so I don't know the in's and out's of applying for externships/residencies. But will the newly converted programs make it obvious that they're not doing rearfoot/ankle? Will you have to outright call up every residency director to clarify or will it be written somewhere online?

It has to be written into the contract and the program has to make it known to the applicant that they will not be receiving rearfoot certification upon graduation from said program. This became effective for the most recent residency interviews just conducted.

 

[air bud]

It has to be written into the contract and the program has to make it known to the applicant that they will not be receiving rearfoot certification upon graduation from said program. This became effective for the most recent residency interviews just conducted.

Do you think there will be an issue with transparency? Aren't some of these programs going to initially be viewed as less desirable, so they will try and make things somewhat cloudy to at least get more students to look at them initially? Obviously it can be figured out, but do you expect residency directors to be beating their chests and yelling on a microphone that they don't give RRA certification?

 

[janV88]

Here are all the current 2yr residencies which will most likely not have RRA training in the near future. http://www.casprcrip.org/html/casprcrip/pdf/Directory/Dir_TwoYear_mlc.pdf

And: DVA Augusta - GA, St. Mary's Hospital - NJ, Interfaith Medical Center - NY, New York Methodist Hospital - NY, St. Barnabas Hospital - NY, and Staten Island University Hospital - NY. (These are PM&S24 programs that require 3 years to complete)

Note: A few of these programs do have PM&S36 spots.

 

[densmore22]

Do you think there will be an issue with transparency? Aren't some of these programs going to initially be viewed as less desirable, so they will try and make things somewhat cloudy to at least get more students to look at them initially? Obviously it can be figured out, but do you expect residency directors to be beating their chests and yelling on a microphone that they don't give RRA certification?[/QUOTE]

Yes. In my opinion, yes. Nope.
I think that initially, programs may suffer, but there are a lot of students out there that just want to do bunions and hammertoes, the occasional LisFranc's and are content with that. I, personally, don't want my training to limit what I can do, I want to limit what I do. As a student setting up clerkships and trying to select a residency program, you have to be diligent and thorough regarding what you choose. If you're unsure, get clarification FROM THE DIRECTOR, no one else and I would get it in an email or some other form of written form so that you can document if you were to end up at that program and it changed.

 

[347932]

Do you think there will be an issue with transparency? Aren't some of these programs going to initially be viewed as less desirable, so they will try and make things somewhat cloudy to at least get more students to look at them initially? Obviously it can be figured out, but do you expect residency directors to be beating their chests and yelling on a microphone that they don't give RRA certification?[/QUOTE]

Yes. In my opinion, yes. Nope.
I think that initially, programs may suffer, but there are a lot of students out there that just want to do bunions and hammertoes, the occasional LisFranc's and are content with that. I, personally, don't want my training to limit what I can do, I want to limit what I do. As a student setting up clerkships and trying to select a residency program, you have to be diligent and thorough regarding what you choose. If you're unsure, get clarification FROM THE DIRECTOR, no one else and I would get it in an email or some other form of written form so that you can document if you were to end up at that program and it changed.

Just because your program may not offer RRA Certification does not mean you will be not be able to perform any procedures you like in practice. This depends on where you practice and the local hospital bylaws. The ONLY procedure you may not be able to be trained to do is TAR if you don't have the RRA Cert. If the community you practice in requires RRA Certification via ABPS, you still have to pass the written and oral examinations as well as get the RRA Cert from your residency. Its more than JUST getting an RRA cert from your residency.

Yes of course I realize that without the RRA cert from residency you are not eligible to sit for the RRA Qual Exam, but again, in most communities, you don't NEED that to perform even the most complex procedures. And, this is not likely to change for some time, as most of our colleagues that manage these credentialing issues at the hospitals have no idea what's going on in that regard, and they won't alienate themselves by changing things.

 

[densmore22]

Just because your program may not offer RRA Certification does not mean you will be not be able to perform any procedures you like in practice. This depends on where you practice and the local hospital bylaws. The ONLY procedure you may not be able to be trained to do is TAR if you don't have the RRA Cert. If the community you practice in requires RRA Certification via ABPS, you still have to pass the written and oral examinations as well as get the RRA Cert from your residency. Its more than JUST getting an RRA cert from your residency.

Yes of course I realize that without the RRA cert from residency you are not eligible to sit for the RRA Qual Exam, but again, in most communities, you don't NEED that to perform even the most complex procedures. And, this is not likely to change for some time, as most of our colleagues that manage these credentialing issues at the hospitals have no idea what's going on in that regard, and they won't alienate themselves by changing things.

While I do agree with you, board certification is not necessarily a must, the end goal of most residency programs is to produce graduates that can become board certified. At least that's one of the primary goals of my program. If you go into residency with the philosophy that you ultimately don't want to become board certified, then I think you're not doing yourself or your profession any favors. People that become eligible to sit for RRA boards have a tough enough time passing even if they did graduate from a program that saw lots of RRA numbers/procedures. I couldn't imagine going through 3 years of training and not getting 50 RRA cases, then trying to sit for written and oral boards. The likelihood of passing them in that scenario is slim at best.

I would say to the students on here just do your research on programs, know what you want to do and what you want out of your career and go for it. If it involves major RRA stuff, then get a program that does a lot of that stuff. Residency training usually correlates to what you will do/feel comfortable doing when you're out on your own.

 

[347932]

While I do agree with you, board certification is not necessarily a must, the end goal of most residency programs is to produce graduates that can become board certified. At least that's one of the primary goals of my program. If you go into residency with the philosophy that you ultimately don't want to become board certified, then I think you're not doing yourself or your profession any favors. People that become eligible to sit for RRA boards have a tough enough time passing even if they did graduate from a program that saw lots of RRA numbers/procedures. I couldn't imagine going through 3 years of training and not getting 50 RRA cases, then trying to sit for written and oral boards. The likelihood of passing them in that scenario is slim at best.

I would say to the students on here just do your research on programs, know what you want to do and what you want out of your career and go for it. If it involves major RRA stuff, then get a program that does a lot of that stuff. Residency training usually correlates to what you will do/feel comfortable doing when you're out on your own.

ABPS certification is required in most communities to maintain privileging at hospitals for inpatient care and surgical privileges and this is becoming the norm at most free standing ASCs. Some private insurances require ABPS certification as well to maintain "participating provider" status. They do not distinguish between Foot and RRA at this time. EVERYONE graduating from ANY PMS residency SHOULD strive to become AT LEAST Foot certified. You are limiting yourself if you don't become certified, not necessarily by choice.

Just as an anecdote about this, the very large private insurance carrier in my community just "cleaned house" and booted every Podiatrist in our area who did not have ABPS Certification. This rocked our community as some of them were "old school" docs who were considered the elder statesman of our profession locally, and now they have to turn patients away that they had been seeing for 20 years. Also, many large private insurances are now getting into bed with the Government and are providing "Medicare" type programs through their private system. Many medicare age folks in my community switched over, which now has increased the number of patients these older docs CAN'T see anymore. Try explaining "out of network benefits" to these people...

Get ABPS Certified. Period.

Edit: You can't have just RRA certification btw. If you fail the Foot portion, but pass the RRA portion, you WILL NOT have the "Qualified" or "Certified" distinction in either. You HAVE to pass the Foot Boards first or simultaneously. If you don't, you're SOL.

 

[Feli]

I think it's a good idea. The minimum residency length for MDs or DOs is 3yrs, and if parity's the goal for DPMs, then it would make sense that we do 3yrs of residency training also.

It should help with some of the residency genesis issues as well, since it will (hopefully) guarantee CME funding for all 3 years of residency...

This is another big reason why standardization makes sense.^

 

[Podfather]

I am starting to think parity has become our invade Iraq when we should finish Afghanistan moment or the WMD that didn't exist. (Please I am not trying to start a debate on the Iraq war and should probably remove this but like the metaphor).

The mantra for all programs being 3 years was that podiatrist's residency training was not standardized and that we needed to create a situation where all DPMs received the same training. I constantly heard/hear from many leaders that "a podiatrist is a podiatrist", and we need to stop creating the haves and the have nots. So we first create programs that require training to permit graduates the opportunity to sit for both boards.(BTW most residents when surveyed do not plan to sit for ABOPPM) Never mind that some students do not have the skills or the desire to be surgeons and some wound care/bracing. No one can answer what we do with the student who is a brillant diagnostician, bright, but has a visual depth perception problem. Even if he choses to do non-operative care for a living as a resident we have to force him to continually do surgery on people at his and the patient's expense. Unfortunately we do not have other specialties we can move these people to like podiatric psychiatry or pathology. With the combined model we diluted surgery and primary podiatry/wound care/biomechanics from previous training models. So we hunker down and do the best we can with the combined PMS 24/36 models and within a few years we change everything again to a PMSR with and without. So now everyone does three years (BTW the MAVS stay the same for the basic PMSR from the PMS24 so another year without increased MAVs? genius). But even after the conversion a "podiatrist will not be a podiatrist" because some will have RRA and some will not. Still haves and have nots. The fact that the third year is only partially funded by CMS just makes administrations roll their eyes about our residencies.

So now that we still have disparity in training (the WMDs didn't exist) we now switch to we need this for parity (I am thinking it may be time for a surge LOL). I am finally going crazy. We have only had the last of the PMS 24/ 36 conversions for a few years now we are converting again. This disrupts residencies, costs money, drives administrations nuts, and confuses everyone (Some DPMs do not get it imagine an MD or lay person). Think about it I am on a credentialing committee and I could see applicaions tomorrow from DPMs that have one of the following as a residency: PPMR(12,24), RPR(12,24), PSR-12, PSR-24, POR(12, 24), PMS 24, PMS 36, soon PMSR, PMSR with RRA. I even saw someone who had a RPR,POR, PSR-24 and one who ran around saying they did a 3 year surgical residency with a RPR,POR, PSR-12. So we can argue the PMSR will solve this with time but it will still have 2 tiers in surgery. We said the same with the PMS 24/36 and yet we switched (in our program's case) to a new system within 3 years. Hopefully this will be our last conversion. NOT!

The solution has been simple and touted by many. The dental model has been sucessful and we should have followed it. We should have all graduates do a 1 or 2 year residency which would provide medical and surgical rotations that exist now with rotations in podiatric surgery, wound care, and biomechanics. These positions would be easy to start and almost every hospital could have one. Larger facilities and the VAs could probably handle most of it. Then after the entry program, interested individuals could apply for 2-4 year surgical programs, programs that say are wound care and bracing/orthotic driven,sports medicine etc. Our versions of maxillofacial and orthodontics. Everyone would be the same after their first residency and if you chose to could get advanced training in a specific area of podiatry with additional training you could. (BTW all of your required rotations would be done and this second residency could focus on the area of interest)

I am afraid we will continue to chase our tails. Let's fix our issues before we talk parity. Adding a poorly thought out year to a PMS24 and saying it's a PMSR 3 year only looks good on paper.

 

[air bud]

i am starting to think parity has become our invade iraq when we should finish afghanistan moment or the wmd that didn't exist. (please i am not trying to start a debate on the iraq war and should probably remove this but like the metaphor).

The mantra for all programs being 3 years was that podiatrist's residency training was not standardized and that we needed to create a situation where all dpms received the same training. I constantly heard/hear from many leaders that "a podiatrist is a podiatrist", and we need to stop creating the haves and the have nots. So we first create programs that require training to permit graduates the opportunity to sit for both boards.(btw most residents when surveyed do not plan to sit for aboppm) never mind that some students do not have the skills or the desire to be surgeons and some wound care/bracing. No one can answer what we do with the student who is a brillant diagnostician, bright, but has a visual depth perception problem. Even if he choses to do non-operative care for a living as a resident we have to force him to continually do surgery on people at his and the patient's expense. Unfortunately we do not have other specialties we can move these people to like podiatric psychiatry or pathology. With the combined model we diluted surgery and primary podiatry/wound care/biomechanics from previous training models. So we hunker down and do the best we can with the combined pms 24/36 models and within a few years we change everything again to a pmsr with and without. So now everyone does three years (btw the mavs stay the same for the basic pmsr from the pms24 so another year without increased mavs? Genius). But even after the conversion a "podiatrist will not be a podiatrist" because some will have rra and some will not. Still haves and have nots. The fact that the third year is only partially funded by cms just makes administrations roll their eyes about our residencies.

So now that we still have disparity in training (the wmds didn't exist) we now switch to we need this for parity (i am thinking it may be time for a surge lol). I am finally going crazy. We have only had the last of the pms 24/ 36 conversions for a few years now we are converting again. This disrupts residencies, costs money, drives administrations nuts, and confuses everyone (some dpms do not get it imagine an md or lay person). Think about it i am on a credentialing committee and i could see applicaions tomorrow from dpms that have one of the following as a residency: Ppmr(12,24), rpr(12,24), psr-12, psr-24, por(12, 24), pms 24, pms 36, soon pmsr, pmsr with rra. I even saw someone who had a rpr,por, psr-24 and one who ran around saying they did a 3 year surgical residency with a rpr,por, psr-12. So we can argue the pmsr will solve this with time but it will still have 2 tiers in surgery. We said the same with the pms 24/36 and yet we switched (in our program's case) to a new system within 3 years. Hopefully this will be our last conversion. Not!

The solution has been simple and touted by many. The dental model has been sucessful and we should have followed it. We should have all graduates do a 1 or 2 year residency which would provide medical and surgical rotations that exist now with rotations in podiatric surgery, wound care, and biomechanics. These positions would be easy to start and almost every hospital could have one. Larger facilities and the vas could probably handle most of it. Then after the entry program, interested individuals could apply for 2-4 year surgical programs, programs that say are wound care and bracing/orthotic driven,sports medicine etc. Our versions of maxillofacial and orthodontics. Everyone would be the same after their first residency and if you chose to could get advanced training in a specific area of podiatry with additional training you could. (btw all of your required rotations would be done and this second residency could focus on the area of interest)

i am afraid we will continue to chase our tails. Let's fix our issues before we talk parity. Adding a poorly thought out year to a pms24 and saying it's a pmsr 3 year only looks good on paper.

awesome

 

[PADPM]

Now I'm REALLY confused. I didn't think it was even possible for a male resident to have PMS😕

 

[347932]

Now I'm REALLY confused. I didn't think it was even possible for a male resident to have PMS😕

I saw what you did there!

 

[347932]

I am starting to think parity has become our invade Iraq when we should finish Afghanistan moment or the WMD that didn't exist. (Please I am not trying to start a debate on the Iraq war and should probably remove this but like the metaphor).

The mantra for all programs being 3 years was that podiatrist's residency training was not standardized and that we needed to create a situation where all DPMs received the same training. I constantly heard/hear from many leaders that "a podiatrist is a podiatrist", and we need to stop creating the haves and the have nots. So we first create programs that require training to permit graduates the opportunity to sit for both boards.(BTW most residents when surveyed do not plan to sit for ABOPPM) Never mind that some students do not have the skills or the desire to be surgeons and some wound care/bracing. No one can answer what we do with the student who is a brillant diagnostician, bright, but has a visual depth perception problem. Even if he choses to do non-operative care for a living as a resident we have to force him to continually do surgery on people at his and the patient's expense. Unfortunately we do not have other specialties we can move these people to like podiatric psychiatry or pathology. With the combined model we diluted surgery and primary podiatry/wound care/biomechanics from previous training models. So we hunker down and do the best we can with the combined PMS 24/36 models and within a few years we change everything again to a PMSR with and without. So now everyone does three years (BTW the MAVS stay the same for the basic PMSR from the PMS24 so another year without increased MAVs? genius). But even after the conversion a "podiatrist will not be a podiatrist" because some will have RRA and some will not. Still haves and have nots. The fact that the third year is only partially funded by CMS just makes administrations roll their eyes about our residencies.

So now that we still have disparity in training (the WMDs didn't exist) we now switch to we need this for parity (I am thinking it may be time for a surge LOL). I am finally going crazy. We have only had the last of the PMS 24/ 36 conversions for a few years now we are converting again. This disrupts residencies, costs money, drives administrations nuts, and confuses everyone (Some DPMs do not get it imagine an MD or lay person). Think about it I am on a credentialing committee and I could see applicaions tomorrow from DPMs that have one of the following as a residency: PPMR(12,24), RPR(12,24), PSR-12, PSR-24, POR(12, 24), PMS 24, PMS 36, soon PMSR, PMSR with RRA. I even saw someone who had a RPR,POR, PSR-24 and one who ran around saying they did a 3 year surgical residency with a RPR,POR, PSR-12. So we can argue the PMSR will solve this with time but it will still have 2 tiers in surgery. We said the same with the PMS 24/36 and yet we switched (in our program's case) to a new system within 3 years. Hopefully this will be our last conversion. NOT!

The solution has been simple and touted by many. The dental model has been sucessful and we should have followed it. We should have all graduates do a 1 or 2 year residency which would provide medical and surgical rotations that exist now with rotations in podiatric surgery, wound care, and biomechanics. These positions would be easy to start and almost every hospital could have one. Larger facilities and the VAs could probably handle most of it. Then after the entry program, interested individuals could apply for 2-4 year surgical programs, programs that say are wound care and bracing/orthotic driven,sports medicine etc. Our versions of maxillofacial and orthodontics. Everyone would be the same after their first residency and if you chose to could get advanced training in a specific area of podiatry with additional training you could. (BTW all of your required rotations would be done and this second residency could focus on the area of interest)

I am afraid we will continue to chase our tails. Let's fix our issues before we talk parity. Adding a poorly thought out year to a PMS24 and saying it's a PMSR 3 year only looks good on paper.

I agree for the most part.

Here's where I differ. Wth does RRA really do for anyone? Why is there even that distinction?

Three years for all. One Board, One College. No confusion. You want more training? Have those that do the more complex stuff (Rob Mendicino for instance) start specialty fellowships for complex procedures like Tibial Transpositions blah, blah, blah.

What NONE of this addressed yet is the state of privileging and scope of practice. So you do a fancy PMSR with RRA and then decide to move to CT. You're SOL. What if the community you move to stil have issues with Podiatrists doing bunions and hammertoes (yes those still exist)? If you come into my community with 3 years of training, Board Qualified in Foot, no hospital will stop you from doing ANYTHING you want F&A EXCEPT TAR. I did 3 years, couldn't pass the RRA exam for my life. I can treat Pilon Fractures with ex-fix in any hospital in my community. I felt three years was enough to have confidence in dealing with patients in the office and in the OR. As Podfather mentioned in a previous post, he knows who I did my residency with and knows I have solid training. How many rearfoot procedures do you really think your going to do in practice that require that RRA certificate? Just saying.

 

[that1guyfromFL]

I am starting to think parity has become our invade Iraq when we should finish Afghanistan moment or the WMD that didn't exist. (Please I am not trying to start a debate on the Iraq war and should probably remove this but like the metaphor).

The mantra for all programs being 3 years was that podiatrist's residency training was not standardized and that we needed to create a situation where all DPMs received the same training. I constantly heard/hear from many leaders that "a podiatrist is a podiatrist", and we need to stop creating the haves and the have nots. So we first create programs that require training to permit graduates the opportunity to sit for both boards.(BTW most residents when surveyed do not plan to sit for ABOPPM) Never mind that some students do not have the skills or the desire to be surgeons and some wound care/bracing. No one can answer what we do with the student who is a brillant diagnostician, bright, but has a visual depth perception problem. Even if he choses to do non-operative care for a living as a resident we have to force him to continually do surgery on people at his and the patient's expense. Unfortunately we do not have other specialties we can move these people to like podiatric psychiatry or pathology. With the combined model we diluted surgery and primary podiatry/wound care/biomechanics from previous training models. So we hunker down and do the best we can with the combined PMS 24/36 models and within a few years we change everything again to a PMSR with and without. So now everyone does three years (BTW the MAVS stay the same for the basic PMSR from the PMS24 so another year without increased MAVs? genius). But even after the conversion a "podiatrist will not be a podiatrist" because some will have RRA and some will not. Still haves and have nots. The fact that the third year is only partially funded by CMS just makes administrations roll their eyes about our residencies.

So now that we still have disparity in training (the WMDs didn't exist) we now switch to we need this for parity (I am thinking it may be time for a surge LOL). I am finally going crazy. We have only had the last of the PMS 24/ 36 conversions for a few years now we are converting again. This disrupts residencies, costs money, drives administrations nuts, and confuses everyone (Some DPMs do not get it imagine an MD or lay person). Think about it I am on a credentialing committee and I could see applicaions tomorrow from DPMs that have one of the following as a residency: PPMR(12,24), RPR(12,24), PSR-12, PSR-24, POR(12, 24), PMS 24, PMS 36, soon PMSR, PMSR with RRA. I even saw someone who had a RPR,POR, PSR-24 and one who ran around saying they did a 3 year surgical residency with a RPR,POR, PSR-12. So we can argue the PMSR will solve this with time but it will still have 2 tiers in surgery. We said the same with the PMS 24/36 and yet we switched (in our program's case) to a new system within 3 years. Hopefully this will be our last conversion. NOT!

The solution has been simple and touted by many. The dental model has been sucessful and we should have followed it. We should have all graduates do a 1 or 2 year residency which would provide medical and surgical rotations that exist now with rotations in podiatric surgery, wound care, and biomechanics. These positions would be easy to start and almost every hospital could have one. Larger facilities and the VAs could probably handle most of it. Then after the entry program, interested individuals could apply for 2-4 year surgical programs, programs that say are wound care and bracing/orthotic driven,sports medicine etc. Our versions of maxillofacial and orthodontics. Everyone would be the same after their first residency and if you chose to could get advanced training in a specific area of podiatry with additional training you could. (BTW all of your required rotations would be done and this second residency could focus on the area of interest)

I am afraid we will continue to chase our tails. Let's fix our issues before we talk parity. Adding a poorly thought out year to a PMS24 and saying it's a PMSR 3 year only looks good on paper.

GREAT post.

 

[Podfather]

I agree for the most part.

Here's where I differ. Wth does RRA really do for anyone? Why is there even that distinction?

Three years for all. One Board, One College. No confusion. You want more training? Have those that do the more complex stuff (Rob Mendicino for instance) start specialty fellowships for complex procedures like Tibial Transpositions blah, blah, blah.

What NONE of this addressed yet is the state of privileging and scope of practice. So you do a fancy PMSR with RRA and then decide to move to CT. You're SOL. What if the community you move to stil have issues with Podiatrists doing bunions and hammertoes (yes those still exist)? If you come into my community with 3 years of training, Board Qualified in Foot, no hospital will stop you from doing ANYTHING you want F&A EXCEPT TAR. I did 3 years, couldn't pass the RRA exam for my life. I can treat Pilon Fractures with ex-fix in any hospital in my community. I felt three years was enough to have confidence in dealing with patients in the office and in the OR. As Podfather mentioned in a previous post, he knows who I did my residency with and knows I have solid training. How many rearfoot procedures do you really think your going to do in practice that require that RRA certificate? Just saying.

Unfortunately the RRA is becoming the weeding out criteria at the state license and local community. Most f this starts with confusion as to what all of our residencies mean and this simplfies it for a credentialing committee. Also our youth are touting as a better than Foot and Ankle or Foot and suggesting it was started because of their better training . A complete lie BTW. Orthos like to use it since it excludes more than it includes. Single boards, PMSR sounds good but people will do fellowships and then say only fellowship trained should do rearfoot ankle etc.

 

[Podfather]

Now I'm REALLY confused. I didn't think it was even possible for a male resident to have PMS😕

I have it everyday just ask anyone who has to deal with me.

 

[dtrack22]

I'm not against a Dental model, but Podfather is clearly in favor of stability. Switching educational/training models would completely blow up any hint of stability for quite some time. So are you saying that the model is a change you would currently support? Or just a switch we should have made awhile ago? Logistically it would be a nightmare, and much like the Dental model you would have to come up with completely different names for the specialties withing Podiatry, names that the public would have to familiarize themselves with rather quickly.

 

[Podfather]

Two things:

1) Kidsfeet is either an idiot or thinks he's really clever...if you didn't pick up on one of his comments then disregard this.

2) I'm not against a Dental model, but Podfather is clearly in favor of stability. Switching educational/training models would completely blow up any hint of stability for quite some time. So are you saying that the model is a change you would currently support? Or just a switch we should have made awhile ago? Logistically it would be a nightmare, and much like the Dental model you would have to come up with completely different names for the specialties withing Podiatry, names that the public would have to familiarize themselves with rather quickly.

Like most issues. A few commited people in a room could put together the model described above and ensure all graduates received a residency and provide more training in specialty areas for those want to put in the time. The transitional years would still be confusing since all of those trained prior to the start of the new model would be around and are entitled to treat patients to the level of their training and experience. However, if we left it alone and only teaked it from time to time in 25 years there would be a clearer understanding of who we are and just like in dentistry, training would dictate who should do what. Board certification could remain the same and be available for those who had the additional training in the areas above. A separate board (that eventually may have the existing as sub specialty boards) could be developed for those who chose the 2 years and out route.

Yes there would be limited positions for the additional training models but everyone could make a living, be trained in a similar fashion and our profession would have a diversity that IMO would add strength rather than the diversity we have and will always have with the new model that is divisive and confusing.

Why has this not happened? It's simple: politics, ego, money, and mostly because the idea makes sense. We all know the obvious is never chosen. BTW every profession deals with many of the same factors that hold them back.

Yours truly Podfather Podiatric orthodontist

 

[Podfather]

Like most issues. A few commited people in a room could put together the model described above and ensure all graduates received a residency and provide more training in specialty areas for those want to put in the time. The transitional years would still be confusing since all of those trained prior to the start of the new model would be around and are entitled to treat patients to the level of their training and experience. However, if we left it alone and only teaked it from time to time in 25 years there would be a clearer understanding of who we are and just like in dentistry, training would dictate who should do what. Board certification could remain the same and be available for those who had the additional training in the areas above. A separate board (that eventually may have the existing as sub specialty boards) could be developed for those who chose the 2 years and out route.

Yes there would be limited positions for the additional training models but everyone could make a living, be trained in a similar fashion and our profession would have a diversity that IMO would add strength rather than the diversity we have and will always have with the new model that is divisive and confusing.

Why has this not happened? It's simple: politics, ego, money, and mostly because the idea makes sense. We all know the obvious is never chosen. BTW every profession deals with many of the same factors that hold them back.

Yours truly Podfather Podiatric orthodontist

One caveat. Putting the model together is the start then several organizations would need to give input as to process, approval, and competencies required for each type of program. CPME, ABPS, ABOPPM all would be involved and of course public comment and input.

 

[347932]

Two things:

1) Kidsfeet is either an idiot or thinks he's really clever...if you didn't pick up on one of his comments then disregard this.

Please elaborate on this comment and point out which comment you are referring to for my edification. Then, please refrain from pretending to guess what I'm about. I am not an idiot nor am I clever. I try to shoot straight from the hip. If you need clarification on something I write, ask and ye shall receive.

 

[Feli]

...The solution has been simple and touted by many. The dental model has been sucessful and we should have followed it. We should have all graduates do a 1 or 2 year residency which would provide medical and surgical rotations that exist now with rotations in podiatric surgery, wound care, and biomechanics. These positions would be easy to start and almost every hospital could have one. Larger facilities and the VAs could probably handle most of it. Then after the entry program, interested individuals could apply for 2-4 year surgical programs, programs that say are wound care and bracing/orthotic driven,sports medicine etc. Our versions of maxillofacial and orthodontics. Everyone would be the same after their first residency and if you chose to could get advanced training in a specific area of podiatry with additional training you could. (BTW all of your required rotations would be done and this second residency could focus on the area of interest)

I am afraid we will continue to chase our tails. Let's fix our issues before we talk parity. Adding a poorly thought out year to a PMS24 and saying it's a PMSR 3 year only looks good on paper.

I agree and have suggested that dent model many times in the forum (all DPMs get 1 or 2yr basic program and smaller % get additional surgical training afterwards), and that would be the ideal way to do it since the surgically trained would get an extremely high volume of cases during training. They'd continue to have high volume as attendings via referrals from all non-surg DPMs in their area, and they'd become rediculously proficient just as OMFS surgeons are at their craft.

It's sorta too late now, though. We've already decided that every grad gets surgical training, and we'll continue to have (nearly) every DPM doing a small to modearte amount of surgery (likely 1-5 cases per week for the vast majority?).

As long as things will be standardized, then it's better that we extend the minimum training. Being a resident is not always fun, but you do learn a lot. I'd much rather not be working the overnight in the ER tonight: stitching up drunks, convincing people they don't need antibiotics and a CT scan for a cough, and doing 10 pages of paperwork to send GI bleeds up to the floors... but it does help you grow in overall skill. You see interesting cases and get better almost every day in terms of medicine, surgery, or just practical "know how" from experienced attendings. While agree that we could save a lot of time by not making everyone do surgical training, we are already committed to that route and mised well make the training higher quality with 3+yrs like MD/DO programs.

 

[Podfather]

I agree and have suggested that dent model many times in the forum (all DPMs get 1 or 2yr basic program and smaller % get additional surgical training afterwards), and that would be the ideal way to do it since the surgically trained would get an extremely high volume of cases during training. They'd continue to have high volume as attendings via referrals from all non-surg DPMs in their area, and they'd become rediculously proficient just as OMFS surgeons are at their craft.

It's sorta too late now, though. We've already decided that every grad gets surgical training, and we'll continue to have (nearly) every DPM doing a small to modearte amount of surgery (likely 1-5 cases per week for the vast majority?).

It's never too late. I mean we have changed residency categories several times over the last decade. Why not one more time? Besides my guts says we will anyway in the next 5 years based upon history

As long as things will be standardized, then it's better that we extend the minimum training. Being a resident is not always fun, but you do learn a lot. I'd much rather not be working the overnight in the ER tonight: stitching up drunks, convincing people they don't need antibiotics and a CT scan for a cough, and doing 10 pages of paperwork to send GI bleeds up to the floors... but it does help you grow in overall skill. You see interesting cases and get better almost every day in terms of medicine, surgery, or just practical "know how" from experienced attendings.

You would do all of this during you 2 year entry residency. Nothing would change and perhaps be enhanced


While agree that we could save a lot of time by not making everyone do surgical training, we are already committed to that route and mised well make the training higher quality with 3+yrs like MD/DO programs.

In my experience we are never committed. And my comments and frustration are to make sure we maintain the training at quality programs and quit basing everything on the weaker ones. Years of training do not correlate quality. I have seen training that people had in the old PSR-12s and definitely the PSR (not PMS) 24s that was better quality than some current programs. It makes us look 10 times worse if we now say we are the best because all of us do 3 years and in fact many still leave less trained than others. Having a PMSR (not with the RRA) 3 years in length with PMS24 MAVs only creates paper tigers that will come back to bite us.

 

[347932]

I agree and have suggested that dent model many times in the forum (all DPMs get 1 or 2yr basic program and smaller % get additional surgical training afterwards), and that would be the ideal way to do it since the surgically trained would get an extremely high volume of cases during training. They'd continue to have high volume as attendings via referrals from all non-surg DPMs in their area, and they'd become rediculously proficient just as OMFS surgeons are at their craft.

We are our worst enemies in this regard. Some of our less generous colleagues sit on boards of hospitals and insurances and dictate some policies that only add to the resistrictive nature of how we are perceived and the priviliges we now enjoy. What's sad for me is that so many of our colleagues made such groundbreaking strides for our profession, but there are always those few that try to stretch that beyond its intention. See Podfather's comment above about RRA and how its now used as a litmus test to get into some communities. Really? Is that necessary? I don't think it is, but the two podiatrists in 50 in that community that have the RRA cert sure think its important. We are all intelligent (except me, according to dtrack, of course) and know EXACTLY why this is.

Just as a side note, I think Podfather can confirm what the pass rate is on the RRA Qualified Written exam and how many of those actually pass the Oral exam. Just for arguments sake, let's say that only 30% of people in residency each year are eligible to sit for the written exam. Of those only 30% pass (it was something like 33% my year). Of those 30%, let's say half pass the oral and are now RRA certified. That is a relateively small number of people who successfully get through the RRA process. Does that make them the top surgeons in our profession? I can't answer that question for a few more years as many of the practitioners in my community are "Foot and Ankle" certified. They went through the process before RRA was created. I can tell you that the "old school" guys have mad skills based on their years of experience and the years they spent having to prove themselves. The younger hotshots (maybe me?), didn't have to go through that, so they take it for granted and its shows. More food for thought I suppose.

 

[Podfather]

We are our worst enemies in this regard. Some of our less generous colleagues sit on boards of hospitals and insurances and dictate some policies that only add to the resistrictive nature of how we are perceived and the priviliges we now enjoy. What's sad for me is that so many of our colleagues made such groundbreaking strides for our profession, but there are always those few that try to stretch that beyond its intention. See Podfather's comment above about RRA and how its now used as a litmus test to get into some communities. Really? Is that necessary? I don't think it is, but the two podiatrists in 50 in that community that have the RRA cert sure think its important. We are all intelligent (except me, according to dtrack, of course) and know EXACTLY why this is.

Just as a side note, I think Podfather can confirm what the pass rate is on the RRA Qualified Written exam and how many of those actually pass the Oral exam. Just for arguments sake, let's say that only 30% of people in residency each year are eligible to sit for the written exam. Of those only 30% pass (it was something like 33% my year). Of those 30%, let's say half pass the oral and are now RRA certified. That is a relateively small number of people who successfully get through the RRA process. Does that make them the top surgeons in our profession? I can't answer that question for a few more years as many of the practitioners in my community are "Foot and Ankle" certified. They went through the process before RRA was created. I can tell you that the "old school" guys have mad skills based on their years of experience and the years they spent having to prove themselves. The younger hotshots (maybe me?), didn't have to go through that, so they take it for granted and its shows. More food for thought I suppose.

Pass rates are public. I do not have them sitting before me. The BQ tests have a relatively high pass rate for both parts for those who have completed 2/3 year residencies (the norm for today). Board certification pass rates historically run usually 70-75% for foot and the mid to high sixties for RRA. IMO not any organizations policy or opinion, I believe the RRA people who have trouble may be those who were trained to do it but in private practice do not do a lot of it.

ABPS and I assume ABPOPPM do not advise anyone to use their certification for licensure or credentialing (especially delineation of privileges). It is usually some DPM who makes this recommendation (sometimes with ortho initiating it). I agree that the person who often recommends something be used typically has the requirement. I will say this however: Often prvileges are obtained using BQ status in Foot and RRA after residency. Qualification currently last 7 years and may be taken again for a second 7 years. After that, if you have not passed the exam you probably should be questioned on your privileges and demonstrate competance (op reports etc.)